James Hamilton - The Public Health Innovator

James Hamilton was Boston’s third island keeper. The Selectmen appointed him to this post on February 2, 1748. Unlike previous island keepers he took a strong interest in protecting his clients from the harsh conditions that existed in Boston harbor and improving the squalid hospital on Rainsford Island. Thanks to his efforts Boston bought its first quarantine vessel. This new vessel was used exclusively to transport sick residents of Boston to the island hospital. Prior to his reign as island keeper, the town rented vessels to bring the sick to the hospital. He argued in favor of a dedicated vessel so that it would be readily available at a moment’s notice. [1]

Hamilton was an innovator in other ways as well. He was also the first island keeper to lobby the Massachusetts General Court for improved hospital conditions. He emphasized the importance of separating those who are well from those infected with communicable disease. Thanks to his efforts, the town of Boston successfully obtained funds from the Massachusetts Bay province for a new hospital for the well, known as the “Well House.” Prior to his efforts everyone placed into quarantine was forced to share the same hospital whether they were sick or well. This did not make sense to Hamilton and his efforts represent one of the first instances in American public health history where public funds were allocated to isolate those exposed to disease from those already infected. It would be another 160 years before his innovative ideas would catch hold and form the basis for the modern distinction between quarantine as a tool for removing those exposed to a disease and isolation as a tool for removing those already infected with disease.

Hamilton was probably in his early thirties when he took his post and lasted for nine years before being replaced by Thomas Hartley. During his tenure he supervised port quarantines against Philadelphia (1750 and 1756)), Rhode Island (1751), and Nova Scotia (1756) and oversaw the inspection of over 4,500 vessels that entering Boston harbor. Fortunately for Hamilton there were only a handful of vessels that were forced to undergo extended quarantines during the period he held office (i.e. 1748 to 1757). Nevertheless, he had other communicable disease responsibilities including caring for the sick of Boston. One of the worst smallpox epidemics in Boston’s history occurred in 1752 when almost half of its 15,734 residents contracted smallpox either the natural way or through inoculation. The magnitude of the epidemic was so great that Rainsford Island was not a feasible quarantine strategy. The island’s bed capacity could handle no more than 100 persons on a good fair weather day. An epidemic of this magnitude convinced James Hamilton and the Selectmen that Rainsford Island only had value in response to small scale smallpox outbreaks.
[1] Provincial Laws of Massachusetts Bay, Chapter 312, Order Empowering the town of Boston to Purchase a Boar for the use of the Hospital on Rainsford Island, p. 385.