The CPUSA and public health dangers in the 1930s: Syphilis and TB

This is the fourth blog post (out of now five) on the CPUSA’s health journal from the 1930s. The other posts are available here, here and here.

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Syphilis was seen as one of the primary public health problems in the United States in the 1930s, with a greater number of people with syphilis living in American cities during the inter-war period and thus more likely to be part of the industrialised working class. Officially, there were 700,000 cases undergoing treatment, according to an article in the journal from October 1935, with New York City registering 50,000 new cases each year. But the journal acknowledged, “We know that the exact number of cases is far beyond the number actually reported by the various public health departments’.

The disease was also costly, in terms of both human costs and economically. For the individual, syphilis was ‘an expensive disease’ as the ‘average worker cannot afford a thorough course of treatment’ and ‘must seek the free clinics which are woefully inadequate and which, in some parts of this country, do not even exist’. It was also costly on a broader scale, with the journal highlighting that ‘thousands are incapacitated by the ravages of syphilis’, which impacted negatively upon the American economy.

The journal emphasised knowing the symptoms of syphilis, because in the first two stages the disease was contagious, yet also overlooked due to the symptoms being so mild. It warned:

The microbe hides in people who look healthy – and so makes such people deadly dangerous to others. They don’t, many thousands of them, even suspect that they themselves have got it. Syphilis is the devilish disease it is because it’s like an iceberg. It travels, eight-ninths of it, under the surface…

It was stressed that there was a cure for the disease, ‘but the probability of cure depends on how early in the course of the disease proper treatment is started’. Thus one of the major campaigns of Health and Hygiene journal was to promote widespread blood testing for syphilis amongst urban workers in the United States, citing a campaign being undertaken by the city of Chicago in the late 1930s. The journal’s campaign asked for readers to send in a form requesting a free blood test with a locally organised physician and to encourage others to do the same thing. It also reassured readers that these blood tests were ‘practically painless’ and that ‘[o]nly a small amount of blood is required’, as well as the fact that the ‘results of the tests will be strictly confidential.’ It explicitly stated, ‘The only persons who will know the result of the test will be you and your doctor.’

As part of this campaign, the journal tried to shift the public view of the disease as one of embarrassment and guilt. This can be seen in the announcement of the campaign, with the journal reassuring its readers:

Intelligent people everywhere are rapidly getting rid of the idea that a stigma is attached to the person with syphilis. We know that a large proportion of syphilis is contracted innocently and that the person who contracts it is often not aware of it until it is too late.

 Celebrating this sentiment, famous microbiologist Paul de Kruif wrote a few months after the campaign began:

A year ago, syphilis, for you young folks and for your parents, too, was mysterious, a secret shame. Its name could hardly he whispered among respectable people, though many good citizens are maimed by it, and die.

Today you have dared to march under syphilis-defying banners. You challenge its deadliness in the streets. It is you young fighters – God bless you – who have smoked one of mankind’s most secret enemies out into the open.

After the announcement of the campaign in the journal’s October 1937 issue, the journal noted that by December 18, 1937, 1,476 people had been referred to a local physician and that extra 15,000 ballot forms had been mailed to readers ‘for distribution to their friends’.

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Another major public health problem in inter-war America was the prevalence of tuberculosis (or TB) amongst the lower classes, particularly amongst industrial workers and those living in overcrowded slum housing. In an article titled ‘TB – Workers’ Plague’, the journal made clear the threat that it posed for industrial workers:

Consumption, the ‘White Plague.’ Pulmonary Tuberculosis it is called in more learned circles. But the workers know it as ‘T.B.’ They know what the disease does to them. They know its horrible dread and the toll it takes from their ranks. T.B. is their disease.

Of the approximately 1 million people suffering from TB at the time, the journal claimed that the ‘vast majority of these sufferers are workers’ and that those workers exposed to silica dust, especially ‘hard-coal miners, stone cutters, ore-miners’, were particularly vulnerable to contracting the disease. It was also contracted via sputum mixed in with dust particles that was evident in close living quarters, where those infected lived amongst the healthy.

The journal attempted to educate its readers about the symptoms of TB and advised anyone whose cough lasted for more than four weeks needed to be checked by a doctor for TB. Furthermore it cautioned, ‘[s]pitting of blood, no matter how small the amount, is also strongly suspicious.’ But it maintained that the ‘only certain way of detecting tuberculosis of the lungs is by x-ray of the chest’. Therefore it campaigned for workers to insist on the right to an x-ray by a doctor or at a local TB clinic. Those workers exposed to dust, the journal suggested, ‘should have an x-ray examination of the chest every six months’ or ‘[i]f the exposure has been heavy, an x-ray should be had every three months’.

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As the disease was also contracted in the slum conditions that many of the working class lived in at the time, the journal also called for the authorities to improve public housing. It cited a report from 1934 that stated that in 64 major cities across the United States, 600,000 homes were without a bathtub or shower, and nearly 450,000 homes did not have an indoor toilet.

Alongside these socio-economic factors, the journal also recommended that readers develop habits to ‘prevent contact with the sputum or secretion of others’. These included:

Fingers should be kept out of the mouth, and hands should be washed before each meal. Material soiled by the cough or sputum of a tuberculosis patient should be burned. One need not avoid contact with a tuberculosis patient, if the patient knows how to protect others from his secretions.

As mentioned above, milk was celebrated by the journal as nutritious for most people, but in its articles on TB, it warned that milk was ‘still an important source of infection with tuberculosis germs’. This was because bovine TB could be contracted by humans. To guard against this, it advised:

Mothers should therefore be certain that all milk used for the feeding of infants and children has been certified or pasteurized by reputable milk companies… The safest milk is that which comes from cows that have been carefully examined, tested with tuberculin, and therefore certified to be free from tuberculosis.

But as much as TB was a deadly disease amongst the working class in the 1930s, the journal acknowledged that due to advances in medicine and the treatment of TB patients, the death rate of those infected with TB has dropped dramatically since the late nineteenth century. In an article dedicated to the work of physician Edward Trudeau, who was the first to develop the TB sanatorium, it noted:

the disease that fifty years ago killed, every year, 300 young adults out of every 100,000 of population, now kills only 60.


