Forgotten Ellis Island (film)

Forgotten Ellis Island is a documentary film directed by Lorie Conway and narrated by Elliot Gould. It is also a book by Lorie Conway, published by Smithsonian Books 2007. The film took 9 years to produce and was supported by three grants from the National Endowment for the Humanities.

Constructing the Ellis Island Immigrant Hospital

“It was a general hospital of all nations.”

As the steamship "Moravia" headed into New York harbor on August 30, 1892, the Marine Hospital Service (MHS) doctors on Ellis Island braced for the worst. The cholera epidemic that was ravaging Asia and Europe—150,000 dead in Russia alone — had infected the ship. Twenty-four passengers had been stricken with the illness, and twenty-two of them had died — all but two of the dead were children under the age of ten. Surviving passengers had panicked, throwing the dead overboard “as if they were dead birds or garbage.” [Howard Markel, 1997, Quarantine! East European Jewish Immigrants and the Epidemics of 1892. Baltimore, Maryland: Johns Hopkins University Press: 93.]

Three times previously in the nineteenth century, the United States had suffered a devastating cholera outbreak, each originating abroad. Would the "Moravia"’s arrival mark the start of the fourth?

Opened as a port of entry only eight months earlier, Ellis Island was poorly equipped to handle the threat. Its two-story wooden dispensary had neither the staff nor the laboratory to contain a disease as deadly as cholera. Believing he had no other choice, Dr. W.T. Jenkins, the Port of New York’s health officer, ordered the "Moravia" to anchor offshore until the outbreak was contained. Five days later, two more “death ships,” the "Rugia "and "Normannia", steamed into New York harbor, and they, too, were ordered to anchor offshore. Dr. Jenkins warned that anyone — passenger or crew member — who tried to leave the quarantined ships would be shot. More than a thousand passengers were stranded on the ships, and they begged to be let off, fearing that infected passengers put them at risk. Their plea was denied. Over the next several days, additional cases broke out, killing most of the infected passengers within a day. Not until nearly three weeks had passed were the passengers finally allowed to disembark. [“Outbreak of Cholera and Quarantine at New York Harbor 1892,” Harpers Weekly Journal of Civilization, September 17, 1892. Information on Dr. Jenkins’ instructions contained in a front-page New York Times’ story, September 4, 1892.]

Was the inadequacy of the medical facility at Ellis Island partly to blame for the additional deaths? [E. L. Godkin, 1892, “A Month in Quarantine,” North American Review, Volume 155, (Issue 432): 737-744.] Health authorities could not easily dismiss the possibility. The arriving passengers might all have lived if they had been immediately removed from the ships and quarantined at a safe medical facility.

The issue of how to protect the health of both the nation and the immigrant would hover over Ellis Island for the next decade. Its medical facility was not equipped to handle anything but routine illness. When the wooden infirmary then caught fire and burnt to the ground in 1897, the problem intensified. A makeshift hospital was established in an old house on Ellis Island but it was small and ill equipped. Passengers with infectious diseases like measles, diphtheria, and favus were shuttled to neighboring hospitals, which increasingly refused to take them. Although New York’s indigent hospital remained open to immigrants for several years to come, even it eventually stopped taking them. The city’s health commissioner Ernst Lederle told reporters: “The patients from Ellis Island should not be brought into the city limits at all. They are a source of infection from the time they leave the island until they reach the foot of East Sixteenth Street. Besides, they have to be placed in wards where they subject other patients to the danger of mixed infection.” [William Williams Papers, New York Public Library.]

In his first State of the Union message, President Theodore Roosevelt proposed a change in immigration policy that would thrust the medical facility at Ellis Island into national prominence. Roosevelt said that America should open its gates to the able bodied while barring the entry of the weak and the infirm. “We can not have too much immigration of the right kind,” said Roosevelt, “and we should have none of the wrong kind.” In order to keep out what he called “undesirable immigrants,” Roosevelt proposed “a more rigid system of examination at our immigrant ports.”

