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Show 4 REPORT OF COMltIt3SIONER OF INDIAN AFFAIRS Yabima Reservation at Top enish, Wash. These hospital andfiana-torium facilities have adde 1 approximately 312 beds for Indyans in need of treatment. New X-ray apparatus has been provided in a number of hospitals and sanatoria and hospital equipment'generally has been improved. There has been an increase in the ratio of nursing personnel, which has permitted a less onerous working day, and a new schedule of pay offers the possibility of advancement for those who do efficient work and are competent to undertake executive responsibility. In addition to the necessity for extension of hospital and sanatorium facilities as well a? field personnel for the Indian reservations, there is pressing need for improvement and upbuilding of the institutions now being operated as infirmaries, hospitals, or sanatoria. Nearly all of these institutions are substandard in their equipment and operative personnel. Constant effort is being made to improve both the char-acter and quality of the service rendered in these plants. With the establishment of adequate facilities and personnel the Indians gen-erally have demonstrated a willingness to accept such services. Attention has been given to the collection of more accurate data relating to health and disease among Indians and the statistical section of the Indian Office has cooperated to the end that better health records and more complete reports of births, deaths, and population may be .available. The accuracy of census returns is obvious1 of great Importance in a determination of the ratio of births, eaths, and health data generally relating to the Indian population. Sanitary surveys by sanitary engineers of the United States Public Health Service are enabling the office to make better provision for safe water supply and proper disposal of sewage. The growing interest manifest on the part of the field employees of the Indian Service is encour6ging. Also the increasing interest and helpful activities of the Public Health Service of Statel coun , voluntary, and other health organizations will be productive of etter health among the American Indians. t EDUCATION AND CIVILIZATION OF THE AMERICAN INDIANS The work of the year represents the continuation of a system of civiliiat~ona nd education which has lone been established, in historical. and, in fact, has necessarily been developed in confbrmity with Federal legislation and limited by financial resources. The energies and powers of the service have been directed toward the improvement of the educational system, although it should be understood that the desired culmination of these efforts has not been attained. In some phases, however, the results achieved at this time are of importance in their bearing upon the eventual solution of the Indian problem. Of these the most important perhaps 1s the present reliance of 35,000 Indian children uoon the State oublic schools for their education. The endeavors of ihe service thus'directed still continue and the next few vears. it is believed. will witness a material increase in the number and"a further elimination from the Federal Indian schools of those who can, to advantaee, attend the vublic schools. Thus ihero are at alis time two means of reaching the end sought, namely, the schools of the several States and the schools conducted by the 'service. So far as the latter are to serve for some years to |