(1) A physical examination to record physical defects or to group any stygmata of degeneration that may be present. (2) A mental examination to determine the alien's constructive imagination, intellectual capacity, or mental aberration. While dense ignorance must not be confounded with feeble-mindedness, there are sometimes cases in which dense ignorance is a sign of defect in itself, when the person is unable to learn although given an opportunity. The detection of the high-grade defective is a subject requiring special care. It is recognized by most authorities that many of the high-grade types can only be detected by more or less longcontinued observation and can not be detected by the usual educational or artificial tests in common use. These cases are skilled in many ways and clever in covering defects. If certified and appeals taken before the courts, they often make excellent showing. This is the type that is unreliable and from which a large percentage of the criminal classes derive their following. They often do excellent work at trades but experience has shown that they have to be watched, for their work is good only when under supervision, and if left to themselves soon follow the line of least resistance. The females of this type are easily led and undoubtedly form a large proportion of the women that live under the control of and furnish a living for a procurer. The low-grade type is easily detected as a rule, hence does not often elude the examiner of the steerage at the port of embarkation, but has been found from time to time in the cabin. Another factor to be guarded against is the natural instinct of relatives to give no information that may count against the weak member, hence it is necessary to catch the other members off their guard or by judicious questioning obtain through their ignorance important facts that would otherwise be lost. When parents are present any stigmata of degeneration in one or both are noted. Taking separate histories from several members individually and comparing results often has given valuable information. Investigation has shown in proof of the above statement that after landing and later seeking hospital aid the parents easily remembered and willingly gave information of the patient's past that had important bearing on its condition. When a suspected child is a member of a family of other children about the same age, comparison with the other children has been found of value. When it is considered that the alien may belong to an illiterate family for generations, never entered a school building, or had anyone undertake to teach him the simplest rudiments of that which is termed education, never saw a clock except on an occasional visit to the nearest village, and then never had a fair explanation of its mysteries, his occupation digging the soil with primitive implements or tending goats from daylight until dark—for this individual tests must be carefully selected. Two important rules are followed in every case: First that the alien is examined in a quiet room, as much at ease as possible; second, an interpreter is selected who speaks the dialect of the suspect to avoid any misunderstanding, and the interpreter instructed to put the questions and repeat the answers exactly as given in order that the stenographer present may get any irrevelant answers recorded. If the suspect is a child the parents' statements are taken as to the details of its early history. Record is made as to age of cutting teeth, walking, talking, investigation for evidence of fits, convulsions, headaches, injuries, nature of birth, operations, prenatal accidents, precociousness, unusual temper, habits of eating, sleeping, and cleanliness. As much as possible of the above history is also taken from the suspect. The family history is traced for any mental types and note made of any signs of alcoholism, or venereal disease. Ability to read and write is tested, history of school attendance, progress made, and if illiterate, further information as to the reason is sought, as to whether the alien had a chance to go to a school, whether it was denied, whether it was given up because he did not learn, whether the parents were illiterate, and whether any outside means of teaching were sought. The nature of his occupation, whether in the city or country, and different periods of employment, have important bearing on the further examination. For instance, it is an aid to learn whether the alien was a farm laborer or a city mechanic, a wanderer through propensity to travel or inability to hold a situation. If married, the alien is questioned as to his family, their number, health, if not traveling with him why they were left behind. If a single adult, he is questioned as to his attitude toward women. With this background the examiner is enabled to have a good idea how the rest of the examination may be conducted, whether or not to avoid tests that require educational training. Estimation is made of reaction time, reasoning power, observation, comprehension, and constructive imagination by the following method: The recognition of simple objects, as thimble, cup, pencil, pen, sugar, salt, keys, coins, penknife, colors, numbers, and letters. Description of simple pictures, fitting together broken objects, and the use of modified apparatus after the plans of Healy, Goddard, and others. The ability of the alien to name the ship on which he arrived, to answer simple questions as to what he saw en route, the time and by what means he traveled from his home town to the port of embarkation, why he came, what ideas he may have as to future intentions, and his age, in connection with which to tell what his age was four years past and what it would be three years hence. Following this, his intellectual and moral judgment is brought out by his interpretations of sentences containing impossibilities or gross errors of fact-differences between right and wrong by the use of questions involving lying, stealing, and the proper course for one to pursue, after breaking, injuring, or losing something belonging to another. Home surroundings are added in order to make sure that the new scenes and questions have not confused the alien to the point of defective answers, but it is also taken into consideration that the defective brain is often very capable in memory of