Although the new policy applied to all points of entry, of which there were more than three dozen, Ellis Island was the key. Because of its location in New York Harbor, it handled more arrivals than all the others combined. The numbers were staggering. A reporter described being overwhelmed by the presence of “nineteen hundred immigrants …in the buildings,” only to be told by an immigration officer: “We sometimes have seven and eight thousand immigrants to handle at once and then we have to work pretty hard. This year we expect a million immigrants.” [“The Spectator,” 1907, Outlook Magazine, Ellis Island Library, Box 21, Medical Inspection.]

Recognizing that Ellis Island would need strong leadership if it was to institute a more thorough screening process, President Roosevelt turned to William Williams, a Wall Street lawyer who also happened to be a friend and a fellow veteran of the Spanish-American War. In some respects, Williams was an odd choice for Ellis Island commissioner. He was a millionaire whose roots traced to a signer of the Declaration of Independence. The immigrants, on the other hand, were new to America, and most of them were dirt poor. When Edwin Moran died of tuberculosis soon after arriving at Ellis Island, his worldly possessions consisted of little more than the rosary and the $23.15 that were found in the pockets of his threadbare pants. [Records of the Public Health Service, National Archives, RG 90.] For his part, the bachelor Williams lived an opulent life at his suite in mid-town Manhattan. As one newspaper wrote, Willians spent his daytime hours, “over at Ellis Island, with all its squalor, its filth, its sorrow,” but whiled away “his evenings in the luxury, the comfort, the elegance of the University Club.” [William Williams Papers, New York Public Library. In 1917, Congress had expanded the legal definition of “likely to become a public charge” to include: “all idiots, imbeciles, feebleminded persons, epileptics, insane persons…persons of constitutional psychopathic inferiority…”]

In his first directive as commissioner, Williams sought to curb Ellis Island’s churlish reputation: “Immigrants shall be treated with kindness and civility by everyone at Ellis Island. Neither harsh language nor rough handling will be tolerated.” Nevertheless, Williams had no particular affection for the new arrivals. A lawyer by training and temperament, he was a stickler for rules. He insisted that immigration law be strictly applied: all able-bodied persons, but only the able bodied, would be allowed entry.

Soon after taking the commissioner’s job, Williams saw that a more rigorous inspection process would require a state-of-the-art medical facility. “An enduring commonwealth,” he said in a New York City speech on the need for a new hospital, “must of necessity guard rigidly the health of its citizens and protect itself against undesirable additions from without.” [Ibid.] William’s goal seemed out of reach, however. Even if he could convince Congress to appropriate the money for a hospital, Ellis Island had no vacant land on which to build it.

Williams found his land in the tons of rocks that New York City was excavating as it built its subway system. Secretary of Labor and Commerce V.H. Metcalf, Department of Commerce and Labor joined in: “We are about to build a hospital . . . but we must first build an island on which to place it.” [Letter from V.H. Metcalf, Department of Commerce and Labor to William H. Taft, Secretary of War, 17 March, 1905, General Immigration Files, National Archives, RG 90.] There was, in fact, so much landfill available that "two" new islands were built next to the existing Ellis Island. Designated simply as Island No. 2 and Island No. 3, they were precisely sited. The Surgeon General of the United States defined the location of the island that would house the infectious disease hospital: “ [W] ith an outside limit of convert|410|ft|m from the present island and with convert|200|ft|m of clear water space between the two islands, [the distance] would be amply sufficient to insure freedom from danger or contagion according to modern ideas of hospital construction.” [Letter from the Public Health and Marine Hospital Service to the Surgeon General, Nov., 1902.]

The first hospital in the Ellis Island complex — the General Hospital — opened on Island No. 2 in 1902. Connected to the main island by a convert|200|ft|m|sing=on gangplank, it had 120 beds, making it larger than most city hospitals of the era. Even so, Commissioner Williams immediately complained to Washington officials that the new hospital’s size was “utterly inadequate.” [Annual Report of the Commissioner General of Immigration, 1903, pp.68, 71, General Immigration Files, National Archives, RG 85.] The General Hospital eventually would expand to 275 beds — more than three times the size of the typical city hospital. It included four operating rooms, a delivery room, and a morgue. Dr. Alfred C. Reed said of it: “A rare variety of diseases is seen. Patients literally from the farthest corners of the earth come together here. Rare tropical diseases, unusual internal disorders, strange skin lesions, as well as the more frequent cases of a busy general hospital present themselves here.” [Alfred C. Reed, 1913, “Going Through Ellis Island,” Popular Science Monthly, LXXXII, 11.]

