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from the school in January was found suffering with a far advanced case of tuberculosis, with the usual findings, including cavitation. In general he presented as typical a picture of the disease as one would ever expect to see. That this case developed within the five months previous to his hospitalization is unbelievable. It is far more probably evidence of a failure to make an early diagnosis, especially as the contract physician concerned was found to be examining the pupils at the rate of 72 per hour, according to an exact count made during the examinations. This physician says that during the school year 1925-26, twenty-two cases of tuberculosis developed at that boarding school, and during the period between opening of school in the fall of 1926 and March, 1927, at least nine cases of pulmonary tuberculosis had been detected. The State Board of Health, knowing of these assertions, offered to supply a trained tuberculosis clinician and staff to cooperate with the school in an effort, if possible, to detect these cases earlier. This offer was declined by the local officers, apparently without any reference of the matter to the Washington office.

This same school may be cited as evidence of the difficulty in caring for cases in the school. A young boy had been diagnosed as in an early stage of the disease. He had been hospitalized at the school hospital until objective symptoms were absent. He was then advised to take limited exercise on the school grounds. No sooner had the boy returned to the campus than the disciplinarian demanded that he assume regulation duties. This employee was informed of the physician’s orders, but repeatedly ignored them. At the time of the survey visit, this lad was found repairing steam pipes in a wet and poorly ventilated room.

The establishment of sanatoria and sanatorium schools constitutes practically the only special activity thus far undertaken for the control and prevention of tuberculosis. No organized machinery, such as clinics, has been established for case finding and follow up. Because of the limited amount of public health nursing on reservations, this important method of prevention and attack is almost negligible. Except for the sanatoria and the sanatorium schools, which are in general disappointingly weak and ineffective, main reliance is placed on the general health organization of the Service.