Indian Hospitals: How the Indian Act, Colonial Governments, and Systemic Racism Created Segregated Health

By Sam Yee

Written in 2021 for the University of Ottawa course HIS 4135 – The Indian Act, for Prof. Daniel Rück

As the discovery of hundreds of unmarked graves at the sites of former residential schools emerges in mainstream news, most Canadians now know of the mistreatment of Indigenous peoples at the hands of the Indian residential school system. However, most people aren’t familiar with Canada’s segregated Indian hospitals, which ran in tandem with residential schools and other assimilatory practices throughout the 20th century. Indian hospitals were originally conceived to quarantine Indigenous people with tuberculosis (TB) from the Canadian population, and became a ‘sister’ of sorts to residential schools. Instead of keeping Indigenous children away from their communities under the guise of providing education, Indian hospitals did the same thing (to both children and adults), but under the guise of providing health care. These institutions were places of rampant medical violence. They reinforced Indigenous people as a second-class, prevented them from using their traditional medicines, and were frequently sites of non-consensual procedures, such as forced sterilization and vaccine trials. In addition to the numerous deaths that occurred in Indian hospitals, many patients were forced to stay for several years, and subsequently lost their cultures, languages, and identities.

Below you’ll find an annotated bibliography with key works about Indian hospitals in Canada. As some of the annotations explain, the Indian Act was instrumental in maintaining the segregated Indian hospital system. It gave rise to the Indian Health Regulations in 1953 which, among other things, made hospitalization mandatory for any “Indian” with an infectious disease. Due to poverty and overcrowded housing, infectious disease epidemics (particularly TB) were common in many Indigenous communities. Of note is that many hospital patients were Inuit, despite not being considered “Indians” under the Indian Act. This is because after the Supreme Court ruled in 1939 that Inuit were Aboriginal people, their health care became a federal responsibility. As a result, the colonial policies of the Department of Indian Affairs, and later Indian Health Services, affected the health care of both status Indians and Inuit. Until the mid-20th century, many privately-run community hospitals refused non-white patients, so non-status, Métis, and even some non-Indigenous people attended the Indian hospitals as well.

The world’s leading scholar on Canada’s Indian hospitals is Dr. Maureen Lux, a history professor at Brock University. Almost a third of the sources in this bibliography are authored by her, and she’s one of the few academics who has focused much of her research on the Indian hospitals. Lux’s 2016 book, Separate Beds: A History of Indian Hospitals in Canada, 1920s-1980s, is the most comprehensive overview of the creation, operation, and legacy of Canada’s Indian hospitals, as well as Indigenous resistance to them. All of Lux’s research on Indian hospitals essentially culminates into this book, and if there is one essential read you take from this bibliography, let it be that one.

While compiling this list of key works, I found that most of the sources could be separated into three general categories based on their main themes. These categories are: works that provide historical context, works about survivors’ stories, and works about Indigenous resistance. Of course, several of the sources overlap into two or all three categories. Lux’s Separate Beds, for example, falls nicely under all three. Nevertheless, this categorization may help you gain an understanding of the important themes in each of these works.

While each work in this bibliography provides some form of historical context, the ones that fall into the first category are primary sources, and pieces with a heavy emphasis on archival research. They do not center the perspectives of survivors; rather, these works focus more on the inner workings of the Indian hospital system itself. There are two primary sources in this bibliography: The Indian Health Regulations and the 1935 Canadian Medical Association Journal article written by E. L. Stone. These require a careful reading and interpretation, and will give you an idea of the attitudes that made their way into colonial policies on Indigenous health. Kelm’s Colonizing Bodies, Lux’s articles “Indian Hospitals in Canada” and “Care for the ‘Racially Careless,’” and Young’s sociohistorical perspective on Indian Health Services all fall under this category, too. These four articles mainly focus on the history of Indian hospitals and how segregated health care in Canada came to be, but differ from the two primary sources because Kelm, Lux, and Young all have a highly critical and generally negative opinion of the Canadian government in their articles.