Age disputes and the non-medical use of x-rays in the UK border control system

Tory backbencher David Davies has recently called for dental x-rays to verify the ages of refugees coming from Calais. Although these calls were dismissed by the Home Office and the British Dental Association, this is an issue that has lingered since the 1970s. Below is a post based on an article that Marinella Marmo and I wrote back in 2013, with a lot more historical data included. This case study also features in our book Race, Gender and the Body in British Immigration Control (Palgrave Macmillan, 2014).


The motive of suspicion

In the UK border control system, there is a high level of suspicion inherent, with border control practices often starting from the assumption that migrants, visitors and those seeking asylum are attempting to evade or deceive the system. The default thinking of the border control system seems to assume that certain migrant groups are not who they say they are when interacting with the system. As Marmo and Smith (2010a; 2010b) have argued, there has been a long-standing belief in the UK border control system that migrants and asylum seekers, particularly from Asia and Africa, are potentially ‘bogus’ migrants, with constant mention by the authorities about the unreliability of the testimony of migrants and asylum seekers from these parts of the world, as well as a suspicion that documentary evidence provided by these migrants is likely to be fake. The authorities claim to weigh up decisions ‘on balance of probabilities’, but it is often the case that the border control staff begin from a point of total disbelief and shift the burden of proof onto the person applying to enter the country. With this burden of proof placed upon the individual, it is often difficult to persuade the authorities that their reasons to enter the country, as a visitor, a working migrant, a migrating family member or even as a refugee, is genuine, which is made more difficult by the presumption that testimony and documentary evidence provided by certain migrant groups is likely to be falsified. Under the intense scrutiny of the border control authorities, if testimony and documents are not considered to be convincing enough, the focus of the authorities may shift to physical examination, with the body becoming the marker of ‘truth’. As Didier Fassin and Estelle d’Hallunin (2005: 598) wrote about refugees in the French border control system, ‘their word is systematically doubted [and] it is their bodies that are questioned’.

This post examines one particular way in which the body is questioned by the border control system – the use of x-rays for age assessment. The use of x-rays for this purpose is a non-medical use of the technology and is used solely for the administration of the border control system in an attempt to determine whether a person intercepted by the system is telling ‘the truth’ or not. This post will look at how x-rays were used in the UK border control system in the past and the continued debate about whether to reintroduce the practice for border control purposes, particular the decision by the UK Border Agency (UKBA) to trial the use of dental x-rays for age assessment in 2012. Within the UK border control system, the authorities have relied on the use of x-rays in an attempt to extract ‘the truth’ from people whose testimony and documentary evidence is not believed, despite the ethical concerns raised in using medical technology for non-medical purposes and criticisms that x-rays are not satisfactory tools for assessing age.

The use of x-rays in the 1970s

In the UK context, x-rays were used in controlling immigration from South Asia during the 1960s and 1970s. By this time, the largest number of migrants entering the UK was from the Indian subcontinent in the form of family reconciliation. Many young men came to the UK from South Asia in the 1950s and early 1960s before the introduction of immigration controls and with a decline in labour migration from this region in the early 1970s, the majority of migrants from India, Pakistan and Bangladesh were the families of the young men who had arrived in the UK in the decades before. Several pieces of legislation had been introduced between 1962 and 1971 to limit mass migration from the British Commonwealth, but the Immigration Act 1971 still allowed the wives and children (under the age of 18) to join their family members already residing in the UK. With the significant number of migrants applying to enter UK under the guise of family reconciliation, particularly as children aged under 18, the UK authorities thought that this was a loophole that could be exploited, often as documentation regarding children was less substantial than an adult (for example, children often did not have their own passports and were simply listed on an adult’s passport). The UK border control staff were especially concerned about teenage male migrants, who, if they were over the age of 18, would not be allowed to enter the UK and who were the least ‘desirable’ (due to their labour capacity) in 1970s Britain. To determine whether teenagers were falsely claiming to be under 18 for migration purposes, the UK border control system, particularly at the British High Commissions in South Asia where applications for entry clearance certificates were first assessed, used x-rays of the wrists of individuals to estimate the skeletal age of the applicant.

Although the practice had occurred for most of the 1970s, it was not until The Guardian published details of gynaecological examinations being conducted on migrating South Asian women in early 1979 that the practice became widely known. At the height of the ‘virginity testing’ controversy in February 1979 (see Smith and Marmo 2011), details also emerged that x-rays were being taken of women and children to ascertain the age of suspected ‘bogus’ migrants, as well as for supposed communicable diseases. It was claimed in The Guardian that these x-rays were being conducted by unqualified immigration officers at Heathrow, as well as at High Commissions abroad, which ‘expose[d] both the passengers and clerks to considerable radiation hazards’ (The Guardian, 9 Feb, 1979: 1). The Guardian (8 Feb, 1979: 1) also reported that at the British High Commission in Dacca, a pregnant woman had her skull x-rayed, ‘despite the fact that Department of Health regulations would prevent such a test on pregnant British women’. A possible indication that the British Government held strict immigration control as a primary concern, rather than providing humanitarian approach to potential migrants, was in the response to these allegations by Eric Deakins, a junior Department of Health Minister, who said that ‘immigration screening cannot be measured against [domestic] NHS standards’ (The Guardian, 9 Feb, 1979: 1). Like the virginity ‘tests’, the veracity and usefulness of these examinations was questioned, with Labour MP Jo Richardson stating, ‘medical opinion… is beginning to query the practice. It is beginning to say that it is an unreliable method of determining age’ (House of Commons, Hansard, 19 Feb, 1979: 216). In response to the questions surrounding the use of x-rays in immigration control, the Labour Government acquiesced somewhat in the face of mounting criticism and Rees announced the Chief Medical Officer, Sir Henry Yellowlees would ‘carry out a review of the objects and nature of all medical examinations in the immigration control context’ (Cited in, Juss 1997: 109).

