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the ones who voluntarily resign. The Indian Service can legitimately point to a number of highly efficient, able, well qualified professional workers in the field of health, but the average falls below a reasonable minimum standard.

Low appropriations also account for the common lack of adequate facilities for the care and treatment of the sick Indians. The government has apparently failed to approach this question of providing facilities from the scientific standpoint of what are the minimum essentials. It has seemingly given too much consideration to the fact that the economic and social conditions of the Indians are low and it has assumed, therefore, that it is unnecessary to supply them with facilities comparable with those made available by states, municipalities, and private philanthropists for the poorest white citizens of progressive communities. The Indian Service hospitals, sanatoria, and sanatorium schools are, with few exceptions, below minimum standards for effective work in the three essentials of plant, equipment, and personnel, as is set forth in detail in subsequent sections of this chapter. It is at once admitted that in many cases the facilities at these hospitals and sanatoria are superior to what the Indian has in his own home, but from the standpoint of the survey itself, that is not the issue; the facilities are not as a rule adequate to render efficiently and economically the needed service. The function of a sanatorium and a sanatorium school, and to a considerable extent of a hospital, is to demonstrate to the Indian what he must do for himself on leaving the institution and insofar as possible to educate him to a higher standard of personal care. This important function many of the hospitals and sanatoria of the Indian Service cannot perform because of deficiencies in plant, equipment, and personnel. They are underequipped for the primary service of curing or arresting the disease which necessitated bringing the Indian to the institution.

Lack of appropriations and, possibly until the recent reorganization of the medical service under the present administration, lack of vision and real understanding have precluded the establishment in the Indian Service of a real program of preventive medicine. For some years it has been customary to speak of the Indian medical service as being organized for public health work, yet the fundamentals of sound public health work are still lacking. The first