'If You Knew the Conditions': A Chronicle of the Indian Medical Service and American Indian Health Care, 1908-1955
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'If You Knew the Conditions': A Chronicle of the Indian Medical Service and American Indian Health Care, 1908-1955
198Overview
Product Details
| ISBN-13: | 9780739130384 |
|---|---|
| Publisher: | Lexington Books |
| Publication date: | 12/27/2010 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 198 |
| File size: | 2 MB |
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"If You Knew the Conditions"
A Chronicle of the Indian Medical Service and American Indian Health Care, 1908â?"1955
By David H. DeJong
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Copyright © 2008 Lexington BooksAll rights reserved.
ISBN: 978-0-7391-3038-4
CHAPTER 1
"If You Knew the Conditions"
On November 15, 1907, Dr. Susan La Flesche-Picotte, a member of the Omaha tribe and the first American Indian female doctor in the United States, penned a letter to Commissioner of Indian Affairs Francis Leupp. "I am an Omaha Indian and have been working as [a] medical missionary among the Omahas," La Flesche-Picotte began, "but [I] have broken down from overwork.... I know what a small figure our affairs cut with all the Department has on its hand, but I also know that if you knew the conditions and circumstances to be remedied you would do all you could to remedy them." She then described the needs of the Omaha people.
La Flesche-Piatte could have been describing the needs of any tribe in the country as, by 1907, most were approaching the nadir of their existence. "The spread of tuberculosis among my people is something terrible—it shows itself in the lungs, kidneys, abdominal track, blood, brain and glands." Recognizing the severity of the situation and the dire need for medical care, she begged Leupp "that something must be done" for the people. "The physical degeneration in 20 years among my people is terrible," La Flesche-Picotte concluded, "but I want to know if the Govt can't do for us, what it did for the Sioux in preventing the spread of the White Plague."
Scores of Indians and non-Indians echoed La Flesche-Picotte's plea across Indian Country. Mary Wynkoop, a field matron from the Gila River (Arizona) Indian Reservation lamented the spread of disease among the Pima and Maricopa. "When we came to the reservation seven years ago (1896) we only knew of one case of tuberculosis among 1,500 people," she informed Commissioner William Jones. "Since that time we have buried by the scores promising young people from the schools." If Jones doubted the extent of disease, the matron encouraged him to order an examination that "would, I think, bring to light surprising results."
Leupp's reply to La Flesche-Picotte is illustrative of the inability of the Indian Service to combat disease. What medical services were provided were scattered and disjointed, with many provided by missionary agencies such as the one employing La Flesche-Picotte. "Owing to lack of funds it is quite impossible," Leupp told the physician, to do more than what is being done. American Indians represented too small a percentage of the overall population and had no voice in government affairs to protest this lack of attention. Conditions continued to decline with mortality rates rapidly rising. A library of cultural history and knowledge was dissipating, as was the loss of spiritual and political leadership in Indian Country. Demoralization, depression and discouragement were rampant in Indian Country. Many American Indians witnessed successive waves of epidemics as evidence the Great Spirit could no longer protect them. Many turned to Christianity believing the "white man's God" was more powerful.
Early U.S. Attempts to Provide Medical Care
The United States Army undertook measures to combat infectious diseases, especially smallpox, as early as 1803, although President Jefferson provided vaccinations for visiting Indian delegations to Washington, D.C. as early as 1801. This protection was largely for tribes residing near military posts along the frontier and was designed more to protect the soldiers than to ensure the health and survival of the Indians. Although some Indians were vaccinated, most were so far removed from military posts and other governmental influences that they did not receive vaccinations.
The United States also assumed responsibility for health care through the education of Indian children. The 1819 Civilization Act, enacted "for the purpose of providing against the further decline and final extinction of the Indian tribes," provided funds for education and "such other duties as may be enjoined" to protect and preserve the Indians adjoining the frontier settlements of the United States. The "civilization" funds, as they were called, were administered by the Superintendent of Indian Trade and, after 1824, by the Office of Indian Affairs under the authority and at the discretion of the Secretary of War. Congress also directed such funds to be dispatched to various missionary societies, some of which provided rudimentary nursing and medical services.
During the time the Office of Indian Affairs was under the auspices of the War Department (1824-1849), the dispensation of medical care was made available to small numbers of Indians living near military posts. These services were provided by army medical staff and were usually minimal, due to absence of resources for Indian health care. Where services were provided, the delivery system was inefficient, with vaccines often arriving late or not at all. Doctors remained in short supply. Indian agents frequently wrote members of Congress and officials in the War Department seeking additional funds and increased medical personnel and supplies, but usually to no avail.
