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Disease and Immigration

Disease and Immigration

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A major problem for emigrants travelling to America was disease. Cholera, transmitted by contaminated water, was a major health problem for those on board ship . In overcrowded conditions the disease spreads very quickly. On 18th May, 1832, the ship Brutus, sailed from Liverpool to Quebec. The first case of cholera was identified on 27th May. By 3rd June so many of the passengers had died the captain decided to return to England. By the time the ship arrived back in Liverpool 81 had died of the disease. Cholera also broke out on other ships bound for the United States and Canada that summer. The Carricks lost 42 passengers before arriving in Quebec whereas 29 died on board the Constantia.

This was the start of a cholera epidemic that was spread from England to Canada and the United States. In 1832 over 4,000 people died of cholera in Quebec and Montreal. There were also large number of deaths in other major immigrant centres such as New York and Chicago.

There were also outbreaks of cholera in 1848 and 1853. Of the 77 vessels which left Liverpool for New York between 1st August and 31st October, 1853, 46 contained passengers that died of cholera on the journey. The Washington suffered 100 deaths and the Winchester lost 79. All told, 1,328 emigrants died on board these 46 ships.

The most common killer was typhus. It was particularly bad when the passengers had been weakened by a poor diet. In 1847, during the Irish Famine, 7,000 people died of typhus on the way to America. Another 10,000 died soon after arriving in quarantine areas in the United States. Most of the deaths were of immigrants from Ireland.

In 1847 a total of 98 passengers died of typhus on the Sir Henry Pottingersailing from Cork in Ireland to Quebec in Canada. Another 158 died on board the Virginius. That year 5,293 died of the disease on the journey to Canada. Another 10,037 died soon after arriving at their destination.

There was another outbreak of cholera in 1866. The England, carrying over a thousand emigrants from Liverpool to New York, had 40 die of the disease while crossing the Atlantic. Another 227 died soon after arriving in America.

The scenes I witnessed daily were awful; to hear the heart-rending cries of wives at the loss of their husbands, the agonies of husbands at the sight of the corpses of their wives, and the lamentations of fatherless and motherless children; brothers and sisters dying, leaving their aged parents without means of support in their declining years. These were sights to melt a heart of stone. I saw the tear of sympathy run down the cheek of many a hardened sailor.

Our water has for some time past been very bad. When it was drawn out of the casks it was no cleaner than that of a dirty kennel after a shower of rain, so that its appearance alone was sufficient to sicken one. Buts its dirty appearance was not its worst quality. It had such a rancid smell that to be in the same neighbourhood was enough to turn one's stomach.

Immigration Act of 1891

This 1891 immigration law clarified and centralized the immigration enforcement authority of the federal government, extended immigration inspection to land borders, and expanded the list of excludable and deportable immigrants.

Discussion Questions

What were the main provisions of the Immigration Act of 1891?

What groups of people did the Act identify for exclusion and deportation?

What might be the long-term significance of centralizing federal immigration enforcement authority and extending immigration inspections to land borders?


The Immigration Act of 1891 centralized immigration enforcement authority in the federal government, overriding state governments’ previous responsibilities to carry out federal immigration laws. The Act also extended immigration inspections to land borders and created the Office of Superintendent of Immigration to supervise new immigration inspectors at points of entry within the Treasury Department, which was charged with overseeing immigration law in 1882. Beyond strengthening the federal government’s power to enforce immigration law, the 1891 Act also placed further regulations on contract labor and expanded the list of excludable and deportable immigrants to include felons, polygamists, “all idiots, insane persons, paupers or persons likely to become a public charge” as well as those suffering from infectious diseases.


Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

That the following classes of aliens shall be excluded from admission into the United States, in accordance with the existing acts regulating immigration, other than those concerning Chinese laborers: All idiots, insane persons, paupers or persons likely to become a public charge, persons suffering from a loathsome or a dangerous contagious disease, persons who have been convicted of a felony or other infamous crime or misdemeanor involving moral turpitude, polygamists, and also any person whose ticket or passage is paid for with the money of another or who is assisted by others to come . . . .

SEC. 3. That it shall be deemed a violation of said act . . . to assist or encourage the importation or migration of any alien by promise of employment through advertisements printed and published in any foreign country . . . .

SEC. 7. That the office of superintendent of immigration is hereby created and established . . . The superintendent of immigration shall be an officer in the Treasury Department, under the control and supervision of the Secretary of the Treasury . . . .

That the Secretary of the Treasury may prescribe rules for inspection along the borders of Canada, British Columbia, and Mexico . . . .

All duties imposed and powers conferred upon State commissioners, boards, or officers acting under contract with the Secretary of the Treasury shall be performed and exercised . . . by the inspection officers of the United States . . . .

Irish Immigration: Beyond the Potato Famine

Ireland sent immigrants to the American colonies early in their settlement. Charles Carroll was a signer of the Declaration of Independence. In the 1840s, the Irish potato sent waves of migrants who could afford passage fleeing starvation in the countryside. The Irish made up one half of all migrants to the country during the 1840s. From 1820 to the start of the Civil War, they constituted one third of all immigrants. Early in the century, the majority of Irish immigrants were single men. After the 1840s, the pattern shifted to families as a few family members came first and earned money to bring relatives later in a process known as chain migration. In later years, women provided the majority of new arrivals.

Irish Immigrants in America

So harsh were conditions in Ireland that the nation's population decreased substantially through the 19th century. From 8.2 million in 1841, the population dropped to 6.6 million in only ten years and to 4.7 million in 1891. From 1841 to World War II, some estimates conclude that 4.5 million Irish came to the United States.

While not all Irish migrants were poor, most were. Many did not have money to move beyond the eastern port where they landed, and their numbers soon swelled cities like New York and Boston. Many found the adjustments from their rural backgrounds to the impersonal urban environments very difficult. They crowded into low-cost housing creating problems for schools, disease and sanitation. Men took whatever jobs they could find, usually at very low pay, while women became domestic workers or other low paying jobs. Often they found themselves competing for jobs with African Americans for work that was the hardest, most dangerous and lowest paying. Employers used the Irish, as well as other newly-arrived immigrants and African Americans, to threaten replacement of workers if they advocated for better working conditions, which created ethnic tensions that sometimes broke out into violence.

