Alan M. Kraut’s Silent Travelers: Germs, genes, and the “Immigrant menace” traced American’s efforts to cope with immigrants whose labor was needed, but foreignness was feared. Nearly every ethnic group that has migrated to the United States, Kraut wrote, was greeted by hostility. During America’s peak immigration period between 1890 and the 1920’s , Americans have blamed the Irish for bringing cholera, the Italians for bringing polio, the Chinese for carrying bubonic plague, the Jews for spreading tuberculosis, and the Haitians for bringing AIDS.

Kraut describes the relationship among disease, nativism, and those prejudices and polices that expressed resentment to the foreign- born. Nativists and public health was most affected by the development of medical bacteriology by Louis Pasteur, Kraut explained. The germ theory and other advances helped physicians’ ability to test for pathogenic organisms, which increased medicine’s value in excluding infected newcomers (p. 4).

However, medical improvements also provided groundwork of hope that with better health care and education, America could allow an equal opportunity for immigrants and natives to compete for political power and to culturally influence the society. Though, Americans broadcasted data that suggested certain diseases were more predominant in foreigners than natives, which added the doubt that immigrants could prove they were equal to the native-born (p. 5). Kraut stated that health education and preventative care could remake an outsider into an insider.

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Assimilation for newcomers was the ultimate goal. Not all believed medicine was a devise to help with foreign inclusion. As Kraut wrote, “Eugenicist, for example, argued that only exclusion and careful education in right choices of human breeding could dilute the potentially disastrous impact that the inferior nature of the foreign-born could have on the future of America physical and mental vitality” (p. 5). The quote demonstrated a problem for integration because most politics were eugenicist. Politicians seized on medicine as a justification to health policies towards newcomers.

However, because America was in high demand of labor, there was a pressure to admit newcomers rather than to exclude. Public policies, which affected immigrant’s health and hygiene, required negotiation between the natives and newcomers (p. 6). Immigrants did not abandon or negotiate their traditions of healing for American’s health care. For example, Kraut explained that Asian immigrants were turning to Asian herb shops rather than consulting a physician. Eventually, this turned into a federal event. Newcomers were hardly passive when it came to their choice of health care.

Americans defined better health as changing traditions and other trusted therapies to create assimilation. Though, various ethnic groups turned to their own institution to maintain their cultural identity (p. 9). Not accepting American traditions created disagreement between natives and newcomers not only in the courts, but also, in hospitals, and the workforce. Kraut’s first chapter, “’The Breath of the Other People Kill Them’”: First Encounters”, argued the Columbian exchange. Many Native American tribes were endangered of extinction because of the contamination the newcomers brought.

Once the interaction of natives and newcomers occurred, many tribes died from malaria and tuberculosis. An estimated 1,100,000 Indians were reduced to 10,000 by disease (p. 13). Horrendous mortality rates were also due to swine influenza. The hogs that were traded with the Columbus expedition appeared to have spread infection. Before Columbus, Native Americans were not exposed to domestic animals, thus, they were first exposed when Columbus landed with sheep, horses, cows, and other animals. Because natives had no immunity to animal viruses; the animals were the mediators to most deaths.

Though, it was not long until Native Americans were being affected with human-borne diseases. Illnesses that Europeans classified as childhood disease, such as, whooping cough, small pox, and mumps, had affected many Native Americans due to their lack of natural immunities (p. 14). Because many members of tribes had died from sickness, survivors had often merged with other tribes. Each merge required assimilations, which weakened tribal rituals and traditions. Dealing with these diseases, as Kraut wrote, Natives were culturally and biologically at a disadvantage.

With the growing fear of disease; the start of legislative quarantine was formed. Quarantine was the first line of defense. Kraut explained a colony in Massachusetts passed a law that selectively excluded the sick or physically disabled. A quote from chapter one explains, “No Lame, impotent, or infirm persons, incapable of maintaining themselves, should be received…” (p. 23). Kraut stated that by 1916, exclusion reached up to sixty-nine percent. The mystery of what kind of people to admit into American and how to increase their physical and mental potential was a central theme of immigration history and health care in the United States (p. ). The background knowledge of how the white man’s disease killed off many natives and how to deal with the spread of disease was the main theme in Kraut’s first chapter. The chapter demonstrated that the damage of epidemic disease caused Americans to stigmatize whole nations the foreigners as disease carriers. As immigration increased, due to the expansion of the industrial world, reliance of quarantine and distrust of foreign-born regulated immigration laws and how people viewed different ethnic groups.

