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EL PASO, A SIGH T FOR

SORE EYES: MEDICAL AND

LEGAL ASP ECTS OF SYRIAN

IMMIGRAT ION, 1906–1907ANN R. GABBERT

The Voyage to America is the Via Dolorosa of the emigrant; and the

Port of Beirut, the verminous hostelries of Marseilles, the Island of Ellis

in New York, are the three stations thereof. And if your hopes are not

crucified at the third and last station, you pass into the Paradise of your

dreams. If they are crucified, alas! The gates of the said Paradise will

be shut against you.

Ameen Fares Rihani1

WHILE PROBABLY LESS than two percent of Syrian immigrants received the

medical rejection certificates at Ellis Island that would crucify their dreams,

rigorous scrutiny for evidence of trachoma (a highly contagious eye disease

frequently leading to blindness) by shipping line physicians at European ports

prompted thousands to choose a more circuitous route from Lebanon,

debarking through Mexican ports and entering the United States at less-

guarded border towns, such as El Paso, Texas.2 Global networks involving

not only helpful friends and relatives, but also unscrupulous entrepreneurs

and emigrant agents, promoted both legal and illegal passage across the

Mexican border. On the local level, prospective immigrants conspired to

Ann R. Gabbert is a doctoral student of history at the University of Texas at El Paso.

1. Ameen Fares Rihani, The Book of Kahlid (New York, 1911), 29.

2. Due to the way the federal immigration service collected immigration data between 1892 and1910, it is necessary to make an estimate from the data available. Senate, Reports of theImmigration Commission, Statistical Review of Immigration 1820–1910, 61st Cong., 3dsess., 1910, Sen. Doc. 756, 367–71; Senate, Reports of the Immigration Commission, Emi-gration Conditions in Europe, 61st Cong., 3d sess., 1910, Sen. Doc. 748, 71–73.

evade medical restrictions and racial borders through the complicity and

greed of local physicians such as Edward D. Sinks and John W. Coffin.3

At the beginning of the twentieth century, many believed that trachoma

and favus (a contagious skin disease) were visible signs of degeneracy, deprav-

ity, illiteracy, and filth.4 This case study of the El Paso trachoma extortion

ring explores the implications of the racialization and medicalization of

United States immigration policy in the early 1900s. Although restrictions

were originally aimed at debarring diseased individuals, in practice public

health officers designated certain nationalities, particularly those from Asia

and southern and eastern Europe, as potentially diseased and thus undesir-

able and therefore targeted for more stringent medical inspection. It is my

contention that medical inspection of immigrants between 1893–1917 was

an important component in the racialization of immigration law, ultimately

leading to quantitative restriction in the 1920s.

Race, as many scholars point out, has always been central to American

immigration policy, beginning with the 1790 naturalization law establishing

16 THE HISTORIAN

3. “Seraphic Report Regarding Conditions on Mexican Border, 1906–07,” Casefile 51423/1;“Braun Report, February, 1907,” Casefile 51411/1, Record Group 85, Microfilm Records,Series A, Part 2, Mexican Immigration, 1906–1930, United States National Archives (here-after cited as Record Group 85).

I will be using the term “Syrian” because this is how these immigrants referred to them-selves. The term Lebanese was adopted in the 1920s and the term Arab came into use forthis group after World War II. Relatively little has been written on the Syrian emigrant expe-rience. Sarah Elizabeth John, “ ‘Trade Will Lead a Man Far’: Syrian Immigration to the ElPaso Area, 1900–1935” (master’s thesis, University of Texas–El Paso, 1982) and Alixa Naff,Becoming American: The Early Arab Immigrant Experience (Carbondale, Ill., 1985) are cul-tural and economic assimilation studies of the American-Syrian community. However, neitherNaff nor John probe this phenomenon of immigration from Mexico from a medical per-spective or question the role of medicalization and racialization in the development of immi-gration policy. There are two monographs that offer the comparative viewpoint of Lebaneseimmigration to Mexico, rather than through it: Martha Diaz de Kuri and Lourdes Macluf,De Libano a Mexico: Cronica de un Pueblo Emigrante (Mexico, 1995); Luis Alfonso RamirezCarrillo, “De Buhoneros a Empresarios: La Inmigracion Libanesa en el Sureste de Mexico,”Historia Mexicana 43 (1994). General studies on immigration include Roger Daniels, Comingto America: A History of Immigration and Ethnicity in American Life (New York, 1990);Roger Daniels, Not Like Us: Immigrants and Minorities in America, 1890–1924 (Chicago,Ill., 1997); Oscar Handlin, Race and Nationality in American Life (Boston, Mass., 1948);Oscar Handlin, The Uprooted: The Epic Story of the Great Migrations That Made the Amer-ican People (New York, 1951); John Higham, Strangers in the Land: Patterns of AmericanNativism 1860–1925, 2d ed. (New Brunswick, N.J., 1988).

4. See for example T. V. Powderly, “Immigration’s Menace to the National Health,” NorthAmerican Review 175 (1902): 59.

that only “free white persons” could become citizens.5 However, early qual-

itative restrictions were aimed at undesirable individuals—convicts and pros-

titutes—rather than racial or ethnic groups. Racialization of immigration

policy began to occur during the late nineteenth century as characteristics of

individuals were projected upon a racial group, and consequently strategies

formulated against the group, rather than a particular person.6 While racial-

ization is evident in many aspects of restrictive immigration policy, as Alan

Kraut argues, “medicalization of preexisting nativist prejudices” through the

creation and codification of “immigrant diseases” occurred as the native-born

population blamed diseases upon foreign-born groups and “stigmatized”

members of the groups as potential carriers of disease.7 Furthermore, racial-

ized policies linked disease to race as an inherited predisposition rather than

a circumstance of culture, place, and time.

Trachoma is a chronic conjunctivitis caused by the bacteria Chlamydia

trachomatis. It occurs at extremely high rates in countries with low stan-

dards of hygiene and a lack of clean running water.8 Undeniably, turn of the

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 17

5. Act of 26 March 1790, 1 Statutes-at-Large 103. For example, see Ian F. Haney López, Whiteby Law: The Legal Construction of Race (New York, 1996); Matthew Frye Jacobson, White-ness of a Different Color: European Immigrants and the Alchemy of Race (Cambridge, 1998).

6. Tzvetan Todorov, On Human Diversity: Nationalism, Racism, and Exoticism in FrenchThought, trans. Catherine Porter (Cambridge, 1993), 90–94; Michael Omi and HowardWinant, Racial Formation in the United States: From the 1960s to the 1990s, 2d ed. (NewYork, 1994), ix, 4, 55.

7. Alan M. Kraut, Silent Travelers: Germs, Genes, and the “Immigrant Menace” (Baltimore,Md., 1994), 2. Within the last several years, there has been a small but growing body ofscholarly work on the interconnections of medicine and public policy formation especially inthe relationship of public health and immigration restriction during the Progressive era. Inaddition to Kraut, Silent Travelers, see also Howard Markel and Alexandra Minna Stern,“Which Face? Whose Nation?: Immigration, Public Health, and the Construction of Diseaseat America’s Ports and Borders, 1891–1928,” American Behavioral Scientist 42 (1999);Howard Markel, “ ‘The Eyes Have It’: Trachoma, the Perception of Disease, the United StatesPublic Health Service, and the American Jewish Immigration Experience, 1897–1924,” Bul-letin of the History of Medicine 74 (2000); Alexandra Minna Stern, “Buildings, Boundaries,and Blood: Medicalization and Nation-Building on the U.S.-Mexico Border, 1910–1930,”Hispanic American Historical Review 79 (1999); Alexandra Minna Stern, “Secrets Under theSkin: New Historical Perspectives on Disease, Deviation, and Citizenship: A Review Article,”Comparative Studies in Society and History 41 (1999).

