Immigrants Starting up the Main Staircase
The medical inspection was the first of several hurdles each immigrant had to clear in Ellis Island’s bureaucratic maze (Yew, 1980). The medical inspections were conducted by physicians stationed along the immigrants’ route through the building. Many immigrants were unaware that their examination began as soon as they began climbing the stairs to the main hall (Benton, 1985; Kraut, 1988). A physician watched their progress from the top of the stairs and observed the arrivals for signs of physical stress, defective posture, unusual gait or weakness (Benton, 1985; Kraut, 1988). Once at the top of the stairs, the arrivals formed two single file lines for the official medical inspection (Moreno, 2004). One medical officer stood at the turn in the line to conduct the general visual inspection as the immigrants filed by (Moreno, 2004). Children appearing over the age of two years would be removed from their mother's arms and made to walk (Benton, 1985; Moreno, 2004; Yans-McLaughlin & Lightman, 1997). Immigrants were required to remove hats or caps, show both hands, and sometimes were asked to put their luggage down and walk several feet so their gait could be observed (Benton, 1985; Moreno, 2004). The inspectors at Elis Island prided themselves on their ability to make a 'snapshot diagnosis' and identify illness or disability upon visual inspection as immigrants streamed past them (Baynton, 2005; Kraut, 1988).
The immigrants would be questioned by the medical officer as to their age, destination, and nationality (Benton, 1985). Sometimes simple questions in addition or multiplication would be put to the immigrant (Benton, 1985). "Should the immigrant appear stupid and inattentive to such an extent that mental defect (was) suspected an X (was) 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 (was) placed on the anterior aspect of the right shoulder in all cases where physical deformity or disease (was) suspected" (Yans-McLaughlin & Lightman, 1997, p.143). While one doctor estimated that 15-20% of immigrants were unfortunate enough to be marked, (Yans-McLaughlin & Lightman, 1997), there were a number of them who figured out how to thwart the system by either removing the chalked piece of clothing, or turning it inside out before the end of the line (Perec, 1994; Smith, 1992). Medical officers used an alphabetical code to alert inspectors as to the malady suspected: B indicated a back issue, C was for conjunctivitis, CT meant trachoma, E for eyes, F face, Ft identified a foot issue, G for goiter, an H indicated heart problems, K hernia, L for lameness, N for neck, P for physical and lungs, Pg pregnancy, Sc scalp, and S meant senility (Morena 2004; Perec, 1994; Yans-McLaughlin & Lightman, 1997; Zalenski, 1999). Some diseases were identified in full: hands, measles, nails, skin, temperature, vision, and voice (Moreno, 2004).
The immigrants would be questioned by the medical officer as to their age, destination, and nationality (Benton, 1985). Sometimes simple questions in addition or multiplication would be put to the immigrant (Benton, 1985). "Should the immigrant appear stupid and inattentive to such an extent that mental defect (was) suspected an X (was) 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 (was) placed on the anterior aspect of the right shoulder in all cases where physical deformity or disease (was) suspected" (Yans-McLaughlin & Lightman, 1997, p.143). While one doctor estimated that 15-20% of immigrants were unfortunate enough to be marked, (Yans-McLaughlin & Lightman, 1997), there were a number of them who figured out how to thwart the system by either removing the chalked piece of clothing, or turning it inside out before the end of the line (Perec, 1994; Smith, 1992). Medical officers used an alphabetical code to alert inspectors as to the malady suspected: B indicated a back issue, C was for conjunctivitis, CT meant trachoma, E for eyes, F face, Ft identified a foot issue, G for goiter, an H indicated heart problems, K hernia, L for lameness, N for neck, P for physical and lungs, Pg pregnancy, Sc scalp, and S meant senility (Morena 2004; Perec, 1994; Yans-McLaughlin & Lightman, 1997; Zalenski, 1999). Some diseases were identified in full: hands, measles, nails, skin, temperature, vision, and voice (Moreno, 2004).
Immigrant Subjected to Eye Exam
A second medical officer stood at the end of each line and did nothing but inspect eyes (Benton, 1985; Moreno, 2004). In particular, they searched for signs of a disease called trachoma, which if left untreated could result in blindness, and was the most frequent ground for medical exclusion of immigrants during this period (Kraut, 1988). The test for trachoma was often the most unpleasant part of the exam and what immigrants dreaded as they arrived for processing (Benton, 1985; Birn, 1997). Doctors used either their bare fingers or simple metal buttonhooks to envert the arrivals' eyelids and inspect for the tell-tail signs of what they termed this ‘loathsome’ contagious disease (Birn, 1997; Kraut, 1988; Markel, 2000; Zalenski, 1999). It was not a coincidence that trachoma and the skin condition, favus, were the most frequent medical diagnoses at Ellis Island until 1906, as both of these diseases could be identified easily on fully clothed immigrants (Birn, 1997). While treatment was attempted at the Ellis Island hospital in an effort to cure some patients with trachoma, it has been estimated that nine out of every ten immigrants diagnosed with the disease were eventually returned to their ports of origin (Markel, 2000).
Officer Using Buttonhook for Eye Exam
Although many government reports and magazine articles of the period document the "scrupulous attention to diagnostic and sanity techniques" employed by the physicians, various eyewitness accounts, including one from then President Theodore Roosevelt, describe doctors conducting "the examinations with dirty hands and with no pretense to clean their instruments, so that it would seem to me that these examinations as conducted would themselves be a fruitful source of carrying infection from diseased to healthy people" (Markel, 2000, p.550). Such procedure did not go unnoticed by those being examined themselves (Markel, 2000). Immigrants indeed "worried and talked about the possibility of contracting trachoma, literally, at the hands of an inspecting physician at Ellis Island" (Markel, 2000, p. 551).