QUARANTINE (Fr. quarantaine, a period of forty days[1]), a term originally applied to the old sanitary preventive system of detention of ships and men, unlading of cargo in lazarets, fumigation of susceptible articles, &c., which was practised at seaports on account of the plague, in connexion with the Levantine trade. It is now a thing of the past in the United Kingdom and in the majority of other states. But, in common usage, the same word is applied to the sanitary rules and regulations which are the modern substitutes for quarantine.
The plague was the only disease for which quarantine was practised (not to mention the earlier isolation of lepers, and the attempts to check the invasion of syphilis in northern Europe about 1490) down to the advent of yellow fever in Spain at the beginning of the 19th century, and the arrival of Asiatic cholera in 1831. Venice took the lead in measures to check the spread of plague, having appointed three guardians of the public health in the first years of the Black Death (1348). The next record of preventive measures comes from Reggio in Modena in 1374. The first lazaret was founded by Venice in 1403, on a small island adjoining the city; in 1467 Genoa followed the example of Venice; and in 1476 the old leper hospital of Marseilles was converted into a plague hospital—the great lazaret of that city, perhaps the most complete of its kind, having been founded in 1526 on the island of Pomègue. The practice at all the Mediterranean lazarets was not different from the English procedure in the Levantine and North-African trade. On the approach of cholera in 1831 some new lazarets were set up at western ports, notably a very extensive establishment near Bordeaux, afterwards turned to another use.
The plague had disappeared from England, never to return, for more than thirty years before the practice of quarantine against it was definitely established by an act of Parliament of Queen Anne’s reign (1710). The first act was called for, owing to an alarm lest plague should be imported from Poland and the Baltic; the second act of 1721 was due to the disastrous prevalence of plague at Marseilles and other places in Provence; it was renewed in 1733 owing to a fresh outbreak of the malady on the continent of Europe, and again in 1743 owing to the disastrous epidemic at Messina. In 1752 a rigorous quarantine clause was introduced into an act regulating the Levantine trade; and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltic. Although no plague cases ever came to England all those years, the restrictions on traffic became more amd more stringent (following the movements of medical dogma), and in 1788 a very oppressive Quarantine Act was passed, with provisions affecting cargoes in particular. The first year of the 19th century marked the turning-point in quarantine legislation; a parliamentary committee sat on the practice, and a more reasonable act arose on their report. In 1805 there was another new act, and in 1823–24 again an elaborate inquiry followed by an act making the quarantine only at discretion of the privy council, and at the same time recognizing yellow fever “or other highly infectious disorder” as calling for quarantine measures along with plague. The steady approach of cholera in 1831 was the last occasion in England of a thoroughgoing resort to quarantine restrictions. The pestilence invaded every country of Europe despite all efforts to keep it out. In England the experiment of hermetically sealing the ports was not seriously tried when cholera returned in 1849, 1853 and 1865–66. In 1847 the privy council ordered all arrivals with clean bills from the Black Sea and the Levant to be admitted to free pratique, provided there had been no case of plague during the voyage; and therewith the last remnant of the once formidable quarantine practice against plague may be said to have disappeared.