8. Eugene Braunwald et al., eds., Harrison’s Principles of Internal Medicine, 11th ed. (NewYork, 1987), 764–65.

twentieth-century physicians had difficulty distinguishing the symptoms of

trachoma from those of simple conjunctivitis, but the observation that the

disease occurred with more frequency in certain national groups allowed

physicians to be unduly influenced by commonly held anti-foreign-born prej-

udices as they made the false connection that trachoma was biologically

linked to certain races or ethnicities, rather than occurring as a result of the

sanitary conditions in the diseased immigrant’s homeland, or indeed through

contact with fellow migrants en route to the United States.9

In order to appreciate the specific events that occurred in El Paso

during 1906–07, it is necessary to understand the formalization of medical

inspection exemplified by the Ellis Island line, as well as the nature of

Syrian immigration. Federal and state disputes over public health jurisdiction

perpetuated the idea of immigrant or filth diseases. As historian Charles

Rosenberg relates, “Quarantines and disinfection were imposed on the

poor and their possessions, not on the wealthy—on the steerage, not the

cabin-class, passenger—even after the germ theory was well established.”10

Although the Supreme Court ruled in two crucial cases in 1875 that

state statutes regulating foreign commerce or immigration were unconstitu-

tional,11 state boards under the direction of the U.S. Treasury Department

continued to perform the actual inspection of immigrants at the ports of entry

after the passage of the first comprehensive federal immigration law in August

18 THE HISTORIAN

9. Certainly the point can be made that regardless of whether they had associated trachomawith biology or circumstance, immigration officers were required by law to deny residenceto persons with the disease. From this perspective, personal prejudice would be irrelevant—their job was to exclude diseased persons, not to determine the origin of the infection.However, the assumption that a biological link existed between a certain disease and acertain racial or ethnic group increased the likelihood of racial and ethnic profiling, asmembers of a targeted group would be more carefully scrutinized and likely to be rejectedas victims of disease than an ethnic group for which no such connection was made.

10. Charles E. Rosenberg, Explaining Epidemics and Other Studies in the History of Medicine(Cambridge, 1992), 286.

11. Act of 3 March 1875, 18 Statutes-at-Large 477; Chy Lung v. Freeman et al. (1875), 92 U.S.275; 1875 U.S. Lexis 1754 (Supreme Court of the United States); Henderson et al. v. Mayorof the City of New York et al. (1875) 92 U.S. 259; 1875 U.S. Lexis 1753 (Supreme Courtof the United States); Commissioners of Immigration v. North German Lloyd (1875), 92U.S. 259; 1875 U.S. Lexis 1753 (Supreme Court of the United States).

1882, which excluded convicts, lunatics, idiots, and people incapable of

caring for themselves.12

By the beginning of the 1890s, anti-immigrant feeling within the United

States was growing. Many American voters who came to believe their country

was being overrun by hordes of undesirable, unassimilable aliens responded

by submitting 116 petitions for immigration restriction during the second

session of the fifty-first Congress.13 The Act of 3 March 1891 created the

Office of the Superintendent of Immigration and established the mechanism

for inspecting and rejecting immigrants.14 While New York state quarantine

officers retained jurisdiction over the germ diseases such as cholera, yellow

fever, plague, and smallpox, federal medical officers of the Marine Hospital

Service at the newly established Ellis Island facility looked for “persons likely

to become a public charge” and those afflicted with “a loathsome or dan-

gerous contagious disease.”15 According to historian E. P. Hutchison, the

latter was a “comprehensive but imprecise term that left considerable margin

of discretion to the examining surgeon at the port of entry” and potentially

allowed for ethnic or racial prejudice to enter the selection process as the new

classification looked beyond mortality and morbidity statistics to the public

economic burden and to the perceived desirability of the immigrant.16

The 1891 Act required that all immigrants undergo health inspections at

departure for and arrival to the United States. Steamship lines, foreign and

domestic, were to vaccinate, disinfect, and examine emigrants before embar-

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 19

12. Immigration Act of 3 August 1882, 22 Statutes-at-Large 214; Marian L. Smith, “Overviewof INS History,” in A Historical Guide to the U.S. Government, ed. George T. Kurian (NewYork, 1998), 305.

13. E. P. Hutchinson, Legislative History of American Immigration Policy, 1798–1965(Philadelphia, Pa., 1981), 100.

14. Immigration Act of 3 March 1891, 26 Statutes-at-Large 1084; Senate, Reports of the Immigration Commission, Immigration Legislation, 61st Cong., 3d sess., 1910, Sen. Doc.758, 89.

15. Immigration Act of 20 February 1907, 34 Statutes-at-Large 899; Elizabeth Yew, “MedicalInspection of Immigrants at Ellis Island, 1891–1924,” Bulletin of the New York Academyof Medicine 56 (1980): 493. The National Quarantine Act was passed in February 1893,shifting responsibility to federal inspectors. 27 Statutes-at-Large 452.

16. Hutchinson, Legislative History of American Immigration Policy, 416–17.

kation to ensure that they were healthy.17 However the use of the term “immi-

grants” in the Act implied to many of the inspectors that only those in steer-

age, not those who could afford to travel cabin class, were likely to have

contagious diseases or to become a public charge. Both the steamship lines

and the immigrants quickly learned to take advantage of this misconception,

and steerage deportees on one ship would return to the United States in cabin

class as soon as they had saved the fare. Furthermore, although the law stip-

ulated that the steamship lines had to transport rejected aliens back to

Europe, it was difficult to enforce. On the other hand, it did compel “some

degree of care in the selection of steerage passengers at foreign ports” and

only 2.1 percent of the aliens debarred between 1892 and 1897 were for

“loathsome or dangerous contagious diseases.”18

Trachoma was specifically listed as a dangerous contagious disease in 1897

because it “impaired the usefulness of the sufferer” and because of the

growing concern over the spread of a disease for which, in the pre-antibiotic

era, there was no simple or effective treatment.19 As a result of the new clas-

sification, the number of aliens denied entry for loathsome or dangerous con-

tagious disease increased from 0.1 percent in 1896 to an average of 18.5

percent of the total rejected for the fiscal years 1898–1907. The 11,870

rejected for trachoma were less than 0.2 percent of the total number of immi-

grants (7,208,746) for the period.20 Changes in immigration law in 1903

20 THE HISTORIAN

17. Immigration Act of 3 March 1891, 26 Statutes-at-Large 1084.

18. “Extract from ‘Emigration Conditions in Europe,’ Reports of the U.S. Immigration Commission, IV (1911), 69–80,” in Immigration: Select Documents and Case Records, ed.Edith Abbott (Chicago, Ill., 1924), 71–72; U.S. Congress, Statistical Review, 367. Forexample, see Ann Novotny, Stranger at the Door: Ellis Island, Castle Garden, and the GreatMigration to America, abridged ed. (New York, 1974), 9–11. Between 1892 and 1897, 179 out of a total of 11,441 were rejected for trachoma and favus.

19. Yew, “Medical Inspection of Immigrants,” 495. Available therapies usually consisted of theapplication of antiseptic or caustic solutions (a 1–2 percent solution of silver nitrate was acommon treatment) with the occasional use of draconian surgical procedures.

