as the bids submitted for them were almost invariably much in excess of the funds appropriated or apportioned. As a return of the cost of labor and material to the prewar status, or even close to it, can hardly be expected in the near future, it is the intention to carry on the construction projects as far as possible in the open market, for the results obtained by that method during the past year have been satisfactory. A practical and important demonstration of this appears in the construction of the Ute Mountain boarding school, Colorado, consisting of 10 buildings, with a central power, heating and electric lighting plant, and water and sewer system. It is expected to complete the school within the year at a saving of 40 per cent over contract work. THE FIELD PERSONNEL.-I have previously reported the serious loss to the field force of this bureau by transfer to direct or associated war work. The epidemic of last fall further disturbed the regularity of the service, so that it became extremely difficult to maintain throughout the year well organized conditions, and inexperienced, temporary help became a necessity in many jurisdictions. However the results under this unavoidable handicap have been generally all that could be expected. I have had frequent occasion to appreciate the loyality of very many employees whose qualifications and efficiency were attracted to other more remunerative employment, but who remained at their posts and even assumed other responsibilities in the genuinely patriotic spirit demanded by the period of extreme emergency. I am impressed that as a class the Indian Service employees are not adequately paid when qualifications and the character of the work performed are compared with other Government and outside employees. I should be glad to go further than available appropriations permit in rewarding the faithful and often self-sacrificing service of my coworkers. INDIAN FAIRS. One of the most helpful means of stimulating the agricultural enthusiasm of the Indians has been the Indian fair held each year on most of the reservations, at which the Indians exhibit their farm products, live stock, etc., in competition with each other, suitable prizes being awarded on the best exhibits. Certificates of merit, over the signature of the Commissioner and under the official seal of the Indian Office, are also given in deserving cases. These fairs are generally managed by the Indians themselves, through the medium of organized fair associations with Indian officers, under the supervision of the superintendent, which gives them practical experience in business organization and management. An important feature of such fairs is "the baby show," where the Indian mothers bring their little ones "in best bib and tucker," cash prizes and certificates being given the winners. Indian exhibits were also shown at county and State fairs, in conformity with the practice inaugurated several years ago, on a larger scale than formerly, with continued good results, many prizes being awarded the Indians in open competition with other exhibitors. Their success along this line portends the final abolishment of the strictly Indian fairs on the reservations, and universal participation by the Indians in the State and county fairs on the same basis as the whites. INDIAN EMPLOYMENT.-From his war experience the Indian has gained a wider vision of life, which has quickened his thought, opened his eyes to opportunity, and stimulated him to action, and many Indian soldiers have thus found work through the exercise of their energetic initiative. Indian youths have been working in this country on motors for Army trucks, tractors, and airplanes, and in France as repair men on motor-driven vehicles, and a number from overseas have returned to the factories for electrical engineering and other kinds of mechanical activities. Applications for automobile factory work are coming in steadily, and all worthy Indians so disposed are given a chance to become skilled mechanics in this way. In that section of the Arkansas Valley between Rocky Ford, Colo., and Garden City, Kans., Indian students from seven schools in the Southwest worked in the sugar-beet fields and factories, over 400 students being thus engaged from the middle of May until the last of December. In the evenings they enjoyed athletic activities, baseball, and band concerts, besides being supplied with magazines and other reading matter. Progress was impeded by the outbreak of Spanish influenza in the camps, three-fourths of the boys being in the hospital at different times with this malady. Many Indians found lucrative employment in the cotton fields of Arizona, particularly the Papago, who do the best work with Egyptian cotton. Many Indian girls were employed in clerical work, and as cooks, teachers, and housekeepers in schools, and others as nurses in Army hospitals in this country, besides three in France with the Red Cross. The extent and the variety of the work in which the Indians have been engaged, and the fact that many from remote districts who have never before shown such interest have asked for employment, presage economic stability and progress. HEALTH. If the figures of the epidemic of Spanish influenza could be deleted from the statistical tables and the sorrows of that visitation effaced from memory, the health record of the Indians of the United States for the fiscal year 1919 could be written as normal, notwithstanding the fact that the facilities of the service were greatly impaired by war conditions. The corps of physicians which at the time of the signing of the armistice was scarcely one-third of its normal numerical strength, has been undergoing rehabilitation, and at the close of the period covered by this report it was gradually approaching its full complement. The nursing corps is still greatly depleted and many positions are being filled temporarily by practical nurses. During the period of the war on some reservations physicians were required to take over the work of two or three other medical districts; in certain localities no medical service could be maintained. other than the supplying of simple remedies. To relieve the situation incidental to the shortage of physicians and nurses the Civil Service Commission waived the maximum age limits and changed the form of examinations from assembled to nonassembled. Through this courtesy and by aid of employees who were willing to perform extra duty it was possible to preserve in some form the integrity of the different health services even at the most remote stations. During the epidemic of Spanish influenza a plan of cooperation was effected between the Public Health Service and the Bureau of Indian Affairs, by which the emergency was well met, and I desire to expresss appreciation for the timely assistance rendered by the Surgeon General. The Chilocco School was a notable example of the efficient control of the influenza epidemic, not a single case having developed among