With the death of Thomas Salmon, M.D. in a sailing accident on August 13, 1927, the mentally ill lost one of their most respected and influential advocates of that era. Salmon’s journey from failed family doctor to the upper echelons of American psychiatry reflects both his personal drive and his empathy for those struggling with their mental health. He was also a man defined by paradoxes. Although Salmon wore the uniform of the U.S. Public Health and Marine Hospital Service or the U.S. Army Medical Corps for much of his career, he had an allergy to authority of all kinds. (A 1906 investigation by the Public Health Service into his refusal of a direct order on Ellis Island pronounced Salmon “far from loyal, obedient or even consistent” (Unrau 1984, 679).) Later, Salmon would be praised for his superb organization and management of psychiatric services for American soldiers in World War I, yet he was also well-known as one who couldn’t pay his own bills or debts on time.

Early Life

Born in 1875 in Troy, New York, Salmon was the son of a family doctor who had immigrated from England. He graduated from Albany Medical College in 1899 and returned home to establish a medical practice. Salmon was a skilled artist whose work appeared in at least one medical textbook (Gordinier 1899). Salmon’s career as a family doctor was short-lived. He refused to advertise in the local newspapers, despite the highly competitive nature of medicine in that era. Although certainly a competent physician, Salmon proved a terrible businessman. When he did bill for his services, he neglected to chase payments. By the time he left his practice, Salmon had uncollected bills of $15,000-$25,000 (Komora 1937,  McKown interview).

Seeking a steady income for his growing family, Salmon took a position at Willard State Hospital in New York, a mental institution, where he was hired to investigate—and end—a diphtheria epidemic (Russell and Salmon 1905).  Not satisfied with laboratory work, Salmon decided to enter the Public Health and Marine Hospital Service (later shortened to “Public Health Service”). He may have at first failed the highly competitive exam, which took place in Washington D.C. each year over a three-day span, but Salmon eventually passed and entered Public Health and Marine Hospital Service in 1903, and was assigned to Ellis Island.

Ellis Island

While Willard State served as Salmon’s entry into psychiatry, it was at Ellis Island that Salmon became fully immersed in the specialty. Salmon was initially assigned to the immigrant inspection line, where he and other Public Health and Marine Hospital Service physicians did a cursory examination of steerage-class passengers, seeking to identify those with dangerous contagious diseases, mental illness, and “feeblemindedness.” These immigrants would be sent to Ellis Island Hospital, a facility on its own artificial island that would grow to 650-beds, for treatment and observation. Some of them would be refused entry and returned to their home country on the basis of their condition.

Unsettled by the rough handling of insane immigrants, Salmon pushed for better care. Arriving immigrants, particularly in the early 1900s, suffered from the harsh conditions of steerage, without clean water, decent food, and proper sanitation for the 7-21 day journey to the United States. Sleep-deprived, they arrived at Ellis Island homesick, disoriented, and afraid. Salmon noted that a bath, clean clothes, good food, and rest often eliminated their “insanity.”

As there were no special wards for these immigrants, Salmon, with his drawing skills, designed one. It would be built after his conflicts with his superior officers, stemming from his unwillingness to work on the inspection line, resulted in his transfer to the port of Boston. With a growing number of foreign-born patients filling its state mental asylums, in 1911 the New York State Commission in Lunacy approached Salmon, whose work at Ellis Island had grown his reputation, to study its immigrant insane, provide statistics, and create a standardized system of reporting admissions and discharges. Granted a leave of absence from the Public Health Service, and offered a substantially higher salary, Salmon got to work. Salmon was among those who pushed for medical examination of immigrants before they departed from their home countries for the United States, so those with mental illness would not be permitted to come to the United States at all.

Mental Hygiene Movement

Salmon’s work in New York State attracted the attention of Clifford Beers, founder of the mental hygiene movement. A Yale graduate, Beers was himself a former mental patient and told his story in A Mind that Found Itself: An Autobiography, which was published in 1907. Beers exposed that too often the only “treatment” for the insane were straightjackets and violence on the part of the untrained attendants. Beers established the Connecticut Society for Mental Hygiene, which by the next year was renamed the National Committee for Mental Hygiene (NCMH). The organization lives on today under the name “Mental Health America” (“Mental Health America: Our History”).

