Office of Indian Affairs, Bulletin 11.(1922). /d % THE INDIAN SERVICE HEALTH ACTIVITIES. "+ Hi stbrv of Development , Since the original inhabitant s ' of this country v,ere e " _ our Government.has been concerned with Indian affairs from is regulating trade with the Indians were passed in the ear-y ays x * ‘ g public and the Office of Superintendent of Indian Trade was created in 1806, lasting until 1822. In 1324 a Bureau_of Indian ^“^^ ^asaed flaw • the War Department by the Secretary oi War, In ' * d x con tinued it . which created the Office of C.ommissione.r of Indian Affairs f • d in in the War Department* When the Department of the * n 0 ^ t has been'ever 1849 the Office of Indian Affairs was transferred to it w since* The only order on record dealing with health con- were under the jurisdiction of the War Department seem f." thi6 order it oeniing the moving of Indians from one country 0 an ^ ' it conditions was stipulated that care should be taken that the bes . A ians were employed prevail and that their health be carefully guarded- ^ fo J the in those days, though more for the benefit 0I Government^gont8 d Indians. Amy surgeons were generally accessible and were frequen y upon to render medical care* in 1873 the first organised effort was made to dealjith the health of the Indians. In that year a aivision of medio .. d & great need for t a Hi shed in the Bureau and .continued until^XSn. ..^^^ the S American such work as disease had oeen a P0*® n ° i « committee had stressed this Indian population. As early as 188b a senatorial c "^® n £ act ^ c _ vili . rapid decrease and had atiriouted no small par this fact, the division zotion and consequent ravages^ of disease. ”® p ^ r/ivsd until 1909, although of medicine was discontinued m -88/, . J n +be field. Since the there was always a certain amount of medical service * year 1909 the medical activities have been gradually increase ent organization of the health work of the :Bureau of for comprehensive description wo a • - - * ' Under the pres Indian Affairs there are for comprehensive^aescrip-^ of the Wash- the administrative which is a L ~^dth the assistance of the ington office. The Commissioner of ^AietraAve’polioy of the section, which Assistant commissioner, o-'-» - - , ds i,heir distribution and ..he handles the submitting of estimates for -und., ^ r Mction is in ch arge of a various health activities o. the ‘* ecognize d school of training, he medical officer who has on the various technical and professional sub T advises with the C ommi s sx ^ A . ‘ ' field section covers all the activi- jocts of administration. The ac..,re . j “ udi the operation qf hospitals, and sanitati!£. The Hospitals The first hospital for Indians was established in 1882* The growth in the number of hospitals is shown in the following table; Total number of hospitals .,.,,,1888...4 ” 1900.»5 " 1911.50 ” ..1912.53 " 1913.48 .1914./,.. . ..-51 " *1915. 74 .1916.81 .1917 • ....81 " 1918.87 " 1919...87 " 1920. 87 w ......1921.85 " 1922.78 The reduction in 1922 is due to increased cost of maintenance, this general trend to reduce the number in 1920 was for the same reasons. Of the 78 institutions now being operated they are divided as is shown in the fol¬ lowing table; Sanatorium schools...5, Capacity 470 Sanatoria.6, " 210 General. 31, ’* 632 School.35, " 826 Nervous and mental diseases._”_84 78 ' n 2,222 In connection with the foregoing classification there are provisions at a number of general and school hospitals in the more isolated sections of the Service for caring for tuberculous patients* During the fiscal year there have been cared for in the foregoing hospitals approximately 16,000 patients giving a total of about 486,000 hospital relief days* At each of the hospitals there is maintained a dispensary or out-patient service which renders medical assistance to a large number of out patients. The sanatorium schools are located in convenient places in the Service. They were designed to provide institutional treatment for the Indian children of school age who are afflicted with tuberculosis, but whose physical condition will permit of a limited amount of academic and vocational education- A course of both classes of education has been modified to meet the individual requirements* It is hoped through the influence of this class of hospitals to arrest a number of the incipient cases of this disease and prepare the individual with sufficient industrial and vocational training to meet the demands of competitive citizenship- For the amusements of the pupils in these institutions and to provide mental diversion there are provided certain physical exercises, competitive games both of ^hich are designed to be consistent with their physical develop¬ ment, and motion^picture shows, music, etc* The diet is especially selected for the pupils in these institutions and are balanced in accordance v/ith the recognized standard for this class of institutions. - 2 - The sanatoria were designed to provide care and treatment of the cases of tuberculosis which owing to age or degree of advancement are not ^fl|| eligible to the sanatorium schools what is said concerning the diet and amu^P ments for the sanatorium schools applies to this- class of institutions, how¬ ever, there, are no regular provisions for providing educational facilities to this class, of patients nor are such provisions considered practicable. The general hospitals are institutions in which provisions are made for caring for the general illness occurring on the various reservations they are. sometimes designated agency, hospitals, the name being derived from the pur¬ pose they serve* .In these institutions which are located on the reservations, the cases of illness developing under the jurisdiction are cared for* The work and management of the agency or general hospitals are very similar to the smaller municipal hospitals* They are nearly all provided with obstetrical wards, and the Indians are being educated to the advantages of hospitalization in this class of cases# They are as a rule constructed with provisions for operating rooms, isolation wards, etc*, the capacity varying from 8 to 80 beds each. The school hospitals