A medical means to 'separate the clean from the unclean, the pure from the polluted'

May 7, 2004

With Sars making a comeback in China, the uneasy politics of forcible mass quarantine is ripe for debate. Linda Vergnani reports

Peering through the dusty window of a red-brick building perched above Sydney harbour, Alison Bashford looks into a hospital room frozen in time - old iron beds, washstands, a figure in a red-and-white nurse's uniform.

The disused 1912 hospital is part of the city's historic quarantine station, now preserved as a museum. Bashford, a historian, has been researching quarantine and public-health measures to control the spread of smallpox and other communicable diseases. She focused initially on the people forcibly detained on this bushy headland.

Australia had the world's strictest quarantine policies - about 13,000 people were detained here between the early 19th and the mid-20th century.

The headland is dotted with the graves of those who died from bubonic plague, Spanish flu, smallpox and other contagious diseases. Under the jungly growth of palms and tree ferns, the sandstone rocks are carved with the details of some of the 580 ships, their passengers and crew who were quarantined here.

Bashford's work on quarantine in Australia led to a much wider interest in isolation and exclusion of "problem populations" - criminals, the mad, the deviant and unfit as well as those with contagious diseases. Bashford, a senior lecturer in history at the University of Sydney, has organised an international conference on "Medicine at the Border" to take place in July.

It will feature not just specialists in historic diseases that led to quarantining but also experts on modern outbreaks such as severe acute respiratory syndrome and bovine spongiform encephalopathy, and commentators on migration, global movement and health. About 60 speakers from across the globe, including epidemiologists, anthropologists and political scientists, will deal with issues ranging from HIV-positive refugees to how to deal with anthrax-infected mail.

One theme of the conference is race, immigration and medico-legal border control, which have played big roles in Australia's draconian quarantine policies. In her recent book Imperial Hygiene , Bashford explores colonialism, race, hygiene and the control of diseases in Australia until the 1950s. She says: "I've always been interested in the way in which public health and medicine put a lot of effort into separating the clean from the unclean, the vulnerable from the immunised and the pure from the polluted."

Because Australia's successive governments saw the country as a "virgin continent", free of diseases such as cholera and largely white, they applied far stricter quarantine rules than any other British colony or nation. It was not only thousands of ship-bound migrants who were held, but also Australian residents. Lepers were forcibly isolated on coastal islands into the mid-20th century. Aboriginals and Asians were subject to much more stringent medical policing than white Australians. Bashford says: "What took me by surprise was how absolutely essentially race was implicated in public health." Lepers who were bacteriologically negative and white or "half-caste" were released into the community in the 1950s, but their Aboriginal counterparts were held. Western Australia retained its "leper line", which restricted movement of Aboriginal people south of the 20th parallel, until 1963.

Disease control and quarantine were used as a critical part of the immigration policy and as a means of promoting the white Australia policy, Bashford says. By the early 1930s, the state of New South Wales had a flourishing racial eugenics movement. "Part of the way authorities thought they could keep the continent clean and pure was to keep it white," Bashford says.

She began her research on isolation of people with communicable diseases at the quarantine station minutes from where she lives. The station complex, which sits near a golden beach, looks like an old brick factory with workers' housing. The journeys, and the lives, of 521 people ended at the station. Quarantining began here in 1828 when the smallpox-infected passengers of a convict ship were detained. As the station expanded, and complete contingents of passenger ships were interned, procedures became institutionalised. On arrival, the healthy were separated from the sick, who were immediately hospitalised. The station had its own mortuary and graveyards. The complex, which was last used in the 1970s, is now a museum and conference centre. Visitors survey the shower houses where inmates were once forcibly fumigated with phenol, which can cause intense skin irritation. While the people were showering, their clothing was sterilised in giant steam-driven autoclaves.

When not writing, Bashford explored the surrounding bushland, where she stumbled on a neglected cemetery that dated back to the 1881 smallpox epidemic. She was amazed to find the headstones of children and parents whose poignant stories she had just read in the archives. During the epidemic, infected Sydney residents and those with whom they had had contact were confined at home and then forcibly quarantined. In the "healthy ground" at the quarantine station, a doctor vaccinated 40 people from the cowpox pustule of a girl who initially seemed fine. Bashford writes: "To the horror of all, the next day she was covered in smallpox pustules and six days later was dead." The camp doctor reported that wives and husbands tried to suck the poison from the vaccine out of each other's arms. Most survived, but some were infected as a result of the government's vaccination programme.

Bashford's research has moved into the history, culture and politics of global health, including travel and migration. She is fascinated by public health policy and the ethics of forcibly detaining the physically and mentally ill and what governments consider to be "problem populations".

The Sars outbreak parallels that of smallpox, Bashford says. "The issue with Sars is how can you coerce people to stay in their homes, or can you (remove and) detain people for the sake of public health? Re-emerging and new infectious diseases have caught governments by surprise, and they react in very crude 19th-century ways."

Conference speakers will examine the impact of medico-legal control measures not only on citizens and travellers, but also on asylum seekers and migrants. Bashford says the big question for governments trying to halt communicable diseases is: "Under what powers can states compulsorily detain people so they can't move from one place to another, and what is the difference between that and imprisonment?"

The keynote speaker, Richard Coker, a senior lecturer at the London School of Hygiene and Tropical Medicine, recently spoke out against any compulsory screening of refugees and migrants to the UK for tuberculosis and HIV. He argued that such policies contravened the European Convention, were not effective and should be rejected.

Another conference speaker, Carolyn Strange, an associate professor of criminology and history at Toronto University, will consider how the Canadian city handled tourism marketing during the Sars epidemic that killed almost 40 people. One area she researches is how former sites of punishment and exclusion become tourist sites - Jfor example, how Hawaii's former Kalaupapa leper colony became a national park.

Strange, who is about to become graduate convener of the Centre for Cross-Cultural Studies at the Australian National University, notes that as quarantine measures were implemented, Toronto became "exoticised". Instead of being a safe North American city, the World Heath Organisation put Toronto on the list of no-go places together with Asian cities such as Taiwan and Singapore.

"Living in Toronto during the Sars outbreak and seeing how issues such as quarantine were managed in relation to Toronto's tourist industry brought these disparate threads together for me," Strange says. The tourism board had to market the city as a safe destination despite a fatal Sars outbreak.

With Sars still a mystery and with older diseases such as TB becoming resistant to drugs, the conference will be very timely.

Imperial Hygiene is published by Palgrave Macmillan, £20.99.

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