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Deportation of the Insane Aliens: 1907

The Deportation of Insane Aliens — 1907

Editor’s Note: This 1907 reprint  is published with permission and derived from the blog researched and developed by Linda S. Stuhler at https://inmatesofwillard.com/

Introduction: By 1880, New York State was overwhelmed with the immigrant pauper insane population which by its own laws, was required to care for them. The state legislature enacted new laws allowing for the deportation of this “dependant, defective and delinquent class” of immigrants in order to relieve the state of its financial burden. One of the problems that resulted from the actions of the state legislature was that the sick, blind, deaf and dumb, crippled, feeble-minded, and insane class of immigrants, were sent back to their original port of departure in Europe by themselves with little or no money, and many were sick and improperly clothed. No one bothered to make sure that these helpless people actually made it back to their homes, which in many cases was quite a distance from the port. Many of their relatives and friends never saw or heard from them again. Without the efforts of Miss Louisa Lee Schuyler and The State Charities Aid Association in 1904, this problem may never have been brought to light. On February 20, 1907, the problem was resolved with a new immigration law.

State Charities Aid Association of New York: 1904

“The United States immigration regulations exclude from admission into the United States insane persons, persons who have been insane within five years previous to landing, and persons who have had two or more attacks of insanity at any time previously. Any alien of these classes who succeeds in entering the United States, or any person who becomes a public charge from causes existing prior to landing, may be deported at any time within two years after arrival, at the expense of the person bringing such alien into the United States. Under certain conditions, the secretary of the treasury is authorized to deport such aliens within three years of landing. Under the provisions of this law 147 insane persons were deported to foreign countries from the State of New York during the fiscal year 1903.

From different sources it came to the attention of the Association that insane aliens deported by the government did not always reach their homes so promptly as they should, and sometimes not at all. In this connection the following quotation from the annual report of the superintendent of the Manhattan State Hospital, West, for the year just closed is significant:

‘While perhaps, it is a matter that does not officially concern the hospital, I desire to state, that I have received several communications from the relatives of patients deported, who claim, up to four or six weeks after such deportation, they have been unable to find that they have arrived at their homes, and could obtain no trace of them. Any conditions which do not afford protection to the insane alien until she reaches her home, are indeed unfortunate, and it appears to me, that some steps should be taken by the proper authorities, toward remedying these matters. The steamship companies do not appear to hold themselves responsible beyond the port where the patient was originally received aboard their steamship.’

The Association, therefore, has made some inquiry into the methods pursued in the deportation ofinsane aliens, and although it has been possible as yet to make only a cursory examination of a few cases, the conviction is inevitable that the methods of deportation are not such as to afford thepatients proper care and protection in all cases, nor to do justice to their friends and relatives. Only five cases have been studied. A brief account of three of the five cases which are at all complete will give some idea of present methods.

1. ‘Case of M.S., a young woman, aged 29 years, a native of Finland, arrived in this country November 1, 1902. About a year and a half later she became insane and was committed to the Manhattan State Hospital, West, April 14, 1904, where she was visited the following week by her friends, the matron and missionary of the Immigrant Girl’s Home. Hearing that the girl was to be deported, these friends offered to arrange for her deportation, hoping to find some woman returning to Finland who would take charge of her. Ten days after this, before the girl’s friends had time to move in the matter, they received a notice from the hospital that she was to be deported in three days. The names and addresses of the girl’s relatives in Europe were not in the possession of the hospital nor of the steamship company which was to take charge of her, and how she was expected to reach her home, the Association has been unable to discover. The friends of the girl, at the suggestion of the Association, procured these names and addresses, and gave them to the purser of the steamer on which she was to sail, and the Association took the precaution of sending the information to the home office of the steamship company in Glasgow, and of asking the officials there for some particulars regarding the method of transporting the patient from Glasgow to Finland. The following extract from the steamship company’s reply shows the methods employed:

‘Immediately on landing at the dock she was taken to a boarding house where she was properly taken charge of, being attended to by the women of that house. We are forwarding her to-night in charge of our shore interpreter to Hull, and he has instructions to see her safely on board the steamer for Helsingfors, which leaves Hull to-morrow. We have also addressed letters to the owners of the steamer, both in Hull and in Helsingfors, with a request to take some interest in the case, and to give the necessary instructions regarding treatment on board.’

