Early transoceanic voyages

When departures to the Americas intensified in the last decades of the nineteenth century, the voyage by ship took up to more than a month and was carried out in pitiful conditions. In fact, until the approval of the law of January 31, 1901, there was no regulation of the sanitary aspects of emigration, and even in 1900, the situation of emigrant ship transportation was summarized by a doctor as follows: "Hygiene and cleanliness are constantly at odds with speculation. There is a lack of space, a lack of air."
The emigrants' bunks were made in two or three corridors and received air mostly through hatches. The minimum height of the corridors ranged from six feet for the first, starting from the top, to six feet for the second. Diseases, especially bronchial and respiratory diseases, were common in the dormitories thus set up. To underscore the lack of the most basic hygienic standards, reference can be made to the problem of storing drinking water, which was kept in iron crates lined with concrete. Due to the rolling of the ship, the cement tended to crumble, clouding the water which, having come into contact with the oxidized iron, took on a red color and was thus consumed by the emigrants as no distillers were provided on board.
Food, regardless of the impossibility for emigrants, illiterate or otherwise unable to have accomplished knowledge of food regulations, was prepared following a series of constant alternations between "fat" and "lean" days, "coffee" days and "rice" days. In addition, depending on the prevalence of northerners or southerners on board, rice or pasta (macaroni) meals were prepared. From the dietary point of view, the daily food ration was sufficiently rich in protein elements and in any case superior in quantity and quality to the emigrant's usual type of diet.

The transoceanic journey

From the health statistics of the General Commissariat of Emigration and from the annual reports prepared by the naval officers in charge of the emigration service, both concerning the morbidity and mortality of emigrants on the outward and return voyages from North and South America, it is possible to sketch a picture of the sanitary situation of Italian transoceanic emigration from 1903 to 1925 which, while discounting the limitations of the partiality and discretion of the survey system, makes it possible to fix some basic elements of the sanitary dynamics of the flow to which to refer the vast case histories reported by the reports and logbooks. The state of disorganization of health services for emigration, both on land and on board, makes the statistical tables take on the character of general indicators of the dimensions assumed by the health problem in the context of the mass migration experience, but instead makes their use problematic in function of the study of specific pathologies. The data collected by the statistics do, in fact, refer to illnesses ascertained during the journey by the government doctor or the traveling commissioner, thus excluding from the survey a certain number of emigrants who, for different reasons, attributable to a widespread distrust of medical power or to the fear of being rejected for illness in the country of destination or hospitalized once repatriated, did not require health care. A substantial part of the migratory flow escaped, then, completely from any form of health control either because they embarked and disembarked in foreign ports, or because they traveled on ships lacking health services, or because they embarked in semi-clandestine forms tolerated by many shipping companies. It appears, therefore, evident that any attempt to systematically estimate the "health issue" of transoceanic emigration on the basis of the sources produced at the official level by the emigration health service presents data that are vastly underestimated in comparison with the real dimensions assumed by the problem of health and disease in transoceanic travel.
Despite the limitations and partiality of the sampling, the health statistics of transoceanic travel remains one of the few tools available to initiate a series of reflections linking the phenomenon of transoceanic emigration with the socio-health conditions of the subaltern classes between the 1800s and 1900s. An analysis of the figures provided by statistics for the period 1903-1925 clearly shows the persistence throughout the time period considered of certain diseases both on outward and return trips from the Americas. Although it is beyond the scope of the research to evaluate the definition of the transoceanic flow in relation to the spread of mass pathologies (pellagra, malaria, tuberculosis) in Italy, due to the complexity of elements that concur in determining the migratory choice in areas of the country that are profoundly diversified in terms of economic and social structure, one cannot, however, fail to note how in the statistics on morbidity in transoceanic voyages some of these pathologies are massively present. Typical is the case of malaria, which gives the highest indices on outbound trips to both North and South America, surpassed only by measles. On trips to the South, the number of trachomatosis and scabies patients is also significant, while on return, trachoma and tuberculosis and, though with lower indices, ankylostomiasis, which is completely absent in the outward statistics, clearly prevail over other diseases. In repatriates from the North, the highest figures are given by pulmonary tuberculosis from mental alienations and trachoma. The latter disease, while not presenting particularly high figures, is more prevalent than in outbound trips. Mortality and morbidity rates in transoceanic voyages, while not reaching very high peaks, are still higher in voyages to and from South America, where migratory currents were headed with a strong prevalence of family groups. The finding of consistently high morbidity on return trips appears particularly significant for returnees from North America. The migratory flow to the United States was, in fact, predominantly composed of people in good physical condition and in the age group of highest physical efficiency, due both to a process of self-selection of the labor force that chose to emigrate and to the strict health controls activated by the United States against European emigration.