Page:LewisMeriam-TheProblemOfIndianAdministration.djvu/258

ratio of physicians to unit of population or area covered can be given. Indian reservations vary in so many important particulars that each jurisdiction must be considered separately. At Crow agency, for example, three physicians are available for 1800 Indians. The distances to be covered and the location of the Indians would require this apparently high ratio of physicians to population. At Pine Ridge only two physicians serve 7800 Indians scattered over an area of approximately 2400 square miles, a ratio altogether too low for effective service in that country. With the exception of the physicians stationed at Talihina, Chilocco, and Pheenix, all other full-time physicians encountered were required to do agency as well as hospital or sanatorium work. It is safe to say in general that where there is one physician now, at least two are needed, and where there are two, at least three are needed.

Until within the past year or so, a school, agency, and hospital have been largely under the direction of the agency superintendent. The physicians had no authority even over hospital employees. Some physicians taken into the Service undoubtedly required the closest sort of supervision. In some instances, however, the reservation situation was impossible because the superintendent, a layman, had little conception of medical matters and might even be hostile to real health work. It has not been so many years since physicians were expected to roll up their sleeves and build fences or do any other manual labor at hand. Within the past year a superintendent objected to supplying the agency physician with running water in his office. Other such instances might be cited. The chief object in mentioning them now is to show some of the difficulties under which the good as well as the poorly qualified physician was forced to work. On the other hand, many superintendents are men of a higher order. Not infrequently they turn over all medical activities to the physician and depend upon his judgment in such matters. Fortunately some of the superintendents have had capable medical men. In a few instances it has been found that the superintendent had a far clearer grasp of the health situation and needs than did the physician. A new era is now dawning in the Service. With efficient direction at the Washington office, the physicians are being handled judiciously.

That the Indian medical service has not been attractive to the younger and more ambitious physician is not surprising. The