Canada’s Residential Schools: The History, Part 1 Origins to 1939: Volume 1

In 1897, Kah-pah-pah-mah-am-wa-ko-we-ko-chin (also known as Tom) was deposed from his position as a headman of the White Bear Reserve in what is now Saskatchewan for his vocal opposition to residential schools. In making his case for a school on the reserve, he pointed to the high death rate at the Qu’Appelle industrial school, adding, “Our children are not strong. Many of them are sick most of the time, many of the children sent from this Reserve to the Schools have died.” Another member of the band supported his position:

I have now two children, I had four. I sent two of these to the Industrial School at Qu’Appelle. They both died there. I was told the school was good. It was not good for my children. I want to send my children to school on the Reserve where I can see them every day. I love my children and wish them to live.²

Louise Moine attended the Qu’Appelle school in the early twentieth century. She recalled one year when tuberculosis was

on the rampage in that school. There was a death every month on the girls’ side and some of the boys went also. We were always taken to see the girls who had died. The Sisters invariably had them dressed in light blue and they always looked so peaceful and angelic. We were led to believe that their souls had gone to heaven, and this would somehow lessen the grief and sadness we felt in the loss of one of our little schoolmates. There would be a Requiem Mass in the chapel. We would all escort the body, which was lying in a simple handmade coffin, to the graveyard which was located close to the R.C. Church in the village.3

Neither the Canadian government nor the churches compiled annual records on the number of students who died while attending residential school. Due to gaps in the historical record, it is unlikely that a complete record of the number of students who died at Canada’s residential schools will ever be developed.⁴ As part of its work, the Truth and Reconciliation Commission of Canada has created a Register of Confirmed Deaths of Named Residential School Students (referred to from here on as the “Named Register”) and a Register of Confirmed Deaths of Unnamed Residential School Students (referred to from here on as the “Unnamed Register”). The first register contains reports on the deaths of students whose names the Commission has been able to identify. The Commission undertook a statistical analysis of the registers in January 2015. According to that analysis, for the period from 1867 to 1939, there were 1,328 reported deaths on the Named Register and 1,106 deaths on the Unnamed Register, for a total of 2,434 identified deaths for this period. It should be stressed that these figures are likely to represent an under representation of the number of student deaths that occurred during this period. Graph 16.1 shows the annual death rate for 1,000 students of the Named and Unnamed registers combined.

Until the late nineteenth century, there was no clear understanding of the disease’s origins or how it spread. Some physicians contended that it was a contagious disease, while many others believed it to be hereditary. In 1882, German physician Robert Koch published his research demonstrating the existence of tuberculosis bacteria that spread the disease.⁸ There was a similar, ongoing debate over whether tuberculosis in cattle could spread to humans. It was only in 1911 that two separate reports, one in Britain and one in the United States, demonstrated the tuberculosis risks from contaminated milk and meat.⁹ Until the late nineteenth century, doctors had to depend on the results of physical examinations for TB diagnosis. They relied particularly on what they could hear through stethoscopes, and on the changes in vibration that could be detected by tapping patients on the back and chest.¹⁰

The tuberculosis epidemic of the eighteenth and nineteenth centuries

Although the disease had always existed, the tuberculosis death rate in England began to rise in the early eighteenth century. By the nineteenth century, it was the largest single cause of death in Europe and North America. This explosion in the incidence of tuberculosis was associated initially with urban life. It is now seen as arising from the social changes and dislocation brought on by the Industrial Revolution. As rural landlords adopted new agricultural methods, peasants were driven off the land and went to the cities in search of work. Their living conditions were crowded and lacked proper sanitation. Their working hours were long, and their workplaces were dark, dirty, and poorly ventilated. Child labour was common.

In Europe, doctors began to send wealthy tubercular patients to sanatoria in the Swiss Alps in the mid-nineteenth century. There, they would be exposed to healthy, fresh air. Other sanatoria were opened by the sea. Eventually, it was recognized that healthy and restful conditions could be established in almost any location.¹³ Initially, sanatoria treatment was aggressive: no matter what the weather, patients were supposed to spend the days on open-air balconies and sleep with the windows wide open. Their days were supposed to follow a rigid and systematic routine.¹⁴ Rest, good diets, and clean air did not cure tuberculosis, but they eased suffering and allowed some patients to recover to the point where the infection was no longer active and they could return to their homes. Sanatoria provided an additional benefit by isolating people with active tuberculosis from the general population.¹⁵

There was a concern that life in a sanatorium would render patients, particularly working-class patients, lazy, leaving them unable or unwilling to return to work. In response to this anxiety, Dr. Marcus Paterson, early in the twentieth century, incorporated “graduated labour” into the daily life of patients at the Frimley Sanatorium in Surrey, England. It was his theory that physical activity would stimulate the immune system and help patients overcome infection.¹⁶ Paterson’s system would later become the model for an early twentieth-century proposal to turn Canada’s residential schools into tuberculosis sanatoria.

Other than sanatorium care, there was little available in the way of medical treatment in the late nineteenth and early twentieth centuries. Tuberculin, an extract of the tuberculosis bacterium, was proposed as a potential cure for tuberculosis in the 1890s, but proved more effective as a tool in diagnosis than as a cure.¹⁷ Doctors also developed surgical interventions that reduced the spread of infection and potentially allowed for a faster recovery. These could involve collapsing one of the patient’s lungs (pneumothorax surgery) and even removing a portion of the ribcage. These highly invasive treatments required ongoing care.¹⁸ Although pneumothorax surgery had become an accepted form of treatment for pulmonary tuberculosis by 1898 in Europe, it was not undertaken with any frequency in North America until the second decade of the twentieth century.¹⁹

By the middle of the nineteenth century, competing, and at times complementary, social reform movements developed. A public health movement fought for improvement in sanitation and the regulation of food and drink. Although these measures were intended to fight more dramatic diseases such as cholera, they also had an impact on the spread of tuberculosis. During this same period, the newly established trade union movement campaigned for better pay, shorter hours, and improved working conditions, all of which led to improvement in the health of industrial workers and their families.20

It is thought that the combination of the isolation of tubercular patients in sanatoria, the impact of improved sanitation, and rising living standards led to a decline in the tuberculosis death rate in Europe and North America. This decline started even before scientists had determined that the disease was caused by a communicable bacterium, and it continued into the twentieth century—although the prevalence and rate of decline varied for different groups in society.²¹

The first effective tuberculosis antibiotic, streptomycin, was not developed until 1943. Its effectiveness was limited by tuberculosis bacteria’s ability to develop resistance to drugs. However, the introduction of para-aminosalicylic salts (PAS) and isonicotinic hydrazide (INH; alternately isonicotinic acid hydrazide or isoniazid) into the treatment process in the late 1940s created an effective chemical treatment of the disease. Patients who had been diagnosed as being near death began recovering. Although the death rate dropped, the demands on the health care system increased, since the new drugs were part of a hospital-based treatment.²² The new drugs also meant that certain surgical treatments could be administered more safely.²³

The tuberculosis epidemic in Canada

Because Canada was later to industrialize than Britain or the United States, it was not until the 1880s that the general tuberculosis death rate in this country reached a peak. By 1880, the tuberculosis death rate for Montréal and Toronto was 200 for every 100,000 people.²⁴ Well into the twentieth century, tuberculosis remained the country’s number-one public health issue. In 1901, almost 10,000 Canadians died of the disease, out of a population of 5.4 million. This was a death rate of 180 per 100,000. By 1908, the death rate had declined to 165 per 100,000.²⁵ Many people who survived faced a bleak future: it was estimated that the disease created 48,000 invalids annually.²⁶

The National Sanitarium Association was created in 1896, marking the beginning of the Canadian campaign against tuberculosis. Five years later, the first meeting was held of the Canadian Association for the Prevention of Consumption and Other Forms of Tuberculosis. The association’s goal was to educate the public on measures they could take to prevent infection, and to establish sanatoria for the treatment of those infected with tuberculosis.²⁷

Farrell’s assessment of the proper method to treat tuberculosis reflected a dominant line of thought in the Canadian medical community. It is the standard against which the treatment of residential school students should be measured in the late nineteenth and early twentieth centuries. As this chapter and following chapters on diet and building conditions demonstrate, the Canadian government failed to meet such a standard.

