TUBE AT SOURCE
http://www.history.com/topics/ellis-...cal-inspection
Quote:
Medical Examination of Immigrants at Ellis Island
Alison Bateman-House, MA, MPH, and Amy Fairchild, PhD, MPH
SARS, avian flu, bioterrorism: such threats to national security at the dawn of the 21st century have renewed anxieties about controlling disease at the nation's borders. Control of infectious agents also provided the impetus for immigrant medical inspections along the U.S. coasts in the late 19th century, but, in practice, it was the weeding out of chronic disease and disability that actually motivated public health officers on "the line" at Ellis Island and other U.S. immigration stations during the first 30 years of federal control of the nation's borders.
Learning Objective Learn about the goals and procedures of the medical inspections that the Public Health Service conducted on immigrants to the U.S. from the 1890s through the mid-1920s.
From the colonial era to the end of the 19th century, each state had borne responsibility for regulating immigration. But with the swelling numbers of immigrants in the 1880s and 1890s, an increasingly complex industrial economy, and mounting concern about the international spread of infectious diseases, the federal government took control of the nation's borders in 1891.
While admission decisions were made by the Immigration Service (IS), the law required medical inspection of immigrants by the United States Public Health Service (PHS). When a PHS medical officer formally diagnosed an immigrant with a disease or defect, throwing his or her admissibility into question, that individual was considered "medically certified." The law required the PHS to issue a medical certificate to those who suffered from a "loathsome or a dangerous contagious disease" [1]. Exclusion of those diagnosed with infectious diseases such as tuberculosis, venereal disease, trachoma, and favus was mandatory [2].
The PHS defined its mission rather narrowly—preventing the entrance of disease to the nation—but PHS officers interpreted their job more broadly. In their eyes, the goal was to prevent the entrance of undesirable people—those "who would not make good citizens" [3]. In the context of industrial-era America, immigrants who would wear out prematurely, requiring care and maintenance rather than supplying manpower, would not make "good" citizens. By 1903 the PHS had elaborated two major categories: "Class A" loathsome or dangerous contagious diseases and "Class B" diseases and conditions that would render an immigrant "likely to become a public charge." A subset of Class A conditions included mental conditions such as insanity and epilepsy.
Inspection on the "Line"
Medical examination centered on the "line," which became shorthand for the set of techniques and procedures that medical officers used to examine thousands of immigrants quickly. Ellis Island—where roughly 70 percent of immigrants entered the United States —set the standard. After an arriving ship passed the quarantine inspection in New York Harbor, IS and PHS examiners boarded and examined all first- and second-class passengers as the ship proceeded up the harbor [4]. Upon docking, PHS officers transferred steerage or third-class passengers to Ellis Island by barge. Proceeding one after the other and lugging heavy baggage, prospective immigrants entered the station and moved slowly through a series of gated passageways resembling cattle pens. As they reached the end of the line, they slowly filed past one or more PHS officers who, at a glance, surveyed them for a variety of serious and minor diseases and conditions, finally turning back their eyelids with their fingers or a buttonhook to check for trachoma.
The diagnostic protocol emphasized the physician's "gaze," demonstrating the conviction that disease was written on the body. Dr. Albert Nute, while stationed in Boston, argued that "almost no grave organic disease can have a hold on an individual without stamping some evidence of its presence upon the appearance of the patient evident to the eye or hand of the trained observer" [5]. Exemplifying this notion, PHS regulations encouraged officers to place a chalk mark indicating the suspected disease or defect on the clothing of immigrants as they passed through the line: the letters "EX" on the lapel of a coat indicated that the individual should merely be further examined; the letter "C," that the PHS officer suspected an eye condition; "S" indicated senility; and "X," insanity [6].
In practice the PHS focused on those diseases and conditions that were transparent not only to highly experienced medical examiners but also to ordinary immigrants. Everyone could see that the elderly were turned aside for further inspection. Everyone could see a stooped back or a pregnant women traveling alone. Everyone could see the attention that was given to eyes and could thus gauge the importance of vision. And everyone could see that the young (except those too young to work), the muscular, and the robust were not turned aside.