For a number of years after the passing of the first Quarantine Act (1710) the protective practices in England were of the most haphazard and arbitrary kind. In 1721 two vessels laden with cotton goods, &c., from Cyprus, then a seat of plague, were ordered to be burned with their cargoes, the owners receiving £23,935 as indemnity. By the clause in the Levant Trade Act of 1752 vessels for the United Kingdom with a foul bill (i.e. coming from a country where plague existed) had to repair to the lazarets of Malta, Venice, Messina, Leghorn, Genoa or Marseilles, to perform their quarantine or to have their cargoes “sufficiently opened and aired.” Since 1741 Stangate Creek (on the Medway) had been made the quarantine station at home; but it would appear from the above clause that it was available only for vessels with clean bills. In 1755 lazarets in the form of floating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure to dews) having been done previously on the ship's deck. There was no medical inspection employed, but the whole routine left to the officers of customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic had to lie forty days in quarantine, and unpack and air the sacks; but owing to remonstrances, which came chiefly from Edinburgh and Leith, grain was from that date declared to be a “non susceptible article.” About 1788 an order of council required every ship liable to quarantine, in case of meeting any vessel at sea, or within four leagues of the coast of Great Britain or Ireland, to hoist a yellow flag in the daytime and show a light at the main topmast head at night, under a penalty of £200. After 1800, ships from plague-countries (or with foul bills) were enabled to perform their quarantine on arrival in the Medway instead of taking a Mediterranean port on the way for that purpose; and about the same time an extensive lazaret was built on Chetney Hill near Chatham at an expense of £170,000, which was almost at once condemned owing to its marshy foundations, and the materials sold for £15,000. The use of floating hulks as lazarets continued as before. In 1800 two ships with hides from Mogador (Morocco) were ordered to be sunk with their cargoes at the Nore, the owners receiving £15,000. About this period it was merchandise that was chiefly suspected: there was a long schedule of “susceptible articles,” and these were first exposed on the ship's deck for twenty-one days or less (six days for each instalment of the cargo), and then transported to the lazaret, where they were opened and aired forty days more. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a “convalescent ship.” The expenses may be estimated from one or two examples. In 1820 the “Asia,” 763 tons, arrived in the Medway with a foul bill from Alexandria, laden with linseed; her freight was £1475 and her quarantine dues £610. The same year the “Pilato,” 495 tons, making the same voyage, paid £200 quarantine dues on a freight of £1060. In 1823 the expenses of the quarantine service (at various ports) were £26,000, and the dues paid by shipping (nearly all with clean bills) £22,000. A return for the United Kingdom and colonies in 1849 showed, among other details, that the expenses of the lazaret at Malta for ten years from 1839 to 1848 had been £53,553. From 1846 onwards the establishments in the United Kingdom were gradually reduced, while~ the last vestige of the British quarantine law was removed by the Public Health Act 1896, which repealed the Quarantine Act 1825 (with dependent clauses of other acts), and transferred from the privy council to the Local Government Board the powers to deal with ships arriving infected with yellow fever or plague, the powers to deal with cholera ships having been already transferred by the Public Health Act of 1875.
The existing British regulations are those of 9th November 1896; they apply to yellow fever, plague and cholera. Officers of the Customs, as well as of Coast Guard and Board of Trade (for signalling), are empowered to take the initial steps. They certify in writing the master of a supposed infected ship, and detain the vessel provisionally for not more than twelve hours, giving notice meanwhile to the port sanitary authority. The medical officer of the port boards the ship and examines every person in it. Every person found infected is certified of the fact, removed to a hospital provided (if his condition allow), and kept under the orders of the medical officer. If the sick cannot be removed, the vessel remains under his orders. Every person suspected (owing to his or her immediate attendance on the sick) may be detained on board forty-eight hours, or removed to the hospital for a like period. All others are free to land on giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew may be kept individually under observation for a few days. The ship is disinfected, dead bodies buried at sea, infected clothing, bedding, &c., destroyed or disinfected, and bilge-water and water-ballast (subject to exceptions) pumped out at a suitable distance before the ship enters a dock or basin. Mails are subject to no detention. A stricken ship within 3 miles of the shore must fly at the main a yellow and black flag borne quarterly from sunrise to sunset.
International Conventions.—Since 1852 several conferences have been held between delegates of the Powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe; all but that of 1897 were occupied with cholera. No result came of those at Paris 1852, Constantinople 1866, Vienna 1874, and Rome 1885, but each of the subsequent ones has been followed by an international convention on the part of nearly one-half of the Powers represented. The general effect has been an abandonment of the high quarantine doctrine of “constructive infection” of a ship as coming from a scheduled port, and an approximation to the principles advocated by Great Britain for many years. The principal States which retain the old system are Spain, Portugal, Turkey, Greece and Russia (the British possessions Gibraltar, Malta and Cyprus being under the same influence). The aim of each international sanitary convention has been to bind the Powers to a uniform minimum of preventive action, with further restrictions permissible to individual States. The minimum is now very nearly the same as the British practice, which has been in turn adapted to continental opinion in the matter of the importation of rags.
