The Commonwealth of Massachusetts has established the most sophisticated and articulate quarantine laws and regulations in the Western Hemisphere. Since 1647, when the Province of Massachusetts Bay issued its first quarantine order, the Massachusetts General Court (the official name of the Commonwealth's legislative branch) has passed over 250 quarantine laws that have had a profound impact on the shape of political, religious and medical intervention strategies against communicable disease. An exhaustive seven year analysis of all of these laws has allowed this researcher to locate the 50 most important quarantine laws issued over this 350 year period. These laws have had a profound impact on the structure of American public health law in general and quarantine laws in particular. These 50 laws are briefly summarized below.
1 Quarantine Order of 1647
1647 The General Court issues an order regulating quarantine of vessels from the Barbados and West Indies and prohibits landing of people or goods in Boston without a license from the council or some three of them. It authorizes infected vessels to land on harbor islands
2 Quarantine Order of 1665
1665 The General Court issues an order establishing a quarantine against ships coming from England due to the plague.
1 Quarantine Order of 1647
1647 The General Court issues an order regulating quarantine of vessels from the Barbados and West Indies and prohibits landing of people or goods in Boston without a license from the council or some three of them. It authorizes infected vessels to land on harbor islands
2 Quarantine Order of 1665
1665 The General Court issues an order establishing a quarantine against ships coming from England due to the plague.
1701 The General Court passes “An Act Providing in Case of Sickness” to address contagious diseases such as smallpox, plague or pestilential fever by allowing selectmen to isolate the sick in separate houses. It also allowed the justice of the peace to issue a warrant to impress housing for the sick and to restrain those with contagious diseases from coming ashore.
4 Order about Funerals & Training in Boston, Chapter 29
1721 This order prohibits the tolling of bells during the epidemic of smallpox that beset the town of Boston in 1721. It also authorizes the Selectmen to regulate the Funerals and associated marches that occur in the town of Boston.
5 An Act to Prevent Persons Concealing the Smallpox, Chapter 13
1732 The General Court passes “An Act to Prevent Persons Concealing the Smallpox” based on evidence that this disease was being concealed amongst diverse families within the province. The law required the head of each family to immediately notify the selectmen of the presence of the disease and hang a red cloth at least a yard long on a 6 foot pole in the most public part of the house until such time as, in the judgment of the selectmen the house is thoroughly aired and cleansed. It also established a penalty of fifty pounds for failure to obey this law.
6 An Act for Regulating the Hospital on Rainsford Island, and Further Providing in case of Sickness, Chapter 8
1738 This was the first quarantine law to extend authority to the quarantine of any person who has been visited with infectious sickness, on land or sea, to be sent to the Province hospital on Rainsford Island. It also eliminated the role of the Governor as the "gatekeeper" for the approval of vessels entering the port of Boston, thereby delegating authority to a lower level of administrators within the Province. Delegation of routine quarantine affairs from the Governor to a subordinate administrator was a clear example of how island quarantine stations soon took on independent authority within Provincial government.
7 An Act to Prevent the Spreading of the Smallpox or Other Infectious Sickness, Chapter 1
1739 This law required a 2 hour notice to the town Selectmen for those smallpox infected persons entering the province. This law has many similarities to English Poor Laws in its warning off strategy for communicable disease. This legislation is one of the clear examples of how British Poor Law policy and practiced affected public health policies in the colonies.
8 An Act in Addition to an Act Made and Passed in the Thirteenth Year of King William the Third, Intitled "An Act Providing in Case of Sickness", Chapter 12
1752 This law regulated baggage and goods that was suspected of being infected with smallpox, plague, pestilential fevers or other malignant contagious distempers. This law also gave the constable the authority to issue a warrant to break into any house, warehouse or shop where such baggage is located.
9 An Act to Prevent if Possible the Further Spreading of the Smallpox in the town of Boston, Chapter 17
1764 The General Court passes “An Act to prevent, if possible, the further spreading of the smallpox in the town of Boston.” This law modified the law of 1742 by requiring 30 families –instead of the previous requirement of 20 families – to have smallpox to be exempt from the provisions of this law. Once 30 families had contracted smallpox then inoculation would be allowed after proper notice had been given in the several Boston newspapers. This legislation revealed the degree to which law makers attempted to avoid the overly rapid activation of inoculation within the population due to its potential to fans the flames of the epidemic rather than abate it.
