Scientific Medical Inspection At Ellis Island - 1912

By Alfred C. Reed M.D., Ellis Island, NY.

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, as well as 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 have created it.

To change social and economic conditions to .meet the changing needs and the changing ideals of the people; is indeed the highest of civic functions. 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 medical inspection of all immigrant aliens is performed by the Public Health and Marine Hospital Service at the 82 immigration stations of the United States and its dependencies. In the fiscal year 1911, there came through all ports of entry 1,032,649 immigrants, 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 with the best facilities. The work of the medical officers at Ellis Island is far in advance of what might be expected because of their number, and the facilities offered them. They work under the conscious disadvantage of insufficient space, lack of time for a thorough examination, lack of enough 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 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 of the different conditions under which they have lived, which vary significantly with different races. Hence it is sought to determine a standard of normal intelligence for the adult of each race. The investigation is being conducted on normal illiterates only 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 long, 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 under which the medical officers labor in detecting these conditions. They will even be surprised that as many are found at present, and 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 at 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 percent 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 of the setting aside of unquestioned medical evidence, by some twist of the law or legal technicality. One may well ask why the 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 which were cured in the hospital or died, 66 were landed.

In other words, 4.2 percent of the cases that the law excludes were landed despite the medical certificate. For 1910, the proportion landed was 2.3 percent, and in 1911 it was 3.4 percent. It would seem that those prone to criticize 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, in hastily reviewing 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 the most admirable precision. It should yield results of interest similar to 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 are found showing a lack of physical and sexual development corresponding to age, especially among immigrants from southern and southeastern Europe. To determine the reasons for this and its relation to definite endemic diseases and local conditions is the subject of another line of inquiry being pursued.

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, and yet the intricacies of legal interpretation again nullify the medical diagnosis in some cases.

A line of laboratory investigation has been pursued on trachoma to elaborate an accurate clinical test for the disease and discover the actual etiology. The immigrant hospital on Ellis Island admitted over 6000 patients last year. It 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 being made to apply the latest medical science t0 the detection of 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.

Medical Review of Reviews, VOL. 18, No. 8, AUGUST 1912