Immigration and The Public Health - 1905

English Immigrants at Ellis Island ca 1905. New York Public Library. GGA Image ID # 21ea39a279

The relation of immigration to public health is dependent upon three factors:

1. The physique of the immigrant
2. His destination
3. The presence or absence of infectious disease

The most important of these factors is the immigrant's physique. A good physique is the first requisite of a desirable immigrant. Without a robust constitution and average physical strength, the immigrant can not cope successfully with the hardships he will be called upon to endure in his new home.

The large employers of labor expect and demand men physically strong enough to do a fair day's work. The only place the immigrant with a poor physique can make a living is in the large city, where he becomes either a parasite or a competitor of American skilled labor.

One can better understand the unfair competition of this type of immigrant if one considers their standard of living and their system of sweat-shop production. The aliens of poor physique, usually skilled laborers, go to the crowded city, to the dark, poorly ventilated, and disease-infected tenement. The thousands of these city dwellers arriving every year perpetuate the tenement-house problem and retard the work of sanitation and reform.

With the change in the racial character of immigration, most marked in the last decade, a pronounced deterioration in the general physique of the immigrants and a much higher percentage of loathsome and dangerous diseases are noticeable.

Doctor's Inspection of Suspects for Skin Diseases. Etc. The Maltine Company, Quarantine Sketches, 1902. GGA Image ID # 14ac9c01b3

Thousands of immigrants with poor physiques are recorded by the medical inspectors at Ellis Island. The immigration authorities admit the vast majority of them because the physical defect noted does not appear to make the immigrant a public charge. A card to this effect is sent to the registry clerk or immigrant inspector with the immigrant, but this mere note of physical defect has little significance under the present law.

When the physical defect or poor physique is so marked, it seems to the medical inspector the second factor to be considered is his destination. The destination is scarcely less important than the physique. It is the rule that aliens of a race with a low physical standard will invariably herd together in our great cities' overcrowded, unsanitary tenement districts. In contrast, the sturdy races of unskilled laborers are scattered over a vast territory. They tend to establish tiny homes in the country or the suburbs of manufacturing towns or cities.

Insanity is analogous to tuberculosis since the actual disease or condition does not exist at the time of landing, although in many instances, predisposing factors are present in the individual's physical or nervous makeup. Together with the exciting causes met within this country after landing, these predisposing factors are sufficient to develop the active disease or condition.

Mr. Goodwin Brown, attorney for the New York State Commission of Lunacy, stated before the Senate Committee on Immigration, Washington, 1902, that although only twenty-five percent of the population of the state of New York were foreign-born, fifty percent of the inmates of the state insane asylum were foreigners. He also stated that this excess is not alone exhibited in New York statistics but that an excess of seventeen percent existed throughout the entire country of foreign-born insane over the percentage of foreign-born population.

A Tottoed German Stowaway, 1911. New York Public Library. GGA Image ID # 21ea335f47

The significant number of foreign-born inmates of insane asylums throughout the country indicates that in the past, immigration officials placed too little restriction on the mentally defective and that the opportunity afforded by an inspection at the port of entry was too scanty to be of much value.

A man mentally oblique, or subject to periods of insanity, would, without doubt, pass the inspectors at the ports of landing if he was at that time rational and quiet. People with epilepsy, too, had an excellent chance of being admitted, their rejection depending upon the remote possibility of their having a paroxysm while passing the inspectors. An anarchist, while passing the officers, would, of course, be belle and quiet, and his detection would be challenging.

Regarding insane aliens, at present, we are, in reality, protected much more effectively than is generally known. One hears much of the enormous number of alien inmates of insane asylums. As intimated before, most of these insane aliens were probably sane upon landing, though possessing the predisposing factors of the disease.

The conditions of life here, possibly nostalgia or homesickness, or other exciting causes, unbalance such an alien. The remedy is provided by the law of 1903. That these mentally defective persons were sent formerly in large numbers by persons living in Europe is scarcely open to question. Still, the period of government supervision and power to deport the landed alien has been extended to two years (Act of 1903).

