Hektoen International

A Journal of Medical Humanities

Ellis Island Hospital, from quarantine to freedom

Annabelle S. Slingerland
Leiden, the Netherlands

 Ellis Island Hospital Overview. U.S. National Archives (12)

The recent news and concerns about immigration into Europe and other parts of the world bring to mind similar events and fears prevailing in the years during which millions of people immigrated into the United States of America.

During that period, under the benevolent gaze of the Statue of Liberty in the Port of New York, over twelve million immigrants were inspected and processed before being admitted into the United States, often in the face of protests expressed in newspaper articles and cartoons.1 No fewer than sixty immigration offices had sprouted up on both coasts in 1892, with Ellis Island processing a full three-fourths of all new arrivals.1,2

Initial concerns were triggered by the third cholera epidemic that swept across Europe in 1891. ‘Loathsome or contagious disease’ became a reason for quarantining recent arrivals. Forcing people to stay on a ship until an outbreak was contained had killed many people and could no longer be embraced.3 Under the new arrangements the first person to indeed greet the newcomers was not an employee of the Immigration and Naturalization Service, but rather a medical doctor. He would have worked for the U.S. Marine Hospital Service, later known as the U.S. Public Health Service, referring immigrants diagnosed with medical conditions to neighboring hospitals such as Bellevue.3,4

At the turn of the century, newspapers and magazines echoed concerns about the new wave of immigrants, many from poorer countries in Europe and with hardly known and often intractable diseases such as favus and trachoma: “We have enough sickness and death of our own!” 5 Fears arose that immigrants with identified illnesses could infect Americans, even the American medical patients at the hospitals to which they were referred.1,3,5,6 The experimental vaccines and antibiotics of Joseph Lister, Louis Pasteur and Robert Koch had not yet dispelled old beliefs. Fear quickly metastasized into hostility toward all immigrants.

When the American Industrial Revolution reached its peak, potential fear of new immigrants had been offset by fears of reduced economic growth. Capable workers were in high demand in order for the country to maintain its economic pace.7 President Roosevelt expressed both concerns: “we should have no [immigrants] of the wrong kind”, and: “we cannot have too much immigration of the right kind”.8 To safeguard the well-being of American citizens, a hospital on Ellis Island was designated as the place where physicians examined immigrants in order to treat their illnesses and approach them with “kindness and civility,” according to its first commissioner William Williams to transform them into healthy, fit laborers.1,9

As a result, a state-of-the-art medical facility took shape on two newly created islands, to “insure freedom from danger or contagion according to modern ideas of hospital construction” with “an outside limit of 410 feet from the present island” and “200 feet of clear water space between the two”. The General Hospital on Island No. 2 with its 120 beds, already more than most city hospitals had at the time, rapidly expanded to 275.1,10 It saw 350 babies born, who automatically received U.S. citizenship and special nutrition to improve their often low birth weight and poor state of health.1 The Contagious Disease Hospital on Island No. 3 replaced the housing built for immigrants suspected of harboring contagion. By 1911, that hospital with its 450 beds had become the largest facility on Ellis Island.1,11 Its leading figure, Robert Watchorn, was driven by his own experiences as an immigrant. He eagerly embraced Roosevelt’s mission of welcoming new arrivals and counterbalancing “the sometimes callous indifference of their new countrymen.” The hospital’s team and 24/7 laboratory diagnosed diseases such as tuberculosis, diphtheria, whooping cough, and measles. There were separate wards for each disease. Staggered doors facilitated the passage of air between the banks of windows to ensure maximum exchange of exterior and interior air. An autoclave sterilized entire beds, and the laundry cleaned 3000 sheets and towels a day. Patients followed a daily exercise regime in the fresh air or went swimming between Island 2 and 3.1,11

