|
Trachoma
The 1911 Encyclopaedia
Brittanica, in its definition of trachoma, states that it is a "contagious
disease, associated with dirty conditions, and common in Egypt, Arabia and
parts of Europe, especially among the lower class of Jews. Hence it has
become important, in connection with the alien immigration into the United
Kingdom and America, and the rejection of those who are afflicted with it.
It is important that all cases should be isolated, and that the spread of
the infection should be prevented."
It is easy to infer that there were a number of would-be immigrants who
might have been diagnosed with trachoma when they probably had another eye
condition, such as a moderate to
severe conjunctivitis (inflammation of a mucous membrane of the eye),
caused by the conditions that existed during their ship voyage.
A
diagnosis of trachoma would automatically be grounds for sending the immigrant
back to where they came. This would not be the case if the immigrant had a
moderate case of conjunctivitis. When one considers the anti-immigrant sentiment
during this time, particularly against the Jews, it is not hard to imagine many
immigrants being turned away with this misdiagnosis.
What then is trachoma? It a chronic infection of the eye, caused by an
organism called Chlamydia trachomatis. Worldwide, it is the second leading
cause of blindness, after cataracts. It is so not because there is no
treatment available, but because many of those who develop trachoma live
in the poorer countries, lack proper health care, and cannot afford such
treatment. Thus it is really the leading cause of preventable
blindness throughout the world. Trachoma is especially prevalent in
countries where it is endemic, where many people have it and can spread it
to others. Trachoma may occur where there are great public health
deficiencies such as malnutrition, poor public sanitation, poor insect
control, e.g. flies, and housing conditions that lead to overcrowding and
filthy conditions. This, along with poor personal hygiene and a lack of
clean water, makes a person even more prone to trachoma and other such
diseases. Trachoma is endemic in much
of Africa, as well as parts of Asia and Latin America.
Trachoma is a disease that is highly contagious in its
initial stages and can be transmitted by direct contact with someone who
is infected or by contact with other articles that may come into contact
with this organism. It first presents itself as
follicles or "bumps" under the upper eyelid. Usually, trachoma is
insidious in its onset, i.e. few if any symptoms appear that might
indicate the seriousness of the condition. On the other hand, a disease
such as adult inclusion conjunctivitis presents itself with an acute
onset, i.e. tearing, light sensitivity, discharge, pain, lid swelling,
often like a bacterial infection of the eye. With the progression of the
disease, trachoma will cause scarring in the underlining (conjunctival
membrane) of the
upper lid, and fine, white, linear scars may appear. What is especially
troubling about this disease is its potential for corneal involvement. The
signs of corneal involvement may include a myriad of conditions such as
inflammation of the upper cornea, corneal ulcers, new blood vessel
formation on the cornea that may all contribute to the eventual scarring of the cornea. Such
severe scarring may occur which may cause tear duct closure, trichiasis and
entropion (i.e. the eyelashes begin to turn inward as do the eyelids,
which subsequently rubs against the cornea causing more inflammation.)
This can be pretty nasty business. So with the corneal ulceration and
scarring, blindness may occur. The final result of such a condition as
trachoma is called xeropthalmia (you can look this one up on the
internet.) Today, the treatment of choice for trachoma is the systemic
administration of the antibiotic tetracycline or erythromycin. Such
treatment may take a few months to achieve maximum effect. Back in the
early days of immigration, there were no such antibiotics to treat the
potential immigrant and the possibility of spreading the disease was
considered too great to permit the person to enter the country.
Penicillin, the first antibiotic, was not discovered until 1928.
Erythromycin was not commercially available until 1952, tetracycline in
1955. Azithromycin may also be used to treat this condition (azithromycin
was patented in 1981.)
The question then, of course, is what diagnostic equipment (and training)
did these health inspectors have to become qualified to examine these immigrants.
Were they all medical doctors? What was their training with regard to eye
diseases? Did they
just invert the upper eyelid, i.e. turn it inside out of did they just
life it to see underneath? Did they just check for
large follicles and arrive at a diagnosis? I am pretty sure that the
inspectors didn't have a "biomicroscope" at ports like Ellis Island that
they could use to view the condition of the eyelids and corneas under a high magnification.
Also, would the immigrant be able to respond properly to questions so that
a basic case history could be established that would aid the examiner in
making a diagnosis, e.g. "Have you had an discomfort in the eyelid
above your eye?" Perhaps there
may have been questions about possible symptoms or about their living conditions and their family
history. How would the inspector
be able to acquire an adequate knowledge of the subjective symptoms of the
immigrant, especially if there was a language barrier? There were not
always people available there to assist in translating questions and
answers. What could the medical examiner see with the naked eye, with his
instruments (see photo below)--just follicles
under the upper lid or obvious signs of corneal scarring? A person also
may have had a corneal ulcer or even a "pterygium" or "pinguecula" (growths
that occur from the outer border of the cornea toward the pupil that are
non-contagious, etc.) This would not be grounds on its own to send an
immigrant back to their home country, but this may have certainly contributed to any
misdiagnosis. It is hard to know exactly what was going on in the minds of
each of these inspectors, how fully they were trained for such
inspections, what their actual medical training was that qualified them to
make such a diagnosis, and what percentage of these immigrants truly had
trachoma.
V.
DiPietro - NPS
Buttonhook collection. U.S.
Public Health Service used items like these to conduct immigrant eye exam
at Ellis Island.
|
The "Buttonhook." Device
used by women during the 19th and 20th centuries to complete the lacing
and buttoning of shoes/boots, blouses and gloves.
Doctors of the U.S. Public
Health Service at Ellis Island often used these devices to check
immigrants for trachoma, a highly contagious and difficult to cure eye
disease. Eyelids were inverted or pulled outward to see if immigrants
displayed symptoms of this dreaded disease. Today, trachoma is still the
most common form of preventable blindness world-wide. Nearly 300 million
people are estimated to have the contagious disease and many never get
properly treated.
Material courtesy of National Park
Service, Statue of Liberty National Monument. |
|