The second category highlights the perspectives and lived experiences of former Indian hospital patients. There may be some or no author interpretation of the experiences shared; the stories often speak for themselves. What makes this category different from the third (Indigenous resistance) is that these works may be more trauma-focused. They highlight the mistreatment of Indigenous people in an effort to spark indignation in the reader towards the racism perpetrated by the settler-colonial state. Geddes’ Medicine Unbundled, Meijer Drees’ Healing Histories, Metcalfe-Chenail’s “Ghosts of Camsell” blog, and Pelley’s CBC News article fall under survivors’ stories. Geddes’ book and the Camsell blog could also overlap into the historical context category due to their heavy archival research, but the authors’ underlying messages behind these works made me feel that they belonged more in the second category.

Finally, the works on Indigenous resistance are the ones that focus less on survivors’ pain and suffering, but rather on what Indigenous people did in response to the Indian hospitals while they were still in operation. Granzow’s article on Inuit resistance and Lux’s article on the Blackfoot Hospital are good examples of this. As mentioned earlier, Lux’s book Separate Beds falls into all three categories, in part due to the length of the work and the author’s extensive research on Indian hospitals. Separate Beds is one of the few works that explores Indigenous-led grassroots activism for better health care that transpired from the discrimination faced in the segregated Indian hospital system.

During my research, I found that there wasn’t a whole lot of literature about Indian hospitals out there. As a result, there are some gaps and limitations that I noticed. Most of the existing work on Indian hospitals in Canada has been authored by non-Indigenous historians. One could argue that perhaps it’s better this way, and that non-Indigenous researchers should be the ones doing the work of critiquing settler-colonial institutions. However, I still found it somewhat surprising that in almost all cases, the stories of survivors were told being told by others rather than through their own voices. So far, the literature on Indian hospitals focuses much more on the first two categories I identified, and much less so on the third. My hope is that there will be more research on Indigenous resistance to the Indian hospitals in the future.

My post began with residential schools, which have been increasingly researched from many different angles in the last few years due to heightened awareness about them. But segregated Indian hospitals? Most Canadians haven’t even heard of them. I hope that the annotated bibliography below helps familiarize you with this topic, and that more historians will soon begin to uncover new stories about this part of Canadian history.

PowerPoint Presentation

Annotated Bibliography

Canada. Department of Indian Affairs. The Indian Health Regulations: Made Under The Indian Act. Ottawa: Canada Gazette, 1955.

This online site contains a scanned copy of the Indian Health Regulations, which were created by the Canadian federal government in 1953 under the authority of section 72 of The Indian Act, 1951. Clauses f-h in section 72 of the 1951 Indian Act allow the Governor in Council (i.e. Cabinet) to make regulations on the provision of medical treatment and health services to status Indians, and control the spread of infectious disease on reserves by enforcing compulsory hospitalization for those with an infectious disease. The regulations developed from these clauses gave power to Indian agents and medical professionals employed by Indian Health Services to forcibly remove any status Indian suspected of being ill from their home, and place them in a federally-run Indian hospital, where it was illegal to refuse treatment. The language in this document clearly treats patients like prisoners; “place of detention” is used throughout to refer to a hospital or clinic. The document also contains three forms that would have been filled out by Indian agents when admitting a patient to an Indian hospital. This primary source is frequently cited in works about Indigenous health in Canada, and is essential to understanding the policy behind the significant increase in status Indians frequenting Indian hospitals in the 1950s and 60s. However, it is important to note that Inuit also occupied Indian hospitals in high numbers, despite not falling under the Indian Health Regulations.Sick Indigenous people faced (illegal) forcible relocation to Indian hospitals prior to 1953, but these regulations made it legal to do so (for status Indians only). A careful reading of this primary source reveals the racism that underwrote colonial health policy, as well as the desire of the Canadian government to forcibly quarantine Indigenous people while colonization of the land continued.