The first Canadian sanatorium opened in Muskoka, Ontario, in 1897. Most of the early Canadian sanatoria were built by voluntary organizations. By 1901, there were only seventy-five sanatorium beds in Canada.²⁹ Despite intense lobbying efforts from a variety of public health advocates, the federal government successfully avoided taking responsibility for dealing with the national health crisis that tuberculosis represented. In 1905, Parliament adopted a resolution committing the federal government to taking measures to reduce tuberculosis mortality. However, since Parliament failed to back this up with any financial commitment, prevention and care were left to the provinces, municipalities, and private charities. Services often were inadequate and delivered on a piecemeal or localized basis.³⁰ Montréal, for example, introduced a system of medical examinations for schoolchildren in 1906 that was soon adopted in other cities. By 1915, the Toronto board of education had a medical branch with over seventy full- and part-time employees, including a tuberculosis specialist.³¹ Some cities established “preventoria” for students. These were, in essence, sanatoria for students infected with childhood tuberculosis. They often included educational facilities and might be attached to existing sanatoria. The treatment the children received emphasized rest, improved diet, and fresh air—a measure that could involve keeping classroom windows open throughout the cold Canadian winter.³²

Tuberculosis among servicemen and servicewomen in the First World War forced the federal government to invest in new sanatoria for veterans.³³ Despite these government initiatives, by 1919, there were only enough sanatorium beds for 15% of the Canadians needing treatment. In the 1920s, the federal government turned the veterans’ sanatoria it had established over to provincial governments and tuberculosis associations.³⁴ As late as 1936, slightly less than half of those who died from tuberculosis in Ontario had received sanatorium care.35 Most sufferers had to rely on clinics and nurses for treatment, much of which was limited to advice.³⁶ The availability of care in rural Canada lagged behind the rest of the nation. Rural municipalities often refused to support a local resident’s stay in a sanatorium unless the patient was indigent. As a result, by the time rural tuberculosis sufferers were admitted to a sanatorium, often they were in the final stages of the disease.³⁷

Throughout the 1920s, municipal and provincial governments increased their support of sanatoria. One of the most significant developments came in 1929 when Saskatchewan made sanatorium care free to all residents—with the exception of First Nations people, who were considered to be a federal responsibility.³⁸ Travelling health clinics were established in the 1920s to address rural needs.³⁹ The introduction of x-ray technology also improved the ability to identify active cases of tuberculosis.⁴⁰ Increasingly, the difference between hospitals and sanatoria diminished as sanatoria employed a growing number of specialists and technicians. Since rest was seen as being central to recovery, the patients spent most of their days in bed.⁴¹

Measures also were taken to limit the impact of tubercular cattle. In the mid-1920s, it was estimated that as many as half of the cattle in Canada were infected with tuberculosis. Just twenty years later, that infection rate had dropped to less than 2%. The most effective measure in controlling the spread of the disease was to kill the bacteria by pasteurizing the milk: heating it to control bacterial growth.⁴²

Canada’s anti-tuberculosis campaign played an important role in effectively isolating people with active tuberculosis, and providing them with a measure of care and comfort. In many cases, infections went from an active to an inactive, or latent, state. Not everyone was so lucky: 19% of the patients who were removed from the rolls of the Saskatchewan sanatorium between 1917 and 1929 had died while in the sanatorium. Of those who left alive, half were working, and 10% had undergone a relapse.⁴³

Canada’s tuberculosis mortality rate fell from 87.7 per 100,000 in 1921 to 53.6 per 100,000 in 1939.⁴⁴ The decline is likely attributable to the same factors that brought down the British and American rates: improvements in living standards, improvements in sanitation, and the isolation and treatment of those with tuberculosis. The effectiveness of the Canadian campaign was limited by the federal government’s insistence that health was solely a provincial responsibility. Living standards also were still in need of much improvement. Governments at all levels, however, placed strict limitations on the provision of relief, often requiring that only people living in absolute poverty could receive assistance.⁴⁵

The tuberculosis epidemic and First Nations in the late nineteenth century

Human beings live in a complex relationship with their physical and social environments.46 Epidemics arise from disruptions to that relationship.⁴⁷ Just as the disruption caused by the Industrial Revolution had opened the door for the European tuberculosis epidemic of the eighteenth and nineteenth centuries, the disruption of long-standing ecological and social conditions unleashed by colonialism in the Americas did the same for an even more virulent epidemic among Aboriginal peoples. Colonization exposed Aboriginal people to diseases to which they had very limited levels of immunity. Outbreaks of smallpox, measles, influenza, and dysentery often had devastating impacts.⁴⁸ It is important to recognize that the impact of these diseases was intensified by the disruption that colonialism exerted on every aspect of the lives of Aboriginal people. It was not government policy to spread tuberculosis; however, it is clear that government policies of the 1880s created the conditions for the outbreak of an epidemic and that the government response to that epidemic was shamefully inadequate.

Although tuberculosis may have existed in the Americas prior to the era of colonization, its presence is rarely mentioned in the memoirs of early missionaries or explorers.⁴⁹ Recent research indicates that French-Canadian fur traders brought a strain of tuberculosis to the Canadian West during the fur-trade period.⁵⁰ The disease reached epidemic proportions among First Nations only in the 1880s as the federal government was forcing them into cramped housing on isolated reserves with inadequate sanitation. At a time when traditional food sources such as the buffalo were disappearing, the government failed to provide the supports promised in the Treaties, which were necessary to allow First Nations to make a quick and effective transition to new economic activities. At the same time, Aboriginal governance structures and processes were placed under the authority of Indian agents, and their spiritual and healing practices were attacked by missionaries and government.

One of the most extensively studied examples of this process is the health experience of people in the Qu’Appelle and File Hills reserves in what is now Saskatchewan. Prior to 1880, tuberculosis among the First Nations people of this region was rare.⁵¹ However, with the collapse of the buffalo hunt and the forced settlement of people in cramped housing on reserves, people’s vulnerability to tuberculosis grew, infections increased, and the death rate soared. On the Qu’Appelle Reserve, the tuberculosis death rate reached 9,000 deaths per 100,000 people in 1886. One history of tuberculosis has identified this as one of the highest tuberculosis death rates ever recorded. It is forty-five times higher than the peak death rates for the cities of Montréal and Toronto (200 deaths per 100,000 people), which were reached in 1880.⁵² The rate began to fall in the Qu’Appelle area in the 1890s. By 1901, the rate was 2,000 per 100,000, dropping to 1,000 per 100,000 by 1907.53 By 1926, the death rate had declined to 800 per 100,000.⁵⁴ This rate was still almost ten times higher than the 1926 national tuberculosis death rate: 84 deaths per 100,000.⁵⁵

The failure of the federal government

Under the provisions of the British North America Act, First Nations were a federal responsibility. Through the Treaty process, the federal government had made additional commitments to maintain the health and welfare of First Nations people. Treaty Six, for example, specifically committed the federal government to maintaining a “medicine chest at the house of each Indian Agent for the use and benefit of the Indians.”⁵⁶ It also made a commitment to provide relief in the event of “any pestilence or general famine.” In his history of the Treaties, Treaty Commissioner Alexander Morris noted that the First Nations people “dreaded … disease or famine.”⁵⁷ The commissioners who negotiated Treaty 8 reported in 1899, “We promised that supplies of medicines would be put in the charge of persons selected by the Government at different points, and would be distributed free to those of the Indians who might require them.”⁵⁸ Despite these commitments, the federal government provided little in the way of organized health services to First Nations people in the nineteenth century.⁵⁹ As late as 1954, the federal Indian Health Service took the position that it had no “statutory responsibility for the provision of either medical or dental care of the Indians.”⁶⁰ The provision of medical services was initially left in the hands of missionaries, who often had limited medical training.⁶¹

