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cars for a number of years. Although no figures on the cost of maintenance of cars in the service seem to be available this cost is believed to be excessive. The inevitable wear and tear on cars, as well as some of the avoidable abuse they get, often leaves them in bad condition within the first year. The lack of trained mechanics to keep cars in shape results in additional deterioration. Thus the conveyance is frequently as poor as the roads over which it must go. Only within the last few years have orders been issued to insure the physician the right to a specific car. Formerly when he wanted to make a call, he competed with some other employee for a conveyance. Thus many a call went unanswered.

Open cars are usually provided for employees so that the only protection from wind, rain, and cold is in many cases a set of tattered curtains. Doctors and nurses are frequently forced to make calls at night as well as day in real discomfort.

The telephone service available on most of the reservations is poor. Occasionally district or sub-agents do not have any such communication and thus the physician may be reached only with great difficulty.

Other difficulties confronting the field health worker are discussed elsewhere in this chapter.

Organization of the Medical Service. The present medical branch of the Indian Service is well informed as to the major needs in the Washington office and the field. It is, however, most seriously handicapped by old legislation and the difficulty of securing adequate appropriations. For many years the Indian Service has sought and secured considerable increase in appropriations for hospitals and other medical work, and has materially improved conditions, but it has not been able to meet the real needs. The recent reorganization of the medical service effected under the present administration has brought about an even keener appreciation of the changes necessary to place it on a par with other federal health services.

The Chief Medical Director reports that whenever practicable the regular administrative men in the Indian Office have made every possible effort to rectify undesirable conditions that had their origin in the past, but old legislation and insufficient funds prohibit in many instances meeting the minimum needs, to say nothing of