Mental Examination of Immigrants - Administration and Line Inspection at Ellis Island - 1917

Immigrants who enter the United States at the port of New York without traveling in the cabin are first brought to Ellis Island to undergo an examination to determine their fitness for admission.

The average immigrant remains at Ellis Island for two or three hours, during which time he undergoes an examination by the Public Health Service to determine his mental and physical condition and by the Immigration Service to determine whether he is otherwise admissible.

Immigrants are brought from various steamships throughout New York Harbor to Ellis Island by means of barges. As soon as they land at Ellis Island, they undergo medical inspection and examination conducted by officers of the Public Health Service.

1. Line Inspection.

Upon entering the Public Health Service examination plant, the immigrants are guided by an attendant to the different inspection lines. These lines, separated by iron railings, are four in number at their proximal end and two in number at their distal end. After extending a distance of 15 feet, each pair of lines terminates in a single line perpendicular to them. The two single or distal lines are also approximately 15 feet in length.

Four medical officers carrying on the general inspection are stationed in one of the four proximal lines. Two medical officers stand at the extreme ends of the two distal lines or where these lines merge into two common exits.

Medical Inspection of Immigrants in the Proximal Lines at Ellis Island. Edwin Levick, New York. United States Public Health Service, Mental Examination of Immigrants, 18 May 1917, p. 737 Fig, 1. GGA Image ID # 1499957b70

Inspection of Immigrant's Eyes in the Distal Lines at Ellis Island. Edwin Levick, New York. United States Public Health Service, Mental Examination of Immigrants, 18 May 1917, p. 737 Fig, 2. GGA Image ID # 149a1b6da2

At this merging point, an attendant stands whose duty is to separate the chalk-marked aliens from those who are not chalk-marked. Accordingly, immigrants who have passed the medical inspection are guided to the exit that leads to the upper hall of the Immigration Service. In contrast, the chalk-marked ones pass through the exit that leads to the examination department of the Public Health Service.

Diagram of the Arrangement of Line Inspection of Immigrants at Ellis Island, United States Public Health Service, Mental Examination of Immigrants, 18 May 1917, p. 734. GGA Image ID # 14987f467a

The diagram shows the arrangement of the lines as described above and the positions of the inspecting officers and attendants therein. In the diagram, the medical officers are indicated by stars, the attendants by squares, and the immigrants by circles.

Thus, every immigrant undergoing medical inspection passes two medical officers. As stated above, the officer occupying the proximal position performs the general inspection.

This officer's function is to look for all defects, both mental and physical, in the passing immigrant. As the immigrant approaches, the officer gives him a quick glance. Experience enables him to take in six details in that one glance: the scalp, face, neck, hands, gait, and general condition, both mental and physical.

Should any of these details not come into view, the alien is halted, and the officer confirms that no suspicious sign or symptom exists regarding that particular detail. For instance, if the immigrant wears a high collar, the officer opens the collar or unbuttons the upper shirt button and sees whether a goiter, tumor, or other abnormality exists. A face showing harelip, partial or complete, is always stopped to see if a cleft palate, a certifiable condition, is present.

It often happens that the alien's hand cannot be distinctly seen; it may be covered by his hat, hidden beneath his coat, or deeply embedded in blankets, shawls, or other luggage.

Of all the physical details in the medical inspection of immigrants, it is most important to watch the hands. In many cases where the hands cannot be seen at a glance, further searching has revealed a deformed forearm, mutilated or paralyzed hand, loss of fingers, or favus nails.

Likewise, if the alien approaches the officer with a hat on, he must be halted, his hat removed, and his scalp observed to exclude the presence of favus, ringworm, or other skin diseases in this region of the body.

Pompadours are always a suspicious sign. Beneath such long growths of hair are frequently seen areas of favus. The slightest lameness will show itself in an uneven gait or a bobbing up-and-down motion. After constantly observing the passing of thousands of immigrants, the experienced eye of an examiner will quickly detect the slightest irregularity in gait.

Where the alien carries luggage on his shoulder or back, it may be necessary to make him drop his parcels and walk 5 or 10 feet to exclude suspicious gait or spinal curvature. At times, immigrants carry large parcels in both arms and over their shoulders so that the gait resulting from a shortened extremity or ankylosed joint may escape notice.