After two mentally ill patients committed suicide in the general hospital, the Psychopathic Pavilion was built. It was charged with housing “idiots, imbeciles, feeble-minded persons, insane persons, and epileptics.” [U.S. Public Health Service Handbook for the Medical Inspection of Aliens, 1903.] According to Thomas Salmon, an Ellis Island physician who helped design it, the Pyschopathic Pavilion would make possible the “humane and efficient treatment to those immigrants who, during the voyage to America, become the victims of acute mental disorders.” [Annual Report of the Surgeon General of the Public Health and Marine-Hospital Service of the United States, 1905, 271-78.] Soon after it opened, however, the psychiatric hospital became a center of controversy, a place where innovative mental tests were developed, yet also a place where ideas about the mental inferiority of Italians, Slavs, and Jews flourished.

During William Williams’ second term as commissioner, the third and largest medical facility opened — the 450-bed Contagious Disease Hospital. Its construction was spearheaded by the previous commissioner, Robert Watchorn. Born of working-class parents in England, Watchorn was laboring in coal mines by the age of eleven. After reaching America as a young man, he worked his way up to become a labor organizer in Pennsylvania’s coal fields before becoming an immigration official. Although Watchorn, like Williams, sought to restrict immigration to those fit for work, he never forgot what it was like to be a newcomer. In a first encounter after his arrival, a Battery Park merchant shortchanged Watchorn and then had a beat cop drag him out of the store when Watchorn complained. Watchorn became Ellis Island commissioner after his expose of New York’s East Side sweatshops caught the attention of Washington officials. The construction of an infectious disease hospital on Ellis Island reflected Watchorn’s commitment to protecting arrivals from the sometimes calloused indifference of their new countrymen. [“Robert Watchorn,” 1905, Outlook Magazine, cited in Harlan Unrau, 1984, Historic Resource Study, Vol. 11, New York, National Park Service, 239-43.]

Located on Island No. 3 and more than convert|400|ft|m from the main island, the Contagious Disease Hospital, which opened in 1911, was the world’s most advanced hospital of its kind. It boasted a mattress autoclave that could sterilize entire beds, an eight-cadaver refrigerator, an autopsy amphitheater that enabled visiting physicians and medical students to study the pathology of exotic diseases, and a sophisticated diagnostic laboratory staffed around-the-clock by a senior physician. [Ibid, 639-49.]

The Contagious Disease Hospital had eighteen wards, each built to house patients with a particular disease. There were, for example, separate wards for whooping cough, measles, scarlet fever, favus, and diphtheria, and two wards each for trachoma and tuberculosis. The wards were connected by a central corridor that was nearly two football fields in length, with the doors to the wards staggered so that air from one could not easily enter another. Built to a size that provided the exact cubic feet of air prescribed by the health guidelines of the time, each ward was ventilated by banks of windows, maximizing the flow of air between the interior and exterior, while minimizing the flow between wards. The Contagious Disease Hospital had its own laundry — upwards of three thousand sheets and towels were washed and dried there each day. [Ibid.]

When fully completed, the hospital complex also included nineteen other buildings. Heat, light, and power for the hospital were furnished by the power plant on the first island. Sewage flowed, by gravity, into New York Harbor. The kitchen alone was a large enterprise — two-thousand meals a day were prepared by its cooking staff. All told, three hundred people worked in the Ellis Island hospital complex, about a third of them medical doctors, nurses, and orderlies, many of whom lived in staff housing on the island. [Ibid]

