In 1860, B. W. Kimball, the physician for the Medicine Creek Treaty Indians stated the Indians’ trust in their medicine men was declining, but only after declaring that most Indians relied on their own “system of medicine” to treat health problems.<ref> Annual Report of the Commissioner of Indian (1860): 201-202.</ref> Dr. Mills, agency physician for the Nebraskan Spotted Tail Agency claimed in 1877 that Indians in his agency had abandoned their own medicine-men and stopped performing their “superstitious and mysterious incantations.”<ref><i>Annual Report of the Commissioner of Indian</i> (1877): 70.</ref> In 1884, the Commissioner of Indian Affairs H. Price blamed Indian medicine men’s condemnation of western medicines as “poison” and “the almost universal belief in spirits…” for high the Native American mortality rate. Price argued that Indians could not be effectively treated by agency physicians because they sought treatment from their own medicine men first.<ref><i>Annual Report of the Commissioner of Indian</i> (1884): xxxv-xxxvi.</ref> In 1894, Frank C. Blackly the physician for the Southern Ute Agency minimized the importance of the tribe’s medicine men, but acknowledged that they were still able to “keep up the practice of their superstition…”<ref><i>Annual Report of the Commissioner of Indian</i> (1894): 130.</ref>
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Whether or not agency physicians were better than medicine men is debatable. Western medicine had learned how to control smallpox, but most of the important parts therapeutic revolution would not occur until the twentieth century. Indian agents even blamed their physicians’ incompetence for the continued survival of medicine men.<ref><i>Annual Report of the Commissioner of Indian</i> (1886): 76</ref> Some agency physicians simply hoped that Indians would stop using medicine men when the older generation of Indians died out.<ref> <i>Annual Report of the Commissioner of Indian</i> (1886): 59.</ref> In 1860, Dr. A. Coleman acknowledged that it would take years before Indians would trust western medicine because their practice of medicine had not only been passed “to them by a succession of generations” but was “interwoven with their religion” and government.<ref><i>Annual Report of the Commissioner of Indian</i> (1860): 76.</ref> Throughout the nineteenth century, Indians relied on their native medical practices and, when available, agency physicians.<ref><i>Annual Report of the Commissioner of Indian</i> (1886): 111. </ref> This reliance on agency physicians was ultimately limited by the both the number and quality of agency physicians and their unwillingness to reject their own traditions.
Adkins’ successor, T. J. Morgan acknowledged that OIA needed to reform its health services. Agency physicians could now be hired and fired by the Commissioner, but the OIA had not consolidated the physicians into an autonomous branch within in the OIA. Agency physicians were not organized under a chief administrator and they completely lacked supervision. Morgan argued that wretched working conditions and lack of supervision, agency physicians would be strongly tempted “to slight their work.” Additionally, Morgan criticized the OIA’s policy of appointing physicians without first examining them. Throughout the United States, states had created new licensing laws which required prospective physicians to pass examinations. The OIA only required that physicians be graduates of “some reputable medical school and submit testimonials as to moral character and correct habits.” Morgan realized that the OIA medical corps could soon become a haven for quacks. Agency physicians needed to be free from political influence, well compensated and thoroughly examined before their appointments.<ref><i>Annual Report of the Commissioner of Indian</i> (1890): xix-xxii.</ref>
It was fairly easy to demonstrate how poorly paid agency physicians were compared to their colleagues working in both the Army and Navy. In 1890, the agency physicians were paid on average $1,062 and Indian school physicians $813. Physicians in the Army and Navy were typically paid between $2,600 and $2,800 per year. Not only was the pay higher for military personnel, but they were required to treat far fewer patients. In the Navy, 160 physicians treated 9,955 sailors while 192 Army physicians were responsible for 26,739 army personnel. On the other hand, 82 agency physicians were responsible for 180,000 Native Americans in 1890. Each year agency physicians treated eight times as many patients. Some agency physicians were accountable for staggering numbers of Indians spread on far flung reservations. One agency physician on the Navajo Reservation was in charge of the health and welfare of 18,000 Indians spread over 12,000 square miles.<ref>Annual Report of the Commissioner of Indian (1890): xxi-xxii. </ref> Despite the obvious problems within the medical corps of the OIA, major institutional reform was still decades away.
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During the nineteenth century, Native Americans faced numerous health crises. Two of the most dangerous and disruptive diseases were smallpox and tuberculosis. Each of these diseases killed thousands of Indians. The different responses the OIA had to the smallpox outbreaks and the spread of tuberculosis may have also represented the central goals of federal Indian policy during this time.
