November 8, 2007
Building the System: Churches, Missionary Organizations, the Federal State, and Health Care in Southern Alberta Treaty 7 Communities, 1890-1930
By Burnett, Kristin
This essay looks at the evolution of institutional structures of western health care in First Nations communities in southern Alberta from 1880 to 1930. During the 1890s various churches and their missionary organizations built cottage hospitals, school infirmaries, and dispensaries in Blackfoot, Peigan, Blood, Stoney, and Tsuu T'ina communities. In order to pay for these facilities churches formed a partnership with the federal government, similar to the existing one around education. European-Canadian women, under the auspices of missions and later employed by the Department of Indian Affairs, were front line health-care workers in Native communities, and occupied a central role in the creation and operation of these institutions. Indeed, the churches and their female workers laid the foundations for the state-run apparatus that emerged in the years before and after the First World War. Cet essai examine l'evolution des structures institutionnelles des soins de sante de l'Ouest au sein des communautes des Premieres Nations, dans le sud de l'Alberta, de 1880 a 1930. Durant les annees 1890, plusieurs eglises et leurs organisations missionnaires construisirent des hopitaux en zone rurale, des infirmeries dans les ecoles et des dispensaires dans les communautes de Blackfoot, Peigan, Blood, Stoney et Tsuu T'ina. Dans le but de financer ces institutions, les eglises creerent un partenariat avec le gouvernement federal, semblable a celui qui existait en enseignement. Les Europeennes-canadiennes, d'abord sous l'egide des missions, puis embauchees par le ministere des Affaires indiennes, furent des travailleuses de la sante de premiere ligne aupres des communautes autochtones et jouerent un role majeur dans la creation et le fonctionnement de ces institutions. Ce sont en effet les eglises et leurs travailleuses qui ont jete les fondations de l'appareil public qui vit le jour dans les annees qui precederent et qui suivirent la Premiere Guerre mondiale.
The late nineteenth and early twentieth centuries marked a period of tremendous expansion in the state and church bureaucracies that managed First Nations people in western Canada. One area that witnessed particular growth was the apparatus intended to deal with Native health. Beginning in 1890, the Methodist, Anglican, and Roman Catholic churches and their missionary organizations established hospitals, school infirmaries, and dispensaries on the five reserves that comprised the Treaty 7 area in southern Alberta. These institutions were created to address both the ill-health prevalent in the Blood, Peigan, Blackfoot, Tsuu T'ina, and Stoney communities and to combat the continued use of Indigenous medical practices among First Nations people. Staffed primarily by female attendants, the western health-care institutions that emerged in Treaty 7 during this period were piecemeal and lacked both a clear direction and a central organization. As a result, the character, size, quality, staffing, and longevity of church-run institutions varied considerably between reserves, and often depended upon the success of individual missionaries. None the less, this mission-based system formed the foundation for an emerging colonial healthcare regime in southern Alberta, and was eventually responsible for compelling the federal government to adopt a more active role in the provision of medical and nursing care for First Nations people.
An examination of health-care institutions created by missions and the nursing care and medical work of female missionaries among Treaty 7 peoples not only illustrates the genesis of the colonial health-care system in southern Alberta, but also offers an explanation as to the form and shape that Indian Health Services assumed during the first half of the twentieth century. Under the Department of Indian Affairs (DIA), the hospitals, school infirmaries, and dispensaries, first established by mission organizations, formed the foundations of Indian Health Services (IHS), and the affordable and available labour of female workers remained essential to the maintenance of this system. Health and health care in Native communities formed a patchwork of experiences rather than a universal model. Studying a particular regional experience is critical for a more sophisticated understanding of how colonialism operated differently according to space and place.
A great deal of scholarly attention has recently been paid to the impact and experience of health and disease among indigenous peoples in North America. Of particular note in the Canadian context are two works by historians Maureen Lux and Mary-Ellen KeIm (Lux 2001; KeIm 1998). Lux and KeIm outline the introduction of western medicine to First Nations people during the late nineteenth and early twentieth centuries in the Prairie West and British Columbia, respectively. Dispelling the myth of Aboriginal bodies as inherently sickly, Lux and KeIm explore the relationship between, on the one hand, rates of morbidity and mortality, and, on the other, poor rations, insufficient clothing, and inadequate housing. Confined to reserves, cut off from hunting and gathering activities, and subjected to the harsh governance of federal authorities, Native peoples were less able to combat and rebound from ill-health. Lux has noted that similar circumstances prevailed in southern Alberta.
Focussing on a discrete treaty area builds on the work of Lux and KeIm by shedding further light on the roots of Indian Health Services. In spite of the weight given male medical doctors and DIA institutions in the documentary record, European-Canadian women and the churches participated in the genesis of colonial health-care regimes. Missionary organizations and government agencies relied on the labour of women because it was more readily available and less expensive than that of male doctors. Indeed, highlighting women's healing and nursing work in Treaty 7 communities reveals the key roles Catholic orders and Protestant missionaries played in designing and building western medical services on Treaty 7 reserves, often pulling the reluctant federal government into funding institutions and personnel.
