Immigration and Disease

SCIENCE – Learn about disease during the age of immigration to the United States.

Immigration and Disease
Photo courtesy of the Library of Congress.

Learning Objective

Use evidence constructed from information from various formats to answer questions, formulate an opinion, and discuss. Scroll to the bottom to find extension activities, additional resources, and Education Standards.

Time needed for implementation: 2 class periods

Beginning- Expert Input: (15 Minutes)

The teacher will introduce the topic of immigration and disease by conducting a discussion and analysis of this primary source from the Library of Congress where an immigration inspector is examining an immigrant.

Teachers need to be culturally sensitive to students who may know immigrants, have family members who are immigrants, or be immigrants themselves.

The beginning of this lesson should emphasize:

  1. Most people around the world do not have contagious diseases and many people in our own country do (e.g. the flu).
  2. We do not need to be afraid of people who are sick because we know how to avoid the spread of diseases and can successfully cure many diseases that could not be cured in the past.
“Leaving Italy for a Better Life,” Oil painting by R. Gambogi, 1890s.

Middle- Task: (50 Minutes)

Students will read the article and interact with the other resources located below these instructions. You can download a pdf of the article to pass out to your students. Students will then complete this Sutori activity.

Next, students will locate (either on the SSHSA website, the Library of Congress, or National Archives) a pertinent primary source that they will upload to Thinglink and create an interactive information source related to the topic using the primary source.

End- Evaluation & Reflection: (15 Minutes)

The teacher will end the activity with a discussion using the discussion questions listed below.

  1. What was the examination procedure like for different classes of immigrants when they arrived at Ellis Island?
  2. Explain the thought behind the rigorous exams for steerage passengers. How does this compare to first-class and why would these passengers have fewer inspections?

Or download the student assessment worksheet with more detailed free response questions.

Article & Resources for Students

By 1870, more than 90 percent of immigrants to America arrived by steamship, most to Ellis Island in New York. Ellis Island was opened January 1, 1892, and was the busiest immigrant inspection station for over 60 years from 1892 until 1954 in the United States.

Steamship companies relied on the immigrant trade as their main source of income into the 1920s. These companies had to inspect their passengers for diseases. Before leaving European ports, the companies had to vaccinate, disinfect, and determine the health of the ships occupants. But often these examinations were superficial.

A physician for the U.S. Marine Hospital Service inspected first and second-class passengers who arrived in New York in the privacy of their cabins. The government believed that these more affluent passengers would not end up in institutions, hospitals, or become a burden to the state because they were more affluent, better fed, and therefore generally healthier than the steerage passengers. On occasion, first and second class passengers had to go to Ellis Island for further inspection because of illness or legal problems.

First and second-class passengers would disembark, pass through Customs at the piers, and enter the U.S. But steerage passengers had to undergo a medical and legal inspection on Ellis Island.

The experience of arriving in America was far different for steerage or third-class passengers. On board, a superficial inspection to check for outbreaks of cholera, smallpox, typhus, or yellow fever occurred. Immigrants in steerage traveled across the ocean below the waterline of the ships. It was crowded and could be unsanitary and unhealthy. Atlantic Ocean crossings, which could last up to two weeks, could be rough, and often left all passengers sea-sick. Arriving in New York City, ships would dock at the Hudson or East River piers.

Ships carrying passengers with contagious diseases were quarantined and flew a yellow flag at their masthead. Authorities then took those passengers to contagion hospitals on Hoffman and Swinburne islands.

Photo courtesy of the Library of Congress.

The Inspection

Once they left Ellis Island, immigrants entered the main building where authorities inspected their bags. Then the new arrivals walked up a stairway to the first in a series of medical inspections. Public Health doctors watched as the immigrants climbed the stairs, looking for signs of wheezing, coughing, or limping, which might have indicated health problems.

In the Registry Hall, an inspector stamped the immigrant’s health inspection card. As the immigrant read what was on the card, doctors looked to see if they revealed any eye problems.

“Beware of the eye man.” The second medical inspection was well known to many immigrants before they event left home. This painful exam checked for trachoma, a highly contagious disease that caused blindness. Officials immediately deported anyone found with trachoma.

Men and women were segregated for inspection, and female doctors and nurses examined the women. By 1924, the Public Health Service had four female physicians on duty. After completing the exams, immigrants waited until their names were called so that they might leave or be taken to another facility.

Ellis Island had its own hospital, contagious disease ward, mental health ward, autopsy theatre, morgue, and crematory. In 1911, physicians examined nearly 750,000 immigrants. Of these, almost 17,000 had physical or mental health problems, which included 1,363 with loathsome or dangerous contagious diseases and 1,167 who had trachoma. Loathsome contagious diseases included favus (scalp and nail fungus), syphilis, gonorrhea, and leprosy. Dangerous contagious diseases included trachoma and pulmonary tuberculosis. During Ellis Island’s history, more than 3,500 immigrants died on the Island, including 1,400 children and more than 350 babies were born.

Additional Resources

This 2007 film discusses the immigrant experience in the hospitals at Ellis Island. It aired on PBS and is played at the Ellis Island Great Hall Museum. (55 min runtime).

