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At the time of its construction isolation was considered of prime importance. A branch line railroad runs within a mile of the institution, but it is of use only as a method of bringing in supplies, for its course does not make it convenient for passenger traffic. The nearest railroad point convenient for passengers is Wadsworth, Nevada, about eighteen miles distant over a primitive desert road, very difficult of passage during bad weather. Practically all patients coming from the states of Washington, Oregon, California, and points south, are transported overland from Reno, a distance of fifty miles, thirty-eight miles of which is improved highway. This means that patients sent from points in Washington and Oregon must travel approximately forty-eight hours to reach Reno, usually in a day coach, and then must travel by car overland. Obviously such a trip is beyond all reason for a case of active tuberculosis. The nearest city of any importance where consultation could be had is Reno. The location of this institution may be briefly characterized as impossible.

A plan has been under consideration, and funds have been appropriated, to rebuild the old Fort Simcoe property on the Yakima Reservation in the state of Washington as a sanatorium. It is located about ten miles from the nearest small town, and thirty miles from Yakima. The present buildings are those customarily found at an old fort. They are of frame construction and in a very bad state of repair. This property was used in years past as a boarding school, and at that time considerable difficulty was experienced in obtaining sufficient water. The buildings proposed for sanatorium use were gone over carefully, and they were found to be totally unsuited for this purpose. The amount of money necessary to convert them into an approved hospital would more than build an entirely new and modern unit, although this does not mean that such a unit could be obtained with the present appropriation of $50,000.

The location of other sanatoria visited is not subject to serious criticism.

The materials used in the construction of new sanatoria have not always been of a fire-resisting character. This is the case at Talihina, Phoenix, and Laguna. The fire hazard in all the institutions is great. None is entirely fire-resisting. This is due not alone to the material from which they are constructed, but also to the