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chapter 7

Making Medical Borders

at Angel Island

It is indeed pitiable the harsh treatment of our fellow countrymen.

The doctor extracting blood caused us the greatest anguish.

Our stomachs are full of grievances, but to whom can we tell them?

We can but pace to and fro, scratch our heads, and question the blue sky.

Poem number 50 in Island: Poetry and History of Chinese Immigrants on Angel Island, 1910–1940

From the turn of the century until 1940, the ordeal of immigration for

Chinese and other Asian migrants to San Francisco began with medical

inspection at Angel Island. The poem above, a translation of one of the

hundreds of poems carved on the walls of the Chinese detention barrack,

expresses the distress and helplessness that many Chinese immigrants

faced. On arrival, they confronted military-style examinations that were

commanded by uniformed white public health inspectors who barked

orders in English, with terse translations offered by Chinese subordi-

nates. Many immigrants found the often unexplained procedures pain-

ful and bewildering. Although the exact requirements of medical exami-

nation shifted over the period of Angel Island’s operation, the required

submission to nude physical exams and the inspection of body parts,

and the demands to supply bodily substances, were remarkably consis-

tent features throughout the period 1910 to 1940. There was no oppor-

tunity to object or withdraw one’s body from scrutiny.

These medical examinations were part of an emerging worldwide net-

work of quarantine and health inspection that served as the “imperial

defence” against the potential invasion of epidemic diseases into metro-

politan ports in North America and Europe.1 Along with the European

imperial powers, U.S. health authorities created information relays to

track the spread of epidemic diseases at ports throughout the globe from

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Hong Kong to Rio de Janeiro. Public health officers sought to allay fears

that disease traveled with trade and migration. Responding to the wide-

spread fears that immigrants carried disease into the American nation,

the federal government established measures to detect diseased aliens and

to deny them entry.2 As quarantine intensified and immigration medical

exams developed, health became a crucial gauge in the management of

national borders.

Chinese immigrants experienced the most strenuous hurdles to legal

entry into the United States. The passage of and amendments to the Chi-

nese Exclusion Acts (1882–1902) prohibited the immigration of Chinese

laborers, required registration and extensive documentation for Chinese

settlers, and denied them the opportunity of naturalized citizenship.3

The health-screening process presented further obstacles to settlement

in the United States. In the early twentieth century, immigration restric-

tions were extended to impede other Asian nationalities. Since San Fran-

cisco served as the principal Pacific Coast gateway for Asian commerce

and migration into the United States, Angel Island became the site of

special medical and immigration hurdles for Chinese, Japanese, Korean,

Filipino, and Asian Indian migrants.4

In the twentieth century, health-screening practices moved from quar-

antining epidemic diseases to screening for the fitness of future citizens.

PHS officers developed a range of techniques to coax “truth” from the

recalcitrant body and to interpret that truth. These techniques, loosely

gathered under the umbrella of medical purpose, can be analyzed as

three stages in the development of medical inspection practices. They

reveal different layers of medical sight and interpretation of the body.

The first technique involved the inspection of the naked body for suspect

symptoms that were visible on the skin or in the swelling of the glands.

Inspectors paid particular attention to swellings and lesions that indi-

cated epidemic diseases such as bubonic plague or “loathsome” condi-

tions such as leprosy. The second set of techniques scrutinized specific

organs to detect infections and defects. During the first decade of the

twentieth century, PHS officers carefully inspected eyes for ailments that

could impair sight and therefore lead to disability. The PHS’s third set

involved examination of the body beneath the skin through the micro-

scopic inspection of internal fluids or waste products to detect traces of

internal parasites. Parasites caused fatigue and declining productivity,

yet the sufferer displayed no visible sign of ailment.

Each new layer of visual scrutiny revealed hidden threats, which, the

PHS confidently asserted, only their specialized expertise could deci-

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pher. With their increasingly specialized expertise, the PHS projected an

image of unequivocal confidence in scientific diagnosis to both the de-

tainees and the American public. The PHS used science’s claims of ob-

jectivity and disinterested inquiry to place its policies above politics. Sci-

entific forms of knowledge dominated the often heated medical debates

and even mainstream political criticisms of disease screening.5

As the truth of the immigrant’s health shifted away from the physical

examination of the body and toward the bacteriological examination of

the body’s fluids and wastes, PHS officers developed a scientific knowl-

edge of race that became increasingly enmeshed in a framework of bod-

ily norms and aberrations. Scientists and administrators of the time and

historians of the period have proclaimed that bacteriology’s focus on

germs, “the most democratic creatures in the word,” would overthrow

a parochial reliance on invidious distinctions of race and class.6 How

was it that, far from making race irrelevant, the PHS’s use of bacteri-

ology made racial assumptions crucial to its own system of border con-

trol? Why did the pursuit of “invisible germs” produce new thresholds

for the visibility of social difference? How did the PHS’s system of inspec-

tion produce an understanding of bodily norms that ignited exceptional

vigilance against aberration that was interpreted in racial and class

terms? And how was it possible that the anomalous procedures imposed

on Chinese, Asian Indian, and Japanese migrants at Angel Island became

justified in PHS explanations as part of a system of universally applied

border controls?

Through the process of medical inspection on Angel Island, other

forms of knowing were also produced about bodies in transit. The

power struggles over naming and defining a body and its excludable

defects and diseases produced a range of different epistemic positions. In

Guangdong villages, onboard the ships, on Angel Island, and in Chinese

communities in the United States, Chinese men and women exchanged

knowledge about the experience of invasive examination that countered

PHS claims about their bodies and the necessity of inspection. The

traces of this immensely varied subaltern public sphere persist in a tex-

tual historical record found in the poetry Chinese men wrote on the An-

gel Island barrack walls; in the satirical editorials published in Chinese

newspapers in San Francisco; in the coaching papers that offered pro-

spective immigrants strategies by which to negotiate border obstacles;

and in the oral histories that suggest the stories, gossip, and advice that

Chinese women and men shared. These forms of knowledge, which dis-

puted the official, scientific positions, were often ridiculed or ignored

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in the dominant record of policy debates. Since PHS medical officers

and U.S. politicians perceived the Chinese and other arriving Asians as

“alien” and unlikely to ever become American citizen-subjects, the Amer-

ican elite ignored the subjectivity and the agency of the Chinese “aliens.”

Chinese detainees insisted on explaining their reality and seizing a

position from which to speak. Many of the Chinese who were detained

left behind poems, either written in ink or carved on the walls of the bar-

racks, that tell tales of the suffering caused by detention on Angel Island.

