Scientific Medical Inspection At Ellis Island - 1912
Doctors Examine Detained Women at Ellis Island ca 1911. GGA Image ID # 21eba7cdb4
The functions of the physician are by no means limited to the diagnosis and cure of physical ailments. There are diseases of society, politics, and industrial life that most strongly demand the application of his keen insight and well-trained intellect to advance the understanding of their pathology, prevention, and cure.
In a broad sense, the physician's obligation lies along this line and in the routine treatment of individual cases. No government and no society are best. In general, each is best suited to the immediate needs of the people who created it.
Changing social and economic conditions to meet the changing needs and ideals of the people is indeed the highest civic function. Few other questions so intimately concern this country today in this regard as the influence of immigration on our American life.
Precisely here, the medical profession has a great opportunity and a -great duty. No one is better qualified than the physician to say which immigrants are desirable. Moreover, under the law, the most crucial feature of immigrant inspection devolves upon physicians.
The Public Health and Marine Hospital Service performs the medical inspection of all immigrant aliens at the 82 immigration stations of the United States and its dependencies. In the fiscal year 1911, 1,032,649 immigrants came through all ports of entry, of whom 749,642 entered through Ellis Island.
The press and medical have recently had a free discussion regarding the many mental defectives and insane who pass Ellis Island. It is true that of the nearly 33,00o insane in the New York State Hospitals, about 8000 are aliens. It is equally valid that of the 10,000 feebleminded children in the New York City public schools, over 3000 are aliens. One can safely assume 30 percent of all the feebleminded persons in the United States to be aliens or of alien parentage.
In place of criticizing the Ellis Island inspection for this state of affairs, it would be well to keep clearly in mind that any person found within three years of landing to be feebleminded can be deported and that this provision of the law extends to imbeciles, idiots, and insane where the insanity depends on causes existing before landing.
It is also to be remembered that feebleminded infants and young children are extremely hard to recognize even with the best facilities. Because of their number and the facilities offered to them, the work of the medical officers at Ellis Island is far in advance of what might be expected. They work under the conscious disadvantage of insufficient space, lack of time for a thorough examination, insufficient interpreters, and too few officers.
Despite all this, they certified 209 mental defectives in the fiscal year 1911.
Under the direction of men specially trained in diagnosing mental disorders, a unique investigation is being conducted at Ellis Island, which promises a means of recognizing feeblemindedness in aliens. Such recognition is now attained with the most significant difficulty.
The principle employed is that of the well-known Binet-Simon system of tests for intelligence, or tests for mental age compared to physical age, which has been so successfully used in a modified form by Dr. Goddard.
Each group of tests furnishes an index of the mental status of the average child of the corresponding age. According to the degree of deficiency, those who fall below the test group of appropriate age are rated as feebleminded, imbecile, or idiot.
This system does not apply to immigrants because their living conditions vary significantly with different races. Hence, a standard of normal intelligence for adults of each race is sought. The investigation is conducted on normal illiterates to establish a minimum standard of normal-mindedness for each race.
All who fall below this standard of mentality can be classed as defective. Such a standard of normal-mindedness will afford a quick, fair, and comparatively accurate means of examination. A continuous series of observations will be necessary to establish a standard for different ages to apply the method to children.
Those familiar with mental defectiveness will realize the enormous difficulties medical officers face in detecting these conditions. They will even be surprised that as many are found at present, they will recognize the value of this attempt to establish a minimum standard of normal-mindedness for each race.
It is impossible that an examination in New York should discover all cases of insanity when it is recalled that no case with very marked symptoms would have been allowed to embark in the first place. These persons are adept at concealing their disorders. Even so, Medical Services stopped a large percentage of insane at Ellis Island in 1911.
What has been said regarding the deportation of mental defectives applies with still greater force to those who become insane within three years from causes existing before landing.
A grave condition associated with the increase of alien insane in this country is that no matter how careful or how skillful the medical officer may be in his diagnosis of insanity, which has developed within the three-year limit, from causes existing before landing, the strange vagaries of legal reasoning often nullify the entire case.
This is illustrated by Decision 120 of the solicitor of the Department of Commerce and Labor. An officer of the Public Health Service, a member of the New York State Board of Alienists, and the physicians of the Manhattan State Hospital had concurred in a diagnosis of manic-depressive insanity in this case.
Psychiatrists recognize that manic-depressive and analogous forms of insanity are due primarily and only to constitutional psychopathic tendencies and mental instability existing from birth.
In the face of this belief, the decision in question concludes that while the diagnosis is correct, this case of insanity developed after landing and could not be deported! A legal opinion is an evident contradiction to medical facts. It illustrates the folly of a layman passing judgment on a question in the most abstruse field of medicine, namely psychiatry!
This decision prevents the deportation of a class of cases that formerly .furnished 350 deportations annually. Other illustrations could be cited as the setting aside of unquestioned medical evidence by some twist of the law or legal technicality.
One may ask why medical examiners should seek to detect even greater numbers of the physically and mentally unsound when their work is disregarded and discredited in a large number of cases that they do see.
The annual report of the Chief Medical Officer at Ellis Island for the fiscal year 1909 showed that 1544 cases were certified to have conditions which the law declares positively shall be excluded. Exclusive of those occurring in citizens, in the native-born, and of cases cured in the hospital or died, 66 were landed.
