Exclusion of Immigrants with a \u201cLoathsome or Dangerous Contagious Disease\u201d<\/strong><\/p>\n\n\n\n Against this backdrop, early in 1921 the House Committee on Immigration and Naturalization held an extraordinary hearing on the \u201cPhysical Examination of Immigrants\u201d (Physical Examination of Immigrants<\/em> 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 \u201cloathsome or dangerous contagious disease,\u201d 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).<\/p>\n\n\n\n The 1921 hearing focused on venereal disease. While the word \u201cloathsome\u201d was not used, of course, in medical diagnosis, certainly \u201cloathsome\u201d (not to mention \u201cdangerous\u201d and \u201ccontagious\u201d) 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 \u201cThe Modern Health Advocate\u201d magazine, testified about the \u201clack of precaution\u201d being taken \u201cto prevent the constant and ever-increasing influx of venereal disease into this country\u201d (Physical Examination of Immigrants<\/em> 3). Being at the intersection of anxiety about both immigration and the loosening of sexual mores at the time, Broadman\u2019s statements at the hearing clearly struck a nerve.<\/p>\n\n\n\n Changes in Women\u2019s Roles in the 1920s<\/strong><\/p>\n\n\n\n Beginning earlier in the twentieth century and escalating in the 1920s, there were unsettling changes in women\u2019s 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\u2019s sexuality, coupled with the opportunity (including especially the use of the automobile) led to more sexual experimentation (Dumenil 131). Indeed, Broadman\u2019s publishing company, the Physical Culture Corporation, sought to capitalize on these trends, publishing \u201cIntimate Health Talks,\u201d a magazine whose titillating title belied its discussions of proper sexual hygiene (\u201cIntimate Health Talks\u201d 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<\/em>, 33)[1]<\/a>, 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.<\/p>\n\n\n\n Broadman\u2019s 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 \u201cnext to measles in frequency\u201d and cited research that 50-60% of adult males in the United States were infected. Broadman stated that \u201c<\/em>Syphilis and gonorrhea are among the most wide\u00ad 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\u201d (Physical Examination<\/em> 6).<\/p>\n\n\n\n Is Venereal Disease More Prevalent Among Immigrants?<\/strong><\/p>\n\n\n\n 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<\/em> 6-8), there was this exchange between Broadman and Congressman Harold Knutson (R-MN), who was himself an immigrant from Scandinavia:<\/p>\n\n\n\n Broadman: \u201c\u2026it is found that the better educated people do not have venereal diseases to the same extent that the poorer classes have.\u201d<\/p>\n<\/blockquote>\n\n\n\n Knutson: \u201cIsn’t it found more prevalent among the Mediter\u00adranean people than among the people of northern Europe?\u201d<\/p>\n<\/blockquote>\n\n\n\n Broadman: \u201cVenereal diseases are more prevalent in those countries\u201d (Physical Examination<\/em> 10).<\/p>\n<\/blockquote>\n\n\n\n The testimony underscores the broad medical and public acceptance of the germ theory of the disease, with little understanding or consideration of the theory\u2019s limitations.<\/p>\n\n\n\n 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 \u201ctwo to three million\u201d 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<\/em> 15).<\/p>\n\n\n\n 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<\/em>, 186, 190).<\/p>\n\n\n\n Congressman Riley J. Wilson (D-LA) pressed Creel on what percent of cases would be discovered \u201cif we had proper examination.\u201d Creel believed that \u201cno more than\u201d 1% of immigrants had venereal diseases (Physical Examination <\/em>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.<\/p>\n\n\n\n USPHS Estimates Venereal Disease Among Immigrants at One-Fifth of One Percent<\/strong><\/p>\n\n\n\n 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<\/em>, 194).<\/p>\n\n\n\n Midway through Creel\u2019s testimony, Raker accused Creel of not supporting thorough examinations of all immigrants \u201cbecause if the immigrants were not permitted to come ashore it would interfere with business and commercial interests.\u201d Creel took great exception to Raker\u2019s 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\u2019s 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 \u201cwould come right down of the head of the Surgeon General\u201d (Physical Examination <\/em>17). Throughout the hearing, there was no discussion at all about how immigrants\u2014most of whom had their initial impressions of American government at Ellis Island and would eventually become citizens–reacted to such invasive examination.