Books and Arts

Hate in the Time of Cholera

By

Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892by Howard Markel(Johns Hopkins University Press, 262 pp., $29.95)


The Yiddish language is only scantily endowed with cuss words. In the shtetlakh of Eastern Europe, it was impossible to "swear like a trooper" or to "curse a blue streak," because the requisite vocabulary did not exist. Still, whatever they lacked in "goddams" and "fuckin' assholes," the millions of Yiddish-speakers of yore were more than adequately compensated by a vast store of imprecations. Limited only by their own linguistic ingenuity, yesteryear's Jews could call misfortune down on the heads of friends and enemies alike, in terms so colorful and even amusing that they later became staples for the Catskill comedians, to wit, "vi a tsibbeleh zolst du vaksen, mit kup in der erd un fis in di luft," "you should grow like an onion, with your head in the ground and your feet in the air," or "vi a kandelaber zolst du zein, hengen beitag un brennen beinacht," "you should be like a chandelier, hanging by day and burning by night."


I learned about these things at a tender age. The rear windows of the small apartment in which I grew up faced out onto a concrete-paved space, surrounded on its four sides by the walls of the two adjacent buildings, ours and the real apartment house next door. Into that busy little square would come an endless stream of old-clothes peddlers, street singers, itinerant tradesmen of various sorts, and other representatives of that entire spectrum of penny-hucksters who made their precarious living by working the backyards of the Bronx in the decades before World War II. My little courtyard had the acoustic qualities of a vertical megaphone five stories high. On summer days, amplified words flew in and out of open windows as though the speakers intended that their conversations should reach the most remote corners of every neighbor's rooms.


Thanks to a constantly bickering couple on the third floor, I enlivened my vocabulary with a goodly store of old-world maledictions before my eighth birthday. The acrimonious Weinstein and his acid-tongued missus lived in a state of perpetual warfare. Although they were not particularly innovative in their verbal assaults on each other, their mutuality of eye-bulging hatred could be depended upon to provide periodic bursts of the more common classics of Yiddish execration. Being much taken, even at such a tender age, with alliteration and parallelism, I was especially fond of "a brannt dir in di kishkes, a bruch dir in di gedayrim:" "there should be by you a burning in the intestines, a breaking in the guts."


The reason that intestinal burning and destruction was so powerful an allusion was simply that it called up a reality of common experience. The immigrant Jews of my childhood knew of such things by having suffered the agonizing symptoms themselves or by having witnessed them in others. To have them wished upon oneself conveyed the absolute earnestness of the curse. Unlike ineffectual references to theoretical onions or chandeliers, the anguish of intestinal fires was not drawn from the imaginative mental meanderings of a ranting belligerent. Such dreadful wishes might actually come true. Everyone of Eastern European origin was familiar with cholera.


 



Wishing cholera's ravages on his wife was more often than not followed by Weinstein's direct invocation of the feared name itself: "zol a cholerye dir choppen!" "May you be seized by cholera!" Though less evocative of the fearsome imagery, this form of the wish left no doubt as to the speaker's meaning. Die, he said, but first endure horrible suffering.


The vast majority of Eastern European Jewish immigrants came from the Russian "Pale of Settlement," a vast landmass that included what is today's Ukraine, Belarus, Lithuania and much of eastern Poland. Beginning in the early part of the nineteenth century, the Pale had suffered one after another epidemic of cholera, and virtually everyone of Weinstein's generation had intimate knowledge of the pestilence's horrors. They are vividly described in Howard Markel's remarkable chronicle of a single landmark year in the history of the inextricable bond that has often been forged between immigration and contagion.


The onset of cholera typically begins with the victim's non-specific sense of simply not feeling well. Soon after this intuition of illness, sometimes in only a matter of hours, there comes a violent wave of vomiting and diarrhea. So forceful are the choleraic propulsions, from both ends of the gut, that the victim experiences intense, painful spasms of the abdominal muscles. The relentless diarrhea soon gives way to dehydration and shock. The victim's face appears blue and tight; the eyes are deeply sunken; the mouth and lips are parched and cracked. The cholera victim's vitality wanes as the diarrhea increases, accompanied by a clouded sense of reality, painful muscle spasms, seizures and coma. Between 30 percent and 80 percent of all cases of cholera during this period resulted in death.


