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])o\V("r of sclf-su|i|iort, consequently laying an additional and undeserved 

 burden on the rest of the community. Many of them result in the trans- 

 mission of hereditary taint or predisjiosition or actual disease to poster- 

 ity. And finally Ihcii- admission into this country simply means a gratu- 

 itous and unnecessary assumption by this country of a burden belong- 

 ing properly to the countries froiu whicii these persons come, and en- 

 courages those countries, as in the ])ast, to unload their decrepit, worn- 

 out and encumbering human stock on us. 



Little is heard as to the bearing that immigration may have on the 

 prevalence of tuberculosis. The status of tuberculosis is influenced by 

 immigration in several ways. The disease in its pulmonary form is 

 usually chronic and marked by a slow and insidious onset. Hence only 

 a careful physical examination, often combined with a suggestive 

 clinical history, will reveal the affection in its early stages, that is, in 

 the first three to six months of its course. It must be borne in mind 

 that the medical officer examining immigrants encounters the shrewdest 

 evasion and concealment. Only too often the diseased immigrant is 

 carefully coached by persons having knowledge of the methods of the 

 medical examination. Altogether the task of the medical examiner is 

 most difficult. It is estimated that 150,000 persons die each year in the 

 United States from tuberculosis, and statistics put the death rate from 

 tuberculosis at 10 per cent, of the total death rate. Yet in the fiscal 

 year 1911, but O.Olo per cent, of the immigrants examined were certi- 

 fied for tuberculosis. This may be explained in no small measure by 

 the fact that in the administration of the law excluding tuberculosis it 

 is the rule to diagnose the pulmonary disease only when the tubercle 



Italian, Sicilian Type. 



