men. If one child cries, others cry. The skill necessary to obviate this state of affairs, the quick change from one kind of examination to another, when necessary for reasons of quiet, the letting children alone till the disturbance has subsided, and all this in crowded quarters, where in spite of the fact that through different doctors and different attendants, many languages are available, at certain times signs are the sole means of communication, makes a very special technique a necessity, as well as medical skill, and a generous understanding of human beings. One realizes the force of a sentence found in the "Regulation for the Medical Inspection of Aliens:"10 "Knowledge of racial characteristics in physique, costume, and behavior are important in this inspection procedure." An understanding, though firm physician, does much to calm an entire family or room full, and this is true even when really a certificate of a specially troublesome kind may have been given. Here again in the case of certification, the wisdom of experience is shown; for the doctors do not explain to the people to whom a "certificate" of some form or other is given-perhaps for hospitalization, perhaps for a Class C defect which has to do with ability to earn a living, perhaps a card showing that further mental examination is called for. Explanation would, of course, be impossible, and the great skill that all workers at Ellis Island have developed in avoiding, where necessary, direct answers to questions, is very remarkable. I have heard this criticised; but when you see the difficulties" that direct answering may bring, the wisdom is understood. The medical division can not answer questions as to what the Immigration Inspectors will do; the examining Doctor can not say what the Hospital will decide; the complicated machinery, to work well, really must work fairly "silently," and sometimes one comes to believe that the mixture of language which halts conversation, is perhaps a factor most conducive to a successful and speedy working of the system. After the medical examination is over, an immigrant may pass out quickly, gather up his luggage, have his card inspected and stamped, and go directly to the Immigration authorities; or if something is physically or mentally wrong, he may be sent to the mental room for further examination or to the hospital. This part of the proceeding seems the most difficult. If one member of a family is sent through a door into the "hospital" waiting room, for instance, while the rest, with cards quickly stamped, are sent suddenly through another door, which leads them on to the Immigration inspection, it is, of course, an anxious and difficult time. "Not to know" is almost unbearable, yet granting that, it seems that the situation is carefully handled. The family, who have passed on, as they are "incomplete," are detained on the Immigration floor, as those "together," pass on to the inspectors together naturally. In time they will know that they are to wait in the detention rooms, till the sick member's case is settled, that if the sick child has gone to the hospital the mother may go to her the next day at visiting hour, etc. I feel that a Medical Social Service worker here, of the type that the Medical Division has in the Hospitals, could help in this hardship, yet the delicacy of handling a "half way through" case without mistake would be enormous, and the wide range of language necessary could never centre in any one person; for here at least words would be necessary." It is particularly dangerous ground too, as it is at the border line. between the Medical and the Immigration side, which work together so well, apparently, because of this strictly separated and carefully respected allotment of jurisdiction. 12 I should like at this point to say a word as to the mental examinations, which are of extreme interest. 13 Dr. Mullan, who writes so clearly and authoritatively on this question, reminds us of the need of racial knowledge here. If an Englishman should react to questions in the manner of an Irishman, his lack of mental balance would be suspected. No physician can do the examining of this kind at an Immigrant Station without having a knowledge far beyond his psychiatric knowledge. In talking with a surgeon who has been doing this work for many years, one is always in a state of amazement at the amount of background he has gained, which makes things intelligible to him, which are entirely unknown and unrecognized by one without this skill. If the immigrant,14 because of fear or fatigue, or excitement, seems unable to show his capacity, such as it may be, on this arrival day he is sent by the physicians, after trial, to the detention rooms, to wait until another day. Then the examination is taken up again, the next day, and the next, if necessary, and soon until the doctor is convinced that there is no need of detention, or that a certificate must be given. In this last case, decision is never rendered without the judgment and signature of two physicians.15 Feeblemindedness, although it is lowered at our stations, because of the greater care of the steamship companies in their examinations, 16 because of the deterring effect of the "illiteracy" test, and because of the lessened numbers brought about by the 3 per cent law, is still