Other Lesson Plans and Unit Plans

Learning Activities

Other Resources

The NOVA episode, The Most Dangerous Woman in America tracks the epidemiology of Typhoid Fever and the asymptomatic household worker who inadvertently spread it throughout families in New York. This is an extension of the current lesson because it also discusses history, but focuses on disease spreading and epidemiology. View the NOVA episode resources. The teacher guide is currently not available on the NOVA site. The video is also not available at the PBS site, but several copies are available on YouTube. Check out an example of curriculum and lesson plan built around this story. Several sites have teacher worksheets related to the episode. Here are examples:

·  Typhoid Fever Student Worksheet

·  Typhoid Fever Teacher Answers

·  Typhoid Mary Teacher Answers

·  Typhoid Mary Student Worksheet

Dr. Howard Markel, “Before Ebola, Ellis Island’s terrifying medical inspections,” PBS Newshour, October 15, 2014.

New York City History: Ellis Island provides information and links to many other resources about Ellis Island and genealogy.

Learn about the history of quarantine from the CDC.

Sharon DeBartolo Carmack, Guide to Finding Your Ellis Island Ancestors (Cincinnati: Family Tree Books, 2005).

See also: Alan M. Kraut, Silent Travelers: Germs, Genes, and the ‘Immigrant Menace’ (New York: Basic Books, 1994).

A detailed set of standards for the teaching of epidemiology at the high school level are formulated in a report by the Centers for Disease Control,  Epidemiology and Public Health Science: Core Competencies for High School Students (2015) by Kelly L. Cordeira and Ralph Cordell.

Ellis Island Oral Histories – Since 1973, the National Park Service has interviewed more than 1,700 Ellis Island immigrants so that they could tell their own stories.

Immigration and Disease
Image courtesy of the Library of Congress.

Measles Ward G, constructed in 1907, is one of 11 individual treatment wards in the contagious disease hospital complex on Island 3. One of eight wards designated as measles treatment buildings, these buildings also housed patients with scarlet fever, diphtheria, pneumonia and whooping cough. Like the other seven measles wards in the contagious disease complex, Ward G was built from a single, standardized design and arranged in a pavilion plan – a wing and corridor form popular for hospitals since the nineteenth century. The plan isolated contagious patients from those in the main hospital. It also helped prevent the spread of disease among patients with other infectious illnesses.

Ward G’s architectural styling, along with its materials and finishes, integrates it with the other buildings within the hospital complex to form a cohesive design unit. Ward G and its sister wards are the largest and most significant group of buildings within the contagious disease hospital complex.

Immigration and Disease
Child with measles in tent home of his migrant parents in Edinburg, Texas, 1939. Photo courtesy of the Library of Congress.

Education Standards

Next Generation Science Standards (NGSS)

Grade Bands

Life Science Content Standard

No specific standard
HS-LS2-8. Evaluate evidence for the role of group behavior on individual and species’ chances to survive and reproduce.

Cross-cutting concept

Cause and effect: Mechanism and explanation. Systems and system models

Science Practices
Asking questions (for science) and defining problems (for engineering). Obtaining, evaluating, and communicating information

National Health Education Standards

1.12.5 Propose ways to reduce or prevent injuries and health problems.

2.12.10 Analyze how public health policies and government regulations can influence health promotion and disease prevention

Common Core State Standards (CCSS)

Grade Bands

Reading Informational Texts
Literacy in History/Social Studies, Science, and Technical Subjects

RI.3 Relationships and connections in historical, scientific, and technical texts.
RI.7 Analyze information presented using different media
RHST.6-8.2  Determine the central ideas or information of a primary or secondary source; provide an accurate summary of the source distinct from prior knowledge or opinions.
WHST.6-8.7  Conduct short research projects to answer a question (including a self-generated question), drawing on several sources and generating additional related, focused questions that allow for multiple avenues of exploration.

RHST.9-10.2  Determine the central ideas or information of a primary or secondary source; provide an accurate summary of how key events or ideas develop over the course of the text.
RHST.11-12.2  Determine the central ideas or information of a primary or secondary source; provide an accurate summary that makes clear the relationships among the key details and ideas.
WHST.7  Conduct short as well as more sustained research projects to answer a question (including a self-generated question) or solve a problem; narrow or broaden the inquiry when appropriate; synthesize multiple sources on the subject, demonstrating understanding of the subject under investigation.

National School Library Standards – AASL

I.B. Learners engage with new knowledge by following a process that includes:
1. Using evidence to investigate questions

II.C. Learners exhibit empathy with and tolerance for diverse ideas by:
1. Engaging in informed conversation and active debate.
2. Contributing to discussions in which multiple viewpoints on a topic are expressed.

IV.C. Learners exchange information resources within and beyond their learning community
1. Accessing and evaluating collaboratively constructed information sites
3. Joining with others to compare and contrast information derived from collaboratively constructed information sites

V1.A. Learners follow ethical and legal guidelines for gathering and using information by:
1. Responsibly applying information, technology, and media to learning..
3. Evaluating information for accuracy, validity, social and cultural context, and appropriateness for need.

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