Page:LewisMeriam-TheProblemOfIndianAdministration.djvu/236

This page has been proofread, but needs to be validated.

Health

209

No standard classification of this disease has ever been made by the ophthalmologists, and therefore diagnoses as trachoma have included such conditions as simple conjunctivitis, folliculosis, and other non-trachomatous lesions.^[1] With all the inaccuracies in present statistics, however, the fact persistently emerges that trachoma is very prevalent among practically all tribes. The only exceptions found were at Neah Bay, La Push, and Taholah in Northwestern Washington. The disease seems to be no respecter of age. It is found among children as well as adults.

The cause of trachoma is not definitely known. One school adheres to the infectious and contagious theory, and the other to a diet deficiency theory. Some of the leading research authorities are now carrying out studies on both hypotheses, and it is hoped that their labors will be completed and will give a definite knowledge of this disease.^[2]

The infectious and contagious theory has evidently received more credence among Indian Service authorities than the one based on

diet deficiency, because, since 1923, the Indian Service has attempted to control the spread of the disease by rules and regulations

↑ Before the survey physician visited the various reservations, this fact had been verified time and again by the special Indian Service physicians who are devoting their time to this work. It has only been within the past year or so that all these specialists have been considered competent to diagnose the disease accurately. This fact was brought out in conferences with the district medical directors. It is only fair to add that these inaccuracies in diagnoses may be accounted for in part by the following facts. Many of the diagnoses were made after a single brief examination, and in a disease so difficult to comprehend in its earlier stages, even the highly trained specialist might err; the rapid turnover of the medical field personnel prevents close follow-up of cases so that many diagnoses are made without knowledge of previous findings, some avoidable duplication in statement of the number of cases is due to the fact that special physicians report on the same cases that the agency physician has already included in his report. Naturally many of the cases examined are “selected” and thus are by no means an accurate cross section of the population at large.
↑ Noguchi at the Rockefeller Institute has discovered an organism from trachomatous eyes with which he has been able to produce follicular conjunctivitis by sub-conjunctival injections of pure culture and, in some monkeys, dying from other conditions, has at least gotten a microscopic evidence of thickening and scar formation. While these findings reveal progress, they are by no means conclusive. Research similar to this is being done by the United States Public Health Service at Rolla, Mo., and at the Hygienic Laboratories in Washington, D. C. As yet a final solution of the problem has not been reached.

[1] Before the survey physician visited the various reservations, this fact had been verified time and again by the special Indian Service physicians who are devoting their time to this work. It has only been within the past year or so that all these specialists have been considered competent to diagnose the disease accurately. This fact was brought out in conferences with the district medical directors. It is only fair to add that these inaccuracies in diagnoses may be accounted for in part by the following facts. Many of the diagnoses were made after a single brief examination, and in a disease so difficult to comprehend in its earlier stages, even the highly trained specialist might err; the rapid turnover of the medical field personnel prevents close follow-up of cases so that many diagnoses are made without knowledge of previous findings, some avoidable duplication in statement of the number of cases is due to the fact that special physicians report on the same cases that the agency physician has already included in his report. Naturally many of the cases examined are “selected” and thus are by no means an accurate cross section of the population at large.

[2] Noguchi at the Rockefeller Institute has discovered an organism from trachomatous eyes with which he has been able to produce follicular conjunctivitis by sub-conjunctival injections of pure culture and, in some monkeys, dying from other conditions, has at least gotten a microscopic evidence of thickening and scar formation. While these findings reveal progress, they are by no means conclusive. Research similar to this is being done by the United States Public Health Service at Rolla, Mo., and at the Hygienic Laboratories in Washington, D. C. As yet a final solution of the problem has not been reached.

[1]

[2]