Whether or Probably the most deadly danger faced by Native Americans was the nearly constant outbreaks of smallpox. Smallpox epidemics decimated Indian tribes throughout the nineteenth century. Smallpox outbreaks threatened not agency physicians were better than medicine men is debatableonly Indians, but posed grave dangers to neighboring American citizens. Western medicine had learned how to control smallpoxIn 1832, but most as result of the important parts therapeutic revolution would not occur until the twentieth centurythis ongoing threat an early smallpox program was created to vaccinate Indians. Indian agents Unfortunately, even blamed their physicians’ incompetence for though over 3,000 Indians were vaccinated, the continued survival of medicine menprogram was largely unsuccessful. Some agency physicians simply hoped that Indians would stop using medicine men when Numerous tribes refused to be treated and eventually the older generation of Indians died program’s funding ran out. In 1860 Soon after the program’s demise, Drthe 1837 epidemic devastated the Blackfeet and Mandan tribes in the Dakotas. A<ref> Martha Hilderth and Bruce T. Coleman acknowledged that it would take years before Indians would trust western medicine because their practice of medicine had not only been passed “to them by a succession of generations” but was “interwoven with their religion” Moran, <i>Disease and government. Throughout Medical Care in the nineteenth centuryMountain West: Essays on Region, Indians relied on their native medical practices History andPractice</i> (University of Nevada Press, when available1998): 44.</ref> Lawrence Taliaferro, agency physiciansIndian Agent at St. This reliance on agency physicians was ultimately limited by Peter’s Iowa Territory, observed that during the smallpox epidemic of 1837 “upward of 60 (Sioux) lodges” had perished.<ref><i>Annual Report of the Commissioner of Indian Affairs Transmitted with the Message of the President at the both Opening of the number and quality 1st Session of agency physicians and their unwillingness to reject their own traditionsthe Twenty-Sixth Congress 1839-1840</i> (1839): 177. </ref>
Adkins’ successorDuring the 1837 epidemic, some OIA employees attempted to stem the epidemic’s tide. In Wisconsin, T. JT. Morgan acknowledged Vandenbrock, Superintendent of the Mission on the Fox River, claimed that he had vaccinated hundreds of Indians during the epidemic without any financial support from the OIA needed to reform its health services. Agency physicians could now be hired and fired by <ref><i>Annual Report of the Commissioner, but of Indian Affairs Transmitted with the OIA had not consolidated Message of the physicians into an autonomous branch within in President at the OIA. Agency physicians were not organized under a chief administrator and they completely lacked supervision. Morgan argued that wretched working conditions and lack Opening of supervision, agency physicians would be strongly tempted “to slight their work.” Additionally, Morgan criticized the OIA’s policy 1st Session of appointing physicians without first examining themthe Twenty-Eighth Congress 1843-1844</i> (1843): 103. Throughout </ref> Fortunately for the Indians on the United StatesFox River, states had created new licensing laws which required prospective physicians Vandenbrock was willing to pass examinations. The OIA only required foot the bill because he believed that physicians be graduates of “some reputable medical school he was simply “discharging my duty to my fellow-creatures and submit testimonials as to moral character and correct habitsmy Creator.” <ref><i>Annual Report of the Commissioner of Indian</i> (1843): Morgan realized that the OIA medical corps could soon become a haven for quacks103. Agency physicians needed </ref> While Vandenbrock may have been discharging his duty to his fellow creatures, he may also have also been attempting to be free get his expenses reimbursed from political influencethe $500 allocated to the Wisconsin superintendency out the $5, well compensated and thoroughly examined before their appointments000 appropriated by the Twenty-Seventh Congress intended “to defray the expenses of vaccinating the Indians.”<ref> <i>Annual Report of the Commissioner of Indian Affairs</i> (1839): 23.</ref>
It was fairly easy to demonstrate how poorly paid agency physicians were compared to their colleagues working in The presence of smallpox both the Army advanced and Navythreatened American interests. In 1890, the While agency physicians were paid on average $1could not always successfully stop these epidemics,062 successfully treating Indians helped smooth relations between Americans and Indian school physicians $813Indians. Physicians in Western physicians could reduce the Army and Navy were typically paid between $2,600 and $2,800 per yeardeaths caused by smallpox through vaccination or inoculation. Not only It was the pay higher for military personnel, but they were required most important way to treat far fewer patientsdemonstrate the superiority of western medicine. In the NavyOf course, 160 physicians treated 9,955 sailors while 192 Army physicians were responsible for 26,739 army personnel. On if smallpox epidemics culled the other hand, 82 agency physicians were responsible for 180,000 Native Americans in 1890. Each year agency physicians treated eight times as many patients. Some agency physicians were accountable for staggering numbers of Indians spread on far flung reservations. One agency physician on Indian population the Navajo Reservation was in charge OIA would have a much easier task of the health controlling Indian populations and welfare of 18,000 Indians spread over 12,000 square milesadvancing federal policy. Despite the obvious problems within the medical corps of Smallpox continued to be a danger to Indians throughout the OIA, major institutional reform was still decades awaynineteenth century.
