In addition to the foregoing about $3,000,000 a year is expended from Indian tribal funds for administrative and other activities of the service.

PERSONNEL

The extent to which good results are dependent upon the more careful selection and placing of employees in the field service work with the Indians and in the schools was appreciated. It appeared necessary that this work should receive systematic direction in order that the best obtainable persons might be appointed and placed in the positions for which they are best qualified to render valuable service. To accomplish this a field representative having special qualifications for work of this character has been appointed to have advisory direction and supervision of the personnel work.

With regard to appointments in general in the field service, reinstatements have been curtailed to such an extent that a considerably larger number of positions have been newly filled by persons who have qualified through the civil service than has been the case in other years. This secures an infusion of new blood, which it is hoped will be of definite benefit.

HEALTH

Continued progress in the general medical work of the Indian field service has been effected during the year. The number of Indians seeking medical and hospital relief for conditions requiring these services is constantly on the increase, and while there is far too much. interruption of hospital treatment and medical care for unimportant reasons, it is believed that the situation in this respect is showing improvement from year to year. Indian mothers and fathers are still inclined to interrupt the hospitalization of members of their families in order that they may attend fairs, rodeos, and for other purposes, not infrequently when such interruptions are detrimental to the welfare of the individual case. Nevertheless, continued educational efforts are directed toward the lessening and discontinuance of the practice.

Emphasis during the year has been placed upon further development of public-health phases of the medical work of the service. An increased number of public health or field nurses has been provided. Agency, school, and special physicians have received instructions to develop to the fullest extent activities of a health character, all of which have been fostered and extended by the district medical directors. Continued interest is manifested on the part of the other Federal, State, county, and local health organizations, as well as by

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several voluntary organizations, until there is gradually being developed an interest in the special Indian problems on the part of these other agencies not directly concerned therewith. Through the instrumentality of the Committee of Indian Affairs of the State and Provincial Health Authorities of North America, information has been and is being disseminated to the several States where Indians live for the purpose of making available to an increasing degree the laboratory, clinical, and diagnostic facilities of the States and the furtherance of other cooperative measures looking toward closer and more harmonious relationships between the personnel of the Indian Office and the various health agencies in these several localities. This includes not only the facilities mentioned but the making available of existing State, county, and municipal institutions for the care and treatment of Indians wherever possible. In several States health workers of the Indian Service are working in cooperation with and, in two instances, under the direction of similar State organizations engaged in the same field.

Special attention is being paid to the more accurate collection and reporting of vital statistics and the collection of morbidity data. In this work also the several agencies above mentioned are cooperating very closely.

The United States Public Health Service is continuing to detail personnel and to make available the service of medical officers, field directors, sanitary engineers, and of the National Institute of Health to the special problems which arise in connection with Indian health. This includes surveys from time to time, special investigations of sanitary and health conditions, and routine studies of water supplies, sewage disposal, and of milk production. In certain sections of the country these activities also include malarial surveys and remedial measures where indicated.

Trachoma, tuberculosis, and diseases of infancy and childhood continue to constitute the outstanding health problems of the Indian population. Some extension has been made to the bed capacity of the several institutions for the care of the tuberculous, though the facilities of this character are still very inadequate to meet the needs of the several jurisdictions. The educational program which is being carried out through the agency of the medical directors, physicians, and field nurses is designed to bring to the Indian knowledge of the factors which have to do with the spread of diseases of an infectious nature and with special reference to tuberculosis and to give them instructions as to the care and feeding of infants and children, the sick and the aged. In time the extension of this program to meet the needs of all of the jurisdictions will have its effect in reducing the mortality of these diseases. It is quite necessary, however, that the facilities for the care and treatment of the tuberculous especially be improved and extended in order that open cases of this disease may be segregated and foci of infection decreased or eliminated. The lack of sanitation in the Indian homes and the absence of the knowledge of the fundamental factors having to do with the transmission of diseases play an important part in its spread and dissemination.

More than 25,000 Indians were examined for trachoma, of which number between 4,000 and 5,000 were diagnosed as either positive or suspicious. The percentage of positive and suspicious findings

was between 19 and 20 per cent. During the year more than 1,300 surgical operations were performed by the special physicians of the service for the amelioration and cure of the disease and more than 3,000 other treatments were carried out. In addition to their activities in the diagnosis and treatment of trachoma, the special physicians of the service were very active in the treatment of other surgical conditions, namely, infected tonsils and adenoids, and in the surgical treatment of tuberculous glands, etc. Special emphasis has been placed by this group of physicians upon the educational phase of their work, to the end that the Indians might be informed of the safeguards to be observed for the protection of themselves and their families.

Of the contagious and infectious conditions, a larger number of cases of impetigo and scabies was reported than during the preceding year. These conditions become prevalent in many of the larger boarding schools especially, and constant vigilance is necessary to keep infectious conditions of this character at a minimum. The occurrence of measles was slightly in excess of the preceding year. A smaller number of cases of whooping cough was reported than for the year 1929. Influenza was reported during the year to the extent of slightly more than 3,500 cases, whereas during the preceding year more than 16,000 cases of this disease were reported. Influenza, measles, mumps, and whooping cough make up the larger number of diseases of an infectious nature occurring among Indian children. During the year 35 cases of cerebro-spinal meningitis were reported, as compared with 3 for 1929, with 9 cases of infantile paralysis reported, as against none for the preceding year. One hundred and seventy-one cases of smallpox were reported during the year, as against 53 cases for 1929. The larger number of cases of this disease occurred on the Flathead Reservation in Montana, 90 cases having been reported at this jurisdiction.