In addition to economic pressures, the Irish also faced religious discrimination. Centuries of conflicts between Protestants and Catholics followed immigrants to the United States, and the Irish Catholic faced hostility from the longer-settled Protestants who feared that the growing numbers of Irish would translate into political power. And it did. As politicians learned to court Irish voters, urban political machines rewarded their supporters with public jobs like policemen, firemen, sanitation workers and road crews. Protestant groups gravitated toward the Republican Party that sometimes promoted discriminatory laws like voting restrictions or the prohibition of the sale and use of alcohol. In response, Catholic immigrants like the Irish became the heart of the Democratic Party in many Northern states.

The Irish in Iowa

In Iowa, the Irish were the second largest immigrant group, topped only by the Germans. They settled in large numbers in the Mississippi River towns like Dubuque and Davenport. The Catholic bishop in Dubuque encouraged Irish and German Catholic immigration to Iowa and directed new arrivals to communities in northeast Iowa where they could be served by Catholic priests. Within the church itself, there was often competition to bring an Irish or German priest to serve the congregation. The railroads needed manual laborers and recruited the Irish to lay the rails and maintain the trains in roundhouses, bringing workers to small towns. The Irish also settled together in towns like Emmetsburg and in rural neighborhoods. They often supported private schools so that they could teach their children in a Catholic environment.

America’s Long History of Immigrant Scaremongering

Photo by Ross D. Franklin-Pool/Getty Images

Since last October, the United States has caught tens of thousands of children crossing the border with Mexico, most fleeing violence in Central America. Thousands continue to come into the country, and President Obama has called the influx an “urgent humanitarian situation,” asking Congress for $3.7 billion in funding to deal with the children and families that have arrived.

Complicating the problem are growing protests against the immigrants. “I’m protesting the invasion of the United States by people of foreign countries,” said one person at a recent demonstration in Oracle, Arizona. “This is about the sovereignty of our nation.” And at a similar one in Murietta, California, demonstrators held signs saying “illegals out!” and called for the U.S. government to “stop illegal immigration.”

But for as much as this anger is organic, growing from fear and anxiety, it’s also true that conservative media figures have stoked tensions with wild and dishonest rhetoric on the supposed threat of new arrivals. “Dengue fever, 50 to 100 million new cases a year of dengue fever worldwide. In Mexico, it is endemic. It’s a terrible disease, for anyone that’s had it,” said Fox News host Marc Siegel, who continued with a warning. “There’s no effective treatment of it. It’s now emerging in Texas because of the immigration crisis.” Likewise, on her radio show, Laura Ingraham declared, “The government spreads the illegal immigrants across the country, and the disease is spread across the country.”

Republican politicians have joined in as well. “Reports of illegal immigrants carrying deadly diseases such as swine flu, dengue fever, Ebola virus, and tuberculosis are particularly concerning,” wrote Georgia Rep. Phil Gingrey in a recent letter to the Centers for Disease Control and Prevention. His colleague, Texas Rep. Randy Weber, sounded a similar note in an interview with conservative pundit Frank Gaffney: “I heard on the radio this morning that there have been two confirmed cases of TB—tuberculosis—and either one or two confirmed cases of swine flu, H1N1. … We’re thinking these are diseases that we have eradicated in our country and our population isn’t ready for this, so for this to break out to be a pandemic would be unbelievable.” And Rep. Louie Gohmert—no stranger to the offensive outburst—told conservative publication Newsmax that “we don’t know what diseases they’re bringing in.”

But we do, and the reality is nowhere close to dire: While a handful of reports suggest there are incoming children with illnesses like measles and tuberculosis, the vast majority of these minors are healthy and vaccinated. Moreover, according to the Department of Homeland Security, border agents are required to screen “all incoming detainees to screen for any symptoms of contagious diseases of possible public health concern.” In short, the odds that migrant children would cause a general infection of anything are slim to none, right-wing claims notwithstanding.

These facts are easy to find, but it’s not a surprise that immigration opponents would claim otherwise. For as long as there have been immigrants to the United States, there has been scaremongering about their alleged disease and uncleanliness. What we’re hearing now, put simply, is an update on an old script.

“On the morning of 19 May 1900,” writes American University professor Alan M. Kraut in an essay titled “Foreign Bodies: The Perennial Negotiation over Health and Culture in a Nation of Immigrants,” “the Chinese community of San Francisco found itself under siege in the name of state and municipal security. It was not fear of bombs or terrorist attack that inspired officials to commit a wholesale violation of civil liberties that morning it was fear of disease, specifically bubonic plague.”

That wasn’t the first quarantine of San Francisco’s Chinatown, and it wouldn’t be the last. Nor was it a surprise—local authorities long regarded Chinese immigrants as a threat to public health, a manifestation of long-standing nativist fears. To wit, notes Kraut, “The Irish were charged with bringing cholera to the United States in 1832. Later the Italians were stigmatized for polio. Tuberculosis was called the ‘Jewish disease.’ ” The entire discourse of 19 th - and early 20 th -century politics was saturated with attacks on immigrants as diseased intruders to the body politic. Indeed, this dialogue culminated, in 1891, to Congress, with revision of the 1882 Immigration Act to exclude “persons suffering from a loathsome or a dangerous contagious disease” from entry into the United States.

Photo by David McNew/Getty Images

“Asians were portrayed as feeble and infested with hookworm, Mexicans as lousy, and eastern European Jews as vulnerable to trachoma, tuberculosis, and—a favorite ‘wastebasket’ diagnosis of nativists in the early 1900s—‘poor physique,’ ” write scholars Howard Markel and Alexandra Minna Stern in a 2002 paper on “the persistent association of immigrants and disease in American society.”

