CHAPTER IXIMMIGRATION AND MENTAL DISEASES
A history of the development of our western civilization is very largely a study of the process of assimilation of the various racial elements representing a new population. While it must be conceded that we are indebted to European countries for much that has been contributory to the welfare and success of American institutions, it is equally true that the tremendous increase in mental diseases and defects here is to be attributed in no small degree to immigration. This constitutes a problem of social and economic importance which is worthy of serious consideration. Perhaps no better evidence of this fact can be offered than a study of such statistics as are available relating to the thirty-three millions of people coming to the United States from other countries during the last century. This would seem to be particularly indicated at this time, in view of the fact that the conclusion of the war has brought about the necessity of a new adjustment of our relations with other countries.
Immigration to the United States has varied greatly from time to time. It is a well known fact that the founders of our government were practically all of English, Dutch, German or Scotch-Irish extraction. Unfortunately no information of any consequence is available regarding the aliens entering the country prior to 1820, when their study was first undertaken by the federal authorities. As far as can be determined, during the ensuing ten years about 128,000 were admitted at the various ports of entry. The history of immigration since that time has been determined very largely by existing conditions in other countries. The famines and politicaldisturbances in Ireland between 1840 and 1850 were the occasion of a large influx, concededly of a highly desirable type. The nature of the tide of incoming immigrants was changed by the revolutionary troubles in Germany during the decade following 1848. There was a decrease for a time during the civil war. This was soon followed by a considerable increase which continued quite consistently until the outbreak of the world war. There would at this time seem to be every reason for thinking that an unprecedented invasion can be expected during the next twenty-five years as a result of conditions prevailing abroad unless some restrictions are imposed. In 1850 and 1860 the number of Irish people in the United States exceeded the German born. The 1890 census showed a predominance of the latter race and they have exceeded the Irish element in the population for some time. Nearly a million Germans were admitted between 1880 and 1885. Since 1890, however, the number of Irish and Germans entering have both decreased markedly. After the Spanish-American war a great increase in immigration was noted and the rate of admission per year reached a million in 1905, but the source of supply had entirely changed.
Salmon[71]has shown that in spite of the fact that in 1882 only 12.9 per cent of all incoming aliens admitted were from those countries, eighty-one per cent of all immigration from Europe in 1907 came from Austria-Hungary, Bulgaria, Greece, Italy, Montenegro, Poland, Portugal, Roumania, Russia, Servia, Syria and Turkey. In 1882, 87.1 per cent of those admitted came from England, Germany, Holland, Norway, Sweden, Switzerland and Belgium. The races represented by the new tide ofimmigration, according to Salmon, were Slavic, thirty per cent, Italian, twenty-six per cent, and Hebrew, fifteen per cent, the remainder being made up of various other miscellaneous elements. This change is shown by the fact that the immigration from Austria-Hungary, which amounted to only 711,926 from 1820 to 1896, increased to 2,303,323 during the first decade of the present century. Five hundred and thirty-four thousand three hundred and thirty-six were admitted from Russia between 1820 and 1896 and 1,756,027 between 1900 and 1911. The Italian immigration, which amounted to 676,826 between 1820 and 1896, increased to 2,228,759 between 1901 and 1911 (Salmon[72]). The numerical status of immigration by decades is shown in the following table:
A study made by the United States Immigration Commission some years ago showed that of 68,942 foreign born males employed in various mining and manufacturing industries, and who had been in the United States for five years or more, only 33.3 per cent had obtained naturalization papers. Of 246,673 of this same class representing non-English speaking races, only 53.2 per cent had learned the language of this country to any extent. A report made by the Commissioner General of Immigration showed that of 719,906 immigrants over fourteen years of age and admitted from 1899 to 1909, 26.6 per cent could neither read nor write and 29.8 percent had no occupation. The following table shows the percentage of foreign born in the population of the United States from time to time as stated in official reports:—
The foreign born population naturally varies more or less in different parts of the country. In New York state it was twenty-six per cent in 1870, 23.8 in 1880, 26.2 in 1890, 26.1 in 1900, 29.9 in 1910, and 26.8 per cent in 1920. In Massachusetts it was 30.6 per cent in 1895, 30.2 in 1900, 30.3 in 1905, 31.5 in 1910, 31.2 in 1915, and 28 per cent in 1920.
