New York Harbor that contains a museum and former

Primary inspection

Arrival, circa 1908 (photo by Lewis Hine)
In the early years of Ellis Island's operation, initial medical inspection was conducted on board ships, while a secondary inspection was conducted at Ellis Island.^[304][305] Those with contagious diseases were quarantined at Hoffman Island or Swinburne Island, two artificial islands off the shore of Staten Island to the south.^{[306][307][308]} The islands ceased to be used for quarantine by the 1920s due to the decline in inspections at Ellis Island.^[305] For the vast majority of passengers, since most transatlantic ships could not dock at Ellis Island due to shallow water, the ships unloaded at Manhattan first, and steerage passengers were then taken to Ellis Island for processing. First- and second-class passengers typically bypassed the Ellis Island processing altogether.^[309]
Medical inspections
To support the activities of the United States Bureau of Immigration, the United States Public Health Service operated an extensive medical service. The medical service at Ellis Island started operating when the first immigration station opened in 1892, and was suspended when the station burned down in 1897.^[310] Between 1897 and 1902, medical inspections took place both at other facilities in New York City and on ships in the New York Harbor.^[311] A second hospital called U.S. Marine Hospital Number 43 or the Ellis Island Immigrant Hospital was built in 1902 and operated through 1930.^{[157][158][159]} Uniformed military surgeons staffed the medical division, which was active in the hospital wards, the Battery's Barge Office, and Ellis Island's Main Building.^[312][313] Immigrants were brought to the island via barge from their transatlantic ships.^[314][315]
A "line inspection" was conducted in the main building. In the line inspection, the immigrants were split into several single-file lines, and inspectors would first check for any visible physical disabilities.^{[313][315][316]} Each immigrant would be inspected by two inspectors: one to catch any initial physical disabilities, and another to check for any other ailments that the first inspector did not notice.^[316] The doctors would then observe immigrants as they walked, to determine any irregularities in their gait. Immigrants were asked to drop their baggage and walk up the stairs to the second floor.^{[317][315][316]}
The line inspection at Ellis Island was unique because of the volume of people it processed, and as such, used several unconventional methods of medical examination.^[313][318] For example, after an initial check for physical disabilities, inspectors would use special forceps or the buttonhook to examine immigrants for signs of eye diseases such as trachoma.^[319] Following each examination, inspectors used chalk to draw symbols on immigrants who were suspected to be sick.^{[320][314][318]} Some immigrants supposedly wiped the chalk marks off surreptitiously or inverted their clothes to avoid medical detention.^[317] Chalk-marked immigrants and those with suspected mental disabilities were then sent to rooms for further inspection, according to a 1917 account.^[314]
The symbols used for chalk markings were:^[320][314]

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