Five tribes, the Blackfoot, Blood, Peigan, Tsuu T'ina, and Stoney living in the southern portion of present-day Alberta, signed Treaty 7 in 1877. The Treaty 7 area was delineated by the federal government for administrative expediency because of the geographical proximity of the five tribes. To the west of Calgary, three Stoney bands took land near what once was the Morleyville mission. The Tsuu T'ina chose a reserve west of present-day Calgary, and today the Tsuu T'ina reserve lies on the western outskirts of the ever- expanding city. The three tribes of the Blackfoot Nation were not allowed to reside on one large reserve. Instead, the Blackfoot took land east of Calgary, just south of the village of Cluny. The Blood originally took land adjacent to the Blackfoot tribe, but this area was only four miles wide and was located in one of the driest regions of southern Alberta. As a result, in 1883, the Blood renegotiated the treaty and took land between the Belly and St. Mary rivers south of Fort Macleod, making it the largest reserve in Canada (Dempsey 1988, 22). The Peigan took land to the west of Fort Macleod.
From a Native perspective, Treaty 7 created, according to interviews performed with Treaty 7 Elders in the early 1990s, a "relationship of mutual obligation" that also extended to the provision of medical care (Treaty 7 Elders and Tribal Council et al. 2002, 319). In contrast, the federal government did not believe that the treaty system created a legal obligation to offer medical care. Thus, the entry of the federal government into providing medical services for Native peoples was not an easy process, and when the DIA was established in 1880, the government made no formal provisions for medical services. Indeed, according to the British North America Act of 1867, medical services were under provincial jurisdiction, while federal authority over medical affairs was restricted to immigrant health and quarantine. For example, when the DIA hired a North West Mounted Police (NWMP) surgeon after 1877 to monitor the health of Treaty 7 people, the surgeon's responsibilities were limited to vaccination and quarantine.
Health services for Canadian citizens were regarded as a local concern and usually fell to municipal authorities; however, provincial and city governments were reluctant to offer health services to Native peoples because Aboriginal peoples were not considered Canadian citizens, did not pay taxes, and were under federal jurisdiction in all other matters. Consequently, responsibility for Native health was unclear, and historians who have examined the health and health care of First Nations peoples in Canada have found that concern for Native well-being by federal, provincial, or municipal governments was usually precipitated by alarm for the supposed health risks Natives posed to European- Canadian communities (Lux 2001, 143-88).
During the late nineteenth and early twentieth centuries, the provision of medical care to Native peoples in western Canada can be compared to the administration of relief by the government. Social welfare was not considered a responsibility of the state in the nineteenth century. The government feared that any kind of "charity" would erode Aboriginal peoples' independence and encourage dependence (Shewell 2004, 30-31). Ottawa regarded the provision of medical care as an act of charity and was determined to make sure that only the neediest of Native peoples were given "free" medical aid. When medical treatment was given, the DIA strove to distinguish between deserving and undeserving Aboriginal peoples. Indian agents were required to swear that a patient was destitute before any aid would be rendered (Reed 1877). The drugs purchased by the DIA were intended to be those given to the poorest class of European- Canadians, and doctors were cautioned to exercise the greatest discretion when sending patients to off-reserve hospitals for treatment (McLean 1899; Assistant Indian Commissioner 1890; Indian Commissioner 1893). DIA employees were regularly admonished by DIA officials to reduce medical costs and refrain from calling doctors to treat "trifling ailments which with medicines and comforts at hand might be treated as satisfactorily by an intelligent farming instructor" (Deputy Superintendent 1885; Reed 1887a, 1887b). Indian agents and farm instructors employed by the federal government, with no real medical training or knowledge, were expected to diagnose patients and offer treatment from a "medicine chest" supplied by the DIA.1 The medicine chest clause was included in Treaty 6. According to historian Kathryn McPherson, this clause was interpreted narrowly by the federal government to refer only to medical supplies, and not a comprehensive system of health services (2003, 226). As a result, the medicine chest was quite literally a box (or container of some sort) comprised of basic medicines supplied by the DIA and dispensed by the Indian agent, farm instructor, or local missionary. Even those Indian agents who complied with the department's restrictions faced criticism from within the department. In 1893, Agent Lucas, after receiving a reprimand for excessive spending, replied with exasperation, "I do not know of any way that I can reduce the cost of medicine or medical attendance. I do not send for the doctor unless he is urgently needed, not on a specified day each month, as was the case before I took charge of the agency" (1893).
The manner in which medical officers were hired by the DIA also reflected the federal government's desire to practice fiscal constraint. When Fort Macleod was built in 1874, a surgeon named Richard Nevitt was attached to the NWMP division stationed there. Since local Aboriginal groups frequently made use of Nevitt's medical services, the DIA, after Treaty 7 was signed, formalized Nevitt's therapeutic work among Native peoples. In return for $600 a year, the NWMP surgeon vaccinated Aboriginal peoples at treaty payment time and made his services available for all on-call emergencies (1883; Lux 2001,143). This arrangement formally came to an end early in 1883, when the NWMP medical officer was relocated to Calgary and his services became even more difficult to obtain (Dewdney 1983; Wadsworth 1881).