A letter received by the girl’s friends in New York from the girl’s sister in Finland says that no communication was ever received by the friends in Finland from the steamship company, or from any one except the New York friends. The sister writes that she spent three days going from place to place trying to get information regarding the whereabouts of the patient, and finally located her in the Helsingfors hospital for the insane, where she had presumably been sent by the steamship company. This was in July, – two months after the girl sailed from America. The latest letter received from the patient’s sister came in October, and mentioned that she had been unable to find the trunk which was sent with the patient by the New York friends, and which contained all her possessions. The steamship company seems to have done nothing to see that the patient’s property followed her to the hospital.

The features of this case to which we would call attention are these: The failure of the hospital to cooperate with the friends of the patient in providing for her deportation, though no great haste was necessary, as the time in which she could be deported would not expire for six months; the failure of the authorities of this State to take any responsibility for the patient after she had been handed over to the steamship company, including a failure both on their part and on the part of the steamship company to notify the relatives in Europe, or even to ask her friends in this country to notify her relatives; the failure of the steamship company to make any effort to secure the names and addresses of the girl’s family or to make any use of them when furnished by others; the lack of proper care and protection shown in sending an insane person to a boarding house instead of to a hospital, and in forwarding her by night, in the company of a male attendant, on a long railroad journey. It would be interesting to know how this girl fared from the time she left Glasgow in May until her friends found her in July and how she would have fared if her friends in this country and this Association had not actively interested themselves in her case.

2. Case of M.R., an Austrian girl, aged 20 years. The following account of this case was given by the girl’s cousin: ‘When she became insane her brother, who lives in New York city, thought he would send her home, and told the Manhattan State Hospital authorities that he would try to arrange to do this, planning to send her with some acquaintance who was going over. The hospital, however, said that this could not be done; that she was to be returned by the government. The brother was not informed regarding the time of her return until May 3rd, when he received a letter saying that she was to be deported on May 4th. By the time he received the letter she was already on board, and it was impossible for him to go to the steamer that night. He went, however, the next morning about 8 o’clock, and had great difficulty in getting permission to see her. Finally he was allowed to see her for a few minutes. He found her dressed in a cotton wrapper, such as is worn at the State hospital, and provided with no other clothing. He would have brought her clothing if he had known that she needed it, but as nothing had been said by the State hospital it had not occurred to him to do this. He wished to give her money so that she could buy clothing en she got to Hamburg and spoke to the captain about the matter. The captain thought it useless for the girl to have money, but finally consented to take a few dollars for her use.’

The girl was taken to a hospital in Hamburg on landing there, and the parents of the patient were notified by the hospital of her arrival. In this case the significant feature seems to be again the failure of the authorities in this State to co-operate with the friends of the patient for her deportation.

3. Case of F.H. This patient is the son of one of the two sisters whose pathetic story appeared in the newspapers in November, 1904, at the time they committed suicide because of inability to support themselves. The following extract from the newspaper account of the case, though not altogether accurate, gives an idea of the story of the boy:

‘Everything went well with the sisters until a little more than a year ago. Then the boy was taken sick. His illness left him with a deranged brain. He was kept for a time in Bellevue Hospital and then was sent to Ward’s Island. The sisters visited him regularly once a week there. One week, about a year ago, they learned on their regular visit, that he had been sent back to Austria. This, friends of the sisters say, had been done without notification being sent to the mother. Her grief and her fear that some harm would come to him on the voyage were intense. She immediately raised all the money she could get, and, taking also the little which her sister had, she boarded a fast ocean liner for Hamburg. She landed there on the same day that her son landed, and, taking him under her charge, continued the journey to Vienna, where she had him put in an asylum. Then she hurried back to her sister in this country. The strain on the income of the two, however, was too great, and when they got out of work a few weeks ago they became despondent.’

It appears from the records of the Manhattan State Hospital, East, that the boy was admitted there September 25, 1902, and was visited by his mother Sunday, October 5. As he was an alien, having been but nine months in the United States, arrangements were made immediately for his deportation. On October 16, the hospital was informed that the boy would be deported on a vessel sailing October 18, and that he was to be placed on board the 17th. A letter dated October 17 was sent by the hospital to the boy’s mother informing her of his deportation.

Again we note the failure of the State authorities to make any effort to co-operate with the friends of the patient. In this case the hospital did not know of the plans of the Immigration Department for the deportation of the patient until the day before his deportation, and cannot be blamed for not writing earlier to his mother, but under such circumstances it would seem that the friends of the patient should be notified by telegram or special messenger, instead of by a letter, which could hardly be expected to reach its destination before the patient sailed.