Observers of cholera have likened the victim's massive evacuation of diarrheal stools to "rice water," because of their distinct appearance of dirty water studded with flecks of gray white matter (damaged and shredded intestinal lining). So copious is the loss of fluid by diarrhea that physicians employed a special "cholera bed," which was little more than a canvas cot with a hole cut in its center and a large bedpan placed directly below it. Even today, untreated cholera continues to carry a mortality rate approximating 60 percent, and no one is spared the brannt and the bruch.


Cholera well deserves its reputation as a disease of the poor. The causative bacterium, Vibrio cholerae, finds its insidious way into the intestine via human fecal contamination of the water supply. Whether in drinking water or on the surface of washed foods, when significant numbers of microbes have entered the gut of even a robustly fit individual, Vibrio begins to wreak its havoc without delay, chewing away at the intestinal lining until it is shredded and sloughing into the cavity of the bowel. Hence the horrible burning and destruction within. Not much longer than four to six hours after the onset of symptoms, a vigorous man in perfect health will not infrequently lapse into shock and die. Most victims destined to succumb do so within twenty-four hours.


Epidemics of cholera were raging in India as early as 400 BC, when Plato was just beginning to muse under the olive trees and Hippocrates was making his peripatetic way from one to another of the towns of Greece. For unknown reasons, the disease was restricted to the subcontinent until 1817, when a trading ship carried it to the Arabian Peninsula, from whence it began its spread northward through Turkey and southern Russia. By 1826, all of Russia, Poland, Austria, Germany and Sweden were inundated with it. Within five years, the rest of Europe and the British Isles had become lethally acquainted with Vibrio. New York City experienced its first outbreak in 1832.


In the eighty-five years between its initial appearance in Europe and 1902, cholera burst forth in huge intercontinental pandemics no fewer than six times. America's eastern seaboard states were hit hard not only in 1832, but again in 1845 and 1866, the year before Joseph Lister introduced the so-called "germ theory" by demonstrating that infections cannot occur in the absence of microbes. When an extensive epidemic appeared in the Middle East, Russia and other parts of Europe in the summer of 1892, New Yorkers read with mounting fear of its westward spread. The disease was particularly rampant in Russia, then undergoing one of its frequent periods of famine. More than half of its 620,000 victims had died. Riots were commonplace, and a general state of unrest prevailed in many Russian communities, as a poorly educated and panicked population lost any semblance of restraint in the face of the devastation caused by the dread malady that medical historians have given the dubious distinction of calling "the classic epidemic disease of the 19th century."


It was for good reason, then, that New Yorkers responded with apprehension to the ever-worsening news of these unsettling events. Immigration was at an all-time high, and a goodly proportion of it originated in the areas hardest hit by the epidemic. A mixture of age-old prejudice and well-justified concern was directed most particularly at Jews arriving from Eastern Europe, 69,140 of whom had entered the United States in 1891. In the seven months prior to August 1, 1892, 21,531 Russian Jewish immigrants had settled in New York City, the great majority of them having arrived in various stages of poverty.


Still uneasy in the aftermath of an outbreak of typhus fever among Russian Jewish arrivals earlier that year, New Yorkers were fearful that further pestilences might reach them from the same source. Not surprisingly, the typhus had served as a focus around which to rally the ever more vocal opponents of unrestricted immigration. Until the relatively recent past, nineteenth-century newcomers to America had for the most part been the admirably assimilable Scandinavians, Irish, and Germans; but more recent arrivals were thought by many to be so remarkably different from the citizenry of our bustling nation that their becoming part of it seemed unimaginable. This was the period when the tempest-tossed were indeed seen by Americans as "huddled masses" and "wretched refuse," whose appearance, dress, language, religious practices and customs brought entire new levels of meaning to words like "alien" and "foreign." The anti-immigrant fervor had already forced the passage of the Chinese Exclusion Act of May 5, 1892.


