Recent Government statistics show the extent of the burden imposed upon the State of New York from the influx of undesirable immigrants pouring into this country through Ellis Island. With the addition of from 1,000,000 to 1,250,000 immigrants annually and with 30 per cent of this number declaring it to be their intention to permanently settle in the State of New York, it can be easily understood that, recruited, as many of these immigrants are, from the poorest sections of Europe, the already large number of defectives in this State is sure to be markedly augmented. It is the imperative duty of the State authorities to provide the necessary means, by inspection at the port of New York, as well as at the different institutions for the insane, to minimize this evil. The commission [the State commission in lunacy], with the aid afforded it by the legislature in providing a State board of examining alienists in the city of New York, has already accomplished a great deal, but without further restrictions, to be imposed by the United States Department of Commerce and Labor and a stricter interpretation of existing statutes, it is doubtful if any considerable relief from present conditions can be expected.

Nevertheless a great step forward was taken by the national authorities in the enactment of the immigration law of 1907 * * *.

In the report of the New York State Board of Alienists for the year ending September 30, 1906, the following statements appear: "

a

We found that many of those [immigrants] coming under observation after landing were not obviously insane while at Ellis Island, but were then in the early stages of the disease, which became well developed in a few months. The average residence before they became public charges was nine months.

The quality of those sent back [because of mental diseases or defects] is thus shown: Of the last 100 deported we found that 16 had been insane in Europe, 45 had developed symptoms of insanity prior to landing, 15 were "always queer," 15 were of low order mentally and prone to the deterioration which came on at once after landing, and the history of 5 showed insanity in near members of the family and mental instability on the part of the aliens.

It is impossible to determine, from the data available, how large a proportion of the aliens admitted to the United States are of the classes of mentally deranged and defective expressly excluded by the provisions of the immigration law. Numbers of immigrants who never develop, in this country, insanity or other mental defects to a degree which brings them to the attention of the authorities, might doubtless have been excluded from the country, had all circumstances been known, for such causes as prior insanity or epilepsy. Upon the other hand, it is probable that many aliens, mentally entirely normal before coming to the United States, become insane at some time subsequent to their arrival. The exact period at which an insane person became insane or exhibited the first recognizable symptoms of mental disease is, in many instances, unascertainable. It is, however, evident that the period of time elapsing between an alien's arrival in the United States and the date of his insanity has a certain bearing upon this subject.

In a passage from the report of the New York State Board of Alienists, already quoted, it is stated that "the average residence. before they [insane persons or defectives] became public charges was nine months." Detailed information as to the length of residence in the United States of insane persons detained in the New York City hospitals known as Bellevue and Allied Hospitals, is afforded by the original data secured by the Immigration Commission. These data are presented in the table following.

a Report of New York State Board of Alienists for the year ending Sept. 30, 1906. Published in the Annual Report of New York State Commission in Lunacy for the year ending Sept. 30, 1906, pp. 52 and 53.

See Immigrants in Charity Hospitals, pp. 253 to 290 of this volume.

TABLE 15.-Foreign-born persons in the United States less than three years who were received at Bellevue and Allied Hospitals, New York City, for treatment for insanity, August 1, 1908, to February 28, 1909.

Foreign-born insane in the United States less than 3 years, by period of residence:
Under 6 months..

It appears from this table that of the 941 foreign-born insane persons reported in the hospitals, 158, or 16.8 per cent, had been in the United States less than three years. Only 2.2 per cent of all the alien insane had been in the country under six months, and only 2.1 per cent had been here between six months and one year. Insane persons who had been in the United States one year but less than two years constituted 6.9 per cent, and insane persons who had been here two but less than three years, 5.5 per cent, of the total foreignborn insane. The proportion of insane persons found in the hospitals after a relatively short period of residence in the United States, as recorded in the above table, does not appear unduly large.

The figures of the preceding table, whatever their apparent indication, are by no means conclusive as to the mental condition, at the time of entering the United States, of immigrants afterwards found insane. An alien who becomes violently insane within three months or six months after his arrival may very well have been entirely normal when examined by the immigration officials.

