Beside The Golden Door

Leah Barr is a fourth year Gender, Women’s, and Sexuality Studies major at Grinnell College from Evanston, IL. Her maternal great grandparents met on the boat to Ellis Island. Leah plans to spend the next few years in pursuit of her lifelong goal of becoming a library curmudgeon.

At the base of the Statue of Liberty, the “Mother of Exiles” as her plaque declares her, sits a poem, “The New Colossus,” written by Emma Lazarus. “’Give me your tired, your poor/ Your huddled masses yearning to breathe free,/ The wretched refuse of your teeming shore./ Send these, the homeless, tempest-tost to me,/ I lift my lamp beside the golden door!’”.

The statuesse lives where the East and Hudson rivers meet, just next to Ellis Island, the main processing and entry point for European Immigrants entering the United States from 1892 to 1925. While a heartwarming message, the immigration process just up the upper bay from Lady Liberty was far from liberatory for many of the 14 million people who passed through it [1].

a black and white photograph of Ellis Island's brick facade with several barges in front
Ellis Island as incoming immigrants saw it from 1905 onward (the original structure burned down)

The first portion of the screening process that took place at Ellis Island was the medical inspection [2]. These medical inspections, many immigrant’s first encounter with America and its people, were heavily shaped by social and economic factors and contexts. In fact, immigrant medical examinations at Ellis Island served as an important means for American social control from the federal level, one that shaped the American workforce and began the process of immigrants’ familiarization with industry and industrialized citizenship.

Before Ellis Island became the port through which massive amounts of European immigrants entered the United States, the major New York immigration port was Castle Garden. In the late 19th century, it became clear that Castle Garden was not only no longer able to handle the volume of immigrants, but also that individual states were not equipped to handle the larger issue of immigration. [3] As Americans became increasingly worried about the origins of immigrants and concerned that European countries may be sending their “problem people”, Americans felt the federal government could better handle the inflow [4].

Immigration became the exclusive responsibility of the federal government the year before Ellis Island opened. This new national focus on and scrutiny of immigrants lead to the introduction to a stricter and more systematized immigrant medical examination [5][6]. The law that put immigration under federal control also, for the first time, enumerated who was to be categorically excluded from the United States: “’idiots insane persons, paupers or person likely to become a public charge, and persons suffering from a loathsome or a dangerous, contagious disease.’” [7]

As Ronald Bayer has noted, this change in immigration policy and procedure was ideologically in line with other trends social, political, and economic trends of the time: “[t]he federal government’s shift to a more regulatory approach to immigration paralleled its other Progressive Era controls in regard to industry and railroads, such as the Interstate Commerce Act of 1887 and the Sherman Antitrust Act of 1890. The government’s power expanded in relation to the growing power of industry…”[8] It is important to understand the transforming power structures related immigration directly preceding Ellis Island in order to situate what happened there are part of a larger, standardized national plan and agenda.

Before even setting foot on American land, American quarantine officials would board ships carrying immigrants to perform a quick check for contagious diseases or “other health problems that would warrant keeping all immigrants on board”. American “officials stopped ships with passengers having cholera or other contagious diseases as defined by law until the disease no longer appeared evident or the sick passengers had been transferred to quarantine hospitals nearby.” [9] American Public Health officials also used this as an opportunity to check first and second class passengers, as only those who rode in the steerage class were required to go through inspection and processing at Ellis Island itself. [10] Ironically, the steerage portion of the steamships that carried Europeans to America were often overcrowded and unsanitary, which could lead otherwise healthy immigrants to catch diseases like diphtheria, measles, and scarlet fever. [11]

Once on the island itself, the medical examination was the first portion of each immigrants’ processing in America. [12] Public Health Service (PHS) doctors observed immigrants at “every point, looking for weakness, disability, poor eyesight, lack of balance, and general instability. Even the manner in which immigrants carried their baggage was of great interest.” Doctors scrutinized immigrants as they made their way down the single file lines they were marshaled into by other immigration officials. Making their ways through these processing lines often took hours, even if there were no hold-ups or extra examinations. [13] At a certain point in the processing line, each immigrant had to turn right after facing a PHS doctor so he could see each arrival from a different angle, trying to ascertain whether they had missed something or if the immigrants was hiding a malady. [14]

Immigrants often faced more than one medical examiner. In fact, some PHS doctors had the sole task of inspecting immigrants for trachoma. While all other diseases and illnesses were initially inspected for only visually, each immigrant underwent a physical examination for trachoma, a highly contagious, bacterial eye disease that causes blindness. Immigration officials used button hooks or their fingers to flip immigrant’s eyelids and check for signs of the infection. [15] Trachoma was among the few diseases that was grounds for immediate exclusion from America, as the PHS classified it as an “immigrant disease” alongside favus, ringworm, tuberculosis, and various venereal diseases. These diseases were viewed, by PHS officials and federal lawmakers, as “symbols of the immigrants’ low condition, greater susceptibility to disease, and congenital ignorance of hygiene”; trachoma fell under the category of a “loathsome” or “dangerous, contagious disease.”[16] Upon a visit to Ellis Island, President Theodore Roosevelt wrote the flowing to the PHS regarding his disturbance at the trachoma exam: “I was struck by the way in which the doctors made the examinations with dirty hands and no pretense to clean their instruments, so that it would seem to me that these examinations so conducted would themselves be a fruitful source of carrying infection from diseased to healthy persons.”[17]

Despite trachoma’s stigmatization and classification, the Surgeon General’s yearly report, which “resounded with names of medical officers struck down by typhus, cholera, or yellow fever… no Ellis Island physician ever came down with trachoma in spite of constant contact with such cases,” leaving us to wonder in the present how truly contagious and dangerous the disease really is. [18] Sometimes new arrivals were sent back to Europe having never even felt any symptoms of the trachoma they were infected with.