Unlike the Chinese, however, the Italian and Eastern European immigrants swarming in large numbers to America's shores, no matter their differences from predecessors, were nevertheless of the same race as those who would attempt to exclude them. Most Americans, narrow-minded or not, were at least just a bit ambivalent about preventing immigration from Europe, and many were unbendably opposed to it. The more bigoted sought objective justification for their inclination toward prejudicial laws, and they found it in the specter of disease. Just as the incoming human tide was rising to its full flood, the Vibrio cholerae and the Rickettsia prowazekii of typhus fever came to the aid of the nativists and the exclusionists. In the perception of many, when the immigrant waves broke on our shores they poured people and pestilence alike into America's crowded harbors.


 



And the busiest of those harbors was New York. So busy was it, in fact, that its tariffs on incoming goods accounted for more than half of the federal government's budget. New York was the port of entry for at least 75 percent of all immigrants. Although many of them moved on to other parts of the country, the great majority of the Russian Jews not only remained in the city, but 82,000 of them had become concentrated in an area of less than a half square mile in size that is estimated--with 523 inhabitants per acre in 1890--to have been the most densely populated area in the world. The so-called Lower East Side is viewed nowadays with a degree of misguided nostalgia by the descendants of its denizens, but it was a district of squalor whose stifling air was fouled, as Markel puts it, with "the odor of rotting fish, meat, and vegetables sold on uncovered pushcarts, the immense amount of animal waste from horse-drawn wagons and trucks, dirty streets and the stench of a crowded humanity." In 1890, Jacob Riis, in his revelatory How the Other Half Lives, described a single, not atypical, tenement in which Jewish parents were raising a total of "fifty-eight babies and thirty-eight children that were over five years of age." The situation is nicely epitomized in a single sentence from Irving Howe's World of Our Fathers: "Life was abrasive, clamorous."


In that summer of 1892, the possibility of an epidemic of cholera was being faced by a populace barely past the outbreak of typhus fever, during which 200 cases had suddenly made their appearance on the Lower East Side. With few exceptions, all the patients had been Russian Jewish immigrants who had arrived on January 30 in steerage aboard the S.S. Massilia, a French steamship whose port of embarkation was Marseilles.


Its precise cause was unknown at the time, but the physicians of 1892 recognized typhus to be a disease associated with crowding and filthy living conditions. (It would later be shown to be transmitted by body lice, which ingest the bacteria in a meal of blood obtained by biting an infected person. When the louse bites the next victim, Rickettsia prowazekii in its feces is ground into the punctured skin by the act of scratching the itchy place.) Known to be easily spread, difficult to diagnose, and with its manner of transmission still a mystery, the disease frightened health officers and the public alike, especially because one of the theories of its origin was that it was emitted by a noxious vapor arising from large groups of dirty people. This was in keeping with the ancient and not completely discarded medical belief in miasma, which held that infectious and other diseases are caused by some vaguely characterized toxic influence in the atmosphere.


 



The response of the health authorities was predictable. Along with the typhus fever victims, the healthy Russian Jewish passengers of the Massilia and many of the contacts they had made in their few American days were rounded up, some of them literally torn from the arms of screaming relatives with whom they had just been reunited. Herded together in quarantine on North Brother Island, five miles up the East River near 140th Street, the bewildered Jews found themselves "downwind from the city's garbage dump at Riker's Island." Neither the ship's cabin-class passengers nor 470 Italians in steerage were detained.


Conditions on the island were even worse than those in the Lower East Side from which the uncomprehending immigrants had been abruptly dragged off. So insufficient was bed space in the closely packed pavilions that many of the 1,200 quarantined Jews (of whom 1,150 never showed any evidence of typhus) were put up in flimsy tents. The outhouses were disgustingly befouled, and the only certain way to bathe was by immersion in the river, when soap could be found. No precautions were taken to prevent previously healthy detainees from acquiring the disease, with the result that six of them died. Medical care was inadequate; the temperature in the first wintry weeks was often in the teens; and the confused, terrified immigrants were left without any way to make contact with the mainland. As if such appalling circumstances needed worsening, the Jews were deprived of the kosher food without which many of them could barely subsist. For those newly arrived from the oppression of Russia, this was a harsh indoctrination into the land of the free and the home of the brave.


