MEDICAL INSPECTION OF IMMIGRANTS.

BALTIMORE, MD.

Surg. J. A. Nydegger, in charge, reports as follows:

Owing to the continuation of the European war since August, 1914, the immigration at this port, which previously amounted to 45,000 annually, has been reduced to less than 200.

Fourteen hundred and eighteen vessels subject to immigration inspection arrived at this port during the year, with a total of 178 passengers (steerage 115, cabin 63).

There were 178 aliens examined upon arrival. In addition to this number 35 were passed by the immigrant authorities as United States citizens. One hundred and forty-eight foreign seamen were also examined, not included in the above, and special certificates as to their physical condition or otherwise were issued in the case of 13. There were 20 regular certificates rendered during the year for various diseases and physical defects as follows:

Class (A) 2. Dangerous or loathsome contagious disease:

Gonnorrhea

Syphilis

Class (B). Disease or defect affecting ability to earn a living--

5

3

12

No aliens were admitted to hospital during the year, and likewise no deaths occurred. Hospital treatment in case of 4 foreign sailors, referred for medical advice, was advised.

No cases of feeble-minded or other abnormal mental conditions were detected in the aliens and foreign seamen examined.

The construction of the hospital, connected with the new immigration station, at Fort McHenry, is now well under way. The building, a three-story one with basement and recreation roof, contains 14 wards, with bed capacity for 60 patients.

BOSTON, MASS.

Acting Asst. Surg. M. Victor Safford, in charge, reports as follows:

During the year 1,226 vessels arrived at Boston from foreign ports. Although the number of those found to have aliens aboard requiring a medical examination under the immigration laws was only 206, the lack of advance information regarding arriving ships made it necessary to have the boarding boat covered continuously by a medical officer to meet all incoming ships.

The immigration at Boston during the year was derived chiefly from countries bordering on the Mediterranean and from Portugal and Portuguese possessions, but ships with at least a few passengers aboard arrived from all parts of the world except Germany, AustroHungary, and Turkey. An interesting feature of the year was a small but regular immigration from South Africa.

The primary inspection of alien cabin passengers was, as a rule, conducted on shipboard; the primary inspection of any considerable steerage passengers was made as usual on shore, and during this year exclusively at the new commonwealth pier. The type of people encountered as cabin passengers is indicated by tables No. 1 and No. 2, wherein it appears that 25 per cent of those classified as second cabin

were certified as diseased or defective, as compared with approximately 9 per cent in the case of steerage passengers.1

In accordance with the agreements resulting from the steps taken by the commissioner of immigration at New York to secure a better inspection and examination of alien cabin passengers, the representatives of the transportation companies at Boston have conferred with the medical officers in trying to devise facilities for making a satisfactory inspection of cabin passengers on shipboard, but combined efforts in this direction can not as yet be regarded as successful. As a matter of fact, even in the case of the steerage passengers, local facilities and methods which have hitherto worked smoothly and successfully in handling the primary medical inspections and examinations have proved inadequate to provide satisfactorily for the increased proportion of obvious defectives encountered in the present immigration. To meet present and prospective demands, plans are now prepared for remodeling and increasing the accommodations for medical examination purposes at the commonwealth pier, although the present arrangements there when provided three years ago were thought to make ample provision to meet any requirements which were likely to arise.

The percentage of steerage passengers receiving medical certificates this year was over 9, or practically twice as great as ever before at this port. No attempt has been made to keep count of the number of aliens whom on primary inspection it has been deemed necessary to turn aside for medical examinations. It has not been undertaken to make complete examinations of aliens except those who on primary medical inspection presented indications of abnormality, yet on one occasion at least 40 per cent of an approximate

1 Defects regarded as of no practical importance are not counted as certificate cases.

total of 300 cabin passengers were turned aside for such examinations, and it is safe to say the same proportion has been closely approached in cases of ships with approximately 1,500 steerage passengers. The records of the office show that during the year of those turned aside on primary medical inspection 870 were held for more thorough examinations than could be completed on the day of the arrival of the ship and that of these so held 395, or nearly one-half, eventually received medical certificates.

For diagnostic assistance the medical officers are continuing to utilize the nine different hospitals with which arrangements exist for the treatment or examination of arriving aliens. During the year the practice has been continued of having Wassermann and stool examinations made of every alien sent to hospital, whatever the reason for which he may be sent. Also during the year an increasing amount of laboratory work particularly with reference to blood has been done at the immigration detention station itself. As a net result of the work of the medical officers at Boston for the year, 1,420 arriving aliens were certified as being physically or mentally defective or diseased, or over 10 per cent of all arriving aliens, there being included in the total the first-class alien tourist travel.

Physical disabilities which disqualified the individuals concerned for military service and made their emigration possible were naturally an important factor in augmenting medical certificate cases and reference to the detailed tabulation of conditions certified would indicate that abnormalities and defects incident to a defective physical development predominate as a cause for medical certification rather than actual diseases or their results.

The number of arriving aliens sent to outside hospitals was 224. These cases were made up to a great extent of detained aliens who became sick during a protracted stay at the immigration detention station. As usual, the surveillance over the cases in the various hospitals where they were distributed claimed a considerable part of the time of the medical officers. The Boston Psychopathic Hospital has been continued to be utilized to advantage during the year as a means of independent confirmation in the examination of mental suspects.

In addition to cases removed to hospitals it was found advisable to maintain intermittently, as during the preceding year, a small hospital service and to conduct daily a regular dispensary service at the immigration detention station itself. The problem of securing proper artificial feeding of young infants detained at the station for long periods has also constantly claimed the time and attention of the medical officers, but as the matrons are becoming better trained this problem is tending to become less difficult.

The detention station has at times during the year been crowded in excess of its sleeping capacity, but for the greater part of the time the average number of the detained aliens has been materially less than during the preceding year. There have been no outbreaks of serious contagious diseases at the station during the year, and on the whole the health of the station has given the medical officers less cause for concern, but the morbidity among the inmates has not been appreciably less than during the preceding year. Early in the year the station was equipped with a 42 inch by 48 inch by 96 inch steam sterilizer with formaldehyde attachment, and this apparatus together

with improvements in bathing and washing facilities, have made it possible to keep the inmates of the detention quarters free from lice, except for a time immediately following the arrival of a ship bringing a large number of newcomers into the station.

By leasing additional space at the beginning of the year the Commissioner of Immigration has been able to provide the medical officers with much needed additional room for office, laboratory, and mental examination purposes at the immigration station. Besides furnishing interpreters, the commissioner is now furnishing this service with an extra clerk and two others of his employees to act as attendants whenever a ship with any considerable number of passengers arrives. These official assistants are additional to the stewards, sailors, or employees of the company regularly detailed to assist in the medical inspection on the arrival of a ship. The commissioner has found it advisable to furnish the service this official assistance to expedite the medical work and enable the immigration examination itself to proceed with the expedition with which the immigration force is prepared to handle it. Through the commissioner also it has been made possible to secure trained laboratory assistance at the immigration station at times during the year.

LANDED CASES.

There appears below a tabulation of cases of aliens alleged to be in the country in violation of law, and referred by State or municipal officials to the United States Commissioner of Immigration at Boston during the year, to be disposed of.

This table includes only such cases as were regularly taken up and disposed of through the Boston immigration office and does not comprise all alien public charge cases which in one way or another may have come to the attention of the office. Every other immigration office in the country is called on annually to handle similar cases.