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of diagnosis have given place to scientific tests, and the former occasional word of admonition on health has been superseded by graded instruction in hygiene and physical culture which extends through all grades as outlined by the course of study.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

year an appeal to all employees, in the hope that the sentiment and views expressed would, under more promising facilities, lead to better organization and corresponding results. This letter follows:

To superintendents, physicians, field matrons, and other employees:

JUNE 18, 1919.

In the Indian Service it is never untimely to preach the gospel of health, but it is especially opportune to do so now when all that enters into the inspiring word"Americanization" summons us to great action. Though the thunders of world strife are stilled we shall not complete our victory until we put into the arts and activities of peace the high purpose and patriotism that gave our best lives and billions of treasure for freedom and justice to all mankind. Our nation henceforth must rest on a citizenship that will prove the efficacy of the ideals we fought for, and for which the Indians touched elbows with the white man on all the heights of heroism. This proof must appear in the unity, the intelligence, the freedom of opportunity, and the mass progress of our people. We are thus called by the triumphs of war to win the equally renowned victories of peace which can be fully told only by coming historians, but which in a sentence means the development of an American people of one language, one love of liberty, one loyalty to law and justice.

In this exalted task, we of the Indian Service have a definite part. It is not only our duty to see how many Indians are among the five and a half millions in the United States who can not read or write any language, or the 3,000,000 over school age who can not speak English, or the one-fourth of our drafted Army who could not read their orders or write home in English, or the 6,000,000 of underweight children in the United States, but we must overcome these conditions so far as they exist on the reservations, and first of all we must have a vital and physical basis to build on. Our fundamental and best work must be in the saving of life and in making life healthy. The monument we build to Indian soldiers, living or dead, should be in the lives of those remaining under our care.

The progress of every people is primarily conditioned upon corporal efficiency. The greatest attainments of civilization do not spring from enfeebled flesh and blood.

I have often emphasized the thought early in my administration, and now give it earnest reiteration that it is our chief duty to protect the Indian's health and to save him from premature death. It is of first importance that we reestablish the health and constitution of the Indian children. Education and protection of property must not be neglected, but everything is secondary to the basic condition which makes for the perpetuation of the race.

We have had some splendid successes in the direction of improved health and vigor among Indian babies, as shown by competitive tests. We have increased all our facilities for medical treatment and nursing. We have recently seen a steady gain in birth rate and decreasing death rate. We have accomplished much betterment in home life. But these and other gratifying results must serve chiefly to stimulate our efforts and to improve our organization for greater achievement. We released many from our health service for the emergent needs of war, but we are restoring them or filling their places, and shall widen their work.

I feel that we are at the dayspring of a new and glorious era in all that pertains to health and the vital possibilities of a great people, and are ready as never before to respond understandingly to the great Teacher's promise: “I came that ye might have life and that ye might have it more abundantly." The abundant life must come through physical, as well as mental and spiritual health. As we emerge from the forces of havoc and death, the impelling thought and aspiration of the hour are reconstructive, renewing, expansive. There is an eagerness to look forward, to move upward, to restore and heal. The swift advances in the science of surgery and medicine, the

quickened humanities of world-wide relief, have bequeathed to us an inspiration to cure and prevent disease, to build up and make strong, and unless we act upon it, we are disloyal to the war's greatest spiritual triumph. We must be instant to grasp the miraculous things done to prevent disease in vast bodies of men. We must appropriate and practically apply the marvelous reduction of war deaths from infectious conditions. We must practice scrupulously the object lessons given by military camps in all matters of health precautions which have so successfully maneuvered against communicable disease through the common essentials of water, air, food, clothing, sewage, exercise, and inoculation. Typhoid and many germ diseases are no longer more destructive than the enemy's guns and gas. These are negligible foes through persistent sanitation and other prevention practicable for every community. We have learned that military morale is chiefly another name for health, for the healthy are seldom downhearted or deficient in courage.

Morale is a good watchword under which to rally all our service personnel, all our pupils, all our returned students, and progressive Indians for a new drive against disease of every description. Health is almost wholly a matter of education, of organization, of cooperative enthusiasm. The health leagues started in many schools should become nation-wide. Hygienic living costs little beyond such actual necessities as food, clothing, water, air, fuel, shelter, work, play. Never before has there been such full and reliable guidance to good health as comes now from the Public Health Service, the State boards of health, and the copious literature on right living from medical and trustworthy sources. To-day there would be no wit or logic in the eloquent agnostic's suggestion for improving the Almighty's plan by making good health catching instead of disease, because the contagion of good health is a fact, and is being demonstrated wherever intelligent effort correlates with nature.