past experiences, quite accurate as to time and place, but it is of value to have this information to see if the alien can form new images from past associations; the normal can, but the defective fails. Questions as to daily duties, recognition of native coins and their value, characteristics of animals and their habits if the alien is from the country, if from the city descriptions of customs and use of appliances in trade. Ability to tell time, to tell something of the origin of various articles of wearing apparel, significance of the principal holidays in his home district, and testing desires by letter or oral request. The latter is of value in bringing out the logical or illogical wishes of the person. Testing by aid of simple numbers has been found useful, for among the illiterate the child automatically learns to recognize numbers and something of their values, while letters follow more as a matter of educational teaching. To those that have had school training more detailed examination after the method of Binet is used in connection with the general outline described. Racial viewpoints of life problems are so different that often considerable time and patience must be used before deciding in what class the individual belongs. Sometimes legal appeal taken cites that the alien certified is a fair standard of his race and while he may not compare well with certain other races he ought to be considered on his own racial standard. In these cases it should be considered that it is rather for the alien to conform to a standard for the protection of this country rather than for the United States to seek the standards of other races or people. Of course it may be fairly said that as yet no entirely satisfactory standard definition exists as to what constitutes the morone and different races having different degrees of intelligence. Nevertheless all races do have certain things in common, such as normal reaction to outside stimulation and coordination as shown in their ability to put past images in new combinations. The question of military service if of age is also investigated to see if the alien has served; been rejected, or discharged for some defect. Delusions, hallucinations, and illusions if suspected are sought for and traced until satisfactory evidence is offered of the sanity or insanity of the alien. It should always be borne in mind that in handling the large number of people and the limited time that can be given to each that some are sure to pass through, for the inspection is rather more of a sieve than a dam and it would be obviously unfair to write certificates on suspicion alone. In conclusion the procedure given and used at this station has been with the object of bringing out the fact whether or not the suspected alien has, in his existing social condition, the mental ability to assume normal relations with society in new environment. Friendly relations exist between the State institutions, State board of lunacy, and this station. This has resulted in interchange of ideas and visits of mutual benefit so that the State officials are familiar with conditions at this port and the efforts made to keep out the mental as well as the physical unfit. Attention should be called to the fact that the station is sadly cramped for room and badly in need of apparatus, modern books, and files of medical periodicals in order that the efficiency may be kept up. Name.. Birthplace. Occupation. Family history. [Chemical Research form in use at Boston, Mass.] U. S. PUBLIC HEALTH SERVICE, 19... Enlargement of liver...... | Enlargement of spleen.... | Gastroptosis.. Ascites... ABNORMALITIES OF NERVOUS AND MUSCULAR SYSTEM. Hernia.... (For full description of significant abnormalities found see detailed records of the case.) HONOLULU, HAWAII. Ten thousand five hundred and thirty aliens were examined on arrival; of these 2,772 were Spanish and Portuguese from Europe and the remaining 7,758 consisted principally of Chinese and Japanese; 10,037 were passed and 493 certified in accordance with the immigration laws and regulations. On January 1, 1913, the examination of arriving aliens for hookworm was begun, and in the period elapsing 28 aliens were found to be infected; of these, 21 were deported, 4 held and treated until cured, and 3 are pending at the close of the year. It has become quite a general practice for the surgeons of vessels carrying immigrants to administer thymol during the voyage; this was done on quite an extensive scale with the Spanish and Portu guese immigrants arriving from Europe, and to a lesser extent with aliens from the Orient. It is questionable whether the administration of thymol to immigrants just previous to arrival is either a safe or suitable routine measure, for the reason that it is believed the drug so stupefies the worm for a few days that no eggs are laid, thus rendering the stool examination probably negative. MANILA, P. I. The number of arriving immigrants inspected increased from 3,132 last year to 6,581 this year. The arrivals by port were as follows: Manila, 5,312; Iloilo, 439; Cebu, 114; Jolo, 326; Zamboanga, 390. The rejections were among the following nationalities: Chinese, 15; East Indians, 52; Japanese, 58; Spaniards, 1; Turks, 1. At the immigrant medical inspection made at the various ports of the islands the arriving aliens examined were classed as follows: 4,037 Mexican.... Chinese.. 1 25 4 8 34 276 5 2 24 6 6, 581 This is the first year that uncinariasis was classified as an excludable disease. There were in all 5,271 examinations made for hookworm of aliens and steerage passengers; of these 388 resulted positively. There were 84 cases of hookworm treated, all of which were negative to subsequent tests except 4, and these were certified and deported. The percentage of hookworm infection by nationality was follows: as The largest percentage of rejections is still due to trachoma. The number from this cause during the year being 90, or 71 per cent of the total rejections, with 83 deportations. The percentage of rejections for all causes was 1.93 per cent, of which 106, or 1.6 per cent of the total arrivals, were deported; and while this percentage is lower than last year, it is believed that it is still a higher percentage of rejections and deportations than is made at the several ports of the United States. |