When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed

by Howard Markel

The struggle against deadly microbes is endless. Scourges that have plagued human beings since the ancients still threaten to unleash themselves; new maladies are brewing that have yet to make their appearance in the headlines; lethal germs employed as weapons of warfare and terrorism have reemerged as a worldwide menace. Regardless of their mode of attack, microbes exist to multiply, thrive, and find new hosts; they cross national boundaries and social classes, attacking without prejudice.

Now medical historian and pediatrician Howard Markel, author of Quarantine! (“Engrossing . . . Meticulously documented” —Sherwin Nuland, The New Republic) , tells the story of six epidemics that broke out during the two great waves of immigration to the United States—from 1880 through 1924, and from 1965 to the present—and shows how federal legislation closed the gates to newcomers for almost forty-one years out of fear that these new people would alter the social, political, economic, and even genetic face of the nation.

Markel writes about tuberculosis today, the most serious public health threat facing the contemporary world. He writes about bubonic plague and how it came to this country in the early twentieth century; about trachoma in the years before World War I; about Ellis Island and how an East European rabbi was diagnosed and treated for the dreaded eye infection; about typhus fever and an epidemic on the Texas-Mexico border in the aftermath of Pancho Villa’s revolution; and about AIDS, the Haitian exodus, and the early years of the AIDS epidemic.

Markel explains how immigration in the twenty-first century is characterized by porous borders, rapid travel, and scattered destinations. While more than 75 percent of all immigrants during the first great wave of immigration came through New York Harbor, transportation today allows travel to all parts of the United States from the farthest reaches of the globe, giving public health physicians little opportunity to definitively diagnose infectious diseases that can incubate silently in a traveler, making the spread of epidemics far more than a theoretical concern.

Markel looks at our nation’s response to the pathogens present in our midst and examines our foolhardy attempts at isolation and our vacillation between demanding a public health system so punitive that it worsens matters rather than protects and settling for one that is too lax; how we are fascinated with all things infectious and then hardly give microbes a second thought; how the United States, a country that since its inception has prided itself on being a nation of immigrants, continues its tradition of blaming newcomers for its physical and social ills; and how globalization, social upheaval, and international travel render us all potential inhabitants of the so-called Hot Zone. Finally, Markel puts forth a plan for a globally funded public health program that could stop the spread of epidemics, help eradicate certain diseases, and protect us all.

Genres: History, Nonfiction, Science, Medicine, Health, Biology, History Of Medicine

288 pages, Hardcover

First published May 11, 2004

About the author

Howard Markel, M.D., Ph.D., is the George E. Wantz Distinguished Professor of the History of Medicine, professor of pediatrics and communicable diseases, professor of psychiatry, and director of the Center for the History of Medicine at the University of Michigan. His books include the award- winning Quarantine! and When Germs Travel. His articles have appeared in The New York Times, The New England Journal of Medicine, and The Journal of the American Medical Association. A member of the Institute of Medicine of the National Academy of Sciences, Markel lives in Ann Arbor, Michigan."

Reviews

[Teri · Rating 5 out of 5]

A fascinating look at six diseases that have entered the United States and the paths they took to get here. Markel, a doctor and a professor of historical medicine takes a detailed look at tuberculosis, the bubonic plague, trachoma, typhus, AIDS, and cholera through the eyes of immigrants who have come to the US with these diseases. Each chapter follows a different immigrant and different disease.
Whereas each of these people was not the first to bring these diseases to the US, their stories show how easily the pathogens can travel throughout the world.

Markel's prose is very readable. He is able to explain each disease in layman's terms and weaves it all in stories of these immigrants that tend to tug on your heartstrings. Some stories end well, others not so much. There are many pictures scattered throughout that give the reader a visual reference to the historical significance of these diseases.

This is an amazing read that will stay with me for some time, especially as we deal with COVID-19.

[sana ୨୧ · Rating 2 out of 5]

i found some chapters to be wayyy more interesting than others

[Pancha · Rating 3 out of 5]

This book feels more like an examination of the attitudes America holds and has held towards immigrants and disease than the diseases themselves, although there is a lot of information on the diseases. While each chapter acknowledges the public health issues of the various diseases, they also focus on how racism, ignorance, and a lack of compassion effect the immigrant communities blamed as carries for the diseases.