Salmon joined the NCMH, serving as its Medical Director from 1912 to 1922, taking a leave of absence from 1917 to early 1919 to serve in the U.S. Army Medical Corps. With a salary paid by the Rockefeller Foundation, Salmon finally resigned his Public Health Service officer commission at the end of 1914. Salmon’s work at the NCMH exposed conditions in state asylums (“Annual Meeting of the National Committee for Mental Hygiene” 211). In the 1920s, the NCMH wrote and lobbied for model commitment laws (“Mental Health America”), which were passed by the states.

Advocating for “Shell-Shocked” Soldiers

In the  U.S. Army Medical Corps had the daunting task of  setting up psychiatric hospitals and recruiting doctors and nurses to work in France. Upon his return in 1919, Salmon pushed for proper care of soldiers suffering from “shell shock,” what is generally known today as post-traumatic stress disorder. When he learned that such victims would be put in hospitals and institutions without proper psychiatric staffing and treatment, he said that “… you can’t take care of these sick men in facilities like those, just as though they were so many stalls to house so many horses” (Komora 1937, Bryan interview). Salmon became a national figure in the 1920s, giving fiery speeches for the American Legion and testifying before Congress demanding that the country provide for veterans who returned with mental disorders. It put him at odds with the Harding administration and the Public Health Service (which was supposed to care for such men), and alienated the Rockefeller Foundation. But his advocacy helped establish what would eventually become the Veterans Administration.

Practical Psychiatric Treatment

After his return to the United States from France, Salmon became active in the American Psychiatric Association. He also developed a lucrative private practice, which didn’t end his lifelong money woes, but did improve his financial standing. Among his patients was Marion Frankfurter, the wife of the future Supreme Court Justice. Marion Frankfurter suffered from bouts of depression throughout her life. She lauded Salmon for the “extraordinary skill and gentleness with which he led me through the dark wood.” Her interviewer, Paul Komora of the NCMH, wrote, “As Mrs. F. put it, Salmon virtually saved her life” (Komora 1937, interview with Felix and Marion Frankfurter). Salmon turned down $50,000 a year to treat Stanley McCormick, an heir to International Harvester’s family fortune (Komora 1937, Brumley interview). At the time, physicians in private practice earned $5,000 to $10,000 a year (Bendix 2023).

Seeking to improve the teaching of psychiatry as a discipline and interest more capable medical students to enter the field, Salmon joined the faculty of the Columbia University College of Physicians and Surgeons in 1921. Psychiatry was very much a rapidly developing field in the first decades of the Twentieth Century, as doctors sought ways to more effectively treat the mentally ill rather than simply warehousing them in institutions. Lynn Dumenil’s 1995 analysis of the forces that shaped the 1920s, The Modern Temper, highlights the work of Sigmund Freud and John B. Watson (146) in its discussion of psychiatry and psychology. Both of these thinkers could be put on the opposite ends of a spectrum. Freudianism, with its emphasis on the unconscious mind, sex, and repressed desires, could be located on one end, while Watson, whose work focused on the study of discernable, measurable behaviors and their manifestation in an individual’s external actions and reactions, could be placed on the other.

Salmon and the mental hygienists are in the middle of this spectrum. Mental hygienists certainly believed in talk therapy (Freud), and they saw the value of identifying behaviors and attempting to understand their relationship to the patient’s environment (Watson). For example, Salmon was called in to treat a boy who was caught tampering with the signal mechanisms of a railroad near his boarding school. Such vandalism could have proved deadly. After spending some time with the child, who was about to be kicked out of his school, Salmon found he displayed an unusual ability in mechanical and electrical work. His “prescription” was to arrange much more time for the boy to study these subjects. In this example there is an attempt to identify the issue and identify a practical solution, rather than delve deeply into a person’s psyche, on the one hand, or reduce them to a simple set of actions/reactions, on the other.

