History of Health Care: Quarantine and Isolation

Before the nineteenth century, quarantine and isolation had been practiced in an effort to protect the community from contagious diseases such as plague and smallpox in the absence of specific treatment. Such diseases were considered contagious even though the cause and method of transmission were not known.

Two important developments occurred during the last half of the nineteenth century. An understanding of the cause and transmission of contagious disease occurred due to research leading to the germ theory. Government assumed increasing responsibility for the protection of the community from contagious diseases with legislation that established provincial and municipal Boards of Health.

Image from National Library of Medicine, http://www.nlm.nih.gov/exhibition/smallpox/sp_threat.html

Throughout the nineteenth century, the citizens of Kingston lived with the fear of both endemic and epidemic contagious diseases. These included a range of infections such as cholera, typhoid fever, diphtheria, scarlet fever and tuberculosis. Although the cause and transmission of these contagious diseases was understood by the end of the nineteenth century, little in the way of specific treatment was available.

The isolation hospital, built for the treatment of infectious diseases, was erected in 1923 with assistance from the City of Kingston. It became obsolete with the trend toward the incorporation of isolation facilities into other nursing units in the hospital.

Thus the community, in response to recommendations of the Board of Health, developed during the latter years of the nineteenth century and the first half of the twentieth century an extensive network of facilities and procedures to assure quarantine and isolation.  These initiatives, which included isolation hospitals, home isolation, and sanatoria for tuberculosis, protected the community and assured optimal care.

During the first half of the twentieth century, there was a dramatic development of vaccines to prevent many of these infectious diseases and antibiotics for treatment. Thus by the middle of the twentieth century, it was felt that infection had been controlled and home quarantine was discontinued and isolation hospitals and sanatoria were closed.

However in recent years, it has been become apparent that this is not so. New diseases such as variants of the flu virus as demonstrated by the SARS epidemic, nosocomial infections in hospitals and the re-emergence of old diseases such as drug resistant tuberculosis continue to challenge our society.

Quarantine and isolation are again requirements. These requirements are best achieved by public education rather than legislation. Are we doing enough regarding public education to assure consent for the increasing requirements to protect the community from these emerging and re-emerging contagious diseases?

James Low,
Executive Director

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