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Although in the medical work of the Indian Service the variation between the best and the worst is wide, taken as a whole practically every activity undertaken by the national government for the promotion of the health of the Indians is below a reasonable standard of efficiency. The health work of the Indian Service falls markedly below the standards maintained by the Public Health Service, the Veterans’ Bureau, and the Army and the Navy, and those prescribed for the states by the national government in the administration of the federal grants to the states under the Maternity and Infancy Act.

The fundamental explanation of these low standards in the medical work of the Indian Service is lack of adequate appropriations. The appropriations for salaries have been too low to permit of the employment of a sufficient number of doctors, dentists, and nurses to render the service required by a people whose health is seriously impaired because of their lack of adjustment to the social and economic conditions of the prevailing civilization which confronts them. The appropriations have prescribed or necessitated salary levels that are not sufficiently high to permit of the maintenance of proper standard qualifications for entrance into the positions in the Indian health service. The course necessarily followed has been either to lower the entrance requirements so that many persons not properly qualified for the duties of the positions secure permanent appointments or to maintain high paper standards, to give permanent appointments to the relatively few who will apply for the positions at the salaries offered, and to fill the remaining positions by the temporary appointment of others who have not, and in many cases cannot, satisfy the established requirements. The low salaries have resulted in a high turnover, and as is commonly the case in such a situation, the better qualified, who have little difficulty in securing better paying positions elsewhere, are