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As American cities industrialized throughout the nineteenth century, infectious diseases emerged as a real threat. The introduction of new immigrants and the growth of large urban areas allowed previously localized diseases to spread quickly and infect larger populations. Towns grew into cities as industrialization sparked urban migration from rural communities in both the United States and Europe. The increased demand for cheap housing by urban migrants led to poorly built homes that inadequately provided for personal hygiene. Immigrant workers in the nineteenth century often lived in cramped tenement housing that regularly lacked basic amenities such as running water, ventilation, and toilets. These conditions were ideal for the spread of bacteria and infectious disease. Without organized sanitation systems, bacteria easily passed from person to person through the water and sewage. As a result, many of America's largest urban areas like New York, Boston, Philadelphia, and Washington DC fell prey to a rash of infectious diseases in the middle and end of the nineteenth century.

"Old" Immigrants (1820-1870)

The nineteenth century was a time of massive population growth for the United States. In 1800, slightly over five million people called America home. By 1900, that number skyrocketed to seventy-five million. A large portion of this extraordinary growth can be attributed to European immigrants. Europeans hit America's shores in two different waves: "old" and "new." "Old" immigrants were those who migrated to the United States between the 1820's and 1870's. It was during this time that many Britons, Germans, and those of Scandinavian descent crossed the Atlantic and landed in America. These immigrants were typically English speaking, literate, Protestant or Jewish-except for the Irish Catholics-and could blend fairly easily into American society. "New" immigrants, however, did not merge into American culture as easily. Instead, they faced a variety of struggles that will be discussed later on in the article.

For "old" Irish immigrants, America was the land of opportunity. Especially in rural communities, Irish immigrants were generally welcomed and easily found work. An 1870's book by an Irish-Catholic priest encouraged Irish immigration by explaining to Irish immigrants the ease of obtaining land and traveling in the United States:

"From Chicago and St. Louis to New York, it now takes less than two days in time and not more than twenty-five dollars in money; and from San Francisco, the trip is made in six or seven days, at a total expense of about one hundred and fifty dollars. The inference is plain that the emigrant of today has many advantages over his predecessor of some years back. But the advantages here alluded to are trifling when compared with the increased facilities of obtaining good and cheap land in every State and Territory of the Union."

German immigrants were similarly encouraged to immigrate to the United States. In his Report on a Journey to the Western States of North America, Prussian lawyer Gottfried Duden detailed the advantages of life in America and described how American life avoided many of the societal and political problems that were present in nineteenth century German society. Duden preached that America was a bastion of cheap and available land, especially in the western states and territories. He encouraged Germans to escape the political chaos and limited economic opportunities of Germany to start a new, freer life on the American prairie.

"New" Immigrants (1870-1920)

The "new" wave of immigrants came to America between the 1870's and the 1920's. These immigrants came in large numbers from southern and eastern European countries such as Italy, Greece, Poland, and Russia as well as Asian nations like China. "New" immigrants were typically poorer and less educated than earlier immigrants. Moreover, these immigrants were very different than the typical American because they were overwhelmingly Catholic or Greek Orthodox, or Jewish, and unfamiliar with democratic government. These cultural differences prevented the "new" wave of immigrants from fully assimilating into American culture. Instead, "new" immigrants often congregated in close-knit communities that consisted only of members of their ethnicity.

The large influx of Catholic immigrants into the United States in the mid to late nineteenth century drastically changed the perception of Catholicism in America. In the early 1800's, the American Catholic population was a small sect of English Catholics who were generally well educated and wealthy. However, following the Irish potato famine of the 1840's and the immigration of Eastern European Catholics later in the century, the American Catholic population became a much more diverse group who came from many different countries and spoke many different languages. In the 1850's, Catholics accounted for only five percent of all Americans, but by 1910 they consisted of seventeen percent of the total population and were the largest religious group in the United States. As Catholics became a large part of the American populace, they also began to face increased discrimination from Nativist and pro-Protestant societies. To combat this discrimination, many American Catholics took refuge in the Catholic Church.