To subject insane persons, many of them young and in an acute stage of the disease, to the vicissitudes of a long ocean voyage, with a further journey on the other side of the ocean, is certainly a sufficient risk under the best conditions, and every possible protection should be provided against physical or moral injury. The inhumanity of subjecting relatives of patients to unnecessary anxiety and alarm by leaving them in ignorance of what is happening to those they hold dear, should also be prevented by the establishment of some system which will provide for more personal attention to each case. At present insane aliens are dispatched with little more ceremony than if they were able-minded and able-bodied immigrants, capable of attending to their own interests.”

SOURCE: Reprinted from Twelfth Annual Report of the State Charities Aid Association to the State Commission In Lunacy, No. 89, November 1, 1904, New York City, Untied Charities Building, 105 East 22d Street, Pages 29-34. <http://books.google.com/>

State Charities Aid Association of New York: 1905

“…For instance, during the past year there have come to the attention of the Association the cases of two Italian young men, both of which would be interesting if we knew their whole story. One of these was deported in March, 1905. The friends in this country who are in correspondence with the patient’s relatives in Italy have reported up to the end of the year, 1905, that the patient has not yet reached home, that his relatives are anxiously searching for him, and that nothing has yet been learned of his whereabouts, or what has become of him. Another young Italian who was deported in July, 1905, appears to have disappeared in the same mysterious way. The patient’s friends in this country, who are in correspondence with the patient’s mother in Italy, wrote in September that the patient had not yet reached home. Such results are naturally to be expected from the present methods employed by the steamship companies. It appears to be the custom for the officers of the steamships on which insane aliens are deported to allow them to land with other passengers if they are able bodied, and to go where they please. It is hardly to be expected that an insane person thus set free and left to his own devic es, frequently in a strange country whose people speak a strange tongue, and usually entirely without money, should safely make his way to his own home. If a deported alien is not able bodied he is turned over to the police, and may be transferred to a suitable institution if the police happen to see the desirability of such a course. Patients landed in Great Britain who came originally from the continent of Europe are, however, turned over to the consuls of the country from which they came, or if able to travel are sent as passengers to some continental port, regardless of the particular part of Europe from which they came, and are landed at this port and left to make their own way. The inhumanity of such a method of treating the mentally diseased and helpless is sufficiently obvious.

The present course taken by the United States Government in deporting insane aliens who have  been in this country for some time is characterized by unnecessary harshness and even injustice. The purpose of deportation is to save this country the expense of maintaining a dependent person. The great majority of the aliens who are deported are persons who entered the country in perfectly good faith, with the intention and desire of earning a living, and in the vigor of youth, the average age of those deported being thirty years. It is not altogether their own fault that such aliens find themselves surrounded by economic and social conditions so unfavorable to their mental and physical health that they break down under the strain of competing with those who are better adapted to the conditions of life in this country. The person who, in the language of the law ‘becomes a public charge from causes existing prior to landing’ is frequently a person who, under normal conditions, would have remained sane and well, but whose constitution was not equal to the strain and stress of adaptation to a new and difficult environment. If we are to deport these persons to save money to our country, doing this in most cases against the wishes of the patients and the patients’ friends, we should at least safeguard the unfortunate aliens in the process of deportation, and not inflict upon them through the carelessness of our methods an injury greater than that they have already suffered. To deport insane persons under conditions which do not assure their safe arrival in the country from which they originally came, but which, on the other hand, are extremely likely to result in their disappearance on the way, is an undeserved and excessive punishment for misfortune; to subject the relatives and friends of these patients in both this country and the countries from which the patients came, to months and perhaps years of anxiety and suspense is unworthy of a civilized government. Even if a better and more humane method of deportation involves additional expenditure of money, this expense should be considered to be outweighed in importance by considerations of humanity. To save the lives of these people; to prevent, if possible, acute and curable cases from becoming
hopeless chronic cases of insanity; to surround the mentally sick with safeguards as adequate to their needs as those which civilization everywhere demands for the physically sick; to save the sane and guiltless relatives and friends of such patients the agony of suspense, which many now endure – surely to secure such results is worth the expenditure of the few thousand dollars a year which it is likely to cost.

