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National Museum of Health and Medicine
February 5 - June 21, 1998

Ellis Island in New York Harbor opened as an immigration station in 1892, the beginning of the peak period of immigration in United States history. During its first year of operation, Ellis Island processed nearly half a million people, an annual number that more than doubled within fifteen years. By 1924, when more restrictive laws greatly slowed the flow of immigrants to America, some twelve million people had passed through the Island. Each of these immigrants passed under the watchful eyes of physicians of the United States Public Health Service before being admitted to this country.

[Image]
All emigrants arriving at Ellis Island passed under the watchful eyes of physicians of the United States Public Health Service.
Uniformed physicians of the Marine Hospital Service (predecessor of the Public Health Service) in 1878. (National Library of Medicine)

The Public Health Service (PHS) had begun in 1798 as the Marine Hospital Service, a Federal government program to provide health care to merchant seamen. A series of marine hospitals were established in port cities across the country to care for the seamen. An 1870 reorganization converted the loose network of local hospitals into a centrally controlled system headed by a Supervising Surgeon (later Surgeon General). The physicians of the Service were organized into a Commissioned Corps with uniforms and ranks modeled after the military.

As public concerns about the spread of epidemic diseases intensified in the late nineteenth century, the Marine Hospital Service was given increasing responsibilities for quarantine inspection of ships arriving from foreign ports. Federal legislation in 1891 mandated the medical inspection of all arriving immigrants and assigned this task to the Marine Hospital Service, which became the Public Health Service in 1912. The law stipulated the exclusion of "all idiots, insane persons, paupers or persons likely to become public charges, persons suffering from a loathsome or dangerous contagious disease" and criminals.

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[1.] This engraving from the September 5, 1885 issue of Harper's Weekly reflects American concerns about the importation of diseases from abroad, depicting an angel "At the Gates" of New York fighting off cholera, yellow fever, and smallpox. (National Library of Medicine)
[2.] The nursery at Ellis Island, early 20th century. (National Archives)

First and second class passengers on steamships arriving in New York were examined in the privacy of their cabins, but the "huddled masses" in steerage disembarked at Ellis Island. Given the flood tide of immigrants, the medical examinations were necessarily brief and superficial. The medical inspection began as the immigrants ascended the stairs to the Registry Room in the main building, with PHS physicians at the top of the stairs watching for signs of heart trouble, difficulty in breathing, or physical disabilities.

The immigrants proceeded through the Registry Room in lines, with each newcomer's hands, eyes, throat, and scalp inspected by a uniformed physician at the head of the line. Eyelids were everted with a button-hook to detect the telltale signs of trachoma, a contagious eye disease that could lead to blindness. The scalp was probed for lice or scabs, symptoms of favus, a contagious skin disorder. Although modern technology was increasing the doctor's diagnostic abilities, the speed with which physicians had to act during the line inspection made an experienced glance the best diagnostic instrument at hand.

Physicians were also required to observe the facial expressions and behavior of immigrants for any sign of mental illness or deficiency. In time, psychological tests were developed to improve the ability to detect mental deficiency and insanity. Frequently these tests were non-verbal, such as wooden block puzzles, to minimize problems due to language barriers.

[Images]
[1.] A Public Health Service physician at Ellis Island examines the eye of an arriving immigrant for signs of trachoma, early 20th century. (National Archives)
[2.] Examination of an Immigrant at Ellis Island, early 20th century. The Public Health Service began hiring women physicians in 1914 to assist in the medical examination of female immigrants. (National Archives)
[3.] Asian immigrants arriving at Angel Island, San Francisco Bay, 1931. (National Library of Medicine)

During the line inspection, whenever an immigrant's condition aroused concern, the doctor made a chalk mark on the right shoulder of the newcomer's garment to signal the need to detain the person for further examination. Letters symbolized the suspected condition, e.g., K for hernia, G goiter, X mental deficiency. Most newcomers filed through the medical inspection in less than an hour, and most passed. Fewer than three per cent were rejected on medical grounds, with trachoma the most frequent cause of rejection.

The PHS erected several hospital buildings on Ellis Island, including communicable disease and psychiatric wards. Immigrants with acute contagious diseases might be detained and treated on Ellis Island until healthy and then admitted into the country. The PHS doctors, nurses, and other health professionals on Ellis Island faced all types of conditions, from broken arms to tuberculosis. One observer commented about the hospital complex: "It was at once a maternity ward and an insane asylum." More than 350 babies were born on Ellis Island.

The uniformed PHS officers constituted the immigrants first contact with Americans in the United States, and no doubt many newcomers were intimidated the martial quality of a process that they little understood. Given the large number of immigrants to be processed, the public pressures to exclude "unfit" immigrants, and the widely- held cultural biases concerning many of the newcomers, in general the PHS physicians "served as evenhanded-even benevolent keepers of the gate" (Fitzhugh Mullan, Plagues and Politics: The Story of the United States Public Health Service, 1989).

National Museum of Health & Medicine
For Museum hours and directions, call 202-782-2200.

"This flyer is issued in conjunction with an exhibit at the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Department of Defense, Washington, D.C., February 5-June 21, 1998. The exhibit was prepared with the cooperation of the Department of Health and Human Services, specifically the Public Health Service Historian, National Library of Medicine, National Institutes of Health and the Media Arts Branch, Program Support Center. Professor Alan Kraut of American University served as a historical consultant on the exhibit.

Various individuals and institutions provided artifacts, photographs, information, and other support essential to the project. Special thanks are extended to the Ellis Island Immigration Museum, National Park Service, site of an exhibition on this subject in 1996.

Department of Health and Human Services