Vivid examples of this association aren’t hard to find. “[E]very ship from China brings hundreds of these syphilitic and leprous heathens,” writes one editor in an issue of Medico-Literary Journal. Likewise, wrote one columnist in an Oct. 3, 1907 edition of the Princeton Union, “[German immigrants] produce large and swarming hives of children who grow up dirty, ignorant, depraved, and utterly unfit for American citizenship.” And in a Dec. 1, 1906 edition of the Deseret Evening News, one writer complained of “runners” in southern and eastern Europe who “tell fairy tales about the prosperity of the many immigrants now in America and the opportunities we offer to aliens. It is by such means that paupers and diseased persons are induced to make the journey, only to find that they are shipped back upon landing.”

Mass participation in World War II changed American perspectives of European immigrants, and later, the Immigration and Nationality Act of 1965 ended national quotas and opened the doors to a huge numbers of immigrants from around the world. Still, the link between immigration and disease has persisted through the 20 th century and into the 21 st .

In the 1980s, for example, the influx of Haitian refugees merged with the AIDS crisis to produce a new wave of anti-immigrant discrimination. “When AIDS appeared suddenly in the 1980s,” writes Markel and Stern, “it was quickly conflated with deviant sexuality and several minority groups, ranging from gays and intravenous drug abusers to Haitians and Africans.” In 1983, the appearance of HIV among several Haitian detainees led the CDC to add the group to its list of “recognized vectors” for the virus, and in 1990—acting on potent AIDS stereotypes—it banned all Haitians from donating blood in the United States. What’s more, that same year, the Immigration and Naturalization Service began to detain and quarantine HIV-positive immigrants at the U.S. base at Guantánamo Bay, Cuba.

And in 1993, echoing earlier language against “paupers and diseased person,” Oklahoma Sen. Don Nickles introduced a bill prohibiting the entry of all HIV-positive immigrants on economic grounds, arguing that—if we didn’t—“it will almost be like an invitation for many people who carry this dreadful, deadly disease, to come into the country because we do have quality health care in this country … and jeopardize the lives of countless Americans and will cost U.S. taxpayers millions of dollars.”

Beyond the present situation, the most recent attacks on immigrants as carriers of disease came during the Bush administration. In 2005, an episode of Lou Dobbs Tonight falsely asserted, “We have some enormous problems with horrendous diseases that are being brought into America by illegal aliens,” including 7,000 cases of leprosy in the past three years. On his radio show, Bill O’Reilly agreed that immigrants were crossing the border with “tuberculosis, syphillis, and leprosy,” and in 2006, Pat Buchanan claimed “illegal aliens” were responsible for bedbug infestations in “26 states.” In reality, health officials attribute the growth in bedbugs to “widespread use of baits instead of insecticide sprays” for pest control.

Today, anti-immigrant protesters hold signs asking Washington to “Save our children from diseases,” while right-wing lawmakers fret about disease screening and spread fears of infection and contamination. In doing so, both draw from a long history of ugly nativism and prejudice dressed as concern for public health. And you don’t have to be a liberal, or support immigration reform, to see that it’s a disgrace.

Disease Control and Prevention

By 1878 the Marine Hospital Service had begun to lose its identity as a relief organization solely for sick seamen. The prevalence of major epidemic diseases such as smallpox, yellow fever, and cholera spurred Congress to enact a national law in 1878 to prevent the introduction of contagious and infectious diseases into the United States, later extending it to prevent the spread of disease among the states. The task of controlling epidemic diseases through quarantine and disinfection measures as well as immunization programs fell to the Marine Hospital Service and hastened its evolution into the Public Health Service which served the whole nation.

As a result of new laws the functions of the Service expanded greatly to include the supervision of national quarantine, the medical inspection of immigrants. the prevention of interstate spread of disease, and general investigations in the field of public health, such as that of yellow fever epidemics. To help the Service meet these increased tasks the Congress in 1889 established the Commissioned Corps along military lines, with titles and pay corresponding to Army and Navy grades. In 1930 and 1944 the Corps was expanded to include, besides physicians, engineers, dentists, research scientists, nurses, and other health care specialists.

As epidemic diseases were brought under control the Public Health Service began to shift its attention to other areas such as cancer, heart disease, health in the workplace, and the impact of environmental problems, such as toxic waste disposal, on health. But the Public Health Service is still called upon to investigate outbreaks of disease such as Legionnaire's, toxic shock syndrome, and now the deadliest epidemic of our age -- AIDS. Much of the work of the early plague fighters and sanitarians is now carried out by the scientists at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.


Public Health Service officers in uniform at the Montauk Point, New York, Quarantine Station. An Act of Congress in 1870 formally organized the Marine Hospital Service as a national agency with centralized administration under a medical officer, the Supervising Surgeon, who was later given the title of Surgeon General. The Service was reorganized along military lines, with uniforms, entrance examinations, and tenure and promotion on the basis of merit, free from politics. Gradually, local physicians were replaced with medical officers, who were admitted only after examination and were subject to assignment wherever required.

Public Health Service officers in front of the quarantine hospital in the Dry Tortugas, Florida. Ravaging epidemics, which were taking their toll on the United States population, and the continued failure of the Federal Government to exert its proper authority in quarantine matters stimulated John M. Woodworth, the first Surgeon General of the Marine Hospital Service, to press for action in developing an effective national quarantine system. Largely through his efforts the national quarantine act "to prevent the introduction of contagious or infectious diseases into the United States" was passed in 1878. This legislation also gave authority for the very important Public Health Service publication now known as Public Health Reports.

North end of the disinfecting wharves at the quarantine station on Blackbeard Island, Georgia. This station for the detention and treatment of infected ship crews and cargoes, together with another quarantine station on Sapelo Sound in Georgia, were established in 1883 as part of a national quarantine system. They constituted part of the South Atlantic Quarantine region.

The Public Health Service quarantine boarding launch "Walter Wyman" in New York City harbor. Walter Wyman was Surgeon General of the Public Health Service from 1891 to 1911 and among his many accomplishments was the development of the national maritime quarantine system.

Fumigation of a ship in New York City harbor by spraying of hydrocyanic acid gas. The introduction of hydrocyanic acid gas by the Public Health Service in 1913 to replace sulphur dioxide the chief fumigant relied upon for centuries was a very important contribution to quarantine procedure.