10 Act Act to Prevent the Continuance of the Smallpox in the Town of Boston, and to License Inoculation There for a Limited Time, Chapter 8
1776 The General Court passed “An act to prevent the continuance of the smallpox in the town of Boston and to license inoculation there for a limited time.” This law allowed anyone to be inoculated before July 15, 1776 but not afterwards, provided that they always remain within Boston from the time of their inoculation and until cleansed of the disease as determined by the town’s selectmen. It also prohibited anyone from entering Boston after July 15, 1776 who had not already had smallpox until such time as the selectmen declare the town free of infection.. It also required householders to declare within 3 days time the presence of any strangers in their houses. Failure to comply carried a 40 pound penalty. After July 15, 1776 all inoculations had to occur at an inoculation hospital. After August 3, 1776 the selectmen were empowered to remove anyone with smallpox to some place where they will not endanger the inhabitants unless, in the judgment of the selectmen, that person cannot be removed without greatly endangering their lives. The law also required posting of guards at the entrances to Boston (ferry ways, and line with Roxbury) after July 15th until such time as the selectmen declare the town free from infection. The guards are responsible for prohibiting those free of smallpox from entering and prohibiting anyone from leaving unless determined free from infection by the selectmen or any two of them.
11 An Act Providing for the Establishment of Hospitals for Inoculating with the smallpox & for repealing all laws heretofore made for that purpose, Chapter 28
1792 This law established inoculating hospitals in the Commonwealth.
12 An Act for Providing Hospitals for Inoculating and Preventing Infection from smallpox, and for repealing several acts heretofore made for that purpose, Chapter 58
1793 This law established revised procedures for inoculating hospitals in the commonwealth by modifying the law of 1792.
13 An Act to Prevent the Spreading of Contagious Sickness, Chapter 16
1797 The General Court passes “An Act to prevent the spreading of contagious Sickness.” This law repealed six (6) previous laws enacted in 1701; 1730; 1742 1751; 1757 and 1758. The new law synthesized all of these previous laws into language that reflected the Commonwealth’s new status as a state not a province. Fines were converted into dollars instead of pounds and references to his Majesty’s government were replaced by the responsibilities of the town selectmen. Despite the overwhelming similarity of this law to those that it repealed, there were some important changes. For one, this law established specific requirements for the detention of baggage and goods that might be contaminated until such time as it was determined to be disinfected. Previous laws provided for fines to be paid to the government and to the informer – presumably to give incentives to rat on violators. The lack of funds after the revolutionary war probably accounts for the fact that any funds collected were to go the towns to take care of the poor as opposed to the pre-revolutionary war strategy of providing these funds to his majesty’s government. The fines for returning to a town after a warrant was issued for a smallpox case to leave town went from 100 pounds to $400. The law also placed the burden on the selectmen to notify outsiders who had smallpox that they had 2 hours to leave. Previously, the law required smallpox infected persons to report their presence within 2 hours of being notified. This was a subtle shift from placing the burden on the individual to that of the government. This law also declared that if a commander of a vessel did not proceed to quarantine within 6 hours of the order being given, they would be held in violation of the law. Clearly, this revision gave more specific standards of judging compliance than the previous laws issued under British rule. Another significant change was to enable the creation of a town health committee to address health issues or to establish a health officer in lieu of a health committee to remove all filth from the streets, lanes, wharves, docks, etc within the town. Finally, this law authorized towns other than Boston to restrict the landing of infected vessels without prior approval of the town selectmen. This particular piece of legislation probably addressed the widespread practice of disembarkation outside of Boston’s port that emerged during and immediately after the revolutionary war.
14 An Act to Empower the Town of Boston to Choose a Board of Health and for removing and Preventing Nuisances, Chapter 10
1799 The General Court passes “An act to empower the town of Boston to Choose a Board of Health and for removing and preventing Nuisances.” This law created Boston’s first Board of Health. It required representation from each ward, members to be selected annually by a vote of persons who are freeholders and residents of the town. The Board was charged with examining into nuisances and such sources of filth as may be injurious to the health of the inhabitants whether these nuisances came from stagnant waters, common sewers, boats, docks, etc. The Board was empowered to make such rules and regulations that they deemed necessary to remove and prevent nuisances and sources of filth. Section 8 of this law authorized the Board to impose quarantine on vessels entering Boston harbor and to establish such rules and regulations the Board deemed necessary. The law required Boston Harbor pilots to notify all vessels that were determined to require quarantine at Rainsford Island. If they failed to do so, they risked the penalty of disqualification from their duties for 12 months. The penalties imposed on commanders of vessels for failing to report exposure to disease in an infected port are the same as those in the law passed in 1797 (i.e. $500 fine or 6 months imprisonment). Section 11 of this law required keepers of lodging houses to report diseases of any seafaring men within their facilities during the period May to November of each year, within 12 hours of their becoming sick. The law also made it a crime to remove a sick person from a vessel without notifying the Board of Health and first obtaining a written permit from at least two members of the Board of Health. The law also established the role of the visiting physician who was charged with purifying vessels and overseeing their quarantine at Rainsford Island – all under the direction of the Board of Health. The cost of disinfection to be borne by the commander of the vessel and the cost of caring for mariners or other persons sent to the island to be paid for by the patient himself or his parents or masters. Otherwise, the cost would be borne by the town to which they belong or if not from the state, then by the Commonwealth. This law referenced the law of 1797 controlling the spread of infectious disease as applicable to Boston. This law also required the use of two red flags – one for vessels held for disinfection and one to be raised on Rainsford Island to make it clear that purification was underway. Anyone entering the island’s quarantine zone would be subject to disinfection. This new law required vessels to proceed to Rainsford Island within one hour after being notified to do so by the Board of Health. Failure to do so would result in a fine of $1,000 dollars or six months in jail or both at the discretion of the court and Board of Health (this is a definite increase in authority over previous laws). One major change made by this law was to give the Board of Health all of the authority granted to town selectmen in the law passed in 1797 titled “An Act to prevent the spreading of contagious sickness.”