As has been shown, many aliens are excluded from the country each year because of mental unsoundness. It seems certain that the inspection of immigrants results in the enforcement of the provisions of the law in practically all cases in which insanity or other mental defects are at all obvious or pronounced, and in many less obvious cases as well. Under the conditions attending the disembarkation of immigrants at the ports of entry, an absolutely complete and errorless enforcement of the law is probably impossible. Nothing could possibly prevent the admission of some insane aliens except the obviously impossible requirement of detaining every arriving alien for observation for a considerable period.

RACIAL OR NATIONAL TENDENCIES.

The high ratio of insanity prevailing among foreign-born persons in the United States may be due, in a measure at least, to racial or national tendencies.

Data showing the number of insane and the ratio of insanity in the principal European countries and in Canada are afforded by the special report of the Census Bureau. These data, together with like data for the United States, obtained from the same source, are presented in the table following.

TABLE 16.-Number and ratio of insane in United States and in foreign countries.

[Compiled from U. S. Census, Special Report, "Insane and feeble-minded in hospitals and institutions,

1904," pp. 9 and 10.]

This table shows that the proportion of insane in hospitals in the years for which data were secured was higher in England and Wales, Scotland, Ireland, Canada, Germany, and Switzerland than in the United States, and lower in France, Italy, Austria, Hungary, the Netherlands, Norway, Sweden, and Denmark than in the United States. Of the foreign countries for which information is given in the table, Ireland, Scotland, and England and Wales have, in the order mentioned, the largest, and Hungary and Austria the smallest, number of insane in hospitals to each 100,000 of the general population. It will be noted that the ratio of insane in Ireland is much larger than in Scotland, the country having the second largest ratio, and that the ratio reported for Hungary is much smaller than that reported for any other country. Data relative to the total number of insane persons are presented for only seven countries, including the United States. The fact that the figures for the United States show a number of insane in hospitals larger than the total number of insane is, of course, due to the securing of data at different periods. The most recent statistics indicating the total number of insane are for 1890, while the insane in hospitals were enumerated on December 31, 1903. Of the countries for which the figures are given, Canada, Norway, and Denmark had, in the years in which the data were secured, a larger number of insane for each 100,000 of the general population than had the United States in 1890. In Austria, Hungary, and Sweden, on the other hand, the ratio of insanity was lower than in the United States.

In the census report the insanity statistics for foreign countries are discussed as follows:"

The latest available statistics of most countries outside of the United States point to steadily advancing ratios of the insane. It is difficult, however, to establish conclusively whether the advance in ratios is due to an actual increase in insanity, to

@U. S. Census, Special Report, "Insane and feeble-minded in hospitals and institutions, 1904," pp. 10 and 11.

a greater accuracy in the enumeration, or to enlarged and improved institutional facilities for the care of the insane, which always tend to an increased use of hospitals by persons who are not compelled to seek public aid. The weight of authoritative opinion appears to support the view of an actual increase in insanity. At all events the ratios of the insane, whether measured solely by the number in hospitals or with the addition of those found outside of institutions, have increased during recent years in all countries for which reliable returns are at hand. * * *

The returns for England and Wales are of all "notified lunatics." The figures for Ireland do not include the insane in private dwellings except a few single chancery cases. In the number shown for Scotland are counted "inmates of training schools and the lunatic department of the general prison.'

The 12,819 insane in Canadian hospitals represent the total treated during the year in public hospitals. The number present on a given date would necessarily be smaller and show a more favorable ratio.

The statistics for France are of inmates of public and private asylums.

There has been no official enumeration of the insane in the German Empire since 1871. The figures given were compiled by Dr. Max Hackl; they are based upon hospital returns and are considered authoritative, though rather conservative.

There has been no general census of the insane in Italy since 1871. In that year the total number of insane persons returned for continental and insular Italy was 44,102. The figures given in the table were compiled by Doctors Tamburini and Fornasari di Verce in "Rivista Sperimentale di Freniatria," 1900.

Of the total number of known insane in Austria January 1, 1901, 46.7 per cent were in asylums, 11.8 per cent were sheltered in other eleemosynary institutions, and 41.5 per cent were in private care.

