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staff regards this basis of judging facilities as unsound. The question is whether the hospitals and sanatoria are efficient institutions for the care and treatment of patients, and this question must generally be answered in the negative.
Although the present administration has made a praiseworthy forward step in the reorganization of the Indian medical service and has secured from the Public Health Service a well qualified director for the chief position, it is hampered at every turn by the limitations of its present staff and equipment and by lack of funds for development. Under the present administration, too, a real beginning has been made in public health nursing. Despite these recent promising developments, it is still true that the Indian Service is markedly deficient in the field of public health and preventive medicine. The preventive work in combating the two important diseases of tuberculosis and trachoma can only be characterized as weak. The same word must be applied to the efforts toward preventing infant mortality and the diseases of children. Here and there some effective work is done in maternity cases, just about enough to demonstrate that competent, tactful physicians can induce a very considerable number of Indian women to have professional care in childbirth and to advance beyond the crude, unsanitary, and at times, even brutal primitive practices.
Another striking need is for the development of the public health clinic, an agency extremely effective in locating cases of tuberculosis and other communicable diseases in their incipiency and thus permitting of the early treatment of the sufferer when there is still chance to help him and, also making it possible to exercise some control over contagion. The number of public health clinics in the Indian Service is small, and the two or three deserving the name are of recent origin and are not adequately equipped.
Vital statistics have been called the handmaid of preventive medicine. They are indispensable for the efficient planning, development, and operation of a sound program for conservation of public health. The Indian Service has not yet been successful in overcoming the great difficulties inherent in securing vital statistics for the Indians and, moreover, its physicians in general have tended to neglect the important work of keeping case histories and other records basic to a public health program. The result is that the directing personnel of the Indian Service and the Department of