By: Lewis Meriam
Date: February 21, 1928
Source: Meriam, Lewis. The Problem of Indian Administration. Report of a Survey made at the request of the Honorable Hubert Work, Secretary of the Interior, submitted to him on February 21, 1928. Institute for Government Research Studies in Administration. Baltimore, Md.: Johns Hopkins Press, 1928. Available online at http://www.alaskool.org/native_ed/research_reports/IndianAd... ; website home page: http://www.alaskool.org/ (accessed January 29, 2003).
About the Author: In 1906, Lewis Meriam graduated from Harvard with a law degree and a master's degree in government and economic studies. In 1916, he joined the staff of the newly organized Institute of Government Relations (IGR). The IGR was founded by a select group of progressive social scientists and Republican businessmen who sought to bring nonpartisan budgetary efficiency to the executive appropriation process. In 1926, the IGR became the Brookings Institution, a nonpartisan, independent research organization.
For nearly four centuries, Native Americans have been subjected to numerous methods designed to assimilate them into "civilized" Euro-American society. The most effective means has been formal education. The earliest attempt to educate Native Americans began in Jamestown. In 1616, John Rolfe and his wife Pocahontas sailed to England and successfully lobbied the King of England to contribute substantial revenue to establish an Indian college. In 1622, Henrico College was set to open, but the endeavor failed following the Indian slaughter of 347 colonists. As a result, colonists were more concerned with warring with the tribes than with educating them.
In the early decades of the nineteenth century, the U.S. government accepted partial responsibility for Native American education, funding missionaries who established reservation schools aimed at "Christianizing the heathen savages" so that they could be rapidly absorbed into white civilization. After the Civil War, the government assumed more direct responsibility for Native American education by establishing off-reservation boarding schools, reservation-based day schools, and industrial schools. In 1889, the course of Indian education was dramatically altered with the appointment of Thomas Jefferson Morgan as commissioner of the Bureau of Indian Affairs. Morgan announced that the federal government would be solely responsible for Native American education, as it would no longer delegate such responsibilities to religious groups. In addition, he sought dramatic increases in federal funding to increase the number of Indian schools. From 1889 to the end of the century, the number of Indian schools increased from 239, with 11,552 students, to 307 schools with 21,568 students. Over this period, federal appropriations increased from $1.3 million to $3 million.
The government's expanded involvement in Native American education paradoxically resulted in greater health risks for its beneficiaries. As more and more children crowded into government schools, the incidence of contagious diseases skyrocketed, causing increased rates in morbidity. In 1912, President William Howard Taft sent a special message to Congress on Indian health. The president revealed that in many parts of Indian country, the death rate was 35 per 1,000, compared to 15 per 1,000 for the United States as a whole. In response, Congress urged the U.S. Public Health Service to conduct a wideranging study. Out of an estimated 322,715 Native Americans, the agency examined an 40,000. The study revealed that Indian schools were generally overcrowded, unsanitary, and served poor food. As a result, the study concluded, nearly 30 percent of Native American children living at boarding schools had contracted the eye disease trachoma, which had quickly spread to the reservations when the students returned home to visit. In addition, the study found that tuberculosis was rampant.
In response to President Taft's concerns, Congress over the next several years increased annual appropriations to combat disease and alleviate poor living conditions among Native Americans. However, the public health of Native Americans failed to improve. In the 1920s, reformer John Collier, president of the American Indian Defense Association, along with John D. Rockefeller lamented the state of Indian health. They charged the government with inefficiency and corruption and demanded that an independent entity investigate the agency. In 1926, the Brookings Institution launched a comprehensive survey of Indian public health. Its findings and recommendations were widely distributed. Embarrassed into action by public outrage over the poor treatment of Native American children, the Hoover administration almost doubled spending on Indian schools between 1928 and 1933.
Primary Source: The Problem of Indian Administration [excerpt]
SYNOPSIS: In 1926, social scientist Lewis Meriam and his research team spent seven months investigating the conditions of Native Americans. They visited ninety-five reservations, agencies, hospitals, and schools, as well as many off-reservation Indian communities. Meriam argued that insufficient funds resulted in poor health, particularly among children. The following excerpt is from Chapter 1 of his report.