Under this wise provision, an insane person of foreign birth, upon admission to an asylum, is investigated and, if landed within two years, can be deported. The same clause covers the deportation of idiots and epileptics so that we are now much better protected against these burdens than ever before.

Section 2, Law of 1903, provides additional protection, excluding "persons who have been insane within five years previous and persons who have had two or more attacks of insanity at any time previously." The third factor to be considered is communicable diseases among immigrants.

Immigrants established a reputation years ago for bringing in epidemic diseases. They have played their part in outbreaks of typhus, smallpox, and cholera in the past. Still, with the disappearance of the old immigrant sailing ships, the advent of fast, clean ocean steamships, and efficient modern methods of quarantine and disease prevention, the immigrant today as a carrier of epidemic diseases no longer causes us apprehension.

The Quarantine Law of 1893 placed all matters about national quarantine in the hands of the public health and marine hospital service. It provided for the formulation of uniform regulations to be observed by all state and local quarantine authorities in preventing the introduction of epidemic diseases from foreign countries and the spread of such diseases from one state or territory to another.

The secretary of the treasury promulgated the regulations. Under the secretary's direction, the surgeon-general of the public health and marine hospital service is charged with performing all the duties concerning quarantine and quarantine regulations provided for by the act. The law further provides that if the states or municipalities fail or refuse to execute the quarantine regulations, the president should appoint a proper person to implement them.

Most important is the provision in this act, by which ships from infected ports or from ports suspected of being infected are inspected by an officer of the public health and marine hospital service attached to the consulate. Under the provisions of sections 2, 3, and 4 of the act, medical officers of the public health and marine hospital service have been detailed to serve. They are now on duty in connection with the consulates at various foreign ports. All necessary information is received about the sanitary condition of vessels, cargoes, crews, and passengers about to depart for the United States.

This means that the ordinary consular bill of health is made to be a certificate of actual observation by a responsible officer whose sole duty is to prevent the introduction of contagious diseases into the United States.

The common quarantinable diseases are eliminated from the question by efficient quarantine methods. Still, specific communicable maladies, classed as loathsome or dangerous contagious diseases, exist among immigrants. Constant vigilance and considerable skill are necessary for medical inspectors of immigrants to detect these cases and separate them from healthy immigrants.

Trachoma, a contagious form of granular lids, is one of the eye's most obstinate and destructive diseases. Oculists from all parts of the country claim that this disease was introduced by immigrants and spread by them in this country. The condition is now epidemic in the poorer districts of many of our cities.

Still, since 1897, it has been one of the causes of the exclusion of aliens. At about the same time, favus, a loathsome, contagious scalp disease, was made a cause for exclusion. Favus is a typical immigrant disease and can not be spread among people with clean habits.

Trachoma a Constant Danger

Because of its frequency, the most important of these diseases is trachoma. Of the total number of cases of loathsome or dangerous contagious diseases found in immigrants, eighty-seven percent are due to trachoma and ten percent to favus. Several years ago, the prevalence of trachoma in the poorer districts of our large cities, particularly among the foreign-born population, caused numerous medical men to engage in eye work in various parts of the United States where trachoma is placed in the list of excluded affections. This was done in 1897, with the result that a great many suffering from the disease were taken from among the steerage immigrants and deported.

Immigration officials then discovered that ordinary steerage aliens suffering from trachoma were being transferred to the cabin while en route or after being refused passage in the steerage at the port of departure would be sold a cabin passage, with the assurance that officials did not inspect cabin passengers at the port of arrival. To check this practice and to make the inspection of aliens complete, Immigration officials instituted an inspection of cabin passengers in the fall of 1898.

The cabin inspection has been very successful in preventing evasions of the law. However, many steamship companies were still apparently careless of the diseased condition of immigrants to whom they sold tickets. By the last immigration Law (1903), a penalty of $100 is imposed upon the steamship companies for each diseased alien brought to our ports, provided the disease existed when the immigrant took a passage and could have been detected by ordinary medical skill.

