the examining surgeon as being mentally or physically defective, such physical defect being of a nature which may affect the ability of such alien to earn a living.. . Section 16 of the Immigration Act of 1917, as amended (8 U. S. C. 152), provides: That the physical and mental examination of all arriving aliens shall be made by medical officers of the United States Public Health Service who shall conduct all medical examinations and shall certify, for the information of the immigration officers and the boards of special inquiry hereinafter provided for, any and all physical and mental defects or diseases observed by said medical officers in any such alien; or, should medical officers of the United States Public Health Service be not available, civil surgeons of not less than 4 years' professional experience may be employed in such emergency for such service upon such terms as may be prescribed by the Commissioner of Immigration and Naturalization, under the direction or with the approval of the Attorney General. All aliens arriving at ports of the United States shall be examined by not less than two such medical officers at the discretion of the Attorney General, and under such administrative regulations as he may prescribe and under medical regulations prepared by the Surgeon General of the United States Public Health Service. Medical officers of the United States Public Health Service who have had especial training in the diagnosis of insanity and mental defects shall be detailed for duty or employed at all ports of entry designated by the Attorney General, and such medical officers shall be provided with suitable facilities for the detention and examination of all arriving aliens in whom insanity or mental defect is suspected, and the services of interpreters shall be provided for such examination. Any alien certified for insanity or mental defect may appeal to the board of medical officers of the United States Public Health Service, which shall be convened by the Surgeon General of the United States Public Health Service, and said alien may introduce before such board one expert medical witness at his own cost and expense. The same act provides that the Federal Security Administrator, upon the request of the Commissioner of Immigration and Naturalization, approved by the Attorney General, may detail officers of the Public Health Service for the performance of duties in foreign countries in connection with the enforcement of the immigration laws. 『*་ The Immigration Act of 1924 sets up a system of immigration quotas and provides for the issuance of immigration visas by consular officers abroad. No immigration visa may be issued if the consular officer knows or has reason to believe that the alien is inadmissible under the immigration laws. Under regu lations of the Department of State all applicants for immigration visas are required to undergo a physical and mental examination. At consular offices at which medical officers of the Public Health Service are stationed, the examinations are conducted by such officers. Admissibility to the United States is not assured for aliens who have been found free from excludable conditions by such examinations, inasmuch as an alien to whom a visa has been issued is not entitled to enter the United States if he is found, upon arrival, to be inadmissible under the immigration laws.. It is important for the examining physicians to bear in mind that the medical examination of aliens constitutes a step in a legal procedure having for its purpose, generally, the determination of whether an alien is or is not admissible to the United States. This decision is made by the immigration authorities. However, the report of the results of the medical examination, made as required by law, constitutes a part of the official record of the legal procedure. That procedure may include a hearing by a board of special inquiry, and review by the Board of Immigration Appeals, the Attorney General, and the courts. Proceedings before boards of special inquiry, although administrative rather than judicial in nature, are subject to the requirements of fair hearing and other legal safeguards. The conduct of the medical examination and the manner of reporting the results therefore must be in accord with the provisions of the immigration laws and the medical regulations issued by the Service under the authority of the immigration laws and the Public Health Service Act. Conclusions reported should be based on demonstrable medical facts in accordance with standard medical practice. The responsibility of the examining physicians is particularly serious in the case of the mental aspects of the examination. The law makes the decision of a board of special inquiry, based on the certificate of the examining medical officer, final as to the rejection of aliens afflicted with tuberculosis or with a loathsome or dangerous contagious disease, or with any mental or physical disability which would bring them within any of the excluded classes. Discretion rests in the Attorney General, however, under certain circumstances to admit, for permanent residence, aliens liable to be excluded because of physical disability other than tuberculosis or a loathsome or dangerous contagious disease. No such discretion is provided with respect to aliens liable to be excluded because of mental disability. Prior to the Immigration Act of 1917 this discretion had extended to mental as well as physical defects. The following excerpt from the report of the Senate committee concerning this change is illuminating as to the reasons for making mandatory the exclusion of mental defectives: The reasons for excluding a physically defective alien are likelihood of his becoming a public charge and inability by his own exertions to care for himself and those dependent upon him, while the real object of excluding the mentally defective is to prevent the introduction into the country of strains of mental defect that may continue and multiply through succeeding generations, irrespective of the immediate effect thereof on earning capacity. This change was made after consultation with persons of knowledge and experience, and is in line with the well established public policy of rigidly excluding the mentally deficient. It is the duty of the examining physicians to perform medical examinations that are sufficiently complete to establish whether or not the alien falls within one of the categories excludable under the immigration laws. In the usual medical examination the physician depends to a large extent upon an accurate medical history of the individual. This may be difficult to obtain in immigration work, because the alien and his family and friends may be loath to admit the existence of any abnormality. This will tend to limit the completeness and effectiveness of a medical examination and must be compensated for as far as possible by astute observations and the diligent investigation of any leads which the examining physicians may uncover. Examinations must be impartially performed; medical officers shall not be influenced by any consequence of enforcement of the law and regulations. Officers shall carefully check identification data in documents or other materials presented by aliens who are examined or inspected, to detect any attempted substitution of persons or papers. In the discharge of their duties officers come in contact with foreign persons who are of varying social attainments and who often speak only a foreign language. Officers should, of course, by their appearance and conduct maintain the dignity of their Government. This implies neatness in personal appearance; tact; courteous firmness in deportment; and consideration of the feelings of others. Comments on this manual are invited, and should be addressed to: The Surgeon General, Public Health Service, Attention: Division of Foreign Quarantine. June 1, 1950. G. L. DUNNAHOO, Medical Director, ix |