Quarantine is “old medicine” reinvigorated for our times because “novel pathogens, both deliberate and newly emerging, may not be amenable to existing modern countermeasures..” . According to this policy report created by the Center for Strategic and International Studies (CSIS, Homeland Security), we live in “a time that has witnessed almost twenty new diseases in two decades [1980-2000] and the deliberate release of Bacillus anthracis through the mail”. http://www.birdflumanual.com/resources/Official_Pandemic_Plans/files/Quarantine%20Guidelines%20CSIS%202Nov2005.pdf
In the history of the United States, public health measures were matters for individual states with the federal government adopting a support role by a formal request for assistance, codified in 1824 by a landmark Supreme Court case, Gibbons v. Ogden. “The Court held that ‘the completely internal commerce of a State..may be considered as reserved for the State itself’ [and] that under the Constitution ‘states are [therefore] able to pass inspection laws, quarantine laws, health laws of every description, as well as laws for regulating the internal commerce of a state’.” In the decades that followed, however, new diseases like yellow fever and cholera strained at the meager resources of pioneer towns and unprepared officials.
In 1878, during a major spread of yellow fever up the Mississippi Valley that claimed 20,000 lives, Congress passed the National Quarantine Act that empowered the Marine Hospital Service (MHS) to dispatch health officers and materiel to any needed area. The Surgeon General of the time, John Maynard Woodworth, is described as having “ambitious goals for the MHS..to provide health services to the entire nation”. http://leda.law.harvard.edu/leda/data/525/vanderhook2.html The Marine Hospital Service had been chartered 80 years previously in 1798 as the Act for the Relief of Sick and Disabled Seamen, funded by a tax on sailors’ salaries, long noted as vectors for the spread of illness dating back to the Black Plague of 1347 when the first quarantine was imposed on ships in Venice, Italy.
The National Quarantine Act of 1878 strengthened US government power to regulate immigration, granted in 1875, which was formerly a right of the states. (US Supreme Court, California case ‘Chy Lung v. Freeman et. al’). Over the next 22 years federal authority was bolstered by a series of legislation designed to exclude undesirable immigrants and impose interstate quarantines until a turning point was reached for the consolidation of federal public health powers in 1900 with a return of the Black Death. It was far from the first time that plague had circulated in America, but the difference was in newly acquired facilities and agencies developed in the intervening years since 1878.
During an outbreak of smallpox in 1895 in Eagle Pass, Texas, MHS physician Milton J. Rosenau was appointed by the Surgeon General to manage a ‘sanitary cordon’ with 20 guardsmen to prevent a group of 300 itinerants from infecting the townspeople. Milton Rosenau was soon appointed as the chief of the new U.S. Hygienic Laboratory, becoming its second director in 1899. The initial director appointed in 1898, Joseph Kinyoun, was the first responder to an outbreak of plague in San Francisco’s Chinatown. He called upon his associate Milton Rosenau*, to bring a 2-man team to manage the crisis; Simon Flexner** and Llewelys Barker. The entire event was fiercely controversial and lasted for several years. The city of S.F. was undergoing intense political turmoil at the onset and the threat of plague, spread widely by stories in national newspapers, dealt a devastating blow to the state’s economy, eventually unseating its governor who claimed all along that the proofs of plague were unfounded.
Two years before the outbreak in 1898, the Marine Hospital Service and its reigning Surgeon General Wyman, had lost a major bid for federalization at the hands of states-rights defenders, but from 1901 onward the federal government had the power to “enforce quarantines without deference to state health laws”. The record of dissent against this power remains in the arguments raised in 1878: “that such power would interfere with fundamental states’ rights…the power to control quarantine is, in essence, the ability to control the threats visited upon one’s own body…[and] would remove from cities and states the ability to protect themselves..as they saw fit and give the MHS [todays NIH] undue power: Is the General Government preparing for the mustering and maintenance of an expensive local health police –an army of sanitarians that, like locusts in the field, eat up our substance and usurp our liberties?”