In May 1883, the DIA, under the instruction of Sir John A. Macdonald, hired its first full-time physician in the North-West. As a result, Indian Commissioner Edgar Dewdney appointed Dr. Francis Xavier Girard to the post at a salary of $1,200 a year. According to historian Maureen Lux, Girard's career was illustrative of the problems encountered by Native peoples in their relationships with DIA medical officers over the next 60 years. Originally from Quebec, Girard was living at Fort Macleod when he received his appointment. At first, Girard was responsible for all of the tribes in southern Alberta, but after several years his responsibilities were reduced (Deputy Superintendent 1885; Dewdney 1885; White 1888). Girard was placed in charge of only two reserves, the Blood and the Peigan, at a decreased salary of $1,000 per year (White 1888). Girard was a patronage appointment, and he used the job with the DIA to sustain him while he established a private practice in Fort Macleod. Girard did not gain the confidence of his patients because he did not speak their language, come regularly to the camps, listen to their problems, or visit their homes. Even after it became quite clear that Girard was not performing his duties adequately, he continued to work for the DIA for almost 20 years (White 1888; 1900; Wilson 1897a; Lux 2001, 143-47). During his visits to the reserve, he was known for visiting the Indian agent's house and the Catholic mission, and returning to Fort Macleod without ever having visited any of the camps (Wilson 1897a; Lux 2001, 144).
For the Blackfoot, Sarcee, and Stoney tribes, the DIA reduced medical costs by hiring doctors on a fee-for-service basis. Doctors received $10 for a home visit, $1 per patient for office visits and prescriptions, and 50 cents a mile for travelling expenses (White 1888). The practice of hiring medical officers on a part-time basis reflected the constant negotiation occurring around what the federal government deemed appropriate or necessary medical attention for Native peoples. This system was invariably determined by two competing concerns: cost and the government's efforts to assimilate First Nations people. Unfortunately for Native peoples, cost was the most important factor in determining the shape and nature of the health care services provided by the department.
This tone of fiscal restraint was vigorously endorsed by Hayter Reed, the major architect of Indian policy in the decades leading up to the 190Os. As Indian commissioner from 1883 to 1889 and deputy superintendent general of Indian Affairs from 1893 to 1897, Reed had a great deal of influence in determining the direction of government policy towards Native peoples, and he believed that calling a doctor to attend "sick Indians was becoming an unnecessary and expensive habit" (1887, 1889). According to Reed, Aboriginal peoples were indolent and lazy, and he instituted policies designed to rid Native peoples of these habits (Carter 1990,15-16). Reed's practices were continued under Duncan Campbell Scott, deputy superintendent general of Indian Affairs from 1913 to 1932. Scott had begun working for the DIA in 1880, and by 1891 was placed in charge of the accountant's branch, a division of the department that became very important (Titley 1986, 24). Perhaps Scott's blind commitment to fiscal responsibility grew out of the years he spent directing the DIA's accounting division.
Reed and Scott established government procedures regarding medical services during this period. Attending physicians were told to bill patients directly if they seemed capable of payment themselves. In most cases, Native peoples were held responsible for any bills accrued from off-reserve medical facilities (Pocklington 189O).2 Even during recognized medical emergencies, which affected European-Canadian as well as First Nations communities, Indian agents were quick to assure the department that they would not make any "undue" purchases regarding medicine or rations (McLean 1899; Assistant Indian Commissioner 1890; Indian Commissioner 1893).3 Such cost-cutting measures extended to the hiring of medical staff, making it extremely difficult to engage and retain people who would provide consistent and regular attendance for limited remuneration.
Churches and Missionary Organizations
In contrast, missionary organizations readily involved themselves in the medical care and physical well-being of Aboriginal peoples. Since their arrival on the northwestern plains, male missionaries and their wives had participated in the informal network of nursing care and medical aid that stretched across the Prairies. After the 188Os, missionaries offered basic first aid, medicine, and caregiving to Native peoples at the mission house on reserves. Initially, this labour was an extension of the informal network of mutual aid between Natives and newcomers in the West. Native women provided the wives of missionaries with obstetrical and nursing care, and male missionaries turned to Native healers when they were injured (Burnett 2006, 80-130). The medical and nursing care that missionaries made available to Treaty 7 peoples, however, was intimately connected to their efforts to Christianize and civilize. Mission medicine in Canada, as in other colonial locales, embraced the perspective that disease and ill-health could only be conquered through the adoption of Christian morality, a specific European- Canadian version of family life, and appropriate gender roles (Vaughan, 56-57).
By the 189Os churches and their missionary organizations had already been providing Native peoples with informal medical aid and nursing care in the camps of Aboriginal peoples and mission houses for over a decade. Concerned about deteriorating health and rising medical costs, missionaries approached the federal government for funding on a mission-by-mission basis. Financial support from the federal government enabled churches and their missionary organizations to build small cottage hospitals and school infirmaries, and to employ field matrons, graduate nurses, and female nursing attendants to work at church institutions. This agreement between the federal government and mission organizations accomplished two objectives. First, the arrangement allowed the federal government to give the appearance of participating in the health of Native communities without having to pay entirely for or administer the system. secondly, this agreement created an intimate relationship between missionary institutions in Canada and the federal state, and laid the foundations for what would later become the Indian Health Services. Some missions were far more effective at acquiring federal patronage than others. The precise reason behind the DIA's preferential treatment is unknown. Father Lacombe, for example, approached the DIA for money to build a hospital at the Blood reserve during the early 189Os and acquired the inexpensive and dedicated labour of the Sisters of Charity to run the institution. The DIA supplied the land for the Blood Hospital, donated money towards building the facility, contributed annual maintenance grants, supplied rations for hospital employees, and paid the sisters a modest allowance (Reed 1894; GAI, M742/36, 6 December 1935). During the first year, the hospital was run by five sisters: two nursing sisters, one matron, a housekeeper, and a cook (GNA L049 El, 1, December 1893; L049 El, 2, December 1894; 1894).4 The sisters ran the hospital until 6 September 1954 (GNA Olivier, 2). As a Catholic institution, the hospital did not experience the same difficulties of employing and paying for the salaries of the nursing sisters as many Protestant organizations did over time, and most of the sisters who worked at the hospital remained for decades. Protestant missionary women frequently left their posts due to loneliness, marriage, or pregnancy.
