Twelve million people passed through the Ellis Island, New York’s immigration station between 1892 and 1954. Before entering the United States, third-class passengers underwent a visual medical inspection by officers of the United States Public Health Service. The woman in the image above is having her eyes checked for

, a highly contagious disease, by doctor who is

. The physicians looked for signs of contagious diseases as well as mental and physical disabilities.

Most immigrants passed inspection and went on their way to making new lives in the United States. Those determined to need additional examination had their clothing marked with chalk. They were sent for further investigation of their mental status and physical health. Some were diagnosed with a treatable condition and sent to the hospital on the island. A small percentage of would-be immigrants were sent home.

There have been many changes to our immigration laws over the past centuries. They reflected a concern about contagious illnesses and the need to protect the public's health but also, at times, prejudicial views of foreigners rather than legitimate public health interests. Over time the laws became more specific in terms of diseases that exclude entrance into the U.S. The laws also changed to reflect advances in medicine, such a growing list of vaccinations required prior to entering the country.

The 1891 Immigration Act, in effect when Ellis Island opened, excluded “all idiots, insane persons, paupers, or persons likely to become a public charge,” as well as those with “loathsome diseases.” It also excluded entry to felons, polygamists, and those whose tickets were bought by others (as a way of avoiding contract labor). The 1917 Immigration Act made the list of exclusions more specific and excluded the mentally or physically defective, the insane, alcoholics, and persons with epilepsy, tuberculosis, or contagious diseases. The protocol changed after the 1924 immigration law, which instituted a visa system, and it has changed many times since then. (A detailed history of immigration laws and information about the United States Customs and Immigration Service is here.)

Medical screening of those seeking permanent or temporary residency in the U.S. continues to this day. Applicants must pass a medical examination and meet the vaccine requirements. The list of communicable diseases that can lead to exclusion includes tuberculosis, syphilis, Hansen’s disease (leprosy), and a few others as well as any diseases designated by presidential order and those listed as part of an international public health emergency; AIDS was on the list from early in the epidemic until a few years ago. Exceptions to exclusion can be made out of national interest or to reunite families.

The rich history of immigration and public health can be explored by visiting Ellis Island. Reopened after sustaining severe damage during Hurricane Sandy in 2012, Ellis Island is free to visitors as part of the National Public Health Service. Getting to the Island requires a paid boat ride, however, from either New Jersey’s Liberty State Park or Battery Park in New York City.

The hospital and the contagious disease wards, where sick immigrants were sent for care, are now decaying and await restoration. But the Immigration Museum, which is almost fully restored and open to visitors, offers a compelling look at the history of the immigrants who passed through Ellis Island, those who worked there, and the public health inspections and medical care that were part of its long history. There is a special exhibit designed for children, too. The main website for Ellis Island includes links to online exhibits and information you may want to view before visiting. Other videos about the history of Ellis Island and about its hospital can be found online.

There are, as well, a number of books about the history of Ellis Island and about the history of immigrants and public health. As Penn science historian David Barnes wrote recently in this space, the Lazaretto in Philadelphia played a key role early in this country's early history. ; the Lazaretto doesn't have the level of financial support that Ellis Island does, but you can take a video tour with Barnes.

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