Short Stories – Public Health Superspreaders (PHS)

Preface: One of the dangers and joys of doing research is finding a source with some tantalizing detail that is only tangentially related to the question(s) at hand but seems interesting enough (to a historian, at least) to learn more about or want to share with others. I usually make a quick note like “write this up,” or “come back to when finished,” which, of course, I rarely ever do. So I have decided to create this special segment–Short Stories–to write them up as I encounter them. (Which hopefully will also help reinforce a regular writing habit.)

Insignia of the MHS, 1871. Source: National Library of Medicine Digital Collections.

For my work on immigration and mental health, I have been reading articles from the early twentieth century about the involvement of the U.S. Public Health Service (USPHS) at Ellis Island. The origins of the modern USPHS can be traced as far back as 1789 by an act of Congress providing for “the temporary relief and maintenance of sick and disabled seamen.”⁠[1] The implementation of the health care suffered from disorganization and inadequate funding. For much of the nineteenth century, customs officials managed the entitlement and hospitals were “often crowded or badly staffed and sick seamen were often forced to seek shelter in municipal alms houses.”[2] In 1870, following several government reviews, Congress altered the law’s provisions to give it more structure, including a “Supervising Surgeon” that created the Marine Hospital Service.

Following the creation of a Commissioned Corps of physicians, appointed by the President with the advice and consent of the Senate in 1889, within the Marine Hospital Service, the agency became known as the Public Health Service, a designation that reflected its relative permanence within the federal government and the expanding boundaries of its work. According to one of the assistant surgeons, in addition to its work for the merchant marines, “The Public Health and Marine Hospital Service operate all national quarantine stations where inspection is made for yellow fever, typhus fever, smallpox, bubonic plague, leprosy and cholera…conducts the Hygienic Laboratory at Washington for the study of the causation and treatment of diseases…and conducts the medical inspection of immigrants.”[3]

It was in that article by doctor Reed, describing the medical inspection of immigrants, which featured this photograph:

Inspection of Immigrant's Eyes in the Distal Lines at Ellis Island. Edwin Levick, New York. United States Public Health Service, Mental Examination of Immigrants, 18 May 1917.

What immediately jumped out to me was the obviously unsanitary examination it depicted. “What are they doing?” you might ask, good question. The two gentlemen in uniform (one on the far left and one in the center, backs to the camera) are inverting the eyelids of the immigrants in line to look for scarring or infection. I knew vaguely that one of the procedures immigrants were subjected to was an inspection for trachoma. And again according to Reed, “certain diseases are found so frequently among immigrants, and others are so inherently dangerous, as to merit special mention…First among these might be placed trachoma, a disease of the eyelids characterized by extreme resistance to treatment…and most serious results.”[4] That does sound bad and probably worth ensuring it does not quickly spread by screening arrivals. But, it gets worse. Apparently they knew (or thought) it was quite contagious!

So here we have a photograph of inspectors using their bare hands screening thousands of immigrants, one after the other, every day for a contagious disease that results in scarring (which is what they were looking for by inverting the eyelids) and blindness, with their bare hands and no sterilization procedures. I have not looked to deep into the specifics, but a quick search of Wikipedia will tell you that Pasteur’s work on bacteria as well as other medical researchers throughout Europe were aware of modern germ theory in the mid-to-late 1800s so it boggles the mind–thus what stopped me in my tracks when I saw this–that they performed this procedure in this way. The irony that these trained medical professionals searched for defects that many of them believed were inherent to immigrants with procedures that almost certainly endangered public health is just too much.

Even if we accept for a moment that the officers of the USPHS were not overly concerned about whether they would possibly infect hundreds or perhaps thousands of immigrants with the bacteria of a single infected individual inspected in this way, clearly they were placing their own health in jeopardy. And, in fact, A.J. Nute, also a surgeon with the USPHS, stationed at the port of Boston, noted the hazardous work of these inspectors. “In the busy season the constant standing and mental concentration tend to produce breakdown and there is always the chance of contracting contagious diseases.”[5] An understatement, I am sure. In fact, as Elizabeth Yew, a medical doctor in New York herself notes, Ellis Island “was considered a hardship post…Line physicians, on their feet hours at a time, were under continual physical and mental strain. Breakdowns were common.” The station’s chief medical officer, Dr. G.W. Stoner, wrote to the Surgeon General that his “force is so frequently reduced by reason of absence of one or another on account of illness…that it is impossible to meet the requirements of the Immigration Service.”[6]

UPDATE - 1 January 2022 - In an instruction manual issued by the Surgeon-General in 1903, it specified that “a basin containing a disinfecting solution should he placed near the examiner, so that he may disinfect his hands after handling cases of trachoma, favors, etc. Care should be taken to prevent crowding, to maintain a single file evenly spaced, with the individuals well separated (10 feet).” [7] I do not even know what to say about this. It certainly reads like the person who wrote it had never been to Ellis Island. 10 feet apart? That would result is lines miles long. In none of the pictures I’ve seen has there been a wash basin. But, it is also humorous and sad that the use of the wash basin was for when the inspectors handled positive (or suspected cases) not in between each and ever inspection.

1 “An Act for the relief of sick and disabled seamen,” July 16, 1798, quoted in Fitzhugh Mullan, Plagues and Politics:The Story of the United States Public Health Service (New York: Basic Books, 1989), 14.

2 Mullan, Plagues and Politics, 19.

3 Alfred C. Reed, “The Medical Side of Immigration,” Popular Science Monthly (April, 1912): 384.

4 Reed, “Medical Side of Immigration,” 384.

5 A.J. Note, “Medical Inspection of Immigrants at the Port of Boston,” Boston Medical and Surgical Journal 152, n. 16 (April 16, 1914): 646.

6 Elizabeth Yew, “Medical Inspection of Immigrants at Ellis Island, 1891-1924,” Bulletin of the New York Academy of Medicine  56 n. 5 (June, 1980): 497; Stoner quoted in Yew, “Medical Inspection of Immigrants,” 497.

7 US Department of Treasury, Bureau of Public Health and Marine-Hospital Service, Book of Instructions for the Medical Inspection of Immigrants, by Surgeon-General, 1903, 6.