<\/p>\n\n\n\n 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, \u201copportunity presented for intensive examination of a considerable number of arriving aliens.\u201d One group of 11,794 immigrants \u201cwere striped of clothing and given a thorough examination in a private room.\u201d Comparing this group to those undergoing a more cursory, standard traditional examination, the PHS found that there was \u201cpractically no difference\u201d regarding the detection of \u201cdangerous contagious diseases.\u201d Of the 11,794 intensively examined, the data showed only 37, about three-tenths of one percent, had any<\/em> 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 <\/em>26).<\/p>\n\n\n\n 1921 Quota Act Passes Just Five Months Later<\/strong><\/p>\n\n\n\n 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<\/em> than the existing US population, did not matter. They would reduce the \u201cimport\u201d 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 <\/em>1984, 113). \u00a0The 1924 act would require the use of visas and passports and that immigrants first be processed at overseas consulates (Moreno xviii).<\/p>\n\n\n\n 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\u2019s 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<\/em> 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.<\/p>\n\n\n\n The attachment of contagious disease to immigrants did not dissipate with the dramatic reduction in newcomer numbers. As Markel and Stern write, \u201c<\/em>\u2026the social perception of the threat of the infected immigrant was typically far greater than the actual danger. Indeed, the number of \u2018diseased\u2019 immigrants has always been infinitesimal when<\/p>\n\n\n\n compared with the number of newcomers admitted to this country\u201d (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.<\/p>\n\n\n\n In September 2023, presidential candidate Donald Trump declared claimed that illegal immigrants were \u201c<\/em>poisoning the blood of our country<\/a>,\u201d a charge that effectively combines the argument of the \u201cdilution\u201d of the hearty American stock of 100 years prior with the fear that immigrants were bringing epidemics. \u201cIt\u2019s so bad, and people are coming in with disease. People are coming in with\u2026 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: \u201cMany, many terrorists are coming in, and people are coming in with very contagious disease\u2026. You know, like it\u2019s all of a sudden you see there\u2019s a run on tuberculosis. There\u2019s a run on things that we haven\u2019t talked about for years in this country\u201d (Trayler, \u201cTrump Says\u201d 2024). It wouldn\u2019t 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 (\u201cTexas measles outbreak\u201d 2025).<\/p>\n\n\n\n Bibliography<\/u><\/strong><\/p>\n\n\n\n \u201cAliens Infested on Ellis Island.\u201d 1921. The New York Times.<\/em> February 19.<\/p>\n\n\n\n https:\/\/nyti.ms\/4ibQWUE<\/a><\/p>\n\n\n\n Annual Report of the Surgeon-General of the Public Health and Marine-Hospital Service of the United States for the Fiscal Year 1904<\/em>. 1904. Government Printing Office.<\/p>\n\n\n\n Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1920<\/em>. 1920. Government Printing Office.<\/p>\n\n\n\n Barry, John M. 2018. The Great Influenza: The Story of the Deadliest Pandemic in History<\/em>. Penguin Books.<\/p>\n\n\n\n Dumenil, Lynn. 1995. The Modern Temper: American Culture and Society in the 1920s<\/em>. Hill and Wang.<\/p>\n\n\n\n Immigration and Other Interests of Prescott Farnsworth Hall<\/em>. 1922. Compiled by Mrs. Prescott F. Hall. The Knickerbocker Press.<\/p>\n\n\n\n https:\/\/ia601308.us.archive.org\/21\/items\/cu31924064104254\/cu31924064104254.pdf<\/a><\/p>\n\n\n\n \u201cIntimate Health Talks.\u201d [Advertisement.] 1922. Physical Culture<\/em>. July.<\/p>\n\n\n\n Kraut, Alan M. 1994. Silent Travelers: Germs, Genes, and the \u201cImmigrant Menace.\u201d<\/em> Basic Books.<\/p>\n\n\n\n Kraut, Alan M. 1995. \u201cPlagues and Prejudice: Nativism\u2019s Construction of Disease in Nineteenth- and Twentieth-Century New York City.\u201d In Hives of Sickness: Public Health and Epidemics in New York City<\/em>, edited by David Rossner. Rutgers University Press.<\/p>\n\n\n\n Markel, Howard. 1997. Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892<\/em>. The Johns Hopkins University Press.<\/p>\n\n\n\n Markel H, Stern AM. 2002. The foreignness of germs: the persistent association of immigrants and disease in American society. Milbank Q<\/em> 80(4): 757-88.<\/p>\n\n\n\n\n
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