Another group that came to America in large numbers in the late nineteenth century were Jews. Between 1870 and 1920, Jewish migration to America shifted from Central Europe to Eastern Europe. Over two and a half million Eastern European Jews were forced out of their homelands by government persecution and economic hardships. Like other "new" immigrants, this new wave of Jews found homes in large cities and settled in "Jewish" areas of town where they spoke Yiddish and operated Jewish businesses.

The Immigration Act of 1882

Prior to the 1880's, there were very few restrictions on immigration into the United States. Starting in the 1870's, though, the federal government faced increasing pressure from the American people to restrict the flow of immigrants-particularly Chinese laborers entering into California. Americans began to associate many of the societal ills related to urbanization-such as overcrowding, the spread of disease, and lack of jobs-with incoming immigrants. In 1882, the federal government attempted to address those concerns by reforming immigration policy with the Immigration Act of 1882. The Immigration Act of 1882 provided the basis for future federal immigration policy as it detailed what types of "undesirable" people would be blocked from entering the United States. The directive prohibited the entry of "any convict, lunatic, idiot, or any person unable to take care of himself or herself without becoming a public charge." This notion of "becoming a public charge" denied foreigners entry who could not demonstrate the ability to financially support themselves. Those who failed to show this were shipped back to their homelands. The Immigration Act of 1882 did, however, made an exemption for political refugees. This was consistent with the American tradition of acting as a safe haven for those persecuted by other governments.

The Chinese Exclusion Act of 1882

The second piece of immigration legislation that Congress passed in 1882 was the Chinese Exclusion Act of 1882. This directive banned the immigration of all Chinese peoples into the United States and called for a one-year prison sentence and $500 fine for any person attempting to smuggle Chinese laborers into the country. An 1882 newspaper article from the Wisconsin State Journal outlines much of the racial motivation behind the legislation:

"(Nevada Senator John P. Jones') final conclusion was that the Chinese race is as obnoxious to us and as impossible for us to assimilate with as was the negro race. His race has outlived every other because it is homogeneous, and for that reason alone it has imposed its religion and peculiarities upon its conquerors and still lived. If immigration is not checked now, when it is within manageable limits, it will be too late to check it.

The Chinese Exclusion Act of 1882 also had economic motives. As Senator John Franklin Miller explains in another 1882 newspaper article from the San Francisco Bulletin, the presence of Chinese workers in the United States was harmful to the American worker:

"The effect of the presence of this persistent race upon the more impressible American, should be considered. Already, in California, the white farm laborer who is forced into competition with them, adopts their nomadic habits, and has no home in the family he serves, but is a "blanket man" who works in the fields during planting and harvest seasons, and roams the remainder of the year in search of other employment. His shelter is the straw stack and his food is anything that he can get. The great wheat growers, in their immense operations, are thus relieved from employing continuous labor, and the result is large farming to the exclusion of small American homes. In the manufacturing districts the result is hoodlumism, which drives the young of both classes to idleness in the street."

There was, of course, a second side to this argument. In an 1882 article from the Worcester Daily Spy, an explanation is given as to why the Chinese Exclusion Act of 1882 was a symbol of American hypocrisy and against American interests:

"Suppose that, upon the enactment of the anti-Chinese bill now pending, the Chinese government should close the ports of the empire to American citizens and American commerce... Apparently the Chinese might make as good an argument for the exclusion of our people from their country as we can for their exclusion from ours. Americans in China are aliens in race and religion; they are not homogeneous, as Senator Edmunds would say; they do not assimilate; they do not become the subjects of the empire, and are not even willing to submit to its laws and local authorities."

Despite such objections, the Chinese Exclusion Act of 1882 and the Immigration Act of 1882 both passed through Congress easily and ushered in a new era of American immigration policy of exclusion. Many powerful organizations supported the passing of these bills. Nativist societies-such as the American Protective Association and the Native American Mutual Protection Association-vehemently opposed the movement of Catholics and Asians into the United States. These organizations contested the immigration of different ethnicities for cultural and economic reasons, but also because of rising health concerns. Towards the end of the nineteenth century, many of Nativist groups viewed immigrants as the cause of America's increasingly dirtier and unhealthier cities.

