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lation, or else they classified Indians under the general headings including negro, Japanese and Chinese.

No systematic effort is made at this time to report morbidity. In a few instances the acute infectious diseases have been reported to the state health officers. Such reports, however, are rare. No epidemiological case record has generally been kept of infectious and contagious diseases, although possibly this may be done in some school or hospital.

The dispensary records examined on reservations were as a whole unsatisfactory. They lack detail. Frequently entries are made according to symptoms, and in one instance a record was found of “supplies.” The present book used for recording such data would be acceptable if the entries were more accurate and complete.

Medical reports made by the agencies to the Washington office have been unreliable for the following reasons:

1. Inaccuracy of the basic source of most figures.
2. Use of figures previously reported without making a careful check-up.
3. Preparation of reports from memory.
4. The editing of the physicians’ reports to conform to the superintendent’s opinion as to the facts. The possibility of this practice will in the future be largely eliminated because physicians may now report directly to the Chief Medical Officer.
5. Changes of forms and character of information desired. In the past ten years, such changes have been frequent. This has caused confusion and too frequently a multiplicity of reports.

Recommendations.

1. The Indian Service should adopt a well-rounded, effective program of preventive medicine and public health service. The outstanding features of this program should be: (1) An adequate directing force of well trained public health physicians ; (2) a greatly increased staff of public health nurses ; (3) well organized and administered public health clinics on all reservations ; (4) special emphasis on the prevention of the three outstanding diseases among Indians, tuberculosis, trachoma, and diseases of infancy; (5) general efforts to interest the Indians in hygiene and to instruct them in it; (6) the collection, tabulation, and use of reliable vital statistics; and (7) full cooperation with state and local government health agencies and with private national and state health organizations.