The medical inspection of immigrants arriving in the United States in the late nineteenth and early twentieth centuries was framed by a need to rapidly process large numbers of people. Scientific medicine, such as it was then, was subordinate to the existing immigration laws which reflected the influences of the powerful anti-immigration forces of eugenics and nativism. The line, or single-file queues in which immigrants were arranged, facilitated rapid processing. The split-second medical gaze was hailed by the then leadership of the U.S. Public Health Service as scientifically sound, based as it was on the alleged exceptional disease detection skills of examining public health physicians. In reality, this system was seriously flawed, led to numerous diagnostic errors, and was free of any form of public outcomes assessment or accountability. In time, trachoma became the principal focus of line physicians because of the belief that it could be easily detected, and those diagnosed with it summarily deported. However, the diagnosis of the early stages of this disease is far more complex since it must be differentiated from other forms of benign conjunctivitis. Described here is the case of Cristina Imparato, a 46-year-old immigrant who arrived in New York from Italy on September 27, 1910, and who was given a diagnosis of trachoma which resulted in her summary deportation three days later on September 30, 1910. Her case serves to illustrate the complex forces at work at that time around the issue of immigration. These included a need to meet the labor needs of expanding industries while responding to the immigration restriction demands of eugenics supporters and nativists and the call to protect the country from imported disease threats.