[Jennifer Collins · Rating 5 out of 5]

Markel's work here is not just about what the title proclaims--and in fact, I imagine that's led to some disappointed readers--instead, it is as much about history, immigration into America, and fear as it is about disease, science, or epidemics. Yet, in bringing all of these topics together, it's a powerful look into the subjects and into the way populations have come to understand a variety of diseases which we're still working against today.

By splitting the book into six different chapters to match up with six separate diseases, Markel works to first explain a disease and where it actually may have begun (or sometimes, where it definitely didn't begin, despite popular thought), and then to dissect the understanding that culture came to about the same -- often, the understandings don't match up with history or truth, of course. And through case studies and discussions of how truth has been twisted or scarred in relation to each disease, many things become clearer, from why the popular understanding might have been shaped to allow for (or even promote) xenophobia and prejudice, on to what contemporary readers might best understand and fear about a disease, as opposed to what popular history or culture might suggest.

If there is a failing here, it's that Markel doesn't attempt (in more than an occasional sentence) to address whether America is like other nations (any or all) in its propensity to blame epidemics on immigrants, or whether this is a uniquely American pattern of thought. In some chapters, there are discussions of other nations/peoples blaming a given disease on another group, but the topic isn't addressed as a whole. In some ways, this is forgivable simply because Markel is admittedly an American historian, and may have felt this topic to be a far reach, but it does feel like something of a missing discussion. Also, the title and subtitle are, as suggested above, a bit misleading.

This book is as much about immigration and prejudice as it is about disease, and it is as much about the making of America as it is about epidemics. Some readers will come to this book for particular insights, based on the title, and perhaps be disappointed. Readers looking for a wider scope of understanding, though, may end up being more than pleased.

Absolutely, I'd recommend it.

[K. Lincoln · Rating 4 out of 5]

I opened up When Germs Travel thinking I'd get a more general description about disease, vectors, bacteria, and how human culture influences transmission.

(Obviously I didn't read the subtitle)

What I got was even more interesting, and heart-breaking.

Markel tells the stories of Tuberculosis, Bubonic Plague, Trachoma, Typhus, AIDS and Cholera all through the lens of the immigrant experience.

The two stories that really hit me were the story of Haitians with AIDS caught behind barbed wire at Guantanamo Bay. As Markel details the ways the virus destroys cells from within, forcing host cells to continue replicating the virus making the host susceptible to other diseases, he juxtaposes those images with the story of one Haitian man and the horrible conditions he was forced to endure.

The other story that hit me was Typhus and the immigration and sanitation procedures set up along the Mexican-US Border between Ciudad Juarez and El Paso. Describing the bath mixture of gasoline, kerosene, etc that day laborers were enforced to endure just to cross the border (to kill typhus-bearing lice) was horrible.

So, in reality, this book taught me more about how race and prejudice contribute to questionable decisions about health care and public health more than it taught me about the science of the diseases themselves.

Very readable and engaging for me, a non-scientist, if difficult to read sometimes (not due to writing, but due to the nature of how the U.S. government has forced immigrants into quarantines and denied them needed healthcare or prevented them from entering the U.S. all in the name of public health).

[Benjamin Bryan · Rating 4 out of 5]

I enjoyed the read, but if you're going to ready anything by Dr. Markel, I would recommend "An Anatomy of Addiction" first.

[Amy Lyden · Rating 3 out of 5]

An interesting public health book covering the intersection of immigration and epidemics. In this current climate, it is good to reflect with a critical eye on our history with respect to immigration policy. This book put a human perspective on how disease shaped our policy and views of incoming people to the US. Spoiler alert: we were far too quick to accuse immigrants of being disease ridden and implement policies bounded by fear instead of rational thinking. I liked how his final story showed he too was not immune to these biases - I enjoy a self-aware author.