In some ways even more egregiously, those who died were autopsied and then either cremated or buried in tightly sealed metal containers, all violations of Jewish laws. It took a major protest by representatives of the city's well-established German Jewish community for the authorities to relent on their burial rules, and then actually to begin the provision of kosher food. By that time, even the typhus-free prisoners (for that is what they were) were "so weak [from hunger] that they fell over each other when they tried to walk about." Still, several newspapers belittled the requests for kosher food, implying that the Jews were overly demanding and ungrateful for what was being done for them.


Health officials responsible for the quarantine justified such inhuman conditions on the grounds that typhus fever must at any cost be prevented from spreading. Even its early symptoms of muscle pain, intense headache and high fever were debilitating. These were followed by the appearance after about a week of a rash consisting of large areas of reddish-pink splotching. In the second and third weeks, blood pressure often fell as kidneys and other organs began to fail, but it was the phase of altered consciousness that was most distressing to onlookers. This often manifested itself as delirium, in which the patient might become incoherent, noisy and violent, requiring constant observation and even physical restraint, lest he injure himself and others. Approximately one in four of the stricken patients died.


 



The result of the strict quarantining was exactly what had been hoped. By April, the epidemic had been conquered and the public was lionizing the Health Department's patrician chief inspector for contagious diseases, Dr. Cyrus Edson, the son of a former mayor and an active member of Tammany Hall and the New York City Democratic Committee. Taking no chances, Edson had employed draconian measures to halt the epidemic, and they had worked. In addition, Dr. William Jenkins, the health officer of the Port of New York (and likewise in political favor, having married the sister of Richard Croker, the boss of Tammany Hall), had not hesitated to invoke a policy of detaining and quarantining every Eastern European Jew coming through the harbor. No other group was affected by the order, which remained in place until April.


William Chandler of New Hampshire, the exclusionist chairman of the U.S. Senate Committee on Immigration, went even further. He proposed legislation severely limiting immigration. His restrictions, aimed at the new kind of immigrant, included a literacy requirement, directed particularly at the Russian Jews. Forbidden under Czarist rule to obtain a Russian education, the great majority of the entering Jews were literate only in Yiddish (few spoke Hebrew with any fluency), which was officially considered a jargon and therefore not satisfying Chandler's criteria for reading comprehension and language.


Emboldened by the success of the anti-typhus measures, and encouraged by the nativist sympathies of so many New Yorkers, Jenkins imposed a strict quarantine over the Port of New York when the threat of cholera appeared that summer, so close on the heels of the typhus outbreak. The cholera scare began with the arrival from Hamburg of the S.S. Moravia, following a voyage on which twenty-two passengers died, twenty of whom were Russian Jewish children under the age of 10. By the time of the ship's landing, the source of the Vibrio cholerae had been traced to drinking water drawn from Hamburg's contaminated Elbe River. But an immediate twenty-day quarantine was nonetheless slapped on all steerage immigrants of every ship entering the United States, no matter its port of origin. The ruling did not apply to cabin-class passengers. In truth, this maneuver was a bit of bureaucratic legerdemain intended to halt all steerage immigration, because no steamship line could afford the $5,000 or more it cost in daily port fees and lost income to keep its vessels in dock.


When several other ships brought in cholera victims, and then sporadic cases were discovered in the city, the panic mounted. Without any supporting evidence from the city's bacteriology laboratories, the authorities instituted the most rigid restrictions and measures, aimed primarily at the immigrants. Kosher butcher shops were closed down for even the most minor infractions of the sanitary code; hundreds of immigrant dwellers in the tenements were evicted from their homes and into the streets, when Edson ordered a meticulous and quite unnecessary inspection of 39,587 houses in the Lower East Side, calling the buildings "breeding places of the allies of cholera;" and each cholera victim was forced into a large canvas bag tied tightly by a drawstring around the neck and in this manner transported to the infectious disease facility at Willard Parker Hospital. These measures, and many others, were utterly inconsistent with germ theory, and more far-reaching than indicated by the facts or recommended by some of the leading medical scientists of the time.


