Fort Defiance, Ariz., 140 beds and laboratory (4 months operation) --- $50, 000 Choctaw-Chickasaw Sanatorium and Hospital:

75 beds increase for tuberculosis cases (4 months). 75 beds for general cases (4 months). Tahlequah Hospital, 75 new beds (6 months). Sioux Sanatorium, 150 beds (6 months)

Total..

25, 000

25, 000

37, 500

75, 000

212, 500

Fort Defiance, $50,000.-The present facilities at Fort Defiance will be continued in operation, the present 30-bed sanatorium for trachoma and other eye patients and the 82-bed general hospital for tuberculosis cases. The new 140-bed hospital will be utilized for general hospital cases. The new institution will contain a laboratory of sufficient size to do work now performed in State or commercial laboratories or not at all, and to conduct research work for which no provision is now made. It is estimated that $140,000 will be required for a full year of support for the 140 additional patients and $20,000 per annum will be needed for laboratory work, a total of $160,000. This institution will be ready for operation at about January 1, 1938. The sum requested may be insufficient to operate this E new unit to the end of the year.

This building will round out necessary facilities (except for quarters for personnel) for a medical center for the Navajo area covering about 25,000 square miles and with a population of about 47,000. In addition to being a service institution for the sick, it will serve as an educational center for the health personnel in this area. It is believed that much outside aid can be obtained in conducting research and clinical work, thus improving the effectiveness of our endeavors to safeguard and improve the health of the Indians.

Choctaw-Chickasaw Sanatorium, $50,000.-The new construction at the Choctaw-Chickasaw Sanatorium, Talihina, Okla., will replace the present 75-bed sanatorium with a modern 150-bed institution for tuberculosis. It will also provide 75 beds for general hospital cases principally for the Indians in southeastern Oklahoma. The size of the project will not permit completion before about March 1, 1938, hence funds for 4 months' operation, or an increase of $50,000 over the funds provided for the present institution, will be required. Of this amount one-half is for the sanatorium; the other for the general hospital.

Tahlequah Hospital, $37,500.-This is a new 75-bed hospital which will draw patients from central and northeastern Oklahoma. It is estimated that $75,000 per annum will be required, but as it will not be ready for use until about January 1, 1938, only $37,500 is requested for 6 months' operation. Contract has been let for the project.

Sioux Sanatorium, $75,000.-Funds for the construction of the Sioux Sanatorium were originally provided in the 1932 appropriation act. Due to economy measures, and other conditions, the funds for construction were withheld. A contract has now been awarded and construction has begun. This institution will be erected on land formerly used for school purposes at Rapid City, S. Dak. Some of the existing buildings will be utilized for quarters, service buildings, and possibly for ambulant patients, the latter making it feasible to provide more space for patients with the funds available. Approximately 150 beds will be provided for patients which will require $150,000 per annum for support. As the institution will not be ready for patients until about January 1, 1938, funds for six months of operation are requested.

Transfers from tribal funds, $90,000.-There are four hospitals, included in this

list:

The cost of operation of these four hospitals for the last 5 years follows:

NOTE.-Cost figures reported by superintendents. Cost for Onigum, 1935, includes care of patients a Ah-Gwah-Ching at $2 per day. Appropriation for 1931 includes $10,000 for equipment, personnel, repairs etc., at Onigum Sanatorium, Second Deficiency Act, 1931, provided $25,000 from Red Lake funds for hospital support, repairs, and construction and equipment of employees' quarters, of which $3,778 was expended 1931, and $21,222 in 1932. Appropriation for 1934 includes $12,000 for improving water and sewer system? at Onigum which was not expended due to ensuing discontinuance of that institution. Bed capacity s Onigum for 1935 was 76 until Jan. 29, 1935, and then 12 beds, due to fire.

The situation with reference to the Chippewa funds has been discussed in connection with other proposed transfers. We repeat here, that if the capital fund of this group is used for Indian Service activities at the rate set for the present year, the tribe will be broke in less than 3 years. They have practically no income.

