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Our present law provides that in case of aliens who are debarred for physical or mental reasons and whose disability might have been detected by the transportation company through a competent medical examination at the time of embarkation, the transportation company shall pay the sum of $200 and in addition a sum equal to that paid by such alien for his transportation from the initial point of departure indicated in his ticket to the port of arrival and such sum shall be paid to the alien on whose account it is assessed. In consequence of these and the preceding regulations, the transportation of diseased aliens has become so unprofitable that the steamship companies have provided, at the leading foreign ports, a medical inspection similar to that made in the United States.*
EFFICIENCY OF INSPECTION IN EUROPE
As a result of this inspection compelled by the rigid enforcement of our laws at our ports of entry, the number of persons debarred at American ports is relatively very small. In the fiscal year 1907, 1,285,349 aliens were admitted, while only 4,400 were debarred on account of physical and mental diseases. In 1914, as against 1,218,480 aliens who entered, 11,068 were debarred. The increase is due largely to the added efficiency of our medical service. The fact that a large proportion of the immigrants arriving in the United States come from countries where trachoma, favus and other contagious diseases are prevalent among the classes of the population from whom the immigrants come, shows how careful the steamship inspection is.
A still further proof is that the persons excluded on
* Immigration Act, 1917, Sec. 9.
account of diseases from the ports of Italy, where the judgment of American medical officers is accepted as final, is slightly larger than those rejected from some other countries where the inspection is made solely by the physicians employed by the steamship companies.
On the whole, the medical inspection of immigrants at foreign ports, while not absolutely effective, seems to be reasonably satisfactory. A considerable time must elapse between embarkation at European ports and arrival in the United States. Moreover, doubtless, in spite of the best efforts that can be made, there will be occasionally an avoidance of inspection; but taking all circumstances into account, the present control of immigrants as regards contagious diseases seems to be quite satisfactory.
It has frequently been suggested that some system should be devised by which immigrants may be inspected before leaving their homes for a port of embarkation. Such an arrangement would, of course, prevent many hardships now suffered by the thousands. that are annually turned back at foreign ports of embarkation; but this is a subject over which our government has no supervision, the governments of the home countries being the only ones which could take effective action.
The policy adopted by the United States, of holding steamship companies responsible for bringing to the United States those physically and mentally diseased, seems to be right, and to have been of increasing effectiveness in late years. Inasmuch, however, as the circumstances in different cases vary materially, it seems desirable that the penalty provided for evasion of the law either through carelessness or connivance
might also be varied so that under certain circumstances as heavy a fine as $500 might be levied.
In order that a more careful test might be made of the physical conditions of the immigrants after their arrival in this country, the Immigration Commission had an accurate record* kept of all charity patients entering the Bellevue and Allied Hospitals in New York City, during the seven months from August 1, 1908, to February 28, 1909, these hospitals being the ones that most frequently treat charity patients of the immigrant classes. Records of 23,758 cases were taken, of whom 52.3 per cent. were foreign born. When any race was represented by 200 or more patients, the results were tabulated, so that some conclusions might be reached regarding the liability to certain diseases of the different classes of immigrants of the various races and nationalities.
It is a rather striking fact that, so far as one can judge from these records kept, the races of the recent immigration, those from southern and eastern Europe, are not so subject to diseases that seem to be allied with moral weaknesses, as some of those of the older immigration races. For example, the largest percentage of diseases treated among Italians is 19.6 per cent. for traumatism, burns, etc., these apparently arising from the fact that the newly arrived Italian immigrant is likely to be employed in unskilled labor, where he meets with slight accidents. The Hebrews also suffer most from this cause, a percentage of 13.1 per cent.
The Irish, who are also largely unskilled workmen,
*Reports of Immigration Commission, Vol. 1.
show only 11.7 per cent. of their cases coming from this cause, whereas 35.9 per cent. of the Irish patients treated were suffering from alcoholism, acute and chronic. Of the English 27.5 per cent., and of the German 12.8 per cent., were treated for alcoholism, and only 7.2 per cent. and 12.4 per cent. respectively, for traumatism, burns, etc. Of the Italians only 1.6 per cent. were treated for alcoholism and of the Hebrews only 0.9 of 1 per cent.
The Swedes with 1.5 per cent, Irish, Italians, Polish and Scotch each with .9 per cent., show a larger proportion treated for syphilis than the English, Germans, Hebrews or Magyars. The English with 2.1 per cent. and the Italians with 1.5 per cent. had a larger proportion treated for gonorrhea than any of the other races of which a detailed study was made.
Among the native-born negroes only 3.6 per cent. were treated for alcoholism.
The Mentally Defective
It is much more difficult, in many instances, to detect the mentally than the physically defective. Often there is nothing to indicate to the medical inspector mental disease, unless the immigrant can be kept under observation for a considerable period of time, or unless the history of the case is known. Under the law, “All idiots, imbeciles, feeble-minded persons, epileptics, are excluded, insane persons, and persons who have been insane within five years previous; and persons who have had two or more attacks of insanity at any time previously." It is the custom invariably to hold for observation any patient who shows any evidence whatever of mental disease; but despite this care not a few cases are found of those who have developed insanity
within a comparatively short period after landing. In some instances this might have been anticipated if the history of the patient had been known, but otherwise there was no means of detection. The present law on this point seems to be satisfactory, and its enforcement generally good under the very difficult conditions; but it would be desirable to have a larger force of experts to examine, and also, if it were practicable, to provide some better means for securing the history of arriving immigrants.
The tables on page 51, taken from the Special Report of the United States Census, which some observations by the Immigration Commission in Bellevue and Allied Hospitals in New York and reports of the Bureau of Immigration tend to confirm, throw some light on the relative tendencies of certain races toward insanity, and show that certain aliens are more inclined toward insanity than are native-born Americans.
RACIAL OR NATIONAL TENDENCIES
The high ratio of insanity prevailing among foreignborn persons in the United States may be due, in a measure at least, to racial or national tendencies.
Data showing the number of insane and the ratio. of insanity in the principal European countries and in Canada are afforded by the Special Report of the Census Bureau. These data, together with like data for the United States, obtained from the same source, are presented on page 51.
Altho in the earlier days before strict regulation of immigration had been provided by law many poor