When Germs Travel

WHEN GERMS TRAVEL: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed. By Howard Markel. Pantheon Books. 263 pp. $25

In 1991, when a bloody coup toppled Haiti’s first democratically elected president, Jean Bertrand Aristide, thousands of Hai­tians fled the island state. Mostly they headed for the United States, in ramshackle boats unfit for the local bays, let alone the open Atlantic.

In the 1980s, the Centers for Disease Control and the U.S. Food and Drug Administration both had singled out Haiti as a nation of people at high risk for HIV infection and AIDS—the only such geographic designation to appear on the high-risk lists, even though several U.S. cities had higher infection rates. In response to criticism and protests, both agencies ultimately removed Haitians from their lists, the CDC in 1985 and the FDA in 1990.

Nonetheless, President George H. W. Bush ordered the U.S. Coast Guard to intercept the boats and transfer the Haitians to Guantánamo Naval Base in Cuba. Some 12,000 refugees ended up there (thousands of others were returned to Haiti), in horrid conditions—too few and rarely emptied toilets, overcrowded housing, poor food, and reported beatings. Approximately 200 of the refugees did test positive for HIV infection; they were kept at Guantánamo for nearly two years with no anti-HIV treatment.

“The comments of President Bush’s [Immigration and Naturalization Service] spokesman, Duke Austin, best reflected the U.S. government’s attitude at the time,” writes Howard Markel. “He refused to acknowledge the moral, ethical, and legal repercussions of imprisoning HIV-positive refugees. ‘They’re gonna die anyway, right?’ he asked a crowd of scribbling journalists just before Christmas in 1992.”

Markel, a pediatrician and medical historian at the University of Michigan, has written a compelling book about immigration and infectious disease. Title notwithstanding, it’s less about traveling germs than about our fear of the unknown, especially the infectious unknown. In addition to U.S. policy toward AIDS, Markel examines the American response to immigrant-borne tuberculosis, typhus, cholera, bu­bonic plague, and trachoma (an eye infection).

He recounts one atrocity after another committed in the name of public health—Mexicans forced to bathe in a mixture of gasoline, kerosene, and vinegar because of fears of lice and typhus, the quarantine of all of San Francisco’s Chinatown for plague, the infection of immigrants as a result of unsanitary medical practices at Ellis Island. Markel’s accounts are powerful and his documentation extensive.

Time and again, Markel shows, Americans have responded to viruses and bacteria with xenophobia, racism, and moral and ethical blindness. Everyone who considers the United States a nation of civilized people should read this book.

—Gerald N. Callahan