Camp E. A. Perry, yellow fever detention camp, on the south bank of St. Mary's River in Florida near the Georgia border, established by the Marine Hospital Service in 1888. During the spring and summer of that year there were numerous outbreaks of yellow fever in the gulf states. The Service assisted state and local health authorities in controlling its spread by setting up camps such as this. Persons traveling from yellow fever areas were required to remain in the camp for the incubation period (6-10 days) before proceeding elsewhere. This camp which was up for several weeks, was named in honor of Governor E. A. Perry of Florida, who cooperated in establishing and maintaining it. Camps near infected cities were not new, but an inland quarantine, where suspects were detained only long enough to demonstrate that they were not infected and then allowed to proceed, were new at the time.

United States troops in the Spanish-American War suffered from yellow fever. Fear of its spread to the mainland after the end of hostilities in 1899 invoked large-scale efforts by the Marine Hospital Service to ensure adequate quarantine inspection of troops being returned from Cuba and Puerto Rico. Here troops are undergoing inspection and disinfection of baggage at the quarantine detention camp on Daufuskie Island South Carolina.

A fumigating and disinfecting team getting ready to work in New Orleans.

Quarantine inspection in Baltimore harbor. Unless specifically exempted by regulation, every ship, aircraft, or other carrier entering a United States port is examined for purposes of quarantine.

The immigration law of 1891 made it mandatory that all immigrants coming into the United States be given a health inspection by the Public Health Service physicians. The law stipulated the exclusion of "all idiots, insane persons, paupers or persons likely to become public charges, persons suffering from a loathsome or dangerous contagious disease," and criminals. The largest inspection center was on Ellis Island in New York Harbor. Here the physicians are looking at the eyes for signs of trachoma.

Quarantine detention at Immigration Station on Ellis Island, New York. Those suspected of having a communicable disease were segregated at once and, after confirmation of the diagnosis, admitted to the communicable disease hospital for care and treatment.

Asian immigrants arriving at the Immigration Station on Angel Island near San Francisco, California. Angel Island was one of about 50 American ports designated as ports of entry for immigrants by the immigration law of 1891.

Disinfecting clothing of immigrants at the Immigration Station on Angel Island, San Francisco, California.

Testing an Asian immigrant at the Immigration Station on Angel Island, San Francisco, California

The foreman of a ratproofing crew in New Orleans, Louisiana, pointing out the progress of the work to Public Health Service officer Dr. Charles V. Aiken. Bubonic plague broke out in New Orleans in June 1914. Full plague control operations such as this continued until 1916 when the city was declared free of infection.

Two sisters suffering from trachoma, a contagious chlamydial disease of the eye which, if untreated, could lead to blindness. Because of its prevalence Congress and President Woodrow Wilson authorized the Public Health Service in 1913 to use money from its annual "epidemic" fund for the prevention and control of trachoma.

Sanitary engineer Ralph E. Tarbett oversees malaria control work during World War I. A drip can containing oil and kerosene is used to eliminate a mosquito-breeding area. Starting in 1912 and 1913 malaria studies and malaria control efforts were led by Public Health Service officer Henry R. Carter and Rudolph H. von Ezdorf. From 1912 to 1917 the main effort was directed toward determining where malaria was prevalent in the United States and measuring its economic impact.

Typhoid fever attributable to poor sanitary conditions, was a major cause of illness in the United States during the 19th and early 20th centuries, especially in the rural areas. Here an entire family receives inoculations against typhoid fever.

The working environment and its effect on worker's health became a major area of study for the Public Health Service starting in 1910. Investigations in the garment making industry, as illustrated by these women making flowers, revealed unsanitary conditions and an excessive rate of tuberculosis. Other studies were done of silicosis among miners, sanitation and working conditions in the steel industry, lead poisoning in the pottery industry, and radiation hazards in the radium dial painting industry. These studies and surveys were coordinated by the Division of Industrial Hygiene and led by such officers as Joseph W. Schereschewsky. They eventually helped to better health conditions and provided safer work environments for many workers.

Rural sanitary surveys conducted by the Public Health Service under the leadership of such officers as Leslie L. Lumsden (1875-1946) and Charles W. Stiles (1867-1941) tried to ascertain the health conditions in rural areas of the United States through house-to-house canvasses. Working in close cooperation with local officials, the public health survey teams also provided advice to these households concerning the safe disposal of human wastes by building sanitary privies, the protection of water supplies by safeguarding wells to prevent surface drainage, and the screening of homes to prevent the entrance of disease-bearing insects, particularly flies and mosquitos. The construction of sanitary privies for each household, such as these shown here in an agricultural migrant village, played an important part in the development of rural sanitation. This work was greatly advanced during the 1930s through the federal privy-building programs of the Civil Works Administration and the Work Projects Administration.

The Public Health Service rural sanitary surveys during the first two decades of the 20th century led to the establishment of many local county health boards and departments who continued the work of rural sanitation on a daily basis. Health education was one of their primary tools. The poster for privies printed for one of Dr. Lumsden's county health campaigns is an example of the methods used. The results were quite dramatic as the incidence of typhoid fever and hookworm markedly diminished in areas where active sanitary measures were taken.

Smallpox has been one of the most devastating diseases in American history especially among Native Americans. Sporadic cases of smallpox were still being reported in the United States during the 1930s and early 1940s. The Public Health Service primarily through the work of the Hygienic Laboratory, played an important role in controlling and finally eradicating this disease. Important contributions included the inspection of vaccine being produced to ensure purity. especially from contamination with tetanus recommending the abandonment of dressings at the vaccination site to avoid post vaccination tetanus and the development of the multiple pressure method of vaccination.

Pneumonia was a serious concern of the Public Health Service in the early decades of the 20th century. Together with influenza it was the leading cause of death in the United States in 1900.

This World War II advertisement informs the soldiers and other citizens about a new wonder drug that can cure venereal disease. The introduction of penicillin, first in limited amounts in 1943 for clinical trials and then in massive quantities by 1944 as a result of the war effort, brought about revolutionary changes in the control of infections and venereal disease. The Public Health Service together with other government agencies carried out an extensive study of the effect of penicillin in treating syphilis and gonorrhea.