Increase for existing hospitals, $47,300.-Funds provided for numerous institutions are inadequate properly to care for the patients admitted. In some cases this is due to isolation requiring heavy costs for transportation of supplies. In other instances abandonment of boarding schools, or curtailment of their enrollments has affected the operating funds of the hospitals. In still other cases. hospitals are admitting patients in increasing numbers, and funds are needed for their support. The amount of $47,300 involves increases for the following: Kayenta Sanatorium....

Phoenix (school)

Winnebago..

Walker River.

Albuquerque Sanatorium_

Albuquerque school..

Santa Fe school...

Charles H. Burke school..

Toadlena school.

Cherokee school.

Turtle Mountain_

Fort Berthold..

Clinton...

Pawnee and Ponca.

Tacoma Sanatorium.

Total...

Less decrease, Tongue River..

Net increase.

$2,000

4,800

2,000

1,000

2,500

1,000

6,000

12,000

1,000

6,000

1,000

2,000

2.000

These miscellaneous increases are explained in the following paragraphs, in the order of the appearance of the item in the text of the estimate. We also include statements concerning the new personnel requested as well as other information in connection with each institution.

Indian Oasis.-This 44-bed hospital now has but four attendants to help in the kitchen, dining room, perform ward cleaning, and other duties of similar character. At least one additional employee is required for these duties for which $960 is requested.

Kayenta Sanatorium.-This isolated institution requires additional funds for general support for which $2,000 is requested. It is 160 miles from the nearest railroad, and a portion of the road to it is in very poor condition. Hauling constitutes a heavy charge against the support fund of this institution. About onefourth of the increase requested is to meet increased costs of materials and supplies. The remainder is justified on the basis of the increasing number of patients accommodated. The capacity is now 52 beds. The daily average for 1936 was 42.8; for 1935, 40.9; and for 1934, 36.4.

Fort Defiance Sanatorium and Southern Navajo General Hospital.-To improve the operating room service, it is desired to provide an additional nurse at $1,620, and a nurse aid at $960 to improve the general nursing service. A clerk should also be provided for keeping records. For this new personnel $3,780 is requested. The daily average of patients cared for increased from 98.6 in 1935 to 109 in 1936. Phoenix Sanatorium.-A large amount of X-ray work is done at tuberculosis sanatoriums for diagnostic purposes. There is also a considerable amount of other laboratory work such as sputum examinations, blood tests, and so forth. To improve the service at the Phoenix Sanatorium, an assistant medical technician at $1,620 per annum is needed. A portion of this expense can be met from funds now provided but $1,200 of new money is needed to meet the remainder. This employee will also perform laboratory tests for the Phoenix School Hospital and possibly for the Pima Hospital, 40 miles distant.

Phoenix Hospital.-An increase of $4,800 is requested for the general support of the Phoenix Hospital in view of the fact that the student enrollment of the boarding school is being curtailed. This will result in a reduction of contributions for the hospitalization of students on a per-diem basis. The school contributed $3,812 during 1936 for the care of pupils. The amount actually contributed, however, has amounted to over $7,000 when allowance is made for supplies furnished from school stores. The cost of operation during 1936 was $36,699 which required an allotment of $387 under the 10-percent clause in addition to contributions from boarding school funds and "Indian moneys, proceeds of labor (Phoenix Hospital)." This is a 69-bed hospital which draws patients from many of the reservations in Arizona for services which cannot be rendered in the local Indian Service hospitals. This increase will make a total support fund of $42,000 which will still be considerably below funds provided for similar hospitals in comparing per-capita or per-diem rates. The daily average attendance for 1936 was 56 and for 1935 it was 60.1. This slight reduction is to be expected due to normal fluctuations in morbidity rates, and the reduction in boarding-school enrollment. It should not be given undue consideration in determining the support appropriation for future years.

Winslow Sanatorium.-To make the personnel complement of this institution more complete, it is desired to provide an employee to serve as technical assistant in the carrying out of laboratory procedures.

