Changes

Even before the Rutherford Hayes administration abandoned appointment by churches of Indian agents, the OIA was finally allowed to appoint physicians to Indian Agency under the civil service system. Instead of relying on local agents or churches to select suitable physicians, the Commissioner could appoint physicians to agency positions. <ref>Stuart, <i>Indian Office</i>, 36-37.</ref> Instead of making these appointments subject to Senate approval, physicians were hired under the civil service system. By allowing the Commissioner to make appointments under the Civil Service Commission, the OIA was finally able to centralize its authority over agency physicians. Still, the OIA did not an administrator, such as a Surgeon General, in charge of agency physicians.

In 1886, Commissioner Adkins acknowledged that the OIA had had numerous problems with incompetent subordinate employees. Adkins indicated that new standards would be instituted for subordinate employees and promised that incompetent employees with the agency would not be eliminated. He argued that physicians should not only be graduates of medical school, but they should focus their undivided attention on the needs of the Indians and agency employees. He discouraged physicians from moonlighting and accepting payment for treating patients “not connected with the agency.” <ref> Annual Report of the Commissioner of Indian (1885): 13.</ref> By the end of the 1880s , the OIA had developed a list of criteria for people applying to become OIA physicians. In addition to being a “regular graduate of some reputable medical school,” physicians were expected to “be actually engaged in the practice of medicine.” <ref><i>Annual Report of the Commissioner of Indian</i> (1885): 12-13.</ref> In addition, to listing a physician’s minimum requirements, the OIA provides provided a job description for agency physicians. Considering the heavy patient load each agency physician faced, the OIA added a number of additional tasks, including eliminating “the influence of medicine men”men, ” treating patients in their homes, reporting questionable sanitary problems to agency authorities, regularly visiting agency schools, organizing classes to teach Indians how to care for the sick, filing monthly reports, and working harmoniously with the Indian agent.<ref><i>Annual Report of the Commissioner of Indian</i> (1885): 13.</ref> ====The State of Western Medicine was a Disaster====It is unsurprising, that the lack of centralized authority at the OIA prevented any organized approach to improving Indian healthcare. Since physicians were employed by the local Indian Agents they would not have been beholden to OIA bureaucracy in Washington. Therefore, it would have been impossible to effectively mandate minimum standards for physicians and promote health initiatives. Even if minimum standards for physician competency could be mandated, finding competent physicians in the United States during the nineteenth century was incredibly difficult. During the nineteenth century, American medical practice fragmented into multiple competing sects.  Before 1800, medical therapeutics had changed remarkably little over the previous two thousand years. At the beginning of the nineteenth century traditional physicians (or “regulars”) viewed themselves as learned professionals, their therapeutic methods were informed by Galen’s two-thousand-year-old “four humoral theory.” “The body was seen, metaphorically, as a system of dynamic interactions with its environment” and physicians believed that specific diseases played an insignificant role in the system.<ref>Charles E. Rosenburg “The Therapeutic Revolution: Medicine, Meaning and Social Change in Nineteenth-Century America,” in <i>The Therapeutic Revolution: Essays in the Social History of American Medicine</i>, ed. Moris J. Vogel and Charles E. Rosenburg, (University of Pennsylvania Press, 1979), 3-6.</ref> During the nineteenth century, this understanding of the human body came under assault because it was ineffective in treating human illnesses. From the 1820s to the 1850s, the regulars’ dominance of American medical practice eroded dramatically. Several unorthodox or irregular medical sects, including Homeopathy, Eclecticism, and Thomsonianism, arose in opposition to the heroic medical practice of the regulars. <ref>Martin Kaufman, <i>Homeopathy in America: The Rise and Fall of a Medical Heresy</i> (Baltimore and London, The Johns Hopkins Press, 1971), 23.</ref>  Unsurprisingly, regular physicians were often seen as incompetent or ineffective. During the mid-nineteenth century, not only were regulars hampered by a fundamentally flawed understanding of medicine, but woefully inadequate medical schools sprouted like weeds throughout the country. These schools were staffed by poorly trained practitioners, who were focused on profit, not education. Admission standards for most American medical schools could be best described as non-existent. Ronald Numbers quoted a physician in “The Fall and Rise of the American Medical Profession” as saying, “[i]t is well understood among college boys that after a man has failed in scholarship, failed in writing, failed in speaking, failed in every purpose for which he entered college; after he has dropped down from class to class; after he has been kicked out of college, there is one unfailing city of refuge – the profession of medicine.”<ref>Numbers, <i>Sickness</i>, 226.</ref>  It would have been even more difficult to locate competent physicians who would have been willing to relocate to the isolated and potentially dangerous Indian reservations. William Mitchell, agent for the Warm Spring Agency in Oregon, complained that for $1,000 per year “no physician of even ordinary ability” could be had. Not only was the pay insufficient, but few gentlemen of “education and ability” would be willing to live somewhere which completely lacked a “society.”<ref><i>Annual Report of the Commissioner of Indian</i> (1869): 169.</ref> Even if the OIA had instituted some standards, it is not clear that the medical profession could have provided physicians who could improve Native American health.