At any point during the medical portion of immigrant processing, if deemed necessary or appropriate by PHS officials, immigrants could be taken for additional and separate inspection. They were first sent to a “cage-like detention area” and from there to sex-segregated examinations for further scrutiny. Immigrants who underwent these additional inspections expressed great fear and anxiety looking back on the event, also noting the lack of privacy. [19]

It isn’t difficult to see, based on this history, how the medical inspections at Ellis Island were used as a means of social exclusion. That said, these examinations served another purpose: shaping the new American industrial workforce. For many immigrants, being processed through Ellis Island marked the inaugural event into the American working class. [20]

Entry into the country itself was demonstrative of America’s obsession and preoccupation with industry. The single-file lines, the ordered processing with machine-like precision and consistency, and the physical tagging of immigrants were reminiscent of the assembly line, a new and exciting piece of technology being used in American factories. Ellis Island was almost like a factory itself, manufacturing laborers and sending “defective” ones back to their point of origin. The new conception of industrialized citizenship was based on the expectations and obligations of workers. In the vast majority of cases, as the Gilded Age coincided with the peak years of arrivals at Ellis Island, these workers were immigrants. [22]

As noted earlier, one reason for exclusion was “likely to become a public charge.” “’Of those denied entry, most were certified, not with loathsome and dangerous contagious diseases,’ but with conditions that limited their capacity to perform unskilled labor.” [23] Healthy bodies were needed to fuel industry, and if immigrants were not healthy enough to contribute to industrial citizenship by working in factories, they were seen as unproductive, useless, and likely to become a drain on state and federal resources. This makes even more sense when we take into account the conditions immigrants were forced to endure in both the tenements where they lived and the conditions and hours they were forced to work under in factories (for an example, see the triangle shirtwaist factory and fire).  Even strong, young, healthy bodies often fell ill or were injured under these conditions, so those without a healthy starting point stood little chance of being productive industrial laborers.

Popular rhetoric likes to paint America as the great melting pot, hearkening back to the days of Ellis Island, but entering the country and becoming an American was rarely as easy as the Statue of Liberty made it seem. Immigrants could be turned away after long and difficult sea voyages. For those suffering from disease and injury, America was not always the land of opportunity, and even those who made it in, it was not without a frightening and intense medical inspection.


[1] Ronald H. Bayor, Encountering Ellis Island: How European Immigrants Entered America. Baltimore: Johns Hopkins University Press, 2014, pg. 25

[2] Ibid., pg. 44.

[3] Ibid., pg. 25.

[4] Ibid., pg. 26.

[5]Amy L. Fairchild, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labor Force (Baltimore: The Johns Hopkins University Press, 2003), pg. 13.

[6] Bayor, Encountering Ellis Island, pg. 26.

[7]E. Yew, “Medical Inspection of Immigrants at Ellis Island, 1891-1924.” Bulletin of the New York Academy of Medicine 56.5 (1980): 488-510, pg., 489

[8] Ibid., pg. 26.

[9] Ibid., pg. 27.

[10] Alison Bateman-House and Amy Fairchild. “Medical Examination of Immigrants at Ellis Island.” American Medical Association Journal of Ethics. Vol 10, no. 4 (April 2008), pg. 236.

[11] Bayor, Encountering Ellis Island, pg. 22.

[12] Ibid., pg. 44.

[13] Ibid., pg. 39.

[14] Ibid., pgs 44-45.

[15] Bateman-House and Fairchild, “Medical Examination,” pg. 236

[16] Yew, “Medical Inspection”, pg. 494.

[17] Bayor, Encountering Ellis Island, pg. 47-48.

[18] Ibid., pg. 49.

[19] Bayor, Encountering Ellis Island, pg. 45.

[20] Fairchild, Science at the Borders, 7.

[21] Bayor, Encountering Ellis Island, pg. 42, 43.

[22]Ibid., pg. 14.

[23] Bateman-House and Fairchild, “Medical Examination,” pg. 237.


Suggestions for further reading:

Fleegler, Robert L. Ellis Island Nation: Immigration Policy and American Identity in the Twentieth Century. Philadelphia: University of Pennsylvania Press, 2013.

Novonty, Ann. Strangers at the Door: Ellis Island, Castle Garden, and the great Migration to America. Riverside: Chatham Press, 1971.

Pegler-Gordon, Anna. In Sight of America: Photography and the Development of U.S. Immigration Policy. Berkeley: University of California Press, 2009.