2d Session. 1 No. 505.

INDIAN TUBERCULOSIS SANITARIUM AND YAKIMA INDIAN RESERVATION PROJECT.

REPORT OF THE JOINT COMMISSION ON INDIAN TUBERCULOSIS SANITARIUM AND YAKIMA INDIAN RESERVATION PROJECT.

DECEMBER 20, 1913.-Referred to the House Calendar and ordered to be printed.

To the Senate and House of Representatives of the United States of America in Congress assembled:

The joint commission of Congress to investigate the necessity and feasibility of establishing, equipping, and maintaining a tuberculosis sanitarium in New Mexico for the treatment of tuberculous Indians, and to also investigate the necessity and feasibility of procuring impounded waters for the Yakima Indian Reservation or the construction of an irrigation system upon said reservation, to impound the waters of the Yakima River, Wash., for the benefit of the Indians of said reservation, respectfully submits the following report:

AUTHORITY AND DUTIES OF THE COMMISSION.

This commission was created by the act of Congress approved June 30, 1913, the Indian appropriation act, section 23, under the following provisions:

A commission consisting of two members of the Senate Committee on Indian Affairs, to be appointed by the chairman of said committee, and two Members of the House of Representatives to be appointed by the Speaker, is hereby created for the purpose of investigating the necessity and feasibility of establishing, equipping, and maintaining a tuberculosis sanitarium in New Mexico for the treatment of tuberculous Indians, and to also investigate the necessity and feasibility of procuring impounded waters for the Yakima Indian Reservation or the construction of an irrigation system upon said reservation, to impound the waters of the Yakima River, Washington, for the reclamation of the lands on said reservation, and for the use and benefit of the Indians of said reservation. That said commission shall have full power to make the investigations herein provided for, and shall have authority to subpoena and compel the attendance of witnesses, administer oaths, take testimony, incur expenses, employ clerical help, and do and perform all acts necessary to make a thorough and complete investigation of the subjects herein mentioned, and that said commission shall report to Congress on or before January first, nineteen hundred and fourteen: Provided, That one-half of all necessary expenses incident to and in connection with the making of the investigation herein provided for, including traveling expenses of the members of the commission, shall be paid from the contingent fund of the House of Representatives and one-half from the contingent fund of the Senate, on vouchers therefor signed by

the chairman of the said commission, who shall be designated by the members of the said commission.

Under the foregoing provisions of law Senators Robinson, of Arkansas, and Townsend, of Michigan, and Representatives Stephens, of Texas, and Burke, of South Dakota, were appointed members of said commission and organized on the 25th day of August, 1913, by the election of Senator Robinson as chairman and Ross Williams, of Arkansas, as special clerk and stenographer.

Two distinct tasks were imposed on this joint commission:

First. To investigate and report on the feasibility of establishing, equipping, and maintaining in New Mexico a sanitarium for the treatment of Indians afflicted with tuberculosis.

Second. To investigate and report on the necessity and feasibility of procuring impounded waters for the Yakima Indian Reservation or the construction of an irrigation system upon said reservation to impound the waters of the Yakima River, Wash., for the reclamation of the lands of said reservation, and for the use and benefit of the Indians of said reservation.

PROPOSED TUBERCULOSIS SANITARIUM IN NEW MEXICO FOR INDIANS.

The joint commission visited a number of Indian reservations and schools in several States, held hearings, and investigated conditions with reference to tuberculosis among the Indians, the prevalence of the disease, and the most practical means of combating it.

Senate Document 1038, Sixty-second Congress, third session, relating to contagious and infectious diseases among the Indians, was available for the use of the commission. This document is a report by the Public Health Service of investigations made in accordance with the act of Congress approved August 24, 1912, into the prevalence of contagious and infectious diseases among the Indians of the United States.

The information contained in Senate Document 1038 above referred to, while incomplete and not claimed to be entirely accurate, is, for the purposes of this investigation, reliable, and, in connection with the testimony taken by the commission, sufficient to compel the conviction that both trachoma and tuberculosis are quite general among the Indians, and that tuberculosis in some localities is rapidly increasing. For the fiscal year ending June 30, 1912, out of 190,791 Indians reported on, approximately 26,500 were estimated to have tuberculosis. Thirty-two per cent of the whole number of deaths reported from the various reservations was alleged to be due to tuberculosis. Out of the total Indian population of 322,765 it is believed that there are approximately 26,500 cases of tuberculosis. We believe that on some of the reservations the percentage of the afflicted is one-fourth of the entire population. A comparison of the death rate between Indians and whites from tuberculosis discloses that 32 per cent of the whole number of deaths reported from the various reservations was due to tuberculosis, as against 11.2 per cent of the deaths occurring from the same cause in the registration area of the United States.

The death rate from all causes among the Indians is approximately 32.24 per thousand. The Census Bureau gives 16 per thousand as the death rate in the registration area. While in a few localities tuberculosis among the Indians is not more common than among the

whites residing in neighboring communities, on many reservations conditions are such that the disease is likely to spread very rapidly unless a campaign against it is speedily inaugurated.

