From 1881 to 1924, more than 23 million immigrants poured into the United States, and the country has never been the same. Many of us are linked to this wave of immigration, making a better understanding of the assimilative process appropriate. Immigration created tension between nativists, who viewed immigrants as a threat to the American way of life, and assimilists, who worked to improve educational and medical opportunities for newcomers. Kraut explores these tensions and links them to our present attitudes toward immigrants while making the point that the United States has a rich history of medical prejudice toward its immigrants. He describes how Irish, Jewish, Italian, and Chinese immigrants have all, in their turn, been held responsible for an extensive array of ills ranging from the introduction of new infectious diseases to a general lowering of intelligence in U.S. society. Some of the nativists' language is unsettlingly reminiscent of Nazi propaganda during the 1930s.

Kraut chronicles the medical assimilation of immigrants through a series of public health and curative initiatives. His descriptions of the abominable living and working conditions of urban immigrants are arresting. Immigrants brought with them their languages and customs, which often included medical beliefs and nostrums that were radically different from those underlying mainstream U.S. medicine. Charlatans flourished as immigrants avoided a health system that they found either incomprehensible or incompatible with their beliefs. The medical needs of many immigrant groups were not fully met until a generation later, when their sons and daughters graduated from U.S. medical and nursing schools and returned to care for them. Kraut vividly describes how assimilists, shrewd politicians, and visionary public health officials created public health programs in response to the health needs of immigrants. Innovations such as public school physical examinations, the visiting nurse program, sanitary codes for buildings, and school-based nutritional programs became institutionalized, and, over time, the medical assimilation of immigrants occurred, but not without considerable misunderstanding and prejudice. For those interested in the public and private response to immigrant health problems, this book is a great read.