However there were many who felt that an internal investigation to be conducted by Yellowlees seemed to be an attempt to stem further discussion of the subject and to deflect further criticism of the Government in the lead up to the 1979 General Election. Various critics, from Jo Richardson in Parliament and from the editorial pages of The Guardian in particular, condemned the lack of transparency in the Government’s immigration control procedures. Ms Richardson declared in Parliament, that it was ‘high time that the secret instructions given by the Home Secretary to immigration officers under the immigration legislation were made public’ (House of Commons, Hansard, 19 Feb, 1979: 217). The treatment of legitimate migrants and the scrutiny placed upon one’s application to enter Britain was heavily determined by the discretion of individual Entry Clearance Officers, but the manner in which these discretionary powers manifested were open to any kind of evaluation by anyone outside the border control system. An editorial in The Guardian (10 Feb, 1979: 8) criticised the extent of the discretionary powers of ECOs and the lack of transparency in the application of such powers:

The central issue thrown up by the variety of medical tests remains that of discretion and its monitoring… When the virginity tests first came to light, we said that investigation of a particular case was not enough and that a full debate on immigration procedures was needed… But it cannot begin until the full codes of guidance for immigration officers and their medical colleagues as well, are published and the scope of their practices is clearly and publicly disclosed.

This frustration with the internal inquiry being conducted by Henry Yellowlees led to the Commission for Racial Equality (CRE) to propose an independent investigation into discrimination within immigration control, which lasted from 1981 to 1985. The inquiry performed by Yellowlees and his assistant, Dr N.J.B. Evans, on the other hand, was undertaken during 1979-1980, with the final report released to Parliament in April 1980.

Evans travelled to South Asia in 1980 to investigate the broad topic of medical examination within the immigration control system and with his fieldwork, much of the final report was written by him. A draft version of the Yellowlees report (1980a: appendix 1, 2) stated, according to ‘orthodox radiological opinion in the UK and overseas’, it was ‘acceptable to use such bone X-rays to assist in estimating the age of children’, while the final report concluded that x-rays were ‘a potentially more accurate method of estimating the age of children’ than other examinations of the body, such as ‘skin texture, wrinkling or firmness of tissues, and of noting indications of puberty’ (Yellowlees, 1980b: appendix 1, 1-2). Based on North American studies, the report claimed that ‘[t]he accuracy attainable is in the order of plus or minus six months and the radiation exposure negligible’ and while noting that tables of skeleton maturity were based on North American children and there is ‘very little firm data’ on how these tables compared with the skeletons of children from South Asia, the report argued that it was assumed that skeletons matured earlier in South Asian children and were thus still useful (Yellowlees, 1980b: appendix 1, 2). The major finding of the report regarding the use of x-rays for age assessment purposes was:

  1. I conclude that the use of X-rays of the bony skeleton provides a useful, fairly accurate and acceptable safe way of estimating age of children when it is important to do so. (Children in this context means up to about 21 years…) Only one or two X-ray pictures need be taken, of the upper limb or the lower limb excluding the hips. Provided proper shielding is used in accordance with normal radiological practice, the radiation dose to the parts X-rayed is minimal and the scattered gonadal dose is insignificant. These views accord with informed radiological opinion in the UK and overseas (Yellowlees, 1980b: appendix 1, 3).

The report also concluded that ‘United Kingdom radiological opinion holds that X-rays are not particularly useful for estimating the age of adults’, but acknowledged that the Foreign and Commonwealth Office had instructed Entry Clearance Officers in October 1979 that x-rays should not be administered on anyone thought to be over 21 years of age (Yellowlees, 1980b: appendix 1, 3-4).

Despite the Yellowlees Report recommending that the border control system continue to use x-rays to assess the age of migrants thought to be under 21 years of age, several other people and organisations criticised this viewpoint. At the AGM of the British Medical Association in 1979, a resolution was passed that stated that ‘radiological examinations, carried out solely for administrative and political purposes, are unethical’ and proposed that the BMA ‘make the strongest possible representation to the Government to ban these practices’ (cited in, Gordon, 1983: 15). A report prepared by Edward White for Lord Avebury, a Liberal member of the House of Lords, cited the past chair of the National Council of Radiation Protection as warning against unnecessary x-rays and claiming that ‘there is no safe level of exposure’ (cited in, Gordon, 1983: 15). White also questioned accuracy of age assessment through the use of x-rays, particularly in relation to the use of generalised data on age/bone ratio based on North American children to assess South Asian children, and concluded:

After a thorough and objective examination of the practice, one must conclude that radiological examinations are a highly inaccurate method of determining chronological age (cited in, Gordon, 1983: 16).

As mentioned before, the Yellowlees Report sidestepped the issue of data on the skeletal maturity of South Asian children and recommended that further research in this area was required. The Joint Council for the Welfare of Immigrants (1981: 13) stated that the report’s findings on x-rays ‘managed to contradict itself and most accepted medical opinion regarding the reliability of such assessment’. However in FCO briefing notes for answering press questions on the report, it stated that the Home Secretary was ‘not aware that the balance of informed medical opinion is against such tests’ (FCO 1980a: 2) and the government persisted with the claim that x-rays for age assessment purposes was both useful and relatively safe (for example, FCO 1980b).

So the x-raying of children continued throughout 1980 and 1981. In January 1981, the Foreign Minister Lord Carrington stated in the House of Lords that in the last nine months of 1980, around 360 children under 21 had been x-rayed in Dacca and around another 300 in Islamabad (House of Lords, Hansard, 19 Jan, 1981: 336w). The following January, Parliamentary Under-Secretary for the FCO, David Trefgarne, announced in the House of Lords that during 1981, approximately 420 children had been x-rayed Islamabad and 262 children in Dacca (House of Lords, Hansard, 28 Jan, 1982: 1114w).