A great read for anyone interested in infectious disease - nothing earth shattering, but definitely engaging vignettes. Comes with the standard plea to put more energy into preventative public health, which I completely agree with.

[Cecily · Rating 4 out of 5]

This was really interesting as it combined immigration and medical anthropology. Of course every time I read about diseases I start worrying about every heart flutter, dry eye, itchy leg, etc.

The author does a great job of informing and providing the stories that make medical anthropology interesting. His writing style is clear.

[Marks54 · Rating 4 out of 5]

“When Germs Travel” is a 2004 book by a distinguished professor of medicine and medical history at the University of Michigan. It concerns six major epidemics that have occurred in the US (TB, Bubonic Plague, Trachoma, Typhus, AIDS, and Cholera. All of these examples have the international movement of diseases as a central feature. All of these examples also include a discussion of the medical details of the illness and how various US agencies became involved in the epidemic and what effects came from that involvement. While COVID-19 was not a featured actor in the book and did not seem to exist yet, the term “pandemic” is used throughout the book and the linkages with our current pandemic are not hard to appreciate.

This is an excellent book that will help readers trying to make sense of the current situation with COVID-19. I liked much about the book.

First, epidemics are highly varied. Adam Kucharski, in “Rules of Contagion” quotes someone to the effect that “if you have seen one pandemic, you have seen one pandemic”. That comes across strongly in this collection. Some of the best known epidemics are widely written about (Plague; AIDS) while others (Trachoma) are highly unusual in the US. Cholera and Typhus have plagued the US in the past but not recently, although they remain problems in the developing world.

Second, epidemics are very scary. A benefit of having a physician as the author of a book like this, is that the reader gets a clear and often terrifying description of how a disease works, how it develops in people, and how its kills people. These descriptions are common in books about particular disease outbreaks (for example, “The Ghost Map” about cholera in London), but collecting six examples together produces a strong effect.

Third, public health (in some form) is involved in all of these epidemics and the effects of the government trying to manage populations to achieve some public health objectives is consistently political, highly contested, and dependent on both political dimensions and an evolving state of medical knowledge. Threats to the economy and to local public welfare abound and are frequently in conflict with each other. Mistakes are frequently made and results are often very messy. Observers of US efforts to control the COVID-19 pandemic and develop medicines and vaccines will feel right at home. They may well feel a bit of “history repeating”.

Professor Markel concludes with the observation that the management of epidemics through effective public health is a continuing tension reflecting the costs and benefits of effective action. The absence of epidemics makes society complacent in that little extraordinary is demanded. During crises such as those profiled in the book, lots is demanded and it is at the point when public health is most needed that it is the most contentious and the most politically messy. Not much appears to have changed.

The book is well written and engaging.

[Celina · Rating 4 out of 5]

When Germs Travel is a wonderful journey into medical anthropology, documenting six major epidemics that have struck the United States as a result of immigration: tuberculosis, trachoma, typhus, bubonic plague, cholera, and AIDS. Markel looks compassionately upon how abysmal homeland conditions and travel conditions exacerbated these epidemics, as well as how the American reaction to the epidemics resulted in policy changes throughout the last century.

It's a fascinating read, and it leaves the reader with much food for thought.

My favorite exerpt:

"Beyond the cultural differences that must be bridged in any international effort, combined with factors of national politics, priorities, and values, we continue to grapple with the essential paradox of public health that began our discussion: when the system is working effectively, it is a silent venture and there are relatively few outbreaks of disease. These very successes lead most of us down a complacent path of false confidence, apathy, and assumptions that the endless dance is over. To complicate matters further, microbes themselves are hardly monolithic or permanently settled beings. For every attempt we make to destroy or weaken them, they respond with an equal and opposite force. The goal of both sides is to assume leadership of the evolutionary waltz ever in progress."

[Maria · Rating 4 out of 5]

Dr. Markel's manages to do what the best nonfiction writers do when they tackle topics too terrifying or foreign to deal with - he puts a human face on six epidemics of contagious disease that have affected American lives. In six chapters - one for each of the six epidemics - he introduces us to diseases and the immigrant and domestic lives they've affected. And he introduces us to ourselves.

