America’s Medicalized Borders: Past, Present, and Possible Future

In this series commissioned by Catherine S. Ramírez and A. Naomi Paik, contributors examine the legacy of the Immigration Act of 1924 and the simultaneous launching of the Border Patrol, which, together, inaugurated the most restrictive era of US immigration history until our own.
“Only by building new models of collective health that are driven by solidarity, rather than fear, do we stand a chance of defeating today’s medical nativists.”

 Syphilis is epidemic in parts of California. This is one of the penalties we pay for an open Mexican border… The Mexican peon does more than bring into the United States smallpox. With his numerous offspring he tends to dilute our old American blood. Immigration Study Commission, “Mexican Strays into California,” Eugenical News, vol. 11, no. 6 (1926), p. 88.

Nobody has seen anything like we’re witnessing right now … It’s poisoning the blood of our country. It’s so bad, and people are coming in with disease. People are coming in with … every possible thing you could have. Donald Trump, interview with Raheem Kassam, September 27, 2023

The notion that immigrants are sources of disease and racial degradation has been a foundational element of US national discourse for generations. Though the two statements above are separated by nearly 100 years, their stunning similarities demonstrate an ideological continuity running through this country’s history. Yet while much has been made of former President Trump’s echoing of fascist rhetoric in the vein of Adolf Hitler, news media has done little to reflect on the profoundly American origins of his recent statements.

If we intend to understand the continued salience of such views, it’s necessary to excavate their sordid roots, particularly on this year’s centenary of the Immigration Act of 1924—a law that was the culmination of years of anti-immigrant pathologization. Reflecting on the past and present manifestations of “border medicalization”—the process by which immigrants are stigmatized and treated as inordinate bearers of dangerous diseases—is necessary for recognizing and resisting its new and emerging forms.


The Past

In the late 19th century, new bacteriological understandings of disease transmission emerged. These, in turn, fused with a new xenophobic panic, which responded to the growing arrival of immigrants from eastern and southern Europe and Asia.

These new immigrants became widely viewed as carriers of the most pernicious infectious diseases ravaging the United States at the time, such as cholera, syphilis, smallpox, typhus, and trachoma. Such diseases were already prevalent in many parts of the US, and there was little evidence that immigrants were a significant source of contagion. Still, prominent medical and political leaders played an important role in portraying stigmatized foreigners as uniquely pathogenic.

In his 1876 official address as president of the American Medical Association, J. Marion Sims proclaimed that “Chinese syphilis” had reached epidemic proportions in California because of the arrival of Chinese women whose “presence necessarily breeds moral and physical pestilence.” Such malevolent depictions of Chinese women, who were assumed to be imported sex workers, were critical in building political support for the 1875 Page Act, the first federal law to restrict immigration into the United States.

Bolstered by alarmist press reports of outbreaks purportedly caused by pathogenic foreigners, this “medicalized nativism” gained traction. In response, several new measures—including rigorous medical inspections at ports of entry, migrant quarantines, and deportations—began to be implemented. The US Public Health Service (USPHS) devoted most of its resources toward carrying out medical inspections at ports of entry. Beyond quarantining immigrants entering through major ports such as Ellis Island and Angel Island, the USPHS established quarantine stations along the US-Mexico border for over 20 years, defending against what the mayor of El Paso, Tom Lea, described in a 1917 telegram as “dirty lousey destitute Mexicans.” Believed to be typhus carriers, border crossers were subjected to humiliating inspections, in which many were doused with noxious chemicals.

Undoing the politics of fear will require us to reckon with the sickening legacies of nativism that are merely diverting our attention from the greatest threats to our health: social and economic inequality, racism, and a frayed social welfare system.

As infectious disease outbreaks began waning, the emerging field of eugenics gained wider influence. Now, concern shifted among medical nativists from the threat of foreign germs to the dangers of introducing new “racial stock,” considered to be “defective,” into the population. Eugenicists feared that immigrants—allegedly affected by a wide array of mental, moral, and chronic conditions—were a menace to the future well-being of the nation. Such immigrants, they argued, might become “public charge[s]” reliant on governmental support, or reproduce new generations of “deficient” offspring. Consequently, over the years, increasingly broad and flexible criteria for disqualification—such as idiocy, lunacy, and feeble-mindedness—were successively added to immigration restriction laws.

The Immigration Act of 1924 was a product of that same eugenics movement. The new law created a stringent nation-based immigration quota system, which was aimed at decreasing entry of immigrants from eastern and southern Europe. To shape the legislation, Congressman Albert Johnson, the bill’s cosponsor, consulted frequently with leading eugenicists, such as Harry H. Laughlin and Madison Grant. Laughlin produced several reports for Johnson’s House Committee on Immigration and Naturalization, warning of the “contamination of American family stocks by alien hereditary degeneracy.”

