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On the assumption that only about 46 per cent of bed space is used in these hospitals in the ratio of one employee to one bed, the degree of understaffing still remains about 64 per cent.

The shortage in hospital staff indicated in the above table results in inadequate supervision and care of patients. Sometimes the patient has to perform many of the routine duties, as well as to wait on himself. It is not uncommon to find patients literally dragging themselves to the lavatory sections; sometimes patients too ill to be out of bed are seen doing work about the hospitals.

A rule is in force that certain ‘specified assistant positions must be filled by Indian employees. This works a serious handicap to the already over-worked staff, because frequently Indians are not available. The positions could be filled by capable whites, but they must remain vacant until an Indian is found. The Indian Office is now changing the nomenclature for assistant positions to conform to hospital practice, and it is assumed that much of this difficulty will be overcome.

The management of the hospital staff is difficult, due to the type of employee, the low salaries paid, the poor housing facilities provided, and the isolation from contact with the outside world. These factors cause a high turnover in personnel and a consequent lack of continuity in effort.

Appropriations for new buildings and repairs to present buildings and equipment as well as funds for maintenance are far below the average. The average per diem costs in the Indian Service are around $1.80. The Public Health Service hospitals,^[1] “without pride of achievement,” point to their average per diem costs in 1926 of $3.71. They have suffered a gradual reduction in such costs since 1923, as follows:

The service rendered by Indian hospitals has been in keeping with the low appropriation made for hospital maintenance. Not alone has the staff been inadequate; the food supply has often been deplorable. A well balanced ration for invalids cannot be supplied