In like manner, they maneuver in attempting to conceal the gaits of Little's disease, spastic paralysis, and other nervous disorders. All children over 2 years of age are taken from their mother's arms and are made to walk.

As a matter of routine, all children's hats and caps are removed, their scalps are inspected, and, in many cases, palpated. If care is not exercised in this detail, ringworm and other scalp conditions are apt to escape the examiner's attention.

Immigrants who are thin and of uncertain physical make-up are stopped. At the same time, the officer concludes that detaining them for further physical examination is inadvisable.

In these cases, the officer often arrives at a correct judgment by placing his hands against the alien's back and chest to obtain an idea of thoracic thickness and also by feeling the alien's arm. Very often, a thin and haggard face will show on palpation a thick thorax and a large, muscular arm.

The medical officer questions many inattentive and stupid-looking aliens in various languages about their age, destination, and nationality. Often, simple questions in addition and multiplication are propounded.

Should the immigrant appear stupid and inattentive to such an extent that a mental defect is suspected, an X is made with chalk on his coat at the anterior aspect of his right shoulder.

Should definite signs of mental disease be observed, a circle X would be used instead of the plain X. In like manner, a chalk mark is placed on the anterior aspect of the right shoulder in all cases where physical deformity or disease is suspected.

In this connection, B would indicate tack; C, conjunctivitis; CT, trachoma; E, eyes; F, face; Ft, feet; G, goiter; H, heart; K, hernia; L, lameness; N, neck; P, physical and lungs; Pg, pregnancy; Sc, scalp; S, senility. The words hand, measles, nails, skin, temperature, vision, and voice, which are often used, are written out in full.

After passing the scrutiny of the first medical officer, the alien passes on to the end of the line, where he is quickly inspected again by the second examiner. This examiner is known in service parlance as "the eye man."

He stands at the end of the line, with his back to the window, and faces the approaching alien. This position affords good light, which is essential for eye examinations.

The approaching alien is scrutinized by the eye man immediately in front of whom the alien comes to a standstill. The officer frequently asks a question or two to ascertain the immigrant's mental state. He may pick up a mental or physical symptom that the first examiner has overlooked.

He looks carefully at the eyeball to detect signs of defect and disease of that organ and then quickly everts the upper lids in search of conjunctivitis and trachoma. Corneal opacities, nystagmus, squint, bulging eyes, eyeglasses, clumsiness, and other signs on the part of the alien will be sufficient cause for him to be chalk-marked with "Vision."

An attendant will then take him out of the line, and his vision will be carefully examined. If the alien passes through this line without receiving a chalk mark, he has successfully passed the medical inspection. Off he goes to the upper hall, there to undergo another examination by officers of the Immigration Service, who take every means to see that he is not an anarchist, bigamist, pauper, criminal, or otherwise unfit.

Roughly speaking, 15 to 20 percent of the immigrants are chalk-marked by the medical officers, and it is these chalked individuals who must undergo a second and more thorough examination in the Public Health Service examination rooms.

Those aliens marked X and circle X are placed in the mental room. All other marked aliens are placed in the two physical rooms, one for men and the other for women.

The physical details in the medical inspection of immigrants have been dwelt on at some length, and necessarily so, because a sizing up of the mentality is incomplete without considering them.

Speech, pupil symptoms, goiter, palsies, atrophies, scars, skin lesions, gaits, and other physical signs all have meaning in mental medicine.

In the medical inspection conducted by the first officer or the one who occupies the proximal position, attention is paid to each passing alien.

The alien's manner of entering the line, his conversation, his dress, and any peculiarity or unusual incident regarding him are all observed. Knowledge of racial characteristics in physique, costume, and behavior is important in this primary sifting process.

Every effort is made to detect signs and symptoms of mental disease and defect. Any suggestion, no matter how trivial, that would point to an abnormal "mentality is sufficient to cause to defer the immigrant for a thorough examination.

The following signs and symptoms occurring in immigrants at the line inspection might suggest an active or maniacal psychosis: Striking peculiarities in dress, talkativeness, witticism, facetiousness, detailing, apparent shrewdness, keenness, excitement, impatience in word or manner, impudence, unruliness, flightiness, nervousness, restlessness, egotism, smiling, facial expression of mirth, laughing, eroticism, boisterous conduct, meddling with the affairs of others, and uncommon activity.