The government began appointing medical officers to provide services on reserves in 1883. Often, the doctors were selected on the basis of their political loyalties, and used their government work as a base on which to build a private practice. In putting these medical attendants under contract, the government was responding both to the health problems on reserves and to settlers’ concerns that contagious diseases could spread to them from reserves.⁶² The care that the physicians provided was often subject to complaint from the First Nations people and from Indian agents. Indian agent R. N. Wilson reported in 1901 that there had been ten deaths in the previous two months on the Peigan Indian Agency. At the time of writing, he said, at least two children were “dying practically without medical aid.” The government’s medical attendant, Dr. F. X. Girard, had not responded to three urgent requests in the previous week. Wilson succeeded in getting a different doctor to attend a seriously ill girl at the Roman Catholic boarding school on the reserve. Although the doctor promised to pay a return visit, Wilson reported, “He has not done so yet and today a note from the matron of the school states that the sick girl is worse, in fact expected to die.”⁶³

The final piece of advice—to avoid “the unnecessary frequenting of and more especially holding of gatherings for dancing or other purposes in houses in which there is consumption”—was sound from a public health perspective. However, singling out dancing reflected government hostility to First Nations spiritual practices, and the overall recommendation ignored the fact that consumption was so rampant that there would be few homes from which it was absent.⁶⁶

The failure to provide needed medical services was coupled with tight-fisted government relief policies that actually served to increase hunger and susceptibility to disease. Lieutenant-Governor David Laird warned in 1878 that the government policy was leading to starvation that could spark a rebellion.⁶⁷ In October 1882, Dr. Augustus Jukes reported to the North-West Mounted Police that there were 2,000 Aboriginal people camped near Fort Walsh, in what is now Saskatchewan. According to Jukes, “They are literally in a starving condition and destitute to the commonest necessaries [sic] of life. The disappearance of the Buffalo has left them not only without food, but also without Robes, moccasins and adequate tents.”⁶⁸ In 1884, Dr. O. C. Edwards reported that the death rates among bands on the Plains “will increase unless a radical change is made in the matter of food.”⁶⁹ Crop failures were not uncommon. Rations were meagre: in the early 1880s at various times, relief was limited to 0.7 pounds (0.3 kilograms) of flour and 0.2 pounds (0.09 kilograms) of bacon per day for adults. Children were provided half-rations.⁷⁰ Relief could be denied completely if people left the reserve without permission, did not engage in agricultural pursuits, or refused to enrol their children in residential schools.⁷¹

Those First Nations people who were attempting to make the transition to agriculture were held back. The government’s promised equipment and supplies were of poor quality, late in arriving, and often insufficient. The people who raised grain crops faced starvation for lack of milling equipment. Some people who abandoned a hunting lifestyle found they could not afford adequate clothing for farming. As a result, they had to leave their farm work to return to the hunt.⁷² Indian agents were regularly instructed to provide relief only “to very poor, aged or sick Indians” and only in extreme cases. Sugar, soap, and tea were not to be provided except in cases of illness. Agents were to exercise the “strictest economy” and ensure that aid was not given to “those not in need or deserving of it.”73

Reserves were placed under quarantine when epidemics of diseases such as smallpox broke out. Quarantines placed tremendous burdens on the community. Provisions ran low, while people were prohibited from hunting, trading, and working off the reserve. At the same time, rations were kept to the lowest rate possible, to ensure the people were not encouraged to become dependent on the government.⁷⁴

Federal government officials were aware of the high death rates among First Nations on the Plains. They sought to place responsibility for these death rates on the First Nations people themselves. In his 1886 report, Indian Commissioner Edgar Dewdney wrote, “A large percentage of the sickness, and consequent death-rate, is directly due to hereditary disease, which had its origin at a time prior to that at which our responsibility began.” He argued that part of the increase in the death rate could be attributed to an improvement in record keeping.⁷⁵ As well, he felt the increase was part of the price that First Nations had to pay to make the transition to ‘civilization.’ As people adopted a “comparatively sedentary and civilized life,” he said, it was not surprising that “the death rate is in the case of many of the bands heavy.”⁷⁶ A decade later, Deputy Minister Hayter Reed acknowledged:

The majority of deaths among adults result from scrofula and consumption. Among our western Indians of Manitoba and the Territories and some parts of British Columbia pulmonary attacks are common, the Indian being particularly susceptible to these during that state of transition from the wild state to the more advanced condition of civilization, and to overcome this efforts are put forth to get the Indians to ventilate their houses.⁷⁷

In 1895, Reed asked doctors in the Northwest whether First Nations health had improved over the previous five years. The answers were not encouraging. Dr. F. X. Girard wrote that “they are losing ground every day instead of increasing.” Tuberculosis, “which was quite unknown in old time [sic] is now prevailing.” Dr. N. J. Lindsay painted a similar picture: “Taking all things into consideration, I am inclined to think the Indians are getting physically weaker and that Scrofula and Phthisis are on the increase.” Lindsay did not recognize that tuberculosis was a contagious, bacteria-born disease, but he did acknowledge that the way of life that First Nations people had followed when their economy centred on hunting had been a healthy one. He wrote that “civilization” had “proved so disastrous to the Indians.” But the only solution was to have it “pushed to its fullest extent, so as to thoroughly civilize them.” Only Dr. A. B. Stewart, who pointed to the “bountiful supply of the various remedies usually prescribed for such chronic diseases as scrofula or tuberculosis,” claimed that conditions were improving.⁷⁸

The residential schools were intended to be an intensification of the government’s overall “civilization” policy. They also intensified many of the factors that affected health on the reserves. They became breeding grounds for such diseases as measles, whooping cough, influenza, and tuberculosis. Poor diet and inadequate clothing added to the students’ susceptibility and made recovery all the more difficult. It was the government position that Aboriginal people needed to assimilate, but policies intended to encourage assimilation aggravated health problems.

Tuberculosis in the residential schools

The initial period: 1867–1904

The first three industrial schools opened in the 1880s just as the First Nations tuberculosis epidemic in the North-West Territories was approaching its peak. The schools were not prepared to identify and treat sick children or to prevent infection from spreading to healthy children. Policies were developed on a piecemeal basis and their implementation was fragmentary. A uniform policy on the medical examination of new students was slow to emerge. Treatment was inadequate, and crowding ensured that infections became general throughout the student body, since there were few sick wards or infirmaries. Principals often were unwilling to abide by government policies, either because they opposed measures that would limit enrolment, or because they simply lacked the funds to do so. Students who came to the schools healthy went home tubercular, thus completing the infection of the community. In this tubercularized environment, other deadly and disabling diseases were able to flourish.

The schools were not prepared to provide adequate health services

The schools provided limited medical attention. When Dr. M. M. Seymour applied for the position of medical attendant to the Qu’Appelle school in 1885, Indian Commissioner Edgar Dewdney refused his appointment, claiming there was no “necessity for a doctor.” According to Dewdney, Indian Affairs had “sent out a supply of medicines to the Industrial Schools with full instructions as to their use.” He also noted that “the Sisters, in connection with the Institution, are somewhat expert in attending on the sick.”⁸³

Many of the early schools lacked hospitals or infirmaries. In 1893, Qu’Appelle school inspector T. P. Wadsworth reported that at the school, “the want of an infirmary is still very much felt.” The previous year, he had managed to contain an outbreak of chicken pox only by keeping the infected students quarantined in the school garret.⁸⁴ Those infirmaries that existed usually were primitive. On an 1891 visit to the Battleford school, Indian Commissioner Hayter Reed noted that the hospital ward was in such poor shape that they had been obliged to remove the children in it to the staff sitting room. According to Reed, “The noise, as well as the bad smells, come from the lavatory underneath.” There were “quite a number of children sick in the Institution, and I fear not receiving that constant attention which might be expected in a place of that nature.” Reed was unable to hire a nurse, having to content himself with “an Indian woman who had a child sick there and appeared to be very attentive.”⁸⁵

Problems were not quickly rectified. In 1901, Dr. H. J. Denovan recommended the construction of a small hospital at the Red Deer school that could be used to isolate contagious students.⁸⁶ Denovan returned to the issue in 1903, writing that the “rooms provided for sick rooms are the most dismal in the buildings. Scarcely any sunlight ever enters.” In 1904, the principal proposed the construction of a building that would serve as both a hospital and a residence for married staff.⁸⁷ A 1904 report on the death of a student at the Regina, Saskatchewan, school due to tuberculosis revealed the need that “a room be set apart for the nursing and treatment of such cases as they arise.”⁸⁸ At the time of the request, the school, which had been built with government approval and support, had been in operation for thirteen years.