Among the immigrants' many apprehensions, the fear of rejection loomed foremost as they undertook passage from abroad. Prospective immigrants were forewarned of the medical examination through immigrant aid guides, steamship brochures, and the initial steamship company medical and quarantine examinations needed to secure passage to America. The PHS faced the immigrant as an adversary of sorts, for the PHS officers encountered "the shrewdest evasion and concealment" [7]. Aware of some of the conditions for which PHS officers searched, immigrants attempted to hide deformities of the arms and hands and to mask disease either physically or pharmacologically. They may not have been able to decipher the code that the PHS officers inscribed on their clothing, but the meaning of the writing was clear, as each marked individual was turned off the line, separated from friends, family, and fellow passengers, and directed into cage-like areas.
PHS officers immediately transferred those bearing chalk marks—typically 15 to 20 percent of arrivals—to either the physical or mental examination rooms. In the semi-private, single-sex physical examination rooms, immigrants partially disrobed and were examined with stethoscopes, thermometers, and eye charts. Sometimes height and weight were measured. Those suspected of having mental defects met with a PHS officer who asked them simple questions, such as their name or age, and gave them tests that required manipulation of cubes or puzzles or interpretation of events depicted in photographs. At the conclusion of the medical or mental examination, the immigrant would receive an OK card or a medical certificate.
Treatment for the Medically Certified
The PHS encouraged its officers to spend as much time as necessary to make accurate diagnoses of those "turned off the line" [8]. Some were confined, often for many months and sometimes years, in the isolation units in the southernmost wing of Ellis Island. Over time, the IS granted medical treatment to more and more immigrants, often justifying it on humanitarian grounds. Of those who applied for hospitalization after 1907—which included not only the medically certified but also those in need of treatment for a condition not covered under the immigration law, such as diarrhea—only 13 percent were denied treatment. Most did not apply for treatment of Class A conditions because, if the request was granted, the immigrant was required to pay all medical expenses. Immigrants granted hospital treatment at Ellis Island and other ports were often deported for inability to pay hospital expenses associated with Class A conditions [9].
Each medically certified individual received a hearing before an IS Board of Special Inquiry (BSI). Here, a panel of three IS officers questioned the immigrant about his or her occupation, finances, and family residing in the United States. In most instances the BSI overruled the medical certificate and did not reject the immigrant. From approximately 1906 to 1930, only a handful (1.6 percent) of the medically certified ever appealed an excluding decision; the odds of success for those launching an appeal were, at best, even [10]. Deportation could split up families; husbands and wives were often separated, and children could be deported without their parents (though a parent might decide to go back with a child).
The procedure was intimidating, and, indeed, between 1891 and 1930 nearly 80,000 immigrants were barred at the nation's doors for diseases or defects. Yet the vast majority were allowed to enter the country—on average, fewer than 1 percent were ever turned back for medical reasons [11]. Of those who were denied entry, most were certified, not with "loathsome and dangerous contagious diseases," but with conditions that limited their capacity to perform unskilled labor. Senility (old age), varicose veins, hernias, poor vision, and deformities of the limbs or spine were among the primary causes for exclusion. That so few of the more than 25 million arriving immigrants inspected by the PHS were excluded sets into bold relief the country's almost insatiable industrial demand for cheap labor.
Origin-Related Differences in Inspection Procedures
Yet the demand for labor conformed to racial ideology. Influenced by scientific racism, the medical examination procedures differed for European, Latin American, and Asian immigrants. On the East Coast, the medical exam served more of a processing than exclusionary function for European immigrants. Non-Europeans faced more considerable medical obstacles to entry at the nation's Pacific Coast and Mexican border immigration stations. At Texas border stations, PHS medical inspectors stripped, showered, disinfected, searched for lice, and physically examined large groups of immigrants. All second- and third-class Asians immigrants arriving in San Francisco endured a physical exam similar to that conducted along the Mexican border in addition to routine laboratory testing for parasitic infection, which required detention at Angel Island for one or more days. Disease, health officials argued, was not so easily "read" in the "inscrutable" Asians, particularly the Chinese [12].