However the following month, the Home Secretary Willie Whitelaw announced that the FCO would no longer be carrying out x-rays on children for these purposes. Whitelaw stated in parliament that Yellowlees had revised his opinion since the report was released in 1980 and advised the Home Secretary that x-rays were now ‘unlikely to provide more accurate evidence of age than the assessment of other physical characteristics of an individual, and therefore can add little to the general clinical examination’ (House of Commons, Hansard, 22 Feb, 1982: 279-280w). The Runnymede Trust archive at the Black Cultural Archives in London has a copy of the letter that Yellowlees wrote to Whitelaw, which concluded that ‘the usefulness of the X-ray method of estimating age must be limited in the immigration context’ (Yellowlees, 1982: 2). Yellowlees maintained that the x-rays were relatively safe, but chiefly found that using the template of the skeletal maturity of North American or European children to assess the age of South Asian children was insufficient to make an accurate assessment of age. Yellowlees (1982: 2) stated ‘the scientific foundation for this when applied – for example – Asian children must be open to doubt’. Whitelaw said that Yellowlees had ‘concluded that such X-ray examinations are of limited value and their continued use in the immigration context can no longer be justified’ (House of Commons, Hansard, 22 Feb, 1982: 279-280w). In its report, the CRE (1985: 40) argued that since the government acknowledged that x-rays were not satisfactorily reliable for estimating age, ‘it should attempt to review previous cases where such evidence was a substantial factor leading to refusal’, but this recommendation was not enacted by the government. In a document outlining the government’s response to the CRE report, held in the Runnymede Trust archive, stated that it was ‘not feasible’ to review all of these cases ‘given the immense amount of work it would involve’ (Home Office, 1985: 12).

The UKBA trial and its critiques

Since Whitelaw’s decision to end the use of x-rays for the assessment of age in migrant children, the topic has been referred to from time to time by parliamentarians. For example, in the House of Lords debate on the Asylum and Immigration Bill 1996, Lord Avebury sought to insert an amendment which would effectively ban the use of x-rays for the assessment of age, but was rebuffed by Lord David Renton who said that, ‘[i]t is difficult for the immigration officers, medical people, or anyone to say what those people’s ages really are. If the X-ray can decide the matter, we should keep an open mind on the issue’ (House of Lords, Hansard, 20 Jun, 1996: 562-563). Aynsley-Green, et. al. (2012: 102) has shown the matter was brought up again in 2006 and 2009, and most recently has been revived by the UKBA in early 2012.

In March 2012, Zilla Bowell, the Director of Asylum for the UKBA, wrote in a letter, reproduced on the website of the Immigration Law Practitioners’ Association, to various stakeholders announcing that there would be a three month trial of using dental x-rays to determine the age of asylum applicants. The letter said that many would ‘be aware of the difficulties that arise when we are not able to establish, with any certainty, the age of an asylum applicant’ and that the UKBA were ‘keen to utilise any appropriate tool which can increase our levels of certainty (as long as it does not have a negative impact on the individual in safeguarding terms, of course)’ (Bowell, 2012a). The trial was aimed at people assessed as adults, ‘but who continue to contend that they are children’ and the UKBA argued that ‘participation in the pilot is completely voluntary’ (Bowell 2012a).

However this proposed trail received significant criticism from immigration lawyers, medical and dental professionals and the four UK children’s commissioners, who were quoted in The Guardian (30 Mar, 2012) as claiming the proposed actions were ‘a clear breach of the rights of vulnerable children and young people and may, in fact, be illegal’. While talking to some stakeholders, Damien Green, the Conservative Minister for Immigration, admitted in parliament that the UKBA had not discussed the trial with the Equality and Human Rights Commission, but had ‘sought legal advice on the legality of the trial’ (House of Commons, Hansard, 30 Apr, 2012: 1081w). A month later, Bowell sent another letter announcing that the proposed trail was being halted, after the Chief Medical officer suggested that the UKBA discuss the trial with the National Research Ethics Service (NRES). According to Bowell (2012b), the NRES ‘concluded that our proposed trail constitutes “research” and that, as such, it requires the approval of a research committee before it can proceed’. Bowell (2012b) argued that this was ‘contrary to their expectations’, explaining that the view of the UKBA was that ‘the trial did not constitute “research” and ethical approval was not therefore necessary’. The Guardian (27 Apr, 2012) called this ‘a profound embarrassment for the Home Office’ and claimed that the Home Office had refused for a month to publicly reveal whether the agency had ever sought ethical permission for the programme’. Both Bowell (2012b) and the Minister for Families, Sarah Teather, said that no x-rays had yet taken place (House of Commons, Hansard, 30 Apr, 2012: 1236w), and the UKBA were looking into whether to proceed with the trial in the future.

With the possibility of the trial still going ahead in the future, the British Medical Bulletin published an article on the various issues surrounding the assessment of age of young people in immigration control, which declared that ‘age assessment practice in the UK remains highly inconsistent’ and was therefore unreliable for border control purposes (Aynsley-Green, et. al., 2012: 23). The authors listed five main reasons for opposing the use of x-rays to assess the age of young people:

  • Firstly, the authors pointed out that x-rays of bones or teeth ‘can never indicate precisely the chronological age of the individual’ and at best could provide an estimate of skeletal/dental maturity compared to an average control subject (Aynsley-Green, al., 2012: 24). Further to this, as x-rays for age assessment were most likely to be used to establish whether a young person was over the age of 18 or not, the authors acknowledged that the most salient group affected by this practice would be young persons between the ages of around 15 to 20 years old and in the article. However, the authors stated, ‘there is no “scientific method” that can provide a precise assessment of chronological age in individuals between 15 and 20 years of age’ (Aynsley-Green, et. al., 2012: 27).
  • Secondly, the authors noted, which the Yellowlees report had sidestepped in 1981, that ‘standards of normality’ in regards to age assessment using physical characteristics are ‘simply not available for children and young people from many countries in Asia, Africa or the Middle East’, with the authors further stating that it would ‘unsatisfactory to assess their images from the standards derived from Caucasian, European or North American children’ (Aynsley-Green, al., 2012: 24).
  • Thirdly, the authors simply state ‘although superficially easy to do, radiography demands expert interpretation by experienced paediatricians, dentists or radiologists’ (Aynsley-Green, al., 2012: 24). What the authors seem to be implying with this statement is in the border control context, x-rays for age assessment might be utilised by border control staff, rather than medical professionals. This was also a concern in 1979 when the controversy over x-rays first emerged.
  • Fourthly, the authors point out that x-rays give a dose of radiation and that the non-medical use of x-rays is not safe or ethical on these grounds, stating that the x-rays are ‘driven solely by a government’s administrative convenience and is without therapeutic benefit to the individual’ (Aynsley-Green, al., 2012: 24).
  • Lastly, the authors propose that all medical procedures should only be conducted with fully informed consent of the individual, but ‘[i]n the immigration context, ensuring that full and informed consent is obtained is complicated by cultural, religious and linguistic factors, often coupled with a general lack of understanding of medical environments’ (Aynsley-Green, al., 2012: 25). Also in the border control context, if a medical procedure is to be used as evidence where the burden of proof falls on the applicant, then the applicant has no choice but to consent or else their application will probably be unsuccessful. This can no longer be considered consent.