Battleford school principal Thomas Clarke was one of the first to note the need for medical examinations of students. In 1884, he reported that a student named Calah had died in May of that year “from internal injuries received previous to his entering the school.” Clarke recommended that in the future, students “should be examined by a medical officer before they are received into the school.”⁹⁶ While the cause of Calah’s death is unclear, by 1886, Clarke was reporting deaths from tuberculosis. In that year, there was one death from brain fever, quite possibly tubercular meningitis, and one death from tuberculosis. Clarke wrote that the cold that finally killed the second boy

was contracted last winter, when he deserted from the school one evening, with the thermometer 40° below zero, and walked home to his uncle’s reserve, a distance of eighteen miles. To the credit of Thunder Child, I feel it my duty to report, that he at once brought the lad back, and gave him up to me.⁹⁷

At Battleford, students were sometimes recruited to provide care to other students in the infirmary. Peter Wuttunee attended the Battleford school in the late nineteenth century. While at the school, he was often assigned to sit with children who were dying of tuberculosis. Later in life, he recalled, “Joseph Thunderchild, you know I watched that man all alone for a month or more.”⁹⁸

Medical services appear to have been provided sporadically. Although the Qu’Appelle school had access to a medical attendant by 1887, three years later, the Bishop of Rupert’s Land complained of the government’s unwillingness to pay for a medical attendant for the Middlechurch, Manitoba, school. He argued that it was a “duty of the Government in placing their wards under our care to see that they are inspected from time to time, and attended by a Medical officer of the government.”⁹⁹ It was not until January 1892 that Indian Affairs instructed its physician who was on contract to provide medical services on nearby reserves to extend those services to the school.100 In British Columbia, a doctor visited the Cranbrook school in the Kootenays only at the request of the Indian agent. The agent “hesitated to send word to the doctor” because he felt the government was paying him too low a fee. As a result, the students were neglected. An Indian Affairs official inspecting the school in 1906 found “two cases of suppurating glands [possible signs of tuberculosis] and a boy with his arm in a sling.” The local doctor reported that he had not been “instructed to operate on these cases of tubercular glands.”¹⁰¹

Parental response to poor quality of care

The poor quality of care led to conflict between parents and school and government officials. The conflicts could arise because of the illness contracted at the school, because parents were not notified of illness, or because parents believed sick children were not being attended to properly.

Such conflicts reached tragic proportions at the Anglican White Eagle school on the Blackfoot Reserve in what is now southern Alberta. Blackfoot leader White Pup told Indian agent Magnus Begg in April 1895, “When children are taken sick at Industrial Schools they should be sent home so that their parents could look after them, and not be kept until they are ready to die, as generally the first thign [sic] parents hear is that their child is dead or at the point of death.”¹⁰²

In the spring of that year, seven of the seventeen children at the Anglican-run boarding school for boys on the Blackfoot Reserve had active tuberculosis. At least one of them, a boy named Ellis, was sent home. Shortly after his return home, Ellis died. His father, Ajawana (his name is also given as Scraping High and Scraping Hide), vowed to avenge his death.¹⁰³ On April 3, 1895, Ajawana shot and killed Frank Skynner, the local Indian Affairs official responsible for distributing rations on the reserve.¹⁰⁴ He then went to the burial site of Blackfoot Chief Crowfoot. Local official R. G. MacDonnell, Indian agent Magnus Begg, and two North-West Mounted Police officers tracked Ajawana to that location, where he was killed in the ensuing gun battle.¹⁰⁵

There was a general belief that Skynner’s attitudes, and possibly his dealings with Ajawana, had led to the tragic confrontation. Writing shortly after the events, MacDonnell claimed the press reports that Skynner had refused to provide Ajawana with beef for his sick child were “an unmitigated falsehood.” However, he was of the opinion that Skynner was “a thoroughly unqualified man to be placed in such a position where tact and suavity of manner are all essential qualities.” MacDonnell added that, in the past, Skynner had told him that once when he had denied rations intended for a man’s child, the man had threatened Skynner “with shooting or stabbing.” In MacDonnell’s opinion, the tragic events were due

to ill feeling caused by the compulsory education rule, unsatisfactory medical oversight and proper care of sick Indians, causing [the] murderer to brood over the death of his child and the taking of Skynner’s life as being due to the Indian not liking him owing to his not having a knowledge of their language and his very hasty temper displayed towards them in the discharge of his duty.106

Deputy Minister Hayter Reed convinced himself that Ajawana “was not of sound mind.” To think otherwise would “suggest the existence of a state of feeling between the wards and employees of the Department which would be most deplorable, and point to something radically wrong about their mutual relations.”¹⁰⁷ The Mounted Police history of 1906 stated that Ajawana was “more or less crazy” at the time of the shooting.¹⁰⁸ But other sources, including MacDonnell, indicated that Ajawana was of sound mind, and that there was indeed “something radically wrong” in the relations between Indian Affairs and First Nations.

Skynner had been put in charge of the distribution of rations on the reserve in 1893. He quickly came into conflict with the people he was supposed to be serving. In the summer of that year, band leaders warned Hayter Reed they feared “there would be bloodshed on the reserve sooner or later” if Skynner were not replaced. Indian agent Magnus Begg replaced Skynner with local farm instructor W. M. Baker. However, when Baker was injured, Skynner was once more given responsibility for the distribution of rations. According to Baker, Skynner was killed for “refusing good rations to sick Indians.”¹⁰⁹ Another Indian Affairs official, John McCrea, wrote that Skynner had been “totally unfit for the position, as he lacked tact, kindness or firmness.” Skynner, he wrote, would swear at people who were seeking rations and “give them less than they were entitled to.” McCrea felt that if he had not interfered, “there would have been some sickly people die for the want of grub.” He stated he “was not surprised when Mr Skynner was murdered as the Indians detested the sight of him.”¹¹⁰ Magistrate MacDonnell said he had spoken to Ajawana on the day he killed Skynner. They had had a pleasant conversation in which Ajawana arranged to pay a debt he owed to MacDonnell. Ajawana also indicated that he was not prepared to mine coal for Indian Affairs for the pay rates the department was offering. MacDonnell said, “No stronger proof of his sanity could in my opinion be adduced than his refusal to work on such a poor basis of remuneration.”¹¹¹

There were other examples of parents being driven to extremes by the death of their children and by the way their concerns were treated. In September 1896, Bull Sittingdown fired off several shots from his revolver at the High River school to express his anger at not being told of his daughter’s death.¹¹⁵ A young girl at the Kuper Island, British Columbia, school came down with an illness that neither the staff nor the local doctor could diagnose in 1902. When her mother was informed of her illness, she insisted that the girl return home. The principal agreed: “If her malady would have proven fatal at the School, there would have been great excitement amongst the Indians.”¹¹⁶ In 1902, Elijah Manass complained to Indian Affairs that the principal at Mount Elgin, Ontario, W. W. Shepherd, had refused to forward a letter from a student informing him that his daughter was ill. The Manass family became aware of the illness only when the girl’s mother visited the school. She withdrew the child and treated her at home.¹¹⁷ Shepherd said the girl had become ill after a vaccination and was being properly treated—“if the Mother had stayed away the girl would have been all right in a short time.” Shepherd claimed to have no knowledge of the letter that he was supposed to have withheld, although he added he did not think informing the parents was “nice to do as there was no danger.”¹¹⁸

Staff concerns

Staff sometimes also complained about the care students received. Middlechurch staff teacher Abbie Gordon sent her complaints directly to the Indian Affairs minister, Clifford Sifton. She had been hired to teach at Middlechurch, but discovered on her arrival that she was “expected to oversee the cleaning of the girls dormitories, and the lady officers’ rooms every morning before school besides looking after all the linen.” Gordon’s chief target was Miss Lang, the matron, whose treatment of the children was, in her opinion, “heartless.” Sick children often were left unattended: “One boy, Willie Currant whose eyes were sore for weeks gradually lost his sight. He was sent home and in a month his eyes were quite well when looked after by his mother. Miss Lang took no interest in the child and even forbid nurse Inkster doing anything to relieve his sufferings.”119

