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

Howard Markel has a distinguished record of writing about the intersection between immigration and public health. Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892 (Johns Hopkins University Press, 1997), in which he dissected epidemics of cholera and typhus fever, was a major contribution to this field, and its laudatory reviews were well deserved. When Germs Travel occupies that same intersection but covers a longer span of time in a more popular vein. Although the subtitle and cover promise more than this slender volume can deliver, this prefatory slip should not be counted against the book itself. This volume is written in an engaging style and contains much that is informative and useful for the general reader.

Markel proposes "six chronicles of epidemics that span decades of medical progress as well as the two 'great waves of immigration' to the United States" (8). These "epidemics" (the reason for the quotation marks later) include tuberculosis (nationally, in the late nineteenth century and today), bubonic plague (San Francisco, 1900–1908), typhus (El Paso and its environs, 1916–1917), trachoma (nationally, 1897–1925), HIV/AIDS in Haitians (1980–present), and cholera (recently, in Detroit). The "great waves of immigration" involved Europeans from roughly 1890 to 1924, and people from Asia, Africa, and the Western Hemisphere south of the United States in the post-1965 wave.

One of the common threads running through these episodes (with the possible exception of the plague) is that while these diseases were, indeed, carried by new arrivals, they were already present in the United States. Among the large-scale epidemics absent from Markel's narrative is the 1918–1919 "Spanish Flu." The name belies a foreign origin, but major narratives demonstrate little connection between the fear of influenza and the mounting nativist sentiment that led to the 1924 National Origins Act and the end of largely unrestricted immigration.

How the diseases Markel discusses became constructed as immigrant diseases should be of great interest to us. Yet When Germs Travel, for all its undeniable readability, addresses this point less forcefully than Alan Kraut's Silent Travelers: Germs, Genes, and the Immigrant Menace (Basic Books, 1994) or, to cite more recent examples, Susan Craddock's City of Plagues (University of Minnesota Press, 2000) or Nayan Shah's Contagious Divides (University of California Press, 2001). Where Markel the physician-historian gives us more bio-medical detail on the etiology of specific diseases, Kraut, the immigration historian, more aptly situates various outbreaks within the contemporary currents of thought about immigrants and immigration.

The chapters on trachoma, plague, and typhus are well-written reviews of the literature, introducing the reader to these diseases and to particular "outbreaks," some of which (in the cases of trachoma and tuberculosis) lasted rather a long time. Specialists will quibble with each of these sections. As one who has written on the bubonic plague outbreaks in San Francisco at the dawn of the twentieth century, I found little new, aside from an egregious misuse of the concluding paragraph of Camus's The Plague. It is hard to see the San Francisco plague outbreaks as "major epidemics," as they led to fewer than 120 deaths spread over eight years and scarcely changed Americans' already negative attitudes toward the Chinese among them.

The cholera "epidemic" was a false alarm. Markel was doing pro bono work at a Detroit hostel for refugees located within sight of the bridge to Canada, when several of the recent arrivals from Rwanda experienced a sudden onset of severe diarrhea. Knowing that cholera was prevalent in Rwanda, Markel suspected cholera and took stool samples to a local emergency room for evaluation. To his chagrin, the culprit turned out to...