I do not see how our service can be anywhere but in the vanguard of this great health movement which has awakened such serious interest, and to be there our Indian schools must reorganize for more effective results. Many of our school periodicals contain in nearly every issue the essential rules for practical hygiene and sanitation. What we probably need is a more systematic plan for creating interest in, and the performance of, what we know ought to be done. The element of a proper incentive is very important with children until practice develops habit, or the joy of health becomes a conscious reward of obedience to instruction. I also regard as of special value such supervision of exercise or athletics as will bring individual benefits to all pupils. The competitive game is a great and wholesome thing, under right control, but every pupil should get into it. All should be actors, and not mostly spectators. But enveloping all our efforts, should be the stirring influence of a health atmosphere, even breezy in its expression of the zeal and confidence of every employee that health must come first and that everybody must have it. I can not believe that many forms of disease can stand against such cooperation inspired by the Superintendent, counseled by the physician, administered by the faithful nurses and matrons, and assisted by the encouragement and sympathy of all.

In this appeal, I have somewhat especially in mind the duties of field matrons and desire to awaken a revival of interest in their work which is so needful to all health and home welfare on the reservations, and to secure for it the support its importance demands.

We must continue more resolutely our contest against disease and insanitation in the family life of adult Indians. Emphasis is given to my earlier declaration, that every Indian hospital bed not necessarily occupied by a sufferer from disease or injury should be available for the mother in childbirth. No baby should be born in the midst of infectious conditions. There must be no neglect of any woman approaching the sacred period of motherhood, and in all this work of home uplift and purification the responsibility rests heavily upon the field matron, who under the direction of the superintendent is entitled to his sincerest aid and council.

The position of field matron is much more than a job. It is an opportunity for service to others; an opportunity for self-sacrifice in the interest of humanity; and for the exercise of the highest attributes of mind and soul in a preeminent cause. The position should be filled only by women who have the desire and the aptitude to teach the things that influence human lives for good and fill them with higher aspirations. No woman should seek or hold the position of field matron who is not endowed with physical strength, with strong moral and mental force, and with the real missionary spirit-a spirit of helpfulness that finds expression in a fervent desire to better the condition of a worthy race that is struggling upward to a realm of higher life, for without these qualifications, the duties will be uncongenial and success can not be attained. The material remuneration is not large and the discouragements and adversities are many. The rewards are chiefly in the sacrifices.

While varied circumstances and conditions are responsible to a great extent for failure, success depends, in a large measure, upon the field matron herself; upon her spirit of helpfulness and sacrifice; upon her fitness for her calling; and upon her moral force.

A field matron, to be successful, must have a profound personal interest in the Indian people and an abiding faith in their possibilities and in the ultimate success of her work. She must labor for the general welfare of all, regardless of their attitude, their status, their character, their reputation, or their condition. If any distinction is made, it should be in favor of those who are farthest down in the scale of life, because their needs are the greatest.

Because of the great importance I attach to the mission of the field matron, I am inclosing herewith a more specific outline of her responsibilities and duties and shall expect every such employee to acknowledge the receipt thereof.

CATO SELLS, Commissioner.

SUPPRESSION OF THE LIQUOR TRAFFIC.

The task of suppressing the liquor traffic among Indians is one which requires constant watchfulness, vigilance, and resourcefulness, in the apprehension and prosecution of offenders. This branch of our service is kept moving all the time to protect our Indians from the evils resulting from the use of liquor, and while substantial progress has been made during the past year, the liquor forces continue to violate the law wherever it seems possible to acquire huge profits, taking great chances and becoming desperate and dangerous when interfered with.

The year has been an active one notwithstanding the war restrictions imposed upon the manufacture and sale of liquors. There were 1,516 new cases instituted during the year; 2,135 cases disposed of; 33,924 gallons of various kinds of intoxicating liquors seized and destroyed; and 112 automobiles engaged in the illegal traffic libeled and sold for $42,869. Fines were assessed in the amount of $82,460. Operations during the fiscal year covered 27 different States and include prosecutions for violations of State, Federal, and municipal laws.

The legislation contained in the act of May 25, 1918, making posses. sion of intoxicating liquor within Indian country an offense was