Introduction
Immigrants and migrants who came to Chicago (and other large cities) at the turn of the 20th century encountered many hardships and barriers to accessing basic necessities like healthcare. They had to navigate a sometimes bewildering landscape that offered many different types of care. When modern medical treatment failed them, they turned to their communities for traditional remedies and wisdom. When the existing medical institutions could not help them, they created their own. Sometimes they became part of the medical establishment themselves.
With so many people suddenly living in close urban quarters, infectious disease could run rampant. Tuberculosis was especially prevalent and medical and public health experts had many ideas about how to prevent and treat it. These ideas were perpetuated by the established educational and governmental systems that trained the physicians and implemented their policies in the city.
As one of the leading medical schools in Chicago at the time, Chicago Medical College (and its successor Northwestern University Medical School) employed and trained many men who were involved in the city’s Department of Health. A survey of medical education at the time shows that students would have followed a curriculum that emphasized public health while also perpetuating a pattern of paternalistic ideas about what was best for the immigrant and migrant communities that sometimes bordered on eugenics.
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Content warning: this exhibit includes outdated historical perspectives and terms that are offensive, xenophobic, and racist. When possible, we have incorporated the views of patients, but the experiences of marginalized and poor communities were and are not commonly included, collected, or archived in traditional historical records. Instead, many of the available primary sources come from those with power, resources, or prestige, such as city officials, social reformers, and the professional class. Please contact Special Collections with any feedback about this exhibit: ghsl-specialcollections@northwestern.edu. |
From March 13 to April 22, 2023, Galter Health Sciences Library & Learning Center hosted the National Library of Medicine’s touring exhibit Outside/Inside: Immigration, Migration, and Health Care in the United States that explored these issues on a national scale. To accompany it, Galter staff curated four exhibit cases to highlight the themes of the NLM’s exhibit as they related to the experience of immigrants and migrants in Chicago. Using materials from the time, these displays tell the story of the local medical establishment and how it helped—or not—the millions of immigrants and migrants who settled in the city.
Events
A Conversation about the Intersection of Immigration Status, Health, and Healthcare Access
Moderated by Verónica Hoyo, PhD, Executive Director at the NNLM National Evaluation Center, with panelists Namratha Kandula, MD, MPH, Professor of Medicine (General Internal Medicine) and Preventive Medicine (Epidemiology) at Feinberg School of Medicine; Uzoamaka Emeka Nzelibe, JD, Clinical Professor of Law at Northwestern Pritzker School of Law; and Luvia Quiñones, MPP, Senior Director of Health Policy at Illinois Coalition for Immigrant and Refugee Rights.
In this hybrid panel discussion, experts in health equity, immigrant and refugee rights, and immigration law explored the current state of immigrant health, policy, and healthcare access. The event offered an opportunity to gain a better understanding of the experiences of immigrants navigating the healthcare and immigration system at the local level.
GalterGuide
In conjunction with the NLM exhibit, Collection Development/Special Projects Librarian Ramune Kubilius created an Immigrant Health GalterGuide that lists resources related to current issues in this area.
Credits
Curated by Katie Lattal, MA, Special Collections Librarian; Emma Florio, MLIS, Special Collections Library Assistant; Ramune Kubilius, MALS, AHIP-D, Collection Development/Special Projects Librarian; Lindsey O’Brien, MSLIS, Cataloging & Metadata Librarian; and Annie Wescott, MLIS, Research Librarian.
Designed by Katie Lattal and Emma Florio.
Immigrant Neighborhoods
An ethnic enclave was not a district in which all of the inhabitants were of the same ethnic stock and in which all of the people of that ethnic group lived. It was a place where the members of one nationality set the tone, because they outnumbered everybody else, or had been there the longest, or were simply the most visible and voluble.
Thomas Lee Philpott. The Slum and the Ghetto: Immigrants, Blacks, and Reformers in Chicago, 1880-1930. 1991. p. 135
Pathways of Immigrant Health
Resources for the care of illness become known in somewhat the following order to the average immigrant coming from a small community to a city in the United States:
Home and Neighborhood
- The home remedy or “wise” woman
- The midwife
- The drug store
Doctors
- The advertising doctor, medical institute, or quack
- The private physician
- The lodge doctor
Organized American Agencies
- The nurse
- The hospital
- The dispensary
Michael M. Davis. Immigrant Health and the Community. 1921. pp. 130.
The Wise Woman and the Witch
In minor illnesses the immigrant, like the native born, appeals to the home remedy. Traditionally potent herbs and concoctions familiar in the home village play a large part in the family dosing of many immigrant adults and their children.
