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On inspection of the above table it will be seen that 16,470 pupils in Indian boarding schools were examined for trachoma and 4,916 cases of this disease found, or a general percentage of 29.86. The highest percentage found was reported by Guthrie at the Rainey Mountain School in Oklahoma where, out of 114 pupils examined, no less than 105, or 92.10 per cent, were found to be suffering from this affection. Only 3 schools contained in the list were found. free from trachoma, the Holy Family Mission School, in Wisconsin, and the Friend's Indian and the Thomas Indian schools, in New York. The absence of trachoma infection in these schools is accounted for by the fact that no trachoma was found in the Indian population from which the inmates of these schools are drawn.

Classifying these schools according to the percentages of trachoma found among the pupils, it will be seen, in the case of the 133 schools tabulated, that in 2 schools over 90 per cent of the pupils were found to be trachomatous, in 8 from 80 to 90 per cent, in 10 from 70 to 80 per cent, in 9 from 60 to 70 per cent, in 8 from 50 to 60 per cent, in 8 from 40 to 50 per cent, in 7 from 35 to 40 per cent, in 12 from 30 to 35 per cent, in 14 from 25 to 30 per cent, in 10 from 20 to 25 per cent, in 17 from 15 to 20 per cent, in 11 from 10 to 15 per cent, in 10 from 5 to 10 per cent, in 4 from 0.5 to 5 per cent, and in 3 schools only was no trachoma found. In 88 schools, or approximately 66 per cent of the total number examined, 20 per cent or more of the pupils examined were found to be suffering from trachoma.

Arizona. Fricks reports the examination of 15 Indian boarding schools in this State, with a total of 2,224 pupils. He found 515 cases of trachoma, or a percentage of 25.85. The greatest amount of infection found was at the Chinn Lee Boarding School, where 50 per cent of the pupils were stated to be trachomatous, as contrasting with the rate of 30 per cent found to prevail for the surrounding reservation Indians. He reports that the pupils at this school have had no medical supervision for the past year. The next highest rate was found at the St. Johns Mission School, which he states to be poorly lighted, without medical attention, and the common towel in use in the wash rooms. While the general trachoma rate in the Arizona boarding schools was found to be 28.85 per cent, Fricks found a rate of only 19 per cent in the reservation Indians examined, exclusive of school children.

California. Three boarding schools, with a total of 729 pupils, were examined by Herring in this State. One hundred and seventyeight cases of trachoma were found, a percentage of 24.41. This is considerably in excess of the general percentage (15.3 per cent) noted for the State. Herring calls attention to the fact that in the large Sherman Institute 133 pupils were members of the mission tribes in southern California, where trachoma is infrequently met with.

Nevertheless, 25 cases of trachoma were found in this group of pupils. Herring believes this to be a convincing proof of the ease with which trachoma may be disseminated through the agency of schools, as it was evident that many of these children did not acquire the infection at their homes. Such infected pupils, however, may well be the means of introducing the disease into territory uninfected at present, upon returning to their families.

Idaho. Five boarding schools were examined by Lloyd, with trachoma percentages running from 22.22 at the Fort Hall Mission

School down to 7.69 per cent at the Fort Lapwai Sanitarium School. Thirty-four cases of trachoma were found in the 218 pupils examined, a percentage of 15.6, which is slightly less than the general percentage of 15.96 per cent found in the State. Dr. Lloyd states that the Sanitarium School at Fort Lapwai is a very creditably conducted institution, a fact which may account for the low percentage of trachoma present.

Kansas and Nebraska.-These States are considered together, on account of the small number of Indians resident in this section of the country. Herring examined five schools in the two States, including two large nonreservation schools, viz, the Haskell Institute, at Lawrence, Kans., and the Genoa Boarding School, in Nebraska. Percentages of 15 and 48 per cent of trachoma, respectively, were found in the pupils of these two institutions. As in the case of the Sherman Institute in California, pupils from a large number of reservations are present, thus emphasizing the possibility of the spread of trachoma from one reservation to another through the agency of returning pupils, even where such reservations are geographically far apart.

Michigan, Minnesota, and Wisconsin.-The boarding schools in these States are considered together by reason of their contiguity. In Michigan, Clark examined one large school, the Hayward, with the result that 15.10 per cent of the pupils were trachomatous. This is double the rate of 7.46 per cent computed for the total number of Indians examined in the State. A number of the pupils with trachoma were Chippewas from Mackinac, where the percentage of trachoma among the Indian population is relatively low (1.47 per cent). The inference is strong, therefore, that the disease was contracted at the school, and the return of such pupils to their homes may be expected further to disseminate an infection which is at present but slight.