20. U.S. Congress, Emigration Conditions in Europe, 71–76; Senate, Reports of the Immigra-tion Commission, Abstracts of Reports of the Immigration Commission, 61st Cong., 3dsess., 1910, Sen. Doc. 747, 1:110. Calculations were made using Dr. Allan McLaughlin’sfigure of trachoma being 87 percent of the total for loathsome or dangerous contagious dis-eases. Allan McLaughlin, “Immigration and the Public Health,” Popular Science Monthly64 (1903): 233.

further reinforced the restriction by fining steamship lines $100 for each dis-

eased passenger transported if proper medical examination before embarka-

tion would have led to their exclusion. Total annual fines ranging between

$24,300 and $37,200 (1904–10) compelled more rigorous medical inspec-

tions conducted by shipping lines at embarkation ports. In consequence,

approximately twenty to forty thousand people per year were refused direct

passage to the United States.21

In the first decade of the twentieth century, trachoma became viewed as a

disease that was limited to lower-class immigrants but that could spread to

the general public. While occasional articles referred to the existence of tra-

choma in the native population in the Appalachians or on Native American

reservations, most presented the disease as “readily traced to immigrant

sources” as more people arrived from southern and eastern Europe.22 “Impar-

tial” politicians, doctors, and public health officials were at the forefront of

the attack on the immigrant source. Terrence Powderly, Commissioner-

General of Immigration, charged, “If in future [sic] we should have occasion

to trace the cause why our people are hairless and sightless through Favus and

Trachoma, we should have ourselves to blame.”23 Dr. Allan McLaughlin

of the U.S. Public Health and Marine Hospital Service wrote numerous

articles asserting that “immigration constitutes a menace to the public

health,” blaming the spread of trachoma to a “change in the racial charac-

ter of immigration.”24 Dr. Thomas Darlington, president of the Board of

Health of New York City, correlated the outbreak of trachoma among New

York school children with the foreign born, while Dr. John McMullen of the

U.S. Public Health Service itemized the offending racial groups, Syrians being

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 21

21. U.S. Congress, Emigration Conditions in Europe, 73–74; U.S. Congress, Abstracts ofReports of the Immigration Commission, 26, 110.

22. John McMullan, “Trachoma: Its Prevalence and Control among Immigrants,” Journal of the American Medical Association 51 (1913): 1110–11; Robert De C. Ward, “The Restriction of Immigration,” North American Review 179 (1904): 231.

23. Powderly, “Immigration’s Menace to the National Health,” 60.

24. Allan McLaughlin, “Hebrew, Magyar, and Levantine Immigration,” Popular ScienceMonthly 65 (1904): 332. See also McLaughlin, “Immigration and the Public Health”; AllanMcLaughlin, “The Problem of Immigration,” Popular Science Monthly 65 (1905).

at the top of the list.25 Even President Theodore Roosevelt was concerned:

“We can not have too much immigration of the right kind, and should have

none at all of the wrong kind.”26 Admittedly, it is impossible to determine if

the medical inspectors acted upon latent prejudice or not, but certainly the

fact that Dr. Alfred Reed of the U.S. Public Health and Marine Hospital ser-

vices advocated a general exclusion of all Mediterranean countries including

Syria because their immigrants were “unfit” and “undesirable” lends credence

to the assumption.27 And that it was an assumption shared by some contem-

poraries is suggested by this quote from Robert DeCourcy Ward, one of the

founders of the Immigration Restriction League of Boston.28

A physical test is uniform for all races of incoming aliens. It is not

intended and cannot be used to exclude those of any special race. To

say, as did a very misleading circular issued during the last Session of

Congress, that “any malevolent or narrow-minded medical inspector

. . . might be tempted to abuse his power,” and exclude large number

of aliens of some one nationality, is to impute dishonest, unpatriotic

and wholly unworthy motives to the able officers of the United States

Public Health and Marine Hospital service. Our medical inspectors may

be trusted in this matter, as we already trust them in the detection and

certification of “loathsome or dangerous contagious diseases.” They are

intelligent, able, and honorable men.29

In 1903, another immigration act was passed that, by changing the legal

wording from “immigrant” to “alien,” was designed to ensure that the same

22 THE HISTORIAN

25. Thomas Darlington, “The Medico-Economic Aspect of the Immigration Problem,” NorthAmerican Review 183 (1906): 1268–69; McMullan, “Trachoma: Its Prevalence and Controlamong Immigrants,” 1111.

26. Congressional Record, Presidential Address, 7 December 1903, 58th Cong., 2d sess., 38:3.

27. Alfred C. Reed, “The Medical Side of Immigration,” Popular Science Monthly 80 (1912):390–92. See also Alfred C. Reed, “Immigration and the Public Health,” Popular ScienceMonthly 83 (1913).

28. For a full explanation of the role of this organization in immigration restriction see BarbaraMiller Solomon, Ancestors and Immigrants: A Changing New England Tradition (Cam-bridge, 1956).

29. Robert De C. Ward, “Pending Immigration Bills,” North American Review 183 (1906):1124.

restrictions would apply to all classes of tickets. It had little effect, however,

since cabin-class passengers continued to receive only a cursory examination

on board ship while immigrants in steerage class were systematically exam-

ined “on the line” at the federal facility on Ellis Island.30 After carrying

all of his or her worldly possessions up a steep flight of stairs, the immigrant

passed single file down a line, making two right-angled turns. A medical

officer was stationed at each of these turns, as well as at the top of the

flight of stairs, to observe whether the immigrant was breathing hard,

limping, had deformities, paralysis, or numerous other defects and disabil-

ities.31 At the end of the line, the eye inspector everted the eyelids, usually

with a buttonhook, and determined whether the immigrant had symptoms

of trachoma.32 Prior to 1905, only those with symptoms suggestive of tra-

choma—redness, discharge, or watery eyes—were examined, but after that

date all eyelids were checked for signs of the disease.33 Although there seemed

to be some fear of the examination, it was a momentarily uncomfortable but

not painful procedure, which most immigrants had experienced many times

on their journey.

More than 80 percent of the financial and personnel resources of the U.S.

Public Health Service were devoted to immigration inspection. At its heyday,

between five and ten thousand immigrants per day were examined at the Ellis

Island facility, the physicians allocating approximately six seconds per person

at a cost of eight cents each.34 The medical inspection line was a marvel of

scientific efficiency, and its function was not final diagnosis but triage of

potential problems for further investigation. As questionable immigrants

passed they were accordingly marked with a chalk “E” for eye, “H” for heart,

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 23

30. U.S. Congress, Immigration Legislation, 51.

31. Victor Safford, Immigration Problems: Personal Experiences of an Official (New York,1925), 244–51; Edward A. Steiner, On the Trail of the Immigrant (New York, 1906), 78–93;Reed, “The Medical Side of Immigration,” 385–86.

32. United States Public Health Service, Regulations Governing the Medical Inspection of Aliens(Washington, D.C., 1917), 6–17, 38–40.

33. Markel, “Eyes Have It,” 523; Kraut, Silent Travelers, 61–62.

34. E. K. Sprague, “Medical Inspection of Immigrants,” Survey 30 (1913): 421–22; Markel,“Eyes Have It,” 526; Markel and Stern, “Which Face?,” 1317–18; Yew, “Medical Inspec-tion of Immigrants,” 488–89.

and so forth. Abnormalities were examined “off the line” and given certifi-

cates of disability if deemed appropriate.35 A special board of inquiry con-

sisting of three members reviewed all medical certificates.36 Trachoma was

technically a mandatory exclusion; nevertheless, hearings for trachoma cer-

tificates were lengthy and eventually 5 to 10 percent of those who were cer-

tified were allowed entry.37 Section 37 of the 1903 Immigration Act also

allowed admittance to diseased wives and minor children of resident aliens

seeking citizenship, but only if the diseases were contracted on board the

ship.38 The small percentage of medical debarments ironically reinforced the

self-perceived model of organizational effectiveness since immigration offi-

cials believed that the low number of rejections at U.S. ports was due to rig-

orous scrutiny at foreign ports. The U.S. government actually proposed that

its American medical officers be allowed to inspect passengers at foreign

ports, but understandably most countries rejected this suggestion as a viola-

tion of sovereign jurisdiction.39 Only two countries, Italy and Hungary, com-

plied with the request, but inexplicably the number of aliens rejected at Ellis

Island from Italian ports was higher than the number rejected from other

ports.40

During the first decade of the twentieth century over 60 percent of the

immigrants to the United States left from Naples, Italy; Bremen and

24 THE HISTORIAN

35. Federal regulations defined a medical certificate as the “certification of facts which have beendemonstrated from appropriate medical examinations. A medical certificate so issued hasthe legal value of a document signed by a public officer which is by law made evidence ofthe truth stated for the purposes of the administration of the immigration law.” Darlington,“The Medico-Economic Aspect of the Immigration Problem,” 1263; United States PublicHealth Service, Regulations, 6.

