in the office time and resources for study of the major field problems and of important data and for formulation of constructive measures now forced aside by pressure of current routine work.

PERSONNEL

During the year the efforts of the bureau have been directed toward the strengthening of the personnel of the field service. The requirements for qualification for civil-service examinations for teaching positions have been made more difficult and the educational standards for the position of principal have been raised. Now the possession of a degree is a prerequisite for examination and appointment to this position for persons not already in the service.

Pursuant to Executive Order No. 325, Indians have been given a classified civil-service status, effective April 1, 1929, but after that date Indians entering the service, except in certain minor positions, are required to qualify in open competitive examination. Certain preferences are allowed, however, in compliance with existing law requiring that Indians shall be employed whenever practicable.

Încreased salaries allowed in conformance with existing reclassification laws have proven of noticeable benefit to the service in giving a more contented and efficient personnel.

HEALTH

There has been progress in the general medical work of the service during the year. The Indian people are increasingly responding to their medical needs; that is to say, an increasing number of Indians are seeking appropriate relief for medical and surgical conditions. Likewise, progress is being made in matters relating to disease prevention and public health. This is becoming manifest in connection with the activities of health workers, as well as of lay personnel within Indian reservations. Greater interest is being developed in Federal, State, county, and municipal health organizations, as well as by voluntary agencies. Closer cooperative health activities are being developed in many States having large Indian populations. In many instances members of the health personnel of the Indian Service are working in conjunction with or under the direction of similar organized health agencies of these States and counties. In this general health work the Indians themselves are believed to be showing a responsive interest.

The Association of State and Provincial Health Authorities of North America has appointed a committee on Indian health and through this committee information regarding Indian health matters is being disseminated to State and local health agencies where Indians reside. Diagnostic, laboratory, and clinic facilities of these various organizations are being made known and available to health agencies of the Indian Service, all of which is conducive to a more complete and thorough health program in all sections of the Indian country.

Trachoma, tuberculosis, and diseases of infancy and childhood continue to constitute the outstanding health problems affecting the several Indian jurisdictions. While increased facilities have been provided for the care of tuberculosis and for incipient cases in Indian children, material progress in the eradication of this disease will not

be brought about until a well organized field nursing service has been instituted, together with an educational program which will reach the Indian home. The extension of this program will have its effect also in the reduction of mortality among infants and children.

While fluctuations occur in the reported incidence of trachoma, it is believed that the activities conducted by the special physicians of the service are bringing about a greater decrease in this disease. Organized primarily as a program exclusively for trachoma prevention and eradication, the work of this group of special physicians tends more and more to comprise a broader field of activity and now includes general and special operative procedure for other eye conditions, for the removal of diseased tonsils and adenoids, and the care of other ailments.

Epidemics of contagious diseases have been somewhat less as compared to preceding years. Influenza has been quite prevalent. Outbreaks of measles have been infrequent, due in all probability to the fact that a number of epidemics of this disease occurred during the two or three years prior to the period of this report. The incidence of whooping cough and chicken pox has been about as usual. The number of diphtheria cases has been low and almost no cases of epidemic cerebrospinal meningitis have occurred. Smallpox has occurred on five or six of the reservations, the largest number of cases being reported from the Nez Perce Reservation at Lapwai, Idaho. Vaccination of Indians throughout the country against smallpox has been continued and protection secured against diphtheria by administration of toxin antitoxin wherever possible.

