Americans of the late 19th century were ambivalent about immigration. Because the nation's booming industrial economy created a need for laborers, popular opinion grudgingly tolerated the admittance of foreigners. At the same time, as Kraut, an American University historian, shows, Americans' xenophobic tendencies (never too deeply buried) were stirred up by contemporary beliefs about the origins of disease. According to the dominant theory of the late 19th century, infections and epidemics were caused by decaying organic matter that provided a hospitable environment for disease-causing "contagia." By popular logic, the damp, filthy tenements where immigrants lived offered a perfect environment for the contagia to flourish. Branding immigrants agents of disease, Americans cried out for measures to protect the public health.
States responded with various quarantine measures which further stigmatized newcomers as a menace to the national welfare. By the 1890s, American concern over disease-carrying foreigners had reached such a pitch that Congress passed an act requiring immigrants to have physical examinations before departing from their native countries and after arriving in the United States. Those who failed were barred from entry.
The collision of cultures only began at Ellis Island, where an authority-cowed immigrant could be rejected as a mental defective for displaying anxiety in front of the uniformed Public Health Service physicians. Misunderstandings and distrust continued thereafter. American health professionals and reformers tried to preach the gospel of sanitation to immigrants living in overcrowded, unsanitary conditions. But many foreigners chafed at the exhortations of intrusive Americans asking them to abandon their traditions. Preferring to rely on amulets and herbal remedies to cure disease, many immigrants distrusted hospitals ("a place you go to die") and organized American medicine in general "cold and impersonal").
Yet, as Kraut relates, the history of immigration and public health has some bright spots. The swell of immigration from the 1880s to the 1920s brought improvements in health care for all Americans. Hospital construction boomed. The institution of the "school nurse" came as a boon to all children who were not receiving proper medical attention at home. Yearly physical and eye examinations for schoolchildren became mandatory. And, finally, the infusion of foreigners into the labor force, often in dangerous jobs, forced lawmakers to pass legislation protecting the health of all U.S. workers.
The story that Kraut tells is not completely behind us. The government's classification of Haitians during the 1980s as a high-risk category because of AIDS and more recent worries about foreigners infected with tuberculosis show that some things remain the same.