During In 1855, the Osages were faced with an outbreak of smallpox.<ref><i>Annual Report of the nineteenth centuryCommissioner of Indian Affairs</i> (1856): 10, Native Americans faced numerous health crises68. </ref> The agency was required to hire a physician who administered the smallpox vaccine to the tribe to prevent further infection. Two Dr. C. W. Dean, from the Southern Superintendency described a smallpox epidemic which killed approximately 400 Indians. <ref> Annual Report of the Commissioner of Indian Affairs (1856): 122. </ref> Additionally, the most dangerous Arapahoes near Fort Laramie admitted to killing cattle and disruptive diseases sheep because they were weakened by smallpox and tuberculosisunable to hunt. <ref> Annual Report of the Commissioner of Indian Affairs (1856): Each 82.</ref> In 1864, an outbreak of these diseases killed thousands smallpox in The Dalles threatened the Warm Springs reservation and another outbreak in Colorado and Kansas forced a Special Agent H.T. Ketham to vaccinate over 1100 Indians. In 1869, the OIA faced several additional occurrences of small pox. Tule Indiansfaced a similar outbreak to the Arapahoes when smallpox appeared in Visalia. The different responses In order to prevent the spread of smallpox; the agent restricted the OIA had Tules to the reservation and vaccinated 190 of them.<ref>Annual Report of the Commissioner of Indian Affairs (1869): 191.</ref> During the first year of Indian school on the Nez Perces Reservation, it was closed after smallpox outbreaks in Lewistown. After approximately 4 months the school was reopened.<ref> Annual Report of the Commissioner of Indian Affairs (1869): 285. </ref> Another outbreak in 1877, threatened the Pima Indian Agency. This outbreak was worrisome because the Pima Agency did not have a physician and the disease spread widely. J. H. Stout, the Pima Indian Agent, was forced to temporarily hire a physician to vaccinate hundreds of Indians. Even though Stout indicated that it was a just mild form of the virus, it still proved to be a fatal outbreak.<ref> Annual Report of tuberculosis may have also represented the central goals Commissioner of federal Indian policy during this timeAffairs (1877): 33. </ref>
Probably Smallpox outbreaks continued throughout the most deadly danger faced by Native Americans nineteenth century and even as late as 1900, smallpox was still a threat. The Rosebud Agency reported a smallpox outbreak which was averted after the agency physician vaccinated the agency’s Indians and surrounding whites. <ref> Annual Report of the nearly constant outbreaks Commissioner of Indian Affairs (1890): 381.</ref> Aside from the Rosebud Agency, several other reported smallpoxoutbreaks. Smallpox epidemics decimated The continued smallpox scares motivated Congress in 1900 to allocate $50,000 to suppress smallpox in the Indian tribes throughout Territory, but it was not designated for Indians. The appropriation was solely intended for residents of the nineteenth centuryterritory who were “not members of any Indian tribe or nation. ” Smallpox These outbreaks represent just a few of the examples of the continual nature of the smallpox threat. Despite these constant smallpox outbreaks threatened , the OIA did not develope a widespread program to vaccinate large numbers of Indians. Instead, the OIA shuffled physicians from one crisis to another. Agency physicians would only Indiansstart vaccinating people once an outbreak or scare occurred. Even in the best circumstances this strategy could endanger people’s lives, but posed grave dangers to neighboring American citizenson far flung Indian agencies with possibly one physician it was often fatal. In 1832Oddly enough, it was not the constant threat of smallpox that convinced the OIA that it needed to take broader action to protect the lives of its charges, as result but the endemic disease of this ongoing threat an early tuberculosis. Unlike smallpox program , tuberculosis was essentially untreatable at the time. During the nineteenth century, tuberculosis was created often referred to as scrofula (cervical tuberculosis) and consumption (pulmonary tuberculosis). It is difficult to vaccinate Indiansdetermine when Indian agents became aware of the presence of tuberculosis. UnfortunatelyBy 1854, even though over 3scrofula,000 a formerly a rare ailment among Indians were vaccinated, had become quite common among Indians in the program was largely unsuccessfulMidwest. <ref>Annual Report of the Commissioner of Indian (1854): Numerous tribes refused 60.</ref> Over the next 50 years, references to be treated tuberculosis and scrofula by agency physicians and agents became increasingly common. Agency physicians pleaded for hospitals, sanitarium and eventually medicine. Other physicians argued that the program’s funding ran outOIA needed to quickly change Indian behavior because they firmly believed that Indians were primarily responsible for the diseases spread. Soon after Despite the growing number of reports from agencies regarding the program’s demisealarming rates of tuberculosis, the 1837 epidemic devastated OIA did not take any major steps to limit tuberculosis until in the first decade of the Blackfeet twentieth century. Between 1865 and Mandan tribes in the Dakotas1890, agency physicians increasing discussed tuberculosis’s grim toll. Lawrence TaliaferroIn 1865, Dr. A. Coleman, physician for the Winnebago agency stated the tuberculosis was “their most frequent and destructive disease.”<ref>Annual Report of the Commissioner of Indian Agent Affairs Transmitted with the Message of the President at Stthe Opening of the 1st Session of the Thirty-Fourth Congress 1860 (Washington, 1860): 76. Peter’s Iowa Territory</ref> In 1875, the Fort Berthold agency physician remarked that tuberculosis and scrofula were still claiming victims, observed but he had that during improved methods of providing fuel and “conveying the products of their agricultural labor” would improve sanitary conditions and limit the smallpox epidemic spread of tuberculosis.<ref>Annual Report of 1837 “upward the Commissioner of 60 Indian (Sioux1877) lodges” had perished: 519. </ref> He failed to explain why he took these actions and how they could possibly control tuberculosis. During the 1837 epidemicAnother physician simply claimed that there were not as many deaths from tuberculosis as he expected, some OIA employees attempted but he makes no attempt to stem justify or explain his claims.<ref>Annual Report of the epidemic’s tideCommissioner of Indian (1877): 140. </ref> The 1885 Annual Report showed that there were 875 cases of consumption and an additional 1,809 cases of scrofula. <ref>Annual Report of the Commissioner of Indian (1885): 400. </ref> The commissioners would have been aware of the growing threat simply by reading the department’s Annual Report. In Wisconsin1894, TDr. TA. VandenbrockE. Marden of the Pima Agency reported that tuberculosis was present with “fully half of the Pima families” and that “three-fifths of the deaths” in the agency were a result of either syphilis or tuberculosis.