the more than 500 Indian students and large corps of employees. While every employee of the Indian Service, by virtue of his position and duties, is concerned with health, which is not secondary to any other activity, those designated as health supervisors, special physicians, special nurses, agency and school physicians, general nurses, field matrons, and field dentists, are charged with the principal duties and responsibilities pertaining to the physical welfare of the Indian people. The health supervisors visit the various reservations and schools for the purpose of advising with the other health employees and gathering information for the office; special physicians are employed primarily to combat trachoma, but it is required that they shall be qualified specialists in diseases of the ear, nose and throat, as well as in diseases of the eye. In addition, they must be prepared to act as epidemologists, for they are frequently detailed to take charge of local epidemics of dangerous communicable diseases. Special nurses are attached to the service of special physicians. Agency and school physicians, whether employed under contract or regular appointment, perform the duties indicated by their designations, and general nurses are nurses employed at the various schools and hospitals throughout the service. Field matrons have a multiplicity of duties. Improvement of home, educational, moral, sanitary, environmental, and social conditions among the Indians is to be regarded as the primary object of their work. Though it is the duty of every employee of the service, regardless of his position, to do everything possible to contribute to such improvement, both by effort and by example, the field matron, whose duties bring her into the closest relationship with the family, especially the mothers and daughters of the home circle, is particularly charged with the responsibility of developing higher standards of living, of inculcating the desire for progress and of evolving plans to make the home more attractive. Field matrons are assigned a leading part in the organized effort to save the babies and keep them well, and they also act as field nurses in combating tuberculosis, trachoma, and other diseases. The traveling field dentists are among the most useful employees of the service. Their professional aid at the schools and reservations largely promote conditions among the pupils and adult Indians now generally regarded as definitely essential to bodily health. The facilities for the treatment of the sick have increased with the progress of medicine. From the primitive dispensary clinics of early days there have developed the hospitals and sanatoria of the present, with their laboratories and special equipment. The guess methods of diagnosis have given place to scientific tests, and the former occasional word of admonition on health has been superseded by graded instruction in hygiene and physical culture which extends through all grades as outlined by the course of study. The hope of the Indian-his development, physically and industrially-lies in his educational opportunity. Since sanitation is a compulsory subject of the curriculum of instruction, in the course of time the principles taught will blend with the daily life and conduct of the people and exert a transforming influence upon their future. With the addition of trachoma as an exception, although this disease also prevails among white people, the health problems as they occur among the Indians are the same as those that pertain to rural communities throughout the country, and the needs are the same better housing conditions, greater industrial prosperity, better water supplies, and all the factors of protection that make for health and longevity. Our efforts cover the whole range of sanitary and medical prevision and aid, beginning with prenatal care and extending on through life to the care of the aged and finally to the burial of the dead. While each duty is important, I would, so far as practicable, emphasize as the most important those things which prevent disease by increasing the resistance of the body cells through proper nutrition and well ordered living, thus making it possible for one, who may not have escaped infecting organisms, through the strategy of knowledge and the tactics of hygiene, to find protection in the defenses of nature. So, believing proper nutrition to be one of the principal armaments of preventive medicine, I have sought to encourage and promote Indian industry in general and Indian farming in particular; I have tried to make agriculture and thrift the pillars of a health arch of which the keystone shall be sanitary education. Poverty and disease are handmaids of destruction and despair and any health policy designed to affect a race must make provisions to overcome these conditions and offer to the people prosperity and hope, encouragement and comfort I have purposely avoided including comparisons in this report, for on account of effects of the epidemic of Spanish influenza they would be of very little value in studying the general conditions of health. Statistical figures appear in the various tables under appropriate headings, and those pertaining to the epidemic will be incorporated in the reports of the United States Public Health Service and in the bulletins of the Bureau of the Census. In general it may be said that apart from the invasion of the Indian population by the great pandemic, the year covered by this report showed progress in health matters; the number of hospitals was slightly increased, the field matron service and the medical corps strengthened I have very definite plans for the expansion of the health service for the next fiscal year, subject to Congressional appropriations. As will be recalled, two health drives operated in the Five Civilized Tribes during the months of July, August, September, October, and November of 1917. One of the drives was carried on among the Cherokees and the other among the Choctaws. From my knowledge of the health conditions of the Indians of that jurisdiction, gained from reports and observations, and from a study of the statistics of those drives, I am convinced that a permanent health organization of sufficient proportions to extend its influence to every restricted Indian of that superintendency is needed. The immediate purpose of those campaigns was to improve the very bad conditions, and instructions were given to those engaged in the work to give their first attention to home betterment; to sanitation and ventilation; and to hygienic relations bearing upon the prevention of tuberculosis and other communicable diseases. Now that the war is over, I intend to renew my request to Congress for the funds to complete and make effective these preliminary campaigns for health betterment among the Choctaws and Chickasaws. With a view to restoring and strengthening our health work, and especially the service of field matrons, I issued near the close of the |