The uneducated mind of the immigrant turns also, with a confidence at which the sophisticated American can only wonder, to the neighbor or friend of reputed wisdom. The grandmother of one’s own or more often of a neighbor’s family, the witchwoman, known in the old country, and now in her little circle here, as one having power to heal or to prevent healing⎯
Michael M. Davis. Immigrant Health and the Community. 1921. p. 130.
The Midwife
In 1915, The Immigrants’ Protective League estimated that 50% of births were attended by midwives. At this time, midwives were typically immigrant women living in immigrant communities. Midwifery in Europe was a long-standing, well-trained and established practice, making the midwife-model a popular choice among recent immigrants who were most familiar with the model. However, there was little-to-no oversight in US midwifery at the time, and many of the practicing midwives, unlike their counterparts in Europe, were untrained and used unhygienic processes.
The Drugstore
Here in this country a druggist does everything: telephones, soda fountains, information bureau, doctor. In Hungary, he is a skilled pharmacist.
Michael M. Davis. Immigrant Health and the Community. 1921. p. 132.
The drugstore was often a first stop for immigrants when seeking healthcare. In Europe, the pharmacist could listen to symptoms and tailor medication to the individual. Several immigrant pharmacists established pharmacies in Chicago to create a place for community and health familiar to what was available in their home countries.
Merz Apothecary, Est. 1875
In 1875, Chicago pharmacist Peter Merz opened a small drugstore on the city’s North Side. Being of Swiss descent, Merz decided to call the store an ‘Apothecary’ in the European tradition. Even from the beginning, Merz Apothecary set itself apart.
At that time, your neighborhood drugstore was not only a place to fill prescriptions, but a source of information and remedies for common ailments. Pharmacists were consulted like family doctors and they would hand mix formulas for each specific customer. However, Merz Apothecary differed from the typical American drugstore because the clientele were mostly European immigrants. Like European apothecaries, Merz focused heavily on herbal medicines and traditional formulas, which were already popular with its international customers.
https://www.merzapothecary.com/our-story/
The Immigrant Doctor
Depending on the community, an immigrant doctor might find a strong community of clients waiting in an immigrant community. Davis's book highlights Italian physicians being preferred by Italian patients because of the time devoted to explaining conditions and treatments, which contrasted to the rushed model of American doctors. Other immigrant communities were said to have put more trust in the American doctors than the doctors of their homelands.
The Advertising Doctor
Often, doctors who could afford to advertise were looked upon with high regard in immigrant communities, but it was not always easy to distinguish between a scam and a legitimate doctor advertising services in the immigrant community newspapers.
Community Hospitals
In the 19th & early 20th centuries, numerous religious and ethnic communities founded hospitals to serve the burgeoning Chicago populace. Most hospitals that admitted both paying and non-paying patients were open to all people, regardless of race, religion, or nationality.
In spite of these declarations of inclusivity, institutions did not always adhere to this principle in practice. Some hospitals were known to bar people based on their identities; some admitted anyone but offered subpar care to certain populations, more often along lines of color and class than nationality or religion.
These unwritten rules shifted over time, reflecting the fluctuations of prejudice and inclusivity in the wider culture at large.
Provident Hospital, Est. 1891
Timuel Black, Chicago Historian & Civil Rights Leader, on Provident Hospital:
Provident Hospital was often the safest—and the only place to go. When I say “only,” I mean that we never could be certain whether we’d be excluded from the white hospitals. This exclusion occurred by various means. So it was safer not to take any risks if there was an emergency.
Provident was there for the community. You’d see your neighbors there ... It wasn’t poverty that brought many to Provident; these people could afford to go wherever they wished. But they respected the quality of care and had confidence in the attending physicians.
Deaconess Hospital*, Est. 1865
Isabella Oakland, Assistant Nurse, 1865; Head Nurse, 1866
Recalling the hospital opening, when she was 16 years old:
Our patients were mostly immigrants, nearly all Swedes. …We had a German doctor and I had to interpret the Swedish to him. The new comers [sic] were often very homesick in this strange land and I had to take care of them…
The neighbors got frightened and sent a petition to the city authorities to have the hospital closed. A committee of the Board of Health came to investigate…When they left they said if every private house were kept as clean as ours, there would be no epidemics in the city.
William A. Passavant, DD, Hospital Founder & Director
On the poor state of health of immigrant patients:
Thus far they [patients] have been largely the fever-stricken immigrants from Sweden, Norway and Germany, whom scarcity, poverty and oppression of the poor have driven from their fatherland, and many of whom after untold sufferings on filthy vessels and crowded railroad cars arrive in Chicago on their westward way sick and strangers and dying, without a crust to eat or a place whereon to lay their heads. The hospital of the Deaconesses has been their only refuge.