Meanwhile the police in Boston, Chicago, Cleveland, Detroit, Port Huron, Montreal and Baltimore instituted a blockade of railroad stations and all other possible portals to prevent what they called "Russian Hebrews" from entering. Although these were initiatives taken by individual cities and states, they were instigated by Walter Wyman, the Surgeon General of the United States, and supported by President Benjamin Harrison. Harrison was such a strong proponent of restricting Russian Jewish immigration that he stated his position on the issue quite forcefully in two of his annual addresses to Congress. In the 1892 equivalent of what is now the State of the Union Address, he proclaimed that "we have, I think, a right and owe a duty to our own people, and especially to our working people, not only to keep out the vicious, the ignorant, the civil disturber, the pauper, and the contract laborer, but to check the too great flow of immigration now coming by further limitations." Yet the political implications of implementing such a policy were too uncertain to allow the president to pursue it directly. The twenty-day quarantine accomplished his intent, albeit temporarily, and avoided direct public confrontation.


As with the typhus, the cholera outbreak occurred against a background of some uncertainty about scientific reality. The germ theory of disease had been introduced twenty-five years earlier through the research of Louis Pasteur and Joseph Lister, but its acceptance was slow, particularly in the United States. After the initial rejection of the idea, the average American physician had gradually, if still incompletely, become convinced of the validity of most of its precepts. The notion that every infectious disease is caused by a microbe was close to being firmly established by the early 1890s, but some significant reservations still existed, and spectra of scientists supported spectra of variations in the doctrine.


It is Howard Markel's contention, and in fact one of the major themes of his book, that the management of the two New York episodes illustrates the striking tension "between the modern science of bacteriology and the politics of nativism." What is meant by "the modern science of bacteriology" as applied to 1892 is the point here in question, and it is a problem that has been teasing medical historians for the better part of the past fifty years. Although the New York health authorities were being advised by some of the most prominent bacteriologists in the country, Markel points out that these experts were rarely heeded. The behavior of the public officials, in his view, was "more in keeping with traditional responses to the diseased: a scapegoating of those afflicted or perceived to be at risk of disease, namely East European immigrants."


 



That insensitivity, class hatred, nativism and anti-Semitism affected New York's response to the epidemics cannot be doubted. Similar factors have always played a significant role in measures which, at least in theory, are meant to protect a threatened populace. They probably always will. Public danger brings out both the best and worst in the citizenry and its leaders, and has ever served as the shield behind which long-standing hostility toward minority groups is allowed to play itself out. Even considering the perhaps less enlightened era in which it took place, there could have been no justification for the callousness and even brutality with which the immigrants were treated.


And yet a complicating factor must be considered, at least in the matter of scientific knowledge and the willingness to apply it. Pitfalls in judgment have always characterized the analysis of past events, especially those whose unfolding was to a significant extent determined by the factor that might most appropriately be called the spirit of the age--a difficult butterfly to capture and even more difficult to dissect. The recent attention of medical historians to individual hospital charts and the daily case records of ordinary physicians--as opposed to the more traditional study of the writings of major contemporary figures--has cast much light on what actually was occurring in the real care of real patients, as distinct from what the profession's leaders were promulgating. Still, the general mood in which events took place at some past period will always for the most part elude us. As abhorrent as were aspects of the behavior of the authorities, it is virtually certain that they stirred up much less resentment among the populace than they would have had they taken place in the climate of today's pluralistic America.


Markel quotes the protestations of some of the press, and of certain prominent members of the Jewish and nonJewish communities, but the influence of their outrage was not as great as a modern reader might expect. By and large, the immigrants were mistreated in an atmosphere of assent. Attitudes change slowly, and it would be a long time before the essential humanity of the struggling new arrivals would become a major factor in evoking the essential humanity of the emotionally distanced decision-makers. In addressing the calculus of immigrant suffering, empathy was an insubstantial consideration.


