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El Paso, a sight for sore eyes: medical and legal aspects of Syrian immigration, 1906-1907.

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 Rihani (1)

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 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, depravity, 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 undesirable 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 that only "free white persons" could become citizens. (5) However, early qualitative restrictions were aimed at undesirable individuals--convicts and prostitutes--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 racialization 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, racialized 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 standards of hygiene and a lack of clean running water. (8) Undeniably, turn of the 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 prejudices 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 unconstitutional, (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 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 dangerous 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 embarkation to ensure that they were healthy. (17) However the use of the term "immigrants" in the Act implied to many of the inspectors that only those in steerage, 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 stipulated 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 classification, the number of aliens denied entry for loathsome or dangerous contagious 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 immigrants (7,208,746) for the period. (20) Changes in immigration law in 1903 further reinforced the restriction by fining steamship lines $100 for each diseased passenger transported if proper medical examination before embarkation would have led to their exclusion. Total annual fines ranging between $24,300 and $37,200 (1904-10) compelled more rigorous medical inspections 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 trachoma 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) "Impartial" 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 character 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 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 services 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 contemporaries 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 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 examined "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 disabilities. (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 trachoma--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, and so forth. Abnormalities were examined "off the line" and given certificates of disability if deemed appropriate. (35) A special board of inquiry consisting of three members reviewed all medical certificates. (36) Trachoma was technically a mandatory exclusion; nevertheless, hearings for trachoma certificates were lengthy and eventually 5 to 10 percent of those who were certified 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 officials believed that the low number of rejections at U.S. ports was due to rigorous 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 violation of sovereign jurisdiction. (39) Only two countries, Italy and Hungary, complied 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 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 persecution 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 "midstream 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 increasing 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 countrymen, 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 providing 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 sometimes crime. (48)

It was also apparently a system that worked. While the official records indicate 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 this figure is that prior to 1899, United States officials combined all ethnicities from the Ottoman Empire under the rubric "Turkey in Europe." Similarly, official 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 rejection sought alternative routes, primarily across the Mexican border. (53) While small numbers did attempt to cross the Canadian border, those inspectors followed 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 Mazatlfin to receive approximately 5,000 "diseased" Syrians annually, predominately on French ships. (55)

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 Diaz, but most, because they were "atraidos por el progreso de sus coterraneos y por el inefable sueno americano," had the intention of following a route to the United States, "[eli pais que les habia negado la entrada." (56) The final route depended on the destination of the immigrant; aliens wanting to relocate 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 surreptitious 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 business" by traveling by steamer to Veracruz with a large group of Syrians. Enterprising Syrian businessmen who instructed them in the necessary procedures 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 discovered that the guides were without fail unscrupulous, claiming to help their compatriots while actually robbing and cheating them, and frequently promising to give them passage to the border while entrapping them in Mexico. (58) Braun and Seraphic also uncovered a number of American physicians who maintained practices for "curing" trachoma in several of the Mexican towns on the Texas border, but they were astounded by the audacity 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 immediately denied them entry on the basis of trachoma. Koury then brought the "diseased" Syrians to Coffin, the physician who "monopolize[d] the treatment 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 investigators, 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 business. 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, 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 extortion ring begin? At least partial answers lie in the hundreds of pages of conflicting 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 (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 "compensation [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 medicine 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 continued, 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 elevator in the Federal building represents the United States treasury department." (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 it deserves closer attention. Sinks reported that after certifying and disbarring thirteen Syrians for trachoma, they had taken up residence in Juarez 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 Juarez, 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 recovered so quickly because he didn't know the difference between simple conjunctivitis 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 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 circumstance 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.
   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 physician/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 December to intensify his investigation of Syrian immigration along the border.

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 introduced 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 participation. His defense for why he certified healthy people as having trachoma continued 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 sufficient to warrant his dismissal." Seraphic did, however, urge that the Mexican 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 scare 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 reinstated 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 Juarez. (88) While his efforts for reinstatement were unsuccessful, 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 meningitis 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 Diaz (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 comprehensive 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 Commission on Immigration. (94) Under the supervision of Senator William Dillingham, the commission produced forty-two volumes of reports reflecting 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 Immigration 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 Juarez) and the Mexican National Railway (Mexico City to Nuevo Laredo and Cuidad Porfirio Diaz) responded that only the Consejo Superior de Salubriad (the Board of Health) was "empowered" to enter into "international agreements" and that they could not negotiate 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 Secretaria de Gobernacion, the agency in charge of medical inspection, rigorously inspected aliens arriving 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 Diaz informally conferred with Braun in May 1907 concerning the immigration question. This meeting led to further negotiations 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 government 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, officials in the Mexican government amended their constitution in 1908 to allow restriction of immigration for the "public health." As a result, the government was able to implement a policy of restricting the immigration and emigration 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 diseased 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 financial advantage as they chose to view all Syrians, not as individuals, not as future citizens, but as potential marks for a scare. 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 perception of a racialized association between trachoma and certain nationalities. Likewise, Sinks and Coffin believed that they could falsely certify and treat trachoma in healthy individuals because Syrians as a race were considered diseased and depraved--in the words of another member of the Public 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 question their actions as objective, honest men of science. And, while it is possible 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 economic 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 transatlantic 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 Juarez and El Paso, providing easy transportation for legal and illegal prospective immigrants. Fifteen years of qualitative immigration restriction had closed the Golden Door at Ellis Island, but a window had opened at the Mexican border. The immigrants, smugglers, guides, and especially Drs. Sinks and Coffin recognized El Paso as a prize worth payment in gold--a sight for sore eyes indeed.