36. U.S. Congress, Immigration Legislation, 89–90. Yew calls this the “Ellis Island Myth.” Yew,“Medical Inspection of Immigrants,” 508 n.57.

37. Reed, “Immigration and the Public Health,” 232; Markel, “Eyes Have It,” 531.

38. Immigration Act of 3 March 1903, 32 Statutes-at-Large 1213.

39. U.S. Congress, Immigration Legislation, 26–27.

40. “Brief Statement of the Investigations of the Immigration Commission, with Conclusionsand Recommendation and View of the Minority,” Reports of the U.S. Immigration Com-mission (1911), in Edith Abbott, Immigration: Select Documents and Case Records(Chicago, Ill., 1924), 203.

Hamburg, Germany; and Liverpool, England.41 While many Syrians followed

this pattern by departing from Naples, the majority were encouraged by

steamship agents in Beirut to take passage on the numerous cargo/passenger

ships departing for Marseilles, France, and from thence to Veracruz, Mexico,

rather than wait for more direct passage to New York.42 Moreover, for many

Syrians there was a sense of urgency due to travel restrictions imposed by the

Ottoman Empire in an attempt to stem the flow leaving for America.43 Much

of the early-twentieth-century literature “ascribe[s] as the cause of [Syrian]

expatriation the rapacity and misrule of the Sultan.”44 In addition, post-

World War II studies of Arab Americans also emphasized religious persecu-

tion as a cause of the early Lebanese migration to the United States, citing

the Massacre of 1860 in which Druze (a Muslim sect) slaughtered large

numbers of Christians in the Mount Lebanon area.45 These works tend to

assign Syrian immigration to the push-pull model of immigration where the

push factors of poverty and religious discrimination encourage immigrants

to respond to the pull factors of economic opportunity. Historian Alixa Naff

dismisses these explanations as a myth that places Syrian migration “mid-

stream among millions of immigrants stereotyped in the American mind, as

poor and oppressed who sought refuge in the land of liberty and democracy.”

Instead, suggests Naff, while Christians outside the Mount Lebanon area of

the Ottoman Empire suffered from continued religious persecution in the

latter half of the nineteenth century, the mutasarrifiyya of Mount Lebanon,

under the rule of a western-oriented international commission, had an

extended period of prosperity, improved trade, lower tax rates, and increas-

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 25

41. Daniels, Coming to America, 186.

42. Braun’s Report, 1906, Casefile 52320/1, Record Group 85; Diaz de Kuri and Macluf, DeLibano a Mexico, 49.

43. Naff, Becoming American, 78–79.

44. McLaughlin, “Hebrew, Magyar, and Levantine Immigration,” 440. See also Louise SeymourHoughton, “Syrians in the United States, Part I,” Survey 26 (1911): 482; Philip K. Hitti,The Syrians in America (New York, 1924), 47–61.

45. Edward Wakin, The Lebanese and Syrians in America (Chicago, Ill., 1974), 11–14; Insti-tute of Texas Cultures, The Syrian and Lebanese Texans (San Antonio, Tex., 1974), 1; John, “ ‘Trade Will Lead a Man Far,’ ” 15.

ing western influence lasting until 1915, all of which might have been

expected to act as a brake upon emigration.46

In fact, prior to World War I, early Syrian immigration, consisting primarily

of Eastern-rite Christians drawn to America by the stories of their country-

men, flourished. Some of the earliest Syrians to experience success in America

participated in the Philadelphia Centennial Exposition of 1876. Visits and

letters from the United States emphasized the economic possibilities and by

the 1880s a chain of migration linked the Mount Lebanon region firmly to

the new world. While chain migration in its simplest form can consist of

friends and relatives helping prospective immigrants, it can also involve

complex networks of helpful as well as “unscrupulous” entrepreneurs pro-

viding transportation, accommodation, appropriate clothing, food, papers,

and the necessary bribes—a system described by one member of the United

States foreign mission as the “emigrant business.”47

A native, usually one that has been to America visits a village,

holds meetings, tells of the wonderful way to make money, where to

go, what to do—in fact everything necessary for an emigrant to

know. . . . This man is one of a long chain whose links are located all

the way from Syria to North and South American seaports. From time

to time, this chain of workers will send and receive warnings to avoid

or to go to this or to that place. Word will come to avoid New York if

diseased; then go to Mexico, and then go north, etc. . . . It is a system

that results in much human suffering, troubles, jealousies, and some-

times crime.48

It was also apparently a system that worked. While the official records indi-

cate that 41,404 Syrians immigrated between 1899–1907, it is possible that

the total number of Syrians entering the United States in this period was as

high as seventy to one hundred thousand. Part of the difficulty in calculating

26 THE HISTORIAN

46. Naff, Becoming American, 28–30, 86–88.

47. Ibid., 77–78, 92–94.

48. Ibid., 93.

this figure is that prior to 1899, United States officials combined all ethnicities

from the Ottoman Empire under the rubric “Turkey in Europe.” Similarly, offi-

cial numbers did not include those emigrating from an intermediary location

such as Australia or South America or those entering illegally from Canada or

Mexico, “the last gateways open to violators of our immigration laws.”49

The statistics force us to ask: if the conditions in Mount Lebanon were not

bad and the journey was difficult, why did so many come? The answer lies

in the words of a traveler in 1908: “It is the judgment of the steerage that

the United States is a place worth striving or struggling or starving to reach.

And against this judgment nothing short of actual exclusion can prevail.”50

Indeed, between 1899 and 1907, 4,648 Syrians were denied admission at U.S.

ports; 33 percent of these (1,578) were due to trachoma.51 These numbers do

not include the many thousands turned away by shipping line physicians at

Naples or Marseilles.52 Unquestionably, in the case of the Syrians, exclusion

did not prevail, for many of those actually rejected or simply fearing rejec-

tion sought alternative routes, primarily across the Mexican border.53 While

small numbers did attempt to cross the Canadian border, those inspectors fol-

lowed the rules stringently, and in 1902, for example, 62.5 percent of the 232

Syrians who attempted to cross from the north were rejected for trachoma.54

During the first decade of the twentieth century, word of mouth stressed the

ease of the southern crossing, causing the ports of Veracruz, Tampico,

Progreso, Salina Cruz, Manzanillo, and Mazatlán to receive approximately

5,000 “diseased” Syrians annually, predominately on French ships.55

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 27

49. Houghton, “Syrians in the United States,” 487–88; Naff, Becoming American, 108. Quo-tation from McLaughlin, “The Problem of Immigration,” 531.

50. Lewis E. MacBrayne, “The Judgment of the Steerage,” Harper’s Monthly 117 (1908): 490.

51. Houghton, “Syrians in the United States,” 490–91.

52. U.S. Congress, Immigration Legislation, 197–99.

53. Casefile 51411/1, Folder #2, Record Group 85; Immigration Act of 3 August 1882, 22Statutes-at-Large 214.

54. Casefile 51411/1, Folder #2, Record Group 85; Houghton, “Syrians in the United States,”491; McLaughlin, “Immigration and the Public Health,” 236.

