Most immigrants entered the United States through New York Harbor, although there were other ports of entry in cities such as Boston, Philadelphia, Baltimore, San Francisco, and New Orleans. The great steamship companies like the White Star, Red Star, Cunard, and Hamburg-America Lines played a significant role in the history of Ellis Island and immigration as a whole.

First and second class passengers arriving in New York Harbor were not required to undergo the inspection process at Ellis Island. Instead, these passengers received a cursory inspection aboard the ship; theory being that if a person could afford to purchase a first or second class ticket they were affluent and less likely to become a public charge in America due to medical or legal reasons. However, regardless of class, sick passengers or those with legal problems were sent to Ellis Island for further inspection.

This scenario was far different for third class passengers, commonly referred to as “steerage.” These immigrants traveled in crowded and often unsanitary conditions near the bottom of steamships, often spending up to two weeks seasick in their bunks during rough Atlantic Ocean crossings. After the steamship docked in the Harbor (typically along the west coast of Manhattan), steerage passengers would board a ferry to Ellis Island for their detailed inspection.

If an immigrant’s papers were in order and they were in reasonably good health, the Ellis Island inspection process lasted 3 to 5 hours. The inspections took place in the Registry Room (Great Hall) where doctors would briefly scan every individual for obvious physical ailments. Doctors at Ellis Island soon became very adept at conducting these “six second physicals.” By 1916, it was said that a doctor could identify numerous medical conditions (ranging from anemia to trachoma) by simply glancing at a person.

The ship’s manifest log, initially filled out at the ship’s port of departure, contained the immigrant’s name and answers to 29 questions. This document was used by the legal inspectors at Ellis Island to cross-examine during the legal inspection. Contrary to popular belief, interpreters of all major languages were employed at Ellis Island, making the process efficient and ensuring that records were accurate.

Despite the island’s reputation as an “Island of Tears” the vast majority of immigrants were treated courteously and respectfully, free to begin their new lives in America after only a few short hours on Ellis Island. Only two percent of the arriving immigrants were excluded from entry. The two main reasons for exclusion were a doctor diagnosing an immigrant with a contagious disease that could endanger the public health, or a legal inspector was concerned an immigrant would likely become a public charge or an illegal contract laborer.