PRESENT PROBLEMS 73 



largest American port, but has relied wholly on the local authorities 

 for their detention and treatment. Two years ago we found that 

 the sick immigrants were so crowding our contagious disease hos- 

 pitals (then notoriously insufficient to care for New York's own 

 contagious sick) that many citizens, who should have had first 

 claim to attention, were being excluded. We notified the federal 

 authorities that they must at once make preparations to isolate 

 and treat contagious sick immigrants without the use of the city 

 hospitals ; and the result has been that the Government is building 

 an island in the bay for isolation hospitals. 



Much mischief has resulted from former lax medical inspection 

 of immigrants, extending over many years. New York, and, I doubt 

 not, other seaboard cities, are to-day troubled with many cases of 

 contagious eye-disease, originally brought from Europe by immi- 

 grants and by them transmitted to their fellows in the East Side 

 tenements, who are some of them only a degree less filthy than the 

 new arrivals. To stamp out this disease will be the work of a gener- 

 ation, if not more, for its spread has been till lately entirely un- 

 checked by the sanitary authorities, and its victims probably 

 number many thousands. 



It has seemed to us in New York that the best means of checking 

 the spread of contagious disease, of which trachoma is only one 

 comparatively unimportant element, was through the public schools. 

 One of our leading sanitarians has well said that schools are the 

 foci of infection. This is amply proved by a study of the reports 

 of infectious disease cases in large cities; almost invariably the 

 number of cases begins to increase with the assembling of pupils in 

 the autumn, and continues large so long as the schools are in ses- 

 sion. Rigid medical inspection in the schools is therefore absolutely 

 necessary, and its advantages are manifest, for in New York City 

 (which I may safely say has now the most highly developed system 

 of medical school inspection in the country) the elaboration of the 

 present method two years ago resulted in a diminution of conta- 

 gious disease cases amounting to about 40 per cent. Incidentally, 

 also, the death-rates of 1902 and 1903 fell to a point never before 

 reached in the history of the city; with the lessened mortality 

 among children particularly marked. 



This system entails extreme care and considerable expense, for it 

 demands the services of a competent medical inspector daily in 

 every public school in the city. 



His work is to exclude from the class-rooms all children under 

 suspicion of infectious disease, and to notify the school authorities 

 of the exclusions, with the reason for each, in order that exclusion 

 may not be mistaken by them for truancy. At this point the dia- 

 gnostician's work ends, and that of the school nurse begins. The 