<ref> Annual Report of the Commissioner of Indian (1894): 107. </ref> Another physician, Superintendent C. H. Kermott of the Mission on Devils Lake Agency, claimed that Indians had strumous blood which caused high rates of tuberculosis and scrofula. Joseph R. Finney, the physician for the Fox RiverFort Berthold Agency, claimed that he had vaccinated hundreds the health of the Indians during was essentially good, except for tuberculosis which had been “a veritable scourge” for a long time. Ambler Caskie, agency physician for the epidemic without any financial support from Lower Brule Subagency, acknowledged that tuberculosis “in one or another guise” was death’s “busiest factor.’<ref> Annual Report of the OIACommissioner of Indian (1894): 218, 223, 282. </ref> Fortunately for In 1901, the OIA sent out a circular to agencies physicians soliciting their opinions on the health and welfare of their Indians on . Despite the Fox Riversometimes “antagonistic” and contradictory nature of reports, Vandenbrock the OIA believed that they convened an accurate impression Indian health. The reports demonstrated that tuberculosis was willing to foot “more widespread among the bill Indians” than whites. The OIA was confused by this response because he it believed that he was simply “discharging my duty to my fellow-creatures the locations of most reservations and to my Creatorthe Indians active, outdoor lifestyle should have reduced, not increased the incidence of tuberculosis.” While Vandenbrock may have been discharging his duty Tuberculosis appears to his fellow creatures, he may also have also been attempting to get his expenses reimbursed from be the $500 allocated exception to the Wisconsin superintendency out belief within the $5,000 appropriated by OIA that if done intelligently a “change from barbarous to civilized modes of life tends to improve health conditions.”<ref> Annual Report of the Twenty-Seventh Congress intended “to defray Commissioner of Indian (1902): 36. </ref> The 1902 report pinpointed nine causes for the expenses high rate of infection:# Failure to disinfect tubercular sputum. # Poor sanitation and lack of cleanliness.# Improper and poorly prepared food.# Intermarriage of Indians of vaccinating the same tribe.# Intermarriage of Indiansand whites.# Taking pupils predisposed to tuberculosis from camp life and confining them in school.# Overcrowding dormitories.# Lack of proper medical attention after infection.# The use of alcohol.” <ref> Annual Report of the Commissioner of Indian (1902): 34.</ref>
The presence report focused blamed Indian behavior and culture for their high rates of smallpox both advanced and threatened American intereststuberculosis. While agency physicians could Physicians did not always successfully stop these epidemics, successfully treating Indians helped smooth relations between Americans and Indiansunderstand the nature of the tuberculosis threat at this time. Western Many physicians believed that tuberculosis could reduce the deaths caused be controlled by smallpox through vaccination or inoculationsanitation and civilization. It was They did not understand the most important way to demonstrate transmission or nature of the superiority of western medicinedisease. Of courseTherefore, if smallpox epidemics culled the physicians delineated problems they saw with Indian population culture which provided convenient explanations which shifted blame from the OIA would have a much easier task of controlling Indian populations and advancing federal policythemselves. Smallpox continued to be a danger to Indians throughout The 1877 report from the Red Lake agency physician blamed the nineteenth century. In 1855, Indians’ “habits” for the Osages were faced with an outbreak prevalence of smallpoxsuch diseases as scrofula and tuberculosis. The agency was required to hire a physician who administered <ref> Annual Report of the smallpox vaccine to the tribe to prevent further infection. Commissioner of Indian (1877): Dr128. C. W. Dean, from the Southern Superintendency described a smallpox epidemic which killed approximately 400 </ref>The 1902 report even stated that Indians. Additionally, were primarily responsible for the Arapahoes near Fort Laramie admitted to killing cattle and sheep lack of proper medical care because they were weakened by smallpox “ignorance and unable to hunt. In 1864, an outbreak superstition” prevented Indians from following the proper courses of smallpox in The Dalles threatened the Warm Springs reservation and another outbreak in Colorado and Kansas forced a Special Agent Htreatment.T. Ketham to vaccinate over 1100 Indians.
In 1869While it was possible that agency doctors may have neglected tuberculosis patients, it acknowledged that any negligence was understandable under the OIA faced several additional occurrences of small poxcircumstances. Tule Indians faced a similar outbreak to Aside from the Arapahoes when smallpox appeared in Visalia. In order to prevent the spread overcrowding of smallpox; dormitories, the agent restricted the Tules to the reservation and vaccinated 190 OIA did not believe that it was responsible for tuberculosis on reservations.<ref> Annual Report of them. During the first year Commissioner of Indian school on (1902): 34-35. </ref> Whether or not there was an internal debate regarding what role the Nez Perces Reservation, it was closed after smallpox in Lewistownreservations system itself played is questionable. After approximately 4 months Physicians were more concerned with ventilation and climate than the school was reopenedpotential problems posed by concentrating Indians on isolated and primitive reservations. Another outbreak in 1877, threatened Despite the Pima increasingly urgent reports from Indian Agency. This outbreak was worrisome because agents and physicians regarding the prevalence of tuberculosis, the Pima Agency first comprehensive survey of Native American health did not have a physician and the disease spread widelyoccur until 1903. J. H. Stout<ref> Francis Prucha, The Great Father: The United States Government and the Pima American Indian Agent(University of Nebraska Press, was forced to temporarily hire a physician to vaccinate hundreds 1984): 846. </ref> The results of Indians. Even though Stout the study were enlightening because it indicated that it was a just mild form large numbers of the virus, it still proved to be a fatal outbreak. Smallpox outbreaks continued throughout the nineteenth century and even as late as 1900, smallpox was still a threat. The Rosebud Agency reported a