Cholera, a silent traveler, as Kraut explains, hit the coast of New York and other east coast ports when increasingly larger numbers of immigrants were arriving. Cholera is an acute disease that is obtained through infected water or food by another contaminated person. After wiping out most of Europe, the infection began to spread westward in 1832 (p. 32). Large numbers of immigrants were infected, especially in poor areas where Irish immigrants lived. Many American perceived a link between cholera and the Irish. After this out break, many examinations and medical inspections of emigrants were admitted.

In 1849 another cholera epidemic struck. Kraut stated that 4,309 of the 5,301 patients were foreign and more than forty percent of the patients were Irish born (p. 35). Just like in 1832, the connection between cholera and Irish was made. The native-born favored taking care of a love one at home, while sick foreigners were sent to institutions. Avoiding the poor conditions of hospitals and “society’s bottom rungs”, as Kraut wrote, which included many immigrants, natives dodged infections, while the immigrants were exposed to uncleanliness and poverty (p. 39).

In chapter two of Silent Travelers, Kraut illustrated how the fear of disease and immigrants merged into the stigmatization of groups, such as, the Irish. Immigration sent uneasiness through Americans, especially in the areas the Irish and other sick foreigners existed. The response to cholera and the Irish resulted in the exclusion of foreign-born who threatened America’s health. Kraut also used this chapter as a template for the rest of the book by examining a particular theme of concerns of public health by stating health problems persisted from unsanitary domestic environments rather than the immigrants themselves.

American opened its door to many needed laborers from around the world; however, the need to protect public health was most important. Quarantine procedures were designed to exclude infectious people and to defend from epidemics; however, those procedures did not seem adequate. Fears of immigrations were so strong it influenced public health to move to Congress. Government acted to exclude immigrants though passing the Act of March 3, 1891. With this act, immigrants had to undergo health inspection before leaving and after arriving in the United States (p. 51). Standing in examination lines became a pre-boarding routine.

Emigrants also had to answers a long list of questions before departure, mainly relating to their medical history. However, those who could afford to travel in first or second class had medical exams that lasted only minutes. Upon arrival, most immigrants spent only a few hours at the depots, Ellis Island is one of the more well-known depots, as Kraut explained. Examinations were the part of the journey that was most traumatic. With each arrival, a uniformed officer pinned an identity tag on the immigrants’ clothing (p. 54). Now labeled, each newcomer had to await another scrutinizing examination.

For example, testimonies of newcomers stated the eye examination was most frightful and painful (p. 55). These examinations were meant to exclude the physically and mentally unfit for American society. In describing the precautions that were taken by Americans, Kraut highlighted the insensitive demeanor of officials and physicians during examination of immigrants, especially in Ellis Island. Most medical diagnoses were altered based on one’s ethnic background. Kraut illustrated in this chapter that scrutinizing immigrants for their varied appearance suggested an inferiority that the natives feared could be infectious.

Stereotyping others created a manner that demonstrated a sense of ethnocentricity. Though, officials were only trying to protect the public health, Kraut stated there was no epidemiological evidence that the physical condition of immigrants have set off a public health crisis. Branding an innate inferiority on immigrants did not seem fair. Kraut also demonstrated a shift from state authorities to regulating immigration policies to a growth in the federal government power. Americans feared that if they made contact with immigrants, or aliens, they would find themselves sick.

Whether it was immigrants’ physical features or habits of personal hygiene, many Americans feared foreigners as health threats. Hopes of health codes and laws increased so the people would be protected from the sickness that lurked around immigrants (p. 79). In California, the want for immigration restriction was heightened. Many people living in California blamed the Chinese for various diseases. Complaints of Chinamen not following sanitary laws and hiding cases of illness, such as small pox, were rising. Kraut told a story about a Chinese man name Chick Gin, who died from the bubonic plague.

Because of this, a huge response from American officials occurred. The chief of police ordered a blockade on the Chinese area in San Francisco (p. 84). Due to the fear of spreading the bubonic plague, Chinatown was under quarantine. The Chinese were unable to obtain much work because of these new restrictions. Many Chinese workers lived under quarantine even if they should no signs of infections. Another story Kraut wrote about was on an Irish woman named Mary Mallon. Mallon infected many individuals with typhoid fever. However, Mallon’s case did not stir up a wave of anti-Irish.

In Kraut’s chapter four of Silent Travelers, he proved preexisting prejudices and social perceptions played a role in creating the reaction of public health and immigrants. Race and gender played a role in the two stories. The chapter was intriguing because it differentiated between two situations, one in which disease provoked a response and another in which it did not. Here Kraut contrasts the obviously racist reaction of San Francisco authorities to the appearance of bubonic plague in Chinatown with the tolerant treatment that allowed an Irish woman to infect more than fifty people.

