At the end of the 19th century, millions of immigrants poured into the United States.

For many, the country they had envisioned as welcoming was suspicious, even hostile.

Fears about their effect on public health — and stereotypes of immigrant groups as carriers of disease — greeted them at ports of entry, along with invasive and humiliating health inspections.

“Outside/Inside,” a digital exhibition at the National Library of Medicine, tells the story of immigrants’ experiences with health care over the past 130 years.

It’s a tale of dramatic change for the nation and those who sought opportunity there. Along the way, concepts of health evolved along with the medical profession.

Progressive-era nurses based at the Henry Street Settlement in New York addressed the needs of many of those new arrivals. Through archival documents and photographs, the exhibition shows how their home visits helped tackle high infant mortality and communicable diseases driven by overcrowding and the low wages that awaited immigrants.

The story isn’t always uplifting: Rampant bias prevailed, fueling myths and laws that stereotyped the new arrivals as dirty or contagious.

In San Francisco and Honolulu, for example, Chinese people were forced into involuntary quarantines and targeted as potential carriers of bubonic plague. During a 1900 plague epidemic in Honolulu, authorities went a step further when they burned buildings in the city’s crowded Chinatown.

The fires burned out of control and eventually destroyed over 4,000 homes, wiping out most of the neighborhood and further impoverishing the city’s Chinese community.

After over a century of advocacy, immigrants’ rights groups have helped ensure that health-care access is available in multiple languages.

But immigrants still face stigmas and barriers to care. “Outside/Inside” explains why — and powerfully documents how health can become a pretext for discrimination.

Visit the exhibition at