*Milton J. Rosenau
-served the MHS as SanFrancisco’s quarantine officer from 1895-1898 and would have been well familiar with the socio-political climate in the years before the plague outbreak! Prior to his service in San Francisco, Rosenau was in Europe attending courses in Berlin and Vienna and advising the US consulars in Hamburg and Antwerp. During his years as the chief of the Hygienic Laboratory (1899-1909) he transformed the agency from a ‘one-man-show’ into a campus-based research facility, and continued his career (1909-1935) at Harvard where he became the chair of the new Dept. of Preventive Medicine and Hygiene, Harvard’s School of Public Health.
During the Spanish Flu of 1918, Rosenau was a Navy chief supervising Boston’s Chelsea Naval Hospital, where he famously attempted to infect ‘volunteer’ sailors, released from detention, with the mucous of flu victims. Despite direct spraying in the face/nose/throat and subjecting the men to continual exposure in the sick wards, they did not contract the Spanish Flu. Boston was a notorious hotspot for the contagion, and the most frightful accounts emanate from the Army’s Fort Devens.
In addition to his quarantine and Naval duites, Milton Rosenau became an expert on polio and milk-pasteurization, writing “The Milk Question” in 1912. He served the Massachusetts State Board of Health from 1913 to 1922, after which he traveled to Russia and Palestine on fact-finding missions. After 1935 and his term at Harvard, Rosenau moved to the University of North Carolina where he established the School of Public Health, its dean until his death in 1946.
-previously at Johns Hopkins working with William Welch (1895-1898) and also traveling abroad on investigative medical missions, accepted a post at the University of Pennsylvania until his appointment as Director of the Rockefeller Institute of Medical Research (RIMR) in 1903, where he served until his retirement in 1936. His most enduring medical legacy is the development of a meningitis vaccine, presumed to have been the test vaccine given to soldiers at Fort Riley, Kansas in 1918 by Rockefeller administrator Frederick Gates.
On page 11 of the CSIS/bird flu manual linked above, the claim is made that “The Influenza Pandemic of 1918-19..infected a fifth of the world’s population, killing an estimated 675,000 Americans…Many of those suffering from the Spanish Flu were subjected to quarantine and isolation,…existing local quarantine stations were gradually turned over to federal control. By 1921, all quarantine stations were transferred to the federal government.” What had been a national ‘stealth’ power of public health in 1901 was functionally manifest in the aftermath of the Great Influenza and defined again in 1944 with the passage of the Public Health Services Act, passed in wartime under the administration of FDR. The US Army documents that the greatest number of influenza cases ever on record occurred in 1943-44, albeit less fatal.
But, for modern purposes, health authorities look to tuberculosis in bringing definition of the challenges inherent in disease control. “TB was once the leading cause of death in the United States…Globally, in 2003, an estimated 8.8 million people were infected and 1.75 million deaths occurred due to all forms of the disease.” Why choose TB for an example and not HIV/AIDS? The true answer may be a complex confrontation between the ‘overlapping’ definitions of “contagious” and “infectious”. TB is an aerosolized pathogen like influenza with the property of having developed multi-drug-resistant forms (MDR-TB) which “requires a minimum regimen of six months of daily drugs..[if] treatment is completed”. It has a long history of being fearful and fatal to the public resulting in quarantines, and the creation of an early NGO, the National Tuberculosis Association, which changed its name to the American Lung Association and came under the political control of the Laskers***. Modern TB patients who do not finish the entire course of drug treatment as prescribed are considered “noncompliant” and “In 1992, the US CDC found that 25 percent of all TB patients were noncompliant [and] recommended the use of quarantines to ensure treatment”.
