"This condition should be remedied and section 9 of the Immigration Act should be broadened so as to include, in the same manner as in the proposed amendment to section 2, not only the insane and the mental defectives, but also persons with chronic alcoholism and persons with constitutional psychopathic inferiority, while the amount of the fine should be substantially increased.

"With their agencies all over Europe the steamship companies have both facilities and opportunity for making careful investigation and examination of intending immigrants in order to prevent the classes above enumerated from coming to us and, in view of the profits derived by these companies from immigrant traffic, it is but reasonable that they should be required to do this, to the best of their ability.

"To see what may be accomplished along similar lines we need only consider what has been done in the past toward eliminating from among immigrants some of the contagious diseases.

INADEQUACY OF MEANS FOR DETECTING INSANITY OF IMMIGRANTS AT THE PORTS OF DEBARKATION

"As to the examinations heretofore had at Ellis Island, it is sufficient to quote from an address of the Hon. William Williams, late United States Commission of Immigration, before the Mental Hygiene Conference at New York City, November 14, 1912, in which he says:

'I shall refer only to the detection of the mental diseases with which immigrants may be afflicted, and shall show how inadequate are the ways and means which Congress has provided therefor. I am one of those who believe that the Legislature does only half its duty when it enacts a good law. The other half is to furnish adequate machinery and ways and means for its execution, without which the law accomplishes only a part of its purpose, and is there to perplex executive officials whose sworn duty and desire it is to execute it.

In

Immigration to this country is at a very heavy rate. round numbers it has during each of the past ten years averaged 900,000 annually, and the great bulk of it has been through Ellis Island. Only last month there arrived at New York over 80,000 aliens, an average of nearly 2,600 a day. Nor are the arrivals. evenly distributed over the days of the month; on the contrary,

there arrive sometimes for several days in succession 4,000 or 5,000 a day. A great many of these people come from the poorer classes of the poorer countries of Europe. Their general physical condition is often far from good and their ignorance beyond belief. Not only are many illiterate, but many do not know the days of the week, the months of the year, their ages, or any country in Europe outside of their own. These people speak many strange tongues and dialects, and interpreters familiar with approximately forty are necessary to enable the government authorities to converse with them. A number of those who are undesirable additions to our population are nevertheless admissible under the low requirements of existing law. Obviously the task of picking out from amongst this heterogeneous mass those suffering from any mental disability is a gigantic one. It would be impossible of complete performance even if the medical staff was in size what it should be. But Ellis Island has to transact its heavy business with the instrumentalities and facilities which Congress provides. It has in all 650 officials. Of these about 130 belong to the Public Health Service, which number includes all medical officers (doctors), hospital attendants, and nurses. The medical officers number only 21, far too few, for they have to perform a multitude of duties in relation both to the inspection of the masses of immigrants who arrive and the care of those detained at Ellis Island hospitals for sickness, such sick numbering at times several hundred.

The process of medical inspection is roughly this: Each immigrant passes before two medical officers who rapidly look him over with a trained eye and set aside for special examination all who bear any indications of physical or mental defects. Those so set aside are, for the purposes of mental examination, subjected to well systematized test questions, which the medical officers have evolved from their own special experience, and they apply also such recent modern and scientific methods as those worked out by Binet-Simon, Fernald, Goddard, and others. All such special cases, of which last year there were about 5,000, are gone into very thoroughly and are often detained eight days, or longer, for mental observation. But not enough cases are thus set aside, because the medical officers are compelled to work too quickly and lack the requisite number of interpreters to enable them to converse with each immigrant as he goes by. Furthermore, the space at Ellis Island available for the observation of immigrants suspected to be suffering from mental defects is too small.'

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Mr. Williams further stated that he had frequently called attention to these matters, asking for an additional force of medi

cal officers, for better accommodations for the examination of the incoming immigrants, and for various other necessary facilities, and that Congress had, to a limited extent only, taken note of these matters.

"Since this address was delivered in November, 1912, reports from Ellis Island show that the examinations there made for the detection of mental disease have been much more effective than formerly but that the number of medical officers, and the facilities and funds are still very inadequate.