Urban Disease and New York City

Large waves of immigration in the nineteenth century, made New York City America's largest and most diverse city, but also its most unhealthy, as the large spike in population made it more susceptible to disease. Compared to other large urban areas, such as Boston or Philadelphia, New York's death rate due to disease was considerably higher. It was not until the middle of the century that New Yorkers realized that their poor living conditions might be the cause of the city's poor health. By the 1840's high rates of disease were ascribed to the housing many of New York's poverty-stricken immigrants lived in. Fear spread that while disease was rooted in the polluted living conditions of New York's poorer communities, disease could easily spread to the more well off citizens too. Public health officials realized that the city's soiled streets and polluted sewers were a health risk to all New Yorkers. In the mid-nineteenth century, New York possessed a primitive sewage system. Poorly planned sewers spanned the city, but most citizens' homes did not connect to these pipes. Instead, most New Yorkers relied on outdoor outhouses and privies. These outhouses were usually poorly maintained and covered in filth. Poorer families did not even have the luxury of an outhouse. They simply dug a small trench into the ground outside of their homes. Trenches and outhouses were both unsavory solutions as waste was rarely removed from them and frequently flowed into the streets of the city.

Because of the high levels of unmanaged waste, epidemics of infectious diseases were commonplace in New York. The city battled outbreaks of smallpox, typhoid, malaria, yellow fever, cholera, and tuberculosis. In 1849, a rash of cholera struck the city, killing more than five thousand people.A wave of typhoid in the mid-1860's resulted in a similar amount of deaths. Port cities and transportation hubs, like New York, were especially prone to outbursts of infectious diseases because of the high volume of travelers that passed through the city. Cholera, for instance, was never a problem in New York until the overseas shipment of goods and persons between Asia and New York drastically increased in the mid-nineteenth century.

These epidemics were particularly deadly to children. In 1840, almost two percent of New York's newborns failed to reach their first birthday. Especially in the summer months, infants and children were extremely susceptible to diarrheal diseases. These infections led to severe dehydration and frequently death. Young adults also faced many health risks. Between 1840 and 1870, nearly twenty-five percent of twenty year olds did not make it to the age of thirty. People in their twenties were often the most exposed to infectious diseases because of the long hours and dirty conditions they were expected to work in. The high death rate for children and young adults also had an impact on how nineteenth century parents planned their families. Urban families realized that most likely at least one of their children would not reach the age of five. It was even more unlikely that parents would have most of their children survive their twenties to have children of their own. As a result, many working-class families adopted a sense of fatalism and planned on having large families so that at least some of their children would survive.

This fatalist attitude was largely caused by the fact that Americans realized that they were contracting and dying from infectious diseases at an alarming rate, but weren't entirely sure of why or how. The answers to these questions came later in the nineteenth century with the emergence of germ theory.

The Spread of Germ Theory

Towards the end of the nineteenth century, people sought to better understand and manage infectious diseases. A large part of this process was the widespread acceptance of germ theory. It was evident that poor living conditions-polluted water, overcrowding, spoiled food, etc.-were contributing to the spread of disease, but the science behind this could not be explained. It seemed that the only way to solve New York's health problems was a massive investment in social programs for better housing and sewage systems, but also an expressed emphasis on personal hygiene. By stressing personal hygiene, however, responsibility for sickness was placed on the individual. This caused many people to blame the poor and infected for spreading their diseases.