Fort Bidwell Hospital.-The $4,000 provided in 1937 for X-ray equipment and alterations has been dropped as a nonrecurring need and no increase is requested. Winnebago Hospital. The $4,000 provided in 1937 for water softening equipment, shelving, etc., has been dropped as a nonrecurring item. An increase of $2,000 is requested for general support purposes, as it was necessary to provide additional funds under the diversion authorization in 1935 and 1936, and similar aid will be necessary this year.

Walker River Hospital. An increase of $1,000 is requested for the support of this hospital, part of which is necessary to meet the increasing costs of materials and supplies and the remainder for general support purposes including needed repairs, improvements, and equipment. Limited funds have precluded keeping this hospital in a proper state of repair and properly supplied with up-to-date equipment.

Albuquerque Sanatorium.-An increase of $2,500 is requested to meet the increasing costs of materials and supplies. The daily average of patients has increased from 88.9 in 1935 to 97.7 in 1936. It is also necessary to provide a clerk and a technical assistant for record and laboratory work.

Albuquerque Hospital. An increase of $1,000 is requested to meet the increased costs of materials and supplies. The reduction in the number of pupils at the boarding school has resulted in reducing the contributions for the care of studeri patients. This hospital draws its patients, principally, from the Pueblo ares Some few surgical cases from the Navajo area are admitted. The daily average of patients increased from 47 in 1935 to 51.3 in 1936.

Charles H. Burke Hospital.-The boarding school at this point has been changed from a nonreservation to a reservation basis, thus eliminating a specific appro priation from which contributions to the hospital can properly be made for the care of student patients. Such contributions amounted to $5,350 in 1935. Also the daily average of patients has increased from 10.9 to 20.3. A further increase is expected when additional funds are available to care for the patients as the hospital has a capacity of 34 and draws from the Navajo area. All hospitals in this area operated at or over rated capacity. It is imperative that the support fund of this hospital be increased from $12,000 to $24,000 so that much needed hospitalization may be afforded the Navajo Indians. The increase includes additional personnel required to provide adequate care for the increased number of patients to be admitted.

Santa Fe Hospital.-The enrollment at the Santa Fe school has been reduced. thereby reducing the number of student patients and the contributions for their care. These contributions amounted to $5,592 during 1936. It is also necessary for the hospital to bear the expense of utilities formerly furnished in part by the school. To meet this situation, an increase of $6,000 is requested. This hospits. is used for general purposes-not exclusively for school students.

Toadlena Hospital. It has been necessary to apply school funds for the pur chase of subsistence and clothing for hospital patients. The school appropriation is too small to permit the continuation of this contribution. A considerable amount of supplies have been furnished from the Northern Navajo Hospital in order that this hospital could function. When first erected this hospital was for the benefit of school children. The need for hospital facilities for reservation cases made it necessary to open this institution for such cases. Its use for school children is now quite limited. An increase of $1,000 is requested to permit more satisfactory operation of this small hospital.

Cherokee Hospital. The new hospital will be ready for operation about January 1, 1937, and will require additional funds for support as it will be of 28-bed capacity instead of 20 as in the present hospital. Furthermore, the existing hospital has been principally for school pupils. The average daily attendance has increased from 11.7 beds in 1935 to 17.3 in 1936 and with the improved facilities and capacity, there will undoubtedly be a further increase when the new hospital is opened as it will be possible to care for cases now cared for at home. The number of live births increased from 43 to 67. The new hospital is modern in every respect. Provision is made for dental and out-patient work. Instead of two large wards, it has wards accommodating from two to four patients each. The cost of operating this health unit cannot be borne by school funds.

Turtle Mountain Hospital.-The $3,000 provided for 1937 for an X-ray equip ment is dropped. An increase of $1,000 is requested to meet the increased costs of materials and supplies.

Fort Berthold Hospital. The support fund of this hospital was reduced by $2,000 for 1937 due to the failure of the Indians to patronize it. A change in operating personnel caused the Indians to refuse hospitalization for a short time. Conditions have now changed. The daily average increased from 9.6 in 1935 to 15.6 in 1936. Regardless, however, of the average number of cases treated, a sufficient amount must be provided for operation. Otherwise we are not in a posi tion to admit patients. A restoration of the $2,000 is requested.