55. Ramirez Carrillo, 456; Casefile 51411/1, Folder #2, Record Group 85; John, “ ‘Trade WillLead a Man Far,’ ” 31–32.

As Martha Diaz de Kuri relates, some of the Syrian emigrants arriving at

Veracruz wanted to settle in Mexico under the stable regime of Porfirio Díaz,

but most, because they were “atraídos por el progreso de sus coterráneos y

por el inefable sueño americano,” had the intention of following a route to

the United States, “[el] país que les había negado la entrada.”56 The final

route depended on the destination of the immigrant; aliens wanting to relo-

cate to the eastern states usually crossed at Eagle Pass or Del Rio, Texas, and

those wanting the far Southwest proceeded to El Paso. Only about 10 percent

submitted to the legal procedures, most escaping “the prescribed [medical]

examination by simply evading the regular points of crossing and entering

. . . [by] row boats, carriage roads, pathways, and mountain trails through

this broad expanse of imaginary line, all passable and all being used for sur-

reptitious entry into the United States.”57

In December 1906, Marcus Braun, an undercover investigator for the

Bureau of Immigration, gained first-hand knowledge of the “emigrant busi-

ness” by traveling by steamer to Veracruz with a large group of Syrians.

Enterprising Syrian businessmen who instructed them in the necessary pro-

cedures for entering the United States met them at that port and again in

Mexico City. These “emigrant agents” made their money not only by the

$1.00–$1.50 a day they charged for room and board and the $2.00 they

charged for translation services, but also by placing the newcomers in the

obligation of working off their debts as peddlers. In fact, A. Seraphic, another

undercover agent for the Immigration Bureau, found enclaves of Syrians

living in filth and poverty in Tampico, Torreon, and Mexico City, exploited

under a padrone system by their fellow countrymen. Braun and Seraphic dis-

covered that the guides were without fail unscrupulous, claiming to help their

compatriots while actually robbing and cheating them, and frequently

28 THE HISTORIAN

56. “Attracted by the progress of their countrymen and because of the ineffable Americandream” . . . “the country that had denied them entrance.” Diaz de Kuri and Macluf, DeLibano a Mexico, 45, 47.

57. Casefile 51411/1, Folder #2, Record Group 85. Attempts at immigration restriction haveperennially failed at the U.S.-Mexican border because of the permeable nature of landboundaries.

promising to give them passage to the border while entrapping them in

Mexico.58 Braun and Seraphic also uncovered a number of American physi-

cians who maintained practices for “curing” trachoma in several of the

Mexican towns on the Texas border, but they were astounded by the audac-

ity of the extortion ring managed by Dr. Edward D. Sinks, acting assistant

surgeon of the Public Health and Marine Hospital Service in El Paso,

Texas; Dr. John W. Coffin, a U.S. physician practicing both in El Paso and

Juarez, Mexico; and to a lesser extent Juarez boarding house manager Kahil

Koury.59

The deception ran as follows: Koury brought Syrians—many of them in

perfectly good health—to the border for inspection by Sinks, who immedi-

ately denied them entry on the basis of trachoma. Koury then brought the

“diseased” Syrians to Coffin, the physician who “monopolize[d] the treat-

ment of Syrian trachomatous eyes.” Upon payment of $20.00 in cash, the

Syrians received two drops of a silver nitrate solution per eye every three days

for a total of ten treatments.60 At the end of the month, Coffin would certify

their cure—“Juarez, Dec. 27, 1906. ‘This is to certify that I have treated

bearer for one month, and he is now cured.’”61 Certificate in hand, the

Syrians proceeded once again to inspection by Sinks who this time allowed

them entry to the United States. When Seraphic, one of the undercover inves-

tigators, asked why Koury didn’t buy the medicine and personally treat the

Syrians, Koury responded,

“My friend, it is the not the medicine, it is the dollars that do the busi-

ness. The paper Coffin writes means to the government Doctor that

Coffin got the $20, and he lets the fellow go.” “How do you know that,

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 29

58. Casefile 51411/1, Folder #2; Casefile 51423/1 Record Group 85.

59. Casefile 51411/1, Folders #1 and #2; Casefile 51423/1 Record Group 85.

60. In the case of Drs. Sinks and Coffin, the question is not whether they were using the stan-dard treatment but whether they were applying it to actual cases of trachoma and whetherthey completed the cure as promised. See Markel, “Eyes Have It,” 555–56 for more infor-mation on trachoma treatment.

61. Casefile 51423/1, Record Group 85.

Koury?” “Why, have I no sense? The Government Doctor took me to

Dr. Coffin and told me to get him for the Syrians.”62

How did this group of perpetrators arrive in El Paso and when did the extor-

tion ring begin? At least partial answers lie in the hundreds of pages of con-

flicting reports and circumstantial evidence produced by the Bureau of

Immigration investigators.

Edward D. Sinks received his medical degree from the Medical College of

Ohio, part of the University of Cincinnati, in 1899.63 After a three-year army

tour of duty in the Philippine Islands, Sinks established a private practice in

El Paso in 1903 and by the end of 1904 was able to secure the position of

quarantine officer in El Paso due to the Republican Party connections of his

father-in-law, Henry J. May.64 There is no record of why John W. Coffin, an

1886 graduate of the Medical Department of Western Reserve University,

came to El Paso in 1904, but it is likely that he was drawn to the area by his

previous involvement with Sinks as a member of the Association of Military

Surgeons.65 It is known that Coffin shared office space with Sinks in the

Guaranty Trust Building in El Paso during 1904–05 and that they and their

families lived within a few blocks of each other.66

Disappointed by the meager compensation for his federal appointment as

acting assistant surgeon of the Public Health and Marine Hospital Service

30 THE HISTORIAN

62. Casefile 51423/1, Record Group 85. There is some discrepancy in the typewritten reportson the spellings of the foreign names. Koury is also spelled Khoury.

63. State Board of Examiners, El Paso Medical Register, Register of Physicians and Surgeons,1907–1909.

64. John F. Worley & Co.’s El Paso Directory 1905 (Dallas, Tex., 1904), 152, 268; John F.Worley & Co.’s El Paso Directory 1906 (Dallas, Tex., 1905), 170, 420; El Paso Times, 14January 1904; E. D. Sinks to Major Ireland, Surgeon United States Army, 31 October 1903;E. D. Sinks to Sen. Marcus A. Hanna, 26 January 1904; Henry J. May to Gen. CharlesDick, 28 January 1904. Record Group 90, United States Public Health Service, Central files,1897–1923, File #1248, Box 117, File #2, Parral Archives, University of Texas–El Paso(hereafter cited as Record Group 90).

65. El Paso Medical Register, Register of Physicians and Surgeons, 1907–1909.

66. John F. Worley & Co.’s El Paso Directory 1905 (Dallas, Tex., 1904); John F. Worley & Co.’s El Paso Directory 1906 (Dallas, Tex., 1905); John F. Worley & Co.’s El Paso Directory 1907 (Dallas, Tex., 1906).

