Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles (review)

Emily Abel's Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles, as its title implies, gives an account of tuberculosis policy in Southern California. California, as anyone who has studied—or lived in—the state surely knows, has been a place of perpetual refashioning. No less true, apparently, was this for thousands of people who came to the state seeking not just to recreate themselves but to remake their health. At first, this health-seeking migration was implicitly encouraged by local boosters who advertised Southern California's regenerative powers. Advertising was one thing, however; actual accommodation quite another. Many a sufferer of tuberculosis arrived in the area to find talk of California's salubriousness overblown. Single men muddled through as they could (much fewer were single women who would have braved the journey alone; "health seeking was clearly an overwhelmingly male enterprise," Abel writes on page 14). More fortunate men could have relied on doting wives or daughters for health care and financial support. To illustrate the point, Abel provides close readings of the published and unpublished diaries and memoirs of women such as Martha Shaw, whose husband developed the disease a scant two months after their wedding.

Tuberculosis had the effect of altering Southern California's cultural landscape. By the early twentieth century, there were thousands of such health seekers in California, most of them stranded there by dwindling resources. State health officials emerged as the most vocal critics of the boosters' claim of California's miraculous healing properties, rhetorically drawing the distinction between poor migrants and the respectable middle class and warning the former group that no social services were available to them. Tuberculosis, of course, was a disease to which society's most unfortunates found themselves most vulnerable. Mexican migrant workers were chief among these, but so too were Japanese, the constant objects (along with the Chinese) of nativist objection.

Though California cannot be said to have ignored the problem, public health professionals and welfare services administrators shifted blame to one another to compensate for the inadequacies of the system. The problem, as Abel informs us, was larger than tuberculosis. Health officials expressed alarm also about the always looming inevitability of outbreaks of typhoid fever or even plague that, they feared, might travel from nonwhite quarters to those of white respectability via Japanese and Mexican food handlers and agricultural workers. Assessing the poor conditions in which these workers were forced to live and work, a Dr. Titian Coffey expressed the sentiment held generally among his class: poor living conditions enforced poor hygiene and even poor morality. All three were so tightly bound together, many argued, that the exact strands of causality and influence were impossible to discern.

I have argued that the economics and politics of the Great Depression quickened black medical and nonmedical leadership's critique of scientific racism in epidemiology and public health, eventually producing limited but important changes in both fields (biology found itself briefly decoupled from the racial construct, but only to be replaced by the "cultural" paradigm).¹ In Abel's California, we find a different story. As much as many Southerners (even "liberal" ones) would have wanted the option, the expulsion of African Americans from the United States was never viable as it had been practiced upon thousands of Mexicans and Filipinos under California's 1935 Repatriation Act. More were expelled during these lean years for having resorted to charity than those who were forced to leave because of their health. Nonetheless, readers understandably might raise the question how government policy influenced and was influenced by nonwhite physicians and lay leadership (one wonders, for example, what messages were sent from the state or national...