HEALTH

Staff and equipment.-Health work among Indians is carried out by a field personnel of 141 full-time physicians, 85 contract physicians, 13 full-time dentists (including 1 detailed to Alaska), 13 parttime dentists, 100 field nurses, 362 hospital nurses, and 645 other employees. The appropriation for health work in 1935 totaled approximately $3,486,085.

During the fiscal year 92 hospitals, with 3,665 beds, and 14 sanitoria, with 1,197 beds, were in operation. The tuberculosis sanitorium at Onigum, Minn., burned. All patients were transferred safely to the State sanitorium at Ah-Gwah-Ching, and there were no casualties as a result of the fire. Fortunately, the new Government wing at the State sanatorium at Ah-Gwah-Ching is completed, accommodating 117 Indians patients, treated on a contractual basis with the State board of control.

The only new hospital under construction at the present time is that on the Colville (Wash.) Reservation.

These figures show the need.-During the fiscal year the Indian birth rate was 21.2 per thousand; the death rate, 14.7; infant death rate under 1 year of age, 120.2 per thousand infants born, exclusive of stillbirths. These figures might be compared to the census of 1932 of the registration area of the United States, in which total births were 17.4 per thousand; deaths, 10.9; infant mortality, 57.6. This is indicative of a larger birth rate among Indians than among the general population, but with a much higher death rate.

Of the total number of Indians examined in hospitals and outpatient clinics, 28.1 percent were found to have tuberculosis, all forms, active and inactive; 32.3, trachoma; 17.8, venereal diseases, These figures are sad evidence of our three major health problems. Health surveys and institutes.-During the year the Phipps Institute conducted a tuberculosis survey at Tucson, Ariz., in which 508 Indians were examined, of whom 402, or 79 percent, were found positive to tuberculin. Sixteen had open pulmonary tuberculosis,

The American Social Hygiene Association conducted a series of in. titutes in venereal disease control for nurses and physicians in the Navajo area and at Carson School, Nevada. These institutes were so marked a success that they will be continued during the next. year. Dr. Walter Clarke, of the American Social Hygiene Association, has been appointed special consultant to the Indian Office in venereal disease at a dollar a year, and Dr. Esmond R. Long, of the Phipps Institute, has been appointed special consultant in tuberculosis at a dollar a year.

In cooperation with the Cattaraugus County Health Unit, New York, a tuberculosis survey was conducted among Indians on the

Alleghany reservation. This survey is not yet completed; over 50ʊ have so far been examined, with 78 reported as positive for tuberculosis but inactive. This incidence among the group so far studied. is much lower than was thought to exist.

A clinical survey of disease conditions among Indians was made in Adair County, Okla. The Indians cooperated willingly and complete physical examinations were given to 1,083, 52 percent of whom were full-blood Cherokees. Eighty percent of those examined were in need of dental treatment; 35.6 percent had diseased tonsils; and 10.2 percent enlarged thyroids. On the other hand, active trachoma was found in only 1.2 percent of the cases examined, and venereal disease as shown by a positive Kline test was found in 2.6 percent. of the 638 cases so examined. The tuberculosis survey is not yet finished as X-ray examinations are being used to follow up the diagnoses among the 75.3 percent positive reactors of the 743 who were given the Mantoux test. It is of interest to note that the positive reactors increase from 40.9 percent in the first 5-year-age group to 94.9 percent in those over 50 years of age.

During the period from March 20 to April 5, 1935, inclusive, a general health survey was undertaken for the Seminoles of Florida. The purpose of the survey was to ascertain the physical condition and health status of this group of Indians with a view of determining their health needs. For comparative purposes the examination of a like number of Indians, whites, and Negroes was made. The survey was a combined effort of State and Indian Service health organizations. Owing to the reluctance of most of the Indians to come for examination to the clinics, it was impossible to examine more than a very small group, altogether only 46 Indians. This group is too small to be of any considerable value in determining the health status of these people, but the survey has been of value in that much of the health information corroborates the conclusions of medical observers and agency records of the past. It certainly does not indicate any alarming health condition. It bears out the observation that there is no trachoma, and a very low morbidity for tuberculosis, both of which are major health problems among other Indian tribes. Venereal disease was shown to present no alarming problem, but under existing circumstances may be expected to increase. The prevalence of disease among the Indians, whites, and Negroes, as shown by examinations, is indicated in the table below.

The outstanding conclusion reached as a result of the survey was that the prevalence of disease among the Seminoles of Florida is no greater than that among either the whites or the Negroes in a like economic status in the same neighborhood, except that the Indians were shown to have more dental defects than either of the other two groups.

Cooperation with other organizations.-Beside the American Social Hygiene Association and the Phipps Institute, the Indian Office is cooperating with the Carnegie Institution of Washington in a nutritional survey among the Pueblo Indians at Albuquerque, and is continuing in its activities in connection with the State boards of health in Florida, North Carolina, Wisconsin, Minnesota, Montana, and California.

Cooperation from Public Health Service.-Continued cooperation is maintained by the Public Health Service in the detail of personnel to the Indian Service. This includes medical officers of the Public Health Service as well as sanitary engineers, who are rendering valuable service in inspection of water supplies and sewage disposal systems.

