Under the Microscope focuses on the medical theories and policies that impacted U.S. Pacific Coast immigration enforcement in the early 20th century. When contemplating past and present health regulations and protocols, underlying questions about responsibility, compassion, control, and safety arise. Under the Microscope is located in the hospital’s historic medical suite. Below are several topics discussed in this exhibit.
DOCTOR’S OFFICE
From 1910 to 1940, this room served as office space for doctors. Because the hospital’s architect did not adequately plan to accommodate staff in the building, this area was also used as a bedroom for hospital attendants at times.
Learn more about the hospital in the Road to Restoration gallery.
DISPENSARY AND LABORATORY
This room was originally intended as a dispensary for storing and preparing medications. Until an addition was built to house a laboratory, doctors also used this space as a lab where they examined blood and stool samples. Experiments were likely conducted here as well, and doctors sometimes used patients as test subjects.
OPERATING ROOM
This room was historically used as a surgery facility. Its large bay windows reflect the early 20th century belief that light played a vital role in health and healing. The walls are curved at the ceiling, a design once thought to prevent germs from collecting in the corners. Unfortunately, historical records leave few clues about the types of procedures that were performed here.
An immigrant inspection is conducted on board a ship. San Francisco, 1931. Courtesy National Archives, D.C.
On-board inspections, line inspections, and bacterial exams were used to assess the health of immigrants arriving on the Pacific Coast during the first part of the 20th century. These medical evaluations impacted whether or not immigrants were allowed to enter the country. Screening practices shifted as new research emerged and as policies and public opinion changed.
ON-BOARD INSPECTIONS
Initial inspections took place on board arriving ships to ensure immigrants were physically fit and legally admissible. First-class passengers, who were mostly white and wealthy, were given hasty exams in the privacy of their rooms—and were then allowed to land in the US.
LINE INSPECTIONS
Most second- and third-class passengers were taken to Angel Island for further inspection. These line inspections were conducted to detect excludable diseases and physical or mental “defects.” Immigrants were instructed to line up beside one another and had little to no privacy.
BACTERIAL EXAMINATIONS
Doctors collected blood and stool samples from certain detained immigrants—mostly Asians. Such samples were examined under a microscope to detect parasitic diseases that were classified as “dangerously contagious.”
Medical policy often reflected an evolving understanding of diseases as well as racist ideas about specific immigrant groups. Additionally, medical policy was used to justify certain immigrants’ exclusion from the US. Over time, emerging medical research, community protests, and changes in public opinion led to new medical screening policies.
DIFFERING VIEWS ON TRACHOMA
Immigration officials sometimes struggled to agree on which diseases should be considered dangerous. Trachoma, a bacterial infection of the eye that can cause blindness, was classified as a “dangerous contagious disease” by the Public Health and Marine Hospital Service (later referred to as the Public Health Service).
But Dr. M. W. Glover, a Passed Assistant Surgeon at the Angel Island immigration station, argued that the danger of trachoma contagion was overestimated.
Dr. F. E. Trotter, also a Passed Assistant Surgeon at Angel Island, was not convinced. He observed that trachoma was contagious, noting cases increased when people gathered indoors to avoid cold, wet weather. Trachoma is now known to be spread easily through personal contact, especially in crowded or unsanitary living conditions. In the early 1900s, it was common practice for officials to use the same buttonhook (an eye examination tool) on several patients without sterilization, thereby potentially spreading the disease.
“ORIENTALS” UNFAIRLY SINGLED OUT?
Dr. M. W. Glover oversaw medical screening at the Angel Island immigration station shortly after it opened in 1910. Using the hospital dispensary as a makeshift research laboratory, he experimented on hospital patients without their consent. He found that many immigrants arriving from present-day India and Pakistan were infected with hookworm. A 1910 newspaper article praised this discovery as a way to stop the “most undesirable” migration of immigrants from Asia.
