Patient Isolation, City Pest-House, Mobile, Alabama, 1836-1910

Special care is first taken of the sick … in public hospitals. They have four at the city limits…very well furnished and equipped with everything conducive to health. Besides, such tender and careful treatment and such constant attendance of expert physicians…, there is hardly anybody in the whole city who, when suffering from illness, does not prefer to be nursed there rather than at home.

Sir Thomas More, Utopia (1516)¹

Malaria, smallpox, and yellow fever were scourges of southern Alabama during the nineteenth century.² Malaria was the most prevalent, severe, and deadly of the endemic and epidemic diseases. Dr. James W. Heustis from Mobile, Alabama, wrote of the devastation wrought by that disease in the early 1820s, stating that "many flourishing towns upon the rivers … received a sudden check, and became suddenly almost totally abandoned, from death and desertion. Strangers with foreign and unseasoned constitutions were suddenly swept off by the thousands. There were not well persons to attend the sick and dying." He remembered the period as "my greatest experience of calamity."³

Other areas were also sorely afflicted with yellow fever, which was of epidemic proportion in 1819, the year Alabama acquired statehood. Approximately twenty-six percent of the estimated 1,500 people living in Mobile died of that disease during two seasons. The small town of Blakeley, Alabama, on the eastern side of the Mobile-Tensaw Delta, "lately full of people, suddenly became as a widow, weeping in lonely desolation."⁴ Many other towns experienced severe population declines several times during the nineteenth century as a consequence of yellow fever epidemics.⁵ Smallpox also assailed the populace, but it was less deadly than malaria or yellow fever, albeit greatly feared. In an effort to prevent, contain, and treat those afflictions, government officials at every level enacted specific, statutory public health laws regarding isolation, quarantine, and sanitation, though such laws were often unfunded.⁶

In 1809, legislators of the Mississippi Territory, from which the state of Alabama was later formed, empowered the governor to administer public health regulations that were to be implemented throughout the territory under the Code of Laws of the Mississippi Territory, as deemed necessary for control of epidemic diseases. County commissioners and mayors of chartered towns were granted authority to pass and enforce local public health regulations.⁶ Many of those regulations were incorporated into the Alabama State Code of Laws, adopted in 1819. For example, the state called for a rigid system of disinfection, sanitation, and isolation. The law ordered that afflicted citizens were to be isolated and those who recovered from the disease could leave isolation only upon securing a physician's certificate of disinfection. The code also required that isolation, medical supplies, and treatment be provided without fee to the indigent, and it advocated for a systematic educational campaign among the citizenry.⁷

At issue in this article are those mandates; how effectively were those unfunded mandates implemented, and how successfully were their intentions achieved in the context of the extraordinary sociopolitical and socioeconomic turbulence of the nineteenth century, including the Civil War and Reconstruction, and the medical scientific revolution that occurred vis-à-vis an understanding of the etiology and transmission of contagious diseases? Undoubtedly, these factors influenced the motivation and decisions of city and state leaders and the availability and allocation of finite personnel and financial resources.

At the center of this analysis are two related but distinct practices, that of isolation and quarantine. Isolation is applied to individuals known to be afflicted with a contagious disease; in contradistinction, quarantine is applied to those who have been exposed to a contagious disease but who may or may not become afflicted. The isolation and quarantine of citizens afflicted with contagious diseases has theoretical and practical legitimacy from several perspectives. The practices allow physicians to contain infectivity and prevent dissemination, to investigate the etiology and natural history of a disease, to facilitate accession and provision of diagnostic maneuvers and therapeutic regimens, and to educate medical and nursing personnel regarding the care of such patient populations.

Through most of the nineteenth...