Preparations were made during the latter part of the year to operate the Tacoma Hospital, Washington, which has been for some years operated by the Veterans' Bureau and was formerly the Cushman Indian School. This institution will have a capacity of about 100 beds and will be principally for treatment of tuberculosis. A new general hospital was constructed at the Western Navajo jurisdiction, Arizona, with a capacity of 36 beds. Small general hospitals were constructed at Taos in the Northern Pueblos jurisdiction, New Mexico, at Chin Lee, Ariz., and Tohatchi, N. Mex., both within the Southern Navajo Reservation. A small hospital or infirmary was erected in the Havasupai Canyon, Ariz., for the benefit of the Indians at this point. A converted hospital proposition was established at Toadlena in the Northern Navajo jurisdiction, New Mexico, with an approximate capacity of 20 beds. A new brick hospital was constructed at the Western Navajo jurisdiction, Arizona, with a capacity of 20 beds. A new brick hospital was constructed at the Keshena Agency, Wis., to replace the old frame hospital destroyed by fire. This has a capacity of 36 to 40 beds. The school plant at Kayenta within the Western Navajo jurisdiction, Arizona, was converted into a tuberculosis sanatorium, with a capacity of 40 beds and with provision of 10 beds for general cases. This sanatorium is 160 miles from the railroad. Its conduct under great administrative difficulties is in the nature of an experiment because of its distance from transportation lines. The Navajo Indians in this isolated section, however, are responding quite rapidly to the facilities thus provided for their welfare. A converted building has been made into an improvised sanatorium at the Crow Creek jurisdiction, South Dakota, and will provide for approximately 22 cases of tuberculosis. A new sanatorium of 40 beds was built on the

Yakima Reservation at Toppenish, Wash. These hospital and sanatorium facilities have added approximately 312 beds for Indians in need of treatment. New X-ray apparatus has been provided in a number of hospitals and sanatoria and hospital equipment generally has been improved. There has been an increase in the ratio of nursing personnel, which has permitted a less onerous working day, and a new schedule of pay offers the possibility of advancement for those who do efficient work and are competent to undertake executive responsibility. In addition to the necessity for extension of hospital and sanatorium facilities as well as field personnel for the Indian reservations, there is pressing need for improvement and upbuilding of the institutions now being operated as infirmaries, hospitals, or sanatoria. Nearly all of these institutions are substandard in their equipment and operative personnel. Constant effort is being made to improve both the character and quality of the service rendered in these plants. With the establishment of adequate facilities and personnel the Indians generally have demonstrated a willingness to accept such services.

Attention has been given to the collection of more accurate data relating to health and disease among Indians and the statistical section of the Indian Office has cooperated to the end that better health records and more complete reports of births, deaths, and population may be available. The accuracy of census returns is obviously of great importance in a determination of the ratio of births, deaths, and health data generally relating to the Indian population.

Sanitary surveys by sanitary engineers of the United States Public Health Service are enabling the office to make better provision for safe water supply and proper disposal of sewage. The growing interest manifest on the part of the field employees of the Indian Service is encouraging. Also the increasing interest and helpful activities of the Public Health Service of State, county, voluntary, and other health organizations will be productive of better health among the American Indians.

EDUCATION AND CIVILIZATION OF THE AMERICAN INDIANS

The work of the year represents the continuation of a system of civilization and education which has long been established, is historical, and, in fact, has necessarily been developed in conformity with Federal legislation and limited by financial resources. The energies and powers of the service have been directed toward the improvement of the educational system, although it should be understood that the desired culmination of these efforts has not been attained. In some phases, however, the results achieved at this time are of importance in their bearing upon the eventual solution of the Indian problem. Of these the most important perhaps is the present reliance of 35,000 Indian children upon the State public schools for their education. The endeavors of the service thus directed still continue and the next few years, it is believed, will witness a material increase in the number and a further elimination from the Federal Indian schools of those who can, to advantage, attend the public schools.

Thus there are at this time two means of reaching the end sought, namely, the schools of the several States and the schools conducted by the service. So far as the latter are to serve for some years to

come, the present problem is the improvement of these schools or such adjustments as may be found possible in order that better results may be secured. This applies more especially to the boarding schools, both reservation and nonreservation. In comparison with the public or with the Indian Service day schools, two important points of difference are to be considered, namely, training in vocations which will be of definite value to the graduate, and in the teaching of the English language.

The necessity for vocational training as an ultimate objective for the great majority of Indian youth has been recognized since establishment of the first Indian boarding schools. Such training has been given by the boarding schools, though imperfectly. While results bearing upon the future life and activities of the pupils have been attained in many cases, this has come about through practical training but without competent and systematic instruction because funds have never been available for employment of expert instructors and for the necessary equipment. In some of the nonreservation boarding schools these essential factors have been available to an extent; in the reservation boarding schools, not at all.