It is evident that to improve conditions under the present methods of deportation would require the cooperation of the State Hospitals, the State Commission in Lunacy, the United States Immigration Service, the steamship companies, and the individuals or institutions to which the patients are delivered at the port of their original departure. So difficult and complicated a method of reform seems impracticable, and we are of the opinion that the only satisfactory method would be to send with the patient or patients a suitable attendant with full instructions regarding the care and treatment of the patients, the names and addresses of their relatives and friends, from whom such an attendant should require a receipt on the delivery of a patient into their hands. The Association hopes to interest the Department of Commerce and Labor in this matter, and to help to secure the necessary amendment to the Immigration Law, making such a course mandatory. Until such an amendment is secured we would recommend that the Department of Commerce and Labor should take such action as is within its power to remedy the evils of the present system.

Among the methods of deportation which require improvement, is the selection of a proper time for deportation from the point of view of the welfare of the patient deported. It is now customary when the immigrant becomes insane on the voyage to this country to return him to the country from which he came on the steamer on which he came over. As such cases are frequently young people suffering from a first attack, who on arrival are in the first stages of the disease, which is frequently of an acute and recoverable character, the subjection of such patients to the strain of another ocean voyage at this stage of the disease is very likely to make the case a chronic and incurable one. There seems to be no reason why persons suffering from acute attacks of mental or nervous diseases should not be allowed to remain in this country until fit for the return voyage, as is the custom in the case of immigrants afflicted with ordinary physical ailments, and ordered deported. Not only are aliens becoming insane on the voyage over returned by the same steamer, but they are ordinarily not even removed from the steamer for treatment, but remain on board throughout the noise and confusion of loading and unloading, with no attendance except such as a busy steward or stewardess can furnish. Of course, no curative treatment of any sort is provided, and the patient is treated rather more as a prisoner than as a hospital case. It would seem that the least that could be done for such cases would be to remove them to some hospital, as is customary in the case of immigrants suffering from diseases other than those of a mental and nervous nature. Unfortunately Ellis Island is not now equipped to care for such cases, and is as yet unable to provide suitable care for patients of this class who are now sent there.

In the course of its investigations the Association has made some inquiry into the methods pursued by the Immigration Service on Ellis Island in connection with the temporary care of insane aliens awaiting deportation. The Association was surprised and shocked to find that there are no facilities at present for affording proper care for such patients. It should be explained at the outset that Ellis Island is administered by the Immigration Service of the Department of Commerce and Labor, and that for the medical inspection and care of immigrants, surgeons of the United States Public Health and Marine Hospital Service are detailed for duty at Ellis Island. The surgeons of this service are directly responsible to the Surgeon-General, not to the Immigration Service, and they undertake only the duties which are assigned to them by the Immigration Law. The treatment of all cases of physical disease is placed entirely in the jurisdiction of the Marine Hospital Service. Unfortunately cases of mental disease and defect are not usually included, except in the inspection of arriving aliens. Immigrants certified for mental diseases or defects, after inspection by the surgeons, are not usually referred to the medical service for care and treatment, and cases brought to Ellis Island for deportation may never come to the attention of the medical officers. It is perhaps in large measure due to this fundamentally defective classification of the insane with the well, rather than with the sick, that the methods involve detention rather than treatment, and result unsatisfactorily. The following report on the subject made by a visitor familiar with modern methods of caring for the insane who was asked to inquire into the methods employed on Ellis Island will give a general idea of the situation.

‘I beg to state that I have visited Ellis Island, and my observations lead me to believe that considerable improvement might be made there in the methods of caring for insane persons. I was surprised to find that insane persons were apparently kept in the rooms with presumably well immigrants, and that the doctor had not been consulted in regard to placing a case in a padded cell. Inquiry, however, brought out that what I had observed was in accordance with the usual methods.

Several hundred insane persons must every year pass through the hands of the Ellis Island authorities, many of whom must be in need of hospital care. There is a good general hospital on the island, and every effort is made, I believe, to give all classes of sick cases, except the insane, such attention as their condition requires. For the insane, however, there is no properly constructed ward or pavilion, no trained attendants and nurses, no provision for medical supervision and care. So far as I could learn they commingle with the other detained immigrants, and if they disturb the peace or prove troublesome in any way they are taken in hand by the guards and secured in a strong room. The methods of the immigration authorities are, it seems to me, not unlike those with which the members of the State Charities Aid Association became familiar as a result of investigations in various parts of the State previous to the passage of the State Care Act. Ellis Island is, of course, under the jurisdiction of the United States Government. It is, however, within the border of our own State, and it seems as though we ought to have a right to exercise an influence in improving conditions there.