Psychoses of a depressive nature would be indicated by: Slow speech, low voice, trembling articulation, sad facies, tearful eyes, perplexity, difficulty in thinking, delayed responses, and psychomotor retardation.

Alcoholism, paresis, and organic dementia may exhibit any of the following signs: Surliness, apprehensiveness, untidiness, intoxication, apparent intoxication, confusion, aimlessness, dullness, stupidity, expressionless face, tremulousness, tremor and twitching of facial muscles, ataxia, stuttering, and tremulous speech, great amount of calmness, jovial air, self-confident smile, talkativeness, fabrications, grandiose, sullenness, fussiness, excessive friendliness, defective memory, misstatement of age, disorientation, difficulty in computation, pupil symptoms, and other physical signs.

Various kinds of dementia, mental deficiency, or epilepsy would be suggested by Stigmata of degeneration, facial scars, acneiform rashes, stupidity, confusion, inattention, lack of comprehension, the facial expression of earnestness or preoccupation, inability to add simple digits, general untidiness, forgetfulness, verbigeration, neologisms, talking to one's self, incoherent talk, impulsive or stereotyped actions, constrained bearing, suspicious attitude, refusing to be examined, objecting to have eyelids turned, nonresponse to questions, evidence of negativism, silly laughing, hallucinating, awkward manner, biting nails, unnatural action(s), mannerisms, and other eccentricities.

On the inspection line, immigrants inflicted with defective hearing, defective vision, and fever frequently assume peculiar attitudes and do strange things, all of which are suggestive of mental disease. Some of these cases are likewise put aside for further mental examination.

Experience enables the inspecting officer to tell an alien's race at a glance. However, there are exceptions to this rule. It occasionally happens that the inspecting officer, thinking that an approaching alien is of a certain race, comes to a standstill and questions him.

The alien's facial expression and manner are peculiar, and just as the officer is about to decide that this alien is mentally unbalanced, he finds out that the alien in question belongs to an entirely different race. The alien's peculiar attitude is no longer peculiar; it is readily accounted for by racial considerations.

Accordingly, the officer passes him on as a mentally normal person. Those who have inspected immigrants know that almost every race has its type of reaction during the line inspection.

On the line, if an Englishman reacts to questions like an Irishman, his lack of mental balance would be suspected. The converse is also true. If the Italian responded to questions as the Russian Finn replied, the former would, in all probability, be suffering from a depressive psychosis.

From 50 to 100 percent of the immigrants who enter the inspection plant are questioned by the medical examiner to elicit signs of mental disease or mental defect.

The exact number of passengers stopped and questioned will depend on the race, sex, and general appearance of the passengers undergoing inspection and on the total number of immigrants to be inspected.

In some instances, an immigrant's mental state may be obtained by asking him simple questions such as: Where are you going? How old are you? Are you a Greek? What is your name?

The majority of immigrants, however, are questioned in simple addition. The kind of addition to be propounded depends upon the age, sex, race, and general appearance of those undergoing the inspection.

The art of propounding addition during the medical inspection of immigrants can be gained only by experience.

A northern Italian girl whose appearance indicates that she has had some schooling, an Irish girl, a Scandinavian, or a male Greek would, in many instances, be thus questioned:

• How many are 14 and 14? 14 and 15? or
• How many are 13 and 13? 13 and 14? or
• How many are 15 and 15? 15 and 16?

An illiterate male Italian from southern Italy would probably respond more readily to addition sums in a somewhat simpler form, such as,

• How many are 8 and 8? 8 and 9? or
• How many are 10 and 10? 10 and 12?

On account of illiteracy, lack of experience, and emotional state at the time of landing, a Greek woman or a southern Italian girl would have to be tested with still simpler sums to bring out the same mental phenomena as observed in the above cases. Hence, such sums as 6 + 6, 7 + 7, and 8 + 8 are frequently used in inspecting this class of persons.

Remarkably simple sums should be given to immigrant children under 12 at the line of inspection. 3+3, 4+4, 2+4, 5+5, etc., are sufficiently difficult to stimulate the child's mentation.

When a family of children comes along the inspection line, it is best to question the oldest child first. For instance, a child of 12 could be asked the sum of 6+6.