smallpox outbreak which was averted after the agency physician vaccinated the agency’s Indians and surrounding whiteswere infected with tuberculosis. Aside from the Rosebud Agency, several other reported smallpox outbreaks. The continued smallpox scares motivated Congress in 1900 to allocate $50Despite this evidence,000 to suppress smallpox in the Indian Territory, but it was not designated for Indiansuntil Francis E. The appropriation was solely intended for residents of Leupp took over the OIA that someone within the organization took the territory who were “not members danger of any Indian tribe or nationtuberculosis seriously.” These outbreaks represent just a few Part of the examples of problem may have been caused the continual nature of longtime belief that alcohol either caused or contributed to the smallpox threattuberculosis epidemic. Despite these constant smallpox outbreaksIn 1905, Leupp took over as the OIA Commissioner for Indian Affairs under Theodore Roosevelt. While Leupp did not develope a widespread program take any immediate actions to vaccinate large numbers reduce the number of Indians. Insteadtuberculosis cases, he did commission a study for the OIA shuffled physicians from one crisis to anotherSixth International Congress on Tuberculosis by Dr. Agency physicians would only start vaccinating people once an outbreak or scare occurred. Even in the best circumstances this strategy could endanger people’s livesAles Hrdlicka, a prominent anthropologist, but on far flung Indian agencies with possibly one physician it was often fatalUnited States National Museum. Oddly enough, it was not the constant threat Hrdlicka determined after an extensive study of smallpox five separate tribes that convinced the OIA that it needed tuberculosis “threatens to take broader action to protect exterminate before long whole units of the lives Indian race, and deteriorate much of its charges, but the endemic disease remainder.”<ref> Transactions of tuberculosisthe Sixth International Congress on Tuberculosis In Six Volumes, Vol. Unlike smallpox3: Hygienic, Social, tuberculosis was essentially untreatable at the time. During the nineteenth centuryIndustrial, tuberculosis was often referred to as scrofula (cervical tuberculosis) and consumption Economic Aspects of Tuberculosis, (pulmonary tuberculosisPhiladelphia, 1908). : It is difficult to determine when Indian agents became aware of the presence of tuberculosis480. </ref>
By 1854, scrofula, a formerly a rare ailment among Indians, had become quite common among Indians in the Midwest. Over the next 50 years, references to tuberculosis and scrofula by agency physicians and agents became increasingly common. Agency physicians pleaded for hospitals, sanitarium and medicine. Other physicians Hrdlicka argued that the OIA needed tuberculosis was only introduced to quickly change Indian behavior because they firmly believed that Indians were primarily responsible for North America with the diseases spreadarrival of Europeans. Despite This late introduction contributed to the growing number of reports from agencies regarding the alarming high death rates of tuberculosis, the OIA did not take any major steps to limit tuberculosis until in the first decade of the twentieth centuryamong Native Americans. Between 1865 and 1890, agency physicians increasing discussed tuberculosis’s grim toll. In 1865, Dr. A. Coleman, physician for Data from the Winnebago agency stated the tuberculosis was “their most frequent and destructive disease.” In 1875OIA, the Fort Berthold agency physician remarked indicated that tuberculosis and scrofula between 1907-1908, 641 Indian deaths were still claiming victims, but he had that improved methods of providing fuel and “conveying the products of their agricultural labor” would improve sanitary conditions and limit the spread of attributable to pulmonary tuberculosis. He failed to explain why he took these actions and how they could possibly control tuberculosis. Another physician simply claimed that there were not as many another 182 deaths resulted from other forms of tuberculosis as he expectedout of 81, but he makes no attempt to justify or explain his claims388 Native Americans. The 1885 Annual Report Hrdlicka’s study showed that there were 875 cases of consumption and an additional 1,809 cases of scrofula. The commissioners would have been aware of the growing threat simply by reading the department’s Annual Report. In 1894, Dr. A. E. Marden of the Pima Agency reported that tuberculosis was present with “fully half of the Pima families” and that “three-fifths of the deaths” in the agency were some tribes as a many a result quarter of either syphilis or all Indians were infected with tuberculosis. Another physician, C. H. Kermott of the Devils Lake Agency, claimed but even more distressing is that Indians had strumous blood which caused high rates of tuberculosis and scrofula. Joseph R. Finneyin some cases, the physician for the Fort Berthold Agency, claimed that the health 40 percent of the Indians lived a family group where someone was essentially goodinfected. <ref> Transactions, except for tuberculosis which had been “a veritable scourge” for a long timeVol. 3 (1908): Ambler Caskie, agency physician for the Lower Brule Subagency, acknowledged that tuberculosis “in one or another guise” was death’s “busiest factor481- 488.” </ref>
In 1901Despite years of reports cataloguing the high rates of tuberculosis infections, these new statistics finally caught the attention of the OIA sent and clarified the scope of the tuberculosis problem in the native population. David Jones accurately pointed out a circular in Rationalizing Epidemics that the rediscovery of the tuberculosis problem among Indians by Leupp’s administration was just the latest attempt to agencies physicians soliciting their opinions on understand the health scope and welfare nature of their Indiansthe tuberculosis crisis. <ref>David Jones, Rationalizing Epidemics: Meaning and Uses of American Indian Mortality since 1600 (2004): Despite 164-165.