file: hph_lec2e.mp3
A History of Modern Public Health: Quarantine, part E
I want to look back now at one of the reasons why I highlighted
the fact that the Chinese population in Sydney were subjected to
special treatment within the context of the plague epidemic. You
recall from an earlier slide that the Chinese who were suspected
of having plague or the Chinese who did have plague were
temporarily isolated in makeshift tents as compared to other
members of the population who might have had the disease were
either hospitalized or placed in pavilions.
And it is an interesting question of the way in which the healthy
are separated from the sick under systems of quarantine, as to
why some populations are selected out for this sort of treatment.
And the argument is -- that social historians have put forward --
is that the search for scapegoats in this way becomes a way of
minimizing the anxiety and the grief that is associated with an
epidemic, and a highly -- in the case of plague -- a highly fatal
epidemic, and it becomes a way of directing anger and frustration
at an enemy that is supposedly visible. And there are numerous
examples of how minorities have been targeted in times of
epidemics. In an earlier section we looked at ways in which Jews
became the focus of scapegoating during plague epidemics, and the
Chinese in Sydney, the Chinese population in Sydney is yet
another example.
And the fear of the Chinese population during the plague epidemic
in Sydney focused on three major issues. First of all, they were
seen as an economic threat, as they were believed to work much
harder for lower wage rates than other sections of the
population. Secondly, they were believed to be more susceptible
to infectious disease, and this was due to their supposed racial
inferiority as opposed to the White population. And also, they
tended to live in conditions of overcrowding, filth, and in
inadequate sanitary provision. So these three factors came
together: the economic threat, the disease susceptibility, and
the fact that the Chinese lived in the -- generally the most
environmentally deprived sections of the city. They came together
and provided a reason for the Chinese population to be
scapegoated.
And plague was termed, in this period "the Asiatic harvest," and
the accusations were directed at Chinese that they hid their
sick, that they refused to submit to inoculation, to quarantine
and to cleansing. And there was a subsequent boycotting of
Chinese businesses, and there was a refusal to allow members of
the Chinese population to use public transport during the period
of the epidemic. And it was the areas where the Chinese lived,
the poorest areas of the city around the wharf and the harbor of
Sydney that became the focus of the quarantine effort. So it was
the Chinese population who tended to be the most controlled and
have their movements monitored as opposed to the wider population
of the city as a whole.
And it is important to emphasize here that the public health
authorities tended to collude and, if you like, reinforce this
image of the Chinese population as a threat. And there is a quote
I'd like to use that came from the chief medical officer,
Ashburton Thomson, he was the chief medical officer in New South
Wales, and he said in July 1900 "There is no particular reason
beyond the old established facts that the Chinese, in common with
Indians, Negroes, and other races who subsist mostly on a
vegetable diet, offer less resistance to disease than other
nations." So you have there an authorized view point about the
inferiority of the living and nutritional habits of the Chinese
population that made them susceptible to disease and therefore
legitimate targets for an intensive quarantine and public health
intervention.
And this type of public health collusion in victimizing and
focusing on particular ethnic groups is also evident when we
consider the case of the outbreak of cholera in New York in 1892.
And here what we are concerned with is the system of quarantine
that is related not only to social class distinctions and ethnic
distinctions but also to the actual policy of immigration itself.
And just to -- as a brief background here to the outbreak of
cholera, the focus of the scapegoats in here was predominantly,
almost solely on the immigrating Russian Jewish population who
were fleeing famine and cholera in Russia in the early 1890s. In
1892 Russian Jews represented around about 10.4 percent of all
immigrants to America, so they represented a very large immigrant
stream in this period. And once the knowledge that cholera was
prevalent or had made itself present in Europe in the 1890s,
systems of quarantine -- and that passengers were bringing the
cholera with them from Europe on the immigrant ships to New York
-- a system of maritime quarantine was put in place in the second
half of 1892. So from the end of August and to the middle of
October in 1892, almost a thousand ships and almost 81,000
passengers were inspected by quarantine staff in New York along
with their baggage and also the cargo that the ships were
carrying.
But what happened was, this quarantine policy took on a class and
ethnic dimension. So for example, cabin class passengers -- also
a term more familiar to you might be "first class passengers" -
were allowed to have their luggage fumigated on board. They were
medically inspected rapidly and briefly, and they were then
allowed to disembark almost immediately. So very soon after the
ship entered the port, the first-class passengers underwent some
fairly cursory quarantine regulations, and they were allowed to
go on their merry way into the city. On the other hand, steerage
passengers -- and by "steerage passengers" I mean passengers who
were traveling in second and third class -- they were only
allowed to disembark the ship after five days. So there is this
class distinction between the first class and the not-first-class
passengers in terms of the quarantine regulations that they had
to undergo. And these were tightened from September 1st, and due
to a presidential proclamation from that date, all steerage
passenger ships were subjected to a 20-day quarantine rule, and
this remained in place until 1893. So what happened was that
there actually came to be a distinction in the type of passengers
that ships coming to New York carried, so some ships were only
allowed to carry steerage passengers, and some ships were only
allowed to carry first-class passengers. And effectively what
that ruling did was it speeded through the process of quarantine
for the first-class passengers and meant that the steerage
passenger ships could be monitored more closely.