The 10-year-old child could be questioned about the sum of 4+4, the 8-year-old child the sum of 3 + 3, while the youngster of 4 or 5 would show his mental alertness by simply responding to the question, "What is your name?"

Due to the emotional disturbance in immigrant children at the time of landing, it may be difficult to obtain responses to the above simple tests. In each child's case, the question, "What is your name?" may have to be resorted to.

As suggested above, it is good to start with the oldest child when asking a group of children, "What is your name?" successively. The younger children will usually follow the leader and reply promptly. In this way, it often happens that a child of 4, smiling, will tell the examiner his name.

On the other hand, if the little ones (4 to 5 years old) are questioned first, they may remain mute. In this event, it is rather hard to understand their mentality.

In all cases, careful attention is paid to the immigrant's facial expression as the latter thinks and responds to the examiner's questions.

These brief questions enable the officer to observe the alien's attention, alertness, reasoning ability, and emotional reaction. Not infrequently, positive signs of mental disease (as enumerated above) are obtained by bringing the alien to a standstill and giving him these brief cognitive tests.

Before leaving this subject, it may be said that in training for line inspection work, it is thought that a brief study of many insane patients is preferable to a comprehensive analysis of a small number of such persons. In other words, in training for line inspection, it is more profitable to study 2,000 insane than to carefully study 200 briefly.

2. Weeding-Out Process

At the line inspection, the immigrants chalk-marked with an X or a circle X are taken immediately to the mental room.

This large room contains two examining desks and 18 benches upon which the detained immigrants sit. The benches are arranged in rows and face the examining desks. This room will seat 108 immigrants and can comfortably accommodate double that number in an emergency.

At the termination of the line inspection, the line officers go to the different examination rooms. Two or three of them usually proceed to the mental room, where they conduct the secondary mental inspection, or, as it is sometimes styled, "the weeding-out" process.

Secondary Mental Inspection or Weeding-Out Process at Ellis Island. This Occurs Immediaately After Line Inspection. Edwin Levick, New York. United States Public Health Service, Mental Examination of Immigrants, 18 May 1917, p. 737 Fig, 2. GGA Image ID # 21ec23d333

In this room, the examiner faces the detained passengers who occupy the benches and galls them up to his desk, one at a time, to give them another brief inspection.

This secondary inspection consists of observing the X-marked alien as he approaches the desk, takes his seat, and responds to tasks in counting, addition, and the Cube Test. The examiner then decides whether or not the subject is a suspect of mental abnormality.

Should the examiner decide to detain the immigrant as a mental suspect, a yellow "hold card" is issued, and the immigrant is held overnight to undergo a complete mental examination.

However, if an alien does not present sufficient symptoms to become a mental suspect, the examiner presents him with a small gray card, which either frees him entirely from the medical department or returns him to one of the physical examination rooms.

In the weeding-out process, the examiner constantly observes the marked aliens seated before him. During such observation, insane persons do not infrequently show symptoms.

It occasionally happens that an X-marked alien, while sitting on one of the benches, will do some strange thing or exhibit some symptom of psychosis. In this event, he immediately becomes a circle X case.

An interpreter examines the circle X cases, after which they are either liberated or held for further mental examination.

At the line inspection, about 9 out of 100 immigrants are set aside as mental suspects to undergo the secondary or weeding-out process. Out of the nine immigrants thus put aside, 1 or 2 are ordered detained for a thorough mental examination.

This last detention lasts 24 hours to a week before the case is disposed of. Most of the circle X cases are sent immediately to the hospital for observation and examination, while the X cases are detained in the immigration service's detention rooms.

In sending the suspect to the hospital, the examining officer makes a notation on the alien's "hold card." This notation is either a statement of the principal symptoms that have occurred or a statement as to why the alien is sent to the hospital for observation.

The following notes have been made on the various "hold cards" by different officers and will give an idea of why immigrants are considered insane or suspected of being so at the time of landing.

The notes will also show why confident children are sent to the hospital for observation.