Dr. Glover distanced himself from the sensationalism of the article. Noting that Asian immigrants at Angel Island were subject to more severe examinations and restrictions than at other Pacific Coast ports, he advocated for uniform screening of “Orientals” at all Pacific Coast points of entry—to prevent the Public Health Service from receiving criticism.
By 1911, hookworm, a parasite, replaced trachoma as the top reason for medical exclusion. Today, hookworm and trachoma are treatable and are not considered barriers to immigration.
HOOKWORM MEDIA STORM
In 1917, the Public Health Service (PHS) changed the classification of hookworm, or uncinariasis, from class A (a “loathsome and dangerous contagious disease”) to class B (a disease affecting an immigrant’s ability to earn a living). This meant it was no longer mandatory to exclude immigrants with hookworm. If inspectors determined an immigrant with hookworm was capable of working despite the parasite, the individual was allowed to enter the country.
In response to the reclassification, San Francisco Commissioner of Immigration Edward White ordered officials at the Angel Island immigration station to end the practice of automatically excluding applicants infected with the parasite.
Dr. W. C. Billings, the chief medical officer stationed at San Francisco, challenged the shift in policy. He argued that hookworm was contagious and should disqualify immigrants from entering the country. The debate between Billings and White flared into a public dispute in the local press.
DEFENDING THE MARGINALIZED
The Chinese Consolidated Benevolent Association (CCBA) was founded in San Francisco in 1882 by immigrants wishing to protect their community from discrimination. The organization advocated for the equal treatment of Chinese immigrants, who were typically singled out by medical examiners to be tested for parasitic infections like hookworm. Immigrants who were found to have hookworm were required to stay in the hospital for treatment until they showed no signs of infection—even after hookworm was removed from the list of dangerous contagious diseases.
In a 1922 appeal to President Warren G. Harding, CCBA described immigrants being detained in intolerable conditions for up to 40 days, held at their own “great expense.” Officials dismissed the complaint, attributing the longer treatment times to changes in medical standards.
In the hospital at the Angel Island Immigration Station, doctors examine Chinese men and boys for trachoma. It is believed this photo may have been partially staged. (Immigrants had to completely undress for actual medical exams.) Angel Island, California. Circa 1910-1940. Courtesy National Archives, D.C.
In the 1800s, deadly outbreaks of cholera, smallpox, and bubonic plague sparked widespread fear. Public health officials, scientists, and doctors began researching the causes of these epidemics. They developed ways to save lives and slow the spread of disease.
As the first federal immigration laws were established in the US, some policies were implemented under the guise of protecting the health of Americans. These policies were often used to discriminate against certain nationalities and classes of people—and sickness was seen as an avoidable flaw.
At the Angel Island immigration station, scientists and administrators dubbed germs “the most democratic creatures in the world.” They believed they could use science as a tool to screen immigrants objectively, regardless of skin color or social status. However, not all immigrants underwent the same types of exams, and certain groups were subject to additional scrutiny.
Immigrants were also evaluated based on their perceived fitness and wealth. They were excluded from the US if they were labeled a “likely public charge” (LPC), which meant they were considered to be a current or future economic burden to the country.
Some immigrants were ruled LPCs because of “physical defects.” Single women were often seen as “moral risks” and then deemed LPCs as a result. In many cases, LPCs were admitted into the US if they could post a $500 public charge bond. Those who could not afford to pay faced deportation.
LETTER FROM DR. GLOVER
April 9, 1910
In this letter to the Commissioner-General of Immigration, Dr. Glover outlines his concerns for the immigration station after opening three months prior.
LETTER FROM DR. GLOVER
November 7, 1910
Dr. Glover describes the role of the immigration station hospital to the Surgeon-General of the U.S. Public Health and Marine-Hospital Service.
REPORT OF MEDICAL INSPECTIONS, YEAR ONE
June 30, 1911
This is the first annual report submitted for the immigration station hospital, describing the diagnoses and treatments administered.
LETTER FROM DR. GLOVER
September 20, 1911
In a letter to the Angel Island Commissioner of Immigration, Dr. Glover addresses his concerns for the sanitation on the island.