Therefore, it should be understood that there are two possible alternatives, either provision of adequate funds for efficient conduct of such vocational courses as are essential and adapted to the needs of Indian youth, or this training can not be given. However, some alleviation of the difficulties appears among the possibilities. If the Government schools may be relieved of those who do not require their aid and who should attend their local public schools, and also those who should rightly be considered white persons by reason of a small degree of Ind an blood, the available financial resources, if not reduced in amount by legislation, will enable the service to perfect the vocational courses as well as to provide more liberally for all educational needs of the institutions. Existing law provides:

That hereafter no appropriation, except appropriations made pursuant to treaties, shall be used to educate children of less than one-fourth Indian blood whose parents are citizens of the United States and of the State wherein they live and where there are adequate free-school facilities provided. (Act of May 25, 1918, 40 Stat. L., 564.)

A study of the enrollment of the boarding schools has already been commenced and elimination of ineligibles should proceed. The States and the local public-school districts appear to be generally in sympathy with the plan of education by the States, conditioned, however, upon such financial assistance as they need and as the Federal Government can offer. At present the rate paid for each day's attendance of each Indian pupil varies from about 20 to 60 cents, the average being slightly above 35 cents.

The objective of the service is admittedly such preparation and development of the individual as will fit him to become a self-dependent and worthy citizen. In the report of the Secretary for the fiscal year 1928, under Indian employment, brief mention was made of the importance of assistance in the placement of the Indian boy or girl graduate in some suitable occupation and environment, and of the need of an organized and efficient personnel to accomplish this work. Also, in prior annual reports it has been explained that considerable work of this kind by superintendents, supervisors, and field employees

has resulted each year in the employment of many young Indians, though this has been accomplished without organized and systematic guidance. A committee called by the Secretary very early in the year made this recommendation:

As a beginning and part of a comprehensive program of guidance and placement, the principal of each Indian school should collect information relative to the present employment of its graduates and forward this to the central office. For the future a record of the employment of each graduate in vocational types of work should be recorded, and a progressive record kept of the same. Many leads to additional opportunities for the placement of the graduates of Indian schools may be obtained in this manner.

Thereafter, attention of school superintendents was called to this recommendation and they were directed to make a study of their former students for the purpose of determining if they are engaged in the vocation for which they were trained and also to secure information of this character concerning all pupils leaving the schools. The action thus taken, while neither new nor radical, should yet be a step in the development of guidance and placement which, with consistent attention of the office and cooperation of the field service, should bring to pass in the near future the more definite growth and development of Indian employment.

Direction was issued to school superintendents to give full attention to the matter of a suitable and sufficient diet for school children, avoiding any possible deficiency, and to supply funds so far as available to the furtherance of this end. In checking over the cost of food for subsistence of Indian children in the Government boarding schools during the year, it has been found that this cost averaged 20 cents per pupil per day, of which 14 cents represented expenditure from the support funds of the schools, and 6 cents the value of food produced at the school. During the year emphasis was again directed to the inadequacy of the food ration and a committee was appointed to consider this question. The committee, consisting of Dr. M. C. Guthrie, chairman, Dr. E. Blanche Sterling, both of the Public Health Service, Dr. Frances Rothert, of the Children's Bureau, Department of Labor, and Dr. Edith Hawley, of the Bureau of Home Economics, Department of Agriculture, after careful study, found that the minimum cost to provide a proper diet for Indian school children would be 40 cents per pupil. Efforts are being made in connection with the budget for the fiscal year 1931 to secure through legislative action appropriations which will be sufficient to meet these requirements.

Emphasis upon child welfare has been embodied in a direction that there be periodical examinations by physician or nurse, record kept and treatment given where indicated. This has been supplemented by a caution to not overcrowd the schools to an extent detrimental to the health of the children.

Attention of the schools was also invited to the value of the use of local material in teaching, as Indian arts and life, Indian history, Indian geography, and matters of Indian daily experience.

Although already embraced within prior plans, attention has again been called to the importance of perfecting the teaching of gardening and poultry raising in the schools.

There is not at hand at this time definite data regarding the agegrade averages of pupils in the Indian schools. So far as the service has secured information, it appears that the Indian children in the Government schools are, on an average, about 2 years older than