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paratively little has been accomplished, because of the failure to prescribe suitable definite forms, give precise instructions, and carefully check the results through actual use of the records. To be fair, certain inherent difficulties in the Indian field service should be considered:

  1. The Scarcity of Physicians: The number of physicians on the reservations has always been much too small, a fact which increases the difficulty in collecting data. If a physician with far more before him than he can do makes an attempt to keep complete records of births, deaths, and disease, he must neglect his care of the patient. At the reservations where complete vital statistics records were found, some of the Indians criticized the physician for devoting more time to the collection of data than he did to the care of the sick. They particularly resented the fact that he came only after the Indian had died to inquire about the cause of death.
  2. Tribal Customs: Some tribes are averse to reporting births and deaths because of prejudices and tribal custom. Many are merely indifferent because of their ignorance of the importance of prompt reporting.
  3. Confusion in Names: The Indians in some tribes have more than one name, which makes it impossible to keep accurate records unless there is an adequate field personnel.
  4. Indians Living off their Reservations: An Indian who dies on some reservation other than the one in which he is enrolled may be counted twice. Many Indians living in urban communities are carried on their tribal roll, but births and deaths among them are frequently not reported to the reservation, or only after a period of time. Again, private practitioners do not always make the proper returns to the agency.

Definite recognition must be given the fact that under existing conditions not all the returns can be equally complete and reliable. For certain jurisdictions the Washington office can reasonably demand approximately perfect figures. For others, notably the Navajo jurisdiction, the difficulties are so great that considerable time will have to be spent in developing an adequate statistical system before reasonably complete figures can be expected. Some jurisdictions have districts from which practically complete figures can be easily obtained, but in others the problem is more like that

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