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would be comparatively simple. But the units of population are frequently small, and some are situated at the far extremities of the district. Two of the districts comprise five states, and two seven states. The area covered by the average western state is considerable in itself. Generally the Indian community is located at a long distance from the main line railroads and highways. Thus a great deal of time is necessarily consumed in travel from point to point. These factors greatly reduce the time spent at the different jurisdictions and the service rendered the Indians by the district director.

The specialized type of service rendered by the district medical director is as important to the preservation of Indian health as is that rendered by a state health officer to the preservation of health in any state.

Each officer maintains an office at about the geographical center of his district. At two of these offices only part time clerical service is available. When the district officer is away on field trips, with the exception of the two instances just noted, the office is closed. The district officers necessarily spend the major portion of their time away from their offices, and frequently on their return from the field find their desks filled with accumulated correspondence and reports. It is difficult at times for the field personnel to get in touch with the district medical director when he is away from his office.

Thus far it has been impossible for these officers to make careful statistical analysis of the problems in their districts, such as trends in mortality and morbidity. So far they have mainly attempted to correct the most outstanding deficiencies.

Special Physicians. Twelve positions have been established for special physicians, whose duties are chiefly concerned with the problem of trachoma. All these positions are reported filled.

A recent re-assignment of territory has been devised with the idea of permitting each physician to follow up his previous work at three months’ intervals. In the past it was the exception for these physicians to be able to follow-up previous operations within periods of less than two years and in some instances some cases were never seen again.

The personnel for these positions has been recruited from doctors already in the Service, except in the cases of the two newest