In Hungary also but a small fraction of the insane were provided for in public institutions.

The figures for the Netherlands and Switzerland include inmates of public and private asylums.

The striking difference between Norway and Sweden in regard to ratios of the total number of insane appears to be due to the fact that the total given for Norway (5,397) was obtained by an actual enumeration, while the total for Sweden (8,093) represents only the number inspected by the authorities whose duty it is to visit known insane persons in their homes. In the year 1903 admissions to the public hospitals of Sweden had to be denied for lack of space in 1,698 cases.

There are certain discrepancies between the ratios of insanity for foreign countries, as set forth in the table, and the relative ranking of the natives of these countries in the United States in the matter of insanity. This is made evident by a comparison of the list of immigrant nationalities, ranked in the order of relative liability to insanity, given in the census report and already quoted, and a similar list showing the different foreign countries in descending order of their ratios of insanity computed upon the basis of insane persons reported in hospitals. These lists are as follows:

Racial or national tendencies, in the United States and abroad, are discussed as follows in the census report: "

a

It is primarily the business of the alienist to trace the relation between the * classification of the immigrant races and the probable causes that make some of them seem so much more liable to insanity than others. It is generally held that the nationalities showing the least liability to insanity are also among the most primitive in point of education and standard of living. Given comparative freedom from vice and comparative virility of stock, so the argument runs, and it will be seen that the mental equilibrium is more frequently upset in the instance of the highly organized nationalities; that is, they show less ability to withstand the shocks of a new environment, the pressure of unwonted economic conditions, etc., than the nationalities lower in the social scale. It is further asserted that an increase of insanity is a concomitant of present-day civilization, and that when the disease appears to be alarmingly prevalent in a nationality which as a whole has not reached a very high level there will usually be found in such a nationality the taint of a common vice.

The facts brought out in the present investigation in regard to the comparative liability to insanity of the immigrants hardly suffice for a confirmation of the above views. The matter is one that must be studied in the light of the statistics of the insane for the countries whence the nationalities in question come. In the case of the English and Welsh, for instance, it was shown that they stand seventh among the foreign nationalities in the United States with regard to the relative number of insane they contributed to the insane population in hospitals in 1903. Yet the number of insane per 100,000 of population in England and Wales is very much larger than the corresponding number for the United States. England and Wales also show much larger ratios of insane than Germany or the Scandinavian peninsula.

According to the classification made of the immigrants with respect to their liability to insanity, the Canadians show the least liability to this disease. Nevertheless, the ratio of the insane in Canada, whether only the number in hospitals or the total for the country be considered, exceeds the ratio for the United States, and is higher than the ratios for the Scandinavian countries and Germany. Yet the Scandinavians and Germans contribute relatively larger numbers to the insane population of this country. *

*

*

The statistics of the insane for the countries from which most of the recent immigrants came are lacking or are too meager for purposes of comparison. The comparatively primitive condition of some of these peoples may perhaps for the present render them less liable to insanity than others. At least this appears to be true of the immigrants from eastern and southern Europe.

The differences beween the ranking of the several countries and the ranking of the corresponding nativities in the United States may be attributed to several causes. They are doubtless due, in part, to the variation in the classification of countries and nativities, and in the degree of completeness of the data upon which the insanity ratios are based.

THE EFFECTS OF CHANGE OF ENVIRONMENT.

It should be remembered that the aliens who have immigrated to the United States, being drawn, in many instances, from the less favored social or industrial classes in the countries from which they come, may not be in a general sense representative of the entire population of these countries. The effect of a change of environment upon the individual immigrant may also be in some cases the occasion of insanity. These subjects are referred to in the census report," as follows:

This rather striking discrepancy between the comparatively slight liability to insanity exhibited by some nationalities among the immigrants and the known large ratios of the insane in their home countries can hardly be due to the fact that some of them are represented in the United States by the best of their stock while others send

a U. S. Census, Special Report, "Insane and feeble-minded in hospitals and institutions, 1904," pp. 27 and 28.