15 An Act in Addition to an Act Entitled "An Act to Prevent the Spreading of Contagious Sickness"
1800 This law authorizes other Massachusetts seaport towns to establish quarantine regulations like those in Boston and Salem.
16 An Act to Empower the Town of Boston to Choose a Board of Health and to Prescribe their power and Duty, Chapter 44
1816 The General Court passes “An Act to empower the town of Boston to choose a Board of Health and to prescribe their power and duty.” This law authorized the Board of health to give orders to remove those with contagious diseases to be removed to the hospital on Rainsford Island or to any other place within the limits of the said town of Boston. Failure to comply with such an order carried a penalty of not less than $5 and not more than $500. This law authorized the establishment of rules and regulations concerning clothing or other articles capable of carrying infectious disease and to establish quarantine to be performed on vessels arriving within Boston harbor. Such quarantine regulations were authorized to cover persons arriving on such vessels and to their property as well as to those visiting such vessels. This law established Rainsford Island as the place for quarantine of people and their goods. This law also created the position of a principal Physician to assist the Board as well as an Assistant Physician who shall reside on Rainsford island. It also created the position of Island Keeper and Boatmen to deal with island activities. This law explicitly passes the authority granted on June 22, 1797 to the selectmen to the Board of Health as set forth in the law titled “An Act to prevent the spreading of infectious disease.” The law also authorized the Board of Health to remove infected prisoners to Rainsford Island.
17 An Act in Addition to "An Act for providing Hospitals for Inoculation and Preventing Infection from the Smallpox and for Repealing several Acts Heretofore made for that Purpose, Chapter 129
1828 This law made it a requirement that physicians report cases of smallpox. It established a fine of no less than $40 and no more than $100 for failure to report.
18 An Act to Secure General Vaccination, Chapter 414
1855 This law authorized towns to require smallpox vaccination. It was one of the key public health laws of the 19th century. The law ensures that children are vaccinated before they reach the age of 2 years and to ensure that children are not allowed into schools without vaccination. Failure to vaccinate ones child carried a $5 fine for each year of neglect. The law also required revaccination to be undertaken by the selectmen of the several towns whenever the mayor and aldermen shall judge the public health requires the same. However, no revaccination is required for those who can show they were vaccinated within the last five years. All state institutions were required to vaccinate their inmates including incorporated manufacturing companies. Those entering such institutions for the first time were required to be vaccinated immediately upon their entrance. The expense for such vaccinations was to be borne by the state institutions. In the case of the citizens, such expense was to be borne by the towns and cities if citizens were unable to meet this expense.
19 An Act to Establish a State Board of Health, Chapter 420
1869 This law authorizes the Commonwealth to create a state board of health.
20 An Act Relating to Smallpox, Chapter 189
1872 This law authorizes the removal of smallpox cases from boarding houses or other locations where isolation is not possible
21 An Act to Amend the Twenty Sixth Chapter of the General Statutes, Relating to the Preservation of the Public Health, Chapter 2
1873 This law makes it a crime and imposes fines on those who remove the red flag or other notice used to make the presence of smallpox cases apparent to the general public.
22 An Act Relative to Notices from local Boards of Health in cases of Smallpox, Chapter 138
1883 This law requires local boards of health to report smallpox cases to the state board of health within 24 hours.
23 An Act to Prevent the Spread of Contagious Diseases through the Public Schools, Chapter 64
1884 This law prohibits pupils from attending public school while any member of the household is sick of smallpox, diphtheria, or scarlet fever.
24 An Act Concerning Contagious Diseases, Chapter 98
1884 This law requires householders, physicians and board of health to report anyone sick of smallpox, diphtheria, scarlet fever or any other disease dangerous to the public health. In addition, the Board of Health must report cases of contagious disease to the school committee.
25 An Act Relative to Notices from Local Boards of Health in cases of Diseases Dangerous to the Public Health, Chapter 302
1893 This law extends the notification and penalty provisions of not reporting contagious diseases to contagious diseases other than smallpox.
26 An Act to Provide Accommodations for the care and treatment of persons suffering from contagious diseases in cities, Chapter 511
1894 This law provides for the care of persons afflicted with contagious diseases and requires towns to appropriate funds for communicable disease hospitals including those with venereal disease.