This penalty has had a beneficial effect in causing the steamship companies to institute a more rigid medical inspection at the European departure ports. Formerly, the presence of a diseased alien in the steerage was a matter of more or less indifference to the steamship companies, as they could carry him back to Europe if deported and still make a profit on the price of his original passage.

Favus has been included in the list of excluded diseases for several years. If the condition has existed for any time, it is, of course, easily detected by the loss of hair and changes in the character of the individual follicles and scalp. However, detection is often difficult in cases of recent origin because of the tricky efforts at concealment. The immigrants are usually prepared for inspection, the tell-tale yellow crusts carefully removed, and the scalp cleansed.

Little Tuberculosis among the Newcomers

Tuberculosis of the lungs is rarely found among immigrants on arrival. Thousands of immigrants are examined, whose poor physique suggests the possible existence of tuberculosis to the medical examiner. Still, out of many thousands thus inspected at Ellis Island last year, only twelve cases were certified as suffering from tuberculosis of the lungs.

This apparent freedom from tuberculosis is partly explained by the fact that tubercular diseases are notoriously diseases of the cities. At the same time, most of our immigrants come from the agricultural communities and small towns.

The remarkable prevalence of tuberculosis among recently landed immigrants is the effect of overcrowding in infected, filthy tenements by immigrants whose poor physique makes them ready prey for infectious diseases. In addition to the congestion of the tenements, insufficient food, fuel, and clothing, especially among immigrants from Mediterranean countries, must be considered factors in tuberculosis development.

The factors or conditions prevailing among aliens will likely prove a menace to public health. The remedies are apparent:

• Insistence upon a higher standard of physique, or rather, more respect for the doctor's certificate of poor physique, which at present, in a majority of instances, is not considered sufficient to exclude,
• Wider distribution of our aliens to deflect them from the tenement districts to the country.
• Inspections of aliens at foreign ports of embarkation help prevent the spread of infection on shipboard and obviate the unnecessary hardship to which an alien is now subject.

The immigrant should have one standard physique, whether his destination is the Pennsylvania mines or the New York sweatshops. The skilled laborer should be expected to possess the same rugged physique as is now expected of the unskilled laborer.

The physique standard should be prescribed by law so that the medical certificate of failure to reach the standard would be final, as it is now in loathsome or dangerous contagious diseases, idiocy, epilepsy, or insanity. The standard required of recruits for the United States Army, with a fixed minimum height and chest measurement, could be employed for this purpose.

Every male immigrant between eighteen and forty-five should be required to pass such a physical test. Immigration requirements should direct each family to possess at least one male, supposedly the breadwinner, who could meet these requirements.

An aged person, if unaccompanied, should not be permitted to land unless they possess a son, daughter, or other near relatives in America who is willing and able to care for such aged dependent. The requirement of a high, definite standard of physique would have minimal effect on the most desirable alien races.

It would fall heavily upon the parasitic and competitive classes. While it would not stop all the yearly alien reinforcement of the foreign quarters and slums, it would at least ensure that the reduced number of additions should be of a physique rugged enough to withstand the influence of such an existence. It would not materially reduce the number of unskilled agricultural and industrial laborers. It would permit the admittance of plenty of men physically able to do a fair day's work for their employers.

In the matter of distributing aliens over a wider area, one must consider two distinct classes—the aliens already established in colonies in our cities and aliens in general who, through ignorance of opportunities offered in different sections of the country, in many instances, go to the congested areas rather than to the places where their labor is needed. No plan for the relief of tenement congestion, by better distribution of aliens already established there, can be successful without reducing the number of yearly steerage arrivals, particularly of those classes that tend to congest the cities.