As well as listing these concerns, the authors mentioned a number of medical and dental bodies that opposed the use of x-rays for age assessment purposes, stating that growing concern that this use of x-rays was ‘imprecise, unethical and potentially unlawful has led every relevant statutory and professional body in the UK to argue against its use’ (Aynsley-Green, et. al., 2012: 25).

Does the border control system lack institutional memory?

The fact that the UKBA has not completely shelved the idea of using x-rays for age assessment purposes shows two things. Firstly, it shows that the border control system maintains the idea of shifting the burden of proof onto the individual applicant and that physical examination is necessary as the applicant is inherently untrustworthy. Secondly, it shows that while this idea has a long history within the border control system, it also shows that the institutional memory of the system is not as far-reaching in other areas as it attempts to recycle ideas that were dismissed as unsatisfactory thirty years ago. As long as the emphasis of the border control system lies in attempting to maintain the ‘secure’ border and the idea of the border as separating the domestic British population from the threat of migrant ‘other’ is still fostered, there will be strict scrutiny placed upon those who attempt to traverse through the system. In this world, the applicant must prostrate themselves to the interrogations of the system and all available avenues are explored to satisfy the administration of a ‘firm’ border control system. Lord Renton’s quote on keeping an ‘open mind’ on the matter of using x-rays, despite the criticisms, for immigration purposes highlights this. The Joint Council for the Welfare of Immigrants wrote in 1985:

entry clearance procedures abroad are operated on the assumption that they need to be directed towards the detection of bogus applicants even if in the process genuine applicants are refused. This licenses entry clearance officers to behave like a fraud squad, rather than as neutral officials processing applications from the wives and children of British and settled men (JCWI, 1985: 2).

This post would argue that this still seems to be the case now.

Palgrave cover


Aynsley-Green, A, Cole, T, Crawley, H, Lessof, N, Boag, L & Wallace, R (2012) ‘Medical, Statistical, Ethical and Human Rights Considerations in the Assessment of Age in Children and Young People Subject to Immigration Control’, British Medical Bulletin, 102 (14 May) 17-42

Bowell, Z (2012a) Letter to stakeholders ‘Age Assessment – Dental X-Rays’ (28 Mar) (accessed 19 Dec, 2012)

Bowell, Z (2012a) Letter to NASF members (27 Apr) (accessed 19 Dec, 2012)

Commission for Racial Equality (1985) Immigration Control Procedures: Report of a Formal Investigation (CRE, London)

Fassin, D & d’Halluin, E (2005) ‘The Truth from the Body: Medical Certificates as Ultimate Evidence for Asylum Seekers’, American Anthropologist, 107(4) 597–608

FCO (1980a) ‘X-Ray Examinations’, FCO 50/679, NA

FCO (1980b) ‘Notes for Press Enquiries: Yellowlees Review’, FCO 50/679, NA

Gordon, P (1983) ‘Medicine, racism and Immigration Control’, Critical Social Policy, 3(7) 6-20

Home Office (1985) ‘Commission for Racial Equality (CRE) Report into Immigration Control Procedures: Government Comments’, RC/RF/1/01/B, Runnymede Trust archive, Black Cultural Archives, London

Joint Council for the Welfare of Immigrants (1981) JCWI Annual Report 1980/81 (JCWI, London)

Joint Council for the Welfare of Immigrants (1985) ‘Briefing on Immigration Control Procedures: Report of a Formal Investigation by the Commission for Racial Equality’, RC/RF/1/01/B, Runnymede Trust archive, BCA

Juss, S (1997) Discretion and Deviation in the Administration of Immigration Control (Sweet & Maxwell, London)

Marmo, M & Smith, E (2010a) ‘Racial Profiling at the British Borders: An Historical Overview of the Process of Selection and Scrutiny’, in J. Shantz (ed.) (2010) Racial Profiling and Borders: International, Interdisciplinary Perspectives (Vanderplas Publishing, Lake Mary) 35-69.

Marmo, M & Smith, E (2010b) ‘Is There a Desirable Migrant? A Reflection of Human Rights Violations at the Border: The Case of “Virginity Testing”’, Alternative Law Journal, 35/4 (December 2010) 223-226.

Smith, E & Marmo, M (2011) ‘Uncovering the “Virginity Testing” Controversy in the National Archives: The Intersectionality of Discrimination in British Immigration History’, Gender & History, 23(1) 147–65

Yellowlees, H (1980a) Draft of The Medical Examination of Immigrants: Report by the Chief Medical Officer, FCO 50/676, NA

Yellowlees, H (1980b) The Medical Examination of Immigrants: Report by the Chief Medical Officer, FCO 50/677, NA

Yellowlees, H (1982) Letter to Willie Whitelaw (14 Jan), RC/RF/1/08, Runnymede Trust archive, BCA


Appeal for primary source material on British/Irish left & female hunger strikers at Armagh 1980

women against

Recently the Irish Times has started running a series of articles on the history of the 1980-81 hunger strikes in the lead up to a symposium being held on the subject in London in June 2016. One of the articles by Maria Power discussed the hunger strike undertaken by three republican women in Armagh Prison in late 1980, whose contribution to the hunger strikes has been overlooked by many.