27 An Act Relative to Vaccination, Chapter 515
1894 This law modifies the 1855 vaccination law to enable physicians to exempt children from vaccination when they determine they are not fit for receiving the vaccination. This law also requires all persons over 21 years of age to receive vaccination as required by every city and town in the Commonwealth. Those in institutions supported by the state are to be provide their inmates with vaccination through their institution at no charge.
28 An Act to Provide for the Establishment in cities of Hospitals for Persons having smallpox or other disesaes Dangerous to the Public Health, Chapter 171
1901 This law requires every city to establish isolation hospitals for those having smallpox or other diseases dangerous to the public health.
29 An Act Relative to Compensating Cities and Towns for Caring for Persons Infected with the Smallpox or Other Disease Dangerous to the Public Health, Chapter 213
1902 This law establishes procedures for determining who will pay for the costs of caring for those infected with smallpox or contagious disease when indigent persons are cared for in isolation hospitals.
30 An Act Relative to Infected Articles, Chapter 306
1903 This law stipulates how infected articles are cleaned and who pays when such articles are destroyed. Payment is limited to $50.
31 An Act to Provide for Compensating persons Held in Quarantine by Order of Board of Health, Chapter 225
1906 This law authorizes the cities and towns to compensate employees who are required to remain in quarantine in their own homes. Massachusetts is one of the few states in the United States to have considered the economic impact of an epidemic upon the working class.
32 An Act to Revise the Laws Relative to the establishment and Maintenance of Pest Houses by Ciities and Towns, Chapter 365
1906 This law summarizes all of the requrements for isolation hospitals in the Commonwealth of Massachusetts as well as disease reporting.
33 An Act Relative to the Appointment of School Physicians, Chapter 502
1906 This law requires school physicians to examine all children at least once a year to evalute their eye sight and hearing and to determine if they are suffering from any other defect. It also required children suffering from communicable diseases to be sent home immediately. It also required the school physician to examine all children returning to school without a certificate from the board of health.
34 An Act to Provide for the Compulsory Notification and Registration of Tuberculosis and other Diseases Dangerous to the Public Health, Chapter 480
1907 This law modifies the 1906 regarding disease reporting to include other dangerous diseases such as Tuberculosis. Legislative action was required in light of the ubiquity of this disease in early 20th century Boston.
35 An Act to Authorize the State Board of Health to Define what Diseases are to be Deemed Dangerous to the Public Health, Chapter 183
1907 This law authorizes the state board of health to determine what diseases are dangerous to the public health. This was a legal milestone in the transfer of public health power from the legislative to the administrative branch of state government.
36 An Act to Standardize Tuberculosis Dispensaries, Chapter 408
1914 This law requires towns to establish Tuberculosis dispensaries for the discovery, treatment and supervision of needy persons afflicted with Tuberculosis.
37 An Act Relative to the Establishment and Maintenance of Pest Houses by Cities and Towns, Chapter 12
1915 This law authorized the issuance of warrants for the removal of those infected with a contagious disease to a location deemed appropriate by the Board of Health.
38 An Act Relative to Prisoners and certain public charges who are afflicted with Communicable Diseases, Chapter 306
1920 This law requires isolation of prisoners that have contagious disease during the time of their incarceration or assignment to a public charitable institution.
39 An Act Relative to medical inspections in the public schools, Chapter 120
1922 This law requires a school physician to examine every child returning to school after having had a contagious disease if they have do not have a certificate from the board of health.
40 An Act Relative to the method of Reporting certain diseases dangerous to the public health, Chapter 215
1925 This law establishes special standards for reporting cases of syphilis and gonorrhea to the local boards of health.
41 An Act Relative to Control of Diseases Dangerous to the Public Health, Chapter 265
1938 This law is the most comprehensive overall of the communicable disease and public health laws of the Commonwealth during the 20th century. It establishes direction on disease reporting, medical inspections at schools, transportation of those with communicable diseases, handling of the dead and authorizes the Department of health to establish definitions of diseases dangerous to the public health.
42 An Act Prohibiting the employment in schools of persons suffering from Tuberculosis in a communicable form and providing for periodic examinations of school employees, Chapter 732
1950 This law prohibits those with communicable disease in its contagious stage from working in schools.
43 An Act Relating to the Hospitalization of Certain Tuberculosis pateints and to the establishment of a State Sanitorium treatment center for such patients, Chapter 615
1956 This law governs the imposition of isolation procedures that may be imposed upon those with active Tuberculosis when they fail to comply with public health protections that they have been asked for follow.
44 An Act Providing for reorganization of tuberculosis care, treatment and control in the commonwealth, Chapter 608
1961 This law sets forth a comprehensive revison to the commonwealth's tuberculosis laws.
45 An Act Relative to the Financial Responsibility for person infected by smallpox or other disese dangerous to the Public Health, Chapter 339
1964 This law makes each victim of disease from Smallpox and Tuberculosis financially responsible for their own treatment costs.
46 An Act Providing for the regulation of the distribution of certain anti-toxins, serums, vaccines and analogous products by the department of Public Health, Chapter 415
1964 This law enables the commissioner of the department of public health when he or she declares an emergency, to prescribe the use of vaccinations to address the crisis.