The care of the insane is such a very special work that I presume the immigration authorities are unable to appreciate how the conditions on Ellis Island appear to an experienced observer, or just what the needs are. I think, however, there can be no question whatever that there should be a small ward or pavilion in connection with the general hospital, on the island where insane persons arriving on the ships or sent to the island for deportation could be given the care and treatment required by their condition. This ward or pavilion should be similar to the Bellevue psychopathic ward or Pavilion F at Albany, and should be well equipped and in charge of a specially trained physician with trained nurses and attendants. With such accommodations immigrants suspected of being insane could be cared for also, and many more cases would undoubtedly be detected. The present method for detecting these cases seems to be crude and inadequate.’

The following facts summarize the conditions found to exist at the present time.

1. No provision is made for hospital care for cases of insanity, though such care is provided for all other forms of disease.

2. Persons discovered to be insane during the ocean voyage or on arrival are left on board while the vessel is in port and deported on the same ship. Cases of other diseases, even if deportable, are invariably removed for treatment.

3. Cases of insanity discovered among immigrants on Ellis Island, or received there for deportation, are placed among the presumably well, and are given no special attention unless they prove troublesome, in which case they are put in restraint by the custodians without consultation with a physician.

4. For detection of insanity among immigrants the methods employed are crude and inadequate, theimmigrants being scrutinized by physicians as they pass in single file. There are no facilities for long detention or careful observation to determine mental diseases or defects.

The two measures which are needed to remedy these conditions, and which are nearly equal in importance, are, first, the recognition by the lay officials, of the principle that insanity is a disease and the care of those afflicted a matter for physicians, and, second, the provision of facilities which will enable the medical officers to accept this responsibility. What is needed for the detection of insanity and the proper care of the insane on Ellis Island may be summarized as follows:

1. A suitable ward or pavilion constructed and equipped in accordance with modern scientific methods in connection with the General Hospital.

2. The assignment to this service of a physician, and a sufficient number of nurses especially trained and experienced in the care of the insane.

3. The temporary detention in this ward or pavilion of all insane persons discovered on arriving ships or among immigrants on Ellis Island, and of all persons suspected of being insane and who should be under observation to determine their mental condition.

We are informed that the Immigration Service contemplates the provision of a special pavilion for the accommodation and care of insane aliens, and of cases under observation to determine their mental condition. We would recommend the construction of a two story pavilion like the psychopathic ward at Bellevue, or Pavilion F, at the Albany Hospital. (It is understood that since the date of this report an appropriation has been secured for a suitable pavilion and that plans are being drawn).

Such a pavilion should be put in charge of a physician and a sufficient number of nurses experienced in the care and treatment of cases of insanity. Pending the construction of such a pavilion either a temporary ward should be provided where such cases can be separated from the sane aliens and be under the care of such a physician and nurses as are required for the pavilion, or else some hospital in the city of New York should be employed to care for such patients on the plan of contract successfully operated in connection with some other classes of sick immigrants.

It should be emphasized in this connection that the failure of the Federal authorities to do this work efficiently up to the present time is not due to any lack of equipment for such work, but altogether to a failure, until recently, to appreciate the need of such work. The medical officers of the Public Health and Marine Hospital Service, who are detailed for duty at the different ports of entry, are entirely capable of performing these duties, if assigned to them. Among these officers are men who have had experience as physicians in public institutions for the insane, and more could be employed as acting assistant surgeons with compensation which would attract qualified men from the State Hospitals. As the United States government has assumed the duty of protecting the country against unsuitable and undesirable immigration it would seem as if it should do this work with a thoroughness which would protect all the States of the Union, and would leave little to be done along these lines by the State governments. The State of New York is certainly among the chief sufferers from the effects of undesirable immigration, and its interest in this matter, owing to the fact that it includes the greatest port of entry and has in its institutions the greatest number of defective, delinquent and dependent aliens is perhaps greater than that of any other State in the Union. It seems proper therefore for those interested in the insane in this State to bring this matter to the attention of the authorities of the National government, and to urge the need of better methods in connection with the detection of insanity, the care of detained cases and the deportation of insane aliens.”

