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inner lining membrane of the lids, and discharge variable in amount, finally leading to scarring
and atrophy of lid structures, the eyeball itself being liable to serious implication as the disease
progresses, ending often in great impairment of vision, sometimes blindness.
History.—Trachoma has been known to literature from early days, as early, in fact, as the
sixteenth century b.c., often mentioned in the Ebers papyrus as existing in North Africa. Later, in
a.d. 1679, in the time of William of Orange, the troops before Breslau were seriously affected with
this disease, then termed Maubeeren-Augenlid (mulberry eyelid). Again, in the Napoleonic
invasion of Egypt, the French troops were badly affected with trachoma, and on their return to
Europe spread the disease far and wide over the European continent. During this period the
disease became endemic in Europe, occurring mainly in over-crowded, dirty homes, and in the
insanitary barracks of continental armies.
The increased facilities for the immigration of impoverished foreigners has, during the last years
of the nineteenth century, resulted in the subjection of this country to further inroads. For years
endemic in East London, there is some risk of the overflow from the overcrowded Ghetto region
distributing the disease slowly over hitherto unaffected London areas. Improved sanitary conditions
and by-laws prevent the alarming spread of older days, yet the distribution of alien immigrants
over wide areas renders the disease endemic in districts other than the Ghetto.
Occurrence in London.—An alien Jewess, A. O., suffering from trachoma was found to
be attending a Council school (A) in the electoral division of Stepney, and on inquiry it was found
that, some months previously, she had come from a Non-provided school (B) in the same neighbourhood.
On visiting the child's home, the following conditions were noted:— "Three-storied tenement
house, let in flats, two homes on each floor, consisting of two rooms and small kitchen. Second floor
tenement, dirty, overcrowded, constantly inhabited by eight people. Several wage-earners in family.
Father works horse and van. One son at home, after stay in hospital. He has bilateral trachoma.
Two brothers and one sister go to school B. This family came from Poland, via Paris, and the
disease was introduced from abroad."
Permission was obtained to inspect school B. Here were found the other 3 members of the
family, 2 affected with trachoma. The whole school was then passed in review. In all, some 3,000
children were examined. Of this number 9 boys and 4 girls were found to have trachoma, and
most of these were having or had had surgical treatment. All these affected ones were foreign-born,
or the brothers and sisters of aliens.
There was no indication of spread of the disease from a member of an affected family to any
other child outside his or her own family. In other words, spread of the disease occurred certainly
in the child's own overcrowded and insanitary home, never in the comparatively clean school
buildings. Mr. Hanson paid domiciliary visits in each of the 14 cases, and invariably found one
or more of the other members of the family affected. In some instances a parent was blind in one
or both eyes as a result of long-standing and bilateral trachoma.
A second series of investigations was carried out in another Council school (C) full of
Jewish children. Here 2 trachoma cases were discovered among 1,200 children; both children were
foreign-born.
A third series was then made in another school with Jewish native children; here 1
trachoma case was detected. A visit to her home revealed "an airy house, S.W. aspect, family
occupy ground floor"; 2 other members of her family (not of school age) have trachoma; the
father has long-standing bilateral disease still active; both eyeballs are grievously affected with the
serious secondary results of the disease.
From a public health point of view this man's occupation is of interest: he is a retailer of milk
—hardly a desirable occupation for a sufferer from trachoma.
Most schools in East London contain no cases of trachoma; amongst 5,000 children included
in the above inquiry there were 16 cases of trachoma, all in alien children.
As far as possible during these inquiries Mr. Hanson investigated the locale of the actual
infection to the cases upon his list—Russia, Poland, Holland, Galicia, France, German Poland,
Austro-Hungary, The Levant, Syria, and Egypt all contributed one or more cases.
Conclusions:—
1.—Alien children, or members of their immediate family circle, are alone affected.