Coincidentally a former student of mine and I are beginning a small project to look at how the British and Irish left, as well as the women’s liberation movement in both countries, expressed solidarity with these striking women. This will be included in a special journal issue on the British left and Ireland currently being put together by Matt Worley and I. The abstract of our article is here:

Intersectional Solidarity: The female prisoners of Armagh, women’s liberation and the left in Britain and Ireland

In 1980, the Republican women prisoners held in Armagh prison in Northern Ireland joined the dirty protest being waged by the male members of the Provisional IRA and the Irish National Liberation Army in Maze Prison. This eventually evolved into a 53-day hunger strike conducted by Republican prisoners in October 1980, which was shortly followed by the more infamous hunger strike in 1981 that claimed the lives of 10 strikers. Overshadowed by the fatalities of the 1981 strike, the 1980 strike involved three IRA women in Armagh, who challenged the traditional nationalist notion of the strong male warrior fighting for a united Ireland. Both the blanket/dirty protests and the two hunger strikes generated sympathy and solidarity across the globe, including with the far left and the women’s liberation movement in Britain and Ireland. The various groups of the left, the women’s liberation movement and the republican movement all claimed that the women involved represented their competing ideals and agendas and these movements sought to weave their actions into their narratives. At the same time, many within these movements were also highly critical of these women and their links to the Republican movement. This article will look at how the left and the women’s liberation movement in both Britain and Ireland looked to portray these women within their narratives and how the solidarity expressed became intersectional, imbued with contesting connotations of liberation from British imperialism, monopoly capitalism and patriarchy.

Stop strip searches

Part of this project has been locating the various publications of the various leftist and feminist groups in both Britain and Ireland. Last month, the Cedar Lounge Revolution blog posted an appeal for primary source material, which was very fruitful. However we’re still looking for more material, so here is the appeal again:

My former student and I are writing an article on the British and Irish left and the female hunger strikers at Armargh in 1980. We have (or are getting) material from the CPGB (Morning Star), the SWP (Socialist Worker and Socialist Review), the IMG (Socialist Challenge), the IRSP (the Hunger Strike Bulletin posted at Irish Left Archive) and Women Against Imperialism (a WAI report from 1980). We are also interested in material from the British and Irish women’s liberation movements and have got material from Spare Rib, the IMG’s Socialist Woman and the SWP’s Women’s Voice.

If anyone has access to material of any other British or Irish left-wing papers/journals from the period, would they be able to check whether there was anything on the strike (lasting from Oct-Dec 1980) or their ‘dirty protest’ (which began in Feb 1980)?

We’d be particularly interested in anything from Militant (or its Irish group), the Communist Party of Ireland or SF-WP, but would welcome any primary source material dealing with the topic.

If anyone has material, please contact me at:


I would like to thank everyone who has helped us find material so far, and hope that people can help us find more!

Thanks to the Bloody Sunday Trust for the archival pictures.

Determining the number of ‘virginity testing’ cases within the UK immigration control system

On this day (February 19) in 1979, Labour MP Jo Richardson led the criticism in the House of Commons of the Home Office and the Home Secretary Merlyn Rees over the gynaecological and physical examinations conducted upon South Asian women migrating to the UK, colloquially known as ‘virginity testing’. During this session of parliament, Rees announced:

a vaginal examination … may have been made only once or twice during the past eight years, according to records which have been looked at.

However a month later, Richardson stated that the Indian government was aware of at least 34 cases. The following post is an excerpt from our book, Race, Gender and the Body in British Immigration Control, which discusses how much we know from the archival records about the number of cases of ‘virginity testing’ there were between 1968 and 1979.

Palgrave cover

We will never know how many women underwent virginity tests, in part because the government pursued a policy of denial and minimisation. Its reconstruction of the facts – and the shielding of evidence – suited its strategy of maintaining ‘good race relations’. For example, on 19 February 1979, Home Office Secretary Rees asserted in Parliament that ‘a vaginal examination … may have been made only once or twice during the past eight years, according to records which have been looked at’.[i] Yet in contrast to this assertion, we know from Amrit Wilson’s visits to immigration detention centres in 1977 that ‘“virginity tests” were routine’[ii], suggesting a completely different picture of what was taking place on British soil. From official and internal documents, we could only establish that the practice was mainly recorded offshore, at the High Commissions on the Indian subcontinent.

In mid-march 1979, more information emerged at the official level about offshore cases. In the House of Commons, Labour MP Jo Richardson, citing the Indian Minister for External Affairs, revealed that ‘at least 34 cases of virginity testing’ had occurred at the British High Commission in New Delhi.[iii] Behind closed doors, stories of these cases and others were already emerging and being shared amongst certain parties at the Home Office. In a letter in early March 1979 from the FCO to 10 Downing Street staff, Private Secretary J. S. Wall stated that ‘[t]he facts, as far as India is concerned, are that since October 1975 … there appear to have been nine cases in Bombay and 73 in New Delhi’.[iv] By January 1980, the FCO had a much clearer picture of the figures, but was reluctant to make them, or the extent of their impact, known. This was evident in a handwritten note to D. W. Partridge from the Migration and Visa Department of the FCO that we identified, which noted that those 73 cases that had occurred at the British High Commission in Delhi since October 1975 were examinations that ‘formed part of the normal medical examination’ and ‘all examinations [of the genitals] had been visual only’.[v] The same note said there had been 10 cases in Bombay, three of which involved internal vaginal examinations, with it unclear whether the other seven examinations were internal or external examinations of the genitals.[vi]

The note to D. W. Partridge also stated that in Islamabad there had been ‘no requests specifically for vaginal examinations made since 1975’, but acknowledged that ‘in some cases ECOs had asked [the] doctor to report “signs of marriage”’, which was a euphemism amongst High Commission staff for scrutiny to be placed upon the applicant’s genitals, breasts and stomach.[vii] It further stated that ‘no record of the number of such cases’ existed but that ‘they may account to a total of under 20 a year in the past two years’.[viii] The note emphasised that in Dacca, where Alex Lyon knew of previous cases of virginity testing occurring in the mid-1970s, ‘[n]o women were ever referred for vaginal examination’, but admitted that ‘one virginity test’ (emphasis in original) was performed in 1978 ‘by purely external examination, not involving examination of [the] vagina’.[ix]

