Changes

After its founding in 1824 within the War Department, the Office of Indian Affairs (OIA) became responsible for the health and welfare of Indians who were removed to reservations. While some treaties mandated providing tribes with medicines or physicians, Indian agents began to employ doctors in different reservations to treat the panoply of ailments afflicting the Indians.<ref> Article 11 of the 1887 Treaty with the Coeur d’Alene Indians mandated that the government furnish a competent physician to the Reservation. P. 421, Kappler, Charles Joseph, <i>Indian Affairs: Laws and Treaties</i>, Vol. 1 (Washington, 1904) Additionally, some unratified treaties, including a an 1864 treaty with the Hoopa, South Fork, and Redwood and Grouse Creek Indian, provided for the appointment of a “competent physician.” P. 135-136, Report of the Commissioner of Indian Affairs for the Year 1864, (Washington, 1865.)</ref>

Even though physicians were hired quite early in some situations, the OIA failed to create a formal medical corps to treat Native Americans for almost eighty years. Physicians were hired in a piecemeal and sporadic fashion by local Indian agents, superintendents, and Indian School administrators. By the end of the nineteenth century, the OIA employed only about 90 physicians for almost 200,000 Indians. Sometimes physicians were hired by agents as salaried employees, ; other times they . They were simply contracted, workers. The OIA struggled to hire competent employees , and some of these problems were magnified in their pursuit of qualified physicians. The OIA lacked sufficient funds and was hampered by ineffective hiring practices.

While the OIA was slowly expanding its medical corps, Indians’ continued survival was threatened by smallpox and the advancing specter of tuberculosis. Under the stewardship of Commissioner Francis E. Leupp , the OIA attempted to reform its medical corps and create a more unified organization which that could meet the needs of reservation Indians in response to the tuberculosis threat. While these reforms did not necessarily solve any of the problems Native Americans faced, they demonstrated that the OIA was cognizant of the health dangers Indians faced on reservation lands and showed they were willing to make coordinated efforts to protect Indians. The tuberculosis threat also provided the OIA with an opportunity to challenge Indian behavior, but provide a rationale for how those behaviors threatened their lives. Even then, the OIA only considered reforming its medical corps after it was clear that tuberculosis threatened the survival of not only numerous Native Americans but whites who lived near reservations.

Even if an OIA commissioner had sought to improve the OIA’s ability to deliver competent health services before 1909, any potential reform could have been rendered meaningless because of its counterproductive hiring and appointment procedures. Essentially, the medical corps of the OIA could be reformed only after the OIA centralized its authority and was in a position to supervise and manage its various employees. Therefore , it is essential to examine the role of the appointment process played in limiting the effectiveness of the OIA’s medical corps' effectiveness.

In addition to examining the OIA appointment policy of the OIA and its role in limiting the effectiveness of its medical corps' effectiveness, this paper will examine the role smallpox , and tuberculosis played in reforming the OIA medical service. Despite the constant specter of smallpox, the OIA did not fully commit to reforming its medical corps until it finally acknowledged the nature of the tuberculosis catastrophe's nature. This paper will examine how these crises differed and why they engendered such different responses. The OIA’s responses were not necessarily driven by over a concern for the Indian’s health and safety. They may not have not reformed the OIA earlier because it did not benefit the broader mission of implementing federal policy.

When the OIA created the Indian Medical Services , it did so because it advanced its broader policy objectives. This paper will focus more on the impetus and obstacles for reform than the reforms themselves. While the reforms did increase the number of physicians, nurses, and hospitals serving physicians, they were not particularly successful. Tuberculosis was still a problem in the 1950s for Native Americans. Throughout the twentieth century, the Indian Medical Services and the successor agency under the Public Health Service, the Indian Health Service, would undergo significant reforms in an attempt to improve Indian health. Therefore, it may be more useful to understand why the OIA has finally instituted reforms as opposed to instead of the efficacy or value of those reforms.