The second hospital built in a southern Alberta First Nations community received only partial funding from the federal government. Like Father Lacombe, Reverend Tims, the Anglican missionary in charge at the Blackfoot reserve, approached the DIA government during the early 189Os to obtain money for a health-care facility. The Anglican mission started construction on the Blackfoot Hospital in 1894 with help from a variety of funding sources: the federal government, the Anglican Church of Canada, and the Toronto Anglican Women's Auxiliary. The original grant from the federal government was insufficient, and although the hospital was built in 1894, it was not completed, furnished, or even occupied until 1897 (UCLSC, box 81: file 18, June 1899; Drees 1996, 164). The building consisted of two wards, one for women and children, and the other for men, with eight beds in each, a bathroom, a dispensary, a kitchen, a hall, a pantry, and seven rooms for the staff quarters (UCLSC, box 81: file 18, June 1899).
Stable financial support from the Toronto Women's Auxiliary was crucial to the success and persistence of the Blackfoot institution. The Blackfoot Hospital would not have been finished without the support of the Toronto Women's Auxiliary, which supplied the linens and furnishings for the nurses' quarters, paid the salaries of three nurses or nursing assistants, and provided an annual maintenance grant (Letter Leaflet, December 1900, 40-41). The Toronto Women's Auxiliary continued to support the Blackfoot Hospital, even forming a Blackfoot Hospital Committee that met annually until 1923, when the federal government, at the insistence of the Blackfoot people, used band funds to erect a new 35-bed hospital (Drees 1996, 165).
The Blood and Blackfoot hospitals were the only facilities in the Treaty 7 area during this period to receive so much financial support from the DIA. Other missions made do with sporadic funding from Ottawa to pay for nurses on an ad hoc basis, equipment, and minor improvements to rundown facilities. None of this funding was long-term, and missions at the Peigan, Sarcee, and Stoney reserves were forced to scramble for money from the churches, women's auxiliaries, and the Women's Missionary Society of the Methodist Church of Canada. Women's auxiliaries and the Women's Missionary Society raised money to pay for the salaries of nurses, equipment, medical supplies, and furniture. In addition, these women's societies also donated clothing, toys, games, and treats for the children.
The Anglican missions at the Blood, Tsuu T'ina, Peigan, and Stoney reserves illustrate well the complicated and precarious financial situation experienced by most church-run health-care institutions in the Treaty 7 area in the late nineteenth and early twentieth centuries. The Anglican missionary at the Peigan reserve, for example, managed to cobble enough money together from the Anglican Church and various women's auxiliaries to build a small cottage hospital-Victoria Home Hospital-near the Anglican residential school. This facility suffered from a lack of stable funding and was regularly without a nurse. The DIA agreed to temporarily pay $25 a month for the salary of a nursing assistant in 1915 (McLean 19ISb). The Victoria Home Hospital functioned principally as a school infirmary and was used to prevent sick children from being sent home to their families (Grain 1914; Lux 2001, 103). Reports from the Victoria Home Hospital reveal that most students sent to the hospital were treated for tuberculosis, and once their health improved they were returned to the school (McLean 1914b; 1914c; Gillespie 1914). The Victoria Home Hospital closed at the end of February 1919 due to a lack of financial support (Graham 1919).
The Anglican mission at the Blood reserve operated in similar circumstances. In this case, the missionary was particularly keen to set up a hospital that could compete with the Catholic institution on the same reserve. Indeed, the Anglicans were fiercely jealous of the Catholic hospital and the funding that the federal government had bestowed on it. The Anglican missionary for the Blood reserve managed to raise money for a building from the Anglican Church, the Society for the Promotion of Christian Knowledge, and various women's auxiliaries. Built in 1896, this short-lived institution did not have a nurse until May 1900, when a small grant from the Huron Women's Auxiliary in Ontario paid for a nurse's salary and finished furnishing the building (UCLSC, December 1896; Report on Indian Missions, 1898, 10; Letter Leaflet, November 1899). Even after the Huron Women's Auxiliary donated money, the facility remained open only part of the year because the Anglicans could not secure a nurse who would remain at such an isolated post (GSA, Report on Indian Missions, 1905).
The Anglican mission among the Tsuu T'ina received even less funding than missions at the Peigan and Blood reserves. In spite of repeated attempts, the missionary in charge was unable to raise enough money to build a hospital. Instead, the Tsuu T'ina Residential School was served by a small school infirmary (Stocken 1892, 7-8; 1894, 403; 1893, 295; UCLSC 10 November, 1898). The proximity of the reserve to Calgary made the erection of a hospital unlikely. The Anglican mission at the Sarcee reserve periodically obtained the services of a graduate nurse to function as both nurse and matron for the residential school (GA, M1356, file 2, 19 February 1897; GA, M1356/6, 22 April 1915; GA, M1356/6, 16 April 1915; McLean 1915a). The nurse's salary was paid for by one of the women's auxiliaries. It was not until 1915 that the DIA provided funding for a full-time trained nurse, and only after the Inspector's report revealed high rates of infection from tuberculosis.