It was not until the 1870's and 1880's that Americans began to realize that an individual was not entirely to blame for the spread of a disease. As scientists analyzed transmission patterns of infectious diseases, they began to understand how specific pathogens were the causes of specific diseases. At first, many doctors doubted that something as small as a single bacterium could cause such deadly diseases. However, by the end of the nineteenth century, germ theory gained widespread acceptance in the medical community. The work of scientists such as Louis Pasteur and Robert Koch helped convince doctors and the public that the ideas proposed by germ theory were in fact true. Their work focused on testing the spawning of infections from bacteria, proving that specific pathogens were the causes of specific diseases. Convinced of the science behind germ theory, doctors and public health officials began testing water, food, and blood samples for traces of specific diseases. Using this data, government officials scrapped the old plan that emphasized simply ridding cities of waster and introduced a new strategy based on germ theory. Highlighting that diseases were often spread by individual contact, the new public health strategy focused on educating people on how they could prevent the transmission of diseases. These practices included recommendations as simple as frequent hand washing and ensuring that food was fully cooked before serving. The introduction of germ theory shifted the focus of public health and disease prevention away from citywide waste control towards an emphasis on personal contact and the individual spread of disease.

"Typhoid Mary"

The most infamous case of germ theory at work is the story of "Typhoid Mary." Typhoid fever was a common problem in many nineteenth century urban areas. A water and food borne bacteria, the disease spread easily and caused about a ten percent fatality rate. Typhoid typically struck hardest in cities without proper water sanitation systems, such as New York. However, by the end of the nineteenth century, when most American cities had built water treatment facilities, typhoid fever was still an issue and public health officials did not understand why. The answer was that many people remained typhoid carriers, without showing symptoms of the disease. Carriers of the disease showed no signs of illness themselves, but were host to the typhoid bacteria and could spread the disease to others.

Mary Mallon, otherwise known as "Typhoid Mary," is the most famous of these carriers. An Irish immigrant cook living in New York City, Mary was the first recorded carrier of typhoid fever. As a cook, Mary unknowingly spread the disease to many of the wealthy families she worked for across the city. In 1906, Mary began working in a summer rental home for a New York banker. Over the summer typhoid fever struck over half the persons living in the home and the banker became worried that he would not be able to rent out the house again until he found the source of the disease. The banker hired George Soper to investigate the outbreak. Soper determined that none of the food or water was contaminated so it must have been a cook who spread the disease. After tracing Mary's work records all the way back to 1900, Soper realized that Mary not only infected this family, but many others as well. Soper attempted to explain the situation to Mary, but she refused to believe him. In 1907, Soper turned over his findings to the New York City health department. The health department proceeded to apprehend Mary and quarantine her in a hospital. By this point, Mary was extremely untrusting of any health officials and frequently acted aggressively towards them. Tests performed on Mary confirmed the assumption that she was a carrier. For three years Mary was forcibly held in health department custody so that she could not spread the disease any further. Mary was eventually released under the condition that she never cook again. However, she was recaptured shortly thereafter when another outbreak of typhoid was traced to her kitchen. Mary lived in forced isolation for the rest of her life, until her death in 1938.

The story of "Typhoid Mary" has remained popular to this day, not because Mary Mallon was terribly unique as a carrier of typhoid fever, but because her tale epitomizes an entire era. Mallon was the first known healthy carrier of typhoid fever, but definitely not the last. At the beginning of the twentieth century, approximately one hundred New Yorkers became carriers of the disease each year. Also, Mallon was neither the most deadly carrier nor the only carrier to disobey the health department's guidelines. Another carrier, Tony Labella, is attributed with spreading typhoid fever to almost three times as many people as Mary and Alphonse Cotils, a bakery owner and typhoid carrier, crossed the health department and continued to operate his bakery against their will. "Typhoid Mary", though, has found a prominent place in America's history books because her story is the same story of thousands of others in the late nineteenth century. Mallon immigrated across the Atlantic to America's largest city in search of a better life. What she found was a dirty and crowded city that offered work that came with low pay and long hours. Mary's contraction and subsequent spread of typhoid fever is the perfect example of the cramped living quarters, poor working conditions, and poor hygiene that many late nineteenth century immigrants faced.

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Immigrants, Cities, and Disease - US History Scene

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Spreading Diseases As American cities industrialized throughout the nineteenth century, infectious diseases emerged as a real threat. The introduction of new immigrants and the growth of large urban areas allowed previously localized diseases to spread quickly and infect larger populations. Towns grew into cities as industrialization sparked urban migration from rural communities in both the...

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