Nursing service.-A much needed increase of nurses in the hospital service has been made during the past fiscal year. But we are still understaffed in many of our institutions, and the use of the hospitals increases. As more serious cases come to the hospital, the variety of nursing care has grown more complicated.

The most interesting development in the nursing work has been the plan to give instruction to Indian girls to prepare them for hospital work as aids to nurses. From this type of employment they may go on into professional training or they may continue in the Indian Service hospitals, giving the simpler types of nursing care under supervision of the graduate nurses.

The following interesting figures denote the increase of employment of Indian girls who are graduate registered nurses. Late in the fiscal year 1934 we had 22 Indians on the nursing staff. There are now 42 employed. It has been our policy to encourage training in white hospitals by arranging for nursing scholarships, by selecting suitable high-school graduates as trainees who have ability and interest in helping in the boarding-school infirmaries. Employment after graduation can be assured and we are finding these young women well qualified not only to serve but also to educate their people in accepted health practices.

The field nursing program in control of communicable disease, maternity and infancy hygiene, and health supervision has been continued. More of this type of service is in demand. The Indians are aware of their need for guidance and instruction. There is much yet to accomplish in order that all may be served.

A survey of the quality of nursing care was made by the consultant nurse of the United States Public Health Service, and some of our needs were pointed out.

To improve the type of care in our hospitals, and to develop better service in the field, are objectives that can be accomplished only by constant checking of existing work and by numerical increase in staff where the patient-nurse ratio indicates the need.

Dental service.-The isolation and distribution of the Indian population make it impossible to furnish adequate dental service with the small number of personnel employed. Many jurisdictions are visited by the dentist only once in 2 years.

A number of the full-time dentists who serve several reservations and Indian schools have been supplied with light delivery cars to facilitate transportation of their equipment and to expedite their travel. One mobile dental clinic was purchased during the year for use in the Pueblo country.

Alaska medical service.-Early in the fiscal year Dr. Vance B. Murray was detailed by the United States Public Health Service as director of the Alaska medical service, with headquarters at Juneau, Alaska.

Dr. Murray proceeded at once to Alaska, taking with him his personally owned airplane for use in traveling throughout Alaska on trips of investigation and inspection. By this means, Dr. Murray was enabled to visit all of the six hospitals and every village nurse in Alaska within a period of 6 months. During his travels he personally rendered needed medical treatment to the natives in each village on his itinerary, and secured much valuable data with reference to health conditions among the natives and the medical work conducted by the Indian Office in Alaska.

On March 31, 1935, Dr. Murray was transferred from Alaska by the United States Public Health Service and severed his connection with the Office of Indian Affairs. His successor had not been selected at the close of the fiscal year.

The outstanding event of the year was the influenza epidemic, extending from Ketchikan, in southern Alaska, to Point Barrow, the northern tip of the continent. While this epidemic was not as virulent in character as that of 1918-19, the total number of deaths was probably more than 200, one village in southeastern Alaska having 40 deaths. Our public-health nurses, stationed in some 25 villages, rendered splendid service in treating cases, and the Territorial Public Health Service rendered fine cooperation and assistance in controlling the epidemic. The University of Pennsylvania Medical School sent two physicians to Alaska to collect specimens of sputum and virus for examination in connection with a scientific study of the disease.

The only expansion of the service was the appointment of two additional traveling nurses-one serving the Eskimo villages on the banks of the lower Kuskokwim River and the other serving villages on the Lower Yukon River.

No progress was made in securing new hospitals so badly needed, especially for the treatment of tuberculosis among the Indians and Eskimos. No further time should be lost in the construction of hospitals at Bethel on the Kuskokwim River and at Ketchikan, in southeastern Alaska. In addition, the need for hospital construction at Seward, Kanakanak, and Kotzebue continues urgent.

More dentists and nurses are sorely needed and should be authorized as soon as possible. Also we need additional funds for the hospitalization of Indians in private institutions.

With proceeds from the sale of Christmas seal stamps enough money was raised by the National Tuberculosis Association to initiate public-health measures against this disease in Alaska. Plans are under consideration now.

INDIAN LAND AND MINERALS-TRIBAL CLAIMS

New land as the first essential in rebuilding.-The task of consolidating lands checkerboarded through allotment, of salvaging the allotted heirship land, and of restoring to many tribes enough of balanced landholdings to make a permanent subsistence economy possible has been discussed in the two preceding annual reports. Perhaps nothing else in Indian need is so fundamental or so difficult. Land acquisitions are now going forward through submarginal grants, later mentioned in this report; through the land-purchase fund under the Indian Reorganization Act, elsewhere reported on; and through the use of tribal funds belonging to the Pueblo Indians, paid them in compensation for lands previously lost through Government dereliction. Some additional land purchases, it is hoped, will become possible through the hoped-for new rehabilitation project earlier mentioned.

Indian land acquisition differs in a significant way from the acquisition of land for such other uses as national forests, national parks, game refuges, and wilderness areas. The procurement of land for Indians is but an incident in the reconstruction of the individual and tribal economy of groups with the most varying backgrounds, situated among the most varying present conditions. Land acquisition, if unconnected with a feasible scheme of economic operation, is of little value to Indians, or of none at all. Indian initiative, and some amount of definite sacrifice by Indians, is quite essential if the landacquisition program is to be humanly successful. Therefore the land program of the Indian Service interrelates itself with every other