But while the demand for labor had assured that the flow of European immigrants to the U.S. would continue relatively unrestricted, in the years after World War I political elites successfully argued that the immigration of "undesirable" southern and eastern Europeans had to be cut off at the source. The Immigration Act of 1924 restricted immigration numerically and made national origin the basis for admission into the U.S. On the European front, the 1924 Act transferred immigrant medical inspection abroad and established the visa system: immigrants could no longer depart for the United States until an American consular office abroad had granted them visas. Medical inspection, which was now conducted along the lines of private medical exams, became a prerequisite for consular approval. One of the consequences of this shift was an increase in the percentage of immigrants denied entry on the basis of disease. Between 1926 and 1930, nearly 5 percent of those examined abroad were ultimately refused visas for medical reasons—a significant increase over the medical exclusion rate of less than 1 percent that had prevailed in the United States since 1891 [13]. As a result, the medical exam came to be viewed as more "scientific" and "objective."
Medical Screening Today
Today guidelines for the medical screening of aliens seeking permanent residency or certain categories of temporary residency in the United States are set by the Centers for Disease Control and Prevention's Division of Global Migration and Quarantine (DGMQ). Health-related grounds for barring admission to the United States include having a "communicable disease of public health significance," including chancroid, gonorrhea, HIV infection, infectious leprosy, infectious stage syphilis, and active tuberculosis [14].
Tuberculosis (TB) provides a vivid example of the complexities that continue to bedevil immigrant medical screening. After decades of decreasing incidence, a TB epidemic occurred in the United States during the late 1980s and early 1990s, reawakening the nation to the presence of what had been considered a conquered disease. Not surprisingly, links between TB and the foreign-born spurred calls for more screening of immigrants, both before and after their arrival in the United States [15]. By law, an applicant for a visa or permanent residency who has TB is inadmissible only if the disease is clinically active, and waivers for prospective immigrants with active disease are available. Individuals with latent TB infection (LTBI) are not barred; however, such infections lead to active disease in about 5 percent of cases, and reactivation of latent TB is believed to account for the majority of active cases in immigrants [16]. The possibility that latent cases will reactivate has led immigration policy to address LTBI. In 2000, the Institute of Medicine (IOM) called for an overhaul of TB screening procedures for prospective immigrants in order to enable more accurate detection of LTBI [17]. The IOM also proposed that aliens with LTBI complete treatment for the infection before receiving a permanent residency card [18].
In keeping with the IOM's recommendations, the DGMQ's updated Technical Instructions for Tuberculosis Screening and Treatment for Panel Physicians, released in 2007, includes a new classification (Class B2 TB) for applicants with suspected LTBI [19]. No such classification was in the previous Technical Instructions (1991). Prospective immigrants with Class B2 TB are cleared for travel to the United States but are to be evaluated for LTBI once in the country [20]. Contemporary screening for TB is thus following the historical trajectory of immigrant medical screening: expanding its scope from infectious agents to chronic ones, but, importantly, not strictly for the purposes of excluding immigrants with disease.
http://virtualmentor.ama-assn.org/20...hst1-0804.html
Quote:
Inspected at Ellis Island circa 1903
By Dr. Allan McLaughlin, U. S. Public Health and Marine Hospital Service.
Inspection of our immigrants may be said to begin in Europe. The immigrant usually buys his steamship ticket in his native town from an agent or subagent of the steamship company. The agents of the best steamship lines are held responsible by the company, for the passengers they book for America, and if they ship one of the excluded classes they are likely to lose their agency. This makes the agent examine the applicants for tickets, and probably quite a large number of defectives are refused passage by agents of the first-class lines. These defectives then usually try some less particular and smaller lines and take chances of escaping inspection at the Canadian or Mexican borders.