The Malaria Control Unit of the Philippines Public Health Rehabilitation Program in front of their headquarters. Following the reoccupation of the Philippines by the United States Armed Forces in 1945 and until 1950 the Public Health Service aided the Philippine government in surveying the general public health conditions on the Islands and reestablishing public health programs and quarantine facilities. The prevention and control of malaria with four to five million cases annually was a major objective of the program.

Medical discoveries and public health campaigns have almost eliminated deaths from the common diseases of childhood such as measles, diphtheria, scarlet fever, and whooping cough. As a result of these successes nearly 20 years were added to the average life expectancy at birth between 1900 and 1950-from 47 to 67 years.

A collage of well known personages who gave publicity and support to a chest X-ray campaign in Los Angeles. During 1950 more than 2 million X-ray examinations were made by the Public Health Service, more than 1.8 million of them in community-wide chest X-ray surveys in Denver, Boston, Salt Lake City, San Diego, and Los Angeles.

The iron lung was used to sustain the lives of polio victims. Dr. James P. Leake and other Public Health Service scientists were instrumental in field investigations of poliomyelitis.

Accurate health statistics are very important for formulating national health policies and funding health programs. This specially designed and equipped mobile examination center is the site of testing for the third National Health and Nutrition Examination Survey (NHANES III). NHANES III is designed to assess the health and nutritional status of adults and children in the United States and is being conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Approximately 40,000 individuals in 88 communities across the country will be asked to participate in this six-year survey which began in September 1988. The first two national surveys were done in l971-75 and l976-80.

Persons who participate in the third National Health and Nutrition Examination Survey receive a physical examination and several other tests from a physician and a highly trained medical staff. These other tests will include a dental examination, hearing test, allergy skin test, lung capacity test, body measurement, electrocardiogram (ECG), and measurement of bone density.

Public Health Service officer Gail Schmidt checking the level of contamination on the exterior of a building used by radium source manufacturer and importer in New York. Health hazards associated with radioactive materials have been a concern for the Service throughout most of this century. Since 1979 the Centers for Disease Control and Prevention in Atlanta, Georgia have had the primary responsibility of responding to environmental emergencies involving radiation and chemicals such as those caused by spills during transport fires, and other incidents. They assisted in the environmental epidemiologic investigation following the Three Mile Island nuclear reactor accident in 1979.

Not only did the Centers for Disease Control and Prevention take over the foreign quarantine functions in 1967 they also extended quarantine into space. The Centers for Disease Control and Prevention provided quarantine equipment and procedures for the United States space program, including the Apollo moon landings.

Wearing high-level protective gear Public Health Service response teams collect samples for toxic substance identification. Since 1979 the Centers for Disease Control and Prevention (CDC) have coordinated activities to protect the public's health against exposure to toxic chemicals in the environment. The Center for Environmental Health and the National Institute for Occupational Safety and Health (NIOSH) are the two organizational units within the CDC responsible for these activities. They include studies of indoor air quality, lead-based paint poisoning, and occupational exposure to asbestos and hundreds of other toxic and carcinogenic substances. Health studies of residents of Love Canal, an abandoned chemical waste dump in Niagara Falls, New York, in 1980 was one of their most well-known efforts.

Health education is an important tool in the fight against the spread of AIDS. Surgeon General C. Everett Koop's Report on AIDS and other brochures produced by the Public Health Service help to disseminate important information about AIDS.

Article & Resources for Students

By 1870, more than 90 percent of immigrants to America arrived by steamship, most to Ellis Island in New York. Ellis Island was opened January 1, 1892, and was the busiest immigrant inspection station for over 60 years from 1892 until 1954 in the United States.

Steamship companies relied on the immigrant trade as their main source of income into the 1920s. These companies had to inspect their passengers for diseases. Before leaving European ports, the companies had to vaccinate, disinfect, and determine the health of the ships occupants. But often these examinations were superficial.

A physician for the U.S. Marine Hospital Service inspected first and second-class passengers who arrived in New York in the privacy of their cabins. The government believed that these more affluent passengers would not end up in institutions, hospitals, or become a burden to the state because they were more affluent, better fed, and therefore generally healthier than the steerage passengers. On occasion, first and second class passengers had to go to Ellis Island for further inspection because of illness or legal problems.

First and second-class passengers would disembark, pass through Customs at the piers, and enter the U.S. But steerage passengers had to undergo a medical and legal inspection on Ellis Island.

The experience of arriving in America was far different for steerage or third-class passengers. On board, a superficial inspection to check for outbreaks of cholera, smallpox, typhus, or yellow fever occurred. Immigrants in steerage traveled across the ocean below the waterline of the ships. It was crowded and could be unsanitary and unhealthy. Atlantic Ocean crossings, which could last up to two weeks, could be rough, and often left all passengers sea-sick. Arriving in New York City, ships would dock at the Hudson or East River piers.

Ships carrying passengers with contagious diseases were quarantined and flew a yellow flag at their masthead. Authorities then took those passengers to contagion hospitals on Hoffman and Swinburne islands.

The Inspection

Once they left Ellis Island, immigrants entered the main building where authorities inspected their bags. Then the new arrivals walked up a stairway to the first in a series of medical inspections. Public Health doctors watched as the immigrants climbed the stairs, looking for signs of wheezing, coughing, or limping, which might have indicated health problems.

In the Registry Hall, an inspector stamped the immigrant’s health inspection card. As the immigrant read what was on the card, doctors looked to see if they revealed any eye problems.

“Beware of the eye man.” The second medical inspection was well known to many immigrants before they event left home. This painful exam checked for trachoma, a highly contagious disease that caused blindness. Officials immediately deported anyone found with trachoma.

Men and women were segregated for inspection, and female doctors and nurses examined the women. By 1924, the Public Health Service had four female physicians on duty. After completing the exams, immigrants waited until their names were called so that they might leave or be taken to another facility.