My main takeaway from this book is that people - perhaps especially Americans - are too often fearful and shortsighted when the situation at hand requires courage and long-term vision. Not a terribly shocking revelation, but rather a really important reminder in a political era where Ebola made headline news for months on end and candidates for president openly advocate deporting 11 million immigrants and building a wall on our southern border.

Dr. Markel will visit the Baldwin Public Library in Birmingham, Michigan on Saturday, November 21st at 3:00 PM to deliver a talk based on this book, and you should totally come because I guarantee you it will be brilliant, compassionate, funny, and informative. Just like the book!

[John · Rating 4 out of 5]

Here are six fascinating stories of invasive diseases (to U.S. borders, that is) and how authorities endeavored to cope: TB, plague, trachoma, typhus, AIDS, cholera. Most engaging is the author’s personal account of involvement with a cholera scare in Detroit in the late 1990s. Though diseases described are now largely contained in the U.S., many (even those not of the six) remain worldwide dilemmas never to be completely conquered.

[Mark · Rating 4 out of 5]

Broken into several readable chapters, each with their own study of a disease, location, and ethnic group different from each other, yet with the common theme of nationalism against the 'other' the author's final chapter is a humble, semi humorous warning of the dangers of 'knowing too much' (or thinking you do anyway).

[Mary Ann · Rating 4 out of 5]

Fascinating and well-written account of six major epidemics. My key take-away: We have gathered a lot of data and information about how germs travel, epidemics, and how people react to them. As a country, we just haven't applied any of those learnings consistently or well, as clearly evidenced by the current Covid-19 pandemic! Sadly true.

[Sarah · Rating 4 out of 5]

A very readable series of vignettes about different epidemics in America. With a view to the historical, it gives a better understanding of the present and the future of contagious disease in the US.

[winona · Rating 2 out of 5]

It's not as nail-biting as the title would have you believe. Interesting stuff, particularly the bits on disease etiology and progression, albeit kinda dry.

[Chole Allyson · Rating 4 out of 5]

This was a great book. I was able to see a disease progress through the eyes of an immigrant. I followed their story and felt as though I were a part of it.

[Kelly · Rating 5 out of 5]

Man am I a sucker for a microhistory; chalk it up to the insatiable consumption of knowledge.

[Kadri · Rating 3 out of 5]

Historical accounts of epidemics and immigration, interesting read with thought-provoking examples.

[Marilyn · Rating 3 out of 5]

Dr. Markel's six major epidemics of the Twentieth Century:

Tuberculosis
Bubonic Plague
Trachoma
Typhus
AIDS
Cholera [I was surprised by this one. I had read about the cholera epidemics in the 1800s. Pretty gruesome. Do any Torontonians know that the northwest corner of busy and upscale Yonge and Bloor streets was once "Potter's Field", and scores of cholera victims were buried there? The bodies were taken elsewhere when the land was developed, but it still gives me the shivers when I remember it while riding the subway line between Yonge and Bay streets. What if...? The possibility of cholera in Detroit scared me, and I don't want to be an actress in a new performance of "Cholera Victims in T.O."]

His argument is that we think antibiotics have kept those plagues from North America's shores; but that is wishful thinking. We have immigrants and tourists arriving from countries who have contracted these diseases arriving by plane. By the time the bacteria and viruses show themselves, the human carriers have been in contact with scores of people. We North Americans have also been tourists or immigrants or aid workers in places where these diseases are endemic.

He is not advocating barricading out the immigrants or staying within our borders. He is advocating an international effort to battle the diseases globally, with the humanitarian and pharmaceutical aid that the first world countries can provide and the public health teaching that should cross borders. The world is getting more resistant bacteria and viruses, and what one country may get can no longer be assumed will be confined in that country.

Dr. Markel's history of the last hundred years of epidemics in the U.S. is not for the squeamish. The AIDs epidemic is in my lifetime after all.

[TBML · Rating 3 out of 5]

With current events what they are, it is interesting to read how the world reacted to historical outbreaks of disease. It certainly gives one perspective.