Many immigrants left the hospital within a week, feeling welcome in their new land, with a free ticket to the American dream. For instance, John Henry Wiberding and his wife Ella, thousands of miles from their home, felt they were in “a place of compassion and understanding,” where it was “good being cared for.”1 But the Wiberdings’ experience was not the norm. Doctors were confronted with a broad array of maladies, from injuries to tropical disease. They often lacked the appropriate means of treatment. Ormond McDermott, a healthy dentist’s son, nineteen years old, who had arrived from Australia for an internship in America, accidentally left his passport on the ship.1,12 While awaiting processing, he was housed among infected immigrants and soon developed scarlet fever, which killed him in a matter of days. If a treatment was available but required extended care, some families could not afford to keep paying the two dollars per day. Some members of a Russian family in that dilemma failed to recover from trachoma and were sent back to Russia, while the rest of the family was admitted.13 Doctors were further thwarted in their work by the challenges of treating patients from different linguistic and cultural backgrounds. Hundreds of patients arrived daily and there was often no time to painstakingly work through the complex barriers to mutual understanding. Not surprisingly, pioneering mental tests that circumvented language and education were developed here.1,14

With regards to the immigrants, the challenges of the doctors matched their own. Those challenges were further exacerbated by the immigrants’ suspicion of the American authorities, who stood between them and their American dream. Deep-seated distrust of government as a result of experiences in their homelands often led to counterproductive action. Examples include a patient who refused to submit to an x-ray thinking it was a police camera; another who rejected a red bathrobe because it symbolized the Turkish nation; and one patient who resisted undressing to take a required bath because she had sewn her money into the seams of her clothes.1,15 Not answering questions (because they seemed stupid) might rank one as feebleminded and lead to entry being denied.1,15 Some attempted to escape by swimming to New York City’s mainland. There are no reports of any patients who succeeded at that endeavor, however. When two aspiring immigrants committed suicide, a psychopathic pavilion was erected to provide for those “who during the voyage to America, had become the victims of acute mental disorders.” There they would receive “humane and efficient treatment,” a response to the situation of many otherwise mentally healthy immigrants whose temporary circumstances had driven them to despair.1,16

Cartoon demanding a finer screen. William Williams Papers, Manuscripts and Archives Division, the New York Public Library, Astor, Lenox and Tilden Foundations (135)

Many ailing newcomers arrived in the wake of Europe’s influenza epidemic in 1918,17 joined by many others seeking asylum after World War I.1 Yet the hospital services became less important as Congress gradually put a chokehold on immigration. Of course, the rise of communism and the unemployment following the economic downturn after post-war demobilization hardened attitudes against immigrants.1 America subsequently enforced the Emergency/Temporary Quota Act in 1921, the National Origins formula by which only 3% of immigrants was admitted according to a quota that reflected the percentage of immigrants from that nation already living in America.1,18 The Immigration Act of 1924 further reduced immigration.1,18 The Public Health Service had withdrawn its support and outsourced health screenings to U.S. consulates abroad and the once famous Contagious Disease Hospital services and its buildings received no further referrals.1,19 The General Hospital would merely house its inhabitants who now consisted of suspected criminals awaiting deportation, disabled American servicemen, and German and Italian prisoners from World War II.1

Still, nearly 40% of all Americans trace their roots to ancestors who passed through Ellis Island. During its years of operation, from 1902 to 1930 all in all about 250,000 patients had been treated at the Ellis Island Hospital. America’s population on the mainland had been well protected: no public health outbreak was ever traced back to an immigrant on Ellis Island.1 Also, it was a minor miracle that so few staff members became ill, since personnel were only inoculated against smallpox and typhoid. In 1915, Frederick Rothe, an interpreter, was the only employee to contract tuberculosis and die.1 Some 3,500 immigrants died, many of whom remained behind in the paupers’ mass graves on Hart Island or in unmarked graves in Mount Olivet in Queens, with their final destination on the mainland still sadly out of reach. In 1951, when America shut its doors to almost all immigration, the hospital buildings and premises were left to decay.

As we look for lessons from the history of Ellis Island Hospital, perhaps we need not look any further than the plaque placed at the foot of the Statute of Liberty during the second year of its existence, in 1903. In that year, friends of poet Emma Lazarus had the words of her poem, “The New Colossus,” engraved in bronze as a reminder of lady liberty’s raison d’être.

“Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!”



  1. Lorie Conway, Forgotten Ellis Island, (New York, USA: HarperCollins Publishers, 2007).
  2. Lorie Conway, Forgotten Ellis Island, PBS Films, documentary.
  3. Outbreak of Cholera and Quarantine at New York Harbor 1892, (New York, USA: Harpers Weekly Journal of Civilization, september 17,1892);
  4. E.L.Godkin, A Month in Quarantine, (North American Review 155, no.432:737-744).
  5. The New York Times, August 29, 1892, (cited in Howard Markel, Quarantine!, 88, 1997).
  6. T.V. Powderly, Immigrations Menace to the National Health, (North American Review, 53-60, 1902, cited in Alan Kraut, Silent Travelers: Germs, Genes and American Efficiency, 1890-1924, Baltimore and London: The John Hopkins University Press, 58).
  7. James Davenport Whelpley, The Open Door for Immigrants, (Harper’s Weekly L, no. 2573: 517-19, April 14, 1906).
  8. President Theodore Roosevelt first State of the Union Message 1901.
  9. William Williams Papers, New York Public Library.
  10. Letter from V.H. Metcalf, Department of Commerce and Labor, to William H. Taft, secretary of war, March 17, 1905, (General Immigration Files, National Archives, RG 90); Letter from the Public Health and Marine Hospital Service to the Surgeon General, November 1902.
  11. Robert Watchorn, (Outlook Magazine, 1905, cited in Harlan Unrau, 1984, Historic Research Study, vol. II, New York: National Park Service, 239-243,639-649).
  12. Additionally: National Archives Washington D.C. archived on request of the family, videotaped interview with Anne McDermott Keeling
  13. Letter from Robert Watchorn, Ellis Island Commissioner of Immigration to Commissioner-General of Immigration, December 17, 1908, (General Immigration Files, National Archives, RG 90).
  14. Dr. Howard Knox, Scientific American, “Measuring Human Intelligence”, 1915
  15. Leah Shain, niece of Pearl Yablonski, videotaped interview at the site of Ellis Island Hospital,1999; Josephine Lutomski, Oral Interview 1986, (the part covering her experience as a ward matron in the  Ellis Island Hospital in 1922); Elizabeth Gardiner, chief social service worker, Red Cross Narrative Report (Ellis Island Hospital, 1922, Ellis Island Library).
  16. U. S. Public Health Service Handbook for the Medical Inspection of Aliens, 1903; Annuar Report of the Surgeon General of the Public Health and Marine-Hospital Service of the United States, 1905, 271-278).
  17. Molly Billings, http://[email protected]/uda/; currently under: https://www.coursehero.com/file/p3ndre/THE-GREAT-INFLUENZA-PANDEMIC-OF-1918-19-to-be-deadly-to-booth-sides-of-the-War/   (accessed, 15 January 2015).
  18. Cited in Henry Guzda, Keeper of the Gate: Ellis Island a Welcome Site? Only After Years of Reform, (Monthly Labor Reveiw, July, 35,1986); A Short History of  U.S. Immigration Policy, the 1920s and 1930s: A Pause or an Ugly Period in American History? (American Immigration Law Foundation, www.ailf.org/ipc/policy_reports_1996_pr9613.htm#2, accessed 15 January 2015).
  19. Dr. John Thill, Oral History interview 1977, (the part covering his experience as a Public Health Service physician on Ellis Island in 1924).

ANNABELLE S. SLINGERLAND, MD, DSc, MPH, MScHSR, Leiden University Medical Center, Leiden, the Netherlands, has a family background of Dutch emmigrants, has lived in New York City and San Francisco, and has visited Ellis Island and its western equivalent Angel Island. Recent cartoons have reminded her of those she had seen in the period, full of tensions in the history of these and their hospitals. She thanks Robin Seeley for her help in preparing this paper, as well as Rosemary McNally, John Rolls, and Talya Tibbon.

Summer 2015



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