HRDLifKA] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 35 



important phase will be to provide all the able-bodied men with 

 suitable and remunerative work, wliich should be, above all, of a 

 nature to be enjoyed. The Indian is not inherently lazy. 



Alcoholism should be repressed. The inclination to drink is, how- 

 ever, often due, as among the wliites, to a deficiency in proper nour- 

 ishment. Another and most important cause of drunkenness is the 

 utter ignorance of the Indian as to its deleterious effects on his health. 



No effort should be spared to bring the Indian medical service to 

 the highest degree of efficiency and dignity. 



Special precautions are called for in the large schools, particularly 

 the nonreservation schools. In the first place, the tuberculin test 

 should always be applied to those who are to be taken to such 

 schools, and all cases where the reaction points to tuberculosis should 

 be denied admission. Introduction of the child into the changed 

 conditions of life should be very gradual. There should be ample 

 opportunity for out-of-door play, and for the systematic exercise 

 needed. Swimming pools must not be allowed to become polluted. 

 Excursions away from the school, particularly into the hills, have 

 shown very encouraging results and should be frequently under- 

 taken. Other important desiderata for the pupils are nourishing 

 food, eaten under the most enjoyable conditions, attention to indi- 

 vidual cases, and care as to their general mental tone. The 

 mouthpieces of musical instruments, cups for water, and faucets 

 at which children drink, should be regularly disinfected, and the 

 indiscriminate use of musical instruments should be discouraged. 

 Weekly weigliings of all the pupils should be practised, for a continu- 

 ous loss of weight is one of the first and most important indications 

 of failing health. The children should have no contact with con- 

 sumptive teachers, employees, or outsiders and should be well 

 instructed as to the dangers of tuberculous infection. Finally, all 

 pupils who become seriously ill, without delay and without being made 

 to feel that they are very sick, should be separated from the others, 

 relieved of regular duties, and given special attention, particularly in 

 regard to food and outings. If the child is kept until it has a well- 

 developed case of phthisis and is then sent back to the reservation, 

 the results are certain to prove unfortunate. Opportunity is 

 given the child to infect objects with which it comes in contact, and 

 possibly other pupils ; it is deprived of a chance of cure, and is sent back 

 at the height of the disease to infect the camp of the family. The 

 schoolrooms are generally good, yet the open-air schools about to be 

 introduced by the authorities of the Indian Office must certainly 

 be regarded as a further step in the right direction. The principle 

 should be extended also, where possible, to the workrooms and 

 dining rooms for the children. Extermination of flies at the schools 

 would aid in preventing infection. 



