By Debra Wood, RN, contributor
December 8, 2014 – Public health screenings of people arriving on U.S. soil and the idea of quarantines for those exposed to Ebola have created quite a stir, but the concepts of immigrant screening and quarantine are not new. In fact, they have protected Americans for more than a century.
Some experts are calling for greater use of these procedures. Orlando Health (Florida) emergency medicine physicians Tim Bullard, MD, and Jay Falk, MD, have advocated for employing quarantine to reduce the risk of Ebola spreading in the country, since current screening will not identify those who are infected but not yet symptomatic.
Nurses at the Ellis Island Hospital cared for more than 1.2 million patients.
Quarantine has long protected U.S. citizens from disease. From 1892 to 1924, about 12 million people from other countries arrived at Ellis Island in New York. Those in steerage were subject to health screenings by physicians from the U.S. Public Health Service. The doctors checked for trachoma, an eye disease that often led to blindness, and watched for other conditions. The process could take anywhere from three to seven hours. Female physicians conducted some of the immigrant screenings on women who were modest and not comfortable undressing before a man.
About 1 in 5 arrivals required more complete assessments, and those deemed a risk were quarantined at the Ellis Island Hospital, which closed 60 years ago and recently opened for limited public tours.
Physicians examining a group of Jewish immigrants at Ellis Island, circa 1907. Photo credit: Library of Congress.
Nurses cared for the 1.2 million patients suffering from heart disease, measles, scarlet fever and other conditions. Those considered infectious were placed on the wards of the 450-bed Contagious Disease facilities, on the farthest island from arriving immigrants. Those with mental illness were held at the 50-bed psychiatric facility until they could be deported. About 355 babies were born at the hospital, and 3,500 people expired during their quarantine.
A corridor in the abandoned hospital on the Ellis Island Immigration Station. Photo credit: The Carol M. Highsmith Archive, Library of Congress, Prints and Photographs Division.
The original 125-bed general hospital was built in 1901 and opened in 1902. In 1907, Contagious Disease Measles Ward A was built. It was designed to embrace the basic ideals of fresh air and sanitary conditions, first espoused by Florence Nightingale, according to a National Park Service (NPS) Historic American Buildings Survey in 2010.
“Motivated by the unsanitary conditions in military field hospitals and her earlier study as a nurse, Englishwoman Florence Nightingale became a champion of hospital reform through her work in war relief, public policy and her writings,” NPS historian Lisa Pfueller Davidson wrote.
Ellis Island Hospital later grew, until the complex comprised 750 beds and 29 buildings when it closed in the 1930s. The hospital was built with water as a barrier between buildings, to reduce the risk of disease transmission between the ill and healthy arrivals. Furniture and medical equipment remained in place for years, but little still exists today.
Carole Limata, MSN, RN, researched the history of nursing on Ellis Island and wrote a book about it.
Altogether about 300 nurses, ward matrons and aides worked at the hospital. More than 25 nurses practiced at Ellis Island Hospital in 1913. They provided treatments and checked patients for lice. They worked 12-hour shifts, said Carole Limata, MSN, RN, author of Ellis Angels: The Nurses of Ellis Island Hospital.
“This is a time when there were not a lot of nursing jobs,” Limata said. “A job with the United States Public Health Department was a good job.”
Nurses lived on the hospital grounds. Nurses’ quarters were completed in 1909 at the tip of the island, where the nurses could look out at the Statue of Liberty.
“They had to get a ferry pass to leave the island, and the chief nurse had to sign the passes,” continued Limata. The nurses’ residence was demolished in 1944.
A long-abandoned hospital building, used to quarantine sick arriving immigrants, on Ellis Island immigration station. Photo credit: The Carol M. Highsmith Archive, Library of Congress, Prints and Photographs Division
Limata researched the nurses’ life and Ellis Island Hospital through conversations with historians and oral history recordings. Little documentation exists, since the medical records were lost. Lorie Conway, author of Forgotten Ellis Island: The Extraordinary Story of America’s Immigrant Hospital, obtained the records of one patient who died of scarlet fever from his family. She includes the nurses’ progress and treatment record in her book.
Ellis Island is not the only former quarantine center in New York. The 20-acre North Brother Island housed New York City residents with tuberculosis, cholera and typhus. Mary Mallon, also known as Typhoid Mary, spent the better half of a quarter century quarantined on the island. Now the city is looking into opening it for public tours.
Much can be learned from the lessons of the past. While antibiotics have made some diseases including trachoma readily treatable, other diseases, such as Ebola, remain without a definitive treatment, raising fear among America’s citizens.
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