Expanding Psychiatry

This sort of approach was particularly important in the “child guidance clinics” the NCMH set up in cities (Blanton et al., 1927), as well as the work Salmon helped organized in Sing-Sing prison (“Psychiatric Services for Prisoners” 1916). Though neither he nor the mental hygiene movement are mentioned in Dumenil’s survey, Salmon and other leaders were effective in reducing the stigma of mental illness and pushing for treatment of the insane, rather than imprisoning  them in state institutions. They focused on not only ending the abuse and isolation of patients in mental institutions, but sought to end long-term, involuntary incarceration. They pushed for psychiatric treatment in the communities where the mentally ill lived, in an out-patient fashion, before such clinics were widely established. We particularly see the legacy of the mental hygienists in the lessening of the stigma of mental illness as well as the evolution of the principal profession body for psychiatrists, the American Psychiatric Association.

Founded in 1844 as “The Association of Medical Superintendents of American Institutions for the Insane” and then in 1892 as “The American Medico-Psychological Association,” the organization finally became “The American Psychiatric Association” (APA) in 1921.  Such name changes signaled the transformation of psychiatry from a discipline concerned with patients in mental institutions to one with broad scope to treat the range of mental disorders (Ozarin and McMillan, “APA History”). In 1923, Salmon was elected the president of the APA, the first one who had not served in a leadership capacity at a state mental institution. “The ideal psychiatrist was no longer the institutional superintendent of the [eighteen] eighties, or even the man of the laboratory of the nineties,” wrote Barbara Sicherman (1967, The Quest for Mental Health in America, 280).  Ever progressive, the new psychiatrist, who worked in schools, prisons, and hospitals, collaborated with social workers and educated laymen, had become an advocate of “science with a public mission,” an apt description of Thomas Salmon.

Bibliography

“Annual Meeting of the National Committee for Mental Hygiene.” 1928. Mental Hygiene. 12: 211.

Beers, Clifford Whittingham. 1907. A Mind that Found Itself: An Autobiography. Doubleday & Company, Inc.

Bendix, Jeffrey. September 28, 2023. “A Century of Primary Care Transformation, Chapter 1: 1923 vs. 2023: A Doctor’s Daily Life.” Medical Economics Journal. 100:10.

Accessed May 4, 2025

Blanton, Smiley and Margaret Gray Blaxton. 1927. Child Guidance. Century Company.

Introduction by Thomas Salmon.

Bond, Earl D. with the collaboration of Paul O. Komora. 1950. Thomas W. Salmon: Psychiatrist. W.W. Norton & Company, Inc.

Chafee, Jr. Z. May 26, 1937. Letter to Paul Komora. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Dumenil, Lynn. 1995. The Modern Temper: American Culture and Society in the 1920s. Hill and Wang.

Gordinier, H.C. 1899. The Gross and Minute Anatomy of the Central Nervous System. Blakiston’s Son & Co.

Komora, Paul. May, 1937. “Visit with Dr. Bryan in New London.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 2, Folder 3.1.

Komora, Paul. (Undated, circa 1937). “Notes from Salmon Dossier in the Public Health Service.” Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Komora, Paul. (Undated, circa 1937). “Visit with J.F. McKown, Carmel, N.Y.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Komora, Paul. (Undated, circa 1937). “Visit with Justice and Mrs. Felix Frankfurter.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

Komora, Paul. (Undated, circa 1937). “Visit with Mr. Brumley.” Interview. Thomas Salmon Papers. The Oskar Diethelm Library, DeWitt Wallace Institute for the History of Psychiatry, Weill Cornell Medical College, Box 1, Folder 1.

“Mental Health America: Our History.” Undated.

Accessed May 3, 2025.

Ozarin, Lucy, and Gary McMillan. “APA History.” Undated.

Accessed August 31, 2023

“Psychiatric Services for Prisoners.” 1916. The Survey. 36: 444.

Russell, W. L. and T.W. Salmon. 1905. “Report of Epidemic of Diphtheria in the Willard State Hospital.” Reprint.  Annual Report, New York State Commission in Lunacy, Oct. 1904. Brandow.

Sicherman, Barbara. 1967. The Quest for Mental Health in America, 1880-1917. Arno Press, 1980. First published as a PhD dissertation in 1967.

Unrau, Harlan D. 1984. Historical Research Study (Historical Component): Ellis Island Statue of Liberty National Historic Monument New York – New Jersey Volume II. U. S. Department of the Interior/National Park Service.

Brian Scanlan

Brian Scanlan is a former publishing executive with an interests in the history of the immigration and medicine. He has a B.A. in history from Rutgers University.