The same note also referred to the Dacca High Commission, where it was much more common for women to be examined for physical evidence that they had borne children, upon the request of an ECO, which involved doctors examining the breasts and stomach for stretch marks. These cases numbered 20 to 30 per year.[x] The note mentioned that on ‘rare occasions’ women were examined ‘to establish whether they were pregnant when they claimed not to be but obviously were’, and ‘whether the applicants had borne children if conflicting evidence from other family members’ was available.[xi] The note concluded that ‘it is not possible for us to quote a precise and accurate figure’, but gave the approximate figures for the number of women given some form of physical examination to determine whether they had borne children or had ever had sexual relations, as requested by ECOs in South Asia:

          Delhi                            73

          Bombay                       10

          Dacca                      40–60 (over 2 years)

          Islamabad                    [unknown]

          Karachi                        [unknown]


          Total                            123–143[xii]

There is no evidence in the file that this note was ever typed up and distributed within the FCO other than to Mr Partridge. We also do not know whether and, if so, how Mr Partridge communicated with others on this matter. However, this is the most detailed document that we have identified in our research that records the number of victims of virginity testing and other forms of physical examination imposed upon South Asian women by the British immigration control system. Even though we have captured these figures, there remains a sense that the total picture is difficult to access. Yet these numbers do help us appreciate that virginity testing was far from an isolated practice.

This handwritten note to D. W. Partridge also attempted to draw a distinction between the examinations that occurred at Heathrow and those that occurred in South Asia. Discussing the examinations carried out in Delhi, the note stated that these ‘formed part of a normal medical examination’, but acknowledged that the gynaecologist ‘had been asked to advise on the marital status of the female applicants’.[xiii] However, even though the gynaecologist later stated that ‘all examinations had been visual only and that she had not carried out any internal examinations’[xiv], the examination of the genitals for administrative immigration control purposes, rather than for a medical purpose, was a violation of the human rights of the women involved. The note confirmed that the 10 cases in Bombay involved examinations of daughter dependants (all over the age of 18), with three definitely involving a vaginal examination, as mentioned previously.[xv] While the FCO claimed that these cases were ‘part of a normal medical examination’, a telegram from the High Commission in Delhi stated that it was ‘the practice at all posts in India not … to refer or encourage wives and children under 18 for settlement to have a routine medical examination’.[xvi] The telegram claimed that in the second half of 1979 no women or children under 18 had been referred for medical examination in India, in contrast to 281 husbands.[xvii] This suggests that the physical examination of women at British High Commissions in India was carried out but was not officially recorded, as were medical examinations for men seeking to migrate to Britain.

Guardian front page

[i] Hansard, 19 February, 1979, col. 221.

[ii] Wilson, Dreams, Questions, Struggles, p. 78.

[iii] Hansard, 21 March, 1979, col. 672w.

[iv] Letter from J. S. Wall to N. Stephens, 5 March, 1979, PREM 16/2000, National Archives, London (hereafter NA).

[v] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 1, FCO 50/675, NA.

[vi] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 1.

[vii] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 2.

[viii] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 2.

[ix] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 2.

[x] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 2.

[xi] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 3.

[xii] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 3.

[xiii] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 1, FCO 50/675, NA.

[xiv] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, p. 1.

[xv] ‘[Mrs K]: Claim for Compensation’, 9 January, 1980, pp. 1-2.

[xvi] Telegram from British High Commission in Delhi to FCO, no. 35, 9 January, 1980, FCO 50/676, NA.

[xvii] Telegram from British High Commission in Delhi to FCO, no. 35, 9 January, 1980.


UK border control has long history of screening for ‘unhealthy’ migrants

High on the excitement of a potential by-election victory this week, UKIP’s Nigel Farage has called for immigration restrictions on people with HIV. This proposal has been roundly criticised as prejudiced against people with HIV, as well as impractical (as argued by The Guardian‘s Sarah Boseley). But Farage’s suggestion taps into a longer history of the UK border control system being used to screen and reject incoming people who were viewed as ‘unhealthy’ or a threat to the health of the body politic. Below is a short excerpt from our new book, Race, Gender and the Body in British Immigration Control, that provides a bit of historical context for this, looking at how the border control system was used to prevent people from entering the country for ‘medical reasons’. People interested in this might also want to check out this 1983 article by Paul Gordon and this 2006 volume edited by Alison Bashford (who has written extensively about this subject in the Australian context).


The ways in which the physical body was to be examined within the British immigration system were codified in the various pieces of immigration control legislation and the internal instructions for immigration control staff and medical examiners circulated by the Home Office and the FCO. Officially, the primary purpose of the medical examinations to be conducted upon arriving migrants was to detect any health issues that might threaten the domestic population (and the migrant themselves); but this rationale was often used to disqualify ‘undesirable’ applicants and to extract further information from applicants (which could then be used to interrogate their claims if deemed unreliable).

The requirement that Commonwealth migrants be subjected to a medical examination was enshrined in the Commonwealth Immigrants Act 1962. The power to refuse entry on medical grounds after such an examination was outlined in the Act as follows:

2 (4) Nothing in subsection (3) of this section shall prevent an immigration officer from refusing admission into the United Kingdom in the case of any Commonwealth citizen to whom section one of this Act applies –

(a) if it appears to the immigration officer on the advice of a medical inspector or, if no such inspector is available, of any other duly qualified medical practitioner, that he [sic] is a person suffering from mental disorder, or that it is otherwise undesirable for medical reasons that he [sic] should be admitted.