a menace that is most carefully and necessarily watched for. These mental examinations average about five hundred people17 a month. This number, of course, does not show the number of examinations any given individual may have; for any one of the "500" may need two or three or four examinations, or more-as the case may be. It also does not show the re-examinations that are constantly going on, for people who have appealed, and who at intervals are brought back to Ellis Island. The number of "certified" cases as they appear in the various reports can therefore give but little idea of the scope of the mental work that is actually done. Now come the individual cases- a sampling of those that were watched by the writer. First it must be remembered that from observing these examinations you learn much that is quite apart from things mental. An Irishman was turned aside on the line, which is to be described later, and sent to the mental rooms. Confusion of any kind can not be handled in the line. Instant turning aside to the mental rooms, when any question arises, has to be the procedure. "Why were you sent in here?" said the doctor. "Because I did the arithmetic wrong that the doctor gave me," the man answered instantly-a good beginning. "What was it?" said the doctor. The man answered instantly again, "I said 21+ 22 were 42, and I ought to have said 43." The man was a steel worker. "Do you drink beer?" said the doctor with a purpose. "No," said the man, "I am a teetotaler." "You drink only oatmeal and water then?" was the doctor's next speech, to which the man said "Yes." Then came questions as to his Irish farm, as to the relative value of the English and the Irish acre, all of which the man handled so intelligently that he was not further held. Now it is this sort of preliminary questioning that shows the fund of knowledge necessary for even the beginning of mental work with aliens. This approach on the part of the doctor establishes a relation which nothing else can do, and as the emotional state plays such a large part, the importance of this preliminary state of adjustment cannot be over emphasized. To know who drinks oatmeal and water and who does not, may seem a little thing; but its effects may be far reaching. Also the things that may cause wrong answers have to be watched for very carefully. In the middle of an examination where a girl was asked the question as to which she would throw overboard, bread or money, if out at sea in a small boat which must be lightened, the answer came "The bread." The doctor said nothing; but very slowly told the story again. Instantly the girl said. "Oh I didn't understand before I was so full of that big boat that I have just been on, that I never noticed the little boat part. I should, of course throw over the gold." Now that was not a changing of the answer because of the suspicion that something was wrong. It was a real lack of understanding because of the omnipresence of that big boat. A hasty decision as to the girl's mental processes would surely in this case not have shown the facts. What an individual does when waiting for an examination is also a matter of great interest. They may walk, or sit stupidly, or sit with a most alert interest in everything that is happening in the waiting room around them. One girl slept. That does not often happen. The process is not conducive to sleep. Three cases may be enough to serve our purpose. Case I. Yiddish boy. (Russian.) Age, fourteen years. Never has been to school. Counted from 1 to 20. Did Sequin form board, after attempts at forcing in unlikely places. Imbecile Form Board: No. The next day the boy came a second time with his mother, and the examination this time was carried on through an interpreter. Two physicians instead of one were present. The mother was first questioned, and that the boy had not talked till he was ten was brought out. That he had not gone to school, she said, was due to the "Bolshevists." She admitted that her three other children, still in Russia, were brighter than this boy. They had gone to school. All this showed that the family knew quite well that there was a difficulty in the case of this, the only boy. So many times the defective child is left at home with relatives, and then brought over if possible when the weight of establishment already completed in the United States, may be an important factor, the family hopes, in all deliberations! Why this boy was brought first, was not clear. This time the examination proceeded as follows: Twenty to one: Failed. The months? Not known. (This is, of course, often true in normal cases.) Digits: Failed. If 5:7:9 were given, the boy would say 9. The imbecile form board: Correct this time on repetition. Failed the day before. Knox cubes: Absolutely at a loss. After 4 repetitions of a simple series (of 3) he finally did it once. But could not do 6 7 or anything beyond. Morning or afternoon? Answered "Afternoon." Why did he say "Afternoon?" Answered "Because I have eaten." Aesthetic card (Binet): 1 Right. Seemed to point as happened. Weights (Binet): No idea. Watch? Knew name. Time? Did not know. How many legs has a dog? Correct. How many legs have both? "Six." Was it the same as a horse? Yes. Well how is it different? "A cow has two horns." Then, "A cow has eyes and a horse has eyes." |