When Germs Travel: Six Major Epidemics That Have Invaded America since 1900 and the Fears They Have Unleashed (review)

When Germs Travel presents six lively episodes of social and political panics unleashed by epidemic fears in the United States in the twentieth century. Historian and physician Howard Markel deftly uses a self-conscious detective narrative approach to both well-known and lesser-known epidemic panics, including bubonic plague and Chinese immigrants in San Francisco, trachoma and Jewish immigrants in New York, typhus and Mexican immigrants in El Paso, AIDS and Haitian refugees at Guantanamo, and Rwandan refugees in Detroit. Every chapter stretches beyond the particular crisis moment to offer historical context and contemporary resonance, but the opening chapter on tuberculosis spans a century of transformations in treatment, surveillance, and eradication campaigns—resulting nevertheless in the disease's tenacious persistence.

Interwoven into Markel's epidemic chronicles are the histories of immigration regulation, public health policy, and the formation of twentieth-century U.S. polity. Markel produces a broad analysis of the problematic processes of securing the nation's borders and protecting its citizens from foreign disease and contamination and shows how international migrants and refugees were cast as feared disease carriers. Throughout, Markel emphasizes the egalitarian impact of contagious disease and its disproportionate distribution of distress and sorrow on the poor. Drawing from rich U.S. historical and medical scholarship, Markel incorporates his research in historical newspapers, medical periodicals, and the archival records of the federal public health service. He analyzes the impact of hierarchies of social and political power on the successes and failures of deciphering illness, communicating knowledge of disease transmission, and providing and receiving treatment.

Markel empathically demonstrates how the zealousness of public health inspection and surveillance throughout the twentieth century has created a legacy of mistrust, uneasiness, and "outright avoidance" and wariness between "American doctors and immigrant patients" (p. 10). Markel compassionately explores the intentions and fallibility of medical professionals and offers as well a sympathetic perspective on the needs and struggles of patients and those perceived as disease carriers in their search for equitable treatment, human dignity, and respect.

In the compelling final chapter, Markel shares his reflections on his experience caring for Rwandan refugees at Detroit's Freedom House and how symptoms of acute diarrhea led to his participation in the premature and mistaken diagnosis of cholera in 1998. Markel demonstrates the dramatic leaps, from suspicion to panic to diagnosis of a prosaic ailment, that reverberate in the other five chapters of epidemic crisis that he has analyzed previously. Markel underlines the potency of apprehension that shapes the medical knowledge of immigrants and refugees and the thin line between professional suspicion and epidemic hysteria.

Markel's thoughtful and engaging book demands a rethinking of the connections among the concepts of health, modern individualism, and the nation. Deeply embedded in strategies of public health protection is a fear of and moral judgment directed toward the ill person, and the tendency to displace disease onto foreign and impoverished scapegoats. The idea of health security for U.S. citizens creates both spatial and bodily boundaries that have counterproductive results both locally and internationally.

The uneven distribution of prophylactics, health care, and clean water and sanitation infrastructure has intensified political and social inequities worldwide. Markel's epilogue redirects public concerns away from recent media-amplified contagions such as bioterrorism, SARS and West Nile disease, and the "antiquated approaches" that "rely on walls and borders as public health safeguards" (p. 209) and shifts these concerns toward the enormous mortality of endemic and preventable childhood diseases, malaria, tuberculosis, and AIDS.

Markel advocates economist Jeffrey Sachs's proposals to the United Nations that direct investment in health care and infrastructure from high-income nation-states to poor nations. The laudable plan, supported by pledges from national governments and foundations, links both international social justice and national self-interest to a health-security framework on a global scale. The challenge...