IMMIGRATION AND TTJE PUBLIC IIKM/rU 323 



iiMiiiiitniiiccrs of Kentucky. Of ;ili(tut 4,000 persons examined, oOO or 

 \'ih ])er cent. Iiad traehoina. From .'3 per eent. to 18 per cent, of the 

 scliool eliildrcn examined suffered from traclioma. At the semi-annual 

 clinic licid l)y Dr. J. A. Stuck-y at llindniMn. Kentucky, in September, 

 1912, 374 patients were examined, of whom 113 had traclioma. Over 

 11 per cent, of the resident pupils of the settlement school at TTindman. 

 and IG per cent, of the day pupils suffered from trachoma. Ahout one 

 half of all those applying for relief to this clinic suffered from trachoma 

 or its sequelae. 



The management of this newly recognized public health problem 

 includes two features. First is the treatment and cure of existing 

 cases of trachoma, and popular education in the hygienic and sanitary 

 measures which will prevent its spread. Second, and equally impor- 

 tant, is the prevention of the development of new cases. Probably the 

 prevention of the introduction of new cases in immigrants is the most 

 important single factor in the prevention of new cases and new foci of 

 "contagion. In 1911 a total of 2,504 cases of trachoma were certified 

 in immigrants. Many of these were admitted, however, in spite of the 

 medical certificate. At New York, for instance, where 1,167 cases 

 were certified, 63 cases were landed. In 1912 of the 718 cases certified 

 at Xew York, 64 were landed. If no inspection were made for 

 trachoma, the victims of the disease would flock to the United States 

 in hordes. We have a weighty and difficult problem in handling the 

 trachoma already existent in this country. Every consideration de- 

 mands its absolute exclusion in immigrants. 



One other disease of national importance for the public health, and 

 which has an intimate relation to immigration, is hookworm infection. 

 The economic and social significance of this disease is well known. 

 The Eockefeller Sanitary Commission for the Eradication of Hookworm 

 Disease in its second annual report shows that a heavy infection exists 

 in Arkansas, Virginia. Tennessee, Alabama, Mississippi, Louisiana, 

 Xorth and South Carolina and Georgia, and that a lighter infection 

 exists in California, Xevada, Oklahoma, West Virginia, Kentucky, 

 Texas and Florida. Maryland is probably also infected. The report 

 states that hookworm' disease belts the earth in a zone 66 degrees wide, 

 extending from 36 degrees north to 30 south latitude. Practically no 

 country within these boundaries is exempt. 



It is a subtle disease with a chronic course, and it attacks the health 

 and efficiency of its victims insidiously. It is beginning to do in the 

 United States what it has already done in Eg3'pt, China and India. 

 It will be impossible to control the spread of hookworm in the United 

 States as long as any considerable number of new cases are admitted in 

 immigrants. The law rates it now as a dangerous contagious disease, 

 subject to exclusion. The exclusion of Hindus at San Francisco on 

 the certificate of uncinariasis practically stopped the immigration of 



