Medical Inspector – Annual Report

At another house, on two occasions, cases of manic-depressive insanity, dementia praecox, general paralysis and involution. melancholia were found. In each instance this was reported to your Commission and the patients ordered discharged. In this case your Commission also directed the attention of the AttorneyGeneral to the matter.

Violations, such as these, of section 1121 of the Penal Code, should, when found, be punished to the full extent of the law, as an example to others who persist in breaking the statute.

It is manifestly unfair that the licensed private houses, which are trying to comply with the recommendations of your Commission, should have in competition institutions in charge of incompetent men who openly violate the law.

In conclusion I wish to extend my thanks and appreciation to your Commission for advice and support given me in the performance of my duties, and to those in charge of the various institutions visited, for many courtesies shown.

Respectfully submitted,

WALTER G. RYON,

Medical Inspector.

REPORT OF BUREAU OF DEPORTATION

To the State Hospital Commission:

I beg to submit the following report of the operations of this Bureau during the fiscal year ending September 30, 1912. It is noted by the appended table, showing the percentage of increase over the preceding year, that the number of alien and nonresident insane deported and removed from the various hospitals and from homes is larger by 55.7 per cent than the preceding year. This increase is accounted for, to a certain extent, by the amendments to the Insanity Law, giving greater powers to your Bureau of Deportation and providing for its reorganization, with much needed additional help.

A total of 1,753 insane alien and nonresidents were removed from the State hospitals or returned to other countries or states responsible for their care and maintenance. Thirteen hundred and eighty-two of this number were patients who had actually become public charges in the New York State hospitals. The effect of this upon the net annual increase in the number of insane persons receiving care at the expense of the State of New York has been noticeable and the close of this year shows that, in spite of the increase in the number of admissions and a marked decrease in the death rate, the net increase is the smallest since 1901. It is now safe to say that, under the present organization of this bureau and the prospects of early federal legislation which will be

Report of Bureau of Deportation

beneficial not only to the State of New York but to other states in the Union, the abnormal increase of years past will be reduced to a very narrow margin, if not entirely obliterated.

The Insanity Law as amended in January, 1912, Chapter 27 of the Consolidated Laws, provides:

First: "That such Bureau shall examine and inspect alien and non-resident insane persons, and alleged insane persons in the state hospitals, other public institutions and elsewhere where such insane persons and alleged insane persons may be, for the purpose of determining whether they are suitable cases for deportation under the immigration law, or removal under the provisions of this section to other countries or states, and shall notify the proper authorities having control of the enforcement of the immigration laws at the ports of entry of such immigrants as are found to be insane, idiotic, imbecile or epileptic, and such insane aliens as are or become public charges, or who are in the country in violation of law, and shall arrange for their deportation in accordance with the provisions of such laws.

Second: The bureau may, upon the request of any indigent insane person, or the written consent of their relatives, legal representatives, or qualified friends, subject to the approval of the Commission, remove such patients to any country, state or place to which they may properly belong.

Third: 'That such bureau shall maintain a careful inspection and observation of the methods and facilities for examining immigrants for mental disease and defect at the port of New York, and shall, from time to time, report to the Commission upon the methods employed and their efficiency. Fourth: That they shall render reports regarding the prevalence of insanity among aliens and the foreign born population of the state and shall make suitable recommendations as to means by which insane, idiotic, imbecile and epileptic aliens may be deported or returned.

The work of this Bureau which has been carried on as heretofore under the direction of your Commission, necessarily, in view of the changes in the law, has been considerably increased and divides itself practically into the following parts:

(a) Securing the deportation of insane aliens who are subject to deportation under the section of the federal immigration law.

(b) Bringing about the repatriation of aliens who are not deportable under the section of the federal immigration law but who desire to return to their native countries or whose relatives desire to have them returned.

(e) Maintaining an inspection and observation of the methods and facilities of examining immigrants for mental disease and defect at the port of New York.

(d) Obtaining information and rendering reports regarding the prevalence of insanity among alien and foreign born population of the state.

(e) Returning non-residents to the states in which they have a legal residence and which are properly responsible for their care and maintenance.