The epidemic takes root in the schools

By the 1890s, evidence was emerging that instead of helping to combat tuberculosis in First Nations communities, the schools were spreading infection. In 1893, Indian Affairs asked principals to provide information on the health conditions of former students. The principal of the Middlechurch school, which had been open for just three years, reported that of seventeen former students, two had died at school, three had died at home, and four had been sent home with illness. Eight of the seventeen students had been diagnosed with some form of tuberculosis.¹²⁰ The Qu’Appelle school reported that since opening in 1884, it had discharged 174 students, 71 of whom died.¹²¹ In the previous year, there had been twelve deaths, eleven of which school principal Hugonnard attributed to consumption. It was, he said, “hereditary in the families of deceased and the germs of which were probably brought from home.”¹²²

Despite Koch’s demonstration of 1882 that tuberculosis was spread by germs, the idea that it was hereditary persisted in the Canadian West into the 1920s. This was in part because of the high rate of infection among First Nations people.¹²³ Death and tuberculosis were present throughout the system. According to the Indian Affairs 1892 annual report, two students at the Regina school had died from consumption in the previous year: one at the school and one at home.¹²⁴ In the six years from 1891 to 1897, those numbers skyrocketed; forty-eight children died at the school.¹²⁵ Yet, in the face of such epidemic numbers, in his 1898 report, the principal reported general health at the school to be “fair, consumption and scrofula are enemies we have learned to dread.”¹²⁶ Hobbema, Alberta, principal Z. Lizeé reported, “Two pupils died in the course of the year. One died of a brain disease; the other, of consumption. Two are scrofulous. All the others have always been well. The old building in which they are living may have been the cause of the sickness.” The “brain disease” could well have been tubercular meningitis.¹²⁷ In 1898, the Duck Lake, Saskatchewan, school principal reported that Gabriel Poundmaker, the son of Chief Poundmaker, had died from a hemorrhage of the lungs—a common symptom of active tuberculosis.

This boy was a general favourite in the school, being of a gentle and amiable disposition. He was particularly kind to the small boys, who often went to him for comfort in their childish troubles. Though never strong, nor possessed of much talent, he showed great taste for music, and his cornet-playing was admired by all who heard him.¹²⁸

In 1896, Indian Commissioner A. E. Forget asked a series of doctors in the North-West Territories for their opinion as to whether residential schooling increased the likelihood of students’ developing tuberculosis. Dr. A. B. Stewart responded that if schools took proper sanitary precautions, they should reduce, rather than increase, students’ risk of developing the disease. He added that “it is a well established fact that Tuberculosis is contagious,” and that when students came down with the infection, “steps should be taken to have them isolated.” That, of course, could be done only if the school had an infirmary. Dr. Lindsay said that whether from “faulty construction, unsuitable location, improper ventilation, uneven temperature, or negligence,” the schools were unhealthy. Given the fact that tuberculosis was uncommon among First Nations people during the years when they “had access to the nutritious buffalo meat,” he thought it important for the schools to provide “a liberal quantity of good substantial food.” He also thought it important that students be well clothed and get plenty of fresh air and exercise. Key to the process were selecting healthy children, removing sources of infection, maintaining high standards of sanitation, and ensuring the regular testing and treatment of the students. Dr. J. L. Hicks wrote that “not enough care was taken to get those who are healthy” when recruiting students. Dr. S. E. Macadam, who believed tuberculosis to be hereditary, said the disease was hastened on in the residential schools by “the greater confinement and less freedom.” Dr. R. Spencer, who subscribed to the view that First Nations people had a hereditary tendency to tuberculosis, attributed some of the blame for the prevalence of the disease to the poor ventilation systems in the schools.¹³⁰

After reviewing the responses, Deputy Minister Reed concluded that the question would be resolved only through the improved collection of statistics. In the meantime, schools should make use of “simple, inexpensive, yet effective” methods to improve ventilation and segregate tubercular students, “especially at night.”¹³¹

In 1904, W. R. Tucker, a day school principal in Moose Woods in what is now Saskatchewan, advised the federal government not to rebuild the Qu’Appelle industrial school, which had been recently destroyed by fire. His reason was the high death rate of students in the schools. He provided a list of the number of students from the reserve where he worked who had attended the Qu’Appelle school or other industrial schools and who had returned to die of tuberculosis.132 In response to the issues Tucker had raised, Indian Commissioner David Laird reviewed the death rates in the industrial schools on the Prairies for the five-year period ending in the summer of 1903. He concluded that the average death rate was 4%. He compared this to the 4.4% child mortality rate for the ten Indian agencies from which students were recruited for 1902. On this basis, he concluded that “consumption and other diseases are just as prevalent and fatal on the Reserves as in the schools.” (These can be expressed as 4,000 and 4,400 per 100,000 of population. As will be discussed later, according to the Indian Affairs chief medical officer, the overall Canadian death rate for those between five and fourteen years of age was 430 per 100,000.)¹³³

Laird then moved on to a problem that the schools were never able to address properly: “what is to be done with the pupils who develop consumption in an Industrial School?” He pointed out that they should not be allowed to stay in the school, where they would be a threat to other students, or sent home “to spread infection there.” He suggested converting an existing industrial school into a sanatorium for students. This proposal, which was completely in keeping with medical thought of the day, would be made again and again during this period by a variety of government officials and medical authorities. On every occasion during this period (from 1867 to 1939), the government failed to take action.¹³⁴

Crowding exacerbates the problem

In some cases, principals recruited more students than they were authorized to enrol. Since they did not receive a per capita grant for these students, there was less to spend per pupil on food and clothing. The practice also strained the already very limited sanitary provisions in the schools. In 1891, there were 112 students at the Battleford school—twelve more than were authorized.¹³⁵ Sarah Soonias, a former student, recalled the primitive sanitary provisions at the school in the early twentieth century. She said the girls all had to use the same towel. “And the same water too. We had a roller of towels which were locked and I remember we could never find a clean place to wipe ourselves.” For a toilet, “there were three pails and there were 20 to 30 girls.”¹³⁶ Gilbert Wuttunee had similar memories of his time at the school in the early twentieth century: “How the Sam Hill did we survive? You see, they had no sanitary facilities. We had the same towels, same basin, using the same water for bathing, once a week, I think, whether they had scrofula or not.”¹³⁷

In 1908, the Cranbrook, British Columbia, school had an authorized enrolment of fifty and an average enrolment of seventy.¹³⁸ The Metlakatla, British Columbia, school had so many extra students in 1905 that the infirmary was converted to a dormitory.¹³⁹ In 1906, an inspector reported that “there is scarcely sufficient accommodation in the boys’ division.”140 When he was the Indian commissioner in 1887, Hayter Reed supported a proposal to expand the Qu’Appelle school, where, he wrote, “the girls are packed together in their dormitory in a way not conducive to health.”¹⁴¹ Eight years later, Dr. Seymour said that the boys’ dormitory at the Qu’Appelle school was four times smaller than it should be. The beds were jammed in, the walls were only eight feet (2.4 metres) high, and, in the morning, the smell was “simply awful.” There was no chance of reducing what he described as the “present very high death rate” from tuberculosis unless the overcrowding was addressed. Putting in a new furnace by the fall would, he wrote, “be the means of saving a number of lives,” since it would improve ventilation and increase the space in the dormitories by allowing for the removal of the coal stoves. Additional dormitories also were needed to further reduce crowding. Seymour believed that Aboriginal children “do not bear confinement well” and are “more or less predisposed through hereditary taints to Tuberculosis.”¹⁴²

Hayter Reed was unimpressed. He asked why, if the need for a furnace was so urgent, had the request been delayed until it would be almost impossible to supply one before winter? His opinion was that “some temporary arrangements can be devised for making some of the boys sleep elsewhere.” He observed that it was difficult to reconcile the request for an additional dormitory to accommodate the existing students when the principal was also asking to be allowed to admit more pupils in the coming year. He had come to view the principal’s requests as being “merely precursors of others kept back at the time, to be brought forwards after receipt of what may first be asked for.”¹⁴³

