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Problem of Indian Administration
  1. The permanent clinic, the back bone of case finding and follow-up machinery of public health practice seems not to have been established until recently[1] and then only at Crow agency, Montana; Cass Lake, Minnesota; and Keshena, Wisconsin. These attempts are commendable, but at this stage cannot be said to constitute a well developed project. This does not refer to the dispensary service rendered in boarding schools. The clinic should carry out preventive as well as curative measures, have access to family case records, and be so organized that it supplements all other preventive and curative health procedures. The manner in which permanent clinics are conducted is in most instances unsatisfactory.
  2. The compilation and analysis of accurate vital statistics has never been a general practice in the Indian Service. Without these essential data it is absolutely impossible effectively to plan or direct a constructive health program. This subject is so important that it will be further discussed later.
  3. Tuberculosis, the most serious disease problem among the Indians, has not been effectively attacked. The sanatoria and reservation schools have been operated far below acceptable standards.
  4. The preventive work in the trachoma campaign has consisted mainly in providing separate towels in boarding schools, displaying posters in Indian communities, and in a small amount of rather ineffective segregating of cases in schools. The really worth while activity is at Fort Defiance, and that is of a curative nature, although it does segregate cases. A more limited, though commendable, activity is at the Reno Colony, where a permanent clinic is being operated jointly by the local field matron and the county public health nurse. As has been pointed out more at length in the section on trachoma the existing knowledge of the disease is limited ; and it may doubtless prove true in trachoma, as it has in tuberculosis, that emphasis must be placed on diet and a hygienic regimen. As the Indian diet both in schools and on reservations is obviously markedly deficient, the tendency to put almost the entire emphasis on local curative measures is open to serious question.
  1. ↑ This statement it should be noted refers to permanent clinics. Special and temporary clinics have been held from time to time in the past.
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