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Medicine | THE UNREAL WORLD

Cinema verite at Ellis Island

July 02, 2007|Marc Siegel | Special to The Times

"Golden Door," originally called "Nuovomondo," a film directed by Emanuele Crialese (in English and Italian, with English subtitles), arrived in U.S. theaters in June.

The premise: At the turn of the 20th century, Salvatore Mancuso (Vincenzo Amato) immigrates to the U.S. accompanied by his mother and his two young sons, one of whom is a deaf mute. Crossing the Atlantic, the boat encounters rough waters and several passengers are injured; some die. Landing at Ellis Island, prospective immigrants undergo a series of medical and psychological tests, including puzzle solving, and a brief medical examination in which their hair and eyes are inspected and they're screened for hernias, genital lesions and a cough. The physicians seem concerned about mental deficiencies, not wanting the mentally infirm and those with low intelligence to "mix with our citizens," and they place a chalk "X" on Mancuso's mother's jacket for not clearly stating the current date. The authorities consider deporting her back to Italy along with her deaf-mute grandson.

The medical questions: Were there no doctors available to treat passengers aboard immigrant ships? Were screening doctors at Ellis Island focused on psychological as well as physical ailments? Did they subject prospective entrants to repeated tests before deportment? Why were screeners concerned about the eyes? Weren't stethoscopes used in screening for lung ailments?

The reality: At the turn of the 20th century, injuries on crossings were common because of rough seas and poorly designed sleeping quarters, but immigrant ships did not routinely have doctors assigned to them. Once at Ellis Island, as immigrants climbed the stairs and walked down the hallways to the large inspection halls, they were observed for lameness and mental, as well as physical, infirmities.

Chalk marks were put on their clothing to signify suspected infirmities -- for example, an X for suspected mental illness, T for trachoma of the eye, H for heart, K for hernia, G for goiter, L for lameness, P for physical and lung problems. Once a person had a chalk mark, he or she was singled out for further tests and possible deportation, as the movie depicts.

Of the close to 1 million immigrants who passed through Ellis Island every year, about 1 in 6 were detained and 1 in 50 were returned to their country of origin after being subjected to repeated tests. The initial screening examinations were brief (called the six-second inspection), conducted by uniformed public health physicians (the U.S. Marine Hospital Service) who rarely used stethoscopes because it would slow them down, and because they felt they could screen for tuberculosis by looking for weight loss and cough. On average, 12 doctors were asked to evaluate the health status of more than 5,000 immigrants every day.

Scalps were examined for lice, and eyes were screened for trachoma, a highly contagious eye infection of the eyelid and conjunctiva that causes eye redness and soreness and can ultimately lead to scarring and blindness. At Ellis Island, examining physicians used a "buttonhook" to pull back the eyelid and search for the condition. The entire screening process was a deliberate attempt to exclude those who were determined unfit morally or physically to be Americans.

When it comes to the medical facts, the movie is amazingly accurate -- although a word or two about trachomas and other afflictions of concern would have been helpful for nonhistorians.

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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University's School of Medicine. He is also the author of "False Alarm: The Truth About the Epidemic of Fear." In The Unreal World, he explains the medical facts behind the media fiction. He can be reached at marc@doctorsiegel.com.

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