47 An Act Further Regulating Testing of school personnel for tuberculosis in a communicable form, Chapter 85
1981 This law prohibits anyone with a communicable disease in its infectious state to work in a school.
48 An Act Relative to the reporting of Tuberculosis
1983 This law establishes special reporting procedures for those with tuberculosis or a venereal disease.
49 An Act Requiring Immunization of certain college students
1985 This law requires students in colleges to receive vaccinations as a condition of admission into schools in the commonwealth.
50 An Act Regulating the reporting of infectious diseases dangerous to the public health
1988 This law establishes policy for unprotected exposure to communicable disease by bystanders and emergency response personnel.
4 Order about Funerals & Training in Boston, Chapter 29
1721 This order prohibits the tolling of bells during the epidemic of smallpox that beset the town of Boston in 1721. It also authorizes the Selectmen to regulate the Funerals and associated marches that occur in the town of Boston.
5 An Act to Prevent Persons Concealing the Smallpox, Chapter 13
1732 The General Court passes “An Act to Prevent Persons Concealing the Smallpox” based on evidence that this disease was being concealed amongst diverse families within the province. The law required the head of each family to immediately notify the selectmen of the presence of the disease and hang a red cloth at least a yard long on a 6 foot pole in the most public part of the house until such time as, in the judgment of the selectmen the house is thoroughly aired and cleansed. It also established a penalty of fifty pounds for failure to obey this law.
6 An Act for Regulating the Hospital on Rainsford Island, and Further Providing in case of Sickness, Chapter 8
1738 This was the first quarantine law to extend authority to the quarantine of any person who has been visited with infectious sickness, on land or sea, to be sent to the Province hospital on Rainsford Island. It also eliminated the role of the Governor as the "gatekeeper" for the approval of vessels entering the port of Boston, thereby delegating authority to a lower level of administrators within the Province. Delegation of routine quarantine affairs from the Governor to a subordinate administrator was a clear example of how island quarantine stations soon took on independent authority within Provincial government.
7 An Act to Prevent the Spreading of the Smallpox or Other Infectious Sickness, Chapter 1
1739 This law required a 2 hour notice to the town Selectmen for those smallpox infected persons entering the province. This law has many similarities to English Poor Laws in its warning off strategy for communicable disease. This legislation is one of the clear examples of how British Poor Law policy and practiced affected public health policies in the colonies.
8 An Act in Addition to an Act Made and Passed in the Thirteenth Year of King William the Third, Intitled "An Act Providing in Case of Sickness", Chapter 12
1752 This law regulated baggage and goods that was suspected of being infected with smallpox, plague, pestilential fevers or other malignant contagious distempers. This law also gave the constable the authority to issue a warrant to break into any house, warehouse or shop where such baggage is located.
9 An Act to Prevent if Possible the Further Spreading of the Smallpox in the town of Boston, Chapter 17
1764 The General Court passes “An Act to prevent, if possible, the further spreading of the smallpox in the town of Boston.” This law modified the law of 1742 by requiring 30 families –instead of the previous requirement of 20 families – to have smallpox to be exempt from the provisions of this law. Once 30 families had contracted smallpox then inoculation would be allowed after proper notice had been given in the several Boston newspapers. This legislation revealed the degree to which law makers attempted to avoid the overly rapid activation of inoculation within the population due to its potential to fans the flames of the epidemic rather than abate it.
10 Act Act to Prevent the Continuance of the Smallpox in the Town of Boston, and to License Inoculation There for a Limited Time, Chapter 8
1776 The General Court passed “An act to prevent the continuance of the smallpox in the town of Boston and to license inoculation there for a limited time.” This law allowed anyone to be inoculated before July 15, 1776 but not afterwards, provided that they always remain within Boston from the time of their inoculation and until cleansed of the disease as determined by the town’s selectmen. It also prohibited anyone from entering Boston after July 15, 1776 who had not already had smallpox until such time as the selectmen declare the town free of infection.. It also required householders to declare within 3 days time the presence of any strangers in their houses. Failure to comply carried a 40 pound penalty. After July 15, 1776 all inoculations had to occur at an inoculation hospital. After August 3, 1776 the selectmen were empowered to remove anyone with smallpox to some place where they will not endanger the inhabitants unless, in the judgment of the selectmen, that person cannot be removed without greatly endangering their lives. The law also required posting of guards at the entrances to Boston (ferry ways, and line with Roxbury) after July 15th until such time as the selectmen declare the town free from infection. The guards are responsible for prohibiting those free of smallpox from entering and prohibiting anyone from leaving unless determined free from infection by the selectmen or any two of them.