In other words, the law excludes 4.2 percent of the landed cases despite the medical certificate. In 1910, the proportion landed was 2.3 percent, and in 1911, it was 3.4 percent. It would seem that those prone to criticizing the medical inspection at Ellis Island would do well to consider just how efficiently the present deportation laws are administered and how often the medical diagnosis is disregarded.
In collaboration with the Smithsonian Institute, Health Service officers hastily reviewed other fields of particular endeavor in the medical work at Ellis Island. Mention must be made of the public's anthropological investigation. The stream of immigrants of all races and nations passing through Ellis Island offers a rare opportunity to collect physical measurements of the most significant anthropological value.
It is arduous and requires instruments and methods of admirable precision. It should yield results of interest similar to those of the pure scientist and the student of American physical development and the factors that must enter into the formation of the best national type of the future.
Many cases show a lack of physical and sexual development corresponding to age, especially among immigrants from southern and southeastern Europe. Another line of inquiry is being pursued to determine the reasons for this and its relation to definite endemic diseases and local conditions.
The well-known economic importance of hookworm disease emphasizes the importance of Uncaria examinations, now made of immigrants showing pronounced anemia. Those having a hookworm infection are excludable under the law.
A recent investigation in the immigrant hospital on Ellis Island indicates that 4 percent of all immigrants are infected with hookworm. It may be noted that in San Francisco, 90 percent of the Hindu coolies on one ship harbored this parasite.
There is no larger trachoma clinic in the United States than at Ellis Island, and the officers there become unusually expert in its recognition. It is safe to say that very little real trachoma escapes detection. Yet, the intricacies of legal interpretation again nullify the medical diagnosis in some cases.
A laboratory investigation has been pursued on trachoma to elaborate an accurate clinical test for the disease and discover its actual etiology. The immigrant hospital on Ellis Island admitted over 6,000 patients last year, which presents an unusual and valuable opportunity for the intensive study of contagious, parasitic, and skin diseases.
A comprehensive routine examination of all cases shows any evidence or suspicion of defect or disease on the primary inspection. Urinalysis, vision tests, and the ophthalmoscope are frequently employed.
Officers are detailed from time to time for particular courses of instruction at various large institutions, especially for the study of insanity and mental defectiveness.
The medical features of the Ellis Island inspection are of vital interest. Every physician should know what is being done there and take an intelligent interest in the efforts to apply the latest medical science to detect the physically and mentally unsound.
As the sole national agency operating to combat epidemic disease and promote preventive medicine, the Public Health Service stands high in the medical profession and deserves hearty sympathy and support.
Alfred C. Reed M.D., Ellis Island, NY., "Scientific Medical Inspection At Ellis Island," in the Medical Review of Reviews, Vol. 18, No. 8, August 1912
Why You Should Read This Article on Scientific Medical Inspection at Ellis Island (1912)
For teachers, students, genealogists, and family historians, this article is an invaluable resource that provides firsthand insight into the medical inspection process that determined whether immigrants could begin a new life in America—or be turned away.
Ellis Island was the gateway to the American Dream, but for many, medical inspections became an unexpected barrier. This article explores how scientific advancements, mental health assessments, and public health concerns shaped the immigration process in the early 20th century.
Key Insights from the Article:
1. The Role of Physicians in Immigration Policy
- Medical professionals had a huge responsibility in determining which immigrants were physically and mentally fit to enter the U.S.
- Public health concerns, racial biases, and economic fears all played a role in how physicians assessed newcomers.
- Mental health evaluations became increasingly important, leading to a pioneering study using intelligence tests to determine cognitive ability.
2. Cutting-Edge Medical Science Was Applied to Immigration Inspections
- The Binet-Simon Intelligence Test was adapted for different ethnic groups to determine mental fitness for admission.
- Researchers studied the physical development of immigrants from various nationalities, attempting to correlate health with race and environment.
- A special laboratory at Ellis Island was used for studying trachoma, hookworm, and other diseases to refine medical screening techniques.
3. Mental Health Evaluations Became a Key Factor in Immigration Decisions
- Feeblemindedness, insanity, and epilepsy were among the conditions leading to immediate exclusion or deportation.
- Psychiatrists and medical officers at Ellis Island worked on new methods to detect mental illness in immigrants.
- Legal loopholes allowed many cases to slip through, and deportation decisions were often overturned due to contradictory legal interpretations.
4. The Legal System Undermined Medical Diagnoses
- The deportation of mentally ill immigrants was frequently blocked by legal decisions that overruled medical diagnoses.
- Even when doctors diagnosed an immigrant with a severe mental disorder, courts sometimes deemed them fit for admission.
- The article criticizes the legal system for interfering with public health concerns, arguing that medical experts, not judges, should determine an immigrant’s fitness.
5. The Struggle to Keep Epidemic Diseases Out of the U.S.
- Medical officers at Ellis Island became experts in detecting trachoma, a highly contagious eye disease common in immigrant populations.
- Hookworm infections were found in 4% of immigrants, leading to increased screening procedures.
- The Ellis Island hospital became one of the largest facilities for studying contagious diseases, providing valuable insights into public health.
Why This Article Matters for Immigration & Medical History
📖 For genealogists and family historians: This article helps explain why some ancestors may have been detained or deported for medical reasons.
📖 For educators and students: It provides a case study of how science, immigration, and public policy intersected in the early 1900s.
📖 For those interested in public health history: It reveals the origins of modern medical screening methods and how they shaped immigration policies.
🚢 Discover the untold medical challenges immigrants faced at Ellis Island—read this article for a deeper understanding of the immigrant experience!