They sought to impart their experiences to those who followed them

from Guangdong province. The poetry came to public attention thirty-

five years after the government closed its Angel Island immigration sta-

tion. In the late 1970s, San Francisco Chinese American activists and

community historians fought successfully to halt destruction of the Chi-

nese detention barracks and preserve the poems. Chinese American com-

munity historians translated and compiled the poetry. In all they col-

lected 135 poems. The poems followed classical style and form, and the

majority of the poems were undated and unsigned. The poems that have

been preserved were written by literate men. Most immigrants did not

have formal schooling beyond the primary grades, and often the poems

violate rules of rhyme and tone required in Chinese poetry. Community

historians have supplemented these poems with extensive interviews

with the detainees who successful entered the United States. The oral

histories were supplied by both Chinese women and men during the late

1970s and 1980s. Although the poems offer the more immediate expres-

sions of anger, frustration, and depression at being in detention, the oral

histories provide remarkable details about the everyday experience of

detention and reflect the continued impact of the experience after decades

of life in the United States. The poems, along with the oral histories, of-

fer rare insight into the subjectivity and perspective of the detainees.7

Throughout this chapter, I have included barrack-wall poetry and sa-

tirical Chinese American press reports in order to emphasize the dra-

matic and often irreconcilable contests in the politics of bodies and their

well-being during their forced encounter with the U.S. state. The PHS of-

ficials and scientists grudgingly acknowledged but dismissed the satire by

Chinese journalists as well as the official representations of Chinese elite

commercial interests by Chinese diplomats. However, Chinese barrack-

wall poetry was ignored by the PHS officials, who had already disqual-

ified any knowledge produced by the alien, the patient, or the ill-person

as naive and beneath the required level of detached cognition or scien-

tificness. Although denied, these Chinese insisted on explaining their re-

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ality and seizing a position from which to speak. Yet even with these re-

markable recoveries there are limits to a historian’s ability to assess the

full dimensions of the subjectivity of Chinese detainees on Angel Island,

since all of those who could write the poetry and the newspaper satires

were literate men. It is even less possible to know the stories of those

who were not male or not of the literate classes, or, in the case of oral

histories, of those who failed to surmount immigration hurdles.

ROUTINES OF INSPECTION

Inspecting travelers for signs of illness had its origins in nineteenth-

century quarantine procedures. In San Francisco, quarantine in the

1870s targeted ships from Asia in order to prevent “invoices of small-

pox” from China.8 Quarantine was a low-threshold filter intended to

thwart the spread of acute, contagious infections such as cholera, yellow

fever, and bubonic plague. The target of investigation could involve per-

sons, animals, commercial goods, or the ship’s hull.9 At many U.S. sea-

ports, local authorities handled quarantine procedures until the last

decade of the nineteenth century and applied general principles of in-

spection, isolation, and fumigation in order to neutralize contagion.10

When the federal government consolidated quarantine responsibili-

ties, it built permanent quarantine facilities at the busiest ports, includ-

ing the Angel Island facility at the mouth of San Francisco’s harbor. In

1890, two decades before permanent immigration facilities were con-

structed, the Angel Island Quarantine Station boasted a hospital, fumi-

gation building, and separate bathing facilities and barracks for all cabin-

class and Chinese steerage passengers. Under the direction of the PHS,

medical officers developed systematic procedures for disinfecting cargo,

people, and ships to screen out contagious diseases such as smallpox,

cholera, and typhoid.11 In 1891, following a U.S. legislature mandate,

PHS officers began to conduct health inspections of all arriving immi-

grants and travelers.12 Different stations developed specific procedures

to respond to the call for mandatory exams. At Angel Island, when

steerage passengers arrived for disinfection the PHS officers used the op-

portunity to scrutinize the bodies of Chinese and Japanese immigrants

by sending them to bathe. In the 1890s the medical gaze focused on the

signs of epidemic diseases, particularly bubonic plague and cholera,

which were believed to be infiltrating the United States from East Asia.13

The PHS employed bathing not only for the disinfection advantages of

“using soap liberally and vigorously” but also for the unparalleled op-

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portunity to “discover glandular swellings and eruptions” that were the

diagnostic signs of bubonic plague.14 Hugh Cummings, the chief quar-

antine officer, valued any procedure that required the disrobing of ar-

riving immigrants because it enabled the “careful examination of the in-

dividual.”15 The exam of the naked body could reap unexpected

revelations, such as evidence of leprosy or hernia.16

Steerage and cabin passengers experienced different levels of scrutiny

at the San Francisco quarantine station. Onboard the ship, a medical of-

ficer would examine all steerage passengers on the deck for quaran-

tinable diseases such as smallpox and cholera. He would also make pre-

liminary assessments of visible “physical defects and deformities” that

would be more thoroughly investigated on Angel Island.17 Then, the

upper-class cabin passengers would be examined in the privacy of the

passengers’ rooms and without the kind of invasive physical contact and

public examination that was routinely applied to steerage passengers.

Cabin passengers were less susceptible to disease, PHS officers believed,

because they could afford better sanitary conditions and nourishment

on ship, and because cabin passengers supposedly possessed “higher in-

telligence to exercise a certain amount of self-care.”18 Medical inspec-

tors also took special care to protect the health of cabin passengers and

protect them from any transfer of disease in the medical inspection pro-

cess. They guaranteed cabin passengers that the thermometers they

used were “thoroughly disinfected” between uses.19 PHS officers treated

upper-class passengers with “discretion,” providing them with the illu-

sion of privacy. The classes of accommodation also masked racial dis-

tinctions. At Angel Island, the steerage passengers were most likely to be

Asian immigrants, while cabin passengers were most likely to be white,

usually U.S. citizens or European visitors.20

During the medical exam on Angel Island, steerage passengers re-

ceived more intensive individual and physical scrutiny than those that

arrived at Ellis Island in New York, where 70 percent of all immigrants

to the United States arrived.21 Upon arrival on Angel Island, Chinese

men and women were led to sex-segregated barracks, where they depos-

ited their luggage. Unlike at Ellis Island, men and women were exam-

ined separately at Angel Island because of the intrusive nature of the

physical examination. In the examination of Chinese men, a PHS officer

would command the detainees to line up and strip to the waist for the

physical exam. Mr. Leung, a twenty-four-year-old at the time of his de-

tention on Angel Island in 1936, recalled that “a whole bunch of us had

to take off all our clothes like marching soldiers.” The PHS officers in-

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spected the men’s “teeth, ears, and nose” and conducted a stethoscope

examination of the chest, and then took them “individually behind a

ward screen,” where each man was “completely stripped” in order to re-

veal any “abnormalities” below the waist. Chinese women underwent a

less rigorous physical exam: PHS officers did not ask women to disrobe

unless they detected specific signs of disease. In the twentieth century,

two new procedures were added to the medical exam. First, all arriving

immigrants had their eyelids everted for signs of trachoma infection.