11 An Act Providing for the Establishment of Hospitals for Inoculating with the smallpox & for repealing all laws heretofore made for that purpose, Chapter 28
1792 This law established inoculating hospitals in the Commonwealth.
12 An Act for Providing Hospitals for Inoculating and Preventing Infection from smallpox, and for repealing several acts heretofore made for that purpose, Chapter 58
1793 This law established revised procedures for inoculating hospitals in the commonwealth by modifying the law of 1792.
13 An Act to Prevent the Spreading of Contagious Sickness, Chapter 16
1797 The General Court passes “An Act to prevent the spreading of contagious Sickness.” This law repealed six (6) previous laws enacted in 1701; 1730; 1742 1751; 1757 and 1758. The new law synthesized all of these previous laws into language that reflected the Commonwealth’s new status as a state not a province. Fines were converted into dollars instead of pounds and references to his Majesty’s government were replaced by the responsibilities of the town selectmen. Despite the overwhelming similarity of this law to those that it repealed, there were some important changes. For one, this law established specific requirements for the detention of baggage and goods that might be contaminated until such time as it was determined to be disinfected. Previous laws provided for fines to be paid to the government and to the informer – presumably to give incentives to rat on violators. The lack of funds after the revolutionary war probably accounts for the fact that any funds collected were to go the towns to take care of the poor as opposed to the pre-revolutionary war strategy of providing these funds to his majesty’s government. The fines for returning to a town after a warrant was issued for a smallpox case to leave town went from 100 pounds to $400. The law also placed the burden on the selectmen to notify outsiders who had smallpox that they had 2 hours to leave. Previously, the law required smallpox infected persons to report their presence within 2 hours of being notified. This was a subtle shift from placing the burden on the individual to that of the government. This law also declared that if a commander of a vessel did not proceed to quarantine within 6 hours of the order being given, they would be held in violation of the law. Clearly, this revision gave more specific standards of judging compliance than the previous laws issued under British rule. Another significant change was to enable the creation of a town health committee to address health issues or to establish a health officer in lieu of a health committee to remove all filth from the streets, lanes, wharves, docks, etc within the town. Finally, this law authorized towns other than Boston to restrict the landing of infected vessels without prior approval of the town selectmen. This particular piece of legislation probably addressed the widespread practice of disembarkation outside of Boston’s port that emerged during and immediately after the revolutionary war.
14 An Act to Empower the Town of Boston to Choose a Board of Health and for removing and Preventing Nuisances, Chapter 10
1799 The General Court passes “An act to empower the town of Boston to Choose a Board of Health and for removing and preventing Nuisances.” This law created Boston’s first Board of Health. It required representation from each ward, members to be selected annually by a vote of persons who are freeholders and residents of the town. The Board was charged with examining into nuisances and such sources of filth as may be injurious to the health of the inhabitants whether these nuisances came from stagnant waters, common sewers, boats, docks, etc. The Board was empowered to make such rules and regulations that they deemed necessary to remove and prevent nuisances and sources of filth. Section 8 of this law authorized the Board to impose quarantine on vessels entering Boston harbor and to establish such rules and regulations the Board deemed necessary. The law required Boston Harbor pilots to notify all vessels that were determined to require quarantine at Rainsford Island. If they failed to do so, they risked the penalty of disqualification from their duties for 12 months. The penalties imposed on commanders of vessels for failing to report exposure to disease in an infected port are the same as those in the law passed in 1797 (i.e. $500 fine or 6 months imprisonment). Section 11 of this law required keepers of lodging houses to report diseases of any seafaring men within their facilities during the period May to November of each year, within 12 hours of their becoming sick. The law also made it a crime to remove a sick person from a vessel without notifying the Board of Health and first obtaining a written permit from at least two members of the Board of Health. The law also established the role of the visiting physician who was charged with purifying vessels and overseeing their quarantine at Rainsford Island – all under the direction of the Board of Health. The cost of disinfection to be borne by the commander of the vessel and the cost of caring for mariners or other persons sent to the island to be paid for by the patient himself or his parents or masters. Otherwise, the cost would be borne by the town to which they belong or if not from the state, then by the Commonwealth. This law referenced the law of 1797 controlling the spread of infectious disease as applicable to Boston. This law also required the use of two red flags – one for vessels held for disinfection and one to be raised on Rainsford Island to make it clear that purification was underway. Anyone entering the island’s quarantine zone would be subject to disinfection. This new law required vessels to proceed to Rainsford Island within one hour after being notified to do so by the Board of Health. Failure to do so would result in a fine of $1,000 dollars or six months in jail or both at the discretion of the court and Board of Health (this is a definite increase in authority over previous laws). One major change made by this law was to give the Board of Health all of the authority granted to town selectmen in the law passed in 1797 titled “An Act to prevent the spreading of contagious sickness.”
15 An Act in Addition to an Act Entitled "An Act to Prevent the Spreading of Contagious Sickness"
1800 This law authorizes other Massachusetts seaport towns to establish quarantine regulations like those in Boston and Salem.