And this rule had an effect on immigration itself. So between
June and September of 1892, the average number of Russian Jewish
immigrants was around about 3800 per month: almost 4000 Russian
Jews were entering New York on a monthly basis in the late summer
and autumn of 1892. Between October and December of 1892 this
number dropped to less than 300 and totaled around about 270. So
you have a clear indication here that quarantine was being used
as a means by which immigration from Europe could be restricted.
There was also a form of quarantine that was instituted within
the city itself. And when cholera cases were reported in the
city, very frequently the public health authorities would try and
establish a link with the immigrant population. And the focus of
investigation was generally the lower East side of New York where
the immigrant communities, particular the Italian and the Russian
Jewish communities resided. There were only, in matter of fact,
there were only 12 cases of cholera actually reported within the
city itself. But victims were removed in large canvas bags with a
drawstring around their neck, and they were taken to an isolation
hospital, the Willard Parker Hospital. Their homes were
disinfected, the homes and neighborhoods where the cholera cases
were found were quarantined, and they were blockaded by the
sanitary police. And these were distinctly in areas where the
Russian Jewish population tended to reside and congregate.
And so what we have here again is a persistence that we observed
in Italy, that we observed in China, and that we observed in the
case of Sydney of particular parts of the city being selected for
intensive public health efforts, and they were cordoned off, and
the space was demarcated effectively by having a cordon sanitaire
being drawn around those areas that contained those populations
that were considered to be the most dangerous and posed the
greatest epidemic threat.
So what we have here in this slide on quarantine and class
distinctions is an image that shows the way, the different ways
in which the passengers were treated when they were isolated in
quarantine. The main part of the image shows nothing more or less
than what looks like a hospital ward with rows of beds and a
quarantine population residing in the beds side by side. It looks
like a hospital ward; it could easily be a converted warehouse.
And you can see on the insert there, the cabin passengers, the
first-class passengers, were isolated and quarantined in their
own room. You can see that there are tables and chairs provided
for visitors; there is a small bed-side table, and so there is
some attempt to make a home-comforts environment for the cabin
passengers to make their inconvenience of the quarantine rather
more acceptable.
And this following image shows the removal of a quarantine victim
from business districts in New York. And you can see the impact
that this sort of removal might have when it takes place within a
quarantined area of a city. If you look in the foreground on the
left-hand side, you can see a police officer is present, you can
see also that the cholera victim, who is at the center of the
picture, is being manhandled or bundled into an ambulance -- that
is the vehicle on the right-hand side of the picture - by two
sanitary officials in what would seem to be against her will, but
of course the justifications for removals of this sort were
provided by law, and quite often if people resisted such a
removal to hospital, they would be fined a financial penalty.
And you can also see other aspects of the scene to emphasize the
way in which the unsanitary conditions of the district are
portrayed, so on the bottom left-hand side of the picture, you
have the trash cans and the decaying, rotting matter. Then you
can see just generally the panic and the commotion that a removal
like this can cause. And it also emphasizes the fact that this
sort of removal was concentrated in particular places that were
subjected to the quarantine regulations.
So we have gone through a number of examples in the various
sections that show the administration of quarantine procedures
through time and in different places. And one of the things I
would like to emphasize in conclusion are the continuities that
we can observe over the periods and between the places that we
have looked at. Quarantine is instituted despite epidemiological
knowledge of how the disease is transmitted, how it moves between
places and between people. Irrespective of the current depth and
the current sophistication of medical knowledge, quarantine is
still used - and it is still used today: you only have to think
back to the SARS epidemic of 2003 when the actual transmission of
the disease was unknown -- that systems of quarantine and
isolation were implemented. So that is one of the main points,
this continuity through time, the similarity of the public health
intervention that was formally introduced in Italy during the
14th century.
And another main point is that quarantine restricted the movement
of people and objects. And the significance here is that people
and objects and their movement connected places. So quarantine is
effectively about the public health management of space and
place. It is about restricting and controlling people and their
belongings in order to attempt to try and break the transmission
of disease.
And finally, I think it is important to draw your attention to
the implications of quarantine, however successful it is in
epidemiological terms as a public health measure. A quarantine
may well indeed break the transmission of disease, it may be well
effective in reducing in the number of cases, but it has a social
implication, and especially in those examples that we drew from
Sydney and from New York, public health quarantine can be used as
a way of stigmatizing particular groups, of placing the focus of
interventions on particular groups, and in a way this quarantine
can be used to characterize particular sections of the population
as harboring a biological threat.
So thanks for your attention while we were considering
quarantine, and next time, what we are going to be doing is
looking at another form of public health invention to deal with
biological threats, and that is the introduction and
implementation of sanitation.
