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Problem of Indian Administration

agency physicians are more conservative both in the diagnosis of trachoma and in the course of treatment applied.^[1]

The most serious fault in the trachoma campaign has been the complete acceptance of a method not sufficiently proved as correct treatment and the attempt to standardize its use. This procedure is the more serious in view of the lack of definite knowledge of the causative factors involved. This method has resulted in large numbers of cases being handled, and has given a false picture of the real facts, because trachoma is not eradicated 100 per cent by any one operative procedure. The specialists have been so busy in operating new cases that they seldom had the chance to check up on their past efforts. Not infrequently two years elapse before the physician is able to return to the jurisdiction, and then it is difficult to locate all the cases previously operated upon. During March and April, 1927, a special physician was detailed to one of the schools. In trachoma work he did sixty-four tarsectomies, and after a period of observation of from twelve to forty days reported “recovery” in forty-one cases. Nine of these recovery cases were re-examined with the local physician who had assisted in most of the operations, and six were found to have definite granules on both their upper and lower lids. None of these children was receiving treatment at the time, and the nurse in charge of the local hospital reported that no follow-up treatment had been ordered.

Ten cases at Phoenix were re-examined in 1926 by the school physician and the sanatorium superintendent. These cases were operated on a year before by various specialists, chiefly the one referred to previously as stating he believed in a general application of tarsectomy. They found that recurrences were 100 per cent in tarsectomy cases, and over 50 per cent in selective grattage. These

↑ While this report was being prepared the Indian Office issued two very significant circulars intended to lessen the generalized application of surgical measures in the treatment of trachoma. No. 2347, under date of July 22, 1927, outlined a more conservative procedure and urged the physician to exercise more precaution in the method of treatment employed; and the other, No. 2369, under date of September 20, 1927, prohibited the use of tarsectomy or radical grattage without consent from the Washington office. For each case in which either of these procedures is deemed advisable, it will require, first a statement from the physician giving the following information: Name, age, sex, tribe, symptoms, approximate duration of disease, methods of treatment previously carried out, response to treatment, and ihe special indications which make either of the above surgical operations necessary at the time.

[1] While this report was being prepared the Indian Office issued two very significant circulars intended to lessen the generalized application of surgical measures in the treatment of trachoma. No. 2347, under date of July 22, 1927, outlined a more conservative procedure and urged the physician to exercise more precaution in the method of treatment employed; and the other, No. 2369, under date of September 20, 1927, prohibited the use of tarsectomy or radical grattage without consent from the Washington office. For each case in which either of these procedures is deemed advisable, it will require, first a statement from the physician giving the following information: Name, age, sex, tribe, symptoms, approximate duration of disease, methods of treatment previously carried out, response to treatment, and ihe special indications which make either of the above surgical operations necessary at the time.

[1]