At Ellis Island

Bain News Service, Arriving at Ellis Island, 1915, photograph, George Grantham Bain Collection, Library of Congress, via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Arriving_at_Ellis_Island_LCCN2014710703.tif.
Lewis Wickes Hilne, Climbing into the Promised Land, Ellis Island, 1908, gelatin silver print, Brooklyn Museum, via Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Brooklyn_Museum_-_Climbing_into_the_Promised_Land_Ellis_Island_-_Lewis_Wickes_Hine.jpg.
William Williams, Immigrants seated on long benches, Main Hall, U.S. Immigration Station, Ellis Island, 1902-1913, photograph, in Photographs of Ellis Island, 1902-1913, New York Public Library Digital Collections, https://digitalcollections.nypl.org/items/39da9ad0-c6da-012f-44dc-58d385a7bc34.
National Committee for Mental Hygiene, “Immigrants Queuing in the Registry Hall”, 1902-1913, lantern slide, National Committee for Mental Hygiene Collection, Box 29, Oskar Diethelm Library, https://empireadc.org/search/catalog/nnod_4919.
National Committee for Mental Hygiene, “Immigrant Examiner Questioning an Immigrant”, 1902-1913, lantern slide, National Committee for Mental Hygiene Collection, Box 29, Oskar Diethelm Library, https://empireadc.org/search/catalog/nnod_4919.

Arriving on Ellis Island, passengers disembarked and made their way to the baggage hall, where they would start the process of immigration screening. They then ascended the stairs into the registry hall where the medical examination would begin. Lining up at one end of the hall, immigrants proceeded under the watchful eyes of psychiatric staff of the Public Health Service, then known as Surgeons. Surgeons conducted visual examinations of immigrants as they passed by, taking note of gait, facial features, temperament, voice, and anything that might offer a hint of transmittable or mental disease. While unremarked upon in the literature written by psychiatrists about examinations, Surgeons probably also took appearance into account, leaving immigrants with signs of visible cultural difference (clothing, for example) at a disadvantage (1). Additionally, Surgeons performed eye examinations, attempting to find signs of diseases like trachoma. Trachoma was seen as a particularly “immigrant disease” which immigration inspectors had a national duty to prevent from spreading into the country (2). If a Surgeon noticed some feature that indicated disease at any stage in this process, they would take a piece of chalk and mark an “X” on the immigrant's shoulder. Those marked with an “X” would be directed to proceed out one end of the registry hall, towards further detention and examination facilities.

Those without an “X” would be directed to proceed to lines at the other end of the registry hall, cordoned off with steel handrails. Here, they would undergo the legal inspection, answering questions about their reasons for coming to America, their relatives or connections already in the country, and their final destination within the US. If the inspectors deemed an immigrant admissible, they would then provide them with a landing card, giving them free passage into the US, and direct them downstairs back to the baggage hall. For those marked with an “X”, they would be directed to a new room for detention and further questioning.

At Ellis Island

"Mental Hygiene" and Immigration: The Thomas W. Salmon MD Papers