MEDICAL INSPECTION OF IMMIGRANTS.

During the fiscal year ended June 30, 1915, 562,263 immigrants were examined by the Public Health Service to determine their admissibility to the United States and its dependencies under the immigration laws. Of this number, 17,840 were certified on account of either mental or physical unfitness. During the fiscal year ended. June 30, 1914, 1,485,957 immigrants were examined, of which number 41,250 were certified for physical reasons, showing a decrease for the fiscal year 1915 of 923,694 immigrants and 23,410 certificates issued for mental or physical defects.

This important work has necessitated the assignment of 82 medical officers, whose duty has been confined exclusively to the mental and physical examination of immigrants; but, in addition to this, nearly every officer in the Public Health Service performs more or less work every year in this connection.

The Public Health Service officers stationed in the American consulates in foreign ports have carried on their work of inspecting intending immigrants in connection with the quarantine inspection of steerage passengers destined to United States ports. It should be understood, however, that medical officers stationed in foreign ports do not reject aliens, even if found suffering from any of the mental or physical diseases deportable under the immigration laws of the United States. They merely notify the proper authorities in the foreign ports that such immigrants are liable to deportation upon their arrival at United States ports.

The past year has marked the usual improvement in the methods of examining immigrants upon their arrival. Studies with a view of ascertaining the most reliable methods of determining mental deviation in aliens have been pursued, and in connection with this work a board of medical officers at the Ellis Island immigration station has been engaged in preparing a manual for the examination of aliens to detect mental diseases, which will be published in the near future.

The officers in the bacteriological laboratory at the Ellis Island immigration station have been making studies regarding trachoma, and have otherwise rendered much aid of a diagnostic and therapeutic character to the two immigrant hospitals.

It has been necessary to reduce the medical staff at Ellis Island on account of the diminution of immigration since the outbreak of the European war, the result being that the medical staff has been relatively larger during this time than before. From this state of affairs two conditions have been noticed which would indicate an increase in the efficiency of the inspection of aliens at that station. Before mentioning these conditions a word may be said as to the general method of inspecting aliens at all immigration stations, which is as follows:

The immigrants are caused to pass slowly in single file along the inspection line. While the line is passing each alien is carefully

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looked at by two medical officers at the rate of 1 to every 20 seconds, which is equivalent to saying that an alien is inspected by one medical officer for 40 seconds. In the course of this observation those who show any evidence of mental or physical disease or defect, or those who excite suspicion that they are so affected, are turned aside for further examination. The number usually turned aside under normal conditions at the large stations, notably Ellis Island, varies from 15 to 20 per cent. The persons thus turned aside are given a careful physical examination, or are examined as to their mental condition, as may be required in each case. Before the European war-that is, during the fiscal year ended June 30, 1914-1,009,854 aliens entered the port of New York, of which number 23,216, or 2.29 per cent, were certified for mental or physical disabilities of various kinds.

The first of the conditions mentioned above as having been observed as a result of the relatively larger size of the medical staff at Ellis Island since the beginning of the European war is that the percentage of certificates which have been given has risen from 2.29 to 5.37 per

cent.

Second, on those days when the number of arriving aliens has been sufficiently small to make it possible to turn all of the steerage immigrants into the examination rooms and give them all a careful examination, the number of certificates increased to 9.37 per cent; or, to repeat these facts concisely—

A. By affording an increased time for the routine inspection the medical certificates at Ellis Island were shown to increase from 2.29 to 5.37 per cent.

B. By subjecting all aliens to a careful physical examination the number of certificates increased to 9.37 per cent.

These observations bring up the question as to what the result would be if there were a sufficient number of medical officers at all immigration stations to give to all arriving aliens a careful physical examination. It is thought that an increase might be expected in the class of diseases known as "loathsome, contagious diseases." It is also thought that venereal diseases would be disclosed in a much larger proportion of cases than is possible at the present time. Then, too, it is thought that conditions could be found in a number of arriving aliens which, while not diseases or defects deportable under the immigration laws, or even, for that matter, directly affecting the public health, might prove to be disabling disorders which would not only severely handicap them in the struggle for existence in this country but would sooner or later make them public charges upon States or municipalities.

A review of the immigration work performed during the past fiscal year by the Public Health Service tends to the belief that a demand has already been created for a more rigid inspection of arriving aliens to determine their exact mental or physical status. It is also believed that the necessity for increased efficiency along these lines will not lessen with the end of hostilities in Europe, at which time students of the subject predict that even if the tide of immigration does not markedly increase, the percentage of mental and physical defectives will be much larger than ever, for the reason that in the scheme of reconstructing the countries at war the main object will be to dispose of, through the avenues of emigration, those persons who will be least useful at home.

BOSTON, MASS.

The regular work of the medical officers of the service attached to the immigration station at Boston is to be considered under seven separate headings, to wit:

(1) The boarding of ships and primary inspection of passengers or members of the crew.

(2) The medical examinations, physical and mental, of aliens detained on primary inspection.

(3) Surveillance over the cases of aliens placed in various hospitals for purposes of treatment or examination.

(4) The medical treatment of aliens kept under treatment at the immigration detention station itself.

(5) Medical surveillance over all inmates of the immigration station and the sanitary care of the station.

(6) General office work.

(7) The investigation of alien public charge cases to supply the Secretary of Labor with the medical information necessary for appropriate action in regard to such cases.

In addition to the foregoing the officers of the service attached to the Boston Immigration Station have, during the year, been utilized for work entirely apart from matters relating to immigration. As for a number of years past, they have acted as medical advisers to the United States Civil Service Commission for the New England district, and during the year have made, in various places in this territory, several hundred physical examinations of candidates for appointment in the United States classified civil service, for whose examination the Government makes no other provision. During the year the medical officers have also delivered courses of lectures on medical examinations at the Harvard-Technology School for Health Officers, on ship sanitation and maritime quarantine at the Massachusetts State Nautical Training School; on three occasions they have served as members of service boards away from their station; they have instructed acting assistant surgeons at Yarmouth, Nova Scotia, and at New Bedford, Mass., in the performance of their duties; one of the medical officers has been detailed for temporary duty at the marine hospital at Chelsea, and another, at the request of the Massachusetts State Board of Labor and Industries, has, since January, been connected with that board in making certain industrial hygiene investigations in the State.

1. BOARDING OF SHIPS AND THE PRIMARY INSPECTION OF PASSENGERS AND MEMBERS OF THE CREWS.

During the year 1,368 vessels arrived at Boston from foreign ports. The number of such vessels which proved on arrival to have passengers or crews requiring inspection for the purposes of the immigration laws was 258. Because the usual advance information as to ships. leaving foreign ports with passengers and wireless advices as to time of arrival were not available or dependable, owing to conditions caused by the war, it was practically necessary to have the customs boarding boat continually covered by at least one medical officer from 7 a.m. until boarding was discontinued at night. The inspection of cabin passengers and such portions of crews as the medical