Geddes, Gary. Medicine Unbundled: A Journey Through the Minefields of Indigenous Health Care. Victoria, BC: Heritage House, 2017.

This book is not only a key work on Canada’s Indian hospitals and some of its survivors, but it also explores the barriers fueled by systemic racism that Indigenous people face when trying to access health care in Canada. Through primary and secondary sources, Geddes effectively demonstrates how the Indian Act and other colonial policies manifested in medical harm towards Indigenous people. When sick, they were legally apprehended, quarantined, and incarcerated by physicians and government officials against their will. Geddes argues that this was a means of isolating Indigenous peoples from the rest of Canadian society, thus facilitating colonization. In addition to presenting original research about the Indian hospitals and its survivors, the author also describes in much detail his own learning journey and methodology in authoring the book. Geddes’ friendship with Songhees Elder Joan Morris (Indian hospital survivor and major contributor to this book) inspired him to begin researching this topic, and helped him connect with other survivors. In addition to library and archival research, Geddes interviewed 34 Indigenous Elders in-person and over the phone to collect their stories and lived-experiences, many of which contained painful memories of forced sterilization and other non-consensual procedures. Geddes supports his arguments very strongly with a variety of sources; he draws from other books on Indigenous health, news stories, Indigenous poetry, as well as academic articles. When the information he needed could not be found from the federal archives, he searched for Indigenous people who had previously written about their time spent in an Indian hospital. This book is a very close and intimate look at the experiences of Indian hospital survivors and their lives today. Many of those interviewed also discussed how residential schools, displacement, and poverty played a role in furthering health inequities between Indigenous and non-Indigenous people. Geddes expands on these stories with extensive scholarly research on residential schools, and the history of systemic racism towards Indigenous people in Canada; in doing so, he provides a holistic survey of the various historical and current factors impacting Indigenous health. Although Geddes acknowledges his privilege as a white settler male trying to tell Indigenous peoples’ stories at many points in the book, he also recognizes the harmful narratives authors have contributed to the historiography on Indigenous peoples. This book shows Geddes commitment to changing those narratives, and to educating other settlers on Canada’s Indian hospitals and the ongoing effects of colonial violence on Indigenous health.

Granzow, Kara. “Against Settler Colonial Iatrogenesis: Inuit Resistance to Treatment in Indian Hospitals in Canada.” Anthropology & Medicine (2021): 1-16. Accessed July 6, 2021.

This is a very recent article on the experiences of Inuit in Canada’s Indian hospitals. Despite not being considered Indians under the Indian Act, and thus not falling under laws mandating hospitalization after diagnosis with an infectious disease, the Supreme Court of Canada ruled in 1939 that “Inuit were Aboriginal people and, therefore, constitutionally, a federal responsibility.” Many Inuit were forcibly relocated to Indian hospitals in southern Canada due to high rates of tuberculosis (TB) among them, largely caused by poverty and overcrowded housing. This article presents Granzow’s analysis of letters found in the federal archives that detail the harmful treatment Inuit received for TB at Indian hospitals, as well as resistance efforts by the Inuit against their oppressors. Many of these letters were written by patients in Inuktitut, and translated for analysis. The author’s methodology is unique from many works on Canada’s Indian hospitals. Granzow responds to Eve Tuck’s call for a desire-based research framework, which focuses less on the damage done to colonized peoples, and more on communities’ survivance and resistance to domination. This article introduces a new term to the existing literature on Indigenous health: settler colonial iatrogenesis, which acknowledges that Indigenous peoples have faced harm at the intersections of settler colonialism and medical intervention. The author’s analysis of primary sources supports her argument strongly, although it is not known if context could have been lost in the translation from Inuktitut to English, making interpretation slightly inaccurate. Nevertheless, Granzow’s capturing of the bigger-picture ideas of Inuit resistance to iatrogenic treatment from these letters, and the use of a desire-based research framework make the nature of this source an unprecedented contribution to the historiography on Canada’s Indian hospitals. Given this publication’s recency, it will be interesting to see if future studies explicitly adopt a desire-based methodology, and if there are letters that reveal resistance efforts of other Indigenous peoples.

