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operations were performed on the promise that the surgical procedure used would cure the disease once and for all without after care, an idea deduced from the writing of specialists whose methods the Indian Service physicians were required to follow.

A review giving more encouraging results was observed at the Fort Totten school. In November, 1926, 332 children were examined, 129 of whom were positive. Either a grattage or tarsectomy was performed on all these positive cases.

In May, 1927, the special physician who had performed the original operation, accompanied by the physician on the survey staff, re-examined one hundred of those operated upon. The results are grouped in the following tabular statement:

Those listed as “cured”? showed no evidence whatever of other pathology than well healed scars, the natural sequence of either type of operation. Those listed in “need of treatment” were those still having some remaining abnormal pathology, such as trachoma granules or proud flesh. In only five of the grattage cases were trachoma granules found to recur, and none recurred in tarsectomy cases. The findings at the Fort Totten school, however, are more favorable than those generally encountered.

Special physicians have not only themselves been unable to follow-up their former cases at frequent intervals, but they have not been able in most instances to be assured that a course of follow-up treatment would be given by the local authorities. This is not in all instances the fault of the local authorities, because the Indian will migrate and fail to return for treatment, or he will not always follow the physician’s orders at his home. The records of an experienced nurse in the Indian Service indicate that the number of visits required to secure observance of instructions is about