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This table shows that the school hospitals had the lowest use of beds, the agency hospitals next, and the school and agency hospitals the greatest.

No adequate scientific study of hospital needs has been made by the Indian Office upon which to base the type and number of beds required for individual reservations.

In well organized hospitals in the average American community, the average use of beds approximates 85 per cent of the available bed capacity. Hence the Indian Service hospitals are using less than half the bed capacity ordinarily used. The question at once arises, are there too many hospital beds in the Indian Service? The answer must be in the negative, for although no accurate figures are available on the sickness rate among Indians, the most superficial observation in the field will impress the observer that scores of Indians are not receiving the hospital attention they need. The cause of this situation as observed at approximately forty-three of these institutions resolves itself into the following :

1. The Indians have to be educated to accept medical treatment and hospital care. This fact makes it imperative that the Service should be of reasonably high grade and that the personnel should be qualified to win the confidence and friendship of the Indians.
2. The medical personnel in charge is not of sufficiently high grade. Physicians are frequently placed in charge who are not experienced in or qualified for hospital administration. The result is lack of interest and poor service.
3. The hospital staff has been so small that reasonably adequate service could not be rendered.
4. The percentage of public health nurses in the service is low. One of their values lies in their ability to discover cases and urge hospitalization.
5. Such case-finding facilities as clinics are lacking.
6. A combination of the above conditions over a period of years has inculcated a distrust in the hospital on the part of the Indians. This distrust combined with their natural reticence has caused them to accept hospitalization very slowly unless in dire straits. But when they have confidence in the quality of the service, it is remarkable to find how readily the Indians accept good hospital service. With the possible exception of a few of the old Indians and some of the less civilized tribes, if they have confidence in the physician