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essential in planning, developing, and directing a public health program is knowledge of the facts. Vital statistics are the first instrument of the experienced qualified director of public health activities. They give him the facts of his problem. The Indian Service has for many years had rules and regulations requiring the collection and tabulation of some vital statistics, but they have achieved the form and not the substance. Really accurate figures based on reasonably complete records are not yet secured. The present director of the medical work of the service, a fully qualified surgeon from the United States Public Health Service, is handicapped by the lack of definite concrete information for his own use and for formulating plans for submission to Congress. The importance of accurate vital statistics as a basis for public health work and preventive medicine can hardly be overstated.
The public health program requires, too, the establishment of an adequate number of public health nurses and of clinics through which cases of incipient disease may be located and treated before they reach an advanced stage and before others have been subjected to contagion. The Indian Service has made an excellent beginning in public health nursing, but as will be shown in detail later,in this chapter, the number of positions authorized is too small and the salaries offered are so low that the service has difficulty in securing persons to fill the positions already authorized. Almost no use has been made of the permanent clinic, although some encouraging beginnings are to be noted.
The reservation physicians and the school and hospital physicians are not generally public health men, nor do they as a rule follow the practices of public health officers, although they may be supposed to do so. Their actual work, as will be discussed in detail later, consists primarily of seeing Indians who come to them or who send for them. These doctors are primarily engaged in the relief of the sick and not in the prevention and eradication of disease. With few exceptions they do not keep complete records and analyze them as do trained, full-time public health officers whose duty is more the prevention of disease than the cure of persons suffering acute illnesses calling for immediate professional attention.
Absence in the past of adequately trained and supported public health physicians is nowhere more apparent than in the boarding