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in Circular No. 2147, under date of October 3, 1925, which stated in part, “It is desired again to state that the duties of special physicians are to instruct the station physicians in the subject of their specialties. Station physicians must learn to treat trachoma and perform operations recommended by Dr. Fox and other eminent ophthalmologists. The office desires that every physician in the Indian Service shall become a trachoma specialist.” Several circulars issued before this time (Nos. 1856, 2013, 2015, 2125) stated that the agency physician was to be held responsible for the treatment of this disease, and gave him a list of the required instruments. It was suggested that their training was to be obtained from the traveling specialists on visits to their reservation or, in a few instances, by attendance at clinics held in Fort Browning, Albuquerque, Phcenix, etc.

Obviously the local physician’s ability to diagnose and his operative judgment were usually a reflection of the specialist visiting his reservation, or the result of the contact he had had at one of the larger clinics.

Naturally some of the first specialists trained were enamoured of the possibilities of radical surgery, and others were more conservative. This difference was found in observing the methods used by these men. One specialist was asked how he would set about the eradication of trachoma, if sufficient funds were made available. In brief, his reply was that he would perform a tarsectomy on every Indian, irrespective of the stage of the disease. At the time he made the statement, he was performing these operations on small children, and the extent of involvement of cases operated upon would indicate that he was doing this very thing.

On the other hand, radicalism has by no means been universal. Some physicians in constant touch with trachoma have observed more conservative procedures, and, greatly to their credit, they have advised the Indian Office in detail of their experiences, showing that not all physicians in close touch with the work could conscientiously accept standardized requirements.^[1]

Within the past year considerable progress has been made in improving conditions. Generally speaking, specialists as well as