• Deported by the United States; insane. Refused admittance by the Brazilian authorities at Santos.
• Insane. He loves America and wishes to defend America. Will go into the Army; delusions of patriotism.
• Six years old; cannot get the child to speak.
• Hysterical behavior.
• She says she is a prophet of the earth.
• Seven years old; unable to count five fingers.
• Speech defect: coarse voice; repeats words spoken to him without attempting to answer the examiner's questions.
• Objects to examination; refuses to cooperate. Fails in Cube and 20 to 1 test.
• I was at Kings Park (hospital for insane] one year ago—some questions about the diagnosis. Dr. M. thought he had a psychopathic condition.
• Alien said he was insane in the summer but is well now. He crossed the ocean for treatment and appearance.
• Rhomberg. Sluggish pupils; tremor of tongue.
• Alien returned from the board with the statement that she acted queerly before the board.
• Agitated, brought into the examination room by relatives.
• Observe the mother; the child is an imbecile.
• Emotional: noisy, boisterous, loss of self-control.
• Tremor of hands and tongue; deep reflexes exaggerated; anxious; agitated.
• Found in a dazed condition, lying on a bench in the New York room.
• Reported by a steamship surgeon as "insane."
• Stupid, erratic answers; wanders about the room.
• Noted on the ship surgeon's report as hysteria. Has little knowledge concerning his voyage.
• Alien admits drinking a good deal. He is easily distracted and flighty in his mental activity. He stands still with difficulty, perhaps a psychosis with a manic phase.
• Wanderer and traveler. Trouble with a woman several years ago.
• Clouding of consciousness; euphoric; tremor of tongue; knee jerks.
• Violent in detention quarters; fighting.
• Alien has a peculiar affected manner.
• He states that he is nervous. His heart beats rapidly when talking with strangers. He is traveling with a female nurse; he was recently discharged from the British Army.
• Steamship's surgeon reports that the alien refused to answer questions. She is on the defensive.
• Emotional, talkative.
• Feeble, agitated, probably senile dementia.
• Silly facial expression. He appears to be thinking of something foreign to the examination.
• Maria says she has been married for 3 years and can sew garments but cannot cut them out.
• Admits illegitimate child 5 months old in Ireland. Has had frequent convulsions.
• It is impossible to get any information from this alien concerning his previous visit to this country. He continues to say that he looked after his family, but we cannot elicit any information regarding his 18-month sojourn in Philadelphia. Advise that he be kept under prolonged observation.
• Irritable, claiming that it is her privilege to do as she pleases; went back to Ireland last December with her sister who was deported from Ward's Island (hospital for insane); another sister was deported 4 years ago; paranoid view of life; ship surgeon reported that patient would burst out into laughter without cause; also get up from dinner table and play the piano to the annoyance of other passengers.
• Alien states she is 38 years old and has been married 22 years; she looks senile.
• Retarded; apathetic; clouding of intellect.
• Catatonic state; will not respond to questions.
• Admits alcoholism; has had delirium tremens twice, last attack 6 months ago.
• Alien is sent to the island by the boarding officer with the notation that she has been depressed since last December; alien is still depressed and says it is due to the death of her mother; some clouding of consciousness is present.
• Alien states that his blood is impure. His blood comes from dead human bodies. He sleeps poorly, cannot concentrate his attention, and is nervous at times.
• They reported to be acting queerly upstairs, suspecting epilepsy.
• Senile; unkempt; filthy; been traveling; authorities refused to grant him a passport from Spain to England. States that he has $3,700 and is a resident of California. Wife is confined in an insane asylum.
• Nervous and Wasser, man.
• "I am all right except for the jerking in my head due to some weakness. My cousin and uncle had the same malady; it began when I was 15 years old. My memory is all right."
• Tremulous, apprehensive, alcoholic?
• Position of inattention while talking.
• Crying and weeping because her little 21-year-old daughter is alone.
• The ship's report states that the alien was irrational and confused and had to be confined to the ship's hospital. The alien is inaccessible.
• "I have seen the Virgin Mary twice; she appeared to me, spoke to me, and told me not to be afraid."
• Talkative and flighty.
• Alcoholic facies.
• Reported by Health Officer J. J. O. to show marked signs of mental disturbance.
• History of head injury when 15 years of age. Some speech defects.
• Jumped overboard from the barge. He told Gordon that he intended to terminate his existence.
• He claims to have studied medicine in Paris, France, and Berne, Switzerland. He has not received his diploma. He has done Red Cross work. He comes here because he can't go to Russia. He is very talkative and given to detail. He is pleased with everything in general and himself in particular. You are advised to observe him for some time.
• Elated, talkative, surly. It may be well to observe him for a few days.
• Troublesome. Claims long residence in the United States. He refused to have his eyes examined.
• A confidential communication in the Commissioner's office states that this alien was once an inmate of a hospital for the insane.
• Facial tremor; alcoholic?
• He says he has loaned money to many people and is 60 or 90 years old.
• Sent down from the board with the statement that he acted queerly. They refused to answer questions. Probably paranoid praecox?
• Wasserman; eruption; general lymphadenitis.
• The baby is 2 years old and unable to walk or observe.
• Sent over from cabin inspection by Dr. M. (G. P.).
• Tremor; deficient in addition (see hands).
• Facial scars; stupid; cried on the line.
• "Father and mother died about a year ago. Since then, I have been depressed and lonesome and have drank heavily."
• At the beginning of the conversation, the alien talked violently and gesticulated, stating that she had been questioned too much; they asked her so many questions that they would drive her crazy. "If I am sick, send me back, if I am well, land me. At home, I did not go with others; I wanted to be at home to look after my mother." Talkative and active, she grimaces, laughs, and becomes angry.
• Tremulous, nervous, interfering; acts like an alcoholic?
• "Yesterday was the 24th, today is the 25th of July. I take two drinks a day when I can get it."
• Alien says that he was sick in the head a few months ago, had noises in his head, and heard voices. He has not heard voices for two weeks.
• The child is abnormally backward and has abnormal fear. She is shy, and it is impossible to get any information from her. Although she is 10 years old, she cannot count to 20; her mother dresses her.
• Spastic paralytic condition suggesting Little's disease; late in walking; mentally deficient; mother accompanies the child.
• He fell in love with a young lady on board a ship. She did not reciprocate. He is very upset about the affair. He is nervous and has not slept. He comes to America because he does not like his home surroundings.
• Perhaps a deaf-mute fails the cube test.
• Vague history of epilepsy.
• "I don't know the day or date. Forget all on board the ship. I was a good worker. Cut wood in the mountains. The boss said I was the best worker." Upon arrival, the alien appeared disturbed and paced up and down the examination room. Observe.

