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part to the rising costs of materials and labor, and partly to the fact that the hospital of today is a much more refined institution than it was twenty-five years ago. Certain conveniences are now regarded as essential that were unknown years ago. In this matter, the Indian Service has not been able to keep abreast of the times.

Unfortunately in making appropriations for Indian hospitals, a tendency has been apparent to consider not what is requisite to meet reasonable minimum standards for the effective treatment of medical and surgical cases among the Indians, but rather what the Indians are accustomed to in their own homes. That the hospital facilities now supplied are in many instances superior to what the Indians have in their own homes is at once admitted, but it must be remembered that not infrequently the disease which the hospital is called upon to combat had its origin in the bad living conditions to which the Indians are accustomed. In many cases an important function of the hospital is to educate the Indians to higher standards so that when they return to their own homes they will know from experience what they should have. This educational work is especially important in the treatment of tuberculosis and trachoma and in maternity cases, in which the mothers should be given sound instruction in infant care. The survey staff holds no brief for ornate elaborate hospitals where patients are given luxuries, but on the other hand it does not regard the Indian’s standards of living as any criterion as to what a hospital should supply. The question is not what the Indians are used to, but what is necessary for the economical and efficient treatment of the diseases which the hospital is created to combat. It is false economy to hold down the capital investment in hospitals, if by so doing they are prevented from rendering effective treatment.

It seems hardly necessary to say that many states, counties, and cities supply as modern and effective hospital care for the indigent case as is supplied for the patients coming from the better homes. The chief differences are that the indigent cases are cared for in wards and the pay cases in semi-private or private rooms according to their ability to pay, and that the pay patients may be furnished some luxuries not regarded as essential for effective treatment. This modern type of hospital service is both humanitarian and economical. The American Indians are entitled to hospitals as modern as those available for the indigent whites in this country.