In the administration of the law excluding tuberculosis, only tuberculosis of the lungs, genito-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 Osler says, are ubiquitous, and practically every person is exposed at some time to infection. One of the very best reasons for placing tuberculous 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 produce 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 diseases is based on the nature of the present-day immigration. More than four fifths of the immigrants entering the United States come from southern and southeastern Europe. As a type these peoples are ignorant of hygiene and sanitation. They live on a low plane. Overcrowding, disregard of privacy, cleanliness and authority, their gregariousness and tendency 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. Trachoma is an inflammatory communicable disease of the eyelids, of unknown causation, having most serious sequelæ of deformity of the eyelids, 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
