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them in the hospital. The inadequate care of the patients may be summarized as follows:

1. Patients often travel long distances by day coach and over land by auto to reach a sanatorium, a trip that in itself is inadvisable.
2. On entrance to the sanatorium, the patient is not given a complete and careful examination. because the physician claims that he is usually so overworked that he does not have the time. Possibly in some instances initiative is also lacking. The available records in sanatoria do not indicate that complete examinations have been made. The physician in charge is further handicapped because of lack of X-Ray and laboratory facilities. The intelligent handling of tuberculosis cases depends, it should be added, upon the accuracy and completeness of diagnoses at the outset.
3. Frequent re-examinations are not uniformly a part of the routine in Indian Service sanatoria. The admittance examination is only a beginning. It is customary to make frequent re-examinations, depending upon the condition of the case in question.
4. Indian Service sanatoria have no segregation of bed space, nor sufficient personnel with which to assure the observation of cases in bed on admittance. On an average, from 40 to 50 per cent of patients admitted to sanatoria are in need of definite bed care for periods of time varying from a few weeks to months. Only the desperately ill Indians are accorded such care.
5. Insufficient personnel necessitates relying upon the patients to do a certain amount of manual labor. Although this practice is permissible in some cases no scientific selection is made in the Indian Service, and doubtless many patients are required to work who would be far better off in bed.
6. A large proportion of patients in these sanatoria are suffering from extra-pulmonary forms of tuberculosis that could be definitely benefited by actinotherapy, either by exposure to natural irradiation or the artificial quartz light therapy. Practically none of the former is being done, and not enough of the latter.
7. Artificial pneumothorax, an approved method of treating selected cases of pulmonary tuberculosis, is not being used in a single Indian Service sanatorium. The explanation usually offered is that the Indian will not remain once he feels his strength returning, and that no facilities exist for continuing the treatment when