(PH&MHS), after six months Sinks requested a pay raise from $100 to $150

a month in May 1905. He complained that he had inspected over thirteen

thousand adult immigrants in the last six months and did not feel his “com-

pensation [was] commensurate with the amount of work required.”67 Sinks

also was accumulating personal grievances against the El Paso community

during this period. In 1904 and again in 1905, Sinks attempted to acquire a

Texas medical license. He did not pass the examination and consequently was

brought before a grand jury several times on the “charge of practicing med-

icine illegally.” Whether the grand jury believed either that he would pass at

the next examination or that the local doctors were unfairly persecuting him

is unknown, but no indictments were ever made.68 Sinks’s troubles contin-

ued, however, and in August 1905, E. Alexander, another acting assisting

surgeon of the PH&MHS stationed in El Paso, published a scathing and

insulting criticism of Sinks in the El Paso Morning Times, stating that Sinks

represented “the Marine Hospital here as much as the man running the ele-

vator in the Federal building represents the United States treasury depart-

ment.”69 The personality conflicts between Sinks and the El Paso medical

community seemed to escalate and it appeared to Sinks that they were

attempting to remove him from his position for political reasons.70 By the

end of the year Sinks had given up his private practice and was devoting all

of his time to the immigration service.71

In December 1905, Sinks requested clarification from the surgeon general

concerning the deportation of Syrians with trachoma at the El Paso port. While

this letter gives the impression of being guileless, in light of subsequent events

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 31

67. Sinks to surgeon general, Public Health and Marine Hospital Service (PH&MHS), 20 May1905, Record Group 90.

68. P. M. Carrington to surgeon general, 18 December 1906, Record Group 90. Under the statelaw current at the time, Sinks was required to have a Texas medical license for the privatepractice of medicine, but not to perform his duties for the federal government.

69. El Paso Morning Times, undated clipping from August 1905 in Record Group 90.

70. Sinks to Charles Dick, 15 September 1905; O. H. Baum to L. M. Shaw, Secretary of theTreasury, 20 September 1905; Baum to Dick, 20 September 1905; H. Edward to WalterWyman, Surgeon General, 22 September 1905, Record Group 90.

71. Carrington to Wyman, 18 December 1906, Record Group 90.

it deserves closer attention. Sinks reported that after certifying and disbarring

thirteen Syrians for trachoma, they had taken up residence in Juárez and were

under the treatment of El Paso physicians for the disease. He continued:

Every few days my attention is called to some one of them who has

been under treatment for a few days and a certificate given me from

some physician stating that he has treated said person for Trachoma

and that the disease is now cured. How long after being certified should

cases be allowed to enter?72

Although the acting surgeon general stated that “these certificates may be,

and should be, disregarded by you,” he continued that “the responsibility of

deciding whether a cure in the case of trachoma has been effected rests with

you alone.”73

Taking this as carte blanche, Sinks appears to have immediately set up

shop. Between 2 January and 7 April 1906, Sinks certified forty-seven

Syrians as having trachoma. According to an investigation in April 1906

by B. O. Crowley of the Department of Commerce and Labor, all were

deported to Juárez, Mexico where they paid a fee of $10.00 to private El

Paso physicians for a cure. Within thirteen to thirty days, they returned to

Sinks, who certified them as having recovered and passed them into the

United States. Upon questioning, Sinks denied “participation in the revenues

accruing to these private medical harpies,” and claimed that he must have

misdiagnosed the cases due to incompetence; perhaps the Syrians had recov-

ered so quickly because he didn’t know the difference between simple con-

junctivitis and trachoma. While Crowley dismissed the charges of dishonesty

against Sinks, he did believe that something should be done about the port

of El Paso:74

It is a natural deduction for a Syrian alien to draw that the payment of

the $10, and not his recovery from a dangerous contagious disease, is

32 THE HISTORIAN

72. Sinks to surgeon general, 28 December 1905, Record Group 90.

73. Acting Surgeon General A. H. Glennan to Sinks, 4 January 1906, Record Group 90.

74. B. O. Crowley to Frank P. Sargent, 30 April 1906, Record Group 90.

what makes him admissible to the United States. . . . It seems to me that

every Syrian alien applying at this port should be the subject of Special

Inquiry. Their appearance at this remote point is a suspicious circum-

stance in itself.75

Despite Crowley’s recommendation, however, nothing was done, and it

appears that Sinks continued to extort ever-increasing amounts of money

from Syrians trying to enter the United States as legal immigrants. Toward

the end of the year, however, and despite the inconclusive findings of the

earlier investigation, T. F. Schmucker, the inspector in charge of the El Paso

Immigration Office, sent a confidential report to the Commissioner-General

of Immigration concerning Sinks and Coffin. On behalf of the El Paso County

Medical Society, W. H. Vilas, a respected El Paso physician, had accused them

of passing Syrian aliens for “excessive sums of money.” Although the doctors

claimed that the “secret arrangement” was common knowledge,76 this second

set of charges appears to have been prompted by an incident relating to a

young Syrian who had been certified and “treated” for trachoma. Upon a

request from a friend of the young man, W. D. Howe, an El Paso judge,

looked into the situation and asked H. E. Stevenson, a local physician in good

standing, to examine the boy. Stevenson reported that the young man was

perfectly well and that there was “no just reason for his being excluded from

the United States on account of his physical condition.”77 As a result, P. M.

Carrington, Surgeon PH&MHS, was sent to investigate the El Paso port for

wrongdoing.

Carrington reviewed the charges and in his official report stated that while

there was no doubt of the incident, there also was no proof of collusion

between Sinks and Coffin.

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 33

75. Ibid.

76. T. F. Schumucker to Commissioner-General of Immigration, 14 November 1906, RecordGroup 90.

77. W. D. Howe to H. E. Stevenson, 30 August 1906; Stevenson to Howe, 1 September 1906,Record Group 90.

It is [in] the very nature of things a secret agreement, [and] if it exists,

would only be known to Doctors Sinks and Coffin, and naturally

neither would admit it. As a matter of fact it is denied by Dr. Sinks.78

In a personal and confidential letter to Surgeon General Walter Wyman,

Carrington spelled out how he “found it an extremely difficult matter to

arrive at a just conclusion regarding Dr. Sinks.” Carrington did not believe

that all of the El Paso medical community would “persecute the young man

from feelings of jealousy” and wondered why even prominent friends of Sinks

described him as “lacking in character,” “wanting in stability of purpose,”

and someone who “just can not help lying.” Unable to decide definitively

one way or the other, Carrington’s final recommendation was to transfer

Sinks to a station outside of Texas and bring an Ellis Island-trained physi-

cian/inspector to run the El Paso immigration station.79 Again, however, as

in April, nothing came of the recommendation.

Still, at this point, by the end of 1906, Sinks must have felt his life was

coming apart at the seams. His wife of two years, Edna (May) Sinks, divorced

him in November, charging him with “a number of acts of cruelty.”80 After

signing a non-disclosure document concerning her husband’s business, she

received her property settlement, which included thirty-two lots in a new El

Paso suburb.81 The property settlement and Sinks’s residence after the divorce,

the exclusive and expensive Toltec Club with its $100 initiation fee, $50

annual dues, and high rent, makes one question whether Sinks was living

solely on his $1,200 annual immigration service salary.82 To add to Sinks’s

problems, and providing what ultimately turned out to be the decisive blow

against the extortion ring, Seraphic arrived in El Paso at the end of Decem-

ber to intensify his investigation of Syrian immigration along the border.

34 THE HISTORIAN

78. P. M. Carrington to Wyman, 18 December 1906, Record Group 90.

79. Carrington to Surgeon General Wyman, 18 December 1906, 19 December 1906, RecordGroup 90.

80. El Paso Herald, 18 December 1906; 31 January 1907.

81. Casefile 51423/1, Record Group 85.

82. John F. Worley & Co.’s El Paso Directory 1908 (Dallas, Tex., 1907), 468, 491; C. L. Sonnichsen, Pass of the North: Four Centuries on the Rio Grande (El Paso, Tex., 1968), 270.

