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The nursing staffs in these hospitals, as has been pointed out in more detail in the discussion of the nursing service, are almost invariably far below the standards for such practice. The accepted ratio of nurses to patients in general hospitals is an average of one to every five patients in open wards, exclusive of the employees required to do the manual labor.

It may be well to consider in. more detail the ratio of total employees per unit of population in these hospitals. The commonly accepted ratio in the average general hospital is one and one-third to one and one-half employees per patient. The Public Health Service hospital authorities report a ratio of three employees to five patients, and at the same time assert that they are considerably understaffed on account of insufficient appropriations.

The most recent figures procurable from the Indian Service regarding hospital employees are based on a check made in April, 1927. They are presented in the following table, which indicates the very serious understaffing of these hospitals. In considering these figures, it must be remembered that practically all physicians listed were devoting only part time service to the hospital, that only about fifty of the nurses listed were graduate nurses on a permanent basis, the remainder being either on temporary service or practical nurses with training and experience insufficient to comply with civil service standards; and that the total employees includes farmers, dairymen, day laborers, and hospital assistants, only a few of whom gave any so-called nursing service to the patient. It was impossible to obtain figures making an accurate division of this latter class.