When military expeditions headed into Indian Country, they were equipped with interpreters and sundry assistants but rarely with physicians to administer health services. Army Colonel Thomas McKenney, later first head of the Office of Indian Affairs, reported he personally treated (with the assistance of an interpreter) an Indian woman suffering from pleurisy because there was no physician available to accompany the troops. The only order on record concerning the health of Indians before 1832 was a War Department directive requiring "the health of the Indians to be carefully guarded" while the military removed tribes from the east to the new Indian Country in the west. When the Creek Nation removed from Georgia and Alabama in the 1830s, for example, the United States agreed to provide a surgeon to attend to the needs for each emigrating party of 1,000 people. When the Cherokee Nation was removed over the Trail of Tears, in 1838, over 4,000 men, women and children died. Smallpox was the primary cause of illness and death among the Creeks, Choctaws, Chickasaws, Seminoles and Cherokees, both during removal and upon arrival in their new lands in the Indian Territory.
Not until 1832 did Congress appropriate money for Indian vaccinations and then only in response to an epidemic. An appropriation of $12,000 was made for smallpox vaccinations to save the Indians "from the destructive ravages of that disease." Secretary of War Lewis Cass was authorized to employ as many physicians or surgeons, military or civilian, as he saw fit to execute the charge. He was also charged with supplying vaccine matter to all Indian agents for "arresting the progress of smallpox among the several tribes." Using the Congressional appropriation, Commissioner of Indian Affairs Elbert Herring paid surgeons a $6 per diem or $6 per hundred vaccinations, to inoculate willing Indians in the Missouri River Valley. Herring reported to Cass that initial reports indicated when the Indians were encouraged to do so they accepted the vaccine and expressed gratitude in the efforts of the government to eliminate smallpox. Other tribes, however, especially those in Kansas and on the upper Missouri River, repeatedly resisted vaccinations due to the influence of Indian traders or their distrust of the efforts of the government. Using the meager appropriation, 10,000 Indians were vaccinated by February 1833, although the vaccination of a few thousand Indians did little to eliminate the need for health services in Indian Country.
A litany of epidemics swept through the western tribes in the first decades of the nineteenth century. In the summer of 1830, for instance, smallpox swept through the lower Columbia River Valley of Oregon, crippling white settlers and decimating the Indians—and this after an 1820 epidemic claimed up to 80% of the tribal people along the Colombia River. By 1833, the same plague spread into the Central Valley of California. Oregon pioneer William A. Slacum estimated some 6,000 Indians died in the Willamette Valley alone between 1830-1837. Some tribes were exterminated, "without leaving a single survivor to tell their melancholy tale." The result of the epidemic in California was nothing short of spectacular, with 20,000 Indians—or 75% of the Indian population—wiped out in just one summer. So crippled were the Indians that they could offer but little resistance to the gold-seeking 49'ers arriving just a decade and a half later.
The 1830s were especially hard on the western tribes. John Dougherty, Indian agent for the Missouri River basin, wrote to Superintendent of Indian Affairs William Clark in 1831 that he had just returned from visiting four Pawnee villages, finding half of them infected with smallpox and fearing the complete annihilation of the village tribes "by the cruel and frightful" disease. Within 12 months, an estimated 4,000 Pawnees, Otoes, Omahas and Poncas had died and the disease continued spreading northward, where it reached the Winnebago. Agent Isaac McCoy exhorted Secretary of War Lewis Cass to adopt the means necessary to "arrest this destroying plague by vaccination."
In 1837, smallpox swept through the upper Missouri River Valley, inflicting havoc on a trading post before sweeping through the Indian villages with horrifying results. "Language, however forcible, can convey but a faint idea of the scene of desolation, which the country now presents," Henry Rowe Schoolcraft wrote in an 1853 description of the account that killed some 10,000 Indians. An eyewitness reported, "In whatever direction you turn, nothing but sad wrecks of mortality meet the eye. Lodges standing on every hill, but not a streak of smoke rising from them." Not a sound was "heard to break the awful stillness save the numerous croaks of ravens and the mournful howl of wolves, fattening on the human carcasses that lie strewed around. It seems as if the very genius of desolation had stalked through the prairies and wreaked his vengeance on everything bearing the shape of humanity."
The epidemic nearly destroyed the Mandan tribe. When it struck, the Mandans—surrounded by their hereditary enemy the Sioux—were unable to disperse upon the Plains. With their outlet to survival closed off, the Indians were forced to remain within their villages, "where the disease in a few days became so malignant that death ensued in a few hours after its attack. So slight were their hopes when they were attacked," George Catlin described, "that nearly half of them destroyed themselves with their knives, with their guns, and by dashing their brains out by leaping headforemost from a thirty foot ledge of rocks in front of their village." Catlin continued:
The first symptoms of the disease was a rapid swelling of the body, and so very virulent had it become, that very many died in two or three hours after their attack, and in many cases without the appearance of disease upon their skin. Utter dismay seemed to possess all classes and ages and they gave themselves up in despair, as entirely lost. There was but one continual crying and howling and praying to the Great Spirit for his protection during the nights and days; and there being but few living, and those in too appalling despair, nobody thought of burying the dead, whose bodies, whole families together, were left in horrid and loathsome piles in their own wigwams, with a few buffalo robes, etc. thrown over them, there to decay, and be devoured by their own dogs.