Acting on information given by Syrians living in Pennsylvania, Missouri,

and Utah who had been refused passage to the United States by steamship

lines in Europe but had gained admittance through El Paso for a fee, Seraphic

posed as a Syrian debarred at the Laredo port and attempting to make

arrangements to cross the border. Seraphic was met at the railway station by

a Syrian who directed him to Khoury’s boarding houses. Khoury first intro-

duced him to Coffin and then to Alfredo Duboys, a Greek working at the

Mexican Central railroad depot, who offered, for a fee, to help him simply

walk across the border disguised as a Mexican. When Seraphic feigned fear,

requesting “legal” papers, Khoury sent him to Sinks’s immigration office for

the first medical debarment certificate.83

When his undercover investigation was derailed by the actions of a local

inspector whose participation in the extortion ring was suspected but not

proven, Seraphic called a formal investigation board hearing designed to

expose both the ring and the identity of the participants. In the resultant

sworn testimony on 31 December 1906, Sinks admitted to knowing about

an extortion ring but claimed that he was being falsely accused of participa-

tion. His defense for why he certified healthy people as having trachoma con-

tinued to be medical incompetence. Unfortunately for Sinks, however,

statements under oath by Koury and others asserted that Sinks had indeed

arranged for Coffin to examine and “treat” the Syrians, that Coffin’s fee had

increased from $14 in gold to $25 in gold over the course of the year, that

between thirty to thirty-five Syrians were debarred and treated each month,

and that no one got past the government doctor without paying the fee.84 As

damning as it appeared, however, even this testimony proved insufficient to

convict Sinks, and allowed Seraphic only to recommend that the smugglers

be watched and apprehended “in the act of smuggling,” and that Sinks be

transferred if “the circumstantial evidence submitted . . . is not deemed suffi-

cient to warrant his dismissal.” Seraphic did, however, urge that the Mexican

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 35

83. Casefile 51423/1, Record Group 85; Crowley to Sargent, 30 April 1906, Record Group 90.At this time, there were no restrictions on Mexican nationals passing across the U.S.-Mexican border. Many Asians and Syrians crossed illegally by pretending to be Mexicans.

84. Casefile 51423/1, Record Group 85.

border be closed to aliens because the possibility of smuggling and extortion

was too great. No action was advised against Coffin.85

While the exact sequence of events in January 1907 is unclear, Sinks must

have realized that the scam was over. Thus, on 14 January, he requested a

transfer to any port in the “Orient, Europe, or South America.” The request

was denied. There is no record of Sinks’s dismissal, but the fact that he sent

a telegram on 16 January to the surgeon general requesting that he be rein-

stated and that his resignation be accepted for 20 January, together with the

fact that John W. Tappan was sworn in as the new acting assistant surgeon

for the El Paso port on 17 January 1907, officially replacing Sinks, suggests

that Sinks had in fact been dismissed. A physician trained on the Ellis Island

line, Tappan met the suggested requirements of both Carrington and

Seraphic.86

Remarried to his ex-wife on 31 January, Sinks spent much of the next six

months attempting to clear his name and regain his federal appointment,

accusing the medical community and the investigators of personal jealousy

and political motives.87 Ironically, he supported himself during this period by

treating trachoma in Juárez.88 While his efforts for reinstatement were unsuc-

cessful, he did gain his medical registration in January 1908 and resumed his

private practice in El Paso.89 During the Mexican Revolution of 1910, he

gained some notoriety by volunteering to join I. J. Bush, the surgeon general

of the Mexican Insurrecto Army, in treating Mexican soldiers, but he

“deserted in the midst of battle.”90 For his part, Coffin registered with the

Texas State Board of Medical Examiners in March 1908. He died of menin-

36 THE HISTORIAN

85. Casefile 51423/1, Record Group 85.

86. Commissioner-General, Department of Commerce and Labor to surgeon general, 16 January1907; Sinks to Wyman, 16 January 1907; A. H. Glennan to Sinks, 21 January 1907; Oathof Office, John W. Tappan, Record Group 90.

87. El Paso Herald, 31 January 1907; Sinks to Wyman, 17 March 1907; Sinks to Wyman, 23April 1907; William Kneedler to Wyman, 9 May 1907; Sinks to Theodore Roosevelt, 27May 1907; Nathan Boyd to Wyman, 19 July 1907, Record Group 90.

88. Tappan to surgeon general, 6 September 1907, Record Group 90.

89. El Paso Medical Register, Register of Physicians and Surgeons, 1907–1909.

90. I. J. Bush, Gringo Doctor (Caldwell, Idaho, 1939), 168–71.

gitis the following year, however, leaving his wife to support the family by

giving voice culture lessons from their family home, the money made in the

heyday of 1906–07 apparently gone.91

With Sinks gone, Tappan instigated proper procedures for trachoma

inspection along the border, requiring the public health physicians to use

the guidelines in the “Book of Instructions for the Medical Examination of

Immigrants” to screen immigrants. Due to Tappan’s more stringent standards

in El Paso, the smuggling network advised Syrians to avoid El Paso and

instead travel to the border communities of Ciudad Porfirio Díaz (Piedras

Negras) and Eagle Pass where the Syrian doctor Anton Acaad, in cahoots

with the Mexican mayor, “guarantee[d], for a definite sum, to get any ‘eye

case’ through.”92 Perhaps aware of this moving immigrant trail, Tappan’s

letters to the U.S. surgeon general continued to express concern for the

border inspection service, a position “in which a medical officer has so many

opportunities to go wrong,” and he seemed to fear that more physicians on

the border would be led astray by the circumstances of low pay and lack of

supervision.93

Tappan’s anxiety over immigration through the Mexican border was

reflected at the national level when, based in part on Bureau of Immigration

and Naturalization recommendations from the undercover investigations of

Braun and Seraphic, the United States Congress strengthened immigration

law, trying to make it more difficult for immigrants to enter through the

Mexican border. Thus the Immigration Act of 20 February 1907 was a com-

prehensive recodification that increased the head tax, added to the list of

excludable classes of aliens, extended the period of time in which an alien

could be deported for being a public charge, established rules for entry and

inspection along the Canadian and Mexican borders, and created a Joint

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 37

91. El Paso Times, 16 September 1909; El Paso Medical Register, Register of Physicians andSurgeons, 1907–1909; John F. Worley & Co.’s El Paso Directory 1910 (Dallas, Tex., 1909),170.

92. Tappan to surgeon general, 10 October 1907, Record Group 90.

93. Ibid.; Tappan to surgeon general, 7 November 1907, Record Group 90.

Commission on Immigration.94 Under the supervision of Senator William

Dillingham, the commission produced forty-two volumes of reports reflect-

ing a formalized belief in racialization. Echoing popular sentiments about the

link between disease and immigration, popular press articles by public health

physicians continued to assert that medical inspection kept at bay the

“hordes” of trachoma victims trying to come to the United States.95

At the local level, the United States redoubled its efforts to close the

Mexican border to illegal immigrants. As early as 1903, the Bureau of

Immigration had attempted to convince the Mexican railroads to cease selling

tickets to diseased aliens attempting to reach the U.S. border. Citing the Immi-

gration Act of 3 March 1903 that expanded the rules for the southern border,

the Commissioner-General threatened to “detain all passengers at the border,

at your expense, pending a thorough inspection.” The Mexican Central

Railway (Mexico City to Cuidad Juárez) and the Mexican National Railway

(Mexico City to Nuevo Laredo and Cuidad Porfirio Díaz) responded that

only the Consejo Superior de Salubriad (the Board of Health) was “empow-

ered” to enter into “international agreements” and that they could not nego-

tiate a contract without the consent of the Mexican government.96 Perhaps

taking the officials at their word, U.S. immigration turned directly to the

Mexican government, a shift that in 1906 resulted in a somewhat insulting

exchange of letters between the Secretario de Relaciones Exteriores of Mexico

and the U.S. ambassador. The initial letter alerted the Mexican authorities

that Syrians diseased with trachoma were using Mexico as a conduit to the

United States and requested that they be stopped. Ignacio Mariscal in the

Ministry of Foreign Affairs responded that the Secretaría de Gobernación,

38 THE HISTORIAN

94. Immigration Act of 20 February 1907, 34 Statutes-at-Large 898; Senate, CongressionalRecord, 59th Cong., 2d sess., 41, pt. 3 (13 February 1907): 2808–17.