William Jenkins was confronted with the uncertainties of the looming epidemic, attacks by both nativists and liberals, and a press that criticized every move he made. In the face of harassment from all sides, he sought refuge in two old patterns of thought: the tradition that poverty and immigration add up to disease, and the exclusionist tradition of his class. Even though no evidence was ever found to support the notion that the cases of cholera within the city (which included ten deaths) were traceable to the immigrants, he instituted stringent measures consistent with the conviction that they were. Markel believes that the commissioner should have known better, or at least behaved in a manner more consistent with what he describes as the state of medical knowledge of the time: "Indeed, the tacit acceptance of steerage immigrants as the cholera vector and the resultant classoriented quarantine effort, rather than the scientific principles of bacteriology, struck the major chord of the Health Department's administration of the crisis."



 


It is precisely here that a small quarrel may be picked with Markel about just what it was that made up "the scientific principles of bacteriology" in 1892. There is no question that several of America's leading authorities on infectious disease stated that many of the precautions being taken were unnecessary. The real issue that must be addressed is the extent of criticism that can rightly be directed at the officials in charge. Buffeted as they were between the nativists and the adherents of open-door principles; by the competing political interests of Tammany Hall and the elements of reform; by the turf battles over various aspects of the public health endeavor; by the sketchy education in the diagnosis and treatment of infectious disease not only of most physicians, but also of the health officers themselves--confronted by all this, their decisions seem to have been motivated not only by the aforementioned retreat to traditional patterns of response, but also by an earnest desire to protect the people for whom they felt primarily responsible: the citizens of their city. Even those who may have overcome an inherent bias against the new species of immigrant should not be overly blamed, in that far less minority-conscious era, for thinking first of those over whose health they had been appointed to watch.


Moreover, historians have recently revised their viewpoints concerning just how much assurance existed in the 1890s about what Markel calls "the scientific principles of bacteriology." In the January 1997 issue of The Journal of the History of Medicine and Allied Sciences, for example, Nancy Tomes and John Harley Warner wrote:



[F]or all the greater sophistication in identifying pathogenic organisms, the interpretation of bacteriological evidence and the study of how germs circulated among large populations was still very uncertain in the late 1890's and early 1900's. In the absence of detailed evidence, public health practices long associated with sanitary science, as well as traditional ideas about disease causation, remained remarkably appealing. And, as perhaps should come as no surprise, ... the indigenous elites dependent on them quickly arrived at explanations that placed the blame on the homes and neighborhoods of the poor.


In acting as they did, the health authorities of New York did what they believed to be the prudent thing, consistent with measures then current among their colleagues all over the world. 1892 was a time when the old "filth theories" (the notion that disease is caused by dirt, on which sanitary science was based) were still so close to the germ theory that it was hard to know where one ended and the other began. No matter the bigotry, the class enmity and the nativism that may have motivated them, the New York officials and the politicians who supported them were acting in the customary and virtually universal manner long applied in anti-contagion efforts.


"The scientific principles of bacteriology" had not yet taken sufficient hold on medical and popular thinking for us, now looking back a century later, to realistically expect them to have done otherwise. The leading medical scientists who were giving advice were far ahead of those who were deciding whether to take it. It would be another decade before the situation would be significantly changed. Markel is clearly aware of all this. His awareness, in fact, somewhat blunts his implied premise, always there between the lines but never overtly stated, that class and ethnic discrimination against this one foreign group was somehow different and in certain respects unique, and that the differentness and uniqueness were the ultimately decisive factors in the officials' behavior.


 



What was being done to the Russian Jews was what had always been done to the poor. The conflict between Markel's sensitivity to the plight of these particular immigrants and his realization that official policy could hardly have been otherwise results in a kind of historical pas de deux in which two accomplished dancers cannot decide which of the pair will lead. First one is more forceful, then the other. Markel, who is himself a physician, never does solve the dilemma; and this is a tribute of sorts to both his scholarly detachment and his compassionate sense of identification with the immigrants. The doctor in him is at war with the historian.


