UC San Diego

Beginning in the 1830s, a nascent federal Indian health care system emerged in conjunction with the acquisition of indigenous lands. This system began with provisions for physicians’ care and the distribution of smallpox vaccines. It expanded over the course of the 1840s and 1850s to include the employment of physicians across reservation, the deployment of military and civilian physicians to treat Native peoples at the centers of smallpox outbreaks, and federal funds for the construction of reservation hospitals. This expansion of federal power in the West served both federal and Native interests. For some Native peoples, engaging in health care services was an adaptive strategy at a time when the power dynamics between themselves and the federal government had shifted dramatically. Removal and the westward expansion of America’s white settler population exposed many Native peoples to the spread of infectious diseases. While many retained and utilized their traditional healers, the flexibility of indigenous world views and medical practices allowed for the integration of federal health care services into their communities. Physicians, however, were first and foremost agents of the state. Their care helped facilitate removal, appease moral apprehensions over the direction of US-Indian policy, protect white settler communities at the periphery, and held promise to support a healthy labor force.

Federal responsibility and oversight of Native health became part of the bureaucratic administration of Indian Affairs in 1873 with the formation of a Medical and Educational Division. Within this structure physicians helped the federal government to construct Native health as a marker of racial and cultural difference, as the product of behavior rather than the result of governmental policies. Within this new structure, physicians provided the state with justification for its increasingly invasive intervention into Native lives. Examining the expanding role of physicians alongside the bureaucratization of Indian health services connects this project to the broader national narrative of the expansion of federal power and governance in the second half of the nineteenth century, particularly the changes and transformations during the period of Reconstruction. It also reveals how the extension of empire evolved into political contestations not only over land, but also Native bodies.