Few hospitals in America were as imposing as the one on Ellis Island. New York’s Bellevue Hospital, which had started as a public almshouse, began an expansion in the same decade as the Ellis hospital was built and eventually grew to 3,000 beds, making it the country’s largest. Its private rival, the New York Hospital, also underwent a massive expansion during this period. [Harry F. Dowling, 1982, City Hospitals, Cambridge, Mass., Harvard University Press, 32-33.] But no hospital could match Ellis Island’s in the array of diseases and patients it handled. Dr. Milton Foster described the scope of its mission: “It is by no means unusual to receive one hundred cases or more at the hospital in one day. The task of admitting, examining, treating, and housing this number of new patients in five or six hours, would tax the capacity of the largest hospitals in the country. Here the problem is also complicated by the fact that practically none of the patients speak English.” [Milton Foster, 1915, “A General Hospital for all Nations,” The Survey, (Feb.), Ellis Island Library.] Upon visiting the hospital in 1922, Sir Auckland Geddes, the British ambassador to the United States, saw fit to remark: “The hospital … has to deal with every sort of disorder, ranging from slight injury to obscure tropical disease. It is at once a maternity home and an insane asylum.” [Sir A.C. Geddes, 1923, “Dispatch from H. M. Ambassador at Washington reporting on Conditions at Ellis Island Immigration Station,” cited in Unrau, Historic Resource Study, Vol. 11, 569.]

Walking the Line

““There’s a constant stream of fresh infection pouring in.”

On August 10, 1908, a 15-year-old German boy landed at Ellis Island, expecting to join his father who had arrived three years earlier. As he went through the inspection line, a medical officer examined his eyes and wrote “Ct” in chalk on his shirt, directing him to step to the side. Theodore Kelsch had trachoma, a contagious eye disease that causes blindness and was grounds for deportation. [Alfred C. Reed, 1912, “The Medical Side of Immigration,” Popular Science Monthly, Vol. LXXX: 384-390.]

Each day at Ellis Island, nearly two thousand new arrivals climbed the most fateful staircase of their lives. A uniformed officer of the Public Health Service stood at the top landing, watching intently. As the passengers scaled the steps, lugging their suitcases, he looked for the slightest indication of poor health. Upon reaching the top, they were handed a medical card and directed to the left or right, depending on whether they were being processed in the registry’s south or north hall. Once there, they stood in line until it was there turn to come forward, each step studied by a uniformed doctor who then examined the scalp, hands, eyes, and throat. [Medical Certificate of Theodor Kelsch, August 14, 1908, General Immigration Files, National Archives, RG 85.]

The inspection process was like an assembly line. [Dr. Allan McLaughlin, 1905, “How Immigrants are Inspected,” Popular Science Monthly, Vol. LXVI:357-359.] Every ten seconds or so, another passenger was instructed to step forward. A chalk mark was swiped across the clothing of anyone suspected of disease. One physician called it “a haphazard method of examination but . . . the only way that it could be done, as we were running about 2,500 immigrants a day.” [Amy L. Fairchild, 2003, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labor Force, Baltimore and London: John Hopkins University Press, 88.] Even the turns in the inspection line had a purpose. Said Dr. Victor Safford: “We used to like to have passengers while under inspection make two right angle turns, the scheme served to bring the light on both sides of a passenger’s face. The turns also helped bring out imperfections in muscular coordination.” [Dr. Grover Kempf, Oral History interview conducted in 1977 about his Public Health Service experiences at Ellis Island in 1912.]

Immigrants who could afford first- or second-class passage and therefore presumed fit to become Americans went through a speedy inspection line that included a cursory medical exam. Close scrutiny was reserved for the poor passengers that traveled in steerage and were presumed headed for factory jobs. [Dr. Victor Safford, 1925, Immigration Problems, Personal Experiences of an Official, New York: Dodd, Mead and Company, 249.] Roughly one in five of these arrivals was pulled out of the line for a fuller medical r examination. Seventeen conditions, ranging from problems of the eyes to weaknesses of physique, could result in detention. “Class A” conditions, which included trachoma, were cause for deportation. The process could be unnerving. “They cannot understand by what stroke of scurvy fortune they have been selected from among all the others and forbidden to enter the Promised Land,” said Dr. Milton Foster. “The more excitable burst into tears, wring their hands and protest loudly against this great and unexpected injustice. It is useless to try to calm or reassure them.” [Frederic J. Haskin, 1913, The Immigrant, An Asset and a Liability, New York: Felming H. Revell Company, 27-34.]

