What can history teach us about Ebola?

A U-M medical historian offers lessons from past outbreaks to put today’s news in perspective

Ellis Island screening

Today’s airport Ebola screenings are a long way off from the medical exams at Ellis Island 100 years ago

The constant stream of news about Ebola right now is enough to scare anyone.

Whether it’s the epidemic in West Africa, the isolated cases in the U.S. and Europe, the impact on travelers, or the search for new treatments and vaccines, the headlines just keep coming at us.

But a U-M doctor and medical historian says it’s time to step back, and get some perspective on the situation.

After all, says Howard Markel, M.D., Ph.D., we’ve all been here before, and history teaches us a great deal about how societies respond to epidemics and handle the fears associated with them. Markel directs the U-M Center for the History of Medicine, and is a professor in the U-M Medical School, School of Public Health and Department of History.

Q: The scary headlines come at us constantly. How concerned should the average American be?

A: You should pay attention, certainly, but, at this point in time, there’s no need to get into the frenzy about Ebola in the United States. We all need to take a breath and do a reality check.

The basic facts — that this virus is hard to catch, and easy to kill — have not changed. Neither has the fact that virtually all cases to date have been in people who live or worked in West Africa.

Here in the United States, we have only had three cases, Thomas Eric Duncan, an immigrant from Liberia who tragically died last week and two nurses who heroically helped treat him and were subsequently infected with the virus.

Given the high level of attention that the world has focused on this disease, there’s no doubt that we’ll continue to see a major push by local, state and federal health agencies here in the U.S. and, hopefully, a full cadre of health professionals to help stem the crisis overseas, stop the spread, and find new options of tackling this crafty virus.

While there may continue to be transmissions to health care workers here in this country, the risk to most of us is quite small.

Q: You study the history of epidemics. What can history teach us in this case?

Howard Markel, M.D., Ph.D., director of the U-M Center for the History of Medicine

Howard Markel, M.D., Ph.D., director of the U-M Center for the History of Medicine

A: One of the most fascinating things about epidemics across time are the many commonalities that appear with each contagious crisis, even as many things about society, science, technology and medicine have changed.

Too often, you have intense attention to a new infectious threat. Fear, panic, and fear-mongering can dominate for quite a while, and that’s where we are right now in mid-October. Perhaps it has been amplified even further in this age of constant social media sharing, the Internet, and 24/7 news. You also often see scapegoating of specific groups or individuals for “importing” or spreading the infection, which we have seen, fortunately on a smaller level, with the current Ebola crisis.

Even as the intense attention continues, the public health authorities and the medical community across the nation are hard at work, doing what they know how to do: containing the spread, getting the affected into treatment, identifying new cases as early as possible, and tracking back to see who else might have been at risk from exposure. Time and again, from smallpox and plague to the 1918 pandemic flu and AIDS, we have seen these tactics work to contain or even stop a disease entirely.

But, once the epidemic has died down or been contained, a kind of society-wide amnesia sets in, and the rest of us return to business as usual, until the next “new” epidemic comes along and the whole cycle starts again. If society lets down its guard to the point where public health systems aren’t effective, the conditions that gave rise to the epidemic in the first place can emerge again.

Q: But even the handling of Ebola in American hospitals hasn’t been flawless. Doesn’t that concern you?  

A: While we have great facilities here in this country, and we’ve gotten very good at preventing the spread of infectious disease in recent decades, it’s true that no human system is 100 percent perfect.

But we should also remember that what really has allowed this situation to reach this point is not a problem with our own health system – it’s the utter lack of health care and public health infrastructure in the poor countries where the outbreak is the worst.

This worldwide crisis reminds us that the health of poorer countries is intimately linked to ours, and that if you don’t help impoverished nations take care of these issues and build their infrastructure, hospitals, and effective health systems, there will be more outbreaks.

And while germs have always traveled, today we all live in a global village. An outbreak anywhere can quickly go everywhere. It’s not an issue of if — it’s an issue of when. All it takes is one plane ride, as we have seen.

Operating room

Protective gear for even ordinary medical care has come a long way from the days when doctors and nurses who treated patients with infectious diseases routinely died of the same conditions.

Q: What should people who work in health care facilities do?