3. Examination.

The third stage of the sifting process has been reached, and it is found that there are two classes of mental cases to dispose of: those sent to the hospital for observation and those held in the detention rooms for further examination.

What becomes of the first class of cases and how they differ from the ordinary run of insane persons will not be touched on in this paper. The disposition of the latter class of cases will now be described.

The detained mental suspects are examined properly on days or at times when the line inspection is not in operation. Twenty-four hours always intervene between the time of arrival and the first regular examination.

First Regular Examination 24 Hours After Arrival at Ellis Island. Edwin Levick, New York. United States Public Health Service, Mental Examination of Immigrants, 18 May 1917, p. 738 Fig, 4. GGA Image ID # 149a33a5c2

Regular mental examinations are conducted in several rooms, each of which is provided with chairs, benches, and an examining desk containing suitable blanks and psychological apparatus. In each examination room, a medical officer examines the detained immigrants one at a time with the aid of an interpreter.

The following hypothetical explanation, which corresponds closely with the facts, shows how the third stage in the mental examination of aliens takes place.

Suppose three large and two small immigrant ships arrive at the port of New York on September 1 and 2. Suppose they bring 2,500 steerage passengers and that 40 of them are presented with "hold cards77 and are detained in the detention rooms for further mental examination. We shall now see what happens to these 40 detained persons.

The line inspection does not occur on September 3; hence, the day is spent mainly on mentally examining the detained cases. Early on this day, the 10 detained Italians are sent to room A to be examined by doctor A.

Ten Greeks go to room B to be examined by Doctor B. Ten Irish are examined in room C by Doctor C. In contrast, Doctor D examined 10 miscellaneous cases in Room D.

The first examination on September 3 is comparatively brief. The main purpose is to weed out the normals who have recovered from a physiological upset arising from various causes incident to landing.

The first examination of an alien is performed in the presence of all the aliens in the same group. Each alien is often subjected to the same tests and questions.

This is done so that the normal, who observe and learn from what the others are doing, maybe more readily separated from the stupid or subnormal cases. On the afternoon of September 3, we find that out of the 40 immigrants who have been examined, 24 have given evidence of normality and have been liberated, while 16 are still held for further examination.