Second, after 1910, the detainees were sent to line up at the toilets and

handed tin basins. Both men and women were required to “furnish a

specimen of feces for hookworm examination.” Afterward, the atten-

dants offered the detainees denim uniforms to wear while their clothes

were sent to be disinfected.22 (See Figure 9.)

The medical examination of immigrants developed in tandem with

other early twentieth-century systems of mass screening of healthy per-

sons for disease and defects, such as the medical examination of appli-

cants for life insurance, industrial employment, primary school educa-

tion, and military service. Rather than addressing specific symptoms of

illness in an individual patient, physicians developed new procedures for

Making Medical Borders at Angel Island 185

Figure 9. Public Health Service officers conduct a medical inspection of Chinese men at Angel Island Immigration Station, 1923. Courtesy National Archives at College Park, RG 090-G-152–2039.

07-C1778 6/18/2001 3:52 PM Page 185

the new technique of examining healthy people. The immigration medi-

cal exam, like the exams instituted for insurance and the military con-

scription, sought to measure fitness and detect defects in a broad spec-

trum of the population. These large-scale health-screening processes

were instrumental in identifying the norms of health and in applying the

eugenic criteria of fitness.23

Although both quarantine and immigrant health exams ostensibly

erected barriers to “contagion,” the focus of medical scrutiny diverged.

Unlike quarantine’s focus on acute infectious disease, health exams of

immigrants began to develop criteria of fitness and identified endemic ill-

nesses that might have long-term consequences for the productive capac-

ity of the arriving immigrant. Politicians and immigration authorities in-

creasingly turned to physicians to arbitrate the grounds of immigrant

exclusion. Although deportation never exceeded 3 percent annually from

1890 to 1924, medical certification became the increasingly dominant

reason for deportation. In 1898 less than 2 percent of total deportations

were for medical reasons, but by 1913 medical reasons accounted for

57 percent of deportations and reached 69 percent in 1916. Medical ex-

clusion overshadowed the formerly “subjective” deportation criteria,

such as subversive and anarchical political activities, criminality, and

prostitution. Public health officials and politicians perceived medical

screening as unfettered by politics and subjective judgments, even though

they frequently designated specific races and ethnic groups to be “unfit”

for entry.24

Despite the increasingly decisive role of medical certification, PHS

medical inspectors positioned themselves as detached and objective, val-

ued qualities in the creation of a scientific bureaucracy. The aura of ob-

jectivity insulated PHS physicians from accusations of political bias and

prejudice. Although PHS officials refused to serve on the U.S. Immigra-

tion Service Boards of Special Inquiry where final appeals were reviewed,

the PHS medical inspectors were comfortably ensconced in the formal

machinery of medical exclusion.25 Immigration and PHS officers were

aware of the need for swift, scientific, and unassailable medical diagno-

sis and the necessity to adjust diagnoses to conform to administrative

categories of exclusion.26 The considerable confusion about, and varia-

tion in, the diagnostic interpretation of eye and parasite diseases in the

first quarter of the century were a vexing problem for both immigration

and medical authorities eager to put political judgments under the cloak

of scientific objectivity.

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OPTICAL ILLUSIONS AND THE DIAGNOSIS OF TRACHOMA

In the first decade of the twentieth century, trachoma was the signa-

ture disease of medical exclusion. Trachoma as a proportion of medical

deportations rose rapidly and paralleled the rise in medical deporta-

tions generally. Its swift dominance and sudden decline in medical cer-

tifications demonstrated how “epidemic” phenomena can be produced

through the development of diagnostic methods and medical definition.

In 1900 most of the trachoma certifications occurred at Ellis Island in

New York, but within five years the diagnostic techniques and interpre-

tation were applied at the other immigration stations, from Galveston

to San Francisco. In 1900, only 1 in 1,631 immigrant arrivals had tra-

choma, but by 1908 it was nearly 1 in 300. In 1900 eye exams were

administered only to those migrants with visible symptoms such as gran-

ules and inflammation around the eye. Medical deportations rose sharply

after 1903, when excludable diseases were systematized and trachoma

became one of two “contagious diseases” that would result in immediate

exclusion.27 Medical opinion considered trachoma a contagious disease

that could in extreme cases result in blindness. In 1905 all immigrants

at Ellis Island were subjected to eye exams; officers used buttonhooks

or fingers to evert eyelids and discover the sores that were trachoma’s

telltale sign. In 1908 there were over 2,900 medical deportations, and

nearly 90 percent of those deported were certified as having trachoma.28

PHS supervisors insisted that its officers fold various diagnoses into

the official administrative definitions of disease in order to ensure ample

numbers of trachoma certifications and deportations.29 Officers at Angel

Island were instructed to refrain from making diagnoses such as “granu-

lar eyelids,” “granular conjunctivitis,” or “folliclosis,” no matter how ac-

curate or medically sound. Similar inflammatory eye diseases generated

unwelcome ambiguity for administrators, eager to distinguish trachoma

from other unhealthy eye conditions that were not grounds for exclusion.

The regulatory power of the trachoma diagnosis made PHS supervisors

all the more suspicious of diagnoses that approximated trachoma.30

Heated debates about trachoma’s symptoms and contagiousness

within the PHS and the medical profession nationwide bedeviled the

quest for uniform diagnosis.31 In 1905 the PHS was embarrassed by

contradictory diagnoses of the same immigrant by PHS inspectors in San

Francisco and a PHS inspector stationed to certify U.S.–bound passen-

gers in Victoria, British Columbia. The inconsistency gave critics within

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both the medical profession and the public grounds to question the

PHS’s definition of trachoma.32 The clinical expertise of PHS officers was

enlisted to account for the discrepancies in trachoma certification. Many

officers, faced with symptoms that ran counter to textbook cases, devel-

oped explanations for the peculiarities of the “Oriental” race. Dr. Vic-

tor G. Geiser, chief quarantine officer in the Philippine Islands, argued

that the “poor physical state of the average Oriental” was responsible

for all kinds of inflammatory eye conditions. Trachoma in “Orientals”

was endemic and impervious to the treatment that would successfully

heal “another race.”33 Putative racial differences also influenced ideas

about immunity. Dr. Carl Remeus, who had inspected immigrants in

Honolulu and at Ellis Island, explained that “white races” suffered from

“dangerous complications” from trachoma infection, but that “Asiat-

ics” had relatively mild cases of trachoma because of their alleged hered-

itary immunity developed through thousands of years of contact with

the disease.34 These theories of the peculiar Asian susceptibility and in-

heritance instantiated a racial hierarchy in the medical knowledge of tra-

choma. Despite differences in their conclusions, all of the scientists mea-

sured trachoma in Asians as abnormal against the typical experiences

of eastern and southern Europeans and against the norms of vulnerable

health in western Europeans.

