“At critical junctures in American history, immigrants have been stigmatized as the etiology of a wide variety of physical and societal ills,” write scholars Howard Markel and Alexandra Minna Stern. “Anti-immigrant rhetoric and policy have often been framed by an explicitly medical language, one in which the line between perceived and actual threat is slippery and prone to hysteria and hyperbole.”

Markel and Stern explore the persistence of the notion that “immigrants threatened the health of the nation,” with “health” here being defined in both the public health sense and the ideological (political, moral) sense. So powerful is this persistence that some descendants of those who were once stigmatized now do the stigmatizing.

Because most Americans are the descendants of immigrants, a division between “us” and “them” developed around the twentieth century, when a politically freighted distinction between the “old” immigrants who came from northern Europe and the “new” immigrants from eastern, central, and southern Europe seemed necessary. Between 1819 and 1880, 95 percent of immigrants came from England, Scotland, Ireland, Germany, France, the Low Countries, and the Nordic countries. By 1892, people from northern Europe made up less than 50 percent of immigrants, and that percentage steady dropped as arrivals from Russia, Poland, Austria-Hungary, the Balkans, Greece, Italy, Spain, Portugal, and Turkey increased.

These new immigrants ran afoul of hardening racial and eugenicist ideologies that defined them as not quite “white” and therefore biologically inferior and disease-ridden, a threat to both public health and a fantasy of racial purity. A diagnosis of a “loathsome or dangerous contagious disease” as the Immigration Act of 1891 put it, at the border “almost always meant deportation,” write Markel and Stern. At entrepôts such as Ellis Island, the US Public Health Service (USPHS) acted as the lookout for contagious diseases. But they also looked for cardiac problems, goiter, trachoma, sexually transmitted diseases, and parasitic infections, as well as “insanity, hernias, rheumatism, senility, malignancies, varicose veins, poor eyesight or blindness, and a range of other infirmities.”

In 1898, some 2 percent of excluded immigrants were rejected entry for medical reasons. (Other reasons included being a contract laborer, criminal, or sex worker.) In 1915, 69 percent of all exclusions were based on medical criteria. This was because the list of medical reasons got longer and longer: the “creation and application of categories of medical exclusion outpaced the actual presence of diseases among the newly arrived.”

On the West Coast, Chinese, Japanese, and Korean immigrants coming through Angel Island were sent back in larger percentages for medical reasons. While “Chinese comprised only 1 percent of the nation’s immigrants [1910–1940],” Markel and Stern write, “they accounted for more than 4 percent of all immigrants deported each year.” (italics in original)

The US/Mexico border, meanwhile, was fairly porous until the early 1900s. In 1917, however, the USPHS, concerned about typhus in Mexico, declared a quarantine over the border.

“Entrants were stripped naked, showered with kerosene, examined for lice and nits, and vaccinated against smallpox,” write the authors.

The typhus scare was soon over, but medical inspections remained in force until the late 1930s, as “a public health response to a manageable epidemic had metamorphosed into a protracted quarantine along the entire border,” Markel and Stern explain. The “harsh reality and duration of the quarantine helped generate and underscore stereotypes of Mexicans as impure and infectious.”

Communicable disease wasn’t the only perceived threat. Eugenicist pseudo-scientific race theories postulated that non-white/Nordic/Aryan immigrants were a threat to the gene pool and therefore the future.

“Long after the admission to American ports and borders of the ‘neurasthenic’ Jew, the ‘criminally minded’ Italian, the grimy Mexican, or the parasite-ridden Asia, their defective genes would multiple and defile the national body,” write the authors.

Eugenics were a big impetus behind the extreme tightening of immigration in the early 1920s. These restrictions, in place for four decades, didn’t end the associations of immigrants and disease, but these connections were overshadowed for a time by the fear of political contagion: communism became the new communicable disease. Post-Cold War, fears of immigrants with HIV, drug-resistant TB, Zika, and the “China Virus” (as some xenophobes named COVID-19), among others, popped up again and again.

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