*Deaconess Hospital changed its name to Passavant Memorial Hospital in 1894, and in 1972 merged with Wesley Hospital to become Northwestern Memorial Hospital.
Infectious Disease
Twenty million new immigrants arrived in the United States between 1890 and 1924. Population growth, especially growth in dense urban areas, made the spread of infectious diseases such as measles, scarlet fever, tuberculosis, and influenza more likely. Crowded tenements, poor working conditions, and difficulty in accessing healthcare left people living in poverty more susceptible to infection.
At the turn of the 20th century, tuberculosis (TB) was the leading cause of death within the city of Chicago. At the time this disease, also historically known as “consumption,” since it caused a slow “consuming” death, was incurable. Before antibiotic treatments became available in the 1940s, treatment largely consisted of getting fresh air and sunshine as often as possible paired with rest and gentle exercise. African Americans and newly arrived immigrants were the hardest hit populations.
A closer look at tuberculosis reveals how this epidemic affected the lives of American immigrants, as well as the immigrants who helped find new treatments.
Tuberculosis Narratives
Until Dr. Robert Koch discovered the bacteria that causes TB in 1882, it was considered hereditary. As acceptance of germ theory grew, the TB origin narrative shifted to fear of contagion aggravated by “hygiene” factors, which, coupled with a growing eugenics movement, sometimes led to vilification of hard-hit communities as “disease spreaders,” as well as speculation about the susceptibility of certain backgrounds.
For example, in 1901, Maurice Fishberg, a Jewish immigrant from modern-day Ukraine, concluded Jewish people were less susceptible to TB due to natural selection from centuries of overcoming hardship. A year later, Theodore B. Sachs, MD, another Jewish immigrant, mapped infection rates in a Jewish area of Chicago and concluded, “the so-called immunity of Jews from tuberculosis is greatly overestimated.”
Racial notions of infection continued to persist in the next few decades as seen in this concerned letter to the editor and its reply published in JAMA in 1925 (see Image Gallery). Medical professionals who supported these ideas had several theories, including that those emigrating from rural areas of Scandinavia and Ireland to American urban areas would be more susceptible to infection.
Consumption: How to Prevent It and How to Live with It
This title highlights both the pervasive nature of the disease in late 19th century America as well as breakthroughs in understanding its spread. Written in 1891 by Nathan Smith Davis, Jr., who would later become Dean of Northwestern University Medical School, the book is aimed at patients. Davis stresses the importance of diet, exercise, climate, and clothing—particularly woolen undergarments, for the overall health of the “consumptive individual.”
Lifestyle changes recommended by Davis, as well as monthslong “fresh air” treatments, were often out of reach to patients of lower socioeconomic status, who tended to have much shorter life expectancies after diagnosis than their wealthier counterparts.
Quarantine & Isolation
Without antibiotic treatment, the best way to prevent the spread of TB was by isolating patients. During isolation, the patient was encouraged to rest and take fresh air—even if only from a large window. Quarantine signs such as this one alerted the public to the possibility of contagion (see Image Gallery).
Construction on the first public TB sanitarium in Chicago began in 1911. While patients there were not completely isolated, they were separated from their family, friends, jobs, and homes for months often leading to emotional and financial stress.
“Don’t Spit – Save Lives”
Once Dr. Koch discovered that tuberculosis was transmitted by bacteria, medical professionals advised patients to spit into sanitizable spittoons. Here we see such hospital approved spittoons for sale by V. Mueller & Co., A Chicago manufacturer of medical devices. Vinzenz Mueller, a German immigrant, founded the company in 1898 (see Image Gallery).
As germ theory became accepted by the general population, campaigns against public spitting sprang up in cities around the country, led by such agencies as the Chicago Tuberculosis Institute.
Preventative Initiatives
Harriet Fulmer and Theodore Sachs of the Visiting Nurse Association chartered the Chicago Tuberculosis Institute in 1906 to spread awareness about the disease’s “causes, prevention, and cure.” One of the Institute’s 1908 projects was an experimental outdoor school for children who lived with family members diagnosed with TB. The outdoor air, sunshine, exercise, and nutritious food available to the children were intended to prevent them from also falling ill. Though all thirty children were born in the United States, all but one were children of immigrants. The Institute still exists today as the Respiratory Health Association and it advocates for respiratory health and clean air in Chicago.
Gustav Fütterer
Gustav Fütterer, MD's research included early work on M. tuberculosis, the bacteria that causes tuberculosis. Though a medical school graduate, he lacked the premedical training desired by German universities. He immigrated to America in 1890 and came to Chicago where he became associated with several area hospitals. The first issue of The Bulletin of the Northwestern University Medical School featured an article introducing Fütterer, the newly appointed Professor of Pathology, and listed his bona fides as an infectious disease expert.
