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 March 2007 | Back to Table of Contents

Book Review

Spreading Germs

A medical historian looks at how diseases from foreigners have fueled fear.

When Germs Travel: Six Major Epidemics That Have Invaded America since 1900 and the Fears They Have Unleashed, Howard Markel, M.D., 2004, Pantheon.

We are a nation of immigrants. Traipsing back through our genealogies, all of us, except for Native Americans, will eventually find an ancestor who came to the United States as a foreigner, a stranger confronting a strange land. Americans rightfully pride themselves on the success of our 200-year melting pot experiment

Diversity built America, and in 2007, the United States is more diverse than ever, and we daily experience globalization. Yet immigration has always had a dark side. For decades, the “huddled masses” of Emma Lazarus’ poem enshrined on the Statue of Liberty have frightened many descendents of immigrants, who associate newcomers with economic competition, social disruption, and a general invasion of “foreign-ness.” And fear of allegedly “disease-ridden” newcomers has long added fuel to politically charged immigration debates. Howard Markel, M.D., a University of Michigan professor of pediatrics and the history of medicine, explores such fear in his recent book When Germs Travel.

The grandson of Eastern European Jewish immigrants, Markel became fascinated with the technique of quarantine during his history of medicine studies. As one of the only weapons for fighting infectious disease during the preantibiotic era, quarantine singled out disease victims and isolated them from the rest of society. Immigrants passing through New York’s Ellis Island who were diagnosed with an infectious disease faced immediate segregation in the Contagious Disease Hospital and possible return to their native land even before they started the slow, sometimes painful, integration into American society.

With Americans already wary of immigrants, disease frequently became a label that identified the suspicious, even though, as Markel notes, the percentage of immigrants who were denied admission to the United States between 1892 and 1924 because of health reasons was “miniscule.”

In When Germs Travel, Markel highlights six diseases that became associated with immigrants—tuberculosis, bubonic plague, trachoma, typhus, AIDS, and cholera—and provoked reactions from the American public and public health authorities that ranged from mild concern to irrational panic.

In the early 20th century, the highly contagious eye disease trachoma, now known to be caused by Chlamydia trachomatis, “came to represent the embodiment of germs that traveled,” according to Markel. The disease sparked an effort to pinpoint and quarantine its primarily Eastern European Jewish victims at Ellis Island, and it was “a topic widely discussed in best-selling books, newspapers, and popular magazines and even at school board meetings, where local outbreaks were often blamed on immigrant children and their families.”
Similar to trachoma’s association with Jews arriving from Poland and Russia, typhus in 1916 became known as a “Mexican disease.” The Mexican revolution that took place between 1916 and 1917 sent thousands of Mexicans across the border into the United States. Discovery of typhus in some of those immigrants led the U.S. Public Health Service to declare a public health threat and to sanction delousing of all immigrants and day workers using kerosene and gasoline baths at the El Paso border crossing. Following a fire at one of the gasoline baths, Mexican workers rioted. All this furor stemmed from an organism that, in the years 1914 through 1917, caused only 31 cases of disease in the entire United States.

A more recent example is the initial description of AIDS in the early 1980s, which included Haitians as a high-risk population along with heroin addicts, homosexuals, and hemophiliacs. According to Markel, “In the eyes of most Americans, being labeled as a member of a ‘risk group’ was synonymous with being both a carrier of AIDS and a public health threat.” He describes beatings of Haitian children and instances in which Haitian immigrants were refused service at grocery stores in the United States. Into the 1990s, long after the isolation of HIV as the cause of AIDS and public exposure of the flourishing Haitian sex tourist trade as the explanation for Haitian AIDS, Haitians were still being excluded from donating blood. Despite the science, the fear lingered and guided policy.

Markel illuminates these six diseases with poignant stories, though not all seem pertinent and he sometimes gets bogged down in describing disease details that detract from the flow of his narrative. But his fundamental theme is sound: As America gets more tightly enmeshed with the rest of the globe, our response to diseases originating in this country or elsewhere should not be fear and rejection of certain groups but concern and action based on objectivity and science. MM

Charles Meyer is editor in chief of Minnesota Medicine.
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