Many schemes for distributing the aliens congregated in cities have been proposed; some are chimerical, others more practical, but the consensus among philanthropic individuals and representatives of charitable societies is that the distribution process is necessarily slow. The city-dwelling immigrant must be here some three or four years before he knows enough of our language and customs to enable him to be self-supporting away from his race. Distribution must be effected individually rather than by colonies.

The experience of the great Hebrew charitable societies at least bears out this view. Their efforts at wholesale rural colonization have almost always failed, and the colonies established, with few exceptions, required the society's constant paternal aid. On the other hand, the same organizations have distributed several thousand Jews in various parts of the country, who have been here some time and have learned something of American ways. These have been almost uniformly successful.

Cut Off the Supply of Slum Dwellers

When one considers how slowly the work of distributing the excess alien population of the tenement districts goes on despite the best efforts of societies, individuals, or municipal officers, the necessity is at once apparent of stopping altogether the annual reinforcement of this tenement population, or at least of so reducing the number of additions that the work may make some progress.

As it is now, the excellent work done each year by charitable organizations and philanthropists goes almost for naught. The splendid work of the New York tenement house and street cleaning departments is nullified to a large extent by the yearly addition of thousands of these alien tenement dwellers, for whom educators must repeat the tedious work of education in sanitary matters from the beginning.

After all, these two problems of exclusion of undesirable immigrants and the distribution of aliens are closely associated. The class that clings most persistently to the crowded city is the undesirable class, and if the majority were excluded because of their poor physique, as it would be if we had a definite standard of physique, the problem of distribution would be greatly simplified.

The rejection of the alien at the port of embarkation is of such obvious advantage to the rejected alien, to the steamship company, and (in the case of a diseased alien being rejected) to the other passengers who would be exposed to infection on shipboard, that it is likely that provision will be made for maintaining a foreign inspection at all the principal European ports. It is no longer an experiment.

Officers of the public health and marine hospital service, stationed abroad in the American consulates under the quarantine law of 1893, have examined aliens embarking for the United States in addition to their quarantine duties. They recommend to the steamship companies the refusal of passage to such immigrants as would likely be rejected at United States ports under our laws.

Italy, Kobe, Nagasaki, Yokohama, Japan, Hongkong, and other ports in the Orient. This foreign inspection is now being made by officers of the immigration service on duty in the American consulates at Naples. As a result of this examination, thousands of aliens are rejected at Naples and the above-named oriental ports each year.

The extension of our immigration service to the Canadian and Mexican frontiers and the splendid work done on the immigration officers' borders have closed the last gateways open to violators of our immigration laws.

Not only are the laws enforced rigidly at United States ports and border towns, but by an agreement with the Canadian steamship authorities. American officers are stationed at Quebec, Montreal, Halifax, St. John, and Victoria, BC, to inspect immigrants destined for the United States through Canada.

Foreign inspections will stop undesirables before they reach the ship. If given proper support, the efforts of Commissioner-General Sargent and various philanthropic societies and individuals to distribute aliens over a wider area will be successful. The recognition of a definite physical requirement will do more than any other thing to reduce the menace to public health due to immigration, to say nothing of the beneficial effect upon some of our social and economic problems.

It will reduce the quantity and improve the quality of immigration, thus allowing the adjustment of conditions in the overcrowded sections. If the yearly reinforcement of the sweatshop army could be cut off for some years, the elimination of slums and the sanitary education of their residents would be easy to accomplish. The numerical reduction and improved physical status of the immigrants resulting from more stringent physical requirements would affect this result.

Dr. Allan Mclaughlin, Denied Their Chance in the New World: Italian Emigrant, Rejected by the Steamship Company on the Advice of the American Health Officer Stationed in Naples, Public Opinion, Founded in 1886, V0l 1. 3,4 new York, Saturday, September 23, 1905.

Why This Article on Immigration and Public Health (1905) is Essential for Understanding America’s Immigration History

The Immigration and Public Health (1905) article offers an unparalleled exploration of the intersection between immigration, public health concerns, and policy enforcement at the turn of the 20th century. This in-depth report by Dr. Allan McLaughlin of the U.S. Public Health and Marine Hospital Service provides critical insights into how medical inspections shaped immigration laws, affected immigrant communities, and influenced public health policies in America.