are. located in'connection with the various boarding schools of the. Service and as the name implies they are provided to supply the necessary hospital facilities for the pupils, in the school# With these institutions it is possible to immediately segregate the cases of illness developing in the schools from the other pupils# It provides for more constant attention and care to the ill pupil than could possibly be provided with the usual boarding-school facilities* These institutions are under the direct supervision of the school physician and admissions and dis¬ missals are made upon his recommendations* In addition to the physician the hospital is in charge of the school nurse who besides caring for the patients in a professional capacity, supervises the preparation of the diet, the general duties of the other employees and instructs regular details of the more ■advanced girls in the vocation of home nursing* These institutions like the others described in the foregoing paragraphs are supplied with a dispensary* All the ambulatory cases are cared for herein* The cases of trachoma in the school are required to report to the dispensary at regular periods for treatments. Gases of minor injuries occurring in the school are immediately referred to this part of the hospital for proper attention# The average school hospital is equipped for handling epidemics and all cases of ordinary illness developing within the school* The consxant supervision of the various employees in e boarding schools renders the most efficient medical service possible. 10 believed that the medical provisions for the Indian Service schools compares favorably with any municipal. State, or other Federal activity of similar classification. The nervous and mental disease hospital for the ^it^is a located geographically in almost the center of indxen popu a 1 ^ d appli- modern institution of this cU*.. It is equipped with "Visions are ances for properly caring for this class oi patiento# P - • & made for entertainment and mental diversions of the pa * ThP capacity of 84 beds and has been filled for the Ind physician in charge of this institution »a oi r cages P alwayg preserl ts special training in this class of work. This e possible pro- pitiable aspect with a gloomy outlook for the future but every possible P vision for their comfort and future welfare is provided. In addition to the hospitalization of the patients it is necessary that the Bureau provide necessary field employees to select the cases from their homes &nd to supply all possible medical aid to the cases of illness in the homes where hospitalization for some reason is either impossible or impracticable* The Indian is not different from the white race in that it is not in all instances possible to place the patient in the hospital* Home con¬ ditions and surroundings, and marital conditions render moving the patient to an institution practically as impossible as in_many of our white homes. In addition the Indian people have not been educated up to hospitalization as we have and the result is that we experience no little difficulty in overcoming among them the hospitalphobia which is present* The following table is designed to give an idea of the growth and present number of health employees engaged in this important phase of health work: Year* Physicians* Nurses 1895 74 8 1897 84 24 1898 83 32 1899 87 30 1900 83 27 1905 96 33 1918 196 99 1922 208 105 Other health Field hospital matrons employees* 7 3 21 16 32 30 19 29 15 21 10 40 100 87 ICO 87 The foregoing figures are approximate and vary from time to ime according to general conditions* During the war and since the Bureau has no been able to keep all the health-section positions filled* Of the p y sl cians enumerated in the foregoing table all except 56 are full-time emp oyeeo* The principal diseases with which the medical service has had to cope have been tuberculosis and trachoma. For instance, it is estima e a 1920 there were nearly 25,000 cases of tuberculosis and over SO,000 cases o trachoma. This gives ‘ah idea of the magnitude of the task coni ron ing - e Bureau* With the growth of the hospital facilities and extension o - per sonnel it is hoped to lessen the morbidity rate for these two diseases. e Bureau has divided the Service into six districts and assigned o eac* a . specialist in diseases of the eye, ear, nose, and throat, with special training in trachoma and supplied each with a nurse* They visit the various jurisdic¬ tions in their district and supply such special services as are indica ed e beneficial results of this work*while it is yet in its infancy are quite manifest* In addition the Bureau supplies seven traveling dentists who visit the jurisdictions similar to the special physicians to perform the necessary dental -work. - 4 - The traveling dentists are among the most useful employees of tl!W ^Service* They travel from jurisdiction to jurisdiction in their respective districts and perform the dental work for the pupils in the schools and also for the reservation Indians* Their professional aid promotes conditions among the Indians now generally regarded as definitely essential ta bodily health* The agency and school physicians whether employed under contract or full time appointment perform the duties indicated by their designations. The term "Agency” applies to the physicians who are employed for agency or general reservation work and the "School" designates a school employee* In many instances where there are reservation boarding schools the agency phy¬ sician also acts in the capacity of school physician. The nurses are simi¬ larly classified and their duties are not different from the position in our municipal institutions* The duties of the field matron are multiple in character, compar¬ able to the'duties of the- visiting county nurse* Improvement of the homes, educational, moral, sanitary, environmental and social conditions among the Indians are to be regarded as the primary object of their work* Though it is the duty of every employee of the Service, regardless of his position, to do everything possible to contribute to such improvement, both by effort and example, the field matron whose duties bring