When the epidemic finally ended less than 150 of the 1,600 Mandans remained alive. A smallpox epidemic in 1838, possibly an extension of the same one that ravaged the Plains, claimed an additional 17,000 lives in the Pacific Northwest.
In 1849, a cholera epidemic, having originated in the east, spread up river to St. Louis where thousands of California-bound 49'ers congregated and from whence the disease was carried across the Great Plains and into the Southwest. A number of tribes, principally the Sioux and Pawnee, contracted the disease and spread it to other western tribes. When U.S. Army Captain Howard Stansbury traveled up the Platte River, in July of 1849, he found "dead and dying" in almost every Sioux village he encountered. The Pawnee agent estimated that 1,200 Pawnees had succumbed to the disease. The Indians had become so frightened of the disease that they scattered in all directions, leaving the dead and dying unattended, and spreading the disease to other villages. When a smallpox epidemic spread through the Sioux villages in 1850, they blamed it "on white magic designed to further their extinction."
Treaty Provisions Related to Health Care
The primary means by which the United States dealt with Indian tribes before 1871 was through the treaty-making process. In exchange for hundreds of millions of acres of land, the United States took upon itself the provision of a variety of goods and services to the Indians. Of the 389 ratified Indian treaties, 31 (12%) contain provisions specifically related to Indian health care: 28 providing for a physician and 9 providing for a hospital. The first treaty provision mentioning the health of Indians was the 1832 Winnebago treaty made at Rock Island, Illinois. Article 5 committed the United States to provide "for the service and attendance of a physician at Prairie du Chien, and of one at Fort Winnebago, each, two hundred dollars, per annum." Other treaty provisions related to health services were regional. In 1854-1855, for example, 14 treaties containing medical provisions were concluded with Indian tribes in Washington, Oregon, Idaho and western Montana. In 1867-1868, seven Peace treaties made with the tribes on the Great Plains contained medical provisions.
Health facilities and physicians were increasingly important to many tribes by the latter half of the nineteenth century. In the 1854 Chasta, Scoton and Umpqua treaty talks, for example, Commissioner Joel Palmer reported the government's promise to establish schools and a hospital among the Indians "contributed very much to overcome their objections." Paternalism was also an inducement for some tribes to sign treaties. In the 1855 treaty with the Nisqually, Puyallup and other tribes in Washington Territory, Governor Isaac Stevens told the Indians: "This paper is such as a man would give to his children and I will tell you why.... Does not a father send his children to school? It gives you mechanics and a Doctor to teach you and cure you. Is that not fatherly?"
Despite treaty provisions that provided hospitals or medical services, the United States often failed to fulfill its obligations. In the 1855 Nez Perce treaty, in which the Indians ceded a vast tract of land lying between the Cascade and Bitter Root Mountains, the United States promised "to erect a hospital, keeping the same in repair, and provided with the necessary medicines and furniture, and to employ a physician." Seven years later, however, as the government prepared to negotiate a new treaty with the Nez Perce, the United States had yet to fulfill its obligations from the 1855 treaty. "On taking charge of this Office I took pains to ascertain what had been promised to, and what had been done for the Nez Perce nation," Superintendent Calvin H. Hale reported. "I found there was not as much as you had the right to expect, not as much as the U.S. Govt supposed." Hale was "surprised to see so little improvements made, in view of the large appropriations, which I know have been made.... I found no hospital built ... (because the agent) had received no money for Mills, Hospital or School." While treaties might commit funds for health care, Congressional appropriation of such funds was another matter.
Treaties did not guarantee continued health care or medical staffing, since most—including several of the 1867-1868 Peace treaties—included stipulations and time limits on government supported physicians. In the 1867 Medicine Lodge Treaty with the Cheyenne and Arapaho tribes, the United States agreed to furnish the Indians with a physician but "at any time after ten years from the making of this treaty the United States shall have the privilege of withdrawing the physician." While most treaties provided stipulated limits on services, typically not to exceed twenty years, the United States adopted a policy of continuing such services under general appropriations.
Post Civil War Years
By the latter decades of the nineteenth century Congress viewed the "Indian problem" as an internal domestic matter rather than a military one. Concurrently, the federal government began confining tribes on isolated reservations, compounding poor health. Cultural and dietary change forced on the sequestered Indians "naturally caused a great increase in their morbidity rate from the diseases to which they were not immune." As more tribes were placed on reservations, the Indian Office sent additional administrative personnel to the agencies. With the limited number of physicians and medical provisions sent to Indian Country, the acute need for medical care only slowly became known.
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Excerpted from "If You Knew the Conditions" by David H. DeJong. Copyright © 2008 Lexington Books. Excerpted by permission of ROWMAN & LITTLEFIELD PUBLISHERS, INC..
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