Traditional Western medicine had long associated disease with filth, a lack of basic hygiene, and, by the later eighteenth century, poverty. From the 1820’s, ships from Europe brought trickles and then floods of immigrants from Ireland and central Europe. Many of these people were both povertystricken and sick with opportunistic diseases such as typhus, influenza, and typhoid fever. Cramped and unsanitary quarters, lack of clean clothing, and poor nutrition shipboard exacerbated weak constitutions and undermined the healthy. Rightly fearful of the spread of infectious diseases, civic and state authorities in North America maintained quarantines and isolation facilities at major ports for sick or suspect passengers. Although a single case of influenza might be gotten over with no lasting effects, chronic conditions such as STDs and Hansen’s disease (leprosy) presented almost no possibilities of cure. Those who suffered from such maladies would be turned away, to find refuge elsewhere. They might then attempt to enter the country illicitly or simply return to their homelands.
Even due diligence could fail, especially with emerging diseases. Cholera had first broken out of its homeland in eastern India in 1817, but America was spared the ensuing first pandemic. The second pandemic proved less accommodating, and Irish immigrants brought the waterborne disease with them to Canadian and U.S. port cities in 1832. New York City lost 3,000 residents in July and August, and New Orleans suffered 4,340 fatalities during three weeks in October. Eventually spreading to the western frontier, cholera killed an estimated 150,000 people in North America between 1832 and 1849. The year 1866 saw the final epidemic of cholera in the United States, when eastern and Gulf port cities counted 50,000 deaths.
The popular conception of Roman Catholic Irish immigrants as lazy, poor, and disease-ridden was reinforced by the huge numbers of penniless refugees who appeared as the potato famine (1845- 1852) ravaged their homeland. A British government report in 1856 noted that malnutrition and starvation among the Irish were accompanied by many other medical conditions, including infectious diseases: “fever, scurvy, diarrhea and dysentery, cholera, influenza and ophthalmia.” Despite the availability of vaccines, smallpox “prevailed epidemically,” and typhus was nearly endemic in crowded Irish cities. Each year, hundreds of thousands of Irish died and one-quarter million Irish emigrated. Although British port authorities were supposed to screen out emigrants carrying diseases before they departed, this task was often left to American officials. As a result, many emigrants died on ships, earning the passenger vessels the nickname “coffin ships.” Despite screening and quarantine procedures, many disease carriers still managed to enter the United States, and many of them settled in already overcrowded and unsanitary ethnic enclaves in American cities, inducing outbreaks as well as increased public health structures and efforts to combat the increasingly complex disease regimes.