Ellis Island had its own hospital, contagious disease ward, mental health ward, autopsy theatre, morgue, and crematory. In 1911, physicians examined nearly 750,000 immigrants. Of these, almost 17,000 had physical or mental health problems, which included 1,363 with loathsome or dangerous contagious diseases and 1,167 who had trachoma. Loathsome contagious diseases included favus (scalp and nail fungus), syphilis, gonorrhea, and leprosy. Dangerous contagious diseases included trachoma and pulmonary tuberculosis. During Ellis Island’s history, more than 3,500 immigrants died on the Island, including 1,400 children and more than 350 babies were born.

Additional Resources

This 2007 film discusses the immigrant experience in the hospitals at Ellis Island. It aired on PBS and is played at the Ellis Island Great Hall Museum. (55 min runtime).

Other Lesson Plans and Unit Plans

  • Common Sense Media lesson plan for teaching epidemiology in middle school.
  • PBS LearningMedia Epidemiology: Disease Detectives online lesson with a case study about the West Nile virus.

Learning Activities

Other Resources

The NOVA episode, The Most Dangerous Woman in America tracks the epidemiology of Typhoid Fever and the asymptomatic household worker who inadvertently spread it throughout families in New York. This is an extension of the current lesson because it also discusses history, but focuses on disease spreading and epidemiology. View the NOVA episode resources. The teacher guide is currently not available on the NOVA site. The video is also not available at the PBS site, but several copies are available on YouTube. Check out an example of curriculum and lesson plan built around this story. Several sites have teacher worksheets related to the episode. Here are examples:

New York City History: Ellis Island provides information and links to many other resources about Ellis Island and genealogy.

Learn about the history of quarantine from the CDC.

Sharon DeBartolo Carmack, Guide to Finding Your Ellis Island Ancestors (Cincinnati: Family Tree Books, 2005).

See also: Alan M. Kraut, Silent Travelers: Germs, Genes, and the ‘Immigrant Menace’ (New York: Basic Books, 1994).

A detailed set of standards for the teaching of epidemiology at the high school level are formulated in a report by the Centers for Disease Control, Epidemiology and Public Health Science: Core Competencies for High School Students (2015) by Kelly L. Cordeira and Ralph Cordell.

Ellis Island Oral Histories – Since 1973, the National Park Service has interviewed more than 1,700 Ellis Island immigrants so that they could tell their own stories.

Measles Ward G, constructed in 1907, is one of 11 individual treatment wards in the contagious disease hospital complex on Island 3. One of eight wards designated as measles treatment buildings, these buildings also housed patients with scarlet fever, diphtheria, pneumonia and whooping cough. Like the other seven measles wards in the contagious disease complex, Ward G was built from a single, standardized design and arranged in a pavilion plan – a wing and corridor form popular for hospitals since the nineteenth century. The plan isolated contagious patients from those in the main hospital. It also helped prevent the spread of disease among patients with other infectious illnesses.

Ward G’s architectural styling, along with its materials and finishes, integrates it with the other buildings within the hospital complex to form a cohesive design unit. Ward G and its sister wards are the largest and most significant group of buildings within the contagious disease hospital complex.

Child with measles in tent home of his migrant parents in Edinburg, Texas, 1939. Photo courtesy of the Library of Congress.

The U.S. has an ugly history of blaming ‘foreigners’ for disease

President Trump has doubled down on calling covid-19 the “Chinese virus,” after earlier calling it a “foreign virus.” These terms may help him increase political support for closing U.S. borders, but they also reflect a much longer history of racist and xenophobic responses to infectious epidemics. Here’s what you need to know.

Names matter

In 2015, the World Health Organization put regulations in place for naming a novel disease. One regulation attempts to correct previous patterns of using geographic descriptions for disease. The 1918 H1N1 influenza, for example, was generally called the Spanish flu. More recently discovered diseases have also been named for the places they were first discovered, in ways that the WHO now prohibits, including Middle East Respiratory Syndrome (MERS-CoV) and West Nile virus, in large part because such names stigmatize groups of people.

When diseases named by the scientific community come to be understood and disseminated in public, descriptors that link to a place, types of professions (remember legionnaires’ disease?) or contain cultural references can take on novel and stigmatizing meanings that can cause severe harm.

Naming diseases is controversial and delicate. Assumptions about a disease’s origins or about the people associated with it can lead to stereotyping, stigma, and mistreatment, and can hamper public health efforts.

In 1982, as what we now call the HIV/AIDS pandemic was just beginning, a New York Times article described the condition as G.R.I.D. or Gay-Related Immune Deficiency. This name associated the disease exclusively with “homosexuals,” the term the New York Times still used at the time. This had two effects. It treated gay men as responsible for the disease — and suggested the disease itself was only a problem for gay men. This had devastating effects on health responses and harmed health interventions for years. That same year President Reagan’s press secretary referred to the disease — which had by then been named A.I.D.S — as “the gay plague.” Homophobia slowed U.S. responses to the epidemic, and increased open discrimination against gay men in policing, housing, jobs and street violence. At the same time, that stigma slowed public health responses to the disease both within the gay community and outside it — leading the epidemic to spread further.

The U.S. has long blamed disease on people of Asian descent

The United States has a history of assigning blame for disease spread to unwanted immigrant populations, often as justifications for anti-immigration policies — in particular, targeting people of Chinese and East Asian ancestry. The United States relied on Chinese labor as it expanded the continental empire westward and laid claim to the Hawaiian Kingdom. But most people in the United States did not want Chinese people to settle here permanently. In the late 1800s, as concerns about Chinese migration and labor competition rose, public health officials and politicians associated Chinese laborers and migrants with sickness, depravity and filth.


The earliest documented epidemic in Oregon was smallpox. The year was most likely 1781, the date of a major epidemic throughout North America east of the Rockies, though this has been hard to pin down because most estimates come from after-the-fact observations by white explorers of pockmarked individuals. An oral tradition from the Clatsop of a shipwreck and the introduction of a spotted disease, however, dates to a decade before Robert Gray entered the Columbia in 1792, providing a close fit with the timing of the East Coast epidemic.