The theories about racial susceptibility and immunity underscored

the insistence on racial measurement during this period. In this era, the

sciences of phrenology and eugenics were not alone in assiduously tabu-

lating the relationship between physical differences and race.35 Despite

claims that Europeans were more vulnerable to acute trachoma infec-

tion than Asians, PHS statistics revealed that Asian and Middle Eastern

immigrants were far more frequently diagnosed with trachoma and de-

ported than the European immigrants. In a study of trachoma diagnosis

at all immigration stations from 1908 to 1910 in the United States, the

PHS officer Victor Safford concluded that Chinese, Japanese, Syrian, and

Asian Indian immigrants were more likely to be certified for trachoma

than the most “susceptible” southern and eastern European “races.”

Among eastern and southern European groups, less than 1 percent of all

immigrant arrivals were certified for trachoma. However, Asians ex-

perienced sharply higher ratios of trachoma detection, with as many as

8 percent and 11 percent of immigrant arrivals from China and India,

respectively, being deported for trachoma.36 These statistics revealed the

increased vulnerability of Japanese, Asian Indian, Syrian, and Korean

immigrants to medical deportations.

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Among PHS officers there was a “wide divergence of views on tra-

choma,” and diagnoses depended on the “personal equation of the ob-

server.”37 However, PHS officers were confident that the discovery of a

“specific microbe of trachoma” would provide an incontrovertible stan-

dard for diagnosis and systematize immigration health controls.38 The

hunt for such a microbe proved elusive. Physical observation and de-

scription, with the attendant dependence on the vagaries of “personal”

interpretation, prevailed. However, PHS officers continued to rely on

characteristics such as racial bodies and racial geographies to arrest the

perceived external traffic in trachoma infection. When new, bacterio-

logically detected, parasite diseases emerged in 1910 at Angel Island, the

proportion of deportations for trachoma detection dropped off sharply.

In 1909 the proportion of trachoma certification of all medical exclusions

hovered at 60 percent. Two years later, in 1911, the proportion had

plummeted to 8 percent. Despite this severe drop in trachoma certifi-

cations, the overall number of medical deportations remained steady be-

cause hookworm had replaced trachoma as the leading cause of medi-

cal exclusion.39

DETECTING “PARASITES”

The rapid proliferation of hookworm diagnoses ushered in a new era in

immigration health exams. Prior to the establishment of a full-scale bac-

teriological laboratory on Angel Island in 1910, PHS officers relied upon

the techniques of physical observation to interpret the health of immi-

grants. The new bacteriology, with its reliance on microscopic slides and

germ cultures, provided a new means of visualizing the body beneath the

skin. PHS officers drew blood and feces samples from the immigrants

and, under the microscope, isolated the traces of intestinal parasites.

In the twentieth century, bacteriological examinations became a

unique but vital technique in the health screening of Asian immigrants.

In the late nineteenth century, bacteriological exams were a precaution-

ary measure that supplemented the physical exams, particularly to ad-

dress suspicions of bubonic plague and cholera. During the era of bu-

bonic plague epidemics, from 1900 to 1908, bacteriological testing

became a ritual of scientific confirmation and buttressed the PHS’s

authority in plague detection within San Francisco.40 During the plague

epidemics the PHS bacteriological laboratory had been located in the

city, which limited its use for immigration inspection. In 1910, with the

consolidation of the Angel Island Quarantine Station with the new An-

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gel Island Immigration Station, PHS officers were able to pursue bacte-

riological testing of Asian immigrants who were already detained for

other illnesses or who awaited immigration interviews.

The testing for hookworm in Asian immigrants developed from just

such detention practices. In September 1910, after inspections onboard

an incoming steamer, the PHS inspector M. W. Glover detained six

Asian Indian men at the Angel Island Hospital with an initial diagnosis

of anemia. After conducting tests of their feces, Glover determined that

they had hookworm. What was visible under the microscope were the

eggs of the hookworm parasite. Glover extrapolated that these eggs in-

dicated that the parasite lived within the individual’s stomach and intes-

tine.41 Glover ordered feces examinations of all Asian Indian men already

in the hospital and found the hookworm ova present in over 70 percent

of the Asian Indian patients.42

Bacteriological examination’s success in providing visible evidence of

infection prompted Glover to extend mandatory examinations to all

Asian Indian and Chinese passengers. The investigations merged the two

groups into the category of “Asian” and confirmed suspicions that all

Asian immigrants were liable to be infected by “parasites,” even when

they demonstrated no visible signs of suffering or incapacitation. These

apparently healthy “carriers” harbored a variety of dangerous portable

pathogens in their bodies—hookworm, whipworm, and roundworm.

These pathogens left the host unaffected but, Glover feared, would have

devastating effects on unsuspecting white Americans.43 Bacteriology

opened a new visual layer to medical interpretation, and, with the dis-

covery of the hookworm parasite in the “healthy carrier,” microscopic

examination supplanted physical observation of the epidermal body.44

At the turn of the century, medical scientists had identified hookworm

as a disease condition with symptoms of anemia, diarrhea, and slight

fever. The parasite caused those afflicted to suffer from lethargy and to

experience diminished mental and physical development. It was not

considered fatal, but the parasite was expected to remain in the human

host for ten years.45 Hookworm was often referred to the as the “germ

of laziness,” and it explained both the poverty of its sufferers, given the

body’s diminished physical capacity, and their disinterest in low-wage

labor. PHS officers and the Rockefeller Foundation medical researchers

developed campaigns to eradicate hookworm in the rural South and the

newly colonized territories of Puerto Rico and the Philippines.46

The use of hookworm diagnosis to bar Asian Indian migrants rein-

vigorated campaigns on the Pacific Coast by labor organizations and

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sympathetic newspapers to limit Asian Indian immigration. Nearly seven

