Four themes braid this tapestry of the linkages between immigration and public health. Their interweaving often leaves a conscientious reader uncertain of where he is, but their breadth supports a richly panoramic survey that will engage the interests of several different sorts of students and survivors.
One theme is fear. Running from the colonial era to the recent ostracizing of Haitians as presumed carriers of the AIDS virus, this story probes the stigma that fears of contagious disease have repeatedly inflicted on newcomers. In the early chapters Alan Kraut stresses the nativist theme so heavily that reviewers have sometimes classified the book, in the words of one of them, as “a history of the legal barricades erected against immigrant-borne disease, and a chronicle of paranoia.” 1 It is true that Silent Travelers generally gives credence to Benjamin Rush’s observation that “loathsome and dangerous diseases have been considered by all nations as of foreign extraction” (p. 28). Yet Kraut’s data seem to suggest that fears of immigrants as carriers of disease have been episodic rather than continuous in American history, and sometimes strangely absent altogether. He does not claim, for example, that North American Indians blamed their enormous tragedy on European invaders; instead, they attributed their own ravaging epidemics to a conspiracy among the animals they hunted or to the displeasure of a divine spirit. The contrasts between Amerindian and white American notions about epidemics need to be probed, not just reported.
One intriguing chapter does differentiate between two situations, one in which disease provoked a nativist response and another in which it did not. Here Kraut contrasts the obviously racist reaction of San Francisco authorities to the appearance of bubonic plague in Chinatown in 1900 with the positively indulgent treatment that allowed an Irish immigrant in New York, “Typhoid Mary” Mallon, to infect more than fifty people from 1906 to 1915. Yet the reasons for panic in one case and laxity in the other turn out—when Kraut unravels them—to be too complex and too dependent on the behavior of individual administrators to yield a clear historical lesson.
Advances in public health in the twentieth century bring Kraut’s other themes to the fore. His narrative takes on a wider, more interactive character. The second theme is the progress of medical knowledge and the moral dilemmas that arise from an increasing recognition of the scale and variety of illnesses that immigrants bring with them. Here the author’s solid grounding in the history of medicine is especially helpful.
A third theme is the development of institutions and policies, especially in the Progressive Era, to guard and care for the health of the large polyglot populations of American cities. In one vast process mass immigration produced refinements of exclusion at Ellis Island and major advances of inclusion through the hospitals, schools, and clinics of urban America. Kraut’s accounts of school lunch [End Page 173] programs and cleanliness lessons are as vivid as his vignettes of the visiting nurse with her distinctive black bag, stepping carefully from the roof of one tenement house to the next in order to bypass long flights of stairs.
Finally, the theme of acculturation highlights the challenge that scientific therapies have posed to folk medicine. In a larger sense, the encounter has undermined all of the traditional cultures that relied on spittle as an antidote to the evil eye and reacted with horror to physicians provided at public expense. As throughout the book, Kraut treats these inescapable cultural conflicts with a generous sympathy for both the public responsibilities and the private sensibilities that were at stake.
1. Verlyn Klinkenborg, “Dangerous Diagnoses,” New Yorker, 18 July 1994, p. 79.