The epidemic probably occurred throughout the Pacific Northwest. There are records in oral traditions or from white explorers of pockmarked individuals among the Tlingit, Haida, Tsimshian, Kwakwakawakw (Kwakiutl), Nuuchahnulth (Nootka), Lummi, Puget Salish, Tillamook, Colville, Flathead, and Nez Perce. The epidemiology of smallpox—spread easily by a sneeze or through touch—predisposed that it would spread rapidly and thoroughly among concentrated populations and by flight from one community to another. The journals of the Lewis and Clark Expedition describe two instances of pockmarked people in Oregon, one from Clatsop and one from a Chinookan village near the Sandy River. William Clark wrote: "they all died with the disorder. Small Pox destroyed their nation."

We do not know how many people died in the first epidemic, but the records suggest it was large. Virgin soil (that is, first-time) smallpox epidemics generally claim an average of 30 percent of the population, but that figure may be conservative. By the time Robert Gray entered the Columbia in 1792 and non-Native fur traders began frequenting the Oregon Coast, Native populations were already depleted and their cultures were damaged.

Smallpox either kills infected individuals or, if they survive, leaves them with an acquired immunity to later outbreaks. There were more smallpox epidemics in the Pacific Northwest, and their timing—1800-1801, 1824, 1836, 1853, and 1863—suggests that the disease recurred whenever there was a sufficiently large cohort of nonimmune people who had been born since the last outbreak and were, hence, vulnerable to infection. In Oregon, both the 1800-1801 and 1824 epidemics are documented, but neither seems to have been as severe as the epidemic of the late 1700s. The 1836 epidemic is not recorded for Oregon other than in the southwest quadrant, and the 1863 epidemic was limited to British Columbia and Alaska. The 1853 epidemic, however, struck people throughout the lower Columbia, claiming half of the Native communities at Chinook and The Dalles. By 1853, smallpox vaccine was available in Oregon, but it did not reach the Indians.

Do Pandemics Strengthen the Case for Restricting Immigration? [updated with response to Jason Richwine]

The rapid spread of the coronavirus pandemic around the world has led some to argue that it strengthens the case for imposing tight restrictions on immigration. Nationalist populists in Europe have begun to promote that idea. Here in the US, President Trump has endorsed a supporter's claim that coronavirus makes it more imperative than ever to build a wall on the southern border, even though the director of the Center for Disease Control indicates there is no evidence that would help curb the virus.

I'm an advocate of open borders. Still, I have long recognized that limiting the spread of a deadly disease can justify some restrictions on freedom of movement across international boundaries I most recently made that point in my forthcoming book Free to Move (written before the coronavirus crisis began).

At the same time, protection against disease does not justify broader, more permanent migration restrictions. The latter actually imperil health more than they protect it.

I. Quarantines as a Justifiable Constraint on International Freedom of Movement

As I envision it, the argument for open borders is not a case for an absolute right, but one for a strong presumption of freedom to migrate across international boundaries, similar to the presumption of internal freedom of movement in liberal democratic societies. Similar views have been advanced by leading defenders of open borders, such as Bryan Caplan, Joseph Carens, and Jason Brennan, among others.

The case for open borders rests on the points that migration restrictions are severe constraints on liberty, that they doom millions of people to lives of poverty and oppression, and that they do so on the basis of morally arbitrary characteristics, such as who their parents were and where they were born. Migration restrictions also restrict the freedom of natives, as well as migrants, and block the production of enormous wealth that could otherwise have benefited both groups. Finally, most standard arguments for immigration restrictions would—if applied consistently—justify severe restrictions on domestic freedom of movement (and other liberties of native-born citizens), as well. That is particularly true of the theory that governments can justifiably restrict immigration because they have the same right to exclude people from "their" land as private property owners have to restrict entry into their homes. Yet few restrictionists are willing to bite this bullet and apply their arguments consistently to both the domestic and international cases.

But there are cases where these points may not apply or are overridden by other considerations, such as a great evil that can only be prevented by limiting migration. Impeding the spread of a deadly disease qualifies as such.

Saving life is is a major moral imperative. And, at least in some cases, a quarantine may be the only way to achieve that goal in the face of the spread of a deadly disease. This differentiates quarantines from most other arguments for migration restrictions, the vast bulk of which address threats that are overblown, can be addressed by less draconian means than exclusion, or both.

Second, unlike most rationales for restricting migration, this is one widely accepted as a justification for restricting internal freedom of movement, as well. Indeed, the most draconian restrictions on movement enacted by any liberal democracy during the coronavirus crisis so far is Italy's lockdown of their entire population—whose main effect is to prevent Italian citizens from moving around their own country.

If fairly applied, quarantines need not discriminate on the basis of place of birth, parentage or any other morally arbitrary characteristic. They can be imposed on anyone—migrant or native—who poses a sufficiently grave threat of spreading the disease in question.

Finally, unlike conventional migration restrictions, quarantines generally need not and do not last more than a few weeks or months. In most cases, this is a far lesser imposition on would-be migrants than conventional migration restrictions, which routinely exclude people indefinitely, condemning many to a lifetime of poverty or oppression. For most potential migrants to the US and other wealthy nations, there is no "line" they can join to have a real chance of getting in legally within their lifetimes. Not so if the only barrier to entry is a quarantine that will be lifted as soon as the crisis at hand has passed. The short-term nature of quarantines also minimizes the economic harm they cause.

The fact that migration-limiting quarantines are theoretically defensible doesn't mean that all actual policies of this type are justifiable. Here, as elsewhere, real-world governments often fall short of theoretical ideals. Trump's recently announced Europe travel ban, for example, seems unlikely to actually impede the spread of coronavirus. Similarly, it is not clear that Italy's draconian restrictions on freedom of movement are actually effective at the very least, considerable evidence suggests they are much less so than South Korea's far less coercive approach.

Still, it is significant that quarantines can be justified on grounds that differentiate them from more conventional migration restrictions. Few if any of the latter have a comparably strong case. Whether quarantines are defensible in a given situation depends greatly on the nature of the disease in question—an issue I must leave to those with expertise on epidemiology and public health.

