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Silent Travelers: Germs, Genes, and the "Immigrant Menace"
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Alan M. Kraut. 369 pages. New York: Basic Books; 1994. $25.00.
Much has been written about the influence of immigration on the history of the United States, and about the ways in which successive waves of immigrants, driven by domestic and foreign economic forces and often confronted by religious and social prejudices, have shaped our population and its culture. Little has been said, however, about the ways in which medical knowledge and public health practices, evolving over time and interacting with socioeconomic trends, have contributed to the total process by which newcomers are assimilated into the population.
Mr. Kraut, an historian and the grandson of immigrants, has undertaken this task, using the image of deoxyribonucleic acid's double helix to symbolize the close but uneasy relationship between concern for health and fear of foreignness that continues to color the manner in which we adapt to new arrivals. He introduces this with a vivid account of the ways immigrants from Haiti, early in the acquired immunodeficiency syndrome epidemic, were identified as a high-risk group, a label which wrongly lingered after the discovery of human immunodeficiency virus infection.
After this contemporary example, Kraut traces the combined history of immigration and public health from the 17th century to the present. In the process, the book describes methods used among groups of immigrants to control or prevent infectious disease epidemics, to promote health education, and to prevent occupational diseases. The first four chapters describe epidemics before the 19th century (Haitians were targeted for the 1793 epidemic of yellow fever in Philadelphia); immigration from Ireland in the middle of the 19th century and the occurrence of cholera at that time; the establishment of systems of public health inspection at Ellis Island; and, finally, two accounts of interactions between public health and so-called "nativism": bubonic plague in San Francisco in the 1890s, which led to quarantine measures against Chinese persons, and the famous episode of Typhoid Mary in New York City in 1906.
The last half of the book focuses on particular groups of immigrants (especially Italians and Jews in New York City); their customs, beliefs, and attitudes towards health and disease; and the interplay of those characteristics with existing systems of medical health care and public health. Throughout the book, four themes are developed: the intertwined relation between efforts to safeguard health and expressions of "nativism" in fear and prejudice; the role of medical advances in shaping public health practices over time; actions by government and private institutions in response to immigration pressures; and the reactions of immigrant groups to such actions on the basis of different cultural views of hygiene, health care, and disease prevention.
The book makes informative and interesting reading, especially when it recounts particular tales of epidemics or public health crises. The writing is vivid, although at times rather strident in its criticism of native prejudices. The language throughout is nontechnical and suited to the general reader. Historical and medical facts are accurately presented and accompanied by 69 pages of documented source notes and commentary. Of particular interest are two appendices which list "excludable medical conditions," part of Public Health Service guidelines for health screening of immigrants in 1903 and 1917.
Given the book's broad approach to immigrants and health, it cannot be said to be fully comprehensive: it makes little reference to Latin American groups, and slavery and African-American populations receive no mention. Still, the book provides excellent insights into the manner in which scientific medicine and public health have matured in their applications to immigration policy, influenced all the while by deep-seated social and economic forces within the general population.
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