The Venice convention of 1892 was on cholera by the Suez Canal route; that of Dresden, 1893, on cholera within European countries; that of Paris, 1894, on cholera by the pilgrim traffic; and that of Venice, in 13971 was in connexion with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe. One of the first points to be dealt with in 1897 was to settle the incubation period for this disease, and the period to be adopted for administrative purposes. It was admitted that the incubation period was, as a rule, a comparatively short one, namely, of some three or four days. After much discussion ten days was accepted by a very large majority. The- principle of notification was unanimously adopted. Each Government is to notify to other Governments the existence of plague within their several jurisdictions, and at the same time state the measures of prevention which are being carried out to prevent its diffusion. The area deemed to be infected is limited to the actual district or village where the disease prevails, and no locality is deemed to be infected merely because of the importation into it of a few cases of plague while there has been no diffusion of the malady. As regards the precautions to be taken on land frontiers, it was decided that during the prevalence of plague every country had the inherent right to close its land frontiers against traffic. As regards the Red Sea, it was decided after discussion that a healthy vessel may pass through the Suez Canal, and continue its voyage in the Mediterranean during the period of incubation of the disease the prevention of which is in question. It was also agreed that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal in quarantine at Port Said by night as well as by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and are provided with a disinfecting stove, have a right to navigate the Canal in quarantine, subject only to the landing of those who are suffering from plague, and of
such persons as have been in actual contact with the sick or with infected articles, together with the disinfection of the infected compartment of the vessel. Passing on to the conclusions dealing with regulations to be imposed “in Europe,” the following are the chief points to be noted:-As regards measures to be adopted at ports of arrival, the conclusions of the Dresden convention were as far as practicable adhered to. In the case of healthy vessels, i.e. those on board of which there is no illness, though they have sailed from an infected port, it was decided that they should at once have free pratique, but at the option of the local authority certain measures of disinfection of soiled articles may be required. For suspected vessels, viz. those on board of which there has been plague, but no fresh case within twelve days, some limited processes of disinfection, &c., as defined, having been complied with, it is recommended that the crew and passengers should be subject to surveillance for a period of ten days from the date of the arrival of the vessel. In the case of infected vessels, viz. those on which plague is actually present, or on which that disease has occurred ten days before arrival, the sick are to be landed and isolated, and the remainder of those on board are to be subjected, at the discretion of the local authority, to “observation” or “surveillance” for a period not exceeding ten days from the date of the occurrence of the last case of plague. In this convention the terms “observation” and “surveillance” are for the first time clearly defined; the definition as to the latter stating that under that system passengers are not to be isolated, but are to be allowed at once to proceed to their homes, where they can remain under medical supervision so long as may be deemed necessary by the local authority. The results of this conference indicated a great advance on the part of the nationalities represented towards a liberal and truly scientific conception of the means to be adopted by their respective Governments for the prevention and control of infective diseases.
Literature.—A quarantine committee of the Social Science Association collected, in 1860-61, valuable consular returns on the practice of quarantine in all parts of the world; these were edited by Milroy and ordered to be printed (with the report and summary) as three parliamentary papers communicated to the board of trade. The third paper (6th August 1861, No. 544) contains, in an appendix, an Historical Sketch of Quarantine Legislation and Practice in Great Britain, by Dr Milroy. Russell's Treatise of the Plague (4to, London, 1791) contains “remarks on quarantines, lazarettoes, &c.,” and an account of the mode of “shutting up” practised by households in Aleppo on the outbreak of plague in the town. The inexpediency of quarantine in the United Kingdom is discussed by John Simon in the eighth Report of the Medical Officer of the Privy Council for 1865, p. 35, and also in Report (Medical) of Local Government Board, xxiv. 1892-93.
- ↑ The strict sense of the term is also preserved in the “widows’ quarantine,” the right of a widow to remain in the principal house belonging to her husband for forty days after his death.