We have little authentic information relative to the institution population prior to 1903. The United States Census Bureau in its report of 1904 on the insane in hospitals shows that in 1903 there were 140,312 patients, of which number 47,078, or 34.3 per cent, were of foreign birth. The percentage of foreign born in state hospitals in various parts of the country at that time were asfollows:—
In 1912 an investigation was made of the foreign born in the New York state hospitals. As a result of the census taken, it was found that of 31,624 patients, 13,728,or 43.4 per cent, were foreign born. Of this number 4,487 had been naturalized and 9,241, or 29.2 per cent of the total hospital population were aliens. At the Manhattan State Hospital in New York City, out of a total of 4,570 patients 2,526 were foreign born and only 708 had been naturalized. The Central Islip State Hospital at the same time had 4,438 patients. Of this number 2,803 were foreign born and only 891 were naturalized citizens. Thus, at the Manhattan State Hospital 39.8 per cent and at the Central Islip State Hospital 43.1 per cent of the patients were aliens. It was shown that the average hospital residence of the insane in the state was 9.85 years. Based on the maintenance expenditures for 1912 it was estimated that the cost to New York for caring for its 9,241 aliens in the state hospitals was $2,579,902.78 per year, and for their entire hospital residence, over twenty-five million dollars.[73]Of the first admissions to the New York hospitals for the eight years beginning October 1, 1904, and ending September 30, 1910, 46.2 per cent were foreign born. The citizenship of the first admissions for this same period is shown by the followingtable:—
It was also shown that 14.7 per cent of the aliens admitted in 1905 had been in the United States less than three years, in 1906, 18.7, in 1907, 21.8, in 1908, 20.1, in 1909, 18.1, in 1910, 15.5, in 1911, 14.9 and in 1912, 18.1 per cent. The birthplace and citizenship of first admissionsto the New York state hospitals since 1912 is shown in the followingtable:—
YearForeign bornAliens191347.0percent22.5percent191446.7""25.2""191547.0""26.4""191648.5""27.8""191747.8""27.1""191846.4""27.5""191946.8""26.4""192045.3""24.8""
The percentage of the foreign born as shown by the first admissions to the Massachusetts state hospitals during the last eleven years was asfollows:—
The percentage of aliens as shown by the first admissions to Massachusetts hospitals was 26.40 per cent in 1918, 27.54 in 1919 and 22.73 per cent in 1920.
Studies of the population of the New York state hospitals show that the aliens have for a period of several years constituted nearly thirty per cent of the entire number. The influence which immigration may have had in determining the relative frequency of various psychoses in our institutions is an exceedingly interesting question. In speaking of the susceptibility of certain races to special types of disease, Salmon[74]says, "This is particularly true of mental diseases, for if racial characteristics profoundly affect political, social and religious ideals we must look for a similar influence upon the individual makeup which so largely determines trends in mental disease. All those who are familiar with mental diseases among the Japanese in California testify to the remarkabletendency to suicide in that race, not only in depressed conditions but in conditions in which suicidal tendencies, in other races, are not frequent. This is in accordance with the general attitude of the Japanese toward self-destruction. The strong tendency to delusional trends of a persecutory nature in West Indian negroes, the frequency with which we find hidden sexual complexes among the Hebrews and the remarkable prevalence of mutism among Poles, even in psychoses in which mutism is not a common symptom, are familiar examples of the influence of racial traits upon mental diseases." As the result of a special study of this subject Salmon has reached the following conclusions: "1. The psychoses more prevalent among Hebrews than in the native stock are manic depressive psychosis, dementia praecox, the psychoneuroses, and psychoses associated with constitutional inferiority. 2. The absence of alcoholic psychoses among Hebrews is the most striking clinical fact in connection with immigration. In 1909 there were but 3 patients with alcoholic psychoses in 448 Hebrews admitted to all the New York state hospitals. 3. The very high prevalence of general paresis among Italians bears a direct relation to the high prevalence of venereal diseases among Italians in New York.... 4. Italians show a freedom from alcoholic psychoses second only to Hebrews. 5. Italians exceed the native born in the prevalence of epileptic psychoses, infective exhaustive psychoses and dementia praecox.... 7. From the data available, alcoholic psychoses are found to be more prevalent among Slavs than among any other races of the new immigration, but not as prevalent as among the native-born. 8. General paresis is nearly twice as prevalent among Slavs as in the native-born, but not so prevalent as among the Italians. Dementia praecox is more prevalent among the Slavs than among the native-born."