General Summary of Findings
The Conditions Among the Indians
An overwhelming majority of the Indians are poor, even extremely poor, and they are not adjusted to the economic and social system of the dominant white civilization.
The poverty of the Indians and their lack of adjustment to the dominant economic and social systems produce the vicious circle ordinarily found among any people under such circumstances. Because of interrelationships, causes cannot be differentiated from effects. The only course is to state briefly the conditions found that are part of this vicious circle of poverty and maladjustment.
The health of the Indians as compared with that of the general population is bad. Although accurate mortality and morbidity statistics are commonly lacking, the existing evidence warrants the statement that both the general death rate and the infant mortality rate are high. Tuberculosis is extremely prevalent. Trachoma, a communicable disease which produces blindness, is a major problem because of its great prevalence and the danger of its spreading among both the Indians and the whites.
The prevailing living conditions among the great majority of the Indians are conducive to the development and spread of disease. With comparatively few exceptions, the diet of the Indians is bad. It is generally insufficient in quantity, lacking in variety, and poorly prepared. The two great preventive elements in diet, milk, and fruits and green vegetables, are notably absent. Most tribes use fruits and vegetables in season, but even then the supply is ordinarily insufficient. The use of milk is rare, and it is generally not available even for infants. Babies, when weaned, are ordinarily put on substantially the same diet as older children and adults, a diet consisting mainly of meats and starches.
The housing conditions are likewise conducive to bad health. Both in the primitive dwellings and in the majority of more or less permanent homes which in some cases have replaced them, there is great overcrowding, so that all members of the family are exposed to any disease that develops, and it is virtually impossible in any way even partially to isolate a person suffering from a communicable disease. In certain jurisdictions, notably the Osage and the Kiowa, the government has stimulated the building of modern homes, bungalows, or even more pretentious dwellings, but most of the permanent houses that have replaced primitive dwellings are small shacks with few rooms and with inadequate provision for ventilation. Education in housekeeping and sanitation has not proceeded far enough so that the Indians living in these more or less permanent shacks practice ventilation and domestic cleanliness. From the standpoint of health, it is probably true that the temporary, primitive dwellings that were not fairly air-tight and were frequently abandoned were more sanitary than the permanent homes that have replaced them. The furnishing of the primitive dwellings and of the shacks is limited. Although many of them still have very primitive arrangements for cooking and heating, the use of modern cook stoves and utensils is far more general than the use of beds, and the use of beds in turn is far more common than the use of any kind of easily washable bed covering.
Sanitary facilities are generally lacking. Except among the relatively few well-to-do Indians, the houses seldom have a private water supply or any toilet facilities whatever. Even privies are exceptional. Water is ordinarily carried considerable distances from natural springs or streams, or occasionally from wells. In many sections the supply is inadequate, although in some jurisdictions, notably in the desert country of the Southwest, the government has materially improved the situation, an activity that is appreciated by the Indians.
The income of the typical Indian family is low and the earned income extremely low. From the standpoint of the white man, the typical Indian is not industrious, nor is he an effective worker when he does work. Much of his activity is expended in lines which produce a relatively small return either in goods or money. He generally ekes out an existence through unearned income from leases of his land, the sale of land, per capita payments from tribal funds, or in exceptional cases through rations given him by the government. The number of Indians who are supporting themselves through their own efforts, according to what a white man would regard as the minimum standard of health and decency, is extremely small. What little they secure from their own efforts or from other sources is rarely effectively used.
The main occupations of the men are some outdoor work, mostly of an agricultural nature, but the number of real farmers is comparatively small. A considerable proportion engage more or less casually in unskilled labor. By many Indians several different kinds of activity are followed spasmodically: a little agriculture, a little fishing, hunting, trapping, wood cutting, or gathering of native products, occasional labor and hauling, and a great deal of just idling. Very seldom do the Indians work about their homes as the typical white man does. Although the permanent structures in which they live after giving up primitive dwellings are simple and such as they might easily build and develop for themselves, little evidence of such activity was seen. Even where more advanced Indians occupied structures similar to those occupied by neighboring whites, it was almost always possible to tell the Indian homes from the white by the fact that the white man did much more than the Indian in keeping his house in condition.
