Avenues of Care

Immigrant Neighborhoods

Pathways of Immigrant Health

The Wise Woman and the Witch

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 

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.

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

Deaconess Hospital*, Est. 1865

*Deaconess Hospital changed its name to Passavant Memorial Hospital in 1894, and in 1972 merged with Wesley Hospital to become Northwestern Memorial Hospital.

Tuberculosis

Infectious Disease

Twenty million new immigrants arrived in the United States between 1890 and 1924. Population growth, particularly in dense urban areas, increased the likelihood of the spread of infectious diseases such as measles, scarlet fever, tuberculosis and influenza. 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 cause 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 persisted over the next few decades, as evidenced by this concerned letter to the editor and its reply, published in JAMA in 1925 (see Image Gallery). Medical professionals who supported these ideas proposed several theories, including that emigrants 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 and 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 months-long “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 most effective way to prevent the spread of TB was to isolate 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 families, 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 gained acceptance among the general public, campaigns against public spitting emerged in cities across the country, led by agencies such 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 living with family members diagnosed with tuberculosis. The outdoor air, sunshine, exercise, and nutritious food available to the children were intended to prevent illness. Although all thirty children were born in the United States, only one was an immigrant. The Institute continues to exist as the Respiratory Health Association and advocates for respiratory health and clean air in Chicago.

Gustav Fütterer

Gustav Füttner, MD, conducted early research on M. tuberculosis, the bacterium that causes tuberculosis. Though a medical school graduate, he lacked the premedical training desired by German universities. He immigrated to America in 1890 and relocated to Chicago, where he became affiliated with several local 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

Medical Education

Public Health in Medical Education

Beginning in the 1880s, Chicago’s burgeoning immigrant population led to numerous cultural changes, which are reflected in the medical school curriculum. To prepare future physicians for work in diverse communities, Northwestern continually adapted its public and community health coursework to address the needs of its surrounding populations.

In the 19th and early 20th centuries, Northwestern medical students learned primarily through structured coursework, such as lectures and demonstrations. As pedagogical techniques transformed, educational offerings expanded to be more patient-centric, hands-on, and culturally inclusive. Today, Northwestern is adjusting its curriculum to address the evolving health needs of a changing demographic in the Chicago area and beyond.

Since the medical school’s founding, the educational resources used to teach hygiene, sanitation and community health have undergone significant changes. The list of courses and departments below highlights that shift as well as the change in terminology:

• 1859-1868 - Pathology & Public Hygiene
• 1868-1875 - Hygiene/Public Hygiene
• 1875-1882 - Medical Jurisprudence & Hygiene
• 1882-1892 - State Medicine & Public Hygiene
• 1892-1909 - Etiology & Hygiene
• 1909-1921 - Sanitary Science
• 1921-1942 - Public Health in the Dept. of Medicine
• 1942-1951 - Public Health in the Dept. of Bacteriology & Immunology
• 1951-1972 - Preventive Medicine & Public Health in the Dept. of Medicine
• 1972-today - Community Health & Preventive Medicine

A Common Tongue

In the early 20th century, the medical school required prospective students to complete at least one year of foreign-language coursework prior to admission. The suggested languages were Ancient Greek, Latin, German, and French, indicating that language proficiency was intended primarily for reading medical literature rather than for speaking with patients. There is, however, evidence that students themselves filled this educational gap. The 1907 student yearbook included an extracurricular Colloquial German class intended for “men previously unacquainted with the language…to carry on intelligible and intelligent communication with any ordinary patient.” The course was taught by a recent graduate and attracted over 40 students.

Clinical Experience

The South Side Dispensary was founded to provide medical care for the poor while serving as an educational resource for medical students. Initially, the faculty presented cases to students at weekly clinics; later, students completed service rotations in which they observed and practiced physical examination, diagnosis, and treatment. While the free dispensary service model ended in 1975, today’s MD students enter clinical training in the first few weeks of their program, continuing and building upon the medical school's legacy of clinical education.

The format of this casebook (not pictured here) reflects the long-held belief that race and ethnicity are integral data points for diagnosing and treating patients, though the ‘Nativity’ field was not always utilized.

Textbooks 

These texts have been excerpted from public health textbooks that were once used in Northwestern's curriculum.

Their language, focus and tone differ significantly from current standards of practice. Some of these texts situate the cause of disease in the temperament, personal mores, race and/or nativity of individual patients. Others recognize that external factors contribute to health disparities in low-income, overcrowded neighborhoods and call for greater government attention. Most texts, however, advocate for assimilation and posit viewpoints ranging from well-intentioned but misguided paternalism to outright eugenics.

1893-1894 assigned textbook

1900-1910 assigned textbook

1920s assigned textbooks

Northwestern Connections

Northwestern faculty and graduates have had a great impact on public health in Chicago from the city’s earliest days. In 1850, future medical school founder Nathan Smith Davis played a vital role in improving the city’s sewer system after a malaria outbreak. Northwestern’s medical school has been connected, in big and small ways, to Chicago’s public health ever since.

As waves of immigrants arrived in the United States in the late 19th and early 20th centuries, many viewed them as disease carriers who lacked proper care for themselves and their homes. Through public health policies and reforms, city officials sought to help populations they perceived as ignorant.

Of the first 11 men to serve as Commissioners of Health, three had ties to Northwestern’s medical school—two as professors and one as a graduate—and many other medical school faculty and graduates served on the Board of Health throughout its history. The evolution of general attitudes towards immigrants and migrants is reflected in changes to public health programs and policies during the three men’s tenures as Commissioners.

Oscar C. DeWolf, MD 

• 2nd Chicago Commissioner of Health, 1877-1889
• Professor of State Medicine and Public Hygiene, 1882-1892
• Instituted inspections of tenements, trying to limit the spread of disease
  • Attributed the worst conditions to immigrant families whose national origin, he believed, determined their sanitary conditions, due to a mix of custom and biology
  • Believed it was difficult to enforce ordinances “against such habitual and hereditary unsanitary modes of living.”
• Reformed the meatpacking industry, which employed many immigrant and migrant workers
• Major works: tenement reform, suppression of epidemics, reform in toilet facilities, food inspection, elevating the general standard of cleanliness in streets, alleys, and yards

William A. Evans, PhD, MD, DPH

• 9th Chicago Commissioner of Health, 1907-1911
• Professor of Public Health, 1908-1928; Professor of Preventive Medicine, 1908-1948
• Early proponent of public health education
  • Health editor of the Chicago Tribune, 1911-1914
  • Wrote column, “How to Keep Well,” for over 20 years
• Perpetuated the idea that immigrant groups had different immunities and susceptibilities to disease and higher or lower birth and mortality rates, as inherent characteristics of their nationalities
• Preoccupied with the high birthrate of immigrants versus that of native-born Americans
• Known as an advocate for pasteurization of milk and an early advocate for better ventilation in schools and factories

Herman N. Bundesen, MD

• 12th Chicago Commissioner of Health, 1922-1927, 1931-1960
• Born in Germany and immigrated to Chicago in the 1880s-1890s with his mother, a widow with scant resources
• Earned an MD from Northwestern in 1909
• Oversaw the publication of Department of Health columns in foreign-language newspapers to better reach immigrant communities
• Made efforts to reduce the mortality rate of Black Chicagoans, e.g., contributing a health column to the Chicago Defender
• Instituted an infant welfare program that emphasized parental education, which drastically decreased infant and maternal mortality