While concern with infectious diseases moved to the background, the impulse to associate racialized groups with new outbreaks never disappeared. This became painfully clear in the early years of the HIV/AIDS pandemic, when over 200 HIV-positive Haitian refugees and their dependents were incarcerated in Guantanamo Bay for nearly two years.

Then came the rise of the COVID-19 pandemic. Suddenly, it seemed, border medicalization roared back, inaugurating an unprecedented new chapter in anti-immigrant pathologization.


The Present

During the first years of the COVID-19 pandemic, Trump depicted immigrants as transmitters of disease and degradation. And such slurs were materialized into immigration policy. Just as lockdowns began to be implemented in March 2020, the director of the CDC—under pressure from the White House—enacted Title 42: an order, based on a 1944 public health law, which confers quarantine powers to the surgeon general during infectious disease outbreaks.

Though Title 42 was designed to allow for the quarantining of all persons arriving from a foreign county suspected of carrying an infectious disease, including US citizens, the CDC focused its order only on unauthorized border crossers from Mexico or Canada who might be held in border patrol facilities. Thus, while the US-Mexico border remained open for US citizens and permanent residents, the CDC’s order gave border agents sweeping powers to immediately expel unauthorized migrants, without providing them an opportunity to request asylum.

Soon, however, COVID-19 cases were widespread across the country, and public health advocates began speaking out against Title 42. Nevertheless, the policy was kept in place for three years, and was used more than 2.8 million times to expel migrants.

In contrast to earlier techniques of border medicalization, the CDC order did not call for migrants to undergo medical inspections, sanitizing treatments, or be placed in quarantine. Rather, it allowed Customs and Border Protection agents to merely expel migrants, without even needing to test them for COVID-19. In this regard, the CDC order was actually a sharp escalation of existing medicalized border practices. Between 1891 and 1924, fewer than 3 percent of the total number of immigrants seeking entry into the US were rejected on medical grounds. In contrast, under Title 42, most migrants seeking entry were expelled, regardless of whether they had COVID-19.

As a result of Title 42, asylum seekers became captives in Mexican border cities. Poorly resourced migrant shelters were stretched far beyond their capacities; open-air migrant encampments began to appear. Migrants living in these conditions were impacted by an astonishing number of health issues. Many of them were fleeing unspeakable violence, only to be confronted with more threats to their safety while stuck in Mexico.


The Possible Future

Title 42 is no longer in effect. Even so, the 2020 law continues to cast a long shadow. Today, it remains an inspirational policy for nativists, especially in ongoing congressional debates aimed at further shuttering the border. In recent months, the Biden White House and congressional Republicans have openly discussed the possibility of including a “Title 42-like” authority to suspend asylum processing and expel migrants as part of a border deal. This would amount to a permanent pandemic-era power, although without the fear of a pandemic emergency needed to bolster it.

Unfortunately, this is not the only proposal aimed at furthering border medicalization that continues to loom. Less than a month before Trump left office, his administration issued a new rule that significantly magnified the authority of border officials to classify asylum seekers as threats to national security. This new rule makes migrants ineligible for asylum based on their suspected contact with a wide range of infectious diseases—which are not typically subject to US quarantine laws—simply based on their travel history.

The rule has been in place since 2020, even though it has never gone into effect. Rather than move to rescind the rule, however, the Biden administration has only delayed its effective date.

Rather than shifting away from the politics of medicalized nativism, the COVID-19 pandemic and recent migration patterns have breathed new life into this long-standing American tradition. Border medicalization has rarely, if ever, been effective in preventing the spread of disease. Even so, such policies have long been highly successful in amplifying fears of stigmatized foreigners.

Undoing the politics of fear will require us to reckon with the sickening legacies of nativism that are merely diverting our attention from the greatest threats to our health: social and economic inequality, racism, and a frayed social welfare system. Only by building new models of collective health that are driven by solidarity, rather than fear, do we stand a chance of defeating today’s medical nativists.


For more from Carlos Martinez on Title 42, view a recording of an online discussion that was part of a symposium on one hundred years of eugenics on the Mexican/US border. icon

This article is part of a series commissioned by Catherine S. Ramírez and A. Naomi Paik on the border crisis 100 years after the Immigration Act of 1924.

Featured image: "U.S. Border Patrol (USBP) San Diego Sector (SDC), in collaboration with Immigration and Customs Enforcement (ICE), began transporting Mexican nationals with repatriations back to their country of origin via air flight." by Mani Albrecht / Wikimedia (CC BY-SA)