The Methodists were the last mission organization to establish a hospital in southern Alberta, and theirs was among the Stoney. This mission received very little funding from the federal government. The life of the small cottage hospital was intimately connected to the school it served and to Women's Missionary Society funding. Maureen Lux has outlined the relationship that existed between hospitals and schools. Residential schools, as an integral part of the department's civilizing program, were priorities when it came to federal funding for medical care (Lux 2001, 138-39). Thus, the tenure of infirmaries or small hospitals built inside or near residential institutions was closely connected to the life of the schools and the students they serviced.
The hospital attached to the McDougall Residential School was erected by the Methodists in 1906. During its tenure, the hospital possessed only one staff member, a female missionary with nursing training whose salary and board were paid for by the WMS (Laing n.d.; Shore 1910). Occasionally a field matron, also employed by the Women's Missionary Society, assisted the nurse. The hospital accommodated eight patients. In 1908, tents were used to enlarge the Stoney hospital to 28 beds and to serve as an isolation ward for tuberculosis patients (Laing 1908). Students from the McDougall Residential School were the institution's primary patrons, and this facility did not outlive the closure of the school in 1910. Another health-care facility was eventually established by the DIA on the reserve in the late 1930s (Laing n.d.; Shore 1910).
While DIA funding of church-run hospitals, school infirmaries, and dispensaries was mainly parsimonious, the federal government none the less fully endorsed the ideological agenda of missionary health initiatives. The DIA believed that Native peoples who did not make use of western medical facilities showed a blatant disregard for the health and well-being of their communities. Thus, after 1915, the DIA expected all of the actual medical work on the reserve to take place in hospital settings, and complained bitterly when it did not. Many European-Canadian women, experienced with providing health care in Native communities, continued to offer their nursing and caregiving skills in the homes of Aboriginal peoples scattered across the reserve.
Front-line Health Care Workers
Those historians who have looked at the provision of western medicine to Native peoples in western Canada have largely overlooked the curative labours of the women hired first by mission organizations and then later by the DIA (Waldram, Herring, and Young 1995; Lux 2001). The irregular attendance and expense of biomedical doctors made the labour of European-Canadian women essential, and as a result those working on Treaty 7 reserves performed a wide range of therapeutic, social service, and educational functions. At the hospitals and schools, female medical missionaries, graduate nurses, nursing sisters, and attendants cared for patients, oversaw necessary treatments, ran the dispensary, and prepared meals for outpatients. The majority of dispensary work at the hospitals was undertaken by graduate nurses or nursing sisters, and the physical isolation and immediate needs of patients necessitated that female attendants go beyond the boundaries of their usual duties. The majority of the day-to-day healing work took place at the dispensary at the hospital or near the Indian agent's house. At the Blood Hospital in June 1911, there were six inpatients and 308 dispensary cases, and in November 1912, 327 dispensary cases compared to 18 inpatients (Blood Hospital 1911). Similarly the Blackfoot Hospital cared for 85 inpatients in 1897-98 and 2,139 dispensary cases (UCLSC, Report on Indian Missions, 1897-1898, 8). In a letter to the Anglican Toronto Women's Auxiliary, Alice Turner described the importance of the hospital dispensary to her community when she wrote "the dispensary is open from early morning till late at night and the Indians very few of whom have clocks, come at all hours for their daily dressings" (1897, 250).
European-Canadian women also provided medical aid, nursing care, social services, and personal and domestic hygiene instruction in the homes and camps of Native peoples. When women worked outside of DIA institutions in the homes of Aboriginal peoples, they had to make a broader range of medical services available. The physical isolation and the immediate needs of their patients necessitated that female attendants go beyond the boundaries of their usual duties because reporting symptoms to a doctor and waiting for his arrival was not a reasonable solution, particularly in emergency situations. In certain instances, nurses went almost entirely without the assistance of a doctor. This was the case at the hospital on the Morley reserve. Margaret Laing, an experienced medical missionary, was hired by the Methodist Women's Missionary Society in 1906 to establish and run the Morley Hospital. Laing had received her nursing training at the General Hospital in Guelph, Ontario, before she spent a year at the Methodist National Training School in 1900. Laing's first mission posting was in Kanazawa, Japan, from 1900 to 1905 before she was stationed among the Stoney from 1906 to 1910.
While working at the Morley Hospital, Laing was rarely supervised by the DIA medical officer. As a result, she examined patients, made diagnoses, and decided on the appropriate course of treatment by herself (UCC, Biographical files, Miss K. Margaret Laing). During her tenure on the reserve, Laing cared for cases of venereal disease, set broken arms, and examined all children under five for tuberculosis (Laing 1908). Although she worked in the small hospital attached to the Morley residential school, much of her medical work took place in the homes of Nakoda residents, who were scattered across the reserve, and the help of the DIA medical officer, who lived in Calgary, would have been impossible to acquire in most circumstances. Laing relied on her own knowledge and skills to deal with most medical situations.