thousand Punjabi men immigrated to the United States during the peak

immigration years of 1907–11 before immigration restrictions were im-

posed. Many Punjabis worked on railway construction, at lumber mills,

and on farms. The San Francisco Bulletin hailed Dr. Glover’s discov-

ery as “an effective dam to the torrent of Hindu immigration which has

been surging the shores of the Pacific Coast at a speed of 5,000 of India’s

riff-raff a year.”47 Although many of these men followed the Sikh faith,

the migrants were both matter of factly and derisively referred to as

“Hindus.”48 The use of bacteriological knowledge to bar immigration

particularly fascinated white labor leaders, who perceived Asian Indian

immigrants as the new “Asiatic menace” for the white labor market.49

Soon after news of the bacteriological detection of hookworm broke

in the news media in 1910, the Asiatic Exclusion League endorsed the

mandatory bacteriological examination of Asian immigrants to detect

hookworm and other parasite diseases.50 White labor leaders concluded

that all “Orientals” should be subject to the same strict immigration

barriers that had been erected against Chinese arrivals, since any Asian

immigration was an “invitation” to epidemic disease and presented

“grave perils to American health.”51

Prior to Dr. Glover’s discovery of hookworm, the PHS officers at An-

gel Island had been acutely aware of the controversy surrounding Asian

Indian immigrants. The bacteriological testing of anemic Asian Indian

immigrants in September 1910 had been spurred by an internal crisis

over medical exclusion procedures. In May 1910 an Immigration Ser-

vice (IS) officer had accused the Angel Island immigration commissioner

Hart H. North of corruption and negligence in medical exclusion pro-

cedures. One of the complaints lodged was that many Asian Indian mi-

grants with “poor physique” were allowed entry even though they had

been designated as likely to become public charges. During the inves-

tigation, Glover testified that IS officers were not qualified to make

judgments about the “physical capability” of the immigrant to earn a

living without conducting a full medical exam.52 In a move calculated

to bolster the PHS’s authority to determine physical fitness, Glover

employed bacteriological tests to provide specialized knowledge of an

immigrant’s capabilities and the precise cause of an immigrant’s disabil-

ity. Popular anti-Hindu politics and the IS controversy emboldened

Glover to demand time-consuming bacteriological exams of all Asian

Indian immigrants.53 Glover was fully conscious of the political effect of

this power when he boasted in his annual report that the hookworm

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exam “was a large factor in stopping the influx of East Indians into this

country.”54

Glover enthusiastically championed Angel Island’s capabilities in bac-

teriological examination for the unparalleled PHS research and training

facilities it would provide in the field of tropical medicine. The volume

and variety of immigration from Asia, he claimed, provided an “excel-

lent opportunity for study of intestinal parasites as the supply of mate-

rial is large and constantly new.”55 Glover freely used hospital patients

as laboratory specimens, in one case administering an anthelmintic drug

to extract “a hundred or more of the worms themselves” from one

Asian Indian patient.56 This use of detainees for medical experimentation

without their consent was a standard practice in the formation of medi-

cal disciplines and demonstrated how bodies were made instrumental

for medical data prior to the advent of patient’s rights.57

Glover’s desire to make Angel Island a laboratory for tropical disease

research spurred sarcastic commentary from Chinese activists and jour-

nalists in San Francisco. The Chinese Defender satirized the inventive-

ness of the PHS: “So the arriving immigrants are now to have hookworm.

Somebody must have stayed awake nights to think that out; it surely was

a stroke of genius!” The Defender editorial characterized hookworm di-

agnosis as an arbitrary and petulant act that relied on inventing fictions

comparable to the fantastic stories of Grimm’s fairy tales.58 The PHS’s

explanation of hookworm as a parasite that slowly consumed and in-

capacitated the human body from within but often manifested no im-

mediate symptoms heightened suspicions about the fictive character of

hookworm infection.

Despite protests to the contrary, PHS officers did target Asian groups

for mandatory bacteriological exams. In hookworm investigations, they

singled out Chinese steerage and second-class cabin passengers who were

already detained, awaiting immigration hearings. In 1913, Chinese were

examined for hookworm prior to embarkation in Hong Kong. Asian In-

dian male laborers and Japanese “picture brides” were also considered

suspect, and mandatory hookworm exams were ordered for them as well.

The latter two groups constituted high-risk groups because of their rural

and agricultural origins, where parasites were presumed to be endemic.59

Bacteriological inquiry into the immigrants made new layers of the

body available to medical sight. Through the examination of fluids such

as blood and of waste products such as feces, bacteriology generated vis-

ible knowledge of new pathogens and multiplied the number of medical

conditions that barred immigrant entry. In 1910 the PHS classified hook-

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worm and threadworm (filariasis), and in 1917 added liver fluke (clonor-

chiasis), as excludable diseases that were likely to make the sufferer be-

come a public charge. These disease conditions linked disability with an

immigrant’s potential fitness for employment. The legislators and PHS

officers feared that the parasite diseases could produce future disability

and dependency that would strain community charity and state coffers.

Like the examination of feces to observe hookworm, the drawing of

blood to test for filariasis drew suspicion from journalists and Chinese

American leaders. The curious procedures became the subject of protest

and ridicule when the San Francisco Chronicle reported on the theatrical

strategies employed by the PHS to defend its diagnosis of threadworm in

Chinese immigrants. The Chronicle reported that at midnight on Angel

Island a group of attorneys, officials, physicians, and Chinese diplomats

surrounded Lin Shee, a Chinese boy who had been brought unwillingly

into the circle. Dr. Glover, “the immigration surgeon who discovered

hookworm in the Hindus,” cut Lin Shee’s “right ear . . . until the blood

dripped, while they gazed in rapt attention at the ruddy gore.” The scene

was reminiscent of the arcane sacrifice rituals of a cult or the initiation

theatrics of an elite male club but was conducted in the “interest of sci-

ence and immigration laws.” The Chronicle writer mocked Glover’s pro-

cedures and the “scientific” purpose of the test’s “peculiar” timing: “the

filaria circulate only at midnight, and to catch them it is necessary to get

the suspect’s blood at that hour of the night.”60 The Chinese Defender

ridiculed the demonstration of “midnight examinations” and the “shed-

ding of blood” as evidence of the intimidation and terror experienced by

Chinese immigrants. The skeptical journalists emphasized the scene of

extraction of blood and ignored the scene of the laboratory identifi-

cation of filaria residues from the blood. This perspective supported the

position of the Chinese consul and attorneys who protested that the ter-

ror produced in the scene of contact between arriving immigrant and

physician could not be justified in the laboratory results of filaria infec-

tion. Both the protesters and the journalists expressed extreme ambiva-

lence in redirecting authoritative medical diagnosis away from the phys-

ical encounter of physician and immigrant and in making the laboratory

a privileged site of medical knowledge. Their skepticism was shared by

many physicians, who doubted the diagnosis furnished through the new

bacteriological world of germ cultures and microscopes.61

Federal immigration authorities dismissed protests about the “humil-

iating or mutilating practices” and earnestly defended the procedures in

innocuous clinical language. The exam for threadworm, for instance, re-

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quired the “pricking of the alien’s finger or ear lobe with a sterilized sur-

geon’s needle, and the drawing of a drop of blood.” The blood sample

could provide invaluable results for the officials in their mandate to

identify “infected” bodies. These tests were “incidentally” valuable to

the arriving immigrants, since those who could know the true “nature

of their affliction can take proper measures to cure themselves.”62

The bacteriological examination only further distanced the arriving

immigrant from possessing control over the “true nature” of their bod-

ies and heightened the adversarial character of the medical inspection

process. Since the diagnosis of parasites had only a “incidental” rela-

tionship to treatment, the “infected” immigrant was even more vulner-

able to the systems of immigration and medical control. In certain in-

stances, when the PHS did offer treatment options, the procedures and

their impact on the body were rarely explained. At the PHS hospital,

hookworm was treated with thymol, which loosened the worms from

the intestinal wall, allowing them to be expelled.63 Mrs. Chin, who was

detained for two weeks at Angel Island in 1913, described the disori-

enting experience of the medical therapy required to “flush” hookworm

out of her system. She took the medicine three times a day and had to

refrain from eating. She recalled the effect of the medicine: “Your body

started feeling as weak as a snake’s. You would walk to the hillside and

lay down like a drunkard.” The following day the attendants gave Mrs.