Many health officials could not ignore the fact the different ethnic groups’ traditions and rituals concerning health were imposing with their policies with the immigrants. Kraut stated officials would blame immigrants’ poor health due to their deficient practices. Now, the Italian immigrants are the main concern to America’s public health. Health officials traced a source of typhoid to an Italian immigrant working on a farm. At the farms, Italian immigrants drank contaminated water and suffered infection. The sick laborers returned to their families where they unknowingly infected other people (p. 107).

Instead of blaming the contaminated water, officials stated the fresh salads and raw vegetables the Italians ate were the primary source. With sanitation and hygiene improvements, there was a decrease in the epidemic of typhoid. However, in the early twentieth century an outbreak of polio occurred, which once again was linked to the Italian immigrants. Many agreed that Italians’ poor life-style made them vulnerable to polio, which they then spread to the natives. Many Italian immigrants lived in crammed, filthy neighborhoods. Italian neighborhoods were then filled with pamphlets and signs urging them to better their hygienic practices.

Also, all public gatherings were monitored by health officials. Though, education and bans on group gatherings did not help the polio outbreak. The next option was quarantine. Nurses and doctors had the power to confine families to their homes (p. 192). Because of this, many Italian immigrants feared nurses and doctors. Quarantine of Italian immigrants cut the families off many benefits. In this chapter, Kraut illustrated how insensitivity to cultural differences between the native and Italians caused disrespect and resistance between the two groups. Kraut highlighted how Americans believe Italian immigrants were seen as inherently unhealthy.

However, immigrants fired back by saying poverty and unhealthy conditions they encountered after arriving in the United States compromised their health. The filthy and poor conditions of homes were the grounds to the polio pathogen, which responsibility should then be placed on the government for failure to achieve “good municipal housekeeping” as Kraut stated. Educators and physicians wanted to educate the immigrants’ youth about health and hygiene. Their motives were selfish, as Kraut informed, because such reforms could only reach those who were willing to abandon their old traditions.

Proper hygiene was seen as crucial to the Americanization of immigrants. Vaccinations at schools became a protocol to school medical inspections. Health inspections turned into a search for victims of illness among school children. However, soon buildings became the subjects of inspections, rather than children. Too many schools were found unsanitary and unsafe. Disease infested barns and stores were divided into youth classes. Kraut stated that according to public health historian John Duffy, in almost fifty percent of public school, boys urinated and defecated on sides of buildings (p. 234).

Many believed that such conditions contributed to making school grounds an environment of disease. Thankfully change came to the state of Massachusetts. Legislature passed a sanitary code of school building that then was passed on to many different states. Legislation also passed many laws that required more thorough examinations that revealed a wider range of illnesses that posed a threat to American society. Many children were excluded from class because they were found to have such diseases as measles, mumps, small pox, and scabies. Aside from disease, many children were found to have poor diets and hygiene.

Exams, such as eyesight tests were required in the state of Connecticut. If students had to squint while reading a chart they would be classified as having a defect (p. 241). Because spending of education was a local responsibility, in the nineteenth century, Kraut wrote, there was minimal funding. However, in the chapter of “East side Parents Storm the School” there was a shift of local responsibility to government responsibility. Kraut explains how legislation took over many laws corresponding to school health. Many nurses and physicians were hired to perform annual inspections.

Health officials gave physical examinations, but most importantly educated immigrant families on disease prevention. In this section of Silent Travelers, the reader sees how public schools were trying to make immigrant youth and families healthy by American standards. Aspects of American culture have been sculpted by immigrants. Public health and American medicine is no exception. In the meantime, Kraut’s Silent Travelers: Germs, genes, and the “Immigrant menace” illustrated how immigrants have been scrutinized by nativists’ suspicion that they are accompanied by germs and disease.

American public health officials were not generally nativists; however, ethnocentrism frequently caused them to link disease to different ethnic groups. Epidemics and immigrants have suffered a lethal association in the public mind, from the Irish wrongly blamed for the cholera epidemic, the Chinese in San Francisco for causing the bubonic plague, to the Italians spreading polio. Through Silent Travelers, Alan Kraut showed how the tie between diseases with foreigners and genetic inferiority affected immigration policy, health care, and the workforce.

The book was also enriched with many immigrant voices. Irish, Italian, Jewish, Latino, Chinese, and others told their stories and experiences with medicine and American prejudice. Kraut’s main idea was to illustrate those immigrant populations, made up of impoverished laborers living in America’s least sanitary and poor conditions have been victims of illness rather than their heritage. However, the medical field has often blamed epidemics on immigrants’ traditions, habits, or genetic heritage. Kraut’s book explained the double helix of health and fear that sticks with immigration.


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