Religious organizations also understood the therapeutic and economic value offered by nurses' work. The visits of DIA medical officers were unpredictable, expensive, and sometimes had limited ameliorative value. Whether formally trained or not, the less costly work of European-Canadian women met the financial constraints of church-run institutions. The fathers at St. Joseph's Industrial School east of High River, Alberta, complained that no benefits were derived from the formal, hurried, and intermittent physician's visits (LAC RG10/3933: file 117, 657-1, 18 November 1911). As an alternative, the fathers suggested that medical decisions at St. Joseph's be left in the hands of Sister Kelly, the Sister Superior at the school (1911). Sister Kelly, although she was not a graduate nurse, had years of hospital experience, was skilled in ordinary diagnosis and the treatment of simple illnesses, knew first aid, and was trained as a pharmacist. Thereafter, the services of the DIA medical officer were retained on an on-call basis, a decision left to the discretion of Sister Kelly (1911).
The financial relationship that developed between the federal state and the churches facilitated the establishment of western health care on reserves in southern Alberta. Catholic orders and Protestant missionary organizations, concerned about the poor health of their congregations in the Treaty 7 area, expanded their health- care work to include hospitals, dispensaries, and school infirmaries, and pressed the DIA to fund these new initiatives. The transition from a church-based system to state-run health care was not an easily demarcated process. Lay female nursing attendants did not outnumber medical missionaries on Treaty 7 reserves until the mid-1920s, and in some institutions, like the Blood Hospital, women with strong religious affiliations continued to blend religion and western biomedicine until well into the 1950s and beyond. The less- expensive labour of trained and untrained female personnel was essential to the creation and maintenance of this system, and few historical works have focussed specifically on the role female health-care workers played in the creation and delivery of western curative services to Aboriginal peoples.
The Expansion of Indian Health Services
After 1915, the DIA moved to control health-care services directly on Treaty 7 reserves. In part, the DIA was responding to the withdrawal of mission organizations from the home mission field. For example, the Methodist Church closed the Morley Residential School and hospital in 1911 and ceased to have a significant educational or medical presence on the Stoney reserve (Cochrane and Area Historical Society 1977, 92). More significantly, though, the DIA assumed direct control over Treaty 7 health services because of its frustration over escalating medical costs, the continued influence of Native healers, and persisting ill-health within reserve communities.
During his time as chief accountant and superintendent of Indian education, Duncan Campbell Scott was surprised by the growing cost of providing health services to Native peoples (Scott 1910, 1911; Titley 1986, 24). Upon his appointment as deputy superintendent of Indian Affairs in 1913, Scott curbed departmental spending by adopting a more active role in the administration and supervision of Indian medical services. Ironically, in spite of Scott's quest for fiscal restraint, the DIA bureaucracy actually grew during these years. Efforts to reduce medical costs were accompanied by a growing centralization of Indian medical services within the DIA bureaucracy during the 1920s. When Dr. Peter H. Bryce retired as chief medical officer in 1921, the position remained vacant for six years. During this period, medical services were managed by the department's accountant, who was less than sympathetic or generous, and the health needs of Aboriginal peoples continued to be a low priority for the DIA and the federal government. In 1919, when the National Department of Health was created, Parliament did not include medical services for Native peoples within its jurisdiction, and a medical branch to administer the health needs of First Nations peoples was not created within the DIA until 1927. Even then, medical historians James Waldram, Ann Herring, and T. Kue Young argue, the primary reason for formally creating Indian Health Services in 1927 was to monitor medical costs more closely (Waldram, Herring, and Young 1995, 158-61).
Dr. E.L. Stone was appointed DIA chief medical superintendent in 1927. As chief medical superintendent, Stone carried out the policies that Scott had put in place over the previous decade, and fiscal restraint and responsibility remained the governing principles of the department (Waldram, Herring, and Young 1995, 160). Prior to his appointment, Stone had been responsible for visiting Indian agencies to treat patients and to perform health surveys. In 1926, he was placed in charge of the DIA hospital at Norway House, Manitoba. He recognized that tuberculosis was a very serious problem in Native communities, but did not see improving Native peoples' standard of living as the solution to the problem. Like his counterparts in urban public health agencies, Stone believed public health instruction on matters of sanitation and hygiene were more important tools with which to combat disease than improved material conditions and access to long-term treatment (Lux 1998, 284-85; Feldberg 1995, 81-124). A transformation in the living standards of all southern Alberta First Nations peoples required a financial commitment that the federal government was not willing to make.
During the 1920s, ill health, underscored by high rates of morbidity and infant mortality in Native communities, continued to be a source of concern, and the DIA took over existing hospitals and, in other places, built new ones (Scott 1927a).5 The DIA believed that the ill health of Aboriginal communities could be addressed through the creation of modern medical facilities. As a result, by the late 1920s and 1930s, the DIA tried to ensure that all services made available by Indian Health Services took place in a hospital environment under the supervision of appropriate medical personnel. The work of physicians was expected to take place on reserves only in the hospital or school infirmary. Nurses, however, continued to visit people in their homes and camps, ostensibly in their guise of public health instructors, but making nursing and caregiving available as well.