Chin a pan for another feces examination. “Even if you didn’t have any-

thing to go, you forced it out. After they examined it, overnight, they

would give you a little something to eat. Then you had to be examined

again. If you were cleared, you could go.”64 Once the hookworm para-

site was flushed out of the body, one could enter the United States. How-

ever, the Chinese detainees perceived that the hookworm diagnosis

made them subject to medical authority and practices they did not un-

derstand. They did not perceive themselves to be under benevolent med-

ical care. The willingness to accept the medical treatment, even by those

who were bewildered, was perceived by PHS officers as an acceptance of

their diagnosis and a willingness to accept modern health instruction.

Although they were obliged to submit to examination and treatment,

many Chinese were skeptical about the validity of the medical diagnosis:

One poet rejected the idea that his diagnosis, which he called the “the

shadow of hookworm,” was serious enough to warrant his detention

and questioned why the cost of the hospitalization was borne by the im-

migrant. Another poet wrote of his hatred for white “barbarians” who

“continually promulgate harsh laws to show off their prowess” and char-

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acterized hookworm exams as evidence of their “hundreds of despotic

acts.”65 This poet refused to grant the medical officials any scientific le-

gitimacy in the pursuit of their inspection for disease but rather per-

ceived it as an arrogant abuse of power. Others considered the test

results to be fraudulent. Mr. Tong, who at the age of seventeen was de-

tained for two months in 1921, shared a story popular among former

Angel Island detainees: “Before I came to Angel Island, I knew of a

friend who shared his feces with another immigrant who couldn’t elimi-

nate at the moment. It was the same feces, but do you know, one was

found to have hookworms and other didn’t!” This story circulated as a

grim joke to lessen the pain of seemingly arbitrary diagnosis. The PHS

procedures of impersonal testing, forced treatment, payment demands,

and indefinite detention heightened the arriving immigrant’s sense of hu-

miliating dependency. One poet wished to escape the “humiliation and

oppression by the devils.” He refused to perceive himself as ill, reveal-

ing his resistance to the PHS’s quest to know his body and make its care

dependent on their expertise.66 The PHS championed scientific logic and

the police practices of detention not to enable social and health change

in an arriving immigrant but to neutralize a potential health hazard.67

The special scrutiny of Asians at Angel Island became apparent when

Chinese began arriving at Atlantic Coast ports. In 1923 the immigration

station in Boston was unprepared to conduct “satisfactory examination

of Chinese aliens” when the Canadian Pacific Railroad began regularly

transporting Chinese from St. John, New Brunswick, Canada, to Bos-

ton. Although Boston PHS officers were aware of intestinal parasites,

they never had occasion to conduct full-scale, routine bacteriological

examinations before the arrival of Chinese immigrants.68 Following the

racialized expectation that they were infected with hookworms, Chinese

immigrants were also singled out for testing for filariasis and other par-

asites. The Boston station lacked the laboratory equipment to conduct

a large number of bacteriological exams, but ordered more equipment

once Chinese immigration became a regular facet of their work. The

bacteriological protocol developed at Angel Island followed Chinese im-

migrants throughout the PHS system.69

Chinese American community organizations and Chinese diplomats

mounted challenges to the PHS testing practices. In November 1910, the

Chinese consulate and the Chinese Consolidated Benevolent Associa-

tion had hired local physicians and professors of tropical medicine to

testify that filaria was not directly communicable in North American

conditions. One expert argued that a person infected with filaria could

Making Medical Borders at Angel Island 195

07-C1778 6/18/2001 3:52 PM Page 195

“live in this community without being a menace to its health,” was un-

likely to become a public charge, and would benefit from a change in

climate.70 Dr. King Kwan claimed that one could be a parasite carrier

without being a threat, in his challenge to federal officials to subject

themselves to a test for the “filaria germ,” insinuating that they too were

probable disease carriers.71 Kwan’s challenge called into question sev-

eral key assumptions in PHS social policy on parasites. The first is the

perception that a healthy body must be a pure body, independent of the

existence of any other organisms. In order for the body to be pure, it had

to be bound within its own flesh, closed off from its ecological context.

The very process of transmission of the parasite was alarming in the

ways in which it made vulnerable the pure, bounded body of the middle-

class ideal.72 Parasites were considered to be foreign entities that poi-

soned and contaminated the body. The idea of the human carrier who

was able to transport pathogens but remain unaffected by the presence

of foreign organisms was deeply alarming to PHS officers, who feared

the possible harm to unsuspecting Americans and the potential financial

burden to the community. The judgment collapsed the identification of

a parasite organism within the body with the status of being a social par-

asite and dependent.

The conflation of the internal parasite and the social parasite had been

amplified in the political discourse on the health dangers of Asian immi-

gration to the productive capacity of white Americans. Charles T. Nes-

bitt, health director of Wilmington, North Carolina, who testified before

the U.S. House of Representatives, claimed that Asia was the “fountain”

of the “most destructive pestilence” in recorded history and that Asians

have consequently “acquired such a high state of immunity to [its] ef-

fects that they have been unconscious carriers.” In Nesbitt’s mind, im-

munity produced stronger, more dangerous bodies that became carriers

that could destroy the health of a putatively parasite-free “white race.”

He perceived Asian immigrants as likely to “introduce among whites on

the Pacific Slope insidious chronic diseases which will subject them to

physical deterioration.” He feared that these “parasitic diseases, just as

capable of destroying the efficiency of the white race (as the hookworm

disease),” but with fatal consequences, were likely to infiltrate from

China, Japan, and India.73 Nesbitt’s fears of future infection drew from

the recent experience of hookworm in the South, where the PHS had

demonstrated that hookworm infection affected substantial portions of

the poor, agricultural black and white populations and was increasingly

found to disrupt the productivity of white factory workers in the South.74

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Unlike immigration interrogations that required oral verifications of

“authentic” life narratives and relied upon the subjective judgment of

officers, medical investigation provided seemingly incontrovertible evi-

dence of an individual’s fitness for entry based on a normative notion of

good health. Medical officers believed that immigrants could not be

“coached” in health as they could be in the nuances of village geogra-

phy and family relationships. The medical criteria, U.S. authorities be-

lieved, provided universal and objective criteria for entrance. They re-

fused to acknowledge that special immigration procedures faced by the

Chinese and, later, other Asian immigrant groups provided the PHS

with a special opportunity to conduct bacteriological tests even when

physical appearance gave no grounds for suspicion, and that the racial-

ized expectations of disease were justified by the results of the examina-

tions. (See Figure 10.)