While an anti-immigrant strain ran through politics in the United States since the very founding of the republic, it was only after World War I and the Red Scare of 1919-1920 that nativists acquired enough clout to push through the quota acts of 1921 and 1924. An important element of the anti-immigrant crusade was the persistent association of immigrants with contagious disease, which served to increase anxiety about their bringing with them the unseen germs of deadly epidemics. Activists sent petitions to Congress calling for restrictions on immigration for public health reasons (Markel 1997, 85).  As Markel writes, “Not only does the infectious disease become the ‘enemy’ but, so, too do the human beings (and their contacts) who have encountered the microbe in question” (Markel, 185). With the “Spanish Flu” pandemic of 1918 (Barry 2018), as well as smaller outbreaks of typhus in 1892 and 1921 (“Typhus and Immigration” 1892 and “Aliens Infested on Ellis Island” 1921), polio in 1916 (Kraut 1995, 66), and cholera in 1892 (Markel 26-27) still fresh in the minds of the public, nativists pressed for reductions in immigrant numbers, especially of  Southern Italians and Eastern European Jews.

These newcomers seeking relief from poverty and persecution had arrived in larger numbers in the previous two decades, and immigration had begun to rise dramatically after the hiatus of World War I. The number of foreigners arriving in New York, for example, would double by the end of June 1921, from the previous fiscal year, increasing from 333,727 to 665,001 (Unrau, Historical Research Study II 1984, 626).

Exclusion of Immigrants with a “Loathsome or Dangerous Contagious Disease”

Against this backdrop, early in 1921 the House Committee on Immigration and Naturalization held an extraordinary hearing on the “Physical Examination of Immigrants” (Physical Examination of Immigrants 1921). Publisher, nativist and ardent eugenicist Albert Johnson (R-WA), who would go on to co-write the 1924 quota act, chaired the all-male committee. He invited Joseph Broadman, MD, who had written to him, to discuss his observations of the medical inspection of immigrants at Ellis Island. The Immigration Act of 1893 required the exclusion of immigrants having a “loathsome or dangerous contagious disease,” as well as the physically and mentally handicapped. The U.S. Public Health Service (USPS) physicians were tasked with inspecting immigrants and to identify and medically certify those with such conditions, and the Bureau of Immigration would then make the decision about exclusion in each case. At the port of New York, through which most migrants traveled, USPS doctors inspected steerage class passengers on Ellis Island. Those traveling first and second class were given a cursory inspection on ship and only those sick or with noticeable defects were sent to Ellis Island for follow-up (Moreno 2004, xiii).

The 1921 hearing focused on venereal disease. While the word “loathsome” was not used, of course, in medical diagnosis, certainly “loathsome” (not to mention “dangerous” and “contagious”) fit the bill when discussing venereal disease. Perhaps only leprosy elicits the same sort of public recoil as both are debilitating and disfiguring. Moreover, syphilis can end in insanity. Broadman, editor of “The Modern Health Advocate” magazine, testified about the “lack of precaution” being taken “to prevent the constant and ever-increasing influx of venereal disease into this country” (Physical Examination of Immigrants 3). Being at the intersection of anxiety about both immigration and the loosening of sexual mores at the time, Broadman’s statements at the hearing clearly struck a nerve.

Changes in Women’s Roles in the 1920s

Beginning earlier in the twentieth century and escalating in the 1920s, there were unsettling changes in women’s roles, especially as they became more independent working outside the home. Working-class women sought respite from tedious jobs demanding long hours and found it in unchaperoned visits to amusement parks, dance halls, and cinemas (Dumenil 1995, 131). Many of these women were daughters of immigrants, if not immigrants themselves. A general increase in awareness of women’s sexuality, coupled with the opportunity (including especially the use of the automobile) led to more sexual experimentation (Dumenil 131). Indeed, Broadman’s publishing company, the Physical Culture Corporation, sought to capitalize on these trends, publishing “Intimate Health Talks,” a magazine whose titillating title belied its discussions of proper sexual hygiene (“Intimate Health Talks” 1922, 131). That the hearing focused on venereal disease put it at the nexus of fear about the so-called dilution of white Anglo-Saxon vitality (Immigration and Other Interests of Prescott Farnsworth Hall 1922, 33)[1], unease about the economic and sexual agency of women, fear of deadly disease brought by immigrants, and revulsion of sexually transmitted infections. Indeed, having syphilis or gonorrhea was viewed more as a moral failing than it was a medical condition.