</ref> Early twentieth century administrators either ignored or dismissed the sometimes “antagonistic” and contradictory nature validity of reports, all the OIA believed evidence that they convened an accurate impression Indian healththe tuberculosis had been present for over a half century. The physicians and agents reports demonstrated that may have also played a factor in minimizing the tuberculosis was “more widespread among the Indians” than whitesrisk. The OIA was confused by this response because it believed Physicians and agents often claimed that the locations health of most reservations and the Indians activeon their agencies were essential good, outdoor lifestyle should have reduced, not increased the incidence of but then acknowledge that tuberculosiswas a constant problem. Tuberculosis appears to be For the exception to the belief within the OIA that if done intelligently a “change from barbarous to civilized modes most part, unless an agency endured some type of life tends to improve deadly epidemic they would classify Native American health conditionsas good.” The 1902 report pinpointed nine causes for the high rate of infection: (a) Failure to disinfect tubercular sputumfact that Indians suffered from tuberculosis was not unexpected. (b) Poor sanitation Physicians and lack agents appear to have seen tuberculosis as just another aspect of cleanlinessIndian life. (c) Improper and poorly prepared foodLike religion, alcoholism, or medicine men it was seen almost as vestige of their Indian character, despite acknowledgement by some physicians that tuberculosis was recent phenomenon among native populations. (d) Intermarriage of Indians of Jones argued that new physicians continually rediscovered the same tribe. (e) Intermarriage problem of Indians tuberculosis and whites.(f) Taking pupils predisposed were “either oblivious to tuberculosis from camp life and confining them in school.(g) Overcrowding dormitories.(h) Lack the existence of past health campaigns or dismissive of proper medical attention after infectionthese past efforts.(i) ” <ref> David Jones, Rationalizing Epidemics: The use of alcohol.164-165</ref>
The report focused blamed Indian behavior and culture Leupp tried to develop a new approach for their high rates of controlling tuberculosis. Physicians did First, Leupp acknowledged that there were simply not understand the nature of the enough physicians to treat every tuberculosis threat at this timepatient. Many In 1897, there were approximately 86 physicians believed that tuberculosis could be controlled by sanitation and civilizationto treat over 180,000 Indians on the nation’s reservations. They did not understand the transmission or nature Instead of the diseasecreating a centrally located sanitarium, Leupp proposed building sanitariums on reservations as needed. ThereforeVarious Indian agents, physicians delineated problems they saw and people who were affiliated with Indian culture which provided convenient explanations which shifted blame from the OIA and themselves. The 1877 report from the Red Lake agency physician blamed the Indians’ “habits” Mohonk Conference had repeatedly proposed establishing a central sanitarium for Indians in the prevalence of such diseases as scrofula and tuberculosisSouthwest. The 1902 report even stated that Leupp opposed creating a central facility because Indians were primarily responsible for the lack of proper medical care because “ignorance “simply unwilling to send their friends and superstition” prevented Indians families away from following home.” <ref> <i>Proceedings of the proper courses twenty-Fifth Annual Meeting of treatment. While it was possible that agency doctors may have neglected tuberculosis patients, it acknowledged that any negligence was understandable under the circumstances. Aside from Lake Mohonk Conference of Friends of the overcrowding of dormitoriesIndian and Other Dependent Peoples 1907 </i> (Lake Mohonk, the OIA 1907): 38. </ref> While Leupp did not believe that it was responsible for tuberculosis intend “to rush into building camps on reservations. Whether or not there was an internal debate regarding what role every reservation, regardless of the reservations system itself played is questionablepossibility of their success,” instead he sought to build a small number of experimental sanitariums to determine if they could be a successful. Physicians were more concerned with ventilation and climate than <ref> Transactions of the potential problems posed by concentrating Indians Sixth International Congress on isolated Tuberculosis In Six Volumes, Vol. 5 State and primitive reservationsMunicipal Control of Tuberculosis, (Philadelphia, 1908): 430-31. </ref>
Despite the increasingly urgent reports from Indian agents and physicians Additionally, he proposed developing a concerted program to educate all Indians regarding the prevalence dangers of tuberculosis, and the possible ways to reduce the first comprehensive survey spread of Native American health did not occur until 1903the disease. The results of the study were enlightening because it indicated that large numbers A key component of Indians were infected with tuberculosis. Despite this evidence, it these plans was not until Francis E. Leupp took over the OIA that someone within the organization took the danger of tuberculosis seriously. Part creation of the problem may have been caused the longtime belief that alcohol either caused or contributed to the tuberculosis epidemic. In 1905, Leupp took over as the Commissioner for Indian Affairs under Theodore Roosevelt. While Leupp did not take any immediate actions Medical Services to reduce centralize the number management of tuberculosis cases, he did commission a study for the Sixth International Congress on Tuberculosis by Dr. Ales Hrdlicka, a prominent anthropologist, with United States National Museumproposed sanitariums and establish education programs.
Hrdlicka determined after an extensive study of five separate tribes Leupp admitted that tuberculosis “threatens to exterminate before long whole units any reform of the Indian racemedical corps would be problematic. The following year, and deteriorate much Dr. Joseph A. Murphy, the first medical supervisor for the OIA, blamed a litany of problems hampering the remainder.” Hrdlicka argued that tuberculosis was only introduced OIA efforts to North America with reorganize the medical services including isolated populations, insufficient resources and the arrival lack of Europeanstrained workers. This late introduction contributed Murphy also argued the Indians compounded these problems because they were ignorant, lazy, unclean, indifferent, unhygienic, unwilling to reform and neglectful of the high death rates among Native Americanssick and the aged. Data from <ref> Proceedings of the OIA, indicated that between 1907twenty-1908, 641 Sixth Annual Meeting of the Lake Mohonk Conference of Friends of the Indian deaths were attributable to pulmonary tuberculosis and another 182 deaths resulted from other forms of tuberculosis out of 81Other Dependent Peoples (1909): 23-24. </ref> Throughout the nineteenth,388 agency physicians often blamed Native Americansfor their own ill health. Hrdlicka’s study showed Only occasionally did they acknowledge that in some tribes as a many a quarter most of all the health problems faced by Indians were infected either a result of their interactions with tuberculosis, but even more distressing is that in some cases, 40 percent Americans or their consolidation of Indians lived a family group where someone was infectedthem onto reservations.
