In the early history of the Bureau, travel was difficult at best. For all practical purposes, the Bureau consisted of a director who was the U.S. Surgeon General (the first three Directors of the organization were U.S. Surgeons General) and one of his staff who served as Vice-Director. The other members of the Bureau resided in countries that were far away from the United States. While Surgeon General, Dr. Hugh S. Cumming, the third U.S. Surgeon General to head the Bureau, delegated most of the Bureau's regular activities one of his Assistant Surgeons General, Dr. J. D. Lloyd.
