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Bulletin of the History of Medicine 74.3 (2000) 525-560

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"The Eyes Have It": Trachoma, the Perception of Disease, the United States Public Health Service, and the American Jewish Immigration Experience, 1897-1924 *

Howard Markel



On the morning of 23 September 1916, the Sicula-Americana steamship San Guglielmo made its way into New York Harbor after a storm-tossed, fifteen-day voyage from Naples. Among the many immigrants on board the vessel was a thirty-seven-year-old East European rabbi named Chaim Goldenbaum. He was completing a long journey of escape from the Pale of Settlement to America, by way of Turkey, Palestine, Egypt, and Italy. 1 Unlike most of the 298,825 immigrants who were streaming into the [End Page 525] United States that year, however, the rabbi was brought to an abrupt halt shortly after he was discovered to have trachoma, a contagious disease of the eye that, if untreated, leads to inflammation, scarring, and, for many victims, blindness. Rabbi Goldenbaum was one of approximately 920 immigrants coming to America in 1916 diagnosed with trachoma.

Between 1897 and 1925, the average annual number of trachoma cases diagnosed at American ports and borders was about 1,500--far less than 1 percent of the annual number of immigrants seeking entry during this period. Yet, for most Americans living during the Progressive Era, the newly arrived immigrant personified the threat of trachoma. Indeed, it was a topic widely discussed in best-selling books and popular magazines, 2 and even at school board meetings where local outbreaks of trachoma were often blamed on immigrant children and their families. 3 More pragmatically, the U.S. Public Health Service (USPHS) burnished its reputation, domain, and resources as a federal agency that protected the nation against imported germs such as trachoma, far out of proportion [End Page 526] to its other, more domestic, public health activities. Indeed, more than 80 percent of its financial and human resources during this period were devoted to medical inspections at the seaports and borders that marked the trail of the immigrant. 4

The immigrant groups stigmatized by trachoma during the Progressive Era included Greeks, Syrians, Italians, Mediterraneans, and Asians; for example, between 1904 and 1909, more than a third of all Chinese and Japanese immigrants who were denied entry into the United States were excluded because of a diagnosis of trachoma. 5 One immigrant group that was particularly affected by the threat of trachoma was East European Jews, who will be the focus of this essay. The association of East European Jewish immigrants and trachoma, however, was not a one-sided diagnosis imposed by native-born Americans upon ignorant newcomers: it quickly found its way into the popular discourse and psyches of prospective immigrants in the "old country," as well as those who came to the "new world," regardless of their ocular health. The East European Jewish American community--represented by immigrant aid societies, the Yiddish press, the Yiddish theater, social agencies, and many concerned individuals--spent considerable time and effort discussing trachoma's epidemiologic characteristics, the medical inspection of immigrants, the politics of American immigration law, how to work with the local and federal public health officials in developing immigrant-friendly programs to recognize and prevent trachoma, and, most urgently, how to handle the social stigma that often results when a so-called "undesirable" social group becomes strongly associated with a particular contagious disease. 6

And so we are confronted with an intriguing paradox to untangle, between the perception of the great threat of trachoma and the relatively small numerical reality of that threat as measured by the incidence of the disease diagnosed at our ports and borders. With each telling and retelling, of course, the story of trachoma and the American immigration experience has acquired the status of legend, making historical documentation [End Page 527] of the disease more difficult than it might seem at first glance. Interviews with settled immigrants several decades after their...


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