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of funds is imperative for the best interests of the Service. Such emergencies cannot be properly met with a rigidly mechanical fiscal scheme.

The office personnel associated with the Chief Medical Director in the Washington office consists of a senior stenographer, an assistant clerk, and one special physician detailed from the field service.

The specialized service connected with the Washington office consists of a public health nurse, who has the direction of the field nursing and matrons service. A relatively large part of her time is spent in local units in the field, however, thus making it difficult to administer effectively this service as a whole. No district supervising public health nurses are provided in the field service.

In the near future, a trained vital statistician will be attached to the medical service to start an evaluation of the mass of medical reports in the Indian Office. No funds are at present available to provide this worker with the necessary clerical assistants.

The position of epidemiologist has been created for some time, but it has never been filled. The delay is due in part to the desire of the present administration to reorganize the field service. It would seem difficult if not impossible to utilize the best efforts of an epidemiologist without a more adequate field personnel.

Thus far no positions have been created for special supervision in the fields of tuberculosis, trachoma, dentistry, child welfare, venereal disease, and hospitals.

It is reported that at some time in the past a system of medical cost-accounting was attempted, but as a result of federal economies, it has been discontinued.

Within the past year, the Indian Office has taken more cognizance of the services that may be available from federal and national agencies specializing in particular phases of health work. This feature of a newer conception of the problem before the Service is especially commended.

District Medical Directors. The Indian territory west of the Mississippi is divided into four districts. The Public Health Service is now supplying two public health physicians to serve as district directors and pays their salaries. The Indian Service pays their traveling expenses; it is assuming full responsibility for the director of the third district. The fourth district is at this writing without separate direction.