SOURCE: Reprinted from No. 91, State Charities Aid Association of New York. Thirteenth Annual Report of the State Charities Aid Association to the State Commission in Lunacy, November 1, 1905, New York City: United Charities Building, 105 East 22d Street, Pages 26-36. <http://books.google.com/>

State Charities Aid Association of New York: 1906

“In May, June and July, of 1904, the Secretary of the Association had some correspondence on thesubject with the Hon. William Williams, then Commissioner of Immigration on Ellis Island. In a letter of July 7th, the attention of the Commissioner was called to the possibly serious consequences of returning certain classes of aliens, particularly unprotected young women, to foreign ports at considerable distance from their homes, without previous provision for their safe transportation to the point of original departure, and the Commissioner was asked whether the phrase of the law requiring that an alien be deported ‘to the country from whence he came’ might not be held to denote the country from which the alien started and in which his home had heretofore been. Commissioner Williams, in a letter of July 8, 1904, made the following reply:

‘I beg to state that it is the opinion of the Bureau that the law does not require steamship companies to take aliens further than the port of embarkation, the phrase ‘on vessels bringing them’ being significant on this point. I trust that Congress may see its way clear to remedying the defect and enacting new legislation providing for the return of an alien to the original point of departure.’

After this correspondence, additional information was secured from time to time regarding the workings of the Immigration Law and the Immigration Service on Ellis Island as related to the insane and the alleged insane, and existing conditions were described and recommendations made in the twelfth and thirteenth annual reports of the Association to the State Commission in Lunacy, for the years ending September 30, 1904 and 1905 respectively. In the same reports will be found a statement upon this subject, quoted from the annual report of the Superintendent of the Manhattan  State Hospital, September 30, 1904.”

“The unsatisfactory nature of existing methods of deporting insane aliens was again forcibly brought to the attention of the Association by a letter of November 15, 1905, from the resident alienist at Bellevue Hospital asking for the assistance of the Association in tracing a patient who had been deported and whose relatives both in Europe and in this country were unable to learn of his whereabouts, and including the following statement: ‘We frequently get letters from the relatives and friends of patients who have been deported (approximately six this year) stating that they have never been heard from. As you know, this is very distressing, and it seems to me that the Immigration Department or the Federal authorities should take some action to secure the safe arrival of such patients to their destination.’

On December 28, 1905, a letter was addressed by the Secretary to Hon. Robert Watchorn, Commissioner of Immigration at Ellis Island, calling his attention to the interest of the Association in this subject, and to the correspondence with his predecessor, and asking him to meet a Subcommittee of the Association’s Committee on the Insane to confer on the general subject of immigration and deportation as it affects the insane. On January 8, 1906, a Sub-committee consisting of Dr. Frederick Peterson, the Secretary and the Assistant Secretary called on Commissioner Watchorn at Ellis Island. A general discussion was had, not only upon the defects in the methods of deporting insane aliens, but also in the methods of accommodating and caring for insane immigrants, or those under observation, to determine their mental condition on arriving steamships or at Ellis Island. There was also discussion upon various defects in the methods employed by the Immigration Service in transferring and temporarily caring for such cases, defects brought to the notice of the Association by officers of State Hospitals, from which patients had been sent to the Immigration Service for deportation, and who had observed the methods of transferring insane aliens from the hospitals to Ellis Island or the steamships, and the methods of caring for such patients before deportation.

The recommendations submitted to the Commissioner of Immigration at this interview of January 8, 1906, were as follows:

I. Relating to the Deportation of Insane Aliens.

1. Longer notice, whenever practicable by telegraph, to be sent to the State Hospitals in which are aliens about to be deported, relative to the time such aliens are to be placed aboard ship, in order that the State Hospitals may give to the relatives and friends of such patients notice of the deportation in time to permit of their visiting the patients before being deported.

2. Insane aliens who are deported to be accompanied to their homes by nurses of the same sex, at the expense of the steamship companies or the Immigration Service, following the methods employed by the State Hospitals when deporting such patients at the expense of the State.

II. Relating to the accommodation and care of insane immigrants, or those under observation to determine their mental condition on arriving steamships or at Ellis Island.

1. Patients sent for by the Immigration Service, to be provided with nurses of the same sex as the patient, as is required by law in the transfer of insane persons in the State of New York.

2. Immigrants, becoming insane on board ship, to be transferred to Ellis Island pending detention at this port and not to be sent back by the same boat unless their condition warrants it.