(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 and 1910, it is necessary to make an estimate from the data available. Senate, Reports of the Immigration Commission, Statistical Review of Immigration 1820-1910, 61st Cong., 3d sess., 1910, Sen. Doc. 756, 367-71; Senate, Reports of the Immigration Commission, Emigration Conditions in Europe, 61st Cong., 3d sess., 1910, Sen. Doc. 748, 71-73.

(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 (hereafter cited as Record Group 85).

I will be using the term "Syrian" because this is how these immigrants referred to themselves. The term Lebanese was adopted in the 1920s and the term Arab came into use for this group after World War II. Relatively little has been written on the Syrian emigrant experience. Sarah Elizabeth John, " 'Trade Will Lead a Man Far': Syrian Immigration to the El Paso 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 cultural and economic assimilation studies of the American-Syrian community. However, neither Naff nor John probe this phenomenon of immigration from Mexico from a medical perspective or question the role of medicalization and racialization in the development of immigration policy. There are two monographs that offer the comparative viewpoint of Lebanese immigration 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 Ramirez Carrillo, "De Buhoneros a Empresarios: La Inmigracion Libanesa en el Sureste de Mexico," Historia Mexicana 43 (1994). General studies on immigration include Roger Daniels, Coming to 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 American People (New York, 1951); John Higham, Strangers in the Land: Patterns of American Nativism 1860-1925, 2d ed. (New Brunswick, N.J., 1988).

(4.) See for example T. V. Powderly, "Immigration's Menace to the National Health," North American Review 175 (1902): 59.

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

(6.) Tzvetan Todorov, On Human Diversity: Nationalism, Racism, and Exoticism in French Thought, trans. Catherine Porter (Cambridge, 1993), 90-94; Michael Omi and Howard Winant, Racial Formation in the United States: From the 1960s to the 1990s, 2d ed. (New York, 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 of scholarly work on the interconnections of medicine and public policy formation especially in the relationship of public health and immigration restriction during the Progressive era. In addition to Kraut, Silent Travelers, see also Howard Markel and Alexandra Minna Stern, "Which Face? Whose Nation?: Immigration, Public Health, and the Construction of Disease at 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 States Public Health Service, and the American Jewish Immigration Experience, 1897-1924," Bulletin 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 the Skin: 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. (New York, 1987), 764-65.

(9.) Certainly the point can be made that regardless of whether they had associated trachoma with biology or circumstance, immigration officers were required by law to deny residence to 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 a certain racial or ethnic group increased the likelihood of racial and ethnic profiling, as members of a targeted group would be more carefully scrutinized and likely to be rejected as 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. Mayor of the City of New York et al. (1875) 92 U.S. 259; 1875 U.S. Lexis 1753 (Supreme Court of the United States); Commissioners of Immigration v. North German Lloyd (1875), 92 U.S. 259; 1875 U.S. Lexis 1753 (Supreme Court of the United States).

(12.) Immigration Act of 3 August 1882, 22 Statutes-at-Large 214; Marian L. Smith, "Overview of INS History," in A Historical Guide to the U.S. Government, ed. George T. Kurian (New York, 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, "Medical Inspection of Immigrants at Ellis Island, 1891-1924," Bulletin of the New York Academy of 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.

(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. For example, see Ann Novotny, Stranger at the Door: Ellis Island, Castle Garden, and the Great Migration 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 the application of antiseptic or caustic solutions (a 1-2 percent solution of silver nitrate was a common treatment) with the occasional use of draconian surgical procedures.

(20.) U.S. Congress, Emigration Conditions in Europe, 71-76; Senate, Reports of the Immigration Commission, Abstracts of Reports of the Immigration Commission, 61st Cong., 3d sess., 1910, Sen. Doc. 747, 1:110. Calculations were made using Dr. Allan McLaughlin's figure of trachoma being 87 percent of the total for loathsome or dangerous contagious diseases. Allan McLaughlin, "Immigration and the Public Health," Popular Science Monthly 64 (1903): 233.

(21.) U.S. Congress, Emigration Conditions in Europe, 73-74; U.S. Congress, Abstracts of Reports 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 Science Monthly 65 (1904): 332. See also McLaughlin, "Immigration and the Public Health"; Allan McLaughlin, "The Problem of Immigration," Popular Science Monthly 65 (1905).