Kelm, Mary-Ellen. Colonizing Bodies Aboriginal Health and Healing in British Columbia, 1900-50. Vancouver: University of British Columbia Press, 1998.

Colonizing Bodies is frequently cited by authors of more recent books on Indigenous health as a work that inspired their research on the topic. The book discusses the impact of colonization on Indigenous health systems, focusing on the First Nations who reside in what is now British Columbia (BC). However, much of the discussion also applies to other Indigenous peoples in Canada. Kelm highlights the differing concepts of health and sickness between settler and First peoples in BC, and contends that these differences were reflected in the Indian Act and other colonial policies that enforced Indigenous marginalization.Chapters 6 and 7 are particularly relevant to Indian hospitals; however, the remainder of the book provides important context on colonialism in Canada and how it manifested through the provision of health care services. Kelm’s research was largely directed by existing scholarly literature on colonialism and health, ethnohistory, and the medical history of Indigenous peoples in BC. She also cites other books, as well as first-person narratives of former hospital patients and medical personnel, and oral histories from Indigenous Elders. While the support for her claims is strong and uses both primary and secondary sources, this book is now over two decades old and is somewhat limited compared to more recent works that draw from a greater body of research. However, Kelm’s interpretation of primary source documents from the first half of the 20th century provide valuable context on the basis for segregated health care in Canada, and on how creating difference between white and Indigenous people underwrote colonial health policy.

Lux, Maureen. “Indian Hospitals in Canada.” Last modified January 31, 2018.

This Canadian Encyclopedia article provides a brief but accessible overview of the origins, operations, and eventual closing of segregated Indian hospitals in Canada. Written by Maureen Lux, the leading scholar on Canada’s Indian hospitals, this article contains most of the key points from her research on these institutions. Although this article appears to be purely informative, the details Lux chooses to include support the argument that Indian hospitals were extensions of colonial and medical violence towards Indigenous people, primarily First Nations and Inuit. Due to poverty and overcrowded housing, Indigenous people in the early 20th century had a substantial risk of contracting tuberculosis, and eventually became highly stigmatized as “vectors” of the disease. This justified the federal government’s creation of segregated Indian hospitals in an effort to reduce contact and infection among the non-Indigenous population. The 1953 Indian Health Regulations criminalized refusing medical treatment for status Indians. The sick were thus removed from their traditional medicines, and faced attempts at assimilation through exposure to western biomedicine. As is the general format for Canadian Encyclopedia articles, this piece contains no in-text citations. However, Lux draws from much of her own academic research (some of which are included in this bibliography), which are well supported with analysis of archival documents and patient oral histories. While the key points are included, this article should serve as a starting point, and encourage readers to search for more detailed works on Indian hospitals.

Lux, Maureen K. “Care for the ‘Racially Careless’: Indian Hospitals in the Canadian West, 1920–1950s.” Canadian Historical Review 91, no. 3 (September 2010): 407-34.