Making Medical Borders at Angel Island 197

Figure 10. Public Health Service and Immigration Service officers interrogate a Chinese immigrant at a meeting of the Board of Special Medical Inquiry, Angel Island, 1923. Photo by the commercial photographer P. E. Brooks. Courtesy National Archives at College Park, RG 090-G-124– 479.

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RESISTING MEDICAL PREROGATIVES

During the era of bacteriological examinations for the detection of para-

site diseases, the PHS insulated itself within the arena of science. Through

the relentless championing of science as the only legitimate language for

dispute, the PHS foreclosed the exchange of crucial information among

the objects of medical scrutiny. Both the Chinese Defender and the CCBA

in two separate challenges to PHS policy employed medical expertise in

varying degrees to legitimate their opposition, complying with and mo-

bilizing the prevailing scientific logic of the regulatory structures. Thus,

not only were Chinese community organizations and periodicals forced

to employ medical expertise in their protests, but they had already ac-

ceded to the PHS philosophy that disease and ill-health were foreign con-

ditions that justified strenuous border screening and exclusion policies.

The singling out of certain groups for intensive investigation drew le-

gal challenges. In 1921 two Chinese merchants, Pang Hing and Hee Fuk

Yuen, filed federal lawsuits questioning the administration of immigra-

tion medical inspections. Both men had been denied reentry to the United

States after being certified at Angel Island as having liver fluke. People

afflicted with clonorchiasis have enlarged livers, bloody diarrhea, and

symptomatic jaundice. Their lawyer, Jackson Ralston, argued that the

targeting of Chinese immigrants reflected an “unequal administration

of the law,” comparable to the San Francisco laundry regulations suc-

cessfully challenged in Yick Wo v. Hopkins (1885). Ralston argued that

“Caucasian passengers no matter what class or nationality are exempt

from the microscopic test of their feces, only the Oriental alien traveling

in other than first class accommodations . . . is required to submit to a

specimen for microscopic tests.”75 The PHS had linked liver fluke infec-

tion to the Chinese and Japanese diet of raw fish and used this cultural

specificity to justify special racial hurdles for immigrant entry. The fed-

eral appeals courts and the Supreme Court affirmed that the cultural sus-

ceptibility could be a criteria for special investigation and that the prac-

tice of not testing all white and Asian first-class passengers could not be

interpreted as discriminatory or as “withholding of the rights of Chinese

persons.”76

The Pang Hing case also challenged the administrative authority of

the surgeon general to designate a disease “loathsome and contagious”

without any opportunity for external review. The attorneys raised ques-

tions about the contagiousness of liver fluke and brought to the courts

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the testimony of experts in parasite diseases who cast doubt on the threat

the disease posed to others in the United States. The federal courts, how-

ever, were unwilling to intervene in the administrative authority of the

surgeon general. On appeal, the attorneys for Pang Hing emphasized

the dangers of allowing the surgeon general’s dubious classifications to

remain unaccountable and “invulnerable to judicial attack.” They at-

tacked the classification of liver fluke, describing it as an “abuse” of the

surgeon general’s authority since internal PHS studies indicated that not

a single Chinese death had been attributable to liver fluke and that in

North America there existed no intermediate hosts to transmit the

disease to other humans. The Ninth Circuit Court of Appeals affirmed

the authority of the surgeon general to classify dangerous contagious

diseases and concluded that PHS officers were warranted in narrowing

their investigation to “second-class Oriental passengers only,” since the

source of the disease was “supposed to be a diet of raw fish.”77

The federal courts limited the grounds for challenges to the policy to

persuading the PHS to change disease classifications. In its campaign

against clonorchiasis certification, the CCBA hired attorneys to gather

medical evidence that liver fluke was not contagious and to lobby the

PHS to develop clinical cures for the disease.78 They proposed to equip

a research hospital with PHS personnel who would test experimental

therapies on infected Chinese arrivals.79 The politics of reclassification

of excludable diseases was complicated. The PHS insulated itself from

political challenges and maintained a reputation for professional inde-

pendence. Surgeon General Hugh Cummings directed the PHS officer

N. E. Wayson, who had served as chief medical officer at the Angel Is-

land Quarantine Station, to conduct epidemiological and bacteriologi-

cal investigations into the contagiousness of clonorchiasis.80 After five

years of study, Wayson came to the same conclusion that had been

reached in earlier scientific public health and tropical medicine studies:

that North America lacked the species of fish and snails that served as

hosts to the fluke’s larva, and therefore it was impossible for the para-

site to spread to other humans. Finally, in 1927, clonorchiasis was re-

classified from an excludable disease to a class “C” disease condition,

which, at the discretion of the medical inspector, could be considered a

class “B” condition if it was deemed to inhibit the sufferer’s ability to

earn a living.81 Similarly, hookworm had been demoted in 1917 to a

class “B” disease that might debar an immigrant only if the disease was

deemed likely to make the individual a public charge.82

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Surgeon General Cummings warned a jubilant Chinese community in

San Francisco that the reclassification occurred despite political pressure

and “solely as a result of scientific and epidemiological investigation”

under PHS direction. The PHS had an interest in characterizing the

reclassification as a “purely” internal matter. Cummings pointedly

dismissed the idea that the findings of a non-PHS physician such as

Dr. Fred K. Lam of Honolulu, whom Cummings had met, had any influ-

ence in the matter. Cummings disdained the credit Lam received in Chi-

nese publications like the San Francisco–based Chinese World.83 Since

the CCBA had challenged the PHS within the parameters of medical

decision-making, the CCBA eagerly credited PHS personnel for their sci-

entific research. Nevertheless, they did take an opportunity to acknowl-

edge “other scientific investigators” and “noted statesmen” for their

“deep interest” in the reclassification. In the listing of acknowledgments,

however, Fong did not include the names of any Chinese physicians or

activists who had labored to change the policy, but rather took the op-

portunity to pay tribute to a plethora of white officials, physicians,

statesmen, and attorneys.84 Fong could declare victory only within the

parameters of public health definitions. Clonorchiasis had been reclassi-

fied, but the ideological apparatus that adjudicated the exclusion poli-

cies of disease had not been dislodged. The Chinese American activists

accepted that the PHS could and should police the entry of immigrants

on the basis of their health status. The Chinese Defender, with its ridi-

culing and dismissive temperament, had, a decade and half later, been

replaced by a more pliant coalition that was willing to comply with the

regulatory structure if this meant it could gain certain adjustments to,

and force official reconsideration of, policy. The CCBA’s success demon-

strated the unequivocal power of “scientific logic” to shape the contours

of debate and to reinforce the prevailing regulatory structures.