3. Provision for a hospital wing or pavilion on Ellis Island, for the care of the insane or those under observation, in charge of a physician and trained nurses experienced in the care of the insane.

4. Pending the provision of suitable quarters for such cases, rules to be made regarding restraint, accommodation, care, etc., of detained aliens.

It was ascertained that while most of these recommendations related to changes that could be made by administrative officers under the existing law, those relating to the deportation of insane aliens and to the accommodation and care of aliens on Ellis Island, could be more readily carried into effect if there were a special provision for such action in the Immigration Law. The efforts of the Association have therefore been directed along two distinct lines, viz.: First, the amendment of the law governing the deportation of insane aliens; and, second, an improvement in the methods of detecting mental disease and defect among arriving immigrants, as also better care for persons detained for observation or certified as insane and awaiting deportation.

I. Federal Legislation.

As a result of the interview held with the Commissioner of Immigration, the desirability of securing amendments to the Immigration Law was presented to the Board of Managers of the Association at a meeting held January 12, 1906, when the following resolutions were adopted:

Whereas, Numerous cases of hardship, in connection with the deportation of insane aliens and their temporary care while awaiting deportation, have come to the notice of this Association, therefore, Resolved, That it is the sense of the Board of Managers of the State Charities Aid Association that such changes should be made in the Federal statutes regulating immigration, and in the administration of those statutes, as will accomplish the following results:

1. That insane aliens deported from this country to the country from which they came, shall be accompanied by a suitable attendant to their final destination in the country from which they came.

2. That insane aliens whose health would be likely to be seriously impaired by immediate deportation, shall be detained until such time as they can be deported without undue danger.

3. That insane aliens, or aliens under observation to determine their mental condition, shall be cared for apart from the sane, and in accordance with modern scientific methods; and Resolved, That the Committee on the Insane be instructed to take such steps as may be necessary to carry into effect this resolution.

There were then pending in both branches of Congress bills which, while dissimilar in important particulars, had for their common purpose the amendment of the Immigration Act with a view to the restriction of immigration, and both of them contained a provision that when, in the opinion of the Secretary of Commerce and Labor, the mental or physical condition of an alien who had been ordered deported was such as to require personal care and attendance he might employ a suitable person for that purpose.

In accordance with the instructions of the Board of Managers, the Secretary entered into correspondence with the Chairman of the Senate Committee on Immigration, and with the Chairman and other members of the House Committee on Immigration and Naturalization, and made detailed suggestions for amendments to the Immigration Act. These amendments comprised the following requirements:

1. That the name and address of the nearest relative in the country from which the alien cameshould be secured at the point of embarkation and included in the ship’s manifest.

2. That the attendant sent to accompany an insane alien who is deported should be a person of the same sex and, if so directed by the Secretary of Commerce and Labor, should accompany such alien to his final destination in the country from which he came.

3. That upon the certificate of a medical officer of the United States Public Health and Marine Hospital Service, to the effect that the health and safety of an insane alien would be unduly
imperilled by immediate deportation, such alien might be held for treatment until such time as such alien might, in the opinion of such medical officer, be safely deported.

These amendments were adopted in part by the Senate Committee and in full by the House Committee, and appeared in both the Senate and the House Bills in their final form. Neither bill has yet become law, but both are pending, and it is hoped that whatever legislation may be passed by Congress on this subject may contain the provisions recommended by the Association. (As this  report goes to press, we learn of the enactment of the Immigration Act including these amendments substantially as submitted).

II. Methods of Administration.

On the occasion of the interview on Ellis Island between the Commissioner of Immigration and members of the Committee on the Insane, it was learned that the provision for a special pavilion, on Ellis Island, for the care of insane aliens was under consideration by the Federal authorities, and that the preparation of plans was in the hands of the officials of the United States Public Health and Marine Hospital Service. An interview was subsequently held by the representatives of the Association with the medical officer in command on Ellis Island, at which plans for the proposed pavilion were discussed. The Committee recommended the adoption of plans similar to those used in connection with Pavilion F, a model reception hospital for the insane, at Albany. The plans for the pavilion, as subsequently adopted, were entirely satisfactory to the Association.