The next scrutiny to which the immigrant is subjected is that of the steamship authorities at the port of embarkation. This was formerly a perfunctory examination, and is so still, as far as some lines are concerned, but first-class lines, notably the English and German, examine the immigrants carefully and with due regard for our laws.
The strict enforcement of our laws, and especially the imposition of one hundred dollars fine for bringing to our ports any ease of a contagious character, have occasioned some improvement in the inspection made by ships' doctors at European ports. At the port of embarkation the immigrants' names are recorded upon lists or manifests, each list containing about thirty names. After each name the steamship officials are required by law to record answers to a certain number of queries relating to the immigrant.
1903 Passenger Manifests
Seton 12 of the act of 1903 provides that the manifests shall state, in answer to the questions at the top of the manifest sheet:
The full name, age and sex ;
whether married or single;
the calling or occupation;
whether able to read or write;
the nationality;
the race;
the last residence;
the seaport of landing in the United States;
the final destination, if any, beyond the port of landing;
whether having a ticket through to such final destination;
whether the alien has paid his own passage, or whether it has been paid by any other person or by any corporation, society, municipality, or government, and if so, by whom;
whether in possession of thirty dollars, and if less, how much;
whether going to join a relative or friend and if so, what relative or friend, and his name and complete address;
whether ever before in the United States, and if so, when and where;
whether ever in prison or almshouse or an institution or hospital for the care and treatment of the insane or supported by charity;
whether a polygamist;
whether an anarchist;
whether coming by reason of any offer, solicitation, promise or agreement, expressed or implied, to perform labor in the United States, and
what is the alien's condition of health, mental and physical, and whether deformed or crippled, and if so, for how long and from what cause.
The master or first officer and the ship's surgeon are required by the same law to make oath before an immigration officer at the port of arrival that the lists manifests are to the best of their knowledge and belief true, and that none of the aliens belongs to any of the excluded classes.
Alien Identification Cards
Each alien is furnished with a card, with his name, the number of the list on which his name appears and his number on that list. The cards of minor children are given to the head of the family. These cards are valuable and necessary for identification, and facilitate inspection at the port of arrival.
Conditions on Steamships
The condition of the steerage quarters of a modern steamship depends largely upon the age of the ship and the degree of overcrowding. The steerage of a first-class ship of recent construction will afford accommodations equal to those accorded second cabin passengers on less progressive lines.
First-class lines are careful also to prevent overcrowding. On some of the smaller and older ships the accommodations are limited, and overcrowding is permitted. But it is safe to say that the worst steerage accommodations to be found on any ship entering New York harbor to-day are infinitely better than the best afforded by the sailing vessels or old 'side wheelers' of the past.
Inspectors Boarding of Ocean Liners
On entering New York harbor the ocean liners are boarded by the state quarantine authorities, and the immigrants inspected for quarantinable disease, such as cholera, small-pox, typhus fever, yellow fever or plague. Then the immigrant inspectors and a medical officer of the Pubic Health and Marine Hospital Service board the vessel and examine the cabin passengers, paying particular attention to the second cabin.
This cabin inspection is very necessary, and, before its institution, the second class cabin was the route most often employed by persons who found it necessary to evade the law. After the completion of the cabin inspection the ship's surgeon reports any cases of sickness among the aliens in the ship's hospital. The medical inspector examines these cases and later arranges for their transfer, if deemed advisable, from the ship to the immigrant hospital. The immigrants are then taken from the ship upon barges to the immigrant station, Ellis Island.
Medical Examination at Ellis Island
The medical examination at Ellis Island is conducted according to a system which is the result of many years of development. The doctors work in pairs, and divide the inspection between them. The immigrants, coming in single file, are examined for certain defects by the first doctor. who detains each one long enough to keep a space of ten to fifteen feet between the immigrants.
