Quarantines and Their Mixed Results

March 14, 2019 Rene F. Najera

Before the development of vaccines against deadly diseases like smallpox, typhoid fever and measles, public health authorities relied heavily on quarantines in order to stop epidemics from spreading. The concept was simple: keep sick people away from the healthy people. Unfortunately, there were plenty of times where quarantines were broken and the epidemics allowed to continue. Then there were the times when the people suspected of being sick or being carriers of the disease found ways around the quarantines or other orders by public health authorities. Let's look at three cases, two from the past and one that recently occurred.

John Early's Treatment by A Confused Nation

John Early of North Carolina was a man who was suspected of having Hansen's disease (commonly referred to as leprosy). He was suspected of having it because his line of work brought him into contact with skin irritants. On a trip to Washington, DC, to see about his military pension, Mr. Early's skin, especially his face, were so swollen that he decided to seek medical care:

"Remembering that Early had admitted to military service in the Philippines, the doctor, in fear of contagion, retired precipitously. He returned shortly with Dr. William C. Fowler, inspector for contagious diseases in the District of Columbia, who had never seen a true case of leprosy in his life. After a brief look, the two medical men went out, carefully locking the door behind them but soon returning with Dr. Joseph J. Kinyoun, pathologist at Washington University and founder of the U.S. Public Health Service Hygienic Laboratory. After a brief examination, Kinyoun remarked that the case was “strongly suspicious” and took a small cutting of Early’s facial skin to his laboratory. There he reported finding bacilli “corresponding morphologically with those of leprosy.” These findings were speedily endorsed by Dr. William C. Woodward, health officer of the District of Columbia and expert in medical jurisprudence, and Early was immediately removed from the locked room at the doctor’s office and forcibly quarantined in a hastily erected tent down on the marshy bottom adjacent to the eastern branch of the Potomac River."

Hansen's disease is caused by a bacteria closely related to the bacteria that causes tuberculosis. It causes lesions of the skin, with some of the skin eventually dying and falling off. It is somewhat infectious, requiring close contact with the infected person for it to be transmitted. Today, it is curable with antibiotics. In John Early's time, quarantine was the only way to control it. So imagine the level of concern that someone might have this disease in a relatively crowded city that was (and is) Washington, DC, and one that is the seat of government for the nation.

As his exposure to chemicals at work was no longer an issue, Mr. Early's skin got better. Several physicians examined him and gave him a clean bill of health. Nevertheless, he was told to not touch his wife as a precaution. He and his wife even lived in a house separated by a wall. As news of his "condition" got around, Mr. Early was mistreated by neighbors and potential employers. He evaded arrest several times form authorities who had not heard of his clean bill of health, or they would not believe the physicians. Because of the stigma, Mr. Early picked up and left for Washington State. His troubles did not end there, however.

When word got out in Washington State of who John Early was:

"[His neighbors] indignantly demanded his removal. It was first proposed to enclose one acre of his farm with two rows of barbed wire fences six feet apart, thereby shutting him off from contact with any other person, but even this plan did not satisfy the local citizens."

As a result of all the trouble, Mrs. Early left her husband, and he was shipped off to a naval station to look after patients with actual Hansen's disease in 1914. He escaped and turned up in British Columbia, Canada, before authorities lost track of him again. Weeks later, he showed up in Washington, DC, to bring attention to his cause. He told the newspapers at the time:

"To demonstrate how easy it is for a leper to mingle in cities, I planned my present trip six months ago. I knew that it is only when a great truth is sent home to the hearts of the people that attention is paid to it. I knew that if I mingled among the well-to-do and the rich and exposed them to contagion that they would arise out of self-protection and further my plan of a national home."

As a result, Congress created a leprosarium, a "national home" for people with Hansen's disease. Mr. Early was forcibly put in that house, and he died there at the age of 64. Psychiatrists at the time treated him for all sorts of conditions similar to those of post-traumatic stress disorder and likely brought upon him by the circumstances he endured since leaving the army in his 20s. He never had a stable home. He was incarcerated to some degree most of his adult life, and he escaped over and over.

Typhoid Mary

You have probably heard of Mary Mallon and her plight for being a carrier of typhoid fever. Ms. Mallon was an Irish immigrant to the United States in the 1880s. In 1906, a wealthy banker hired her as a cook at his summer home. Half of the people in the home became ill with typhoid fever. A sanitarian by the name of George Sober investigated the outbreak, initially believing oysters were at fault. However, in 1907, Mr. Sober caught word of other cases of typhoid fever around New York City. He would run into Mary Mallon as part of his investigations, so he decided to follow her. Based on his observations, Ms. Mallon seemed to be everywhere there was an outbreak of the disease.

Based on George Sober's observations, Mary Mallon was tested for the bacteria and found to have them in her feces. However, she was completely healthy. This was the first documented case of a carrier of typhoid fever. (A carrier of a disease has the infection but shows no disease, and they are able to transmit the disease to others.) From 1907 to 1910, Mary Mallon was confined to a hospital on an island off Manhattan. Her stool continued to test positive for the bacteria. She tried suing the health department, but that didn't work. In 1910, a new health officer offered her her freedom on the condition that she not cook, prepare or serve food to others, or face stiff penalties. However, cooking and serving people was the only thing Mary Mallon knew how to do, so she disobeyed the orders several times and found herself in trouble for doing so.

Because she continued to work preparing food and infecting many people -- some of whom died, Mary Mallon was quarantined for the last time back at North Brother Island. Ironically, she ended up working in a laboratory while there. She died in 1938, having never regained her freedom. (The vaccine for typhoid fever became available in 1911, and antibiotics that were effective against it were available in 1948.)

Measles in Wisconsin

This all brings us to today, where there have been cases of people returning from West Africa and being put on quarantine for several weeks on fear that they may be carrying Ebola. During the current measles outbreaks in New York City, Washington State and elsewhere, children who are not immune against measles and were exposed to the disease have been quarantined. At the very least, they've been ordered not to attend school.

In Wisconsin, Jeffery Murawski was ordered to stay home by the local public health authorities because he had potentially contracted measles. He wasn't put in jail or held in confinement. He just had to stay home for 21 days. If he developed measles, he would be taken care of. If not, no problem. However, for some reason, the local police put an officer outside Mr. Murawski's home to make sure he obeyed the quarantine.

A few days into his quarantine, Jeffery Murawski evaded the police guarding his home and escaped with his wife's help to a nearby gym. He stated that he was growing sick from being confined to his home. Once at the gym, Mr. Murawski had a change of heart and left, turning himself in to the authorities when they discovered his violation of the quarantine order. Both he and his wife now face up to 30 days in jail and a permanent criminal record for their actions. It should be noted that, like with John Early back in the early 1900s, Mr. Murawski was quarantined out of precaution and without showing signs of the disease or laboratory tests to that effect.

Conclusion

Today, we have effective antibiotics against the bacteria that cause Hansen's disease and typhoid fever. We also have a vaccine against typhoid fever that is recommended for people traveling outside the United States and is used in many parts of the world. We also have a vaccine against measles that is recommended for use in the United States for children at 12 months of age and before they start elementary school. For those diseases, quarantine should be the last resort. For other diseases that have no treatment, cure or prevention available, quarantines could still be used as a way to stop contagion. However, as history has shown, human beings can be very creative in how they get around quarantines, especially when they feel persecuted for a disease for which they feel no symptoms.

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