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- mous amount of time. At present apparently physicians rarely make the attempt. The rapid turn-over of the medical personnel prevents the physicians from learning the local fields and discourages them from attempting to compile case records. The fundamental records from which reliable data could be taken are therefore almost totally lacking.
- Inaccuracies in Diagnoses: The diagnoses made by physicians are frequently little more than guesses. Some guesses are made in all vital statistics, but in the Indian Service figures the percentage of preventable inaccuracies is undoubtedly far above normal. At one agency, a list of thirty-six deaths was examined, regarding which the physician admitted that he knew one-third were incorrect. He had made no effort to rectify the errors. The annual report on disease at this agency was admittedly compiled at the close of the year by paging through Osler’s Practice of Medicine, and tabulating largely from memory the number of cases of this or that illness seen. Colds and influenza were excepted.
Little effort is being made at this time to analyze existing facts. In some instances much valuable information could be compiled from existing data if an attempt were made. In the work of this survey it was possible on several occasions to use such data to determine certain trends in mortality.
Since January, 1919, the Indian Office has requested its physicians and agencies to make all vital statistics records in triplicate, retaining one copy at the agency, sending one to the state department of health, and one to Washington. In the past eighteen months the Indian Office has attempted to take off the data contained on the census forms, and then forward them to the United States Census Bureau for checking and tabulation. The copies retained at the agency are often not filed in any logical order.
The Census Bureau compiles its vital statistics of Indians from the various census areas, irrespective of agency or tribe. Thus a comparison of statistics from the two sources is sure to reveal wide variations. Navajo reservations spread over the corners of four states.
The same difficulty in obtaining accurate vital statistics exists in most of the states. By and large, the state boards of health could not supply data that they considered really accurate. As a rule they either did not segregate Indian deaths from those of the total popu-