This article is a much more detailed overview of the Indian hospital system than Lux’s Canadian Encyclopedia article (citation and annotation above). Lux argues that the Indian hospitals were part of a systematic approach at defining whiteness as the norm for Canadian citizenship, thus determining who deserves adequate health care, and who does not. She contends that these institutions played a particularly key role in the colonization and “modernization” of western Canada throughout the 20th century. This article describes the roles that both Christian missionaries and rising tuberculosis (TB) infections played in creating sanatoria, which were run by the clergy and used to nurse TB patients back to health. However, Indigenous people were deemed unworthy of the mostly white, Christian sanatoria, and in need of separation from white TB patients, ultimately leading to the creation of segregated Indian hospitals. Lux also describes how this blatant systemic discrimination continued; Indian hospitals, many of which were retrofitted school buildings, were often located directly beside private community hospitals that only accepted white patients. She also discusses non-consensual vaccine trials done on Indigenous infants, the post-WWII expansion of Indian hospitals, and the roles the Canadian Tuberculosis Association and the Communicable Disease Control Act played in maintaining the Indian hospital system. The author’s argument is strongly supported with assessments of many letters, memoranda, and reports containing discussions between government officials about the operation of the Indian hospitals. It is clear from Lux’s analysis of these sources that disease (most often TB) was used as an excuse to confine and control Indigenous people while the state continued colonial expansion. There is little to support that the intention of the Indian hospitals was to hastily nurse patients back to health and return them to society. Rather, the longer patients were kept in hospital, the less likely they were to live. If patients did survive, they often lost their connections to culture and language, and thus, many lost their sense of identity upon returning to their home communities. In compiling several primary sources together, this article provides a detailed examination at how state-controlled Indigenous health care was used to advance notions of white nationalism across western Canada.

Lux, Maureen K. Separate Beds: A History of Indian Hospitals in Canada, 1920s-1980s. Toronto: University of Toronto Press, 2016.

In this book, Maureen Lux compiles her years of research on the history of Canada’s segregated Indian hospitals, making it the most comprehensive published work on the subject to date. A couple of Lux’s key research papers that preceded this book are included in this bibliography.  Lux describes how patients’ poor treatment in these institutions led to Indigenous activists calling for better health care, and she explains how these experiences intersect with the “arbitrary and contradictory policies” created by the federal government to exert control over Indigenous peoples through the health care system. She argues that the Canadian government created a system of segregated health care to maintain racial hierarchies of difference between white Canadians and Indigenous people. Lux explains that in approaching her research, her goal was not to further victimize Indigenous people; rather, the book aims to highlight resistance efforts of Indigenous people to the Indian hospitals. She notes that Indigenous resistance coincided with grassroots activism among white Canadians for public medicine, but was not met with the same response from the federal government. Separate Beds contains intense archival research, newspaper excerpts, primary and secondary sources, oral histories from Indigenous Elders, and interviews with former hospital staff. Most are secondary sources (i.e. academic articles) and overall, the evidence to support her argument is strong. This book may be the most in-depth work on the history of the Indian hospital system in Canada, and the rise in Indigenous health care-based activism that came from it. Although Lux attempts to avoid victimization as much as possible, this work proves that this is often difficult when the existing historiography of a topic has largely documented suffering.

Lux, Maureen. “We Demand ‘Unconditional Surrender’: Making and Unmaking the Blackfoot Hospital, 1890s to 1950s,” Social History of Medicine 25, no. 3 (August 2012): 665-84.

This article highlights the Siksika (Blackfoot) Nation’s attempt at managing their own hospital, only for government officials from the Department of Indian Affairs (and later Indian Health Services) to create bureaucratic hurdles to subvert the Siksika’s control over their health care. For years, poverty forced the Siksika into selling much of their government-mandated reserve lands. By 1924, the Siksika had amassed a fairly large trust fund, and the federal government encouraged them to use part of it to build the 16-bed Blackfoot Hospital. The Siksika agreed to fund its construction and operations as long as their own healers could practice there, and it could be non-denominational. Post-WWII, the cost of health care rose significantly, but the Siksika’s annuities did not. With a lack of funding and no government support (despite provincial hospitals for white Canadians and state-run Indian hospitals receiving federal funds), the Blackfoot Hospital was forced to close. Lux uses primary sources (letters, reports) obtained from federal and provincial archives to argue that the creation of a segregated health care system defined those deserving of access to health care as white Canadians, and further marginalized Indigenous people. Despite status Indians being the only population in Canada at the time to have a publicly-funded, state-controlled health care system, this right was removed from the Siksika when they tried managing their own hospital with their own healers and medicines. Lux’s sources effectively demonstrate that government officials knew that denying the Siksika financial aid would lead to the Blackfoot Hospital’s closure, thus forcing them to use the closest off-reserve, state-run Indian hospital (the Charles Camsell Hospital in Edmonton). This article provides an in-depth look at how the federal government used its power to undermine Indigenous peoples’ management of their own health care on a systemic level. It may be the only piece of published literature about an Indigenous-run hospital during the Indian hospital era.