On the morning of September 4, there were no immigrants on land. Consequently, the examination of the detained cases has resumed. This morning the remaining five Italians are examined in room B by Doctor B, the five Greeks in room C by Doctor C, and the three Irish in room D by Doctor D. In contrast, Doctor A examines the three miscellaneous cases (West India negro, Englishman, Scandinavian) in room A.

In other words, a shift has occurred, and each detained immigrant now meets a different examiner who puts him through a more searching examination than he encountered on September 3.

The second examination of each immigrant takes 20 to 60 minutes. It may comprise an inquiry into the subject's home life, customs, schooling, occupation, voyage, and intentions. When necessary, questions are asked to illuminate the whys and wherefores of the immigrant's attitude, emotional states, habits, interests, and health.

In addition to the psychological tests and questions, a neurological examination and test of vision are occasionally performed. This examination endeavors to size up the immigrant from all angles.

At the second examination, it will be found that the more intelligent immigrants have improved in their execution of the various tests and can still be classified as normal.

They are consequently liberated, and only those who still show symptoms of mental deficiency or mental abnormality are detained. During the second examination, one of the detained aliens was found to be markedly inattentive and exhibit a facial mannerism.

Consequently, he is considered an insane suspect and is sent to the hospital for observation. Therefore, at noon on September 4, when the line inspection again begins, only 6 of the original 40 immigrants remain for further examination. They are distributed as follows: Italians 3, Greek 1, Irish 2.

On September 5 at 11 a.m., during a temporary recess in the line inspection, a third examination of the 6 detained immigrants takes place. This time, Doctor C examines the three Italians in Room C, Doctor D examines the Greeks in Room D, and Doctor A examines the two Irish immigrants. This is the third regular examination, at which time the most prominent cases of mental deficiency are certified.

This examination is thorough and, in all respects, resembles the second examination. During the third examination, one of the Italians, although stupid, showed a definite improvement in responding to questions and in performing the tests. While this was a borderline case, Doctor C doubted how the immigrant should be classified.

He was consequently liberated by Doctor C at 4 p.m. September 5; we find that a Greek, an Italian, and an Irishman have been certified as being feeble-minded, while an Irishman and an Italian are still held for further mental examination.

Third and Fourth Regular Examination, One Week After Arrival. Alien is Certified "Feeble-Minded." Edwin Levick, New York. United States Public Health Service, Mental Examination of Immigrants, 18 May 1917, p. 738 Fig, 5. GGA Image ID # 149a6f7600

On September 6, the line inspection was in operation all day, and the mental cases could not be taken up. On September 7, the two detained cases were again examined, which certified the Italian as "feeble-minded " and detained the Irishman for further examination.

On September 8, this Irishman was again carefully examined and certified as "Feeble-minded." Thus, 5 immigrants out of the original 40 are certified as "Feeble-minded."

While the above description of the examination and certifying process is hypothetical, it is believed to be a fair presentation of what actually happens. It is the rule that no immigrant is certified as feeble-minded until he has had three regular examinations.

In some cases, four or even five examinations are given before such a certificate is rendered. The experience gained in the careful examination of subnormal immigrants is certain to assist medical officers when conducting the primary line inspection.

No attempt is here made to explain the various mental abilities of normal and defective immigrants. Certificates of feeble-mindedness are not rendered because an alien failed a tills test or that test or because he is at a particular mental age according to a certain standard.

The immigrant is certified "Feebleminded" because his common knowledge, retentiveness of memory, reasoning power, learning capacity, and general reaction are severally and distinctly below normal.

The feeble-minded alien learns with difficulty. His attention may be at fault, and he may exhibit peculiar and subnormal mental traits. These traits point to an awkward mentality that is beyond hope of much improvement. His appearance, stigmata, and physical signs may confirm such a diagnosis.

The certifying officer further believes that his mental condition will decidedly handicap him among his fellows in the struggle for existence. The following table is inserted to show what was accomplished in the mental examination of aliens in the line department at Ellis Island during June, July, and August 1916.