Fort Totten Hospital. The 1937 appropriation provided $1,000 for X-ray equip ment which is eliminated returning the support fund to $23,000. No increase is requested.

Standing Rock Hospital. The $2,000 provided in 1937 for X-ray equipment for this hospital is also eliminated. A request for an increase of $10,000 based on increased capacity is discussed elsewhere.

Fort Totten Preventorium. The 1937 appropriation provided $10,000 for improvements to the heating system. This amount is dropped from the 1938

request.

Clinton Hospital.-The support fund of this hospital was reduced by $2,000 for 1937 due to lack of patronage. A change in medical service and other factors has brought about a marked increase in average daily attendance, that for 1936 being 17.2 as against 10.1 for 1935. It is requested that $2,000 additional be

allowed to offset the reduction made last year. Regardless of patronage, funds must be provided for operating this unit. Nurses and other employees must be on duty to care for those patients admitted. Overhead costs go on, even though the number of patients is small.

Pawnee and Ponca Hospital. -The daily average attendance at this hospital increased from 30.3 in 1935 to 33.1 in 1936. The support fund is below that of similar hospitals considered from either a capacity or a per-capita basis. In order to provide an adequate service, an increase of $2,000 is requested, making a total support fund of $36,000.

Tacoma Sanatorium.-This institution was formerly compensated for the care of Alaskan natives sent there for treatment for tuberculosis. This compensation has been discontinued. Partially to offset this loss of revenue, an increase of $4,000 is requested in the support fund. Payment was made for only a portion of care rendered during 1936 but the total is not available at this time. During 1935, $7,737.14 was received and during 1934, $8,322.60 was received, payments being made on the basis of $20 per week. It will be noted that the increase requested is approximately 50 percent of the contributions formerly received.

Tulalip Hospital.-While the rated capacity of this hospital is only seven beds, it is always utilized considerably over capacity. The daily average of patients for 1934 was 11.4, for 1935 it was 10.7, and for 1936 it was 12.8. Much obstetrical work is done, the total of live births during these years being 29, 32, and 53, respectively. At present there are two nurses, a cook, an attendant, and a small amount of irregular labor to perform all service for patients. This necessitates overwork which cannot be long endured by the personnel without ill effects on their health. Since the patients must be given the service indicated, it is requested that an increase of $1,600 be granted in order to provide a third nurse. per diem cost per patient has not exceeded $2.37 during the past 6 years, which is unusual for a small institution and compares favorably with that of hospitals of several times that capacity.

The

Mr. JOHNSON. On this subject of conservation of health among Indians we have Dr. Townsend here.

Dr. Townsend, you might state your official position and make a short general statement.

Dr. TOWNSEND. My official position is Director of Health, Office of Indian Affairs. As such I have general supervision of the medical and public-health activities in Alaska insofar as the Indians are concerned, as well as the Indians in the United States.

TUBERCULOSIS AMONG INDIANS

Tuberculosis is, I think, the major health problem of the Indians of the United States. Trachoma is the second major health problem, and the high infant mortality is the third. Venereal disease is also a problem which gives us some concern. But tuberculosis and the high infant death rate are the outstanding conditions.

Mr. JOHNSON. Will you tell the committee what you are accomplishing in the way of eradicating any of those diseases or all of them? Dr. TOWNSEND. Yes, sir.

Probably we can divide our work into three main parts-clinical relief, public-health activities, and scientific research. Our relief work may be further subdivided into hospital relief and out-patient relief, and also contract hospital relief.

We have 86 sanataria and hospitals for the treatment of the tuberculous Indians and for general hospitalization. We do not have enough tuberculosis beds to treat all Indians that need such treatment, but the beds that we do have available are about 95 percent occupied.

The difficulty is, as we meet it in the field, that the Indian finds it difficult to stay a long enough time at a hospital to effect a cure. He