Hives of sickness: public health and epidemics in New York City

became stigmatized by particular disease associations born more of cultural prejudice than epidemiological fact, and how they adapted to the prejudice and poverty of the new world often by creating their own health institutions, based on American models but imbued with elements native to their indigenous traditions. Second, it analyses the institutional responses of native-born Americans to immigration, and in particular the adoption of quarantine as the paradigmatic solution to foreign health threats, visible in the procedures at Ellis Island to identify and exclude "unhealthy" or "undesirable" immigrants and in the various immigrationrestriction acts of the late-nineteenth and earlytwentieth centuries. Third, Silent travelers describes how the demands for good health and sanitation, coming from both native-born and immigrants, helped further the process of "Americanization", as visiting nurses, school health programmes, labour reforms, and the burgeoning interest in public health all combined to spread a particular gospel of good living, one based largely on American middleclass notions of cleanliness and health. In addition to rejecting simple social-control arguments and to portraying newcomers as active participants in their acculturation, Silent travelers merits praise for linking issues of health and medicine to broader social and political themes. The story of germs and immigrants, as Kraut tells it, is one intimately related to Americanization, the nature of urban poverty, and the institutionalization of public health as a state concern, and provokes anew the question of how health became such a powerful social/political language throughout the west in the late-nineteenth century. Kraut's strength, however, lies more in raising such issues than in providing a searching analysis of them. Silent travelers spends little time on the process of the medicalization of social discourse, and while a central concern of the book is the codification of "the connection between immigrant and illness", the dynamics of the process of stigmatization are left curiously underexplored. Finally, Kraut's own data raise a question about the significance of the phenomenon he is investigating. Even at its height, exclusions of immigrants on medical grounds never exceeded 2 per cent per year. If virtually all immigrants were being admitted, however, then what does this say about the actual practical consequences of linking newcomers with disease? Silent travelers provides important insights into this question, but ultimately no thorough answer.