Accomplishments of the Mental Examinations of Aliens in the Line Department at Ellis Island, June through August 1916. Mental Examination of Immigrants, 18 May 1917, p. 746. GGA Image ID # 149aa132d3

Note 1: Some of these aliens were sent to hospital and were certified as insane and feeble-minded. The total number of mental certificates at Ellis Island for June, July, and August was 108.

Each officer's method of conducting a mental examination is individual, but there is also a great deal in common about the various examination methods.

Some tests and questions are used by all, while individual preference applies to other tests. As time goes on, new tests and methods are tried, and the ones that are found to be of value are adopted by all. Other tests are tried, found to be useless, and given up.

E. H. Mullan, "Mental Examination of Immigrants: Administration and Line Inspection at Ellis Island," in Public Health Reports, Vol. 32, No. 20, 18 May 1917, pp. 733-746.

Why You Should Read This Article on Mental Examination of Immigrants at Ellis Island (1917)

For teachers, students, genealogists, family historians, and researchers of public health and immigration, this article offers a rare and detailed look at how immigrants were medically and mentally assessed at Ellis Island during the early 20th century. It sheds light on the rigorous process of screening for mental illnesses and cognitive deficiencies, which played a significant role in determining whether an immigrant would be admitted or deported.

Key Insights from the Article:

1. The Critical Role of Mental Health in Immigration Decisions

• Mental and physical fitness were key factors in determining an immigrant’s entry to the U.S.
• Mental health screenings sought to identify feeblemindedness, insanity, dementia, epilepsy, and other cognitive impairments that might prevent an immigrant from thriving in American society.
• A series of mental tests and observations were used to assess immigrants, with final decisions often requiring multiple examinations over several days.

2. The Detailed Process of Medical and Mental Examination

• Line Inspection: Every immigrant passed through a rapid but meticulous visual and behavioral assessment by medical officers.
• “Chalk Marks” for Further Review: If an officer noticed a potential defect (e.g., odd behavior, unusual gait, poor responses), they marked the immigrant’s clothing with a chalk symbol (e.g., "X" for mental concerns, "G" for goiter, "P" for pulmonary issues).
• Weeding-Out Process: Marked individuals were separated for secondary examinations, where medical officers conducted cognitive tests, memory exercises, arithmetic problems, and language assessments to determine intelligence levels.
• Final Determination: If an individual failed multiple assessments or showed clear signs of mental illness, they were certified as feebleminded or insane and scheduled for deportation.

3. How Immigration Officers Assessed Mental Fitness

• Common mental tests included:
  • Simple addition and arithmetic problems based on the immigrant’s age, nationality, and education level.
  • The Cube Test (a well-known intelligence test of the time).
  • Observation of speech patterns, emotional reactions, and memory recall.
• Mental illness symptoms such as incoherent speech, erratic behavior, paranoia, excessive talkativeness, or extreme sadness were red flags.
• Cultural biases played a role—examiners had to distinguish between normal racial and ethnic behaviors and actual cognitive deficiencies.

4. The Impact of Mental Examination on Immigrant Families

• Families were often separated if one member was detained for further testing.
• Children as young as four were tested for cognitive function—failure could result in family-wide deportation.
• “Borderline” cases were observed for up to a week, sometimes undergoing four or five tests before a final decision.

5. The Ethical and Social Controversies

• High error rates: Some immigrants failed tests due to stress, fear, or language barriers, rather than actual mental deficiency.
• Biases against Southern and Eastern Europeans: Immigrants from Italy, Greece, and Russia were more likely to be flagged for mental concerns than those from Northern Europe.
• Immigrants had little recourse: If an officer certified someone as feebleminded, they were almost certainly deported—even if the diagnosis was incorrect.
• Economic impact: Steamship companies opposed strict inspections because each deported immigrant meant a financial loss.

Why This Article Matters for Immigration & Public Health History

📖 For genealogists and family historians: This article provides critical insight into why an ancestor may have been detained or deported due to medical reasons.

📖 For educators and students: It offers a case study in medical ethics, public health policies, and early 20th-century immigration laws, making it an invaluable resource for studies in history, sociology, and psychology.

📖 For public health researchers: It reveals the early methods of psychiatric evaluation and their impact on immigration policy and mental health stigmas.

🚢 This article is a must-read for anyone seeking a deeper understanding of how mental health, public health, and immigration intersected at America’s primary gateway for immigrants.