The CDC’s euphemistic ‘guidelines’ were applied in New York City to “detained noninfectious TB patients in the Goldwater Hospital until they were cured…median length of confinement was 168 days; one patient was detained for an unprecedented 654 days [22 months]. Patients in other hospitals were only held an average for half that time” [10 or 11 months?]. Somehow and at some time, quarantine has become synonymous with forced treatment in lieu of a public perception to the contrary. Seemingly, forced treatment was not the case in the recent SARS outbreak of 2003, but forced quarantine with accompanying violence was a part of the larger picture of SARS.
Albert D. Lasker (1880-1952), considered the founder of modern advertising, was the CEO of ‘Lord and Thomas’ company for 40 years, specializing in the promotion of liquor, tobacco and food products. Lasker’s family roots in Galveston,TX and Germany generated wealth through the cotton exchange and flour-milling. Albert got a jump on a political career as well in 1917 as an assistant to the Secretary of Agriculture. Under FDR, he became an Asst. Sec. of the Navy. His friends, William ‘Wild Bill’ Donovan (OSS) and Lewis L. Strauss (Navy Admiral and chief of the Atomic Energy Commission), introduced him to his future wife Mary Woodard, a daughter of a banker who worked as a New York art buyer. The Laskers are noted for taking control of the American Cancer Society in 1944 and using a power base that included the American Heart Assoc., the American Lung Assoc. and the American Public Health Assoc. to drive national health policy. The 1946 National Mental Health Act was a key piece of legislation for the Lasker agenda, enabled by high-powered friends and insiders like Clark M. Clifford and Paul G. Hoffman. Mary Lasker worked together with Florence Mahoney and Anna Rosenberg lobbying privately in Wash,DC. The Lasker Award in medicine is presented by the foundation they established in 1942.
In the section “Quarantines Post 9/11” on page 12 (birdflumanual/CSIS) it’s stated that “most US states are ill prepared to undertake a large-scale quarantine…no large-scale quarantine has been implemented within US borders in modern day”. This is one of the many reasons, along with uncontrollable international travel and commerce, that the federal government has instead funded “international disease prevention”. Federal authority at home, however, is poised to override the actions of any state “if it is believed that a state’s actions are inadequate” and the CSIS evidently found this to be so, writing “most –if not all– states today lack operational plans”.
“Through a combination of vigilance and pure luck, the United States was able to elude a large-scale SARS outbreak” notes CSIS. What happened with SARS? Severe Acute Respiratory Syndrome was an emerging infection that started in November of 2002 in Guangdong Province, China –the same region that saw China’s first influenza over a century ago. What began as a local outbreak was ‘carried’ to Hong Kong by a medical doctor who reportedly infected 12 people in his hotel who then further carried the infection into Hong Kong, Singapore, Vietnam and Toronto, Canada. The outbreak spread to Taiwan where the highest recorded number of people were affected; 150,000 ordered into quarantine, bringing the global total near to 200,000. The undeniable element in the SARS outbreak was that medical personnel became the VECTOR.
“In Hong Kong, over 22% of those hospitalized for SARS were medical workers; in areas of Taiwan the number reached 33%; and in Toronto, 46%”!! Only in an upside-down, inside-out reality does it seem as if exposed medical workers were victims of the public, and yet sick medical workers were allowed to continue and interact with “proper equipment”. Is it not curious, with known and documented associations of vaccines causing illness, that 46% of the Toronto health workers who were hospitalized corresponds very closely to western statistics of health workers who receive regular vaccinations? Sick medical workers who were able to perform did so because “almost all response teams were severely overburdened and understaffed”, an echo of the state of stress in US Public Health labs during the 2009 spring H1N1 episode. Field tactics used during the SARS epidemic included “phone calls, house visits, electronic picture monitoring and electronic tagging of noncompliant detainees” in a variety of settings from family homes to detention camps; the same techniques being broadcast as applicable to today’s pandemic, minus other measures forecast to ensure compliance such as road-block dragnets. What is the likelihood that these measures will be used? On a return to this subject, I’ll post some examples from the news.