(25.) Thomas Darlington, "The Medico-Economic Aspect of the Immigration Problem," North American Review 183 (1906): 1268-69; McMullan, "Trachoma: Its Prevalence and Control among 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 Science Monthly 83 (1913).

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

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

(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 Inspection of Immigrants," 488-89.

(35.) Federal regulations defined a medical certificate as the "certification of facts which have been demonstrated from appropriate medical examinations. A medical certificate so issued has the legal value of a document signed by a public officer which is by law made evidence of the truth stated for the purposes of the administration of the immigration law." Darlington, "The Medico-Economic Aspect of the Immigration Problem," 1263; United States Public Health 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 Conclusions and Recommendation and View of the Minority," Reports of the U.S. Immigration Commission (1911), in Edith Abbott, Immigration: Select Documents and Case Records (Chicago, Ill., 1924), 203.

(41.) Daniels, Coming to America, 186.

(42.) Braun's Report, 1906, Casefile 52320/1, Record Group 85; Diaz de Kuri and Macluf, De Libano a Mexico, 49.

(43.) Naff, Becoming American, 78-79.

(44.) McLaughlin, "Hebrew, Magyar, and Levantine Immigration," 440. See also Louise Seymour Houghton, "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; Institute of Texas Cultures, The Syrian and Lebanese Texans (San Antonio, Tex., 1974), 1; John, "'Trade Will Lead a Man Far,'" 15.

(46.) Naff, Becoming American, 28-30, 86-88.

(47.) Ibid., 77-78, 92-94.

(48.) Ibid., 93.

(49.) Houghton, "Syrians in the United States," 487-88; Naff, Becoming American, 108. Quotation 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, 22 Statutes-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 Will Lead a Man Far,'" 31-32.

(56.) "Attracted by the progress of their countrymen and because of the ineffable American dream" ... "the country that had denied them entrance." Diaz de Kuri and Macluf, De Libano a Mexico, 45, 47.

(57.) Casefile 51411/1, Folder #2, Record Group 85. Attempts at immigration restriction have perennially failed at the U.S.-Mexican border because of the permeable nature of land boundaries.

(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 standard treatment but whether they were applying it to actual cases of trachoma and whether they completed the cure as promised. See Markel, "Eyes Have It," 555-56 for more information on trachoma treatment.

(61.) Casefile 51423/1, Record Group 85.

(62.) Casefile 51423/1, Record Group 85. There is some discrepancy in the typewritten reports on 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, 14 January 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. Charles Dick, 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).

(67.) Sinks to surgeon general, Public Health and Marine Hospital Service (PH&MHS), 20 May 1905, Record Group 90.

(68.) P. M. Carrington to surgeon general, 18 December 1906, Record Group 90. Under the state law current at the time, Sinks was required to have a Texas medical license for the private practice 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 the Treasury, 20 September 1905; Baum to Dick, 20 September 1905; H. Edward to Walter Wyman, Surgeon General, 22 September 1905, Record Group 90.

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

(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.

(75.) Ibid.

(76.) T. F. Schumucker to Commissioner-General of Immigration, 14 November 1906, Record Group 90.

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

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

(79.) Carrington to Surgeon General Wyman, 18 December 1906, 19 December 1906, Record Group 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.

(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/l, Record Group 85.

(85.) Casefile 51423/1, Record Group 85.

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

(87.) El Paso Herald, 31 January 1907; Sinks to Wyman, 17 March 1907; Sinks to Wyman, 23 April 1907; William Kneedler to Wyman, 9 May 1907; Sinks to Theodore Roosevelt, 27 May 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.

(91.) El Paso Times, 16 September 1909; El Paso Medical Register, Register of Physicians and Surgeons, 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.

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

(95.) Reed, "Immigration and the Public Health," 323. Other diseases were occasionally targeted but trachoma was one of the most highlighted by the press. It was highly contagious, difficult 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 memorandum concerning "Efforts Made to Perfect an Agreement with the Railways of Mexico Concerning Inspection of Aliens," Casefile 51463/A, Record Group 85.

(97.) D. E. Thompson to Ignacio Mariscal, 7 June 1906; "Trachoma Monograph," 22 March 1907; J. J. Sholgers to Commissioner-General of Immigration, 25 March 1907; Unsigned Bureau of Immigration and Naturalization Memorandum, 11 November 1907, Casefile 51463/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 Support of the Government of Mexico, between the Immigration Authorities of the United States and the Several Transportation Companies of Mexico Engaged in the Carriage of Alien Immigrants Destined to the United States," 7 February 1908, Casefile 51463/C, Record Group 85; Immigration Act of 20 February 1907, 34 Statutes-at-Large 898. (See specifically sections 32 and 36.) The Seraphic report explains several smuggling methods of this sort. Casefile 51423/1, Record Group 85.

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

(102.) McLaughlin, "Hebrew, Magyar, and Levantine Immigration," 440, 442.

(103.) See Walter Nugent, Crossings: The Great Transatlantic Migrations, 1870-1914 (Bloomington, 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.

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