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a normal expansion of activities. The Indian medical service has been starved throughout its history and does not offer any opportunity for reductions in a wisely directed general policy of economy.

The discussion that follows of the medical organization is made in light of existing conditions and is not intended as a reflection on the ideals of the present Indian Service. A careful analysis of the problem must be made, and upon that a constructive program based. This will require time and study.

Office of the Chief Medical Director. At the request of the Secretary of the Interior, the United States Public Health Service detailed one of its surgeons to the Office of Indian Affairs in 1926 to serve as Chief Medical Director, supervising all medical, dental, hospital, and sanatorium activities and also acting as chief medical advisor to the Commissioner of Indian Affairs.

The Chief Medical Director, since his incumbency, has of necessity devoted his attention chiefly to becoming acquainted with the needs in the Washington office from an administrative standpoint and with the problems that exist in the field. The lack of organization and the paucity of reliable vital statistics and of records of medical activities have made his problem difficult. It is by no means solved.

The solution of the Indian health problem depends upon a close interrelation of the economic, social, and educational activities of the Indian Office. For this reason the medical service can be of the greatest effectiveness if operated so as to interlock with other activities. The highly specialized character of health work demands that its policies and administration shall be under the direct control of a technically trained medical worker, with full authority in the technical matters related to his specialty.

The medical needs of the Indian Office in the past were presented to the Bureau of the Budget and the Appropriations Committees, by non-medical employees, and therefore it may be questioned whether these important bodies fully comprehended the seriousness of the situation.

The Chief Medical Director has no control over the appropriations made for the various health activities. For example, appropriations are made for specified hospitals and sanatoria, rather than for the hospital service at large. Emergencies arise, such as epidemics or over-crowding of certain institutions, when a shifting