The DIA built hospitals on every reserve in the Treaty 7 area to ensure the transition of medical treatment and nursing care from informal settings to hospitals and institutional space. The growth of DIA hospitals reflected more generally the changing place of hospitals in European-Canadian society. The late nineteenth and early twentieth centuries witnessed a shift from charity hospitals as places where only the poor and destitute received treatment, to scientific medical facilities where people expected to be cured (Gagan and Gagan 2002). The large dormitory-style wards that continued to be used in reserve hospitals were similar to large public wards used by working-class patients in urban centres, while middle-class patients increasingly demanded access to private or semi-private rooms (Drees 1996, 158). In 1923, the DIA took over management of the Blackfoot Hospital from the Anglican Church and used band funds to rebuild the facility (Drees 1996, 165).6 The new building had two stories and 35 beds, and was staffed by lay nurses (167-69). The DIA took over administration of the Blood Hospital in 1928, enlarged the institution, and moved it from Standoff to Cardston, Alberta. The sisters continued to work in that hospital until 1954. During the late 1920s and 1930s, the DIA built hospitals at the Sarcee, Stoney, and Peigan reserves (GA, M742/36, 6 December 1935). Under the direction of Dr. Thomas Murray, newly appointed Indian agent for the Sarcee reserve, the Sarcee Residential School was converted into a tuberculosis sanatorium in 1921 for the 29 students attending it (Calgary Herald 1921). The staff consisted of a practical nurse, a cook, and a school teacher. A hospital was built at the Peigan reserve in 1927 with eight beds, one graduate nurse, and a housekeeper. The hospital at Morley was built in 1935 and opened in January 1936 with 10 beds and a staff of two graduate nurses (GA, M742/36, 6 December 1935).
As in the pre-1915 era, securing high quality medical personnel remained a problem for DIA officials, and so the DIA remained reliant on the health-care work of European-Canadian women. Physicians were hired on a part-time basis, with visits to the reserve once a week, and remained on call for emergencies. For example, the Blackfoot Hospital was visited weekly by Dr. Rose, who later became the medical officer for the entire reserve. Dr. Edwards was the medical officer for the Blood and Peigan from 1901 until his death in 1915. He lived near the agency in Cardston and travelled once a week to visit the Blood Hospital, the Anglican mission school, and the Peigan reserve (Lux 2001, 167-68). After his death, a permanent replacement was hard to find, and a succession of doctors briefly filled the post (Lux 2001, 175). A shortage of doctors persisted following the outbreak of the First World War, and it was difficult for the department to find good physicians. Most reserves did not enjoy an appropriate level of medical attendance by physicians. Indeed, the Tsuu T'ina reserve did not have a regular physician until the employment of Dr. Murray as Indian agent in 1921. European-Canadian women working as graduate and public health nurses, nursing sisters, and nursing attendants thus remained an integral part of the health system taken over and managed by the DIA. They worked as full-time employees in hospitals, school infirmaries, and dispensaries; as temporary emergency health-care workers; and as travelling public health nurses.
The new hospitals at the Sarcee, Stoney, and Peigan reserves, like the ones on the Blackfoot and Blood reserves, were run primarily by female personnel with services of a male doctor on a part-time basis. After 1923, only the Blood Hospital continued to be staffed by a female religious order. After 1928, the Blood facility was run by three nuns who were graduate nurses, and by several nursing sisters with a great deal of experience but no formal training. Centralizing the site of medical treatment and care on reserves was regarded as a means of decreasing rising medical costs while maintaining a certain level of care (Waldram, Herring, and Young 1995, 156-65).
The DIA launched a program of travelling nurses in 1922 to extend the existing educational and public health work of missionaries and field matrons. The work of travelling nurses blended curative and nursing care with instruction on domestic hygiene and child care. The travelling nurse program reflected the department's belief that once Native peoples adopted the appropriate modes of living their health problems would be resolved. European-Canadian women figured prominently in this educational process. Travelling nurses were in charge of a single district, and one nurse was responsible for all the reserves in southern Alberta. Only four nurses administered the three prairie provinces (Department of Indian Affairs 1927, 10). In areas where the Aboriginal population was regarded as too insignificant by the DIA to justify the expense of a public health nurse, the services of European-Canadian women without formal nursing training, known as field matrons, were retained (Department of Indian Affairs 1928, 9). Field matrons were expected to be on call for all emergencies and were supplied with drugs, dressings, and basic medications (Department of Indian Affairs 1927, 11).
When emergency medical situations did arise-such as whooping cough epidemics-nurses were temporarily posted on reserves to deal with the crisis, but then removed after the immediate outbreak had passed. According to Duncan Campbell Scott, education offered both a lasting and less costly solution, and DIA policy and the allocation of staff and resources during the 1915-30 period reflected this policy. As a result, the resources of the DIA were directed towards instructing Aboriginal peoples about hygiene and sanitation rather than providing long-term medical treatment. Temporary treatment facilities were established only as long as medical emergencies were perceived to require such facilities.
The persistent poor health in some communities meant that nurses could not be withdrawn unproblematically. Where health conditions were considered particularly dire, the DIA paid for a full-time nurse to remain at the reserve. The permanent posting of a nurse usually occurred after complaints had been made by non-Natives about health conditions or high death rates among children were observed. In most cases, the parents, especially mothers, were held responsible for these conditions. For example, at the Tsuu T'ina reserve the DIA agreed to appoint a full-time graduate nurse after the new medical officer, Dr. Follett, revealed shocking rates of tuberculosis infection among residential school children and reserve residents. The Indian department agreed to hire a nurse under the condition that she made her services available to both students at the Residential School and reserve residents (GA, M1356/6,16 April 1915; GA, M1356/6, 22 April 1915; McLean 1915a). The DIA paid for the nurse's salary while the Anglican residential school provided room and board and space for a dispensary (GA, M1356/6, 19 April 1915; Fleetman 1916). Reverend Tims, principal of the residential school, was satisfied with this arrangement because the nurse would have to be a member of the Church of England and conform to all the rules and regulations of the mission. For its part, the department was happy with the arrangement because the contract saved the federal government $500 a year (GA, M1356/6, 19 April 1915; GA, M1356/6, 16 April 1915; Fleetman 1916).