95. Reed, “Immigration and the Public Health,” 323. Other diseases were occasionally targetedbut trachoma was one of the most highlighted by the press. It was highly contagious, diffi-cult to treat, disfiguring, and would eventually cause blindness.

96. Immigration Act of 3 March 1903, 32 Statutes-at-Large 1213; Sargent to H. R. Nickerson,12 March 1903; P. Martz Del Rio to A. A. Robinson, 16 March 1903; undated memoran-dum concerning “Efforts Made to Perfect an Agreement with the Railways of Mexico Concerning Inspection of Aliens,” Casefile 51463/A, Record Group 85.

the agency in charge of medical inspection, rigorously inspected aliens arriv-

ing at Mexican ports. The U.S. ambassador forwarded a copy of a Public

Health Service monograph concerning trachoma, rejoining that the Mexican

officials apparently did not recognize the disease.97 More congenially,

Mexican president Porfirio Díaz informally conferred with Braun in May

1907 concerning the immigration question. This meeting led to further nego-

tiations between the two countries, and in August 1907, the Mexican Herald

stated that the Mexican government would no longer allow their country to

be the “stamping ground of Syrians and other foreigners, who have come to

this country because they have been denied or know that they will be denied

admission to the ports of the United States because they are the victims of

[trachoma].”98 While these initial legal measures enacted by the Mexican gov-

ernment to prevent diseased Syrians from landing in Mexico and using the

national railway systems to cross into the United States did reduce the total

number of legal immigrants by over 50 percent (9,130 for the six months

prior to 1 July 1907 to 4,188 for the six months prior to 1 January 1908),

illegal immigration continued at approximately ten thousand per year—

mostly Chinese, Japanese, Syrians, and Greeks.99 Since the specifics of the

U.S. Immigration Act of 20 February 1907 allowed “bona fide residents of

Mexico [to] be freely admitted to the United States without examination,”

smugglers persisted in helping excluded groups of aliens across the border

disguised as Mexican peasants.100 In an attempt to close this loophole, offi-

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 39

97. D. E. Thompson to Ignacio Mariscal, 7 June 1906; “Trachoma Monograph,” 22 March1907; J. J. Sholgers to Commissioner-General of Immigration, 25 March 1907; UnsignedBureau of Immigration and Naturalization Memorandum, 11 November 1907, Casefile51463/B, Record Group 85; Diaz de Kuri and Macluf, De Libano a Mexico, 47–48.

98. Unsigned Bureau of Immigration and Naturalization Memorandum, 11 November 1907,Casefile 51463/B, Record Group 85; Mexican Herald, 17 August 1907.

99. Unsigned letter to Elihu Root, 12 February 1908, Casefile 51463/C, Record Group 85.

100. “Memorandum of an Agreement Proposed to be Concluded, with the Consent and Supportof the Government of Mexico, between the Immigration Authorities of the United Statesand the Several Transportation Companies of Mexico Engaged in the Carriage of AlienImmigrants Destined to the United States,” 7 February 1908, Casefile 51463/C, RecordGroup 85; Immigration Act of 20 February 1907, 34 Statutes-at-Large 898. (See specifi-cally sections 32 and 36.) The Seraphic report explains several smuggling methods of thissort. Casefile 51423/1, Record Group 85.

cials in the Mexican government amended their constitution in 1908 to allow

restriction of immigration for the “public health.” As a result, the govern-

ment was able to implement a policy of restricting the immigration and emi-

gration of diseased persons into and out of Mexico. Implicitly aimed at

nationalities assumed to have trachoma, the changes not only protected

Mexico’s citizenry from contagious disease but also made it harder for dis-

eased individuals to use Mexico as a conduit to the United States.101

In many respects this article has been about attitudes and beliefs, things

that are difficult to prove but whose tracks can be found in the written and

oral record and are evidenced by the actions of those to whom they pertain.

Between 1893 and 1907, the U.S. government’s immigration policy reflected

a fluid and confused understanding of races, nationalities, and peoples. Prior

to 1899, immigrants were listed by country of national origin; however, after

that date, passenger lists required classification by language and racial stock.

This shift in categorization promoted a false correlation between “immigrant

diseases” and race, and rather than examining individuals and their economic

or social circumstance, racialized medical policy reflected prevailing racist

social attitudes and was justified by “objective” science. For their part, by

circumventing established legal immigration procedures, trachoma extortion

rings reflected a distorted, twisted image of that policy. However, there is no

doubt that the perpetrators used prevailing racial stereotypes to their finan-

cial advantage as they chose to view all Syrians, not as individuals, not as

future citizens, but as potential marks for a scam. The medico-legal cases

from the Mexican border should have illuminated the deficiencies of racial

profiling for medical exclusion, but instead they reinforced the public’s per-

ception of a racialized association between trachoma and certain nationali-

ties. Likewise, Sinks and Coffin believed that they could falsely certify and

treat trachoma in healthy individuals because Syrians as a race were consid-

ered diseased and depraved—in the words of another member of the Public

40 THE HISTORIAN

101. Wm. R. Wheeler to Secretary of State Elihu Root, 26 October 1908, Casefile 51463/C,Record Group 85; Mexican Herald, 7 October 1908.

Health Service, they were “human parasites” and the “scum of the Levant.”102

As a consequence of the “common knowledge” that southern and eastern

Europeans were inferior races, Sinks and Coffin believed no one would ques-

tion their actions as objective, honest men of science. And, while it is possi-

ble that some of these doctors and businessmen were evading an unjust law

in an attempt to help the Syrians, it seems more likely that they were simply

taking advantage of the situation.

Syrians left the Ottoman Empire because they believed that there were eco-

nomic opportunities in the United States that justified sacrifice and, in some

cases, creative methods of arrival. Whether the movement of Syrians out of

the Mount Lebanon area is viewed as part of a larger thirty-five year trans-

atlantic migration pattern or as the response by this specific group of people

to the lure of the American dream, their actions in seeking alternative routes

to the United States lend credence to the supposition that as Syrians they

believed they would have a difficult time being accepted through the “front

door.”103 Indeed, as Carrington reported, “the steamship officers advise these

immigrants to seek entry via Mexico, presumably because they have good

reasons to think that many of them would be rejected at New York.”104 On

the contrary, as Seraphic noted, many were healthy and could have entered

at Ellis Island without difficulty, but were persuaded to take surreptitious

routes due to their nationality.105 In 1906, El Paso was a key stage on that

route. The east-west railway lines of the Southern Pacific, the Texas and

Pacific, and the Chicago, Rock Island, and Pacific adjoined the north-south

Mexican Central in the border towns of Juárez and El Paso, providing easy

transportation for legal and illegal prospective immigrants. Fifteen years of

MEDICAL AND LEGAL ASP ECTS OF SYRIAN IMMIGRAT ION 41

102. McLaughlin, “Hebrew, Magyar, and Levantine Immigration,” 440, 442.

103. See Walter Nugent, Crossings: The Great Transatlantic Migrations, 1870–1914 (Bloom-ington, Ind., 1992).

104. Carrington to surgeon general, 18 December 1906, Record Group 90.

105. “Seraphic Report Regarding Conditions on Mexican Border, 1906–07,” Casefile 51423/1,Record Group 85.

qualitative immigration restriction had closed the Golden Door at Ellis Island,

but a window had opened at the Mexican border. The immigrants, smug-

glers, guides, and especially Drs. Sinks and Coffin recognized El Paso as a

prize worth payment in gold—a sight for sore eyes indeed.

42 THE HISTORIAN