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By the 1920s the Bureau of Indian Affairs had changed its opinion about boarding schools, responding to complaints that the schools were too expensive and that they encouraged dependency more than self-sufficiency. By 1923, the majority of Indian children nationwide attended public schools. A report on Indian education issued in 1928 revealed glaring deficiencies in the boarding schools, including poor diet, overcrowding, below-standard medical service, excessive labor by the students and substandard teaching. The 1930s witnessed many changes in federal Indian policy, among which was a shift in educational philosophy. Classroom lessons could now reflect the diversity of Indian cultures. States assumed more control over Indian education as more children enrolled in public schools. Most of the boarding schools were closed by this time, Tulalip in 1932 and Cushman in 1920, leaving Chemawa as the sole government boarding school remaining in the Pacific Northwest.
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Illness was another serious problem at the boarding schools. Crowded conditions and only the basic medical care no doubt contributed to the spread of diseases such as measles, influenza and tuberculosis. Tuberculosis was especially feared and at the Tulalip Indian School the dormitories were kept cold by leaving the windows open at night. Several students were sent to sanitariums in Idaho or Nevada. In a letter issued to superintendents in 1913, the Indian Office advised disinfecting all textbooks at the end of each school year to reduce the chance of spreading disease. Hospital reports for Tulalip indicate that boys spent a total of 110 days in the hospital during one month and girls 125 days. Death was not an unknown occurrence either. At Chemawa, a cemetery contains headstones of 189 students who died at the school, and these represent only the ones whose bodies were not returned home for burial.