Broadman’s appearance at the hearing may have been a publicity stunt to promote his publications. He criticized the process on Ellis Island as too focused on excluding those with obvious diseases or mental disabilities and not enough on venereal disease. He declared that gonorrhea was “next to measles in frequency” and cited research that 50-60% of adult males in the United States were infected. Broadman stated that “Syphilis and gonorrhea are among the most wide­ spread of all infectious diseases. Their victims are numbered in many millions, not in hundreds. Not a man or woman lives who does not touch elbows with them daily; whose house has not seen their entry and departure and who may not at any time themselves become afflicted” (Physical Examination 6).

Is Venereal Disease More Prevalent Among Immigrants?

After claiming that venereal diseases could be contracted from toilet seats, or even from a glass of water handed to you by waiter in a restaurant (Physical Examination 6-8), there was this exchange between Broadman and Congressman Harold Knutson (R-MN), who was himself an immigrant from Scandinavia:

Broadman: “…it is found that the better educated people do not have venereal diseases to the same extent that the poorer classes have.”

Knutson: “Isn’t it found more prevalent among the Mediter­ranean people than among the people of northern Europe?”

Broadman: “Venereal diseases are more prevalent in those countries” (Physical Examination 10).

The testimony underscores the broad medical and public acceptance of the germ theory of the disease, with little understanding or consideration of the theory’s limitations.

The second person to testify at the hearing was Assistant Surgeon General R.H. Creel, who had served on Ellis Island and defended the inspection process of the USPHS. Creel stated that even eliminating every case of immigrant venereal disease, there would still be “two to three million” cases in the country (of a population of about 108 million in 1921). Creel asked if it was worth spending the money ($600,000 for an additional 200 doctors annually), when venereal diseases would not be eliminated, nor even marginally reduced (Physical Examination 15).

Creel cited several studies, including one by the New York City Draft Board, which found only a 2.4% rate of venereal disease among draftees and an Ellis Island study showing the rate among seamen as less than 3%. When Congressman John E. Raker (D-CA) asked Creel about the number of venereal disease cases detected at Ellis Island, Creel apparently provided instead the figures for all immigration to the United States: in the fiscal year ending June 30, 1920, there were 3,869 cases of venereal disease out of a total of 1,537,527 immigrants and seamen examined (.25%, or one-quarter of 1%). Some of these were discovered by ship doctors who reported them to immigration authorities in port. The actual figures for Ellis Island for the fiscal year ending June 30, 1920 were that of 333,727 aliens and 27,341 crew examined, the rates of venereal disease were .04% and 2.21% respectively (Annual Report of the Surgeon-General 1920, 186, 190).

Congressman Riley J. Wilson (D-LA) pressed Creel on what percent of cases would be discovered “if we had proper examination.”  Creel believed that “no more than” 1% of immigrants had venereal diseases (Physical Examination 14-16), an estimate he would later lower. Ironically, some of those with venereal diseases were permitted to undergo treatment in a hospital and allowed to enter if cured. The expense of treatment was, by law, paid for by the steamship lines, which were required to do their own inspections to weed out such cases before leaving the port of departure.

USPHS Estimates Venereal Disease Among Immigrants at One-Fifth of One Percent

Creel also referenced an investigation prompted by New York Commissioner William Williams in 1903-1904. For one week, physicians took unmarried male arrivals to a separate examination room and had them strip en masse. They found one case of swollen glands in the groin (a sign of venereal disease or a skin infection) and one case of gonorrhea. Moreover, of the 3,427 aliens sent to Ellis Island Hospital for observation or treatment that fiscal year, only two were found to have syphilis, hardly an epidemic (Annual Report of the Surgeon-General 1904, 194).

Midway through Creel’s testimony, Raker accused Creel of not supporting thorough examinations of all immigrants “because if the immigrants were not permitted to come ashore it would interfere with business and commercial interests.” Creel took great exception to Raker’s comment, as USPHS physicians prided themselves, as a uniformed, commissioned service (much like members of the military), on remaining apolitical and focused on the practice of medicine in a scientific fashion. Creel’s argument was simply that he believed it would not be worth the expense of increasing the number of doctors as well as the space at Ellis Island to thoroughly examine every immigrant, and that ship congestion in the port might result, which “would come right down of the head of the Surgeon General” (Physical Examination 17). Throughout the hearing, there was no discussion at all about how immigrants—most of whom had their initial impressions of American government at Ellis Island and would eventually become citizens–reacted to such invasive examination.

