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physician in constant touch with such conditions should not more quickly suspect the presence of tuberculosis. Diagnostic facilities, such as X-Ray and laboratory and tuberculin tests, have not been available in the Service and it is only on rare occasions that such aid is sought from the outside.

The prevalence of tuberculosis in boarding schools is alarming. This condition is apparently due to the failure to make complete health examinations when the children are admitted, and, later, to the serious overcrowding practiced, the poorly balanced ration, and the industrial method of operating these schools. Instances were noted where a child with incipient tuberculosis was required to assume duties too difficult for his physical strength. A full-fledged case of the disease thus develops before the case is diagnosed and treated. To aggravate these conditions the child in an advanced stage of the disease is frequently returned to his family, there to infect others in the home and himself to be the victim of neglect on account of ignorance and lack of facilities to meet his needs. Under a recent ruling the Indian Office is attempting to provide beds for some of these cases in the school hospital when sanatorium facilities are not available.

At one hospital, a case was seen of a girl about 18 years old who had been sent home from a large non-reservation boarding school about a month previous to the visit of the survey staff. Physical examination of her chest revealed unmistakable evidence of infiltration throughout the left and part of the right side. The fibrosis was sufficient to indicate that the process had been going on for perhaps a year or more. The symptoms dated back approximately two years. This case was detected at the boarding school only about three months previous to the time she was examined by the survey physician and was hospitalized only a month at the school before she was sent home. At the time she was visited by the survey physician, she was in a small agency hospital which took all classes of cases. Danger of contamination existed for the maternity cases in nearby beds.

At one non-reservation boarding school the contract physician asserted that all cases of tuberculosis were detected on admission each fall, and therefore all cases found during the school year were developed at the school. One case from this school was observed at a sanatorium in March, 1927. A young man transferred there