However, the full parameters of the medical examination and its purpose in the immigration control system were only outlined in internal documents. Instructions given to Medical Inspectors in 1967 detailed six categories of Commonwealth migrants that could be referred to a Medical Inspector:

  • holders of Ministry of Labour vouchers and their dependants (emphasis in the original text);
  • other Commonwealth citizens intending to make their home in this country or to remain for more than six months…
  • any immigrant appearing to … be mentally or physically abnormal or both;
  • any immigrant appearing … not to be in good health;
  • any immigrant appearing to be bodily dirty;
  • any immigrant in regard to whom there is any mention of health as a reason for his visit.[i]

The medical examination posed a bureaucratic hurdle for most Commonwealth migrants entering during the 1960s, as they entered on work vouchers that depended on a clean bill of health; but the fact that dependent wives and children were also subjected to these examinations demonstrates the ‘desire for order’ of the immigration control system. The Home Office acknowledged that the ‘power to refuse on medical grounds does not apply to persons entitled to admission as wives … or children under 16’, but their referral to Medical Inspectors reinforced notions that migrants from the former colonies needed to be inspected to ascertain their physical ‘worthiness’ and that they needed to be screened as harbingers of disease. The FCO’s argument was that, although dependants could not be refused entry for medical reasons:

it is in their interests to be medically examined before leaving home, since if they require medical treatment, the medical report they bring with them will enable the British authorities to ensure that they receive such treatment as soon as possible after arriving in this country.[ii]

We would argue that it was in the interests of the British state to encourage those who did not technically require a medical examination to submit to one as this presented another administrative obstacle for the applicant, and could be used as an impetus for the authorities to find another official reason to deny them entry. FCO advice released in 1969 reiterated that dependants could be refused entry on medical grounds, but if an examination voluntarily submitted to ‘reveals that the dependant will need treatment in the United Kingdom’, the FCO stated that ‘a condition on admission may be imposed’.[iii]

The powers of Immigration Officers to refer migrants to a Medical Inspector and to refuse entry on medical grounds were made more explicit in the Immigration Act 1971. Schedule 2 of the Act simply stated:

(2) Any such person, if he [sic] is seeking to enter the United Kingdom, may be examined also by a medical inspector or by any qualified person carrying out a test or examination required by a medical inspector.

The Immigration Rules concerning medical examinations put forward that the ‘general aim’ of such examinations was ‘to enable [the] Immigration Officer to refuse entry to persons having a serious illness which might endanger the health of others’ or ‘persons suffering from a mental disorder or some serious condition which would prevent them from supporting themselves and their dependants’.[iv] However medical examinations were used to discredit the claims made by potential migrants and to intensify the scrutiny placed upon them. The scrutinising gaze of the immigration control system was thus cast upon the physical body as a marker of ‘truth’ when other forms of evidence (such as oral testimony and written documents offered by the applicants) were considered to be unsatisfactory.

Under the intense scrutiny of the border control authorities, if testimony and documents were not considered to be adequately convincing, the focus of the authorities shifted to physical examination, with the body becoming the marker of ‘truth’. As Didier Fassin and Estelle d’Hallunin wrote about refugees in the French border control system, ‘their word is systematically doubted [and] it is their bodies that are questioned’.[v] Unlike Foucault’s concept of torture, whereby the physical body is manipulated to extract the confession of ‘truth’ and the ‘truth’ is uttered or written by the tortured individual[vi], in the context under examination here the body becomes a text that is ‘read’ by the authorities, and the ‘truth’ is thus determined by those who ‘read’ it. In this process, the body reveals what the authorities want to see.


[i] ‘Instructions to Medical Inspectors’, n.d., FCO 50/132, National Archives, London.

[ii] ‘Medical Examination Overseas of Commonwealth Citizens Coming to the United Kingdom’, n.d., p. 2, FCO 50/132, NA.

[iii] ‘Advice to Medical Referees’, n.d., pp. 102, FCO 50/284, NA.

[iv] ‘Instructions to Medical Inspectors’, p. 1, RCRF/1/08, Runnymede trust archives, Black Cultural Archives, Lambeth.

[v] D. Fassin and E. d’Halluin, ‘The Truth from the Body: Medical Certificates as Ultimate Evidence for Asylum Seekers’, American Anthropologist, 107(4), 2005, p. 598.

[vi] See Michel Foucault, Discipline and Punish: The Birth of the Prison (London: Penguin Books, 1991) pp. 35-42; Michel Foucault, The History of Sexuality Vol. 1 (London: Penguin Books, 2008) pp. 58-61.

Another endorsement for our forthcoming book


Following on from the very nice endorsements that I blogged about last month, I thought I’d mention this wonderful endorsement we received from Imogen Tyler, author of the brilliant Revolting Subjects and the Social Abjection blog. Tyler writes:

This historical study examines the intertwining of ‘race’, gender and the body in the application of immigration controls in Britain since the 1970s. Drawing on research in British Government archives, Race, Gender and the Body in British Immigration Control begins with the shocking case of virginity testing of a 35 year old woman, who arrived at Heathrow Airport, London in 1979 to marry her fiance. Smith and Marmo unpick these obscene practices as symptomatic of the de-humanising treatment of migrants from the former colonies and the dense racialized, sexual politics of British border controls. Crucially, Smith and Marmo also explore the incredible resistance of South Asian women and anti-deportation activists against the discriminatory practices of the British state. This important new history of immigration control speaks directly to the contemporary situation of border securitisation in Britain and beyond. It will be of interest to, and will be widely read by all interested in migration, citizenship, human rights, post-colonial migration, and histories of resistance to unjust border controls.

We greatly thank Imogen for her kind words and if you haven’t already read Revolting Subjects, what are you waiting for?

And most importantly, you can pre-order our book here (order it for your library NOW!).

Endorsements for our forthcoming book

Palgrave cover

I’m pretty chuffed at these two endorsements we have received for our forthcoming book, Race, Gender and the Body in British Immigration Control: Subject to Examination (Palgrave Macmillan) and would like to share them with you all:

“An important and revelatory study of a shameful episode in 20th century British immigration history that was shaped by imperial racism.” – Alan Travis, Home Affairs Editor, The Guardian
“It is impossible to over-estimate the importance of Smith and Marmo’s study. Their chilling documentation of abuses permitted – and vigorously denied – by the Home Office represents feminist scholarship at its best.” – Philippa Levine, Mary Helen Thompson Centennial Professor in the Humanities, University of Texas at Austin, US

These endorsements are up on the Palgrave website at the moment and remember that you can pre-order the book now.