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The general plan and arrangement of the Indian Service hospital space has been poor. Usually no isolation rooms are available for patients. The separate rooms provided are as a rule occupied by the hospital staff.

The appropriations for hospital upkeep have been so restricted that the older buildings especially have deteriorated to a point where large sums would be necessary to restore them even to their original inferior condition, much less to remodel them. In fact many of them should be replaced with new structures embracing modern planning and arrangement. The lack of permanency in building materials causes an unavoidable deterioration that costs heavily in the end. In planning new structures and in considering the replacement of the old, consideration should be given the possibility of their future use for the community as a whole, both white and Indian. In many instances it may prove feasible to coöperate with state, county, or other local agencies in perfecting plans whereby joint hospital facilities may be provided. If such coöperation can be arranged superior hospital facilities may be made available for the entire neighborhood, giving both to whites and to Indians advantages they could hardly secure if each should have an independent hospital.

As many of these hospitals are of frame materials and none of them are of completely fire resisting construction, the fire hazard is great, especially as they are often far removed from organized fire fighting apparatus and are not provided with adequate apparatus on the ground. In addition to the insufficiency of fire fighting apparatus, water supplies are often inadequate. The number of chemical extinguishers, their distribution, and the frequency with which they are recharged, have often been found faulty. Fortunately most of the buildings are of one-story construction so that patients could be taken out if the occasion demanded it.

The fixed equipment such as plumbing, lighting fixtures, and radiators, is often inadequate, in some instances in respect to numbers, and in others, in respect to capacity, and is frequently in poor repair. The hospital at Cheyenne River, South Dakota, is of two-story construction. On the second floor are two glassed-in wards that would be suitable for the housing of tuberculosis cases. It is reported that radiators were provided, but that some time ago they were removed and placed in the children’s dormitories at the reser-