The racial representation as shown by statistics offirst admissions is fairly constant in New York state, at least, as is shown by the following table ofpercentages:—
The 1916 report of the Commission on Mental Diseases shows the following analysis of the nativity of the 34,300 first admissions to the Massachusetts state hospitals covering a period of thirteen years (1904-1916):—
BirthplaceNumberUnited States18,757Africa7Armenia68Austria319Azores187Canada3,315England1,359Finland250Germany486Greece129Ireland5,033Italy719Nova Scotia136Poland190Russia1,139Scotland381Sweden539Turkey100
It should be borne in mind that these statistics represent birthplace and not race. An analysis of the above figures shows that 54.68 per cent were born in the United States and 44.42 per cent in other countries. Of the other countries represented, 3.96 per cent were born in England, 3.32 per cent in Russia, 9.63 in Canada and 14.67 per cent in Ireland.
A comparison of the more important psychoses represented by the various races, as reported by the New York State Hospital Commission in 1918, is shown in the followingtable[75]:—
Some variation is shown by a similar analysis of the New York admissions for the year 1919, as is illustrated by the followingtable[76]:—
Per Cent of Total First Admissions of Each RacePsychosesAfricanGermanHebrewIrishItalianSlavonicMixedSenile8.012.76.914.94.91.611.5General paralysis15.715.111.512.016.29.212.3Alcoholic4.04.00.47.92.47.03.0Manic-depressive10.413.721.611.120.617.613.1Dementia praecox31.324.232.025.529.742.323.8
For purposes of comparison an analysis of the psychoses shown by various races in the admissions of the Massachusetts state hospitals for a period of three years is added (1917-1918-1919):—
SenileArterio-GeneralAlco-Manic-DementiaRaceNo.PsychosessclerosisParesisholicDepressivePraecoxAfrican2115.68%4.73%6.16%7.10%4.26%27.96%English328110.759.877.465.769.9918.65French6476.646.9512.058.196.8024.88German2836.007.7710.609.9212.0121.20Hebrew353.562.265.661.4110.1937.11Irish29949.017.117.1116.137.1123.31Italian5223.442.667.665.3410.3435.44Mixed12448.7612.627.708.117.5524.35Slavonic6356.777.0812.288.356.9325.20
This shows some very interesting results. It will be noted that the Hebrews and Italians have the highest rate for dementia praecox, the percentage shown bythese races being much higher than any of the others. The Germans, Italians and Hebrews, in the order mentioned, have the highest rates for manic-depressive psychoses. The frequency of alcoholic psychoses as shown by the Irish is nearly double that of any of the others. The Slavonic race has the highest rate for general paresis, followed in close succession by the French and Germans. The highest rate for senile and arteriosclerotic psychoses combined is shown by the races of mixed origin, the next highest by the English, closely followed by the Irish. The most common psychosis in every instance is dementia praecox. In the admissions to the institutions for the criminal insane in New York the highest percentages are represented by the Irish, Italian and Hebrew races, as shown in another chapter. During a period of six years (1912 to 1918) a study of first admissions to the New York state hospitals shows an incidence of dementia praecox in the native-born of 75.2 per hundred thousand of the population and in the foreign born of 161.4. The importance of this is shown by the fact that over fifty per cent of the entire hospital population is made up of cases of dementia praecox.
The necessity of some supervision of immigration for the purpose of preventing the entrance of undesirable aliens has long been recognized. As early as 1824 the state of New York tried by legislation to prevent the admission of the insane and mental defectives. This effort was a failure, probably owing to the fact that the proposed enactments would have compelled the companies responsible for the entrance of undesirable aliens to remove them if they became a public charge. The introduction of discordant racial elements from abroad at one time disturbed the equilibrium of the entire country. The agitation for the restriction of immigration before the civil war led to the formation of a political organization known as the "Native American" or "Know Nothing"party, as it was usually called. It at one time had forty representatives in Congress and nominated a candidate for President in 1856. These disturbed conditions led to the consideration of this subject by Congress as early as 1838 and the Judiciary Committee recommended legislation prohibiting the entrance of idiots, lunatics and those suffering from incurable diseases or convicted of crime. The action of several foreign countries in pardoning murderers with the provision that they should emigrate to the United States led to a resolution of protest by Congress in 1860 and shortly thereafter a statute intended to encourage immigration was repealed. An investigation made by the United States Immigration Commission brought to light the fact that the great influx of foreigners was largely caused by the agents of the steamboat companies abroad and that they had "five or six thousand ticket agents in Galicia alone."[77]
The activities of those opposed to the indiscriminate entrance of objectionable aliens led to the federal enactment of August 3, 1882. The Secretary of the Treasury was charged with the duty of prohibiting the landing of lunatics, idiots and persons liable to become a public charge. The provisions for the execution of this law were not satisfactory and it was amended by an act of 1891. This made it a misdemeanor to bring in any of the above proscribed classes and imposed a fine of over one thousand dollars upon anyone guilty of so doing. Section 11 provided that aliens entering in violation of this law could be returned at any time within one year thereafter at the expense of the person or persons, vessel, transportation company or corporation responsible for their entry, and further, that those becoming public charges within one year from causes existing prior to landing should be considered as having entered in violationof law. The provisions of this statute were unchanged until the act of March 3, 1903. This excluded persons insane within five years previous to landing, those having had two or more previous attacks at any time, paupers and all others liable to become a public charge. Section 17 delegated to the officers of the United States Public Health Service the duty of determining the condition of all immigrants. Section 20 provided that aliens coming to the United States in violation of law, or who were found to be public charges from causes existing prior to landing, could be deported at any time within two years. Section 21 authorized the Secretary of Commerce and Labor to deport any alien within three years of entering in violation of the act.
