Boston is one of America’s oldest cities — and one that has arguably fought the lengthiest battles with infectious disease. It is, as Charles Vidich puts it, the “most quarantine tested city in America.”
For more than three and a half centuries, the city’s leaders have struggled to develop strategies for keeping citizens safe from communicable disease. Boston’s situation was unique, Vidich explains, because of its role as a major center of trade and commerce; because many of its quarantine strategies were copied by other cities; and because, thanks to the Massachusetts Bay Colony’s charter, it had a significant degree of independence in terms of setting policy.
Investigating this history has been a lifelong project for Vidich, a consultant on public health and bioterrorism issues. He’s also been a visiting scientist at the Harvard School of Public Health, where he spent a decade working on quarantine policy. Vidich also served on the U.S. Postal Service’s national anthrax response in the early 2000s, following the 9/11 attacks.
The culmination of his research is “Germs at Bay: Politics, Public Health, and American Quarantine,” published by Prager last month.
Our interview has been edited for length and clarity.
Undark: How long has quarantine been used as a strategy for preventing the spread of disease, in Boston, or in the United States?
Charles Vidich: Within the United States, the first known quarantine was in 1647, which was imposed by Gov. John Winthrop — he was one of the first governors of the Massachusetts Bay Colony. That lasted for roughly two years. It was applied, at the time, to what was thought to be yellow fever from Barbados. That’s the first documented one, but there were multiple ones after that.
UD: In your book you discuss a number of communicable diseases, but smallpox seems to stand out from the rest, in terms of the danger it presented. How big of a threat was smallpox in the early history of Boston, or of the country?
CV: It was the number-one most-feared disease that existed in the colonies. The main reason— and there’s a close correlation with quarantine —was the gruesome impact it had on one’s body. It left permanent scabs on individuals, and even once they healed, it was gruesome what it did to people. It was a highly lethal disease.
UD: How deadly was it?
VD: As many as 70 percent of the people got infected in some of these 17th-century smallpox epidemics in Boston, and as many as 30 percent of the people infected died, in the early years.
UD: How difficult was it to treat diseases such as smallpox before the underlying science — such as the germ theory of disease — was properly understood?
CV: It was an evolving process in the 17th and 18th century. It went by fits and starts. We had some people, such as Dr. [William] Douglass, in the 1721 epidemic, who understood that it was communicable; but then we had, in the 18th century, people who pooh-poohed the communicability of it. In our nation, in the early days of the colonies, we really had a lot of fumbling around, in terms of understanding the nature of it.
UD: As you note, things improved with the widespread use of inoculation and vaccination. But how easy or difficult was it for the health authorities to convince the population that these strategies were safe and effective?
CV: The only time early colonialists were really interested in getting inoculated or vaccinated was when an epidemic was imminent — or in the midst of an epidemic. It was very difficult to get anyone to take on inoculation. Because, first of all, there was a percentage of people who would die from taking the inoculation; it was not without consequence.
UD: What was the public opinion of doctors, and of the medical profession, at that time?
CV: The entire medical profession was really not like it is today. They weren’t licensed, there were no certification procedures. Medical doctors worked in a guild system; you learned on the job. Many people felt they knew better than the doctors, especially since it was the exception if a doctor actually went to medical school.
UD: Do you see vestiges of those attitudes today?
We’re much more sophisticated with vaccination, but we still haven’t fundamentally educated people enough about these issues, so that they can understand what is fact and what is fiction. That’s a significant aspect of the whole quarantine story, because vaccination is, ultimately, when done right, the greatest answer to minimizing the use of quarantine.
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UD: You point out in your book, there were links between immigration and public health — and Boston was a key center for immigration, especially in the 19th century.
CV: The biggest infusion of immigrants into America, and I’m talking a quantum level of infusion, was in 1839, 1840, when the first big ships started coming from England to Boston. And Boston was really the closest port to England, so there’s an enormous amount of travel there. It became a bit like ‘People’s Express Airlines’ of the 1980s, where you could hop on a boat and you get there in a short period of time, maybe two weeks compared to six weeks back in the 1700s. We started seeing tens of thousands, and then hundreds of thousands, of people coming into Boston, in the short period of ten years. Many of these people were coming at the time of the Irish potato famine. And these people were not only impoverished, they were immuno-compromised, simply because they didn’t have the nutrition to be able to withstand the kind of assault that disease brings to bear on people. So there was a clear connection between immigration and the transfusion of disease into the colonies.
UD: If those arriving by ship were thought to be carrying disease, what steps could be taken?
CV: This is where we get the idea of ‘island quarantines’ which, in the case of Boston, turned out to be ‘island detention centers’ that were used for multi-fold purposes. It was almost a sinister arrangement, in which all of the so-called social ills of that time, which was basically: Immigrants were one group; criminals were a second group; children who had no parents, or were in reform school, was another group; and then those who were psychiatrically off-balance were another group. And all of those people represented a fiscal burden for the city of Boston. And the answer they came up with, which was unprecedented, was to take all of these groups, from whatever location they were in, in Boston, and put them out on Deer Island, which was several miles off the coast of Boston, and put them into these massive detention centers, which segregated them according to the various classes of issues they faced.
So for the immigrants that were coming into this country, who were trying to get away from what you might call the pressure and micro-management of the English government, which was taking over their lives — they come to this country, and their first experience was to be tossed into quarantine, and treated like they were lepers. So it was a very dark period in Boston history.
UD: Looking back at the last 350 years of fighting infectious disease, what lessons are there for today?
CV: One of them is, having public health professionals, and not politicians, leading the way — that’s critical. In all too many cases, with the epidemics of the past — and this was almost axiomatic — the first thing you’d see in a newspaper, or from the chief elected officials, is: “This is no big deal. We don’t even see any problems.” You’d be halfway through an epidemic before people would wake up and say, “We really do have a problem.” And then you see the wheels grinding. So, item number one is …. giving much greater authority to public health officials. As you may know, in the United States right now, that is not what’s going on. At best, they’re almost like puppets, where the governors are using them to say what they want them to say. That whole paradigm has to shift.
UD: It seems as though cities, and even nations, can only do so much on their own?
CV: The other lesson is strategic. It has to do with the ability of the World Health Organization to resolve issues which are international in scope. When one person is sick in another country, traditionally people say, “It’s not my problem.” In reality, if anyone is sick in this world right now, that could potentially be everyone’s problem, when the disease is highly communicable.