The oral histories and barrack-wall poetry, however, expressed little

tolerance for such a political philosophy shrouded in scientific logic.

The frequent mention of assault, “humiliation,” and unjustified oppres-

sion in the verses and testimonies recognized the PHS practices as a kind

of despotic military oppression. The poetry, in particular, unequivo-

cally refused such prerogatives, calling them “unjust” and highlighting

the political intentions and psychic effects of such scientifically endorsed

measures.

Many Chinese immigrants fundamentally doubted that they carried

sickness in their bodies and instead presumed that the process of deten-

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tion produced illness. In a long poem published anonymously in Chinese

World in March 1910, an Angel Island detainee wrote:

In this newly opened wild land, the environment is not agreeable.

Drinking water, many developed coughs.

Sipping it, not so few developed sore throats.

A hundred symptoms of sickness developed; it is difficult to put our misery

into words.85

The paradox of the PHS’s detection and treatment of disease in Chinese

and other Asian immigrants was that it forced these immigrants into

detention in what was regarded by the PHS officers themselves as un-

sanitary and unhealthy conditions. In their pleas for appropriations for

basic improvements, the PHS officers described the Chinese barracks as

filthy, crowded, and rat-infested.86

The question remains, why didn’t bacteriology, with its interest in the

microbial pathogen, interrupt the medical obsession with racializing

disease? The microscopic detection processes were intended to provide

the “truth” of an individual’s health condition independent of clinical

signs or symptoms. Despite the PHS’s unwavering justification of its

policies as scientifically guided health measures, unaffected by politics

or prejudice, the practices of bacteriological examination necessitated

a selection strategy. The PHS had neither the facilities nor the politi-

cal will to detain all incoming passengers for full bacteriological exams.

Universal application would require that white first-class passengers be

treated the same as most Asian steerage passengers. It would unsettle the

health authorities’ underlying insistence that disease was exclusively un-

American and nonwhite.

The very means of identification and the statistical tabulation em-

ployed by the PHS both relied upon and reproduced categories of nation-

ality and race. The naming of racial and national groups did not simply

specify origins. They strategically influenced policies, expectations, and

treatment while masquerading as objective, scientific findings. Through-

out the bacteriological revolution, the ability to conduct individual di-

agnosis had been enfolded into group expectations. And the “truth” of

national difference inexorably invoked race so that the expectation of

Chinese health and illness served to define the characteristics of “Asiat-

ics” or “Orientals” and affected the immigration treatment and health

concerns of Asian Indians, Japanese, Koreans, and Filipinos.

The history of immigrant exclusion as a result of trachoma, hook-

worm, threadworm, and liver fluke at the San Francisco quarantine sta-

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tion reinforces Charles Rosenberg’s observation that medical knowledge

has been framed, in part, by a “socially constructed and determined be-

lief system, a reflection of arbitrary social arrangements, social need and

the distribution of power.” Medical knowledge, however, is neither ar-

bitrary nor compulsively functionalist. The developments in microbiol-

ogy shaped the choices available to societies in developing institutional

responses to disease.87 These choices operated within a political world

that had conflated fears of immigrants, particularly from Asia, and anx-

iety about disease. It was possible in managing national borders to mobi-

lize bacteriological expertise to screen particular migrants. The bacterio-

logical revolution did not disrupt racial formation of medical knowledge;

its techniques and insights meshed with prevailing policies about the

danger of racial bodies and racial geographies. Although the statistical

frequency of disease detection differed by nationality, the organizing cat-

egory of “Orientals” shaped the expectations and practices of the PHS,

allowing them to detain Asian Indian and Japanese steerage passengers

as they had Chinese passengers. Race shaped the inspection treatment

that immigrants received, and the process of inspection carried an ex-

pectation regarding which national bodies were most likely to bring dis-

ease to U.S. shores.

The right to medicalize arriving immigrants had been rationalized by

U.S. politicians and PHS officers as a national necessity, an issue of health

security. But the anonymous poetry on the barrack walls disavowed the

legitimacy of medical science to regulate entry into the nation. The pro-

cedures were viewed instead as the capricious and cruel barriers erected

by an unjust and despotic government. Through their poetry and testi-

mony, Chinese detainees demonstrated a variety of different visions of

mobility, justice, and bodily autonomy.

San Francisco Chinese American activists pragmatically sought mid-

dle ground. They opposed discriminatory treatment but summoned

medical expertise in order to challenge the exclusion of those affected by

intestinal parasites. Much as during the 1900–04 bubonic plague epi-

demic in San Francisco, this strategy was politically effective in adjust-

ing public health policy. Under pressure from Chinese American lobby-

ing efforts and lawsuits, the PHS had to reconsider tropical-medicine

evidence that challenged their definition of contagious. In 1917 the PHS

demoted hookworm from a disease that resulted in immediate exclusion

to one that could potentially exclude the sufferer at the discretion of the

medical officer. In 1927 the PHS reclassified liver fluke as well. Though

they were important victories, these adjustments did not interrupt the

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Making Medical Borders at Angel Island 203

racial selection of Asians for bacteriological testing. Rather, they rein-

forced the legitimacy of the medical management of the nation’s borders.

The process of medical screening and, in particular, the treatment for

hookworm administered at Angel Island offer a significant hint of the role

of public health reform in transforming Chinese American society in San

Francisco in the early twentieth century. In the second and third decades

of the twentieth century, many of the Chinese women who successfully

passed through Angel Island joined husbands, had children, and created

domestic lives in urban centers like San Francisco’s Chinatown—a con-

trast with the enduring legacy of Chinese bachelor society. Their chil-

dren were part of a small and growing class of second-generation Chi-

nese Americans who participated in the process of hygienic self-care

through organizations like the YWCA and the YMCA, public schools,

and well-baby and child-health clinics. These institutions offered moth-

ers and their children training and consciousness of public health re-

form. The aim was to cultivate individuals who shared a quest for health

and the capacity to achieve it through personal hygiene, vaccination,

and professional medical care sought when necessary. Race continued to

shape the expectations of the immigrants likely to be “carriers” of dis-

ease and disability into the United States. However, the willingness to

undertake medical testing and treatment to ensure fitness and health en-

abled Chinese Americans to be considered potential citizens—like those

who had been permitted entry into the nation from Angel Island.

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