Both the Commissioner of Immigration and the medical officer in command at Ellis Island extended to members of the Committee a cordial invitation to visit Ellis Island and study the operations of the Immigration Service and the Public Health and Marine Hospital Service. The Assistant Secretary therefore made a visit to Ellis Island on April 19, 1906, reporting to the Committee the result of her observations. Previous to this, on February 16, 1906, the Secretary and the Assistant Secretary visited a steamship, on which an insane alien was to be deported, at the time of the arrival on the boat of the patient from Ellis Island, for the purpose of observing the methods of transference. The case was that of a young Italian woman who was being deported six days after landing, though she was in an acute stage of manic depressive insanity and likely to be badly affected by another ocean voyage. She was brought to the steamship by two male attendants, gatemen or doorkeepers on Ellis Island. The Assistant Secretary also visited on the same day a steamship where a young woman with suicidal tendencies and marked delusions was being detained in the steerage during the nine days stay of the steamship at the dock.

While in Washington, in May, 1906, for the sessions of the National Association for the Study and Prevention of Tuberculosis, the Secretary called upon the Hon. Frank B. Sargent, Commissioner General of Immigration, and the Hon. Walter Wyman, Surgeon General. He submitted to the Commissioner General the following suggestions:

1. There should be provided on Ellis Island suitable dayrooms for the detention and examination of suspected cases of insanity – separate rooms for men and women, – and separate dormitories for suspected cases of mental disease. Sometimes there are as many as eighty such cases in one day. It is important that suitable dayrooms and dormitories for such cases apart from other cases should be permanently designated. Both dayrooms and dormitories should, of course, have separate toilet accommodations for each sex.

2. The care of aliens detained because of suspected mental disease should be under the direction ofthose members of the medical staff who have been appointed because of their experience in the diagnosis and treatment of mental diseases, and who have been assigned to the special duty of the detection of such cases.

3. Gatemen and matrons assigned to the care of aliens, detained because of suspected mental disease, both in the dayrooms and in the dormitories, should be persons with experience in the care of the insane, preferably those who have had experience in State Hospitals. The salary is sufficient to attract trained and reliable attendants from the State Hospital Service. Attendants and matrons who have not had experience in dealing with the insane would inevitably think it necessary to use measures of violence which a trained attendant would know to be unnecessary, and would fail to take precautions for the prevention of injuries and suicides which would naturally occur to a trained attendant. The observations of trained attendants and matrons would be of great value to the physicians in making a diagnosis, as is the case in the State Hospital Service.

4. Suitable rooms for the examination of suspected cases of mental disease, adjoining the dayrooms for those cases, should be permanently designated therefor. Rooms are now provided for this purpose temporarily and the arrangement should be made permanent.

5. There should be two interpreters assigned exclusively to assist in the examination of suspected cases of mental disease. The absence of interpreters assigned exclusively to this service frequently causes long and unnecessary detention of these cases, interferes with and interrupts examinations in process, and prevents the detection of cases in certain instances.

6. A stenographer should be assigned exclusively for the use of physicians in taking immigrants’ statements, and samples of characteristic utterances, and to write the records of each case certified. This is provided in every important hospital for the examination and diagnosis of the insane, and also for the examination of the insane in the State Hospital Service.

On the occasion of the Secretary’s visit to the Surgeon-General he submitted the following recommendations:

It is suggested that the service for the detection of insane aliens should be perfected and made more permanent by the establishment of rules, or the issuing of an official memorandum, to secure the following results:

1. That there shall always be three medical officers, who shall be alienists with experience in the diagnosis and treatment of mental diseases, stationed at Ellis Island for the purpose of examining incoming immigrants, detecting cases of insanity and mental defects, and providing modern treatment for those under detention suffering from mental disease.

2. That these three alienists shall be relieved from all other duties except those above mentioned.

3. That whenever immigrants are being admitted, one alienist shall devote himself exclusively to the inspection of the line, and in such inspection shall be required to examine only for evidences of insanity or mental defect, this duty of inspection of the line to be performed by the three alienists in rotation.

4. That the preliminary examination of aliens separated from the line be made as soon as there is an interval in the passing of the line, and by the alienist who separated them from the line.

5. That a Public Health and Marine Hospital Service attendant be assigned permanently to assist in the examination of cases detained for alleged insanity or mental defect.”

SOURCE: Reprinted from Fourteenth Annual Report of the State Charities Aid Association to the State Commission in Lunacy, November 1, 1906, No. 93, New York City, United Charities Building, 105 East 22d Street, Pages 20-29. <http://books.google.com/>

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