It appears that for the year ending June 30, 1912, there were 53 hospitals and sanitariums in the Indian service with a capacity of 1,256 patients. For the most part these are mere school hospitals with only sufficient capacity to accommodate sick pupils. The discovery of the generality of tuberculosis among the Indians is of comparatively recent date. The Commissioner of Indian Affairs realizes the necessity for promptly adopting some feasible method to remedy the deplorable conditions herein set forth. Owing to the vast territorial area of many of the reservations, and the inadequate medical and other necessary service now afforded, little can be done to check the disease until Congress has provided the necessary means. When the Indian appropriation act, approved June 30, 1913, under which this commission was created, was under consideration in the Senate, an amendment carrying $100,000 for the establishment of a central tuberculosis sanitarium for the treatment of Indians generally was inserted in the bill. It was suggested that this sanitarium should be established at a point in New Mexico on the Mescalero Reservation, approximately 50 miles from the Mescalero Agency, for the treatment of tuberculous Indians from the various reservations throughout the United States.

The following letter from the chairman of the commission to the Commissioner of Indian Affairs, September 8, 1913, and his reply thereto, with accompanying data, disclose not only the alarming prevalence of said diseases among the Indians, but also the totally inadequate facilities available for the use of the department in checking the ravages of trachoma and tuberculosis:

Hon. CATO SELLS,

Commissioner of Indian Affairs,

Washington, D. C.

SEPTEMBER 8, 1913.

MY DEAR MR. SELLS: Will you please furnish for the use of the commission appointed to investigate the management and conduct of the Bureau of Indian Affairs a statement showing

1. The number and percentage of Indians afflicted with trachoma at Indian schools and on the Indian reservations.

2. The number and percentage of Indians afflicted with tuberculosis and the deaths from these diseases among Indians on reservations and in the schools; also, a comparison of the death rate as between the Indians and the whites from tuberculosis within the registration area of the United States.

3. The number and capacity of each hospital available for Indians. 4. Whether, in your judgment, it would be desirable to have a large hospital on the Mescalero Reservation, or smaller hospitals at the various reservations where conditions are most acute.

I should appreciate early information regarding these subjects.
JOE T. ROBINSON,

Sincerely, yours,

(Signed)

Chairman.

DEPARTMENT OF THE INTERIOR,

OFFICE OF INDIAN AFFAIRS,
Washington, September 9, 1913.

MY DEAR SENATOR: In response to the questions submitted in your letter of September 8, I have the honor to reply as follows:

1. The number and percentage of Indians afflicted with trachoma at Indian schools and on Indian reservations:

This table is given in further detail in accompanying Exhibit A.

(b) On Indian reservations-Adults and children.

This table is given in detail in accompanying Exhibit B.

Using this rate, 22.70 per cent, with a population of 322,765 Indians, it is estimated that there are 71,997 cases of trachoma among the Indians.

2. The number and percentage of Indians afflicted with tuberculosis, and the death from this disease among the Indians on reservations and in schools; also, a comparison af the death rate as between the Indians and the whites from tuberculosis in the registration area of the United States.

For the fiscal year ended June 30, 1912, the following information is available regarding tuberculosis:

Of 190,791 Indians reported upon by superintendents, 13.89 per cent, or 26,500, are estimated to have tuberculosis. During that year 1,905 deaths due to tuberculosis were reported from the various agencies.

Thirty-two per cent of the whole number of deaths reported from the various reservations were due to pulmonary tuberculosis as against 11.2 per cent of deaths due to the same disease occurring in the registration area of the United States. The death rate among Indians is 32.24 per thousand, while the Census Bureau gives 16 per thousand in the above registration area.

3. The number and capacity of each hospital available for Indians: Ending June 30, 1912, there were 53 hospitals and sanatoria in the service, with a capacity of 1,256 patients. Since this report was compiled several others have been constructed, and the capacity of others increased. The accompanying table will give the location and capacity of each. It will be noted that they are mostly school hospitals, of capacity sufficient only to accommodate sick pupils. (See Exhibit C.)

In answer to your question 4, I am quoting the following paragraph from my letter of September 8:

The solution of the problem of caring for this vast number of cases would be the establishment of tuberculosis camps on the reservations. This has been done in a few instances and will be done on others as funds become available and where local conditions are conducive to their proper maintenance. There are, however, many smaller agencies and isolated bands of Indians where cases are few and where the cost of maintenance of camps or hospitals would be excessive, and there are also hundreds of Indians receiving absolutely no treatment whatever and as many more within reach of physicians who are not equipped to care for them. Again, there are very many incipient cases in whom the disease could be arrested by treatment such as could be offered at the proposed sanatorium. Indigent cases, of which there are many, when neglected become foci, from which the disease spreads. Removal to a sanatorium is the only satisfactory method for caring for such patients.

In addition I will say that, having approximately 26,500 cases of tuberculosis among Indians, it is with me hardly a question of whether it would be more desirable to have a large hospital on the Mescalero Reservation than smaller ones on the other reservations, but one providing adequate sanatorium facilities for a large per cent of the vast number of Indians sick with tuberculosis. Mescalero could accommodate at the most only a very small percentage of these. The remainder must be treated on the reservation. Mescalero, however, would care for the indigent sick and many of those who must for one reason or another be removed from the reservation for treatment. Even though Mescalero is provided for by Congress, our great problem