Introduction: The Historical Borderlands of Health and Mobility

RECENT MASS MIGRATIONS, fueled by nation-state instability, war, environmental degradation, and staggering global disparities in wealth, have pushed issues of border control and immigration to the top of international concerns. After two generations of forging larger, supranational institutions and promoting freer trade and movement of labour, it would appear that the pendulum has begun to swing in the opposite direction, towards greater insularity, protectionism, and xenophobia. Political borders—physical walls even—have loomed large in the rhetoric and reality of contemporary political life. Although economic self-determination and protection from terrorism have fueled much of the political rhetoric, the longstanding issues of epidemic surveillance and the medical burdens of immigrants also lurk close to the surface. Fear of disease and fear of the foreigner have combined to ensure powerful reactions in host communities.

Social historians of immigration and medicine have multiple perspectives to add to these important contemporary debates.¹ From the seventeenth century, settlers began to flood into North America from overpopulated, disease-ridden Western European cities, creating a clear association between the newly-arrived immigrant and the spread of contagion, with devastating consequences for Indigenous peoples in particular. Eastern and western ports of the Americas and Australasia attempted to erect protocols of quarantine, controlling infectious disease "at the border"² through the inspection and temporary isolation of merchant and passenger ships. Quarantine has been a longstanding public health response in the West,³ but it found new expression in the successive waves of pandemics associated with different generations of newcomers: smallpox, brought by the Spanish, French, and English, which terrorized colonists and First Nations after Contact; typhus, festering in the transoceanic migrations of the Irish fleeing the Great Famine; influenza, facilitated by the demobilization of tens of thousands of soldiers at the end of the First World War; tuberculosis, which surged in the postwar era of refugees from East as well as West; and, at the end of the twentieth century, the HIV/AIDS epidemic, which devastated sub-Saharan Africa and the Caribbean, and which was supercharged due to its association with people of colour, with drug users, and with homosexuality.⁴

As nation-states developed their administrative apparatus to monitor otherwise porous borders, each generation attempted (largely unsuccessfully) to erect controls that would address contemporary preoccupations with disease and fear of migrants. In the modern era, the transnational cholera epidemics of 1831-32, 1848, 1854-56, and 1866 figured prominently by inspiring novel techniques of surveillance and inspection as well as providing a human laboratory for scientific inquiries that would lend credence to the new germ theory of disease. Canada, like many parts of the world, had commandeered islands off principal ports, constructing small communities of doctors, clergy, staff, and the long-suffering migrants. Although isolation was logical from a medico-sanitary standpoint, the legacy was often one of misery and memorials, exemplified by the 1847 tragedy on Grosse Île, near Quebec City.⁵ By the time of the 1854 epidemic, the principle of medical inspection of immigrants—as well as their disinfection and decontamination—had become part of an elaborate apparatus of surveillance and control, providing some reassurance (even if a false one) to the general public that something was being done to combat contagion.⁶ Advances in transportation, of course, altered (and complicated) the medical screening at the border, particularly as the rise of steamships by the 1880s, and the advent of affordable postwar air travel, increased the dynamics (and reach) of potential epidemics.⁷

It should occasion little surprise that the fear of imminent death and disease would incite and exacerbate underlying racial, class, and religious tensions in affected and threatened communities. As racial theories began to circulate—indeed predominate—in political and medical discourses in the second half of the nineteenth century, an added justification of exclusion and culpability was too easily employed during times of public health crisis. In this way, smallpox outbreaks in late nineteenth-century San Francisco and Calgary would result in 1892 race riots (in these cases, against the Chinese immigrants...