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are frequently found in a semi-powdered state. Other drugs have been purchased at the lowest bid from pharmaceutical houses not manufacturing the highest grade of product. This practice is receiving attention at the present time. It is reported that in the future only bids from reliable houses will be considered.
Biologics are now contracted for at the leading laboratories. Previously the agency was required to order all such supplies at specified distributing centers. In the case of diphtheria, this arrangement caused unnecessary delay in administering anti-toxin and the difference between the cost and the purchase price in the local market was negligible. The Indian Office has now issued orders permitting the purchase of such supplies locally in emergencies. Large supplies for immunization purposes are purchased directly from the main supply depots.
The agencies are now supplied with catalogues of the more reputable houses and their requisitions are carefully checked in the Washington office before being finally approved. Thus a better quality is assured, unnecessary supplies are eliminated, and additional ones are added where the chief medical director determines that the need exists. The specifications for medical supplies are being revised to conform to existing standards in other federal bureaus.
Large quantities of army cotton in small packages is being supplied to the agencies. It is not suitable for refined operating room use, but can be used in small dressings.
Recommendations. The more necessary organization changes are summarized in the following recommendations:
- The Headquarters Staff: The Chief Medical Officer of the Indian Service, under the general direction of the Commissioner of Indian Affairs, should determine the policies to be followed in respect to strictly medical affairs. Policies in matters which involve medical affairs and economic and social conditions or general education should be formulated jointly by the Chief Medical Officer and the specialists in other branches of the Service. The Chief Medical Officer should prepare and present the sections of the budget directly relating to medical activities and he should be present when other sections that involve health are presented. In making appropriations for health work more use should be made of lump sums not designated for specific institutions or for detailed