(A) DEPORTATIONS UNDER THE FEDERAL IMMIGRATION LAW

It will be noted that during the year there has been an increase of 21.4 per cent. in the number deported by the United States Immigration Service. At the same time a comparatively large

Report of Bureau of Deportation

number of warrants of arrest or deportation were canceled by the Department of Commerce and Labor, a total of 80 against 32 of the preceding year. It is also noted that twenty-two aliens died. while awaiting deportation, accounting for 511 certificates issued through this Bureau during the year. The large increase in the number of warrants canceled by the Department of Commerce and Labor is due to a great extent to a decision known as "Decision No. 120" rendered January 11, 1912, by Charles Earl, Solicitor of the Department of Commerce and Labor, which was approved February 3, 1912, by the Attorney-General of the United States and widely distributed to immigration officials and others by the Federal Department. The decision referred to an insane alien at the Manhattan State Hospital who had been certified to by this Bureau as becoming a public charge on account of insanity. The certificate set forth that her mental disease resulted from causes existing prior to landing, such causes being constitutional psychopathic tendencies, mental instability and deficiency. This certificate was endorsed by a Passed Assistant Surgeon of the Public Health and Marine Hospital Service who certified that in his opinion the patient was insane from predisposing causes existing prior to landing and that his opinion was based upon a careful examination of the alien, the history of the case and the records on file at the institution. Furthermore, an independent examination on the part of the Commissioner of Immigration at Ellis Island by a lay immigrant inspector corroborated the details of the history, and, as the result of the combined examination on the part of the Passed Assistant Surgeon of the Public Health and Marine Hospital Service, the medical members of this Bureau and the lay immigrant inspector attached to the immigration station at Ellis Island, the Commissioner of Immigration recommended the deportation of this alien in accordance with the laws. The honorable solicitor in this decision examined the same medical records and the testimony of the various alienists, both state and federal, and arrived at the conclusion that "neither the history of the case nor the hospital records as presented to the Department contained any reference whatever to causes existing prior to landing, giving rise to the alien's present insanity." He

Report of Bureau of Deportation

quoted certain parts of the history which appeared to him to be especially significant and concluded:

"That the statement that the alien's insanity is caused by constitutional psychopathic tendencies or mental instability, or other predisposing causes existing prior to landing, is given in the form of a bald medical opinion or conclusion, unaccompanied by any facts or reasons showing on what it is

based.

'That there is not an affirmative fact in the record including the family history and the hospital history of the alien, tending to show either that the alien exhibited constitutional psychopathic tendencies and mental instability at the time of landing or prior thereto, or that such constitutional psychopathic tendencies, or mental instability, or other predisposing causes likely to lead to insanity, could by any known means have been detected at that time.

'That in view of this wholly negative aspect of the evidence, it must be assumed that the medical opinion concerning the underlying of insanity and the prior existence thereof is wholly ex post facto, because the alien has become insane; the alien was a person of constitutional psychopathic tendencies and mental instability; and because the alien was such a person when insanity developed the alien was such a person at all prior times.

That in many cases, as in this, some circumstances or event in the life of the alien since landing affirmatively appear from the evidence, suggesting to the ordinary mind an adequate cause to account for present insanity, independently of any constitutional psychopathic tendencies or mental instability on the part of the individual, e. g., as the account in the present case of a sexual assault upon an ignorant 16-year-old girl in her own home, and the ensuing shame and worry on her part."

In this decision we have the clinical records examined by a layman, and this examination convinces him that the physicians had no grounds for their opinion as to the causes of disease and it also warrants him in assuming that, because he found no such evidence, the physicians must have reached their conclusion in an opinion wholly ex post facto because the alien is insane.

The statement of a sexual trauma appearing in the decision of the Honorable Solicitor was strenuously denied by the parents and other relatives of the alien.

This tendency on the part of the Department of Commerce and Labor to ignore medical testimony and to accept the result of investigations of officials who possess no special qualifications to pass upon medical facts, is further exemplified in the case of an inmate of the Gowanda State Hospital. A case of dementia praecox of the paranoid type was certified to by the medical superintendent of that hospital on the grounds of constitutional psychopathic tendencies, mental instability and deterioration. Upon the recommendation of a lay inspector, the Department of Commerce and