The struggle against deadly microbes is endless. Scourges that have plagued human beings since the ancients still threaten to unleash themselves; new maladies are brewing that have yet to make their appearance in the headlines; lethal germs employed as weapons of warfare and terrorism have reemerged as a worldwide menace. Regardless of their mode of attack, microbes exist to multiply, thrive, and find new hosts; they cross national boundaries and social classes, attacking without prejudice.

Now medical historian and pediatrician Howard Markel, author of Quarantine! (“Engrossing . . . Meticulously documented” —Sherwin Nuland, The New Republic) , tells the story of six epidemics that broke out during the two great waves of immigration to the United States—from 1880 through 1924, and from 1965 to the present—and shows how federal legislation closed the gates to newcomers for almost forty-one years out of fear that these new people would alter the social, political, economic, and even genetic face of the nation.

Markel writes about tuberculosis today, the most serious public health threat facing the contemporary world. He writes about bubonic plague and how it came to this country in the early twentieth century; about trachoma in the years before World War I; about Ellis Island and how an East European rabbi was diagnosed and treated for the dreaded eye infection; about typhus fever and an epidemic on the Texas-Mexico border in the aftermath of Pancho Villa’s revolution; and about AIDS, the Haitian exodus, and the early years of the AIDS epidemic.

Markel explains how immigration in the twenty-first century is characterized by porous borders, rapid travel, and scattered destinations. While more than 75 percent of all immigrants during the first great wave of immigration came through New York Harbor, transportation today allows travel to all parts of the United States from the farthest reaches of the globe, giving public health physicians little opportunity to definitively diagnose infectious diseases that can incubate silently in a traveler, making the spread of epidemics far more than a theoretical concern.

Markel looks at our nation’s response to the pathogens present in our midst and examines our foolhardy attempts at isolation and our vacillation between demanding a public health system so punitive that it worsens matters rather than protects and settling for one that is too lax; how we are fascinated with all things infectious and then hardly give microbes a second thought; how the United States, a country that since its inception has prided itself on being a nation of immigrants, continues its tradition of blaming newcomers for its physical and social ills; and how globalization, social upheaval, and international travel render us all potential inhabitants of the so-called Hot Zone. Finally, Markel puts forth a plan for a globally funded public health program that could stop the spread of epidemics, help eradicate certain diseases, and protect us all.