The day after the hearing, Creel wrote to the Committee to augment his testimony. He stated that in 1915, because of greatly reduced immigration owing to the war, “opportunity presented for intensive examination of a considerable number of arriving aliens.” One group of 11,794 immigrants “were striped of clothing and given a thorough examination in a private room.” Comparing this group to those undergoing a more cursory, standard traditional examination, the PHS found that there was “practically no difference” regarding the detection of “dangerous contagious diseases.” Of the 11,794 intensively examined, the data showed only 37, about three-tenths of one percent, had any dangerous contagious disease. Creel lowered his estimate of immigrant venereal disease from the one percent he stated at the hearing to one-fifth of one percent (Physical Examination 26).

1921 Quota Act Passes Just Five Months Later

It’s likely that Committee Chair Johnson had no intention to consider intensifying the medical examination at Ellis Island or any of the other ports of entry. That venereal disease among immigrants was hardly a raging contagion or, in fact, that the rate of infection was actually lower than the existing US population, did not matter. They would reduce the “import” of what tiny amount of venereal disease there was arriving by reducing immigration, and they would do so primarily by restricting it from Eastern and Southern Europe. The 1921 Quota Act, passed overwhelmingly just five months later, limited by nationality immigrants by country to 3% of the declared number of foreign-born living in the United States in the 1910 census, and the total number of immigrants to 355,000 per year (Unrau, Historical Research Study I 1984, 113).  The 1924 act would require the use of visas and passports and that immigrants first be processed at overseas consulates (Moreno xviii).

The 1921 act was reauthorized twice to keep it in place for the next two years, but it was deemed insufficient. In 1924, Congress would pass and Calvin Coolidge would sign the most far-reaching immigration restriction law in the nation’s history. The Johnson-Reed Act limited by nationality immigrants by country to 2% of the declared number of foreign-born living in the United States in the 1890 census, and the total number of immigrants to just 164,667 per year. Countries in northern and western Europe received 85.6% of the quotas, while just 12.4% were allotted to southern and eastern Europe. These restrictions would remain in place until 1965 (Moreno 116) and essentially changed the function of Ellis Island from an immigrant processing facility to a deportation center.

The attachment of contagious disease to immigrants did not dissipate with the dramatic reduction in newcomer numbers. As Markel and Stern write, “…the social perception of the threat of the infected immigrant was typically far greater than the actual danger. Indeed, the number of ‘diseased’ immigrants has always been infinitesimal when

compared with the number of newcomers admitted to this country” (Markel and Stern 2002, 758). In the early 1990s, Haitian immigrants were accused of bringing AIDS into the country and were required to undergo blood tests (Kraut 1994, 1-2). Policies of both the Trump and Biden administrations used COVID as a reason to restrict immigration not just from China, where COVID first surfaced, but at the US southern border as well.

In September 2023, presidential candidate Donald Trump declared claimed that illegal immigrants were  “poisoning the blood of our country,” a charge that effectively combines the argument of the “dilution” of the hearty American stock of 100 years prior with the fear that immigrants were bringing epidemics. “It’s so bad, and people are coming in with disease. People are coming in with… with every possible thing that you can have,” he said. In May 2024, as the Presidential election moved into full swing, Trump combined the dread of disease with anxiety of terrorism: “Many, many terrorists are coming in, and people are coming in with very contagious disease…. You know, like it’s all of a sudden you see there’s a run on tuberculosis. There’s a run on things that we haven’t talked about for years in this country” (Trayler, “Trump Says” 2024). It wouldn’t be until 2025 that Trump would appointment an anti-vaccine activist as secretary of the U.S. Department of Health and Human Services and that the country would witness not an epidemic of venereal disease among immigrants but the outbreak of measles, whose victims are mostly the native-born living in insular communities (“Texas measles outbreak” 2025).