A: Certainly, as we have done here at Michigan, all health care professionals should familiarize themselves with the risk factors, symptoms, proper screening and proper treatment protocols for patients who might be at risk. If you might be in a position to come in contact with a patient at risk of or diagnosed with Ebola, you should know how to protect yourself – including actually practicing putting on and taking off the gear that’s recommended for different situations.

Not so long ago, maybe a century or so, the idea of a doctor or nurse dying of the disease they had been treating patients for was not so rare. It was an all too frequent part of the profession, though some did walk away from that risk, such as during the Middle Ages – to the point where governments in some cases had to appoint designated medical professionals to take care of bubonic plague victims.

Fortunately, today we have much more to protect ourselves than the “plague doctors” of medieval times, and those who cared for yellow fever patients in the late 1800s did.

Ellis Island waiting

As immigrants arrived on steamships to Ellis Island, they lugged their belongings up stairs and to the Great Hall, to wait for a medical inspection.

Q: Airports have started to screen travelers from West Africa for fever, and some people are calling for a travel ban from the hardest-hit countries.

Is this a return to what happened at Ellis Island back in the 1800s and early 1900s?

A: At Ellis Island in New York Harbor, which was the entry point for 75 percent of the immigrants to America in that time period, the medical exams were intensive, intrusive, and decisive. They were carried out by a team of physicians under the Public Health Service, which inspected every one of the millions of men, women and children who were streaming into our country at that time.

After getting off your ship, your very first stop was a health inspection that checked everything from your eyes and heart to your posture. Even getting to the medical exam was a test: You had to lug your suitcases and trunks up a long flight of stairs and across the Great Hall, under the watch of health officials looking for signs of physical disability.

If you failed any of the medical tests, often for illnesses that today we can easily treat with antibiotics or other medicines and therapies, there was a very good chance you’d be sent home. That meant a return trip by steamship to the homeland you thought you had fled forever, often leaving behind the family who had come with you. The power of the U.S. Public Health Service doctors to decide someone’s fate was absolute, even though less than one percent of immigrants were sent back for health reasons.

Ellis Island medical exam

The U.S. Public Health officers inspected every immigrant to Ellis Island for signs of multiple illnesses

If you go to Ellis Island today, you can walk through many of these spaces and imagine what it was like, though the medical buildings haven’t yet been fully restored.

Thankfully, because medicine has advanced so much in 100 years, we no longer need to take such extreme measures – – though the Ebola crisis reminds us that we are still battling terrible epidemics and must take steps to slow or stop their spread.

As of this week, travelers from West Africa are getting screened for fever at our major airports, and asked about any contact they might have had with Ebola patients. They’re being asked to track their temperatures for three weeks after arriving even if they don’t have a fever when they land. If they do have a fever, officials will whisk them off to an isolation room at a well-equipped hospital. This is in addition to the screening being done at airports in Africa as passengers leave the affected countries.

It’s a long shot from Ellis Island, and much less draconian, but it’s an important component in the response to Ebola.

Statue of Liberty

An immigrant family on Ellis Island looks across New York Harbor at the Statue of Liberty.

Q: So what’s the bottom line for all of us?

A: Be concerned, certainly. But remember that there’s a great difference between informed concern and panic. Everyone knows that when you’re panicked and scared you don’t make good decisions.

Rest assured that there’s a highly professional corps of public health professionals at government agencies, hospitals and universities working on this. The response may not be perfect, but it will be managed and we have every expectation that it will be managed well.

And then, take a moment to reduce your very real risk of an illness that we all can prevent, and protect others from.

Go get yourself vaccinated against the flu — a virus that enters the U.S. every year from other countries, and kills tens of thousands of people because not enough people get vaccinated. It’s a risk we can control, and we should.



All historical images in this article are from the National Archive.

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Simpson Memorial InstituteThe U-M Center for the History of Medicine, part of the U-M Medical School, conducts research and collaborations that place contemporary medical dilemmas in context with past events to help inform public health and medical policies. It also serves as consulting historians to the Medical School, and fosters appreciation of the medical humanities among U-M medical students. It is housed in the Simpson Memorial Institute, a 1926 building on the U-M medical campus shown at left.


new_logos_180x1806For more than 160 years, the University of Michigan Health System has been a national leader in advanced patient care, innovative research to improve human health and comprehensive education of physicians and medical scientists. The three U-M hospitals have been recognized numerous times for excellence in patient care, including national rankings in 25 specialty areas by U.S. News & World Report.