I especially enjoyed the chapter on the typhus "outbreak" in my hometown of El Paso, Texas around the turn of the 20th century. The majority of deaths that can be laid at the feet of this local outbreak had nothing to do with the disease itself but the fact that people crossing the border into the US from Mexico had a disturbing habit of bursting into flames when doused with kerosene, which border officials believed would kill the disease. And I suppose it did...in a way.
-Margaret
http://chile.las-cruces.org/search/?s...

[Kathryn · Rating 5 out of 5]

Summary: Markel walks you through epidemics that have occurred in the US since 1900 and how they have impacted both public sentiment and public health procedures.

Why I Read This: I ask our staff to have him to the library. He seemed pretty darn awesome.

Review: This may be my favorite book that I've read all year. It was fascinating. Granted, I skipped some of the parts that were like, "and this is how typhus affects your intestines". But most of the book is about the history of that disease, the history of the discovery of its epidemiology, and how it likely traveled to the US. Then a lot is about the social uproar caused by these epidemics and how the American government reacted (properly or improperly) in medical ways but mostly in human rights ways. The content was fascinating. The pace was moderate. The tone was perfect.

[Kate · Rating 3 out of 5]

When Germs Travel takes a look at 6 epidemics: bubonic plague, typhus, trachoma, HIV, tuberculosis and cholera that arose in the US in the past century or so. If you read a lot of medical history, much of the information will be old news. What may not be, however, is Markel's analysis of the role that immigrants have played in bringing illness across national boundaries, and more importantly, how much undeserved blame is laid at their feet when epidemics do strike. Markel is a fine writer; he is personable and his writing is accessible to someone without a medical background. This book is recommended to anyone interested in the history of immigration to the US or interested in epidemiological history.

[Margaret von Fizzlewick · Rating 3 out of 5]

I especially enjoyed the chapter on the typhus "outbreak" in my hometown of El Paso, Texas around the turn of the 20th century. The majority of deaths that can be laid at the feet of this local outbreak had nothing to do with the disease itself but the fact that people crossing the border into the US from Mexico had a disturbing habit of bursting into flames when doused with kerosene, which border officials believed would kill the disease. And I suppose it did...in a way. A bit drastic, though.

[Jennifer · Rating 3 out of 5]

3.5*

This book gives a good overview of six major epidemics that have affected America throughout its history: tuberculosis, bubonic plague, trachoma, typhus, AIDS, and cholera. When Germs Travel: Six major epidemics that have invaded America since 1900 and the fears they have unleashed is informative, but the writing is not as good, or as engaging as his book An Anatomy of Addiction. Overall, I enjoyed this read, but I don’t know if I would recommend it.

[Marie · Rating 3 out of 5]

I read this late at night, then didn't sleep worrying how to avoid getting TB. Not as worried about bubonic plague, typhus or cholera . . . but the TB chapter kept me awake! I will no longer shake hands with anyone, wash my hands obsessively, stay away from anyone with a cough. In fact, I think I'll never leave my home. That's the answer.

[Sarah]

Love the history provided of both the germ/disease, the places where the epidemic took place, and the lifestyles and hardships of immigrants both in their home country and upon their arrival in the US. The personal stories showed how strong and proud the individuals were and continued their battle even after they became ill.

[Kelsey · Rating 3 out of 5]

A bit on the brief side, but plenty interesting. Published in the early 2000s, I often wondered if the statistics on certain things had changed. There's also a somewhat dated obsession with the terror attacks of 9/11. Still. The author has chosen interesting examples and writes in a clear, engaging manner. I'm obsessed with epidemics, and still found plenty of new information here.

[David Wen · Rating 3 out of 5]

Interesting background regarding how US treated various disease, epidemics, and ultimately immigrants in the 19th and 20th century. The lack of knowledge and how far we've progressed since them is fascinating and yet disheartening at the same time.

[Laurie Fosburgh · Rating 5 out of 5]

This is a great book. Disease is linked to the experience of immigrants and racism in this country and how our public health policy is driven by the fear of the unknown and not altruism. Great read, but heartbreaking.