An important step in the legislative restriction of immigration was the amendment of Feb. 20, 1907. This made mandatory the exclusion of idiots, imbeciles, the feebleminded, epileptics, insane, all who had been insane within five years and persons having had two or more attacks of insanity at any time, or who were likely to become a public charge, as well as individuals not comprehended in the foregoing excluded classes but found to be suffering from mental or physical defects of such a nature as to affect their ability to earn a living. Section 20 provided that an alien entering in violation of law or becoming a public charge from causes existing prior to landing should, upon the warrant of the Secretary of Commerce and Labor, be taken into custody and deported to the country from whence he came at any time within three years after the date of his entry into the United States. The cost of this removal was to be a charge upon the owners of the vessel or transportation line immediately responsible. When the mental or physical condition of the alien was such as to require personal care or attention, the Secretary of Commerce and Labor was authorized to employ a suitable personfor that purpose. This was a great step in advance. There were, however, some very great difficulties to be overcome. The force placed at the disposal of the Public Health Service for the inspection and examination of incoming immigrants was entirely inadequate and one or two men were sometimes responsible for the examination of several thousands aliens in a day. This was, of course, impossible. The burden of proof in showing that the mental condition was due to causes existing prior to landing, furthermore, devolved upon the persons requesting deportation. It was impossible in many instances to submit actual proof even where there could be no reasonable doubt as to the facts. This led to great difficulties and much dissatisfaction. Another serious objection to the provisions of this law was the requirement that only such persons could be deported as were likely to become a public charge. In many instances such persons were supported by private funds until they were no longer deportable, after which they became a burden upon the state in which they resided.
These conditions were much improved by the action of the Sixty-fourth Congress in 1917. This definitely excluded "all idiots, imbeciles, feebleminded persons, epileptics, insane persons; persons who have had one or more attacks of insanity at any time previously; persons of constitutional psychopathic inferiority," etc., or "persons not comprehended within any of the foregoing excluded classes who are found to be and are certified by the examining surgeons as being mentally or physically defective" or persons likely to become a public charge. Section 9 provided that it shall be unlawful for any person, "including any transportation company," to bring either from a foreign country or any insular possession of the United States any alien afflicted with idiocy, insanity, imbecility, feeblemindedness, epilepsy, constitutional psychopathic inferiority, etc., and subjected to afine any person or persons so doing. The Secretary of Labor was also authorized to detail inspectors and matrons to duty on vessels carrying immigrants, who shall "report to the immigration authorities in charge at the port of landing any information of value in determining the admissibility of such passengers that may have become known to them during the voyage." It also provided that a mental examination of all arriving aliens should be made by medical officers of the United States Public Health Service who shall certify all mental defects or diseases observed. "Medical officers of the United States Public Health Service who have had special training in the diagnosis of insanity and mental defects shall be detailed for duty or employed at all ports of entry designated by the Secretary of Labor." Section 19 provided, that any alien "who within five years after entry becomes a public charge from causes not affirmatively shown to have arisen subsequent to landing" shall, upon warrant of the Secretary of Labor, be taken into custody and deported. The act also made provision for the first time for a literacy test which has been a subject of discussion for years. These amendments are of far-reaching importance and will eventually undoubtedly afford the hospitals considerable relief. The fact still remains, however, that the individual states are expending millions of dollars annually for the care and maintenance of an alien population which should have been excluded by the federal government. Under these circumstances it would seem nothing more than fair that the states should be reimbursed for the cost of carrying a burden for which they are in no way responsible.