Indian Affairs official Martin Benson was convinced by 1897 that the schools were unhealthy. He asked whether it was “any wonder that our Indian pupils who have an hereditary tendency to phthisis, should develop alarming symptoms of this disease after a short residence in some of our schools, brought on by exposure to draughts in school rooms and sleeping in over-crowded, over-heated and unveltilated [sic] dormitories.”¹⁴⁴ In 1903, he supported a request from Regina school principal J. Sinclair to spend $250 to purchase tents to house tubercular students, because the principal had demonstrated that “the health of the students is to a great extent dependent upon their obtaining plenty of fresh air.” He noted, ironically, that the arguments the principal used “in favor of camp life can be used with equal force against the establishment of boarding and industrial schools.”¹⁴⁵ He was not the only one to make this observation. Dr. Seymour had commented in 1895 that “sick pupils who are allowed to go home, invariably improve, notwithstanding the fact that at home they are not nearly as well fed as at the school.”¹⁴⁶ In reporting on the deaths of six students from tuberculosis, three of whom were from “the Hudson’s Bay country,” Red Deer principal C. E. Somerset asked in 1903 if “the change of life has not been greater than the children could stand—from the wild, free life, living largely upon fish, to the confined life here—and one is compelled to ask if after all the boarding school on the reserve is not more likely to make strong children.”147 In short, many observers believed that conditions in Aboriginal communities, even communities with high levels of tuberculosis, might be healthier than conditions in residential schools. They also recognized that treating children in tent hospitals and ensuring that they get plenty of fresh air was not so different from life in many Aboriginal communities.

Pre-enrolment examinations

Regular examinations of students prior to enrolment were a long time in coming. The 1892 Order-in-Council that established the per capita funding model for all industrial schools required that schools maintain “dietary and domestic comfort.” The only restriction on admission was a requirement that no child be admitted without the approval of the Indian commissioner.¹⁴⁸ There was no requirement for medical examinations for all students prior to admission. Winnipeg physician George Orton wrote in an 1895 report on the Middlechurch and St. Boniface schools that he would recommend against

the admission in the future of children of a scrofulous character, whether with enlarged glands or bone affections, or with any marked tendency to consumption, both on account of the well-known infectious character of these diseases and from an economic point of view, it being better to educate and train thoroughly those only of robust constitutions, who are likely to live long useful lives.¹⁴⁹

The fact that he was speaking of future admissions suggests that, to that date, students with active tuberculosis were being admitted to the schools.

In the spring of the following year, Indian Commissioner A. E. Forget distributed health certification forms to all principals in Manitoba and the North-West Territories. He informed them:

It is felt that the standard of health required for admission to Boarding and Industrial schools should be raised and that a sufficient number of healthy recruits to keep your authorized enrolment to the maximum can be secured, thus reducing to a minimum the probability of being called upon to discharge a pupil on the grounds of health before his, or her, training is complete.

Principals were to send him a copy of the completed form when a student was admitted.¹⁵⁰

owing to improved sanitary arrangements and to the fact that the medical examination, which every recruit has to undergo, has been made more stringent; no alarm need now be felt in regard to the health of pupils attending industrial and boarding schools, and all who come in contact with Indians should strive to disabuse their minds as to the danger.¹⁵²

In reality, progress was much slower. Because of difficulties in recruitment, principals continued to accept children who were ill. It was only in 1900 that Middlechurch principal James Dagg could report, “Owing to the great number of applications for admission, we were enabled to discharge every case of scrofula and consumption we had in the school, thus making the health of our pupils excellent.”¹⁵³

Disputes could arise between principals and doctors over how students should be treated. In southern Alberta, a conflict arose over who was to control the small Anglican hospital on the Blackfoot Reserve. Like the Catholic hospital on the Blood Reserve, the Blackfoot hospital was one of a number of mission hospitals receiving varying degrees of government support. These hospitals constituted the limits of the federal government’s efforts to provide hospital care to Aboriginal people during this period.¹⁵⁴ In the 1890s, Dr. James Lafferty, the Indian Affairs medical officer for the Blackfoot, Sarcee, and Stony reserves (although later spelled as “Stoney,” “Stony” was the spelling used at the time), sought to exercise control over the Anglican hospital on the Blackfoot Reserve. In one case, the wife of the Anglican boarding school principal refused to allow Lafferty to operate on two boys suffering from tuberculosis. The principal, H. W. Gibbon Stocken, later forbade Lafferty to treat any of his students. When presented with written instructions from Indian Commissioner A. E. Forget to turn the hospital over to Lafferty, Stocken refused to give him the keys to the building.¹⁵⁵ In response to this conflict, Indian Affairs Minister Clifford Sifton ordered that Lafferty be given

authority to remove any child from any such school whom he thinks might develop an incurable disease which would render further expenditure on its education unavailing and to remove any child temporarily or permanently suffering from an infectious disease dangerous to the others; that no child should be admitted into any school without a health certificate from him.¹⁵⁶

A 1906 inspection of the Shingwauk Home demonstrated that the medical examination system was not keeping tubercular students out of the schools. The doctors who carried out the inspection reported:

We also find that there are a few children suffering from tuberculosis attending the school in whom the signs of the disease are quite evident in the lungs, glands or bones. Such cases should never be admitted, and in the cases where the disease develops in the school, should be isolated and sent home or to some Sanitarium for the treatment of tuberculosis.¹⁶⁰

In 1908, parents stopped sending their children to the Chapleau, Ontario, school after seven of thirty-one children died in a three-month period. Benson could find “no record of any of the pupils having been medically examined before admission, as they were nearly all enrolled before the school was placed on a per capita grant.” The local Indian agent was instructed to ensure that in the future, no children were “taken into this school without passing a thorough medical examination.”¹⁶¹

Treatment or conversion?

Lafferty’s conflict with Anglican missionaries in southern Alberta underscored an important issue. The churches sought to maintain control over the operation of hospitals on reserves on which they had a presence. To the government’s frustration, this could lead to the costly and ineffective duplication of services.¹⁶²

When students died, school officials sometimes consoled themselves that religious instruction had provided the children with comfort and hope in their final hours. An 1873 report from the Muncey, Ontario, school reported, “Two of the girls have succumbed to pulmonary disease. Both gave pleasing evidence of their saving interest in the atonement, and died rejoicing in the hope of eternal life.”¹⁶³

In discussing student deaths in the school’s 1892 annual report, Middlechurch school principal A. Burman wrote:

As evidence of the benefit the school is conferring upon the Indians themselves, it may be stated that the mother of one of the deceased scholars was so touched by the happiness of her dying child, and her earnestly expressed desires that she would herself renounce heathenism, that the poor woman not only met sorrow with calm resignation, but has since earnestly begged for baptism. Doubtless the future will often bear like witness to the far reaching value of the task committed to us.164

The nursing experiment

Indian Affairs embarked on a poorly conceived effort to expand nursing services at the prairie schools in 1901. Three nurses were hired to “give Indian girls at these schools regular instruction in caring for the sick.” The nurses were to work out of the industrial schools, staying at each school for between six months and a year. The principals thought the students were too young to be trained as nurses, but recommended that those with aptitude might be kept in school for an additional year of training or placed in hospitals.¹⁶⁵ Dr. Lafferty questioned whether the “practical result will be very great.” He based this judgment on the limited amount of training the nurses were able to give and on what he viewed as the “absence of initiative and prompt decision in the Indian character.”¹⁶⁶ By 1906, Martin Benson had concluded that the program was a failure. He said that the physician in charge of the project, Dr. Fraser of Brandon, had never properly carried out the “arrangements which were entered into with him.” Benson thought that if the government were serious about training First Nations nurses, “some of the girls from the industrial schools should be placed in hospitals” for training.¹⁶⁷ The nurses, who actually spent only three months a year at any given school, often found themselves in conflict with school staff.¹⁶⁸

