摘要：The racial politics of immigration have punctuated national discussions about immigration at different periods in US history, particularly when concerns about losing an American way of life or American population have coincided with concerns about infectious diseases. Nevertheless, the main theme running through American immigration policy is one of inclusion. The United States has historically been a nation reliant on immigrant labor and, accordingly, the most consequential public policies regarding immigration have responded to disease and its economic burdens by seeking to control the behavior of immigrants within our borders rather than excluding immigrants at our borders. CARVED IN STONE IN A PILLAR adorning the National Archives in Washington, DC, is a line from Shakespeare that has captured my imagination: “What is past is prologue.” Day after day I read this phrase as I entered the archives, reviewing the records of the US Public Health Service (PHS) relating to the immigrant medical inspection that was required at the nation’s borders beginning in 1891. Whether boxes and boxes of records impaired my judgment, whether I was swayed by its inexorable logic, or whether it simply felt true for the ways in which we have thought about the intersection of immigration and disease, I became a firm believer: “What is past is prologue.” But the problem is that historians have provided us with multiple prologues, and this can trip us up when we try to make the past speak to the present. Despite widespread assumptions about the exclusionary nature of American immigration policy, the history of immigration at the beginning and end of the 20th century is in fact a history of inclusion. The period 1924 to 1965 is set off by 2 landmark pieces of legislation: the Immigration Act of 1924, which made national origin the basis for admission into the United States, and the Immigration Act of 1965, 1 which eliminated the national origins systems and at the peak of the Civil Rights Movement restored what President Lyndon Johnson called “the basic principle of American democracy.” 2 But in placing undue emphasis on the racially restrictive nature of policy between 1924 and 1965, it becomes too easy to view all policies—past and present—through a lens of exclusion. 3 I had been led to explore the early history of medical inspection by a contemporary policy disaster that occurred while I was working in the Policy Unit of the New York State Department of Health’s AIDS Institute in the early 1990s. At that time, the US detention of some 200 Haitian immigrants infected with HIV at the naval base at Guantanamo Bay, Cuba, reached its climax. I found it very easy, using the Immigration Act of 1924 and histories of eugenics and scientific racism as a lens, to tell a story of racial restrictions masquerading as public health policy. It was a story, I argued, emblematic of our larger immigration policy. 4 Conversely, I was prepared to see the historical origins of immigrant medical inspection as the story of public health used for racial demarcation and exclusion. This interpretation is very much in keeping with how social historians have traditionally viewed the relationship between immigration and disease. 5 In this article, I compare the broad intentions of US policy fundamentally concerned with managing the economic burden of disease in 2 periods: the Progressive Era, in which medical inspection sought to control the consequences of disease not by turning immigrants back but by introducing them to industrial values and expectations regarding work and dependency, and the current era of immigration and welfare reform. Although the racial politics of immigration have typically framed our understanding of Progressive Era policy, in discussing that period I consider the day-to-day practice of immigrant medical inspection and the ways it was shaped by industrial demands. For the present era, in which individuals certainly live within the constraints of both federal and state policy on a day-to-day basis, I focus on the politics and policy at the broadest level, considering the provisions of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA, or Personal Responsibility Act), which excluded illegal and legal immigrants from many public benefits such as Medicaid. There are, of course, important differences between the 2 eras: immigrants, particularly illegal immigrants, fuel the service industry and highly skilled immigrants fill the ranks of the information sector in the current era of globalization, whereas in the late 19th and early 20th centuries immigrants joined the unskilled industrial labor force. Likewise, the changing position and power of organized labor potentially gives different meaning to the notion of inclusion in the 2 different eras. Nonetheless, at both the dawn and dusk of the 20th century, I argue, the most consequential public policies responded to disease and its economic burdens by seeking to control the behavior of immigrants within our borders rather than excluding immigrants at our borders. That this theme of inclusion marks 2 such different eras underscores its enduring significance in American public policy.