Despite years of reports cataloguing Leupp left his position as commissioner at the high rates end of tuberculosis infections, these new statistics finally caught the attention of the OIA and clarified the scope of the tuberculosis problem in the native population. David Jones accurately pointed out in Rationalizing Epidemics that the rediscovery of the tuberculosis problem among Indians by Leupp’s Theodore Roosevelt’s administration was just the latest attempt to understand the scope and nature of the tuberculosis crisis. Early twentieth century administrators either ignored or dismissed the validity of all the evidence that the tuberculosis had been present for over a half century. The physicians and agents reports may have also played a factor in minimizing the tuberculosis risk. Physicians and agents often claimed that the health of the Indians on their agencies were essential good, but then acknowledge that tuberculosis was a constant problem. For the most part, unless an agency endured some type of deadly epidemic they would classify Native American health as good. The fact that Indians suffered from tuberculosis was not unexpected. Physicians and agents appear pressure to reform to have seen tuberculosis as just another aspect of improve Indian lifehealth continued. Like religionBy 1912, alcoholism, or medicine men it was seen almost as vestige of their Congress began appropriating money specifically to expand Indian character, despite acknowledgement by some physicians that tuberculosis was recent phenomenon among native populationsmedical service. Jones argued that This new physicians continually rediscovered money allowed for a dramatic expansion of the problem number of tuberculosis physicians working for OIA and were “either oblivious contributed to the existence of past health campaigns or dismissive of these past effortsa hospital building spree on reservations.” Leupp tried Congressional appropriations continued to develop grow and by 1917 Congress was appropriating $350,000 a new approach year for controlling tuberculosisIndian health. First, Leupp acknowledged that At the turn of the century there were simply not enough approximately only 90 physicians to treat every tuberculosis patient. In 1897in the OIA, but by 1918 there were approximately 86 physicians to treat over 180,000 Indians on the nation’s reservations87 separate hospitals. Instead of creating a centrally located sanitarium<ref> Jones, Leupp proposed building sanitariums on reservations as needed<i>Rationalizing Epidemics</i> (2004) 170-171. Various Indian agents, physicians and people who were affiliated with </ref>Reform stalled during the Lake Mohonk Conference had repeatedly proposed establishing a central sanitarium for Indians in the Southwest. Leupp opposed creating a central facility because Indians were “simply unwilling to send their friends and families away from home.” While Leupp did not intend “to rush into building camps on every reservation, regardless of the possibility of their success,” instead he sought to build a small number of experimental sanitariums to determine if they could be a successfulFirst World War. Additionally, he proposed developing a concerted program to educate all Indians regarding After the dangers start of tuberculosis and American involvement in the possible ways to reduce war the spread number of physicians in the diseaseIndian Medical Service decreased dramatically. A key component of these plans was At the creation start of 1917, the Indian Medical Services to centralize the management of the proposed sanitariums 186 physicians and establish education programs91 nurses. Leupp admitted that any reform of the By 1918, those numbers had dropped dramatically; only 139 physicians and 55 nurses worked for Indian medical corps would be problematicMedical Services. The following year, Dr. Joseph A. MurphyUnsurprisingly, the first medical supervisor for momentum that had been built up during the OIA, blamed a litany of problems hampering the OIA efforts to reorganize the medical services including isolated populations, insufficient resources and Taft administration was completely dissipated by the lack fall of trained workers1918. Murphy also argued the Indians compounded these problems because they were ignorant, lazy, unclean, indifferent, unhygienic, unwilling to reform and neglectful The grossly understaffed IMS was little of no match for the sick and the aged1919 influenza epidemic. Throughout A quarter of the nineteenth304, agency physicians often blamed Native Americans for their own ill health. Only occasionally did they acknowledge that most of the health problems faced by 000 Indians were either a result of their interactions came down with Americans or their consolidation of them onto reservationsinfluenza and 6,270 died from the disease. <ref> Prucha, <i>The Great Father</i>, 854-855.</ref>
Leupp left his position as commissioner at the end of Theodore Roosevelt’s administration, but the pressure to reform to improve The hope that Indian health continuedcould be improved diminished. By 1912, Congress began appropriating money specifically Tuberculosis continued to expand rage on Indian medical servicereservations during the twentieth and it would even spread to Indians who had low incidence rates in 1905. This new money allowed for The Navajos in Arizona had a dramatic expansion lower rate of tuberculosis than was present in United States general population, but during the number of physicians working for OIA and contributed to a hospital building spree on reservationsfirst half the century climbed dramatically. Congressional appropriations continued to grow and While the mortality rate for tuberculosis had declined by 1917 Congress 1947 it was appropriating $350still seven to ten times higher than other American citizens.<ref> Jones,000 a year for Indian healthRationalizing Epidemics, 170-172. At </ref> While tuberculosis mortality rates declined during from 1900-1950 it would be difficult to claim that reforms instituted during the turn of the century there approximately only 90 physicians in the OIA, but by 1918 there Roosevelt and Taft administrations were 87 separate hospitalsprimarily responsible.
Reform stalled during Ultimately, these reforms did not have the First World Warintended effect, but they did demonstrate a shift in United States policy towards Native American health. After the start While Smallpox epidemics wiped out large numbers of American involvement Indians in the war the number of nineteenth century; government agents, missionaries and physicians in the Indian Medical Service decreased dramaticallyexpressed concern and attempted to inoculate and vaccinate some Indians. At But the start of 1917, the Indian Medical Services 186 physicians and 91 nursesOIA response was essentially reactive. By 1918Instead of preventing smallpox outbreaks, those numbers had dropped dramatically; only 139 physicians would react to each and 55 nurses worked for Indian Medical Servicesevery outbreak. Unsurprisingly, The failure of the momentum that had been built up during the Taft administration OIA to develop a more proactive or extensive policy regarding smallpox was completely dissipated by hampered the fall inherent weaknesses with institutional make up of 1918the OIA. The grossly understaffed IMS was little Jones argued that the claims by agency physicians at the end of no match for the 1919 influenza epidemicnineteenth century that they effectively reduced the threat of smallpox are questionable.<ref> Jones, Rationalizing Epidemics, 121. </ref> A quarter number of completely reasons completely unrelated to OIA efforts could have played a larger role in reduced mortality rates including less virulent strains of the 304virus,000 Indians came down with influenza and 6increased immunity,270 died from the diseaseor unreported deaths.