Minnesota. Ten boarding schools were inspected in this State, 9 by Clark and 1 by Preble. Eight hundred and thirty-three pupils were examined and 193 cases of trachoma found, or a percentage of 23.16. This is again far in excess of the general percentage of 15.05 found for the State. The percentages ran from 42 per cent at the White Earth School down to 1.2 per cent at the Vermilion Lake School. The low percentage prevalent at this school is explained by Clark as due to the very low percentage found among the Indians from which this school is recruited.

Wisconsin. Ten schools were examined by Clark in this State with 1,296 pupils and 137 cases of trachoma, or a percentage of 10.57. This is again nearly double the general trachoma percentage found prevalent in the State. In one school (Holy Family Mission), no case of trachoma was found, while in the St. Mary's Mission School but 1 case, out of 194 pupils, was detected. These low percentages are again due to the absence of trachoma among the Indians in those parts of the State from which the pupils at these schools are recruited. Discussing the prevalence of trachoma in the schools of these three States, Clark writes as follows:

The highest percentage of trachoma among school children is found in the boarding schools of heavily infected reservations. It is found that the percentage of trachoma in boarding schools is invariably in excess of that in the reservations in which they are situated.

A still more significant fact, from an epidemological standpoint, is the higher percentage of trachoma in the nonreservation boarding schools than the percentage for the State in which they are situated. Only one explanation is possible for this condition, the intimate personal contact and daily association of the healthy with the diseased in schools must, of necessity, result in an increased number of cases of trachoma in such schools. The ominous portent of such a condition is the possible spread, through children thus infected, of trachoma in Indian populations not infected or only slightly so.

Montana.-Eleven Indian boarding schools in this State were examined by White. One hundred and eighty-eight cases of trachoma were found among the 740 pupils examined, or a percentage of 25.27. The highest percentage encountered was at the St. Labres Mission School on the Tongue River Reservation, where 59 per cent of the pupils were found infected, while at the St. Ignatius Mission School on the Flathead Reservation only 17, or 9.88 per cent out of the 172 pupils were infected.

Nevada. At the Carson School, Billings found a trachoma infection of 12 per cent. This is considerably below the percentage of trachoma found on the reservations of the State, which ranged between 21 and 47 per cent, and forms an exception to the generally greater prevalence of trachoma in boarding schools than on reservations.

New Mexico.-Four boarding schools in this State, with a total of 728 pupils and 177 cases of trachoma, were inspected by Smith. The extraordinarily high percentage of 83.87 was encountered in one school, the Presbyterian Mission School. The general prevalence of trachoma for all the boarding schools is 24.31 per cent, slightly in excess of the percentage of 22.38 per cent computed for the State.

New York. Two boarding schools with a total of 126 pupils were examined within this State by Leake. No case of trachoma was found, a circumstance well explained by the fact that only in two instances was trachoma present in 943 New York Indians examined. As has already been pointed out, these Indians contracted the infection at a nonreservation boarding school in another State.

North Carolina.-At the Cherokee Boarding School examined by Fricks, 11 cases of trachoma, or 8 per cent, were found among the 141 pupils examined.

North and South Dakota.-These States are considered together owing to contiguity and general similarity in climate and character of Indian population. Twenty-three boarding schools in the two States were visited by Schereschewsky, Herring, and Preble. A total of 800 and 2,240 pupils were examined in North and South Dakota, respectively, with the result of finding 207 cases of trachoma in the former State and 466 cases in the latter, giving percentages of 25.87 and 20.8 per cent. These percentages, as usual, are in excess of the general percentages computed for these States as a whole, the latter being 22.94 and 17.24 per cent, respectively. The highest percentage found was by Preble at the St. Elizabeth's Mission School at Wakpala, S. Dak., while the lowest was reported by Schereschewsky at the St. Francis Mission School on the Rosebud Reservation, where only 21 pupils out of 270, or 7.9 per cent, were found suffering from this disorder. Schereschewsky points out that trachoma had been vigorously treated at this institution the previous year, which accounts in part at least, for the low incidence of the disease at this school.

Oklahoma. The prevalence of trachoma in the boarding schools of Oklahoma is so great that it merits special attention. Guthrie

reports that he visited 30 schools, inspected 3,069 pupils and found 2,122 cases of trachoma, or 69.14 per cent. In some schools nearly all the pupils were infected with the disease. As the Oklahoma Indians are in rapid process of assimilation with the general population, the prevalence of trachoma among them to such considerable extent constitutes a serious menace to the future general population of that State.

Pennsylvania.-Five hundred and fifty-two pupils at the wellknown Indian school at Carlisle were examined by Clark and 76 cases of trachoma found, a percentage of 13.76. As has already been pointed out, the presence of trachoma at this institution, with its wide tribal representation, is of great moment. An instance has already been cited of pupils, coming from noninfected regions, who contracted trachoma during their stay at a nonreservation boarding school.