Immigrants with infectious diseases like measles, mumps, diphtheria, and whooping cough were sent to the Ellis Island hospital for what was usually a short stay. When 5-year-old John Gacquer arrived from France, his throat was inflamed from a tonsil operation earlier that year. Unwilling to accept that explanation, the PHS doctors sent him to the hospital. “They thought I had diphtheria or the beginnings of diphtheria, which was at epidemic stage at that time in New York. And I guess to play it safe, they sent me to the hospital in isolation.” [Broughton Brandenburg, 1904, Imported Americans, New York, Frederick A. Stokes Company, 215-18.]

Other arrivals went to the hospital without much hope of a cure. When 22-year-old Pearl Yablonski went through the line, her dull expression caught the attention of the examining physician, who asked: “How many feet does a horse have?” Pearl’s family would later claim that she did not answer because she thought the question was stupid. But after psychiatric testing at the hospital, she was diagnosed as feeble minded and shipped back to Romania. [See Fairchild, Science at the Borders, 7.]

The medical inspection at Ellis Island was conducted by order of Congress. Diseases that scarcely get passing notice today were life threatening in 1900. Measles was easily spread and could be fatal. Life expectancy in America was only 48 years of age for whites and a mere 33 years of age for blacks. The PHS physicians at Ellis Island were “guardians of the gate” — the nation’s first line of defense against immigrant-borne illness. As Ellis Island Commissioner William Williams noted at a conference in New York: “The importance of the medical side [cannot be overstated] ….Medical officers of the U.S. Public Health Service . . . are expected to detect and report to the immigration authorities all disease, physical and mental, that immigrants may bring.” [Dr. Milton H. Foster, 1915, “A General Hospital for All Nations,” Records of the Public Health Service, 1912-1968, National Archives, RG 90.] Even so, disease slipped through. When polio broke out in the Italian section of Brooklyn, frightened residents blamed it on a recent immigrant. Dr. Charles Lavinder acknowledged the possibility: “Cases might develop on board during the voyage and contacts, incubating the disease, might easily pass inspection at Ellis Island, to develop the infection later at their point of destination.” [John Gaquer, 1999, Videotaped interview at the Ellis Island Hospital location.]

Fifteen years after Ellis Island opened, growing opposition to immigration led Congress to expand the Public Health Service’s authority, requiring it to weed out the weak and the unemployable as well as the sick. The new list of excludable conditions included “likely to become a public charge” — meaning someone who had little hope of finding a job. It was a Class A condition — cause for deportation. The head of the Bureau of Immigration, Terrence Powderly, was among those calling for stricter standards. “There exists no reason,” Powderly claimed, “why the United States should become the hospital of the nations of the earth.” [Leah Shain, 1999, niece of Pearl Yablonski, Videotaped interview at the Ellis Island Hospital location.]

As medical doctors, the PHS physicians were sworn to heal the patient. As uniformed officers of the Public Health Service, they were obliged to identify the medically unfit. [William Williams Papers, New York Public Library] Which imperative should govern? The available evidence, though largely anecdotal, suggests that most PHS doctors adhered to the strictures of the law while showing leniency when possible. Dr. Alfred Reed claimed: “Seldom, indeed, does the alien suffer from too harsh a medical judgment.” [Letter to the Surgeon General, 1916, July 5th, from Dr. Charles Lavinder] One such patient was 13-year-old Dante Pavoggi, who was diagnosed in 1911 with “chronic inflammation of glands of the neck” that could inhibit his “ability to earn a living.” Instead of being deported, however, Dante was allowed to join his uncle in rural Illinois: “The fact that this boy is destined to a farm, rather than a congested city is very much in his favor. With good air, the suitable environments, he will very likely recover.” [T.V. Powderly, 1902, “Immigration’s Menace to the National Health,” North American Review, 53-60.]

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