The second doctor, placed about thirty feet from the first, disregards that part of the examination entrusted to his colleague and confines his examination to such defects as are not looked for by the first doctor. The file of immigrants makes a right-angle turn just as it reaches the second doctor and this enables the examiner to observe the side and back of the passenger in the shortest time possible.
The examiners follow a routine in this examination, and the scrutiny begins at the approaching passenger's feet, before he comes within fifteen feet of the examiner. The examiner's scrutiny beginning at the feet travels upward, and the eyes are the last to be inspected. In this way, lameness, deformity, defective eyesight (through efforts to adjust his vision, after making the turn, to a new course) are detected.
The gait and general appearance suggest health or disease to the practiced eye, and aliens who do not appear normal are turned aside, with those who are palpably defective, and more thoroughly examined later.
The medical examiners must ever be on the alert for deception. The nonchalant individual with an overcoat on his arm is probably concealing an artificial arm; the child strapped to its mother's back, and who appears old enough to walk alone, may be unable to walk because of infantile paralysis; a case of favus may be so skillfully prepared for inspection that close scrutiny is required to detect the evidences of recent cleansing, and a bad case of trachoma may show no external evidence and be detected only upon inverting the eyelid.
After the last alien in line has passed the doctor, the suspected ones turned aside are thoroughly examined, idiots and those suffering with a loathsome or dangerous contagious disease are certified and sent to the board of special inquiry. Cases not deemed fit to travel are sent to the hospital, and cases with some disability likely to make them a public charge are certified accordingly and also sent to the board of special inquiry.
Minor defects, such as anemia, loss of an eye, loss of a finger, poor physique, low stature, etc., are recorded on the alien's card and he is allowed to go to the registry clerk and immigrant inspector in charge of the manifest, who takes the defect into consideration as contributory evidence, and may or may not send him to the board.
Grouping of Immigrants
After passing the doctors, the immigrants are grouped, according to the number of their manifest sheet, into lines of thirty or less. At the head of each line is a registry clerk, or interpreter, and an immigration inspector. The clerk, or interpreter, interrogates each alien, and finds his name, and verifies the answers on the manifest sheet before him, and if, in the opinion of the immigrant inspector, the immigrant is not clearly and beyond doubt entitled to land, he is held for the consideration of the board of special inquiry.
Board of Special Inquiry
A board of special inquiry according to the law of 1903 `consists of three members selected from such of the immigrant officials in the service as the commissioner general of immigration, with the approval of the secretary of commerce and labor, shall designate as qualified to serve on such boards.'
"The decision of any two members of a board shall prevail and be final, but either the alien or any dissenting member of said board may appeal through the commissioner of immigration at the port of arrival, and the commissioner general of immigration to the secretary of commerce and labor, whose decision shall then be final, and the taking of such appeal shall operate to stay any action in regard to the final disposal of the alien, whose case is so appealed, until receipt by the commissioner of immigration at the port of arrival, of such decision."
To this `board of special inquiry' are sent the aliens certified by the medical officers as suffering from loathsome or dangerous contagious disease, idiocy, epilepsy and insanity.
Deportation for Unfit Immigrants
In cases so certified the law is mandatory, and the medical certificate is equivalent to exclusion, the board simply applying the legal process necessary for deportation. Aliens certified by the medical officers as suffering from disability, likely to make them public charges, are also held for examination before the hoard of special inquiry.
The board in these cases takes into consideration the medical certificate and such evidence as may be adduced by the alien or his friends which, in the opinion of the board, would offset the physical disability. In these cases the hoard has full discretionary powers, and in a great majority of instances the alien is admitted.
Those certified as defective by the doctors group themselves naturally into four classes, and the following table indicates the disposition of such cases by the boards of special inquiry at New York during a fairly representative month:
Disposition of Immigrants Certified at Ellis Island, New York
Month of October, 1903
Read more: Immigration Archives - How Immigrants Are Inspected at Ellis Island circa 1903 http://www.gjenvick.com/Immigration/EllisIsland/1905-02-