The Bryce years: 1904–1914

The federal government was also aware of the very serious health problems affecting the First Nations population of the country at this time. According to the 1903 Indian Affairs annual report, among First Nations peoples, the “death-rate remains proportionately high, and consequently the aggregate increase in the population falls short of what might be expected.” Tuberculosis and “infantile diseases” were seen to be the underlying causes of the high death rate.¹⁷⁷

Bryce was recognized as one of the country’s leading public health authorities. Prior to his appointment, he had been the secretary of the Ontario Board of Health.¹⁷⁸ In 1900, he was elected president of the American Public Health Association, the first Canadian to hold this position. He was also a member of the Canadian Association for the Prevention of Tuberculosis.¹⁷⁹

Given this background, it is not surprising he made the control of tuberculosis a central focus of his work at Indian Affairs. Over the next five years, Bryce would draw national attention to the tuberculosis crisis in the Aboriginal population in general and specifically in residential schools. Bryce was well aware of the socio-economic roots of the illness. In 1908, he said, “The death rate from tuberculosis in any family, community or state is the most exact measure we have of the social status of the individual, community or state.”¹⁸⁰

His 1906 annual report outlined the extent of the Aboriginal health crisis. He observed that “the Indian population of Canada has a mortality rate of more than double that of the whole population, and in some provinces more than three times.” Tuberculosis was the prevalent cause of death. He described a cycle of disease in which infants and children were infected at home and sent to residential schools, where they infected other children. The children infected in the schools were “sent home when too ill to remain at school, or because of being a danger to the other scholars, and have conveyed the disease to houses previously free.”¹⁸¹

Given the degree of infection in Aboriginal communities, he felt that treatment at home would not be effective. Hospital and sanatorium treatment were required to reduce infection and increase the chances of recovery. These views were in keeping with contemporary thinking about the control of tuberculosis in the general population.¹⁸² But Dr. Bryce specifically recognized that the numbers of First Nations people needing treatment were daunting. He recommended

the construction at the most central points for several bands of a simple “Home,”—in many cases large double-walled tents, strengthened with a frame when necessary, with proper floors, stoves, and such other requisites, so that several patients could be housed there comfortably and yet supplied with food from the band’s funds or rations.183

Although this might sound like primitive accommodation, it was not out of step with medical thinking of the day, which, for example, instructed low-income people who had no other access to fresh air to sleep on the roof.¹⁸⁴ The homes that he called for would also be “schools for training young Indian women as nurses and housekeepers.”¹⁸⁵ He established such tent hospitals in Calgary and Morley in Alberta, in the Touchwood Hills in Saskatchewan, and near Birtle in Manitoba.¹⁸⁶ Even before his appointment, the government had been making use of tent hospitals. In 1903, Sam, a File Hills student with tuberculosis, was being housed “in a tent by himself.” In addition, there were several other students at the File Hills school with what Dr. C. E. Carthew described as “scrofulous sores.”¹⁸⁷ By 1910, the Chilliwack, British Columbia, school had two tent dormitories that were built at a cost of $407. They had floors, shingled roofs, chimneys, and canvas sides.¹⁸⁸

In his 1906 annual report, Dr. Bryce was particularly critical of the conditions in the small boarding schools, noting that the

monthly reports of the physicians attending upon the school children very frequently refer to the presence of cases of tubercular disease in its infectious stage, and do not fail equally often to refer to the unsanitary condition of the school buildings, erected, in many instances, years ago by some devoted missionary, from the standpoint more often of proximity to the band than of regard for a sanitary location, with inadequate ideas as to the necessity for sunlight, ventilation and fresh air, and often with the crudest ideas of maintaining the water-supply and disposing properly of sewage.

These conditions led to “an unusual number of cases of scrofula in the pupils” and required “a systematic and thorough overhauling.”¹⁸⁹

The Bryce report of 1907

The government was also coming under growing pressure from business organizations in western Canada to prevent tuberculosis from spreading from the Aboriginal community to the non-Aboriginal community. In 1906, the Saskatchewan Medical Association, the Battleford Board of Trade, and the Associated Boards of Trade of Western Canada all called on the federal government to establish sanatoria for industrial school students who had been diagnosed with tuberculosis. It was proposed that there be a sanatorium for each province in which industrial schools were located.¹⁹⁰ Despite these recommendations, no such sanatoria were ever established. The following year, Bryce was instructed to inspect thirty-five residential schools in Manitoba, Saskatchewan, and Alberta. This inspection would lead to the first of two major reports that he would write on residential school conditions.

with but two or three exceptions no serious attempt at the ventilation of dormitories or school-rooms has hitherto been made; that the air-space of both is, in the absence of regular and sufficient ventilation, extremely inadequate; that for at least 7 months in the long winter of the west, double sashes are on the windows in order to save fuel and maintain warmth and that for some 10 continuous hours children are confined in dormitories, the air of which, if pure to start with, has within 15 minutes become polluted, so as to be capable of detection by ordinary chemical tests.191

He found the school staff and even physicians “inclined to question or minimize the dangers of infection from scrofulous or consumptive pupils and nothing less than peremptory instructions as to how to deal with cases of disease existing in the schools will eliminate this ever-present danger of infection.”¹⁹² He gave the principals a questionnaire to complete regarding the health condition of their former students. The responses from fifteen schools revealed that “of a total of 1,537 pupils reported upon nearly 25 per cent are dead, of one school with an absolutely accurate statement, 69 per cent of ex-pupils are dead, and that everywhere the almost invariable cause of death given is tuberculosis.” He drew particular attention to the fate of the thirty-one students who had been discharged from the File Hills school: nine were in good health, and twenty-two were dead, all from either consumption or tuberculosis. (The table in Bryce’s report presents slightly different information: there, he says that nine students were in good health, one was sick, and twenty-one were dead.)¹⁹³

It should be noted that the 24% figure that Bryce produced was not a death rate (otherwise known as “mortality rate”). Such rates (whether expressed as a percentage or as a figure of so many deaths per 100,000 of population) record the number of deaths under specific circumstances in a specific time period (often, but not always, a single year). Bryce’s figures were drawn from a period that, in the case of five schools, dated back to the late 1880s. It is uncertain whether the 24% included both students who had died while attending school and those who had died after their discharge. The total 1907 enrolment for the schools he was surveying was, according to the Indian Affairs annual reports, 536 students.¹⁹⁴ In his report and subsequent writings on the 1907 study, Bryce never stated that all the students had died while at school. In one article, he wrote that “24 per cent. of all the pupils, which had been in the schools were known to be dead.”¹⁹⁵ This lack of certainty is likely due to deficiencies in the reports the principals gave him: in his report, Bryce referred to the “defective way in which the returns had been made.”196

Upon its release in the fall of 1907, the report made national headlines. Saturday Night magazine reviewed the statistics presented by Bryce and concluded, “Even war seldom shows as large a percentage of fatalities as does the educational system we have imposed on our Indian wards.” The headline in the Montreal Star read “Death Rate Among Indians Abnormal.” A similar story in the Ottawa Citizen concluded that the schools were “veritable hotbeds for the propagation and spread” of tuberculosis.¹⁹⁷

In releasing the report, Indian Affairs asked for comments from Indian agents and school principals. The Indian Affairs inspector at Gleichen, Alberta, wrote that “on the whole, I agree with the Dr.’s conclusions.” He said that “if more funds had been expended to better the conditions complained about in this report and a great deal less on drugs, there would have been fewer deaths among the pupils.”¹⁹⁸ The Indian agent in Morley, Alberta, J. I. Fleetham, wrote that “as far as the Stony Reserve is concerned I am fully of the opinion that fully 40% of the population more especially those under 25 years of age have more or less tuberculosis in their blood and that 75% of the deaths during the last three years are from this disease.”¹⁹⁹

The churches and schools aggressively defended their records. Brandon, Manitoba, principal T. Ferrier pointed out that when the schools were first established, there was no medical screening of students and “a large number of pupils were taken into the schools that should never have been admitted.” Admission was now much tighter, and the diet and clothing were much improved. He argued that since the schools that responded to Bryce’s survey had been in operation for an average of fifteen years, the death rate should have been stated as 1.6% per year, not 24%.²⁰⁰ This is an early example of how Bryce’s findings were going to be misread over the years, both by supporters and critics of the schools. As noted above, Bryce did not present the figure of 24% as a death rate. He stated that, according to figures provided to him by the principals, a quarter of the individuals who had enrolled in these schools since they opened (and he noted that some had opened as early as 1888) were dead. Since 24% was not a death rate, dividing it by fifteen (as Ferrier had done) does not produce an annual death rate.

