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limited water supply as at Fort Lapwai, the poor water storage facilities as at Sac and Fox, and the absence of fire escapes as at Shawnee. Modern sanatoria are as substantially built as hospitals and are permanent buildings. In the end the greatest economy is found in concrete, stone, or brick materials. The old system of cottages, as used at Phoenix, and of large wards as used in all other Indian Service sanatoria, has been obsolete for years. The American Sanatorium Association for the past ten years or more has recommended a definite division of bed capacity according to the type of patient, as follows: Infirmary cases, or those confined to their beds, 40 per cent; semi-ambulant cases, or those who are in bed the majority of the time, about 35 per cent; ambulant cases, or those who are up most of the time, 25 per cent of the bed space.
These figures are based on the average use of sanatorium beds as observed in dozens of sanatoria all over the country. In other words, the average sanatorium, taking average cases of tuberculosis finds that 40 per cent or more of its cases are in need of infirmary treatment for a variable period of time. No evidence is available to indicate that the Indians would not require the same provision.
The infirmary space more than any other demands the most modern arrangement and equipment. The patients are bedfast and require the same bedside care as the acutely ill hospital cases receive. This type of case requires a large proportion of single rooms but some rooms should be provided for two and a few rooms for four, the exact ratio depending upon the size of the institution.
In the Indian Service it is rare to find a single isolation room for the terminal cases. Screens are used to segregate the patient from the others in the ward.
This faulty construction might be expected in the case of a converted boarding school, but it is also found in the newer buildings, such as Talihina, Laguna, Phoenix, and Fort Lapwai. Phoenix and Fort Lapwai are the only sanatoria said at this time to have infirmary buildings. At Phoenix a new frame unit has just been completed. It accommodates fifteen boys and the same number of girls in two wards. The only single rooms are for the employees. Other major faults in the planning of this unit were the presence of cross ventilation and the absence of sheltered porches, advisable in that climate. Four water closets and the same number of shower