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tasks. They are invariably quartered in the hospital and in some instances have to share the sanitary facilities provided for patients.

Conditions such as these tend to discourage the nurses and account for the rapid turn-over and the difficulty the Indian Office experiences in getting additional nurses to enter and remain in the Service. They are also responsible for the unsympathetic type of nurse seen on a few occasions, women who because of their personalities have difficulty in securing permanent positions on the outside.

Practical nurses have been utilized far more in the past than they are at present. Their employment has been largely a matter of expediency, resorted to because of the difficulty in securing trained nurses, a difficulty resulting from the low salaries offered, the heavy duties imposed, and the isolation and hardship involved. The approximate number now in the service has been mentioned in the discussion of graduate nurses,

The most serious phase of this situation apparently lies in the fact that practical nurses are given positions requiring graduate nurses. This may be well illustrated by a description of conditions seen on one reservation. The hospital there had two nurse positions, each filled by a practical nurse. The head practical nurse for some time had been away on account of illness and all duties fell on the second nurse and such assistants as were provided. The physician had arranged to perform several tonsillectomies on the day of the visit and had given notice twenty-four hours in advance, but at the time set to start the operation, he himself had to stop and prepare the operating room, the instruments, and the dressings. This preliminary work required at least two hours, and by that time everybody was in a state of nervous excitement. It was finally discovered that enough sterile dressings had not been prepared. The one nurse on duty was doing her utmost, but in a way that showed plainly her lack of training.

The Indian Office reports that it is no longer employing practical nurses. It is a sound policy to discontinue giving this type of nurse administrative duties or work requiring training. The practical nurse could, however, be used to advantage in the hospitals under the direction of a trained nurse more nearly to adjust the ratio between nurses and the unit of patient population.