IMMinnATfOX AXn the PIIUJC JIKALTII 321 



In tlie ailiuinistration of the law excluding tuberculosis, only tuber- 

 culosis of the lungs, gcnito-urinary tract or gastro-intestinal tract is 

 considered to be indicated. It would seem that an arbitrary limitation 

 of the scope of the law to these three forms leaves out of account the 

 serious nature of tuberculosis of the bones and glands at least. There 

 is no doubt that the widespread popular interest and agitation against 

 tuberculosis has overemphasized the importance of the tubercle bacillus, 

 and the diagnosis and care of tuberculous patients. But equally or even 

 more important is the prevention of the disease by sanitation, personal 

 hygiene and increase of individual resistance to it. The bacilli, as 

 Osier says, are ubiquitous, and practically every person is exposed at 

 some time to infection. One of the very best reasons for placing tuber- 

 culous patients in sanitaria, and for scrupulous sanitary care of those 

 who can not be so placed, is that each case, especially in the humbler 

 walks of life, tends to become a constant focus of infection, spreading 

 the germs broadcast. This is prevented by proper care. Linked with 

 this consideration is the fact that the tuberculous patient tends to pro- 

 duce feeble offspring, predisposed to this and other diseases and defects. 

 It is no small advantage to the community to have tuberculous cases in 

 proper institutions where these dangers are averted. The advantages of 

 removing tuberculous patients from contact with the general public in 

 the ordinary activities of life are at least no greater than the advantages 

 of preventing the entrance into the country of tuberculous aliens. 



Another consideration which increases the danger of admitting 

 immigrants who are subject to tuberculosis or other communicable dis- 

 eases is based on the nature of the present-day immigration. ]\rore than 

 four fifths of the immigrants entering the United States come from 

 southern and southeastern Europe. As a type tiiese peoples are ignorant 

 of hygiene and sanitation. They live on a low plane. Overcrowding, 

 disregard of privacy, cleanliness and authority, their gregariousness and 

 tendencT to congestion along racial lines in cities, are all important 

 factors in the spread of disease among them and by them. 



Among the diseases whose prevalence, manner of spread and results 

 constitute a national health problem, trachoma must be reckoned. Tra- 

 choma is an inflammatory communicable disease of the eyelids, of un- 

 known causation, having most serious sequelge of deformity of the eye- 

 lids, impairment of vision and blindness. In Europe and Asia it is a 

 terrible scourge. " Egyptian ophthalmia " has a long and famous history. 

 The wide prevalence of trachoma in the United States and its importance 

 in decreasing economic efficiency are only now beginning to be fully 

 realized. It is stated that half of the 64,000 registered blind persons in 

 the United States are needlessly blind and that the maintenance of 

 one blind person for life by the community costs an average of $10,000. 

 Sixty-seven per cent, of the blindness in the Ohio State Institution for 



