They suffered from malnourishment and harsh discipline that would not have been tolerated in any other school system.[12][14] Corporal punishment was often justified by a belief that it was the only way to save souls, civilize the savage, or punish and deter runaways – whose injuries or death sustained in their efforts to return home would become the legal responsibility of the school.[12] Overcrowding, poor sanitation, inadequate heating, and a lack of medical care led to high rates of influenza and tuberculosis; in one school, the death rate reached 69%.[19] Federal policies that tied funding to enrollment numbers led to sick children being enrolled in order to boost numbers, thus introducing and spreading disease. The problem of unhealthy children was further exacerbated by the conditions of the schools themselves – overcrowding and poor ventilation, water quality and sewage systems.[14]:83–89