Meijer Drees, Laurie. Healing Histories: Stories from Canada’s Indian Hospitals. Edmonton: University of Alberta Press, 2013.

Contrary to most of the works in this bibliography, which mainly interpret the Indian hospital system within the context of Canadian health policy and colonialism, settler historian Laurie Meijer Drees’ Healing Histories centers on sharing survivors’ stories. She asserts that storytelling is a form of healing, and in order to help the storytellers heal, outsiders must focus their attention on these individuals. This book contains stories the author listened to through interviews, largely intact and unedited. Meijer Drees purposely did not provide her own interpretation of the stories, and instead wanted to allow readers to interpret the stories on their own. This contrasts with most other works on Indian hospitals, which often contain only parts of a story, sometimes taken out of context, and are interpreted by the author through a colonial or critical theory lens. This source adds a lived-experience perspective to the academic work on Indian hospitals thus far. Most of its sources are interviews, although other books, articles, and archival documents are used to provide context on the stories. The intimate oral stories shared by participants are important primary sources for understanding the patient experience in Indian hospitals, and how some survivors have coped with these memories over the years.

Metcalfe-Chenail, Danielle. Ghosts of Camsell: Unearthing Stories From the Charles Camsell Hospital (blog).

This blog explores the history and legacy of the Charles Camsell Hospital (“the Camsell”), which operated as a federal Indian hospital in Edmonton, Alberta from 1946-1996, and served First Nations, Inuit, and Métis from the Prairies, British Columbia, and Northern Canada. Settler historian Danielle Metcalfe-Chenail began compiling stories from former tuberculosis patients at the Camsell in 2012 after conducting research for her book, Polar Winds: A Century of Flying the North. She started posting her research on this site in 2015. This blog inspired the Edmonton Heritage Council to produce a 13-minute documentary called Camsell, which can be found on the site. Interestingly, the film speaks of the friendships made at the hospital, and some of the joyful memories former patients remember from their stay. The author’s goal is to create a publicly-accessible space containing as much information as possible (both the good and the bad) about the Camsell’s operations and former patients. Metcalfe-Chenail may also be the only historian to specifically explore the role that aviation played in colonizing northern and western Canada, and how this maintained Indian hospitals like the Camsell. The credibility of some of the sources is questionable (i.e. online forums) and the blog’s content is not peer-reviewed. Some posts analyze various conspiracy theories about what happened at the Camsell; however, the author is clear about where her sources come from, and which posts are for fun rather than good historical research. This blog contains many posts with fairly robust research that draws from the author’s interviews with survivors, as well as primary sources from Canada’s and Alberta’s archives. This site’s focus on the Camsell is important because this hospital likely treated the most patients out of any other Indian hospital in Canada (due to the large geography it served and how long it operated).

Pelley, Lauren. “Mistreated: The legacy of segregated hospitals haunts Indigenous survivors.” CBC News, January 2018.