Bibliography

“Aliens Infested on Ellis Island.” 1921. The New York Times. February 19.

https://nyti.ms/4ibQWUE

Annual Report of the Surgeon-General of the Public Health and Marine-Hospital Service of the United States for the Fiscal Year 1904. 1904. Government Printing Office.

Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1920. 1920. Government Printing Office.

Barry, John M. 2018. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books.

Dumenil, Lynn. 1995. The Modern Temper: American Culture and Society in the 1920s. Hill and Wang.

Immigration and Other Interests of Prescott Farnsworth Hall. 1922. Compiled by Mrs. Prescott F. Hall. The Knickerbocker Press.

https://ia601308.us.archive.org/21/items/cu31924064104254/cu31924064104254.pdf

“Intimate Health Talks.” [Advertisement.] 1922. Physical Culture. July.

Kraut, Alan M. 1994.  Silent Travelers: Germs, Genes, and the “Immigrant Menace.”  Basic Books.

Kraut, Alan M. 1995.  “Plagues and Prejudice: Nativism’s Construction of Disease in Nineteenth- and Twentieth-Century New York City.” In Hives of Sickness: Public Health and Epidemics in New York City, edited by David Rossner. Rutgers University Press.

Markel, Howard. 1997. Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892. The Johns Hopkins University Press.

Markel H, Stern AM. 2002. The foreignness of germs: the persistent association of immigrants and disease in American society. Milbank Q 80(4): 757-88.

https://pubmed.ncbi.nlm.nih.gov/12532646

Moreno, Barry. 2004. Encyclopedia of Ellis Island. Greenwood Press.

Physical Examination of Immigrants: Hearings Before the Committee on Immigration and Naturalization. 1921. House of Representatives, Sixty-Sixth Congress, Third Session. Government Printing Office.

https://www.google.com/books/edition/Physical_Examination_of_Immigrants/dXWqbRfc_okC?hl=en

“Texas measles outbreak draws attention to traditionalist Mennonite community.”

Anabaptist World. March 14, 2025.

Traylor, Jake. (2024). “Trump says people crossing the border bring ‘very contagious disease’ with them.” May 22, 2024.  

https://www.nbcnews.com/politics/donald-trump/trump-says-migrants-bring-contagious-disease-border-rcna153631

Accessed March 7, 2025

“Typhus and Immigration.” 1892. New York Times. February 13.

https://nyti.ms/4biRcym

Unrau, Harlan D. 1984.  Historical Research Study (Historical Component): Ellis Island Statue of Liberty National Historic Monument New York – New Jersey Volume I. U. S. Department of the Interior/National Park Service.

https://www.nps.gov/parkhistory/online_books/stli1/hrs1.pdf

Unrau, Harlan D. 1984. Historical Research Study (Historical Component): Ellis Island Statue of Liberty National Historic Monument New York – New Jersey Volume II. U. S. Department of the Interior/National Park Service.

https://www.nps.gov/parkhistory/online_books/stli1/hrs2.pdf

Resources

Resources listed below were freely accessible at the links shown on March 19, 2025.

A transcript of the 1921 hearing is here:

Physical Examination of Immigrants: Hearings Before the Committee on Immigration and Naturalization. 1921. House of Representatives, Sixty-Sixth Congress, Third Session. Government Printing Office.

Markel H, Stern AM. 2002. The foreignness of germs: the persistent association of immigrants and disease in American society. Milbank Q. 80(4):757-88.

https://pubmed.ncbi.nlm.nih.gov/12532646

This article is a good overview of the perception of immigrants and disease.

Federal historian Harlan D. Unrau wrote this general, three-volume history of Ellis Island:

Unrau, Harlan D. 1984.  Historical Research Study (Historical Component): Ellis Island Statue of Liberty National Historic Monument New York – New Jersey Volume I. U. S. Department of the Interior/National Park Service.

https://www.nps.gov/parkhistory/online_books/stli1/hrs1.pdf

Unrau, Harlan D. 1984. Historical Research Study (Historical Component): Ellis Island Statue of Liberty National Historic Monument New York – New Jersey Volume II. U. S. Department of the Interior/National Park Service.

https://www.nps.gov/parkhistory/online_books/stli1/hrs2.pdf

Unrau, Harlan D. 1984. Historical Research Study (Historical Component): Ellis Island Statue of Liberty National Historic Monument New York – New Jersey Volume III. U. S. Department of the Interior/National Park Service.

https://www.nps.gov/parkhistory/online_books/stli1/hrs3.pdf

[1] Hall, co-founder and secretary of the Immigration Restriction League, was enamored of English mathematician and eugenicist  Karl Pearson, and a statement attributed to him: “You cannot change the leopard’s spots, and you cannot change bad stock to good; you may dilute it, possibly spread it over a large area, spoiling good stock, but until it ceases to multiply it will not cease to be.”