But nothing else in this engrossing book is blunted, nor do his opposing loyalties otherwise strain its author's commitment. Whether discussing the national policy debates over immigration that grew out of the events of 1892 or describing the anguish of individual defenseless and terrified families as they faced the hostility and mistreatment forced on them, Markel's fascination with his subject, and with the personalities of those involved in it, never flags. Even the forums leading up to the Rayner-Harris National Quarantine Act of 1893 are presented in a fashion that is personal and dramatic, while at the same time meticulously documented. Indeed, Markel's documentation (running to fifty-seven pages of endnotes) is almost as absorbing as his text. The range of his book is nicely captured by the content of the very first and very last of the listed references. The former adduces a collection of essays titled Framing Disease: Studies in Cultural History, the latter adduces Fiddler on the Roof.


Quarantine! unites the best of the two worlds of social history and clinical history. And it is written in a narrative style so personal and at times so gripping that a reader forgets that the book is meant primarily to be a scholarly text. A wide variety of personalities appear in Markel's detailed study of this slice of American urban culture taken through the length of a well-defined period in our nation's history. Not only the patients and the public health authorities are brought vividly to life, but so are newspapermen, police, political figures and leaders of the various Jewish-American groups, be they representative of the well-settled Germans or the newly arrived Eastern Europeans. Events and the people who took part in them are presented with an immediacy uncommon in the current climate of specialization and relativism that has lately overtaken the community of historians. Markel is as much spinning a complex yarn as he is writing a scrupulously researched chronicle. Being one of our few card-carrying medical historians who is also a highly skilled clinical physician, he brings perspectives that would certainly have eluded his more sociologically minded colleagues. His work is a refreshing zephyr in a field that is nowadays frequently more windy than enlightening.


Markel resists the temptation to make sweeping statements about philosophy, character and psychology, the sort of empty generalizations that would make him friends in the precincts of multicultural relevance. He restricts himself to creating an accurate picture of a specific series of events that occurred among specific participants in a specific place at a specific time. He has presented his work in a narrative fashion that should be the envy of his colleagues in a discipline that has surrendered more and more to the cholerye of a formalized and recondite practice.


The legislation growing out of the episodes of 1892 was the result of the determination of two far-thinking political leaders who were committed to the principle of separating considerations of immigration from those of public health. In personal style and appearance, they could not have represented more of a contrast. Congressman Isador Rayner, Democrat of Maryland, was the short, balding son of Bavarian Jewish immigrants. Senator Isham Harris, Republican of Tennessee, was a tall courtly quintessential Southern gentleman who had been a supporter of secession. Together they overcame Chandler's scheme of immigration restriction and even convinced Surgeon General Wyman to back their plan.


The Rayner-Harris bill focused only on the public health needs of America's seaports and borders, by creating nationalized standards to be administered by the U.S. Marine Hospital Service. The bill set up specific procedures for medical inspection of immigrants and cargo, and it created a national system of quarantine regulations to be carried out with the cooperation and consent of state or local authorities. The power to suspend immigration on a temporary basis was put into the hands of the president. Harrison signed Rayner-Harris into law on February 15, 1893. The act's centralization of responsibilities would lead to the creation of the U.S. Public Health Service from the Marine Hospital Service in 1902.


Unfortunately, legislation has never erased bigotry. Only seven years after Rayner-Harris was signed, a severe epidemic of bubonic plague among residents of San Francisco's Chinatown resulted in another unnecessarily severe and racially insensitive quarantine, authorized by Surgeon General Wyman himself. The same thing happened to Chicano immigrants in 1924, when they were hit by pneumonic plague. To a greater or lesser extent, in America and elsewhere, it has ever been thus. In our time, we have witnessed the hysteria of some of our citizenry's private and public reactions to aids, not only when it was initially discovered among homosexual men, but also later--even now--as the disease has become increasingly identified with the disenfranchised and with particular immigrant groups. There is no reason to expect that the future will be any different.


Sherwin B. Nuland's new book, The Wisdom of the Body, has just been published by Knopf.

By Sherwin B. Nuland

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