her into closer relation¬ ship with the family, especially the mothers and daughters of the home circle, is particularly charged with the responsibility of developing higher standards of living. She visits the homes, renders such assistance as is possible in cases of illness, assists in hospitalization and works with the agency physicians in their reservation health work* Realizing the vast importance of this service from a standpoint of health and sanitation the Commissioner, Hon* Chas* Burke, has been successful in obtaining cooperation from the American Red Cross society which society is sending a limited number of nurses onto the reservations for the purpose of studying the requirements for an efficient service of this kind and they will cooperate with him in suggesting appropriate plans for increasing the realm of this activity. The administrative duties of the Washington Office includes the changes in personnel, construction, and repair of hospitals, purchase of medical and hospital supplies and all other expenditures for health work, to¬ gether %ith the allotment of such funds as are necessary and available* In¬ structions from this section are issued through the superintendents to the field employees and direct to the supervisors, special physicians, and den¬ tists . There are at present 336,337 Indians in the United States includ¬ ing the Five Civilized Tribes* Many of them are citizens and tax payers* While ,the Indians are scattered through the country, the largest number, 119,255, are in Oklahoma* In general, the majority are in the States of the West and Southwest as Arizona, New Mexico, South Dakota, etc* The duties of the Medical Supervisor are of the same general character as those of the Chief Medical Supervisor, though somewhat more restricted in scope. - 5 - The Special physicians r ptf the Indian Service are primarily specialists in trachoma and other diseases of the eye, ear, nose, and throat They select many cases for hospitalization at the various jurisdictions. In addition they are frequently detailed in emergencies to take charge of epi¬ demics, fill special assignments, etc* They report fully on the work accom¬ plished and the sanitary conditions to the Commissioner on each jurisdiction in their districts. The general description of their districts is mentioned in another paragraph. The traveling nurses accompany the special physicians, assisting them in their work and taking charge of the medical and surgical bases operated on or treated by the Special physician. In addition to the foregoing provisions for the health of the Indians there are at many of the schools in the Service supervised play grouifds with appropriate equipment and many of the larger schools are provided with modern gymnasiums. Special provisions are made in the course of study for the physi¬ cal development of the pupils. To obtain a comprehensive idea of the progress that has been made in medical activities'and the magnitude of the task of establishing an effi¬ cient medical service, it is necessary to consider that modern medicine, surgery and hospitals were all foreign to the inherited Indian nature* The earlier Indians were and some of the older ones are to this day skeptical as to the value of this science. In most instances their original medical procedures^ were closely allied to their religionsand the process of diverting or changing their nature from inherited customs centuries old to our present advancement of medical science has required careful study of their nature, and the gradual application of such measures as tended to promote confidence in the results of our medical procedures. The remnants of the earlier periods of Indian life with their oya y to tribal customs regarding mode of habitation and the art of healing the sic has in many instances led the occasional observer of Indian life to the errone¬ ous conclusion that the Indian is not being'properly cared for and that he is being neglected by the Government* However, the brief foregoing descrip ion of the medical facilities and tche increasing progress that is being made u y indicates, in view of the natural Indian customs to be overcome, a mos rapi advancement. Health conditions in general among the Indians are influence y e same factors that influence the health of a circumscribed wh-ute communi /, epidemics, climatic conditions, economic disturbances, etc*, have o e s.ne effect upon them that they do to a white community. As these con i ions p n themselves on the various reservations specialists employed by the Bureau are immediately sent to the reservation in question with instructions o c.rr c the conditions found and outline a plan for general health improvemen For example it has just recently- d ^ e ^ P ^. a ^^ a ^tubercul!sis^"and on the Blackfect Reservation an unusual commissioner of Indian dental caries. As a result of this inform -it ructions- a special physician, Affairs immediately assigned, by to ^-e-vat-ion with instructions to a field nurse, and a field dentist to the And surgical action as is examine each individual and to apply such, medical and surgi possible in each instance. - 6 - The Indian" O'frlce^'a-voitis’;' ac ■ f~a-r'as-is practicable the application of stringent measures requiring the Indian to accept recognized medical or surgical services* It is a custom among our white population to select the mode. of. treatment consistent, with their v^ev/s and whilelvevery opportunity of. pereuasion is used to obtain consent* for• hos-pitaiizatior^windng the Indians, and acceptance, of .rapdip 51 I '.services, except .in rare instances .as in epidemics, etc*, forcible. measures are not employed among’the older Indians. With'the" pupils in the schools careful professional attention is given each case of illness. Through education and with a knowledge of Indian riat'ufe, the workers ihe Bureau*are gradually and progressively convincing the Indian people of the value and comfort to be derived from, modem medical and hospital facili¬ ties* . ,; ;7 . . „ , .. .. , , . With.the education of the Indian people,to the value of our medical science the corresponding financial necessities have annually increased^ each succeeding year finds