16 An Act to Empower the Town of Boston to Choose a Board of Health and to Prescribe their power and Duty, Chapter 44
1816 The General Court passes “An Act to empower the town of Boston to choose a Board of Health and to prescribe their power and duty.” This law authorized the Board of health to give orders to remove those with contagious diseases to be removed to the hospital on Rainsford Island or to any other place within the limits of the said town of Boston. Failure to comply with such an order carried a penalty of not less than $5 and not more than $500. This law authorized the establishment of rules and regulations concerning clothing or other articles capable of carrying infectious disease and to establish quarantine to be performed on vessels arriving within Boston harbor. Such quarantine regulations were authorized to cover persons arriving on such vessels and to their property as well as to those visiting such vessels. This law established Rainsford Island as the place for quarantine of people and their goods. This law also created the position of a principal Physician to assist the Board as well as an Assistant Physician who shall reside on Rainsford island. It also created the position of Island Keeper and Boatmen to deal with island activities. This law explicitly passes the authority granted on June 22, 1797 to the selectmen to the Board of Health as set forth in the law titled “An Act to prevent the spreading of infectious disease.” The law also authorized the Board of Health to remove infected prisoners to Rainsford Island.
17 An Act in Addition to "An Act for providing Hospitals for Inoculation and Preventing Infection from the Smallpox and for Repealing several Acts Heretofore made for that Purpose, Chapter 129
1828 This law made it a requirement that physicians report cases of smallpox. It established a fine of no less than $40 and no more than $100 for failure to report.
18 An Act to Secure General Vaccination, Chapter 414
1855 This law authorized towns to require smallpox vaccination. It was one of the key public health laws of the 19th century. The law ensures that children are vaccinated before they reach the age of 2 years and to ensure that children are not allowed into schools without vaccination. Failure to vaccinate ones child carried a $5 fine for each year of neglect. The law also required revaccination to be undertaken by the selectmen of the several towns whenever the mayor and aldermen shall judge the public health requires the same. However, no revaccination is required for those who can show they were vaccinated within the last five years. All state institutions were required to vaccinate their inmates including incorporated manufacturing companies. Those entering such institutions for the first time were required to be vaccinated immediately upon their entrance. The expense for such vaccinations was to be borne by the state institutions. In the case of the citizens, such expense was to be borne by the towns and cities if citizens were unable to meet this expense.
19 An Act to Establish a State Board of Health, Chapter 420
1869 This law authorizes the Commonwealth to create a state board of health.
20 An Act Relating to Smallpox, Chapter 189
1872 This law authorizes the removal of smallpox cases from boarding houses or other locations where isolation is not possible
21 An Act to Amend the Twenty Sixth Chapter of the General Statutes, Relating to the Preservation of the Public Health, Chapter 2
1873 This law makes it a crime and imposes fines on those who remove the red flag or other notice used to make the presence of smallpox cases apparent to the general public.
22 An Act Relative to Notices from local Boards of Health in cases of Smallpox, Chapter 138
1883 This law requires local boards of health to report smallpox cases to the state board of health within 24 hours.
23 An Act to Prevent the Spread of Contagious Diseases through the Public Schools, Chapter 64
1884 This law prohibits pupils from attending public school while any member of the household is sick of smallpox, diphtheria, or scarlet fever.
24 An Act Concerning Contagious Diseases, Chapter 98
1884 This law requires householders, physicians and board of health to report anyone sick of smallpox, diphtheria, scarlet fever or any other disease dangerous to the public health. In addition, the Board of Health must report cases of contagious disease to the school committee.
25 An Act Relative to Notices from Local Boards of Health in cases of Diseases Dangerous to the Public Health, Chapter 302
1893 This law extends the notification and penalty provisions of not reporting contagious diseases to contagious diseases other than smallpox.
26 An Act to Provide Accommodations for the care and treatment of persons suffering from contagious diseases in cities, Chapter 511
1894 This law provides for the care of persons afflicted with contagious diseases and requires towns to appropriate funds for communicable disease hospitals including those with venereal disease.
27 An Act Relative to Vaccination, Chapter 515
1894 This law modifies the 1855 vaccination law to enable physicians to exempt children from vaccination when they determine they are not fit for receiving the vaccination. This law also requires all persons over 21 years of age to receive vaccination as required by every city and town in the Commonwealth. Those in institutions supported by the state are to be provide their inmates with vaccination through their institution at no charge.
28 An Act to Provide for the Establishment in cities of Hospitals for Persons having smallpox or other disesaes Dangerous to the Public Health, Chapter 171
1901 This law requires every city to establish isolation hospitals for those having smallpox or other diseases dangerous to the public health.
29 An Act Relative to Compensating Cities and Towns for Caring for Persons Infected with the Smallpox or Other Disease Dangerous to the Public Health, Chapter 213
1902 This law establishes procedures for determining who will pay for the costs of caring for those infected with smallpox or contagious disease when indigent persons are cared for in isolation hospitals.
30 An Act Relative to Infected Articles, Chapter 306
1903 This law stipulates how infected articles are cleaned and who pays when such articles are destroyed. Payment is limited to $50.