In justice to the Indians, it should be said that many of them are living on lands from which a trained and experienced white man could scarcely wrest a reasonable living. In some instances the land originally set apart for the Indians was of little value for agricultural operations other than grazing. In other instances part of the land was excellent but the Indians did not appreciate its value. Often when individual allotments were made, they chose for themselves the poorer parts, because those parts were near a domestic water supply or a source of firewood, or because they furnished some native product important to the Indians in their primitive life. Frequently the better sections of the land originally set apart for the Indians have fallen into the hands of the whites, and the Indians have retreated to the poorer lands remote from markets.In many places crops can be raised only by the practice of irrigation. Many Indians in the Southwest are successful in a small way with their own primitive systems of irrigation. When modern, highly developed irrigation systems have been supplied by governmental activities, the Indians have rarely been ready to make effective use of the land and water. If the modern irrigation enterprise has been successful from an economic standpoint, the tendency has been for whites to gain possession of the land either by purchase or by leases. If the enterprise has not been economically a success, the Indians generally retain possession of the land, but they do not know how to use it effectively and get much less out of it than a white man would.
The remoteness of their homes often prevents them from easily securing opportunities for wage earning, nor do they have many contacts with persons dwelling in urban communities where they might find employment. Even the boys and girls graduating from government schools have comparatively little vocational guidance or aid in finding profitable employment.
When all these factors are taken into consideration, it is not surprising to find low incomes: low standards of living, and poor health.…
The Work of the Government in Behalf of the Indians
The work of the government directed toward the education and advancement of the Indian himself, as distinguished from the control and conservation of his property, is largely ineffective. The chief explanation of the deficiency in this work lies in the fact that the government has not appropriatedenough funds to permit the Indian Service to employ an adequate personnel properly qualified for the task before it.
Absence of Well-Considered, Broad Educational Program
The outstanding evidence of the lack of an adequate, well-trained personnel is the absence of any well considered, broad educational program for the Service as a whole. Here the word education is used in its widest sense and includes not only school training for children but also activities for the training of adults to aid them in adjusting themselves to the dominant social and economic life which confronts them. It embraces education in economic production and in living standards necessary for the maintenance of health and decency.
Work for the Promotion of Health
The inadequacy of appropriations has prevented the development of an adequate system of public health administration and medical relief work for the Indians. The number of doctors, nurses, and dentists is insufficient. Because of small appropriations the salaries for the personnel in health work are materially below those paid by the government in its other activities concerned with public health and medical relief, specifically the Public Health Service, the Army, the Navy, and the Veterans' Bureau, as well as below those paid by private organizations for similar services. Since its salaries are sub-standard, the Indian Service has not been able to set reasonably high entrance qualifications and to adhere to them. In the case of doctors, the standards set for entrance have been too low. In the case of public health nurses the standards have been reasonable, but it has not been possible to secure at the salary offered a sufficient number of applicants, so that many people have to be employed temporarily who do not possess the required qualifications. Often untrained, inexperienced field matrons are attempting to perform duties which would be fairly difficult for a well-trained, experienced public health nurse. For general nursing positions, it has often been necessary to substitute for properly trained nurses, practical nurses, some of whom possess few qualifications for the work.
The hospitals, sanatoria, and sanatorium schools maintained by the Service, despite a few exceptions, must be generally characterized as lacking in personnel, equipment, management, and design. The statement is sometimes made that, since the Indians live according to a low scale, it is not necessary for the government to furnish hospital facilities for them which are comparable with those supplied for poor white people in a progressive community. The survey staff regards this basis of judging facilities as unsound. The question is whether the hospitals and sanatoria are efficient institutions for the care and treatment of patients, and this question must generally be answered in the negative.
Although the present administration has made a praiseworthy forward step in the reorganization of the Indian medical service and has secured from the Public Health Service a well-qualified director for the chief position, it is hampered at every turn by the limitations of its present staff and equipment and by lack of funds for development. Under the present administration, too, a real beginning has been made in public health nursing. Despite these recent promising developments, it is still true that the Indian Service is markedly deficient in the field of public health and preventive medicine. The preventive work in combating the two important diseases of tuberculosis and trachoma can only be characterized as weak. The same word must be applied to the efforts toward preventing infant mortality and the diseases of children. Here and there some effective work is done in maternity cases, just about enough to demonstrate that competent, tactful physicians can induce a very considerable number of Indian women to have professional care in childbirth and to advance beyond the crude, unsanitary, and at times, even brutal primitive practices.
