mountaineers of Kentucky. Of almost 4,000 persons examined, 500 or 12½ per cent. had trachoma. From 3 per cent. to 18 per cent. of the school children examined suffered from trachoma. At the semi-annual clinic held by Dr. J. A. Stucky at Hindman, Kentucky, in September, 1912, 374 patients were examined, of whom 113 had trachoma. Over 11 per cent. of the resident pupils of the settlement school at Hindman, and 16 per cent. of the day pupils suffered from trachoma. About one half of all those applying for relief to this clinic suffered from trachoma or its sequelæ.
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 important, 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 New 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 demands 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 Rockefeller 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, North and South Carolina and Georgia, and that a lighter infection exists in California, Nevada, 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 Egypt, 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