More than 32,000 vaccinations and inoculations were performed during 1930. Of this number, more than 12,000 were vaccinations against smallpox, more than 7,000 vaccinations against typhoid fever, and slightly more than 10,000 immunizations for protection against diphtheria.

The following hospitals were completed during the year: Colo rado River Hospital, with a capacity of 30 beds; Phoenix School Hospital, with 60 beds, by addition of 20 beds to the total; Fort Bidwell Hospital, with 35 beds; Fort Berthold Hospital, with 20 beds; Claremore Hospital, with 34 beds; and Flandreau Hospital, with 35 beds, adding 13 beds to the total; or a total of 152 additional hospital beds provided.

The following hospitals were commenced during the year and were well under way toward completion at its close: Fort Belknap Hospital, adding 37 beds to the total; Tongue River Hospital, adding 32 beds to the total; Turtle Mountain Hospital, adding 27 beds to the total; Pawnee and Ponca, Pine Ridge, and Hayward Hospitals, with 47 beds each, making a total addition of 237 beds. Each of these new hospitals is of approximately 47-bed capacity.

There were also additions to, or remodeling of, the following hospitals: Western Navajo Hospital, wings added, 20 beds; Hopi Hospital, capacity doubled, 28 beds; Fort Totten Hospital, remodeled and enlarged, 20 beds; Cheyenne and Arapahoe Hospital,

roofs of wings raised, 28 beds; Kiowa Hospital, addition to make 100-bed capacity, 48 beds; Keshena Hospital, pavilions for tuberculosis and venereal cases, 24 beds a total addition of 168 beds, with a total of 557 beds added for the three groups mentioned.

The further extension of hospital facilities is necessary in order to make provision of the care and treatment of Indian patients of jurisdictions for which such provision has not been made. The largest of these is the Eastern Navajo jurisdiction, New Mexico, with a population of approximately 7,000, for whom the hospital facilities are very meager and inadequate. Several other smaller jurisdictions are still without hospitals. As said before, additional tuberculosis sanatoria should be established, preferably at population centers, where public utilities are available, where transportation facilities both by rail and highway are present, and where specialistic medical service from private sources may be secured. The establishment of such institutions at such centers would enable them to serve a number of jurisdictions within the particular State or in adjoining States. Cooperative arrangements whereby hospital and sanatorium beds in State, county, or municipal institutions may be made available for the care and treatment of Indians should be encouraged. Some of the States with a considerable Indian population have extensive systems of county sanatoria. The reception, care, and treatment of Indians in these institutions should be brought about if practicable. In States having large Indian populations where there are no hospitals and sanatoria of such kind, or where facilities are very limited, consideration should be given to the establishment of such institutions by the Federal Government. The existing hospitals and sanatoria of the Indian Service which are being conducted in improvised or converted buildings are in great need of physical improvement and all Indian institutions are in need of increased diagnostic and treatment facilities, as well as an augmented personnel. Every effort should be made to raise the standards of these institutions to a basis comparable with similar institutions, whether governmental, State, or private, in order to conserve to the utmost degree the welfare of the Indian patients treated therein.

Acknowledgment is due of our appreciation of the increased interest shown and the material assistance extended by the other Federal health agencies, by State health forces, and by the various organizations of a semiofficial or private character.

The regular gratuity appropriation for health purposes for the year was $2,658,600, an increase over the previous year of $1,218,600. Supplemental appropriations during the last session of Congress made available $400,000 more for this activity, and further increases have been granted for next year. The following tabula, tion discloses the division of this appropriation over a 3-year period:

REPORT OF COMMISSIONER OF INDIAN AFFAIRS

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The appropriation of $65,000 for the construction of the Oraibi Sanatorium in Arizona is not shown in the 1930 total but is taken up in 1931 by reason of its reappropriation for general purposes. In addition to the amounts shown, tribal funds aggregating approximately $350,000 annually are used for medical and hospital

purposes.

EDUCATION

Encouraging developments in education recorded in the 1929 report have been continued and suplemented during the year. The increased appropriations mentioned have begun to yield results, and while a large part of the improvement to date has necessarily been on the material side-better feeding and clothing of boarding school children, building construction, repairs and equipment-the fundamental needs of teaching personnel, content, and methods of education are beginning to receive more nearly adequate attention.

EDUCATION Staff at the WASHINGTON OFFICE

Professional leadership has become axiomatic in State and National programs of education. During the past year the Indian Office has been able to make substantial additions to the group at Washington responsible for advising the commissioner on educational organization and methods, recruiting of teaching personnel and the building up of a definite program for the future in relation to the States. An assistant director of education, with special preparation and experience in educational administration and vocational guidance, has been appointed. In the field of home economics, where some of the most conspicuous advances had already been made, two additional supervisory positions were established in the fall of 1929. The two specialists appointed to these positions were women of high professional qualifications; their employment has not only made possible a definite supervisory program with a follow-up plan, but relieved the chief supervisor of home economics for important work at the Washington office.

One of the most significant steps of the year was the appointment of a supervisor for elementary education, with university training and successful State experience, and five field assistants, or so-called demonstration teachers in elementary education, all persons who qualified through civil service examinations based on modernized statements of requirements. Each of the five demonstration teachers, under the direction of the supervisor of elementary education, is supervising approximately 55 elementary teachers in sections of the country having the densest Indian school population-South Dakota, northern Arizona, southern Arizona, northwestern New Mexico, and Oklahoma. These demonstration teachers are women who are thoroughly conversant with modern elementary school practice and have pursued graduate study in their field. Already their helpful influence is observable in the work of the teachers of the elementary grades.

For secondary education it was found possible to transfer to the Washington office one of the field supervisors who had had superior preparation and valuable experience in the school of education of a western State university, to help in the organization and develop