Regulations for the mental examination of aliens are given in sections 24-61 of Miscellaneous Publications No. 5.[superior 1] The procedure to be followed at the different ports will depend in great measure upon local conditions. That followed at Ellis Island, through which seven-tenths of all immigrants pass, will be found in detail in Reprint No. 398 from the Public Health Reports.[superior 2] It appears desirable to consider some points not touched upon in these two publications in regard to the signs to be detected at the primary inspection.
The ideal method of detecting mental irregularities would to subject each individual to careful examination and more or less prolonged observation. Unfortunately the volume of work which must be performed in a given time and other circumstances usually preclude such a course, and the method used must be that of attempting rapidly to select from the total number those individuals whom it is thought may have some mental defect. These are then held for a more careful examination and, under certain circumstances, for prolonged observation.
This primary medical examination represents, of course, the first contact with the alien, and is of supreme importance. It is, indeed, the critical point. Once it is passed and the immigrant allowed to go his way, he will never again be seen, unless he be apprehended and returned by municipal or State authorities.
The detection of insane persons at the primary examination will, of course, depend to some extent on such circumstances as the type of insanity and the stage of the disease. Evidently certain types which do not show mental deterioration or physical
[footnote][superior 1] "Regulations governing the Medical Inspection of Aliens," Public Health Service, 1917.
[superior 2] May 18, 1917.