31 An Act to Provide for Compensating persons Held in Quarantine by Order of Board of Health, Chapter 225
1906 This law authorizes the cities and towns to compensate employees who are required to remain in quarantine in their own homes. Massachusetts is one of the few states in the United States to have considered the economic impact of an epidemic upon the working class.
32 An Act to Revise the Laws Relative to the establishment and Maintenance of Pest Houses by Ciities and Towns, Chapter 365
1906 This law summarizes all of the requrements for isolation hospitals in the Commonwealth of Massachusetts as well as disease reporting.
33 An Act Relative to the Appointment of School Physicians, Chapter 502
1906 This law requires school physicians to examine all children at least once a year to evalute their eye sight and hearing and to determine if they are suffering from any other defect. It also required children suffering from communicable diseases to be sent home immediately. It also required the school physician to examine all children returning to school without a certificate from the board of health.
34 An Act to Provide for the Compulsory Notification and Registration of Tuberculosis and other Diseases Dangerous to the Public Health, Chapter 480
1907 This law modifies the 1906 regarding disease reporting to include other dangerous diseases such as Tuberculosis. Legislative action was required in light of the ubiquity of this disease in early 20th century Boston.
35 An Act to Authorize the State Board of Health to Define what Diseases are to be Deemed Dangerous to the Public Health, Chapter 183
1907 This law authorizes the state board of health to determine what diseases are dangerous to the public health. This was a legal milestone in the transfer of public health power from the legislative to the administrative branch of state government.
36 An Act to Standardize Tuberculosis Dispensaries, Chapter 408
1914 This law requires towns to establish Tuberculosis dispensaries for the discovery, treatment and supervision of needy persons afflicted with Tuberculosis.
37 An Act Relative to the Establishment and Maintenance of Pest Houses by Cities and Towns, Chapter 12
1915 This law authorized the issuance of warrants for the removal of those infected with a contagious disease to a location deemed appropriate by the Board of Health.
38 An Act Relative to Prisoners and certain public charges who are afflicted with Communicable Diseases, Chapter 306
1920 This law requires isolation of prisoners that have contagious disease during the time of their incarceration or assignment to a public charitable institution.
39 An Act Relative to medical inspections in the public schools, Chapter 120
1922 This law requires a school physician to examine every child returning to school after having had a contagious disease if they have do not have a certificate from the board of health.
40 An Act Relative to the method of Reporting certain diseases dangerous to the public health, Chapter 215
1925 This law establishes special standards for reporting cases of syphilis and gonorrhea to the local boards of health.
41 An Act Relative to Control of Diseases Dangerous to the Public Health, Chapter 265
1938 This law is the most comprehensive overall of the communicable disease and public health laws of the Commonwealth during the 20th century. It establishes direction on disease reporting, medical inspections at schools, transportation of those with communicable diseases, handling of the dead and authorizes the Department of health to establish definitions of diseases dangerous to the public health.
42 An Act Prohibiting the employment in schools of persons suffering from Tuberculosis in a communicable form and providing for periodic examinations of school employees, Chapter 732
1950 This law prohibits those with communicable disease in its contagious stage from working in schools.
43 An Act Relating to the Hospitalization of Certain Tuberculosis pateints and to the establishment of a State Sanitorium treatment center for such patients, Chapter 615
1956 This law governs the imposition of isolation procedures that may be imposed upon those with active Tuberculosis when they fail to comply with public health protections that they have been asked for follow.
44 An Act Providing for reorganization of tuberculosis care, treatment and control in the commonwealth, Chapter 608
1961 This law sets forth a comprehensive revison to the commonwealth's tuberculosis laws.
45 An Act Relative to the Financial Responsibility for person infected by smallpox or other disese dangerous to the Public Health, Chapter 339
1964 This law makes each victim of disease from Smallpox and Tuberculosis financially responsible for their own treatment costs.
46 An Act Providing for the regulation of the distribution of certain anti-toxins, serums, vaccines and analogous products by the department of Public Health, Chapter 415
1964 This law enables the commissioner of the department of public health when he or she declares an emergency, to prescribe the use of vaccinations to address the crisis.
47 An Act Further Regulating Testing of school personnel for tuberculosis in a communicable form, Chapter 85
1981 This law prohibits anyone with a communicable disease in its infectious state to work in a school.
48 An Act Relative to the reporting of Tuberculosis
1983 This law establishes special reporting procedures for those with tuberculosis or a venereal disease.
49 An Act Requiring Immunization of certain college students
1985 This law requires students in colleges to receive vaccinations as a condition of admission into schools in the commonwealth.
50 An Act Regulating the reporting of infectious diseases dangerous to the public health
1988 This law establishes policy for unprotected exposure to communicable disease by bystanders and emergency response personnel.
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Source 1: Acts and Resolves passed by the Legislature of Massachusetts, 1792 to the present.
Source 2: The Acts and Resolves, Public and Private, of the Province of the Massachusetts Bay, 1647 to 1782