Brian Scanlan

Brian Scanlan is a former publishing executive with an interests in the history of the immigration and medicine. He has a B.A. in history from Rutgers University.

On January 11, 1921, as the post-Great War alarm about increased immigration intensified, the Congressional Committee on Immigration and Naturalization held a hearing called the “Physical Examination of Immigrants.” Members of the all-male Committee invited Joseph Broadman, MD, to discuss his observations of the medical inspections of immigrants at Ellis Island. At the hearing, Broadman, editor of “The Modern Health Advocate” magazine, testified about the “lack of precaution” being taken “to prevent the constant and ever-increasing influx of venereal disease into this country” (“Physical Examination of Immigrants” 1921, 3). Being at the intersection of anxiety about both immigration and the loosening of sexual mores, Broadman’s statements at the hearing clearly struck a nerve.

Beginning earlier in the twentieth century and escalating in the 1920s, there were unsettling changes in women’s roles, especially as they became more independent working outside the home. Working-class women sought respite from tedious jobs demanding long hours and found it in unchaperoned visits to amusement parks, dance halls, and cinemas (Dumenil 1995, 131). Many of these women were daughters of immigrants, if not immigrants themselves. A general increase in awareness of women’s sexuality, coupled with the opportunity (including especially the use of the automobile) led to more sexual experimentation. Indeed, Broadman’s publishing company, the Physical Culture Corporation, sought to capitalize on these trends, publishing “Intimate Health Talks,” a magazine whose titillating title belied its discussions of proper sexual hygiene (“Intimate Health Talks” 1922, 131).

Broadman’s appearance at the hearing may have been a publicity stunt. He criticized the process on Ellis Island as too focused on excluding those with obvious diseases or mental disabilities and not enough on venereal disease. He declared that gonorrhea was “next to measles in frequency” and cited research that 50-60% of adult males in the United States were infected. After claiming that venereal diseases could be contracted from toilet seats, or even from a glass of water handed to you by waiter in a restaurant (“Physical Examination” 6-8), there was this exchange between Broadman and Congressman Harold Knutson (R-MN), who was himself an immigrant from Scandinavia:

Broadman: “…it is found that the better educated people do not have venereal diseases to the same extent that the poorer classes have.”
Knutson: “Isn’t it found more prevalent among the Mediterranean people than among the people of northern Europe?”
Broadman: “Venereal diseases are more prevalent in those countries” (“Physical Examination” 10).

The second person to testify at the hearing was Assistant Surgeon General R.H. Creel, who had served on Ellis Island and defended the inspection process of the Public Health Service. He cited several studies, including one by the New York City Draft Board, which found only a 2.4% rate of venereal disease among draftees and an Ellis Island study showing the rate among seamen as less than 3%. Creel believed that fewer than 1% of immigrants had venereal diseases (“Physical Examination” 14-16).

Creel’s testimony fell on deaf ears. Committee Chair Albert Johnson (R-WA), an anti-immigrant activist, eugenicist and publisher, would push through the first quota act four months later, and it would severely limit immigration from Eastern and Southern Europe. The hearing served to whip up unfounded concern in Congress about venereal disease and immigrants, attaching to them both infectious illness and blame for the relaxation of Victorian sexual attitudes.

Bibliography
Dumenil, Lynn. 1995. The Modern Temper: American Culture and Society in the 1920s. Hill and Wang.

“Intimate Health Talks.” [Advertisement.] 1922. Physical Culture. July.

Physical Examination of Immigrants: Hearings Before the Committee on Immigration and Naturalization. 1921. House of Representatives, Sixty-Sixth Congress, Third Session. Government Printing Office.

Brian Scanlan

Brian Scanlan is a former publishing executive with an interests in the history of the immigration and medicine. He has a B.A. in history from Rutgers University.