Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labor Force (review)

Amy L. Fairchild's Science at the Borders is a thoroughly researched, well-written, and provocative account of the immigrant medical examinations administered by the Public Health Service and overseen by the Immigration Service between the 1890s and the 1920s. Fairchild argues that the medical examinations, and indeed the admissions process more generally, served to inculcate newcomers into—and, in a distinct minority of cases, to exclude immigrants from—the United States' emerging industrial and civic order. The immigrant medical exam, in Fairchild's telling, was a product of early modern industrial America and reflected contemporary political, economic, cultural, and racial demands and biases. Like the best recent works in American immigration history, Science at the Borders combines rich historical detail with a broad and integrative approach to illuminate multiple aspects of life in early twentieth-century America.

The first part of the book, "Numbers Large," focuses on the millions of immigrants who won admission to the United States. After a concise discussion of the importance of immigrants to early modern America's developing industrial economy, Fairchild describes how the need for a large and docile workforce helped create an immigrant medical inspection process that disciplined and socialized newcomers in preparation for the factory floor. The inspection was about more than discovering an immigrant's maladies and afflictions; it was a powerful demonstration of the immigrant's place and future in the United States' economic and civic order. The Public Health Service officials who administered the medical inspections derived their authority not from technology, but rather from their judgment and knowledge of the art (as opposed to the science) of medicine. To gain admission, then, an immigrant passed under the "medical gaze" of government doctors.

"Numbers Small," the second half of the book, looks at the relatively small number of immigrants turned away at the nation's borders, showing how the medical inspection could become an exclusionary tool. Fairchild demonstrates that immigrant medical inspections varied—and produced different rates of exclusion—between entrance points on the East Coast, the West Coast, the Canadian and Mexican borders, the Gulf Coast, and in the United States' island possessions. These distinctions, Fairchild asserts, reflected regionalized understandings of often intertwined ideas about race, class, disease, labor, and the economy.

Science at the Borders has a number of strengths. The book carefully reconstructs the process by which immigrants were admitted to the United States, details that most histories of American immigration ignore. Fairchild provides readers with an intimate, and often moving and personal, portrait of newcomers' first moments in their new country—and their first interactions with the American state and the nation's racial and class structures. Moreover, Fairchild's patient examination of the medical inspection highlights the autonomy and power exercised by Public Health Service officers on a daily basis. Not merely cogs in a nascent bureaucratic machine, these men literally picked and chose the next generation of Americans.

By examining the medical inspection process at multiple entry points—and not just Ellis Island, which received seventy percent of incoming immigrants between 1892 and 1930—Fairchild shows that both the immigrant admissions experience and the work of the Public Health Service was far more peculiar and particular than monolithic. Along the Mexican border, for instance, government officials potently mixed the languages of race, class and disease as they sought to exclude, rather than discipline and socialize, potential immigrant entrants. In contrast, government officials working on the Eastern seaboard aimed mostly to discipline immigrants. Interestingly, Fairchild discovers that these officials tended to be more concerned with the immigrants' social class, which connoted susceptibility to certain diseases, rather than their race.

This fine book leaves a few interesting issues unexplored, however. Industrial citizenship in the early twentieth century was based not only on race and class, but also on gender, a factor which Fairchild largely overlooks. As a result, the author...