Washington and Oregon.-Three schools examined by Billings and Lloyd are tabulated for these two States. The general percentage of trachoma found is relatively low, being 9.1 per cent for Oregon and 14.21 per cent for Washington. One small school, however, the Colville Mission, presented the very high rate of 67.74 per cent.

Wyoming. As might be expected from the heavy rate of infection found among the Shoshones and Arapahoes of the Wind River Reservation, the Indian boarding schools of this State presented a high percentage of trachoma among the pupils. Three boarding schools, with a total of 217 pupils, were examined by Hercing, and 131 cases of trachoma found, or 60.36 per cent.

It is evident from the foregoing that trachoma is widely prevalent in the Indian boarding schools, and to a greater extent than among the whole number of Indians examined. The conclusion seems inevitable, therefore, that these institutions constitute an important contributory factor to the dissemination of this disease, and may be the means of infecting Indian populations among whom the disease is absent or uncommon.

PREVALENCE OF TRACHOMA IN INDIAN DAY SCHOOLS.

The data collected as to the prevalence of trachoma in Indian day schools were not so complete as those for the boarding schools for the following reasons: Many of the camps were visited on days when the day schools were not in session and the pupils were seen in their homes, or some day schools were located at such distances from agencies (90 to 100 miles) that it would obviously have been wasteful of valuable time to spend several days in travel to see 10 or 20 children when much larger numbers of Indians were at hand for examination. Nevertheless, from the observations made, it would seem that trachoma is, in many instances, as common in the day schools as in the boarding schools.

Thus Fricks in Arizona, as the result of the examination of 990 children in the day schools, found 409 cases of trachoma, a percentage of 41.31. This is greatly in excess of the general rate (24.9) found for the State. In California 11 day schools were examined with 131 scholars and a trachoma percentage of 14, in Colorado 1 with a percentage of 25.6, in Iowa 1 with a percentage of 36.66, and in Kansas 2 with a percentage of 41.93.

On the other hand, in Montana the result of the examination, by White, of 473 day-school scholars showed 94, or 19.87 per cent, to be trachomatous, a rate distinctly lower than that found in the boarding schools of the State, and lower than the general rate computed for Montana.

In Michigan, Minnesota, and Wisconsin, Clark examined 334 day scholars, with the result of finding 13 cases of trachoma, a percentage of 3.98. This percentage is relatively low, and corresponds to the low general trachoma rate in the sections where these day schools were situated.

In New York State 335 day-school scholars were examined by Leake, but, as previously stated, no cases of trachoma were found.

In North Carolina, 66 day pupils were examined and 6 cases of trachoma found, or 9 per cent. This is 2 per cent in excess of the general rate determined for the Cherokee Indians.

In North Dakota 179 day pupils were inspected by Schereschewsky and 20 cases of trachoma found, or a percentage of 11.8, which is far below the average found either for the boarding schools or the whole number of Indians examined in the State. In South Dakota a similar condition is manifest. Out of 473 day scholars examined by the same investigator in this State but 23 cases of trachoma were found, or 4.9 per cent. This percentage is seen to be relatively very low when compared to the percentages found in the boarding schools of the State. Schereschewsky states that it can partly be accounted for by the disinclination manifested by the Indians of North and South Dakota to send their children to school when they are suffering from "sore eyes," and partly to curative measures which have been instituted by the Indian Office, particularly at Rosebud, among the Indian day scholars of these States.

In Oklahoma, among 34 scholars in 2 day schools, 23 cases of trachoma were found, or a percentage of 67.2.

In Utah, 1 day school was examined and 7 out of 10 pupils were found to be trachomatous. In Wyoming, 8 out of 14 day pupils were found infected with the disease.

The result of the examination of 274 day scholars in Washington by Lloyd gave 66 cases of trachoma present, or 24.48 per cent, a rate in excess of that prevalent in the Indian boarding schools and among the total Indian population examined in that State.

To summarize, out of 3,488 day scholars inspected and considered here, 752 cases of trachoma were found, or 21.55 per cent. If we exclude from the above figures the relatively large proportion of New York day-school scholars, in which no trachoma was found, we find a prevalence, exclusive of the day pupils of this State, of 24 per cent. This is in excess of the general average found for the total examinations, but it is considerably below the percentage found for the boarding schools.

It seems likely that the prevalence of trachoma in the day schools corresponds, in most instances, with the prevalence of the disease on reservations in general, and further strengthens the inference that the higher trachoma rate prevailing in boarding schools is due to the fact that the disease is being spread among the inmates of these latter institutions. Here it is necessary to state, however, that in certain of these institutions little trachoma was found, and the several officers reported in some of them excellent sanitary conditions.

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