For teachers, students, genealogists, family historians, and immigration researchers, this article is an invaluable resource that explains how immigrant health screenings impacted individuals, families, and entire ethnic communities. It also illustrates how evolving medical concerns shaped U.S. immigration laws and reinforced exclusionary policies.

Key Highlights of the Article:

1. The Three Major Public Health Concerns in Immigration

Dr. McLaughlin outlines the three factors that influenced an immigrant’s health-related admissibility:

• Physique: Immigrants had to meet a minimum standard of health and endurance to be considered desirable for labor markets. Those deemed weak or unfit were often pushed into city tenements, contributing to poor living conditions and public health issues.
• Destination: Immigrants who moved to urban centers were more likely to face disease and hardship, while those settling in rural areas or small towns had better health outcomes.
• Infectious Disease: Diseases like trachoma, tuberculosis, smallpox, and typhus were major concerns, and medical inspectors worked to prevent the spread of these conditions through quarantine and deportation policies.

2. The Medical Screening Process at Ellis Island and Beyond

• Thousands of immigrants were flagged for poor health, deformities, or contagious diseases at Ellis Island, but many were still admitted because their conditions did not make them an immediate “public charge.”
• The immigration medical inspection process was flawed, as individuals with latent mental illness, epilepsy, or tuberculosis often passed undetected, only to require institutionalization later.
• The Act of 1903 expanded medical screenings, making it easier to deport immigrants who developed insanity, epilepsy, or other disqualifying conditions within two years of arrival.

3. Immigrants and the Spread of Epidemic Diseases

• Immigrants were often blamed for outbreaks of typhus, cholera, and smallpox, even though better quarantine measures and cleaner steamships had significantly reduced these threats by 1905.
• Trachoma, a highly contagious and blinding eye disease, became a primary focus of exclusion efforts. 87% of deportations for contagious diseases were due to trachoma, and steamship companies were penalized for transporting infected passengers.
• Favus, a fungal scalp infection, was another disease associated with poor hygiene among immigrants, further reinforcing prejudices against certain ethnic groups.

4. The Push for Stricter Immigration Laws and Medical Standards

• The call for a standardized physical fitness requirement: Dr. McLaughlin proposed that male immigrants should meet the same health standards as U.S. Army recruits to ensure they could perform physical labor.
• Targeting “parasitic” immigrants: There was growing concern that some immigrants relied too heavily on urban welfare systems rather than contributing to industrial and agricultural labor.
• Tighter enforcement at foreign ports: By stationing U.S. medical officers at European departure points, immigration authorities prevented sick or unfit individuals from even boarding a ship, reducing rejections at Ellis Island and other U.S. ports.

5. The Role of Immigration in Overcrowded Tenements and Disease Spread

• The majority of immigrants settled in congested city tenements, leading to the rapid spread of tuberculosis and other diseases.
• Attempts to redistribute immigrants to rural areas largely failed, as most new arrivals preferred to live among their own ethnic communities.
• The connection between slum living conditions and poor health became a justification for restricting immigration from southern and eastern Europe, reinforcing racial and economic biases.

Why You Should Read This Article

This article provides a comprehensive look at how immigration policy and public health concerns were intertwined, ultimately shaping who was allowed to enter the United States and who was turned away.

For genealogists and family historians, this article offers insights into why ancestors may have faced deportation, medical challenges, or difficulties in adjusting to life in America.

For students and educators, it highlights the scientific, political, and social forces that influenced U.S. immigration policies—many of which laid the foundation for today’s debates on public health and immigration.

📖 Explore the full article to gain a deeper understanding of how medical inspections shaped America’s immigration policies, influenced the lives of millions of immigrants, and contributed to public health advancements at the turn of the 20th century!