NEW ENVIRONMENT OF THE IMMIGRANT

"It has been suggested, and with reason, that one of the causes of insanity among our alien population is changed environment. Immigrants are plunged into a hurried struggle for existence, quite different in many instances from the slower and more even life to which they have been accustomed; a vast rural population suddenly enters city life; they are in a strange country, whose language, food and customs differ from their own; they are called upon to make unusual exertions and to undergo much privation, frequently in order that they may send for their families as soon as possible, and often, having but weak resisting powers, they succumb to an hereditary taint or to a fundamental defect in personality and their insanity develops.

"It is doubtless true that the new environment of the immigrant is in part responsible for some of the insanity among aliens, but to what extent it is impossible at this time to determine. It is very significant, however, that many, if not the majority of authorities believe that an unfavorable environment, as a cause of insanity, is usually associated with an inherited weakness or a fundamental defect in makeup; that the mental breakdown occurs in such instances when the stress of existence bears down upon an individual already thus predisposed.

"As bearing upon the subject of environment some of the statistics published in the New York State Hospital Commission's 'Statistics of the Insane for the year ending September 30, 1912' are of interest. It appears therefrom (pages 26 and 27) that 65.1 per cent of all the first admissions to the civil state hospitals for that year were residents of first class cities, New York

City alone furnishing 58.3 per cent, of which 1,673 were males and 1,672 females. In the villages and rural districts the male first admissions numbered 577 and the females 480, while in the rural districts alone the male first admissions numbered 205 and the female 122.

"Of the first admissions for 1912 the number of insane per 100,000 of population was as follows:

"The greater frequency of insanity in the cities as compared with the country is apparent from the foregoing.

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Other interesting data in 'Statistics of the Insane' show that senile insanity is relatively less frequent in the larger cities than in the villages and rural districts, but that dementia paralytica and alcoholic insanity are much more prevalent in the former.

"To improve the environment of the immigrant in this country is highly desirable, but that alone will not solve this portion of the problem of the alien insane, if we are to continue to receive numerous individuals with an inherited weakness or a fundamental defect in makeup. Both improvement in environment and exclusion of these individuals are essential. From the standpoint of humanity alone, and aside from all thought of the State, the community and the future generations, we should not permit such persons to be subjected to the possibilities of mental disaster present in a new and strenuous environment.

PREVALENT PSYCHOSES

"What we term 'insanity' includes many different mental diseases or psychoses.' In a study directed to the consideration

of insanity as a disease it would be desirable to consider these psychoses at length.

"According to the testimony of the various hospital superintendents and the statistics of the New York State Hospital Commission the most prevalent psychosis in the civil hospitals of New York is what is now generally known as dementia praecox; the second in order of prevalence is general paresis (dementia paralytica) with manic-depressive insanity, senile dementia and alcoholic insanity following.

"The first of these is an incurable psychosis of long duration, having in some instances periods of lucidity; the second is uniformly fatal, while alcoholic insanity may present an apparent cure yet the individual afflicted with it usually succumbs to his dipsomania with the result that the return of his psychosis is only a matter of time.

"From the testimony of the hospital superintendents but little difference exists in the prevalence of dementia praecox in nativeborn and foreign-born, but general paresis and alcoholic insanity are relatively more frequent among the foreign-born than among the native-born.

"The consensus of medical opinion given this Commission was to the effect that dementia praecox and manic-depressive insanity depend, in a great number of instances, upon fundamental defects, or inherited weaknesses, while the causation of general paresis was, in every instance, ascribed to syphilis, the disease originating five years or more after the appearance of the original lesion.

"The possibility that the insane may procreate does not in all instances terminate upon their commitment to a State hospital. In cases of dementia praecox as well as those of alcoholic insanity, patients not infrequently have intervals of considerable duration of freedom from mental symptoms, during which they are discharged from the hospital and in some instances have offspring to whom the hereditary taint may be transmitted.

"As general paresis rarely develops within five years after the original lesion, and often not until ten years thereafter, the inadequacy of the deportation period of the Federal law to cover these cases is obvious.