It is unsurprising, that ====The Failure of the lack Medical Corps ecourages use of Native American Medicine====While treating Indian disease was an auxiliary mission of centralized authority at the OIA prevented any organized approach , its primary goal was to improving control the Indian healthcarepopulation and permit westward expansion. Since physicians were employed Unfortunately, several agents believed that this mission was severely compromised by the local Indian Agents they would not have been beholden to failure of the OIA bureaucracy in Washington. Therefore, it would have been impossible to effectively mandate minimum standards for provide enough qualified physicians and promote health initiatives. Even if minimum standards for physician competency could be mandated, finding competent physicians in the United States during the nineteenth century was incredibly difficultIndian communities. During the nineteenth centuryIn 1886, American medical practice fragmented into multiple competing sectsJohn S. Before 1800Ward, medical therapeutics had changed remarkably little over the previous two thousand years. At Indian Agent for the beginning of the nineteenth century traditional physicians (or “regulars”) viewed themselves as learned professionals, their therapeutic methods were informed by Galen’s two thousand year old “four humoral theory.” “The body was seen, metaphoricallyMission Indians in California, as a system of dynamic interactions with its environment” and physicians believed complained that specific diseases played an insignificant role in the system. During his physician could not adequately care for the nineteenth century3, this understanding of the human body came 000 Indians under assault his care because it the physician was ineffective in treating human illnesses. From the 1820s required to cover an area the 1850s, the regulars’ dominance of American medical practice eroded dramatically. Several unorthodox or irregular medical sects, including Homeopathy, Eclecticism, and Thomsonianism, arose in opposition to heroic medical practice size of the regularsNew England. Unsurprisingly, regular physicians were often seen as incompetent or ineffective. During the mid-nineteenth century, not only were regulars hampered by Ward argued that his physician needed a fundamentally flawed understanding of medicine, but woefully inadequate medical schools sprouted like weeds throughout the country. These schools were staffed by poorly trained practitioners, who were focused on profit, not education. Admission standards for most American medical schools could be best described as non-existent. Ronald Numbers quoted a physician in “The Fall horse and buggy and Rise of the American Medical Profession” as sayingat least $1, “[i]t is well understood among college boys that after 000 a man has failed in scholarship, failed in writing, failed year in speaking, failed in every purpose for which he entered college; after he has dropped down from class pay to class; after he has been kicked out treat his charges.<ref><i>Annual Report of college, there is one unfailing city of refuge – the profession Commissioner of medicineIndian</i> (1886): 45.” </ref>

It would have been even more difficult Because the OIA was unable to locate competent physicians who would have been willing provide enough doctors, Indians continued to relocate rely on their own medicine. Despite concerted efforts by the OIA throughout the nineteenth century to the isolated undermine and potentially dangerous degenerate Indian reservations. William Mitchellmedicine men, agent for the Warm Spring Agency in Oregon, complained that for $1,000 per year “no physician influence of even ordinary ability” could be hadmedicine men continued. Not The OIA believed that medicine men stalled the assimilation of Indians because they preserved not only was the pay insufficienttheir medical, but few gentlemen of “education and ability” would be willing to live somewhere which completely lacked a “societyreligious traditions.” Even if While the OIA had instituted some standardssought to eliminate their influence, it is not clear that they failed to understand the roles these individuals played in Indian society or provide Indians with medical profession could have provided physicians who could improve Native American healthalternatives.

While treating Indian disease was an auxiliary mission of Throughout the OIAnineteenth century, its primary goal was to control Indian agents provided contradictory reports regarding the Indian population influence and permit westward expansion. Unfortunately, several agents believed that this mission was severely compromised reliance on medicine men by the failure of the OIA to provide enough qualified physicians for Indian communitiesIndians. In 1886, John S. Ward, the Indian Agent for the Mission Indians in California, complained that his physician could Whether or not adequately care for the 3,000 Indians under his care because the physician was required these reports were accurate is difficult to cover an area the size of New Englandascertain. Ward argued that his physician needed a horse and buggy and at least $1,000 a year in pay Due to treat his charges. Unsurprisingly, because the OIA was unable to provide enough doctorsoften contradictory nature of these reports, Indians it appears that medicine men continued to rely on their own medicine. Despite concerted efforts by the OIA play prominent roles tribes throughout the nineteenth century . Even though some Indian agents insisted that their Indians were not “superstitiously attached to undermine and degenerate Indian their medicine men, the influence of ” others reported that medicine men continuedplayed a prominent role in tribal life. The OIA believed that medicine men stalled <ref><i>Annual Report of the assimilation Commissioner of Indians because they preserved not only their medical, but religious traditionsIndian</i> (1843): 201. While </ref> Reports from the OIA sought to eliminate their influence, they failed to understand the roles these individuals played in Indian society or provide Indians with medical alternativesagents during those years were often wildly inconsistent.

Throughout the nineteenth century, Indian agents provided contradictory reports regarding the influence and reliance on medicine men by Indians. Whether or not these reports were accurate is difficult to ascertain. Due to the often contradictory nature of these reports, it appears that medicine men continued play prominent roles tribes throughout the nineteenth century. Even though some Indian agents insisted that their Indians were not “superstitiously attached to their medicine men,” others reported that medicine played a prominent role in tribal life. Reports from the same agent during the same years on the influence of medicine men could be internally inconsistent. In 1860, B. W. Kimball, the physician for the Medicine Creek Treaty Indians stated the Indians’ trust in the 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.

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. Some agency physicians simply hoped that Indians would stop using medicine men when the older generation of Indians died out. 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. Throughout the nineteenth century, Indians relied on their native medical practices and, when available, agency physicians. 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.

Leupp’s reform efforts gained traction because the tuberculosis threat to Native Americans could no longer be ignored, Roosevelt was interested in health and physical fitness, the OIA was sufficiently centralized to aid a broad reform effort and controlling tuberculosis dovetailed nicely with the OIA’s effort to integrate Native Americans into American society.<ref> Roosevelt served as the president of the 1908 International Congress on Tuberculosis in Washington D. C.</ref> Leupp and Murphy not only sought to reform the OIA’s medical corps, but tuberculosis provided a powerful justification to change the behavior and culture of Native Americans. The OIA could increase its control over its charges under the guise of health reform and eliminate some of their more objectionable behavior. Not only could Indians be taught how to behave in civilized society, but if they failed to follow the OIA’s directives they could claim that their Indian behavior would kill them.