Another striking need is for the development of the public health clinic, an agency extremely effective in locating cases of tuberculosis and other communicable diseases in their incipiency and thus permitting of the early treatment of the sufferer when there is still chance to help him, and also making it possible to exercise some control over contagion. The number of public health clinics in the Indian Service is small, and the two or three deserving the name are of recent origin and are not adequately equipped.
Vital statistics have been called the handmaid of preventive medicine. They are indispensable for the efficient planning, development, and operation of a sound program for conservation of public health. The Indian Service has not yet been successful in overcoming the great difficulties inherent in securing vital statistics for the Indians and, moreover, its physicians in general have tended to neglect the important work of keeping case histories and other records basic to a public health program. The result is that the directing personnel of the Indian Service and the Department of the Interior, the Bureau of the Budget, and Congress and its committees lack the information essential for planning, development, and control. Under such circumstances it is inevitable that some of the money actually appropriated and expended will be wasted, if it is not almost equally inevitable that appropriations will not be proportional to needs.
Because of these numerous defects in the medical service, it is not surprising to find that serious errors have been made in the treatment of Indians suffering from trachoma. Practically entirely ignoring the view held by many students of the disease that a close relationship exists between trachoma and dietary deficiencies, the Service for some years pinned its faith on a serious, radical operation for cure without carefully watching results and checking the degree of success achieved. The Service has now recognized the marked limitations of this radical procedure and has stopped its wholesale use. Serious errors of this nature are likely to occur in a service which is so seriously understaffed that following up cases and checking results are neglected. This serious operation was unquestionably performed on many Indians who did not need it, and, because of the difficulties in diagnosis of trachoma, upon some Indians who did not even have the disease.
Formal Education of Indian Children
For several years the general policy of the Indian Service has been directed away from the boarding school for Indian children and toward the public schools and Indian day schools. More Indian children are now in public schools maintained by the state or local governments than in special Indian schools maintained by the nation. It is, however, still the fact that the boarding school, either reservation or nonreservation, is the dominant characteristic of the school system maintained by the national government for its Indian wards.
The survey staff finds itself obliged to say frankly and unequivocally that the provisions for the care of the Indian children in boarding schools are grossly inadequate.
The outstanding deficiency is in the diet furnished the Indian children, many of whom are below normal health. The diet is deficient in quantity, quality, and variety. The effort has been made to feed the children on a per capita of eleven cents a day, plus what can be produced on the school farm, including the dairy. At a few, very few, schools, the farm and the dairy are sufficiently productive to be a highly important factor in raising the standard of the diet, but even at the best schools these sources do not fully meet the requirements for the health and development of the children. At the worst schools, the situation is serious in the extreme. The major diseases of the Indians are tuberculosis and trachoma. Tuberculosis unquestionably can best be combated by a preventive, curative diet and proper living conditions, and a considerable amount of evidence suggests that the same may prove true of trachoma. The great protective foods are milk and fruit and vegetables, particularly fresh green vegetables. The diet of the Indian children in boarding schools is generally notably lacking in these preventive foods. Although the Indian Service has established a quart of milk a day per pupil as the standard, it has been able to achieve this standard in very few schools. At the special school for children suffering from trachoma, now in operation at Fort Defiance, Arizona, milk is not part of the normal diet. The little produced is mainly consumed in the hospital where children acutely ill are sent. It may be seriously questioned whether the Indian Service could do very much better than it does without more adequate appropriations.
Next to dietary deficiencies comes overcrowding in dormitories. The boarding schools are crowded materially beyond their capacities. A device frequently resorted to in an effort to increase dormitory capacity without great expense is the addition of large sleeping porches. They are in themselves reasonably satisfactory, but they shut off light and air from the inside rooms, which are still filled with beds beyond their capacity. The toilet facilities have in many cases not been increased proportionately to the increase in pupils, and they are fairly frequently not properly maintained or conveniently located. The supply of soap and towels has been inadequate.
The medical service rendered the boarding school children is not up to a reasonable standard. Physical examinations are often superficial and enough provision is not made for the correction of remediable defects.
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