The withdrawal of churches from the provision of health care was an uneven process, and in certain circumstances their health-care activities persisted (Fleetman 1916).
A similar set of circumstances existed at the Stoney reserve in 1928, when a nurse was posted at Morley after appallingly high rates of infant mortality were disclosed to the general public by R.B. Bennett, leader of the Conservative Party (Scott 1927c). Scott immediately authorized the employment of a graduate nurse to address infant mortality. Believing the Stoney were for some reason unaware of the health conditions on their reserve, Scott directed the nurse to inform the Stoney community about the seriousness of the situation. The nurse was told to pay particular attention to expectant mothers and young children (Scott 1927b). A graduate nurse was hired by the DIA at a salary of $960 a year, and her job description was
To conduct an intensive training campaign on the care of children with mothers and expectant mothers; to give special attention to infants and young children; to report to the agent when it is necessary to have the services of a doctor; to administer necessary medicines in cases of minor illnesses, and to have such care and treatment as a graduate nurse is called upon to administer. (LAC RG29/3402: file 823-1-A772, 2 May 1927)
This position was formalized at Morley in 1928 (Department of Indian Affairs 1929, 13). The permanent presence of a graduate nurse on a reserve was unique to the Tsuu T'ina and Stoney; nurses were rarely stationed in one place permanently unless they worked in a DIA hospital. Usually the services of a nurse were retained only as long as the DIA thought they were absolutely necessary. Tracing the erratic pattern of where and when nurses were placed in southern Alberta Native communities and institutions is thus an important element of understanding the delivery of health services for First Nations in this region.
In 1932, Dr. Harold McGiIl was appointed deputy superintendent general of Indian Affairs. McGill's appointment did not appear to alter significantly the delivery of health care to First Nations peoples. McGiIl had moved to Calgary in 1910 where he was the medical officer for the Tsuu T'ina before he enlisted in the army during the First World War. Following his return from Europe, McGiIl resumed his post with the DIA (GA, M742). Under McGiIl, Indian Health Services grew very slowly, and by 1935, 11 full-time medical officers were employed by the medical branch. Eight Indian agents possessed medical training, and 250 physicians were hired on a part- time or on-call basis (Waldram, Herring, and Young 1995, 160). A grand total of 11 field nurses were engaged by the branch. In 1934, the per capita cost of medical treatment expended by the average European-Canadian was $31.00, while the per capita cost for a Native person remained well below that of the average Canadian at $9.60 (Waldram, Herring, and Young 1995,161). Health-care services for First Nations peoples remained a low priority for the federal government. In 1936, Indian Affairs, including the medical division, was absorbed by the Department of Mines and Natural Resources. This reorganization was a reflection of the impact of the Depression on government resources and the importance placed on the management of Indian Affairs generally. It was not until after the second World War that medical services for First Nations peoples improved. The Department of National Health and Welfare, a new federal government department, was created in 1944, and the following year Indian and Northern Health Services was incorporated into that department. In 1949, Indian Affairs became a branch of the new Department of Citizenship and Immigration and remained there until 1966, when it became part of the new Department of Indian Affairs and Northern Development (Waldram, Herring, and Young 1995, 165).
The basic health-care structure established by the churches and their missionary organizations during the late nineteenth and early twentieth centuries remained much the same after the DIA began to assume direct control after 1915. Indeed, the basic composition of Indian Health Services changed very little before the second World War. Like the churches, the DIA relied on the cheap labour of women to run hospitals, dispensaries, and school infirmaries. The educational and public health programs of the DIA were also run primarily by European-Canadian women. By including the healing and nursing work of women within the western health-care systems established on Treaty 7 reserves, this article highlights not only the essential roles women played as front-line health-care workers, but the often-overlooked role of missionary organizations as well.
The federal government was unwilling to pay for and operate western health care in First Nations communities. The arrangement the DIA made with the churches and their missionary organizations allowed Ottawa to monitor the health of First Nations peoples without having to shoulder all of the responsibility to administer or pay for medical and nursing care. After 1915, the DIA moved to control directly the medical services for Treaty 7 people because morbidity and mortality rates remained high in Native communities despite growing medical costs. Instead of improving extant health- care facilities, the DIA placed greater importance on the educational and supervisory roles of the public health nurses and field matrons. Indeed, the healing, nursing, and educational work of European-Canadian women remained the cornerstone of colonial health- care regimes established in southern Alberta First Nations communities during the twentieth century.
1. The medicine chest referred to a clause included in Treaty 6 regarding a guarantee of aid from the federal government during disease or famine. The federal authorities interpreted this clause narrowly to mean providing only supplies (Morris 2000, 177-78; McPherson 2003, 226-27).
2. Comparable evidence can be found in the DIA records through the 1920s (Rivers 1903; McLean 1914a; McLean 1919; Gooderham; Stocken 1912).
3. Similar concerns were even expressed during the 1918 flu pandemic (Gunn 1918).
4. The nursing sisters possessed a great deal of experience but no formal training as nurses.
5. An examination of the Stoney pay list for the year 1925-26 found that there were 12 births and 14 deaths. Scott believed this situation demanded immediate attention.
6. Cardston was chosen as the new site because it was a more convenient location and closer to the Indian agency.
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