II. Why Conventional Migration Restrictions are Often a Menace to Health.

By contrast, standard long-term migration restrictions not only cause greater harm than quarantines, but also often are a menace to health. Perhaps the biggest reason is that they block the production of enormous amounts of wealth by preventing people from moving to places where they would be more productive. A world of free migration would be vastly wealthier than the status quo.

One of the better-established findings of social science is that wealthier societies are also healthier ones. We are healthier and longer-lived than our ancestors primarily because we are much wealthier than they were. Wealth enables us to produce more medical innovations, and allows us to devote more resources to health care. As a consequence, wealthier nations generally also do much better in minimizing the loss of life caused by epidemics. Migration restrictions make the world much poorer than it would be otherwise, and thereby also slow the pace of improvement in health.

In the United States, migration restrictions also imperil health because immigrants and their children are disproportionately represented among doctors and scientists. Many of the doctors treating coronavirus victims and the scientists working on producing a vaccine are likely to be immigrants. We would be in far worse danger without them.

Perhaps the doctors and scientists in question could have made similar contributions to health care if they had stayed in their countries of origin. But in most cases, that isn't true. The US and other advanced nations offer far better opportunities for medical training and scientific research than the often dysfunctional nations from which migrants hail. Scientists, like many other people, are more productive in nations with better institutions.

It can also be argued that the US should let in migrants who who seem likely to become doctors or scientists, but keep out most others. This, however, assumes that government can do a good job allocating labor, and predicting which types of workers will make useful contributions and where. That assumption is unlikely to be true if it were sound, the Soviet Union might have been a great economic success story. Moreover, immigrants who are not scientists or doctors themselves can nonetheless increase the productivity of those who are, by increasing the overall wealth of the economy. As already noted, additional wealth tends to translate into improved health.

Immigration restrictions also imperil health in two more direct ways, both of which have special relevance to the coronavirus situation. First, our immigration restrictions have created a large undocumented population. If members of this group come down with the coronavirus (or some other contagious disease), they may be reluctant to come in for testing and treatment for fear that revealing themselves to the authorities will result in detention or deportation. That could imperil not only the undocumented themselves, but others who come into contact with them.

For that reason, a recent statement by experts in public health and health law urges that health care facilities addressing coronavirus cases should be immigration enforcement-free zones:

Healthcare facilities must be immigr ation enforcement-free zones so that immigration status does not prevent a person from seeking care. The COVID-19 response should not be linked to immigration enforcement in any manner. ​It will undermine individual and collective health if individuals do not feel safe to utilize care and respond to inquiries from public health officials, for example during contact tracing.​​

I worry, however, that the federal government may not adopt this sensible policy. Even if they do, official assurances may not be perceived as credible by migrants who have good reason to be wary of immigration enforcers, who have a history of using deceptive tactics.

Second, immigration enforcement has created a system where the federal government detains thousands of migrants in facilities that often feature poor hygiene and medical care. That increases the risk that coronavirus (and other diseases) might spread rapidly among the detainees, and potentially also imperil the surrounding population.

In sum, there is good reason to believe that migration-restricting quarantines are justifiable—at least in some cases. But that justification does not apply to more conventional long-term migration restrictions.

UPDATE: Jason Richwine of National Review responds to this post, as follows:

Libertarians who take Somin's position — that almost everyone should be allowed to enter, but not terrorists or disease-carriers — need to answer a follow-up question: How do they intend to enforce the restrictions? Surely not with a border wall, which is anathema to immigration boosters. How about expanding the Border Patrol? ICE raids? A nationwide ban on sanctuary jurisdictions? To my knowledge, they oppose all of these tools for immigration enforcement.

In order to place meaningful restrictions on who enters our country, we need to have mechanisms in place to ensure that the rules are being followed. That's true for any immigration policy short of open borders. Whether the law bars nearly every foreigner or just a handful of bad actors, enforcement is required to make it happen. And such an enforcement regime cannot instantly materialize in a crisis — it requires an existing set of institutions and procedures developed over time.

As noted in my post, a pandemic can justify not only restrictions on international freedom of movement, but also even some constraints on internal mobility. It does not follow that we must have a large-scale ongoing regime for constraining internal freedom of movement. We can instead have special rules that apply only during an appropriate crisis, and resources to implement them that are available in reserve. When it comes to terrorists and similar bad actors, we can use law enforcement to track international terrorists, much as it does with domestic ones, without a general regime of constraining internal movement.

These sorts of policies do require resources. But nothing like the massive enforcement regime that currently exists to keep out the far larger number of potential migrants who wish to enter during normal times in search of greater freedom and opportunity.

Indeed, the extra wealth generated by increased migration and by reductions in conventional "border security" spending can easily be used to fund a more limited enforcement capacity focused on unusual crises, such as pandemics. And, as noted above, "ordinary" border enforcement has side effects that actually make combatting pandemics more difficult.

Disease and Immigration - History

At the end of the 20th century, long-distance migration increasingly involves the movement of people from Third World to advanced industrial countries. Contributing to this immigration flow is a growing income gap between the richer and poorer countries Third World populations increasing faster than economic growth political conflicts that create large numbers of refugees and improved means of communication and transportation, which alert migrants to opportunities available in affluent countries and make it easier to travel to them.

Perhaps the most important factor stimulating global migration in the late 20th century is the advanced countries' need for workers to perform low wage jobs that their own citizens are unwilling to take. A heightened demand for low-wage laborers from underdeveloped areas arose at mid-century. During World War II, the United States instituted the bracero program to bring migrant farmworkers from Mexico. After the war, many Western European countries brought in guestworkers to work in construction, manufacturing, and service occupations. Many of these guestworkers came from North Africa and Eastern and Southern Europe and former European colonies.

During the prolonged period of economic stagnation and inflation that began with the oil price hikes of 1973, immigration became an increasingly contentious political issue. Many European countries encouraged guestworkers to return to their homeland. Across the western world, societies debated whether to restrict immigration.

Due to advances in communications, including the spread of cable television, the development of videocassettes, and the declining cost of long distance telephone service, migrants are able to maintain contact with their native culture to a much greater degree than in the past.

Watch the video: Americas Biggest Issues: Immigration (August 2022).