The hope that Indian health could be improved diminished. Tuberculosis continued to rage Unlike smallpox, the tuberculosis threat slowly crept up on Indian reservations during the twentieth and it would even spread to Indians who had low incidence rates in 1905OIA. The Navajos in Arizona had a lower rate of tuberculosis than was present in United States general populationUnlike smallpox, but during the first half the century climbed dramatically. While the mortality rate for tuberculosis had declined by 1947 did not sweep through reservations and kill thousands; it was still seven to ten times higher than other American citizens. While tuberculosis mortality rates declined during from 1900-1950 it would be difficult to claim that reforms instituted during the Roosevelt slowly integrated itself onto reservations and Taft administrations were primarily responsible. Ultimately, these reforms did not have the intended effect, but they did demonstrate a shift in United States policy towards Native American healthIndian schools. While Smallpox epidemics wiped out large numbers of some Indians in the nineteenth century; government agentsquickly succumbed after being infected, missionaries and physicians expressed concern and attempted to inoculate and vaccinate some Indiansmost victims lingered on for extended periods of time. But By 1880, the OIA response was essentially reactive. Instead had become increasingly centralized and capable of preventing smallpox outbreaksmanaging its physicians, physicians would react but its response to each and every outbreak. The failure of the OIA to develop a more proactive or extensive policy regarding smallpox tuberculosis was hampered the inherent weaknesses with by its lack of institutional make up of the OIAmemory. Jones argued that Despite repeated warnings from its employees, the claims by agency physicians at the end of the nineteenth century OIA did not remember that they effectively reduced the threat of smallpox are questionableit had problem. A number of completely reasons completely unrelated Instead, each new agent, physician, and commissioner was surprised to OIA efforts could have played a larger role in reduced mortality rates including less virulent strains discovery the presence of tuberculosis among the virus, increased immunity, or unreported deathsIndians.
Unlike smallpox, Leupp’s reform efforts gained traction because the tuberculosis threat slowly crept up on the OIA. Unlike smallpoxto Native Americans could no longer be ignored, tuberculosis did not sweep through reservations Roosevelt was interested in health and kill thousands; it slowly integrated itself onto reservations and in Indian schools. While some Indians quickly succumbed after being infected, most victims lingered on for extended periods of time. By 1880physical fitness, the OIA had become increasingly was sufficiently centralized to aid a broad reform effort and capable controlling tuberculosis dovetailed nicely with the OIA’s effort to integrate Native Americans into American society. <ref> Roosevelt served as the president of managing its physiciansthe 1908 International Congress on Tuberculosis in Washington D. C. </ref> Leupp and Murphy not only sought to reform the OIA’s medical corps, but its response tuberculosis provided a powerful justification to tuberculosis was hampered by its lack change the behavior and culture of institutional memoryNative Americans. Despite repeated warnings from The OIA could increase its employees, control over its charges under the OIA did not remember that it had problemguise of health reform and eliminate some of their more objectionable behavior. InsteadNot only could Indians be taught how to behave in civilized society, each new agent, physician, and commissioner was surprised but if they failed to discovery follow the presence of tuberculosis among the IndiansOIA’s directives they could claim that their Indian behavior would kill them.
Leupp’s ====Conclusion==== The effort at the turn of the century to reform efforts gained traction because the tuberculosis threat to Native Americans could no longer be ignoredOIA’s healthcare was largely unsuccessful, Roosevelt was interested but it is significant because it pinpoints a clear change in health OIA and physical fitness, its policies. By the 1900 the OIA was sufficiently centralized to aid a finally capable of implementing broad reform effort and controlling tuberculosis dovetailed nicely with the OIA’s effort to integrate Native Americans into American societyinstitutional reforms.<ref> Roosevelt served as the president of the 1908 International Congress on Tuberculosis Advances in Washington Dmedicine would have provided compelling reasons to expand its medical corps. C.</ref> Leupp and Murphy It should not only sought to reform be ignored that these reforms occurred when the OIA’s medical corps, but tuberculosis provided a powerful justification government’s relationship to change the behavior and culture of Native Americanschanged. The OIA could increase its By 1909, the United States wanted to control over its charges under the guise of health reform and eliminate some of their more objectionable Native American behavior. Not only could Indians be taught how Tuberculosis provided the OIA with a good reason to behave in civilized society, but if they failed to follow the OIA’s directives they could claim that educate Native Americans about their Indian behavior would kill thempotentially dangerous behaviors.
====Conclusion====
The effort at the turn of the century to reform the OIA’s healthcare was largely unsuccessful, but it is significant because it pinpoints a clear change in OIA and its policies. By the 1900 the OIA was finally capable of implementing broad institutional reforms. Advances in medicine would have provided compelling reasons to expand its medical corps. It should not be ignored that these reforms occurred when the government’s relationship to Native Americans changed. By 1909, the United States wanted to control Native American behavior. Tuberculosis provided the OIA with a good reason to educate Native Americans about their potentially dangerous behaviors.
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