This “CBC Interactive” news article contains personal stories of Indian hospital survivors, many visuals from government and hospital archives, and interviews with academics who have researched Canada’s Indian hospitals. Pelley highlights the experiences of Annie Michael, an Inuk woman who was sent to the Queen Mary Hospital for Tuberculous Children in Toronto, and Teresa Leon, a non-Indigenous woman who stayed the hospital for a short time. Both spoke of the racism they witnessed, with Leon remembering that she was treated significantly better than the Indigenous patients. This piece also features a short video clip of Michael describing how hospital staff treated her and other patients like “savages.” Other survivors interviewed by Pelley spoke of the lasting effects of being removed from their families and growing up in a hospital for several years, such as losing their native language. Pelley’s goal is to show the mistreatment of Indigenous people by Canada’s Indian hospital system. This is effectively demonstrated through the variety of visuals and quotes from those interviewed. However, it should be noted that this source should serve primarily to show the effects on survivors, and to provide audio and visual components about this topic in an accessible way to the general public. It does not focus significantly on the Indian Act or other colonial policies. Given that the medium is a special issue news piece, this article is very brief look into the topic, but can act as a catalyst for members of the public to do more of their own research and read more detailed works about the Indian hospital system.

Stone, E. L. “Canadian Indian Medical Services.” Canadian Medical Association Journal 33, no. 1 (July 1935): 82-85.

This article was written by E. L. Stone, former director of medical services of the Department of Indian Affairs (DIA). Stone claims that this article does not “commend or apologize for” the medical services provided to status Indians, and neither does he argue for or against a state-controlled health care system. He states that his purpose is to provide an overview of the DIA’s provision of health care to status Indians for all those interested in studying how state-run health care systems operate. It is important to know that at the time, there was no universal health care system for the general Canadian population. Despite Stone’s claims to neutrality, this article has a clear viewpoint and is quite racist. Stone characterizes certain diseases by their supposed higher prevalence among Indigenous people, specifically tuberculosis. The article’s tone implies that the DIA is doing status Indians a favour by providing free health care, as Stone claims that no treaty states an obligation to provide health care (wholly ignoring the “medicine chest clause” in Treaty 6). He places himself in a spokesperson position for the health needs of status Indians, without reference to any patient testimony. The article also contains no citations to support any claims, and must be read through a critical lens to determine if what appears to be fact is actually Stone’s own opinion. However, Stone’s firsthand observations are still useful for understanding how DIA officials at the time viewed Indigenous people and the health services provided to them. This article was published before the post-WWII expansion of the Indian hospital system, and well before the 1953 Indian Health Regulations took effect. It is suggested to use this source only to understand the early beginnings of the Indian hospital system in Canada from the perspective of DIA officials, their general perceptions of Indigenous health care, what they reported to the public at the time, and how they presented this information.

Young, T. Kue. “Indian Health Services in Canada: A Sociohistorical Perspective.” Social Science & Medicine 18, no. 3 (1984): 257-64. This work provides an overview of the Indian Health Services’ (IHS) operations from Confederation to the 1970s, and includes background information on the “medicine chest clause” in Treaty 6. Young primarily cites Department of Indian Affairs and Department of National Health and Welfare annual reports, which contain the observations of several Indian agents and health care administrators who were employed by IHS. The author’s assessment of these reports clearly characterizes the IHS as racist and grossly inadequate at providing health care; Young uses the oxymoronic term “benevolent paternalism” to describe IHS’ dominant philosophy. While arguing that federal health care services are still inadequate, Young acknowledges that they have improved slightly since major structural reorganizations and streamlining of medical services for people whose health care falls outside provincial jurisdiction, such as status Indians, Inuit, and the military. Many primary sources are used to support Young’s argument, which is generally strong. Although this article is a few decades old, it still contributes important historical context on the colonial management of Indigenous health in Canada. Young explains the structural issues the IHS faced, such as high turnover of physicians and nurses, and having to compete for labour with the private system that served affluent, white Canadians. In addition, this article describes the Canadian government’s intentional disregard of Treaty 6’s “medicine chest clause,” and of orally-exchanged promises to provide adequate health care in the negotiations of other numbered treaties. Young’s analysis demonstrates how this combination of systemic racism and structural issues in health care management contributed to the segregated environment in which a broken health care system for Indigenous people festered.

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