The health of the children and all connected with the school has been excellent. In view of the present exaggerated, and in some cases, most unfair agitation, regarding the unhealthy condition of Indian schools in general, I would like to draw attention to the fact that for the past year in this school, with a roll of over 60 children, half-breeds, Indians and whites, gathered from different places throughout Alberta and Saskatchewan, hundreds of miles apart, there has not been a single case of sickness serious enough to prevent attendance of the child at school and dining table for any two days in the year, and all this without any change in the system of ventilation and sanitation pursued by this school for the last 15 years. Can any public school in Canada show a better, or as good a record.201

The responses from other principals made it clear that many schools were still admitting tubercular students. The principal of the Anglican school at Brocket, Alberta, W. R. Haynes, wrote, “Anyone who has been amongst the Indians for any length of time, know [sic] that practically all are full of tuberculosis, and how can he expect their offspring to be otherwise.” He said the local doctor did not admit any “who has any signs of the dread disease.” But he recognized that if “every pupil were rejected on the grounds of tuberculosis in their families, I am afraid you might as well close the schools altogether.”²⁰² From Qu’Appelle, Principal Hugonnard responded that many students with scrofula had “no better place to be sent” than his school. He concluded that the school’s death rate, which had been declining, was “due to the poor health inherited from their parents and not to the sanitary conditions of the schools.”²⁰³ At a single medical clinic at the Qu’Appelle school, forty children, or 20% of the enrolment, underwent surgery for the treatment of tubercular glands.²⁰⁴

Bryce’s report did not contain any recommendations. However, he prepared a separate set of wide-ranging recommendations for Deputy Minister Pedley. He did not limit himself to health issues. While he was highly critical of residential schooling as it then existed, he was not an opponent of residential schooling in principle. Given the irregular attendance at day schools, he accepted that residential schooling would continue to be necessary in western Canada. He expected that the schools would further a process by which “bands gradually surrender their treaty rights and become enfranchised citizens.” In other words, he was supportive of the system’s assimilative agenda.

Like Martin Benson, Bryce thought the industrial schools were overly ambitious. Although some industrial schools were “expensive successes,” most were “expensive failures.” And, while he was highly critical of the health conditions in existing boarding schools, he favoured the boarding school model of a small school with thirty to fifty students that focused on providing agricultural training. All new schools, he thought, should have farms, make use of the half-day system, and require student attendance until the age of eighteen. He proposed that, on finishing their education, students be settled on homesteads laid out for them on nearby reserves. The model for this was the File Hills Colony that had been developed by Indian Affairs official W. M. Graham in Saskatchewan.

Bryce also called on the government to assume the “financial management and systematic control of all Indian education.” The churches would not be completely excluded, since each of the four churches involved in operating residential schools would have a representative on a national board of trustees that would be responsible for the appointment of staff and operation of the schools.

The Lafferty report of 1908

The following year, Dr. James Lafferty carried out a study of the students at five schools in Alberta. He concluded that 80% of the students at the Sarcee (near what is now Tsuu T’ina), McDougall (later Morley), Old Sun’s (near Gleichen) on the Blackfoot Reserve, Cluny, and High River schools had tuberculosis of the lungs. One hundred per cent of the students at the Sarcee and McDougall schools were diagnosed with tuberculosis. At the Cluny school, twenty-two of thirty-nine students were diagnosed with tuberculosis. Lafferty concluded that First Nations children had little resistance to tuberculosis, and that life in the schools was “not conducive to the increase of this resistance.” As a result, he recommended that “no child suffering from the disease should be admitted to any school or allowed to remain in any school after it is affected with the disease.” That he felt compelled to make this recommendation, and to underline it for emphasis, highlights the fact that tubercular students were still being admitted and retained in the schools.

Lafferty also felt compelled to answer a counter-argument that had been put to him by church and school officials. Their position was that there was no need to ban tubercular students, since the level of infection in the schools and in First Nations communities was roughly the same. Lafferty said that by recruiting children into residential schools, the government “becomes responsible for the consequences that follow.” In particular, he felt it was wrong to recruit a healthy child and then expose “this child to the very great risk of contracting the disease from children in the school affected with it.”²⁰⁶

Lafferty was particularly critical of the Old Sun’s Anglican school on the Blackfoot Reserve. The school “has never been free from cases of tuberculosis in my ten years of attendance and at the present time there are eight or ten cases of tuberculosis in various stages in the school.”²⁰⁷ On the basis of the report, Duncan Campbell Scott, the department’s accountant, recommended that the school not be allowed “to remain open for a day longer than is absolutely necessary.”208 Deputy Minister Frank Pedley concurred and recommended to the minister that the school be closed immediately.²⁰⁹ When informed that he must close the school, the local missionary, H. W. Gibbon Stocken, who had come into conflict with Dr. Lafferty in the past, now tried to blame Lafferty. He pointed out that the doctor had the power to prohibit the admission of students who were ill, and to remove those who became infectious while in the school: “How is it then that the School has never been free from tubercular cases. Who admitted them? In every case Dr. Lafferty. Who retained such cases? Dr. Lafferty.” Why, Stocken asked, was he being punished for Lafferty’s failures? He also maintained that tuberculosis was less prevalent in the schools than in the community. The problems that did exist lay with the government, which had failed to provide a long-promised new school.²¹⁰ Scott described the church position as “disingenuous.” He pointed out that in correspondence going back to 1904, the church had recognized the problems with sanitation and uncontrollable disease at the school. He also noted that the Anglican Bishop of Calgary had opposed the government’s efforts to reorganize the Protestant boarding schools. Construction of the new boarding school was delayed by conflict between the church and the government over who would pay for it. Scott complained that “in their dealings with the Department the Church authorities have always been shifty on this question of funds.”²¹¹ Nonetheless, in the face of protests from the church, the closure was delayed and the school stayed in operation for three more years until a new building was constructed in 1911.²¹²

In the spring of 1909, Deputy Minister Frank Pedley addressed Lafferty’s two recommendations. A recent amendment to the school application form had instructed physicians who were inspecting potential students not to admit any “child suffering from scrofula or any form of tubercular disease.” This, he believed, fully implemented Lafferty’s suggestion that “no child suffering from the disease should be admitted to any school.” But he felt that discharging all tubercular students already in the schools would lead to the closing of many schools and would “seriously inconvenience others financially.” This was a problem the department failed to address. In this case, Pedley also chose to limit action to the five schools Lafferty had inspected. He recommended that the infected students Lafferty had identified be dismissed and replaced with healthy students. Where the principals were to find enough healthy students to fill the schools was a question he avoided.²¹³

The Bryce report of 1909

Bryce sought Lafferty’s assistance in preparing recommendations based on their study. Lafferty, however, said he was “at a loss to offer any suggestions” without first knowing what the government was prepared to undertake.²¹⁵ Bryce did not suffer from such trepidation. His recommendations were clear and, once more, wide-ranging. Given the extent of tuberculosis infection, he felt it was appropriate to consider each student as “a case of probable tuberculosis—in a word a patient.” The schools should be required to address the patient’s needs, specifically

his food, its amount and kind, his clothing, the amount of rest required, the amount and nature of his exercise, whether in manual labour or calisthenics, and the facilities existing for his obtaining what is called today the fresh-air cure. Naturally as a part of the consideration of each case, will be the treatment of any special symptoms which may arise, such as removal of tuberculous [sic] glands, adenoids, as well as his general medical treatment.

Under this approach, the schools would be transformed into sanatoria. The degree of change was underlined by Bryce’s comment that all the above tasks would have to take into consideration the “time to be spent on school work proper.” Bryce proposed that the schools be placed under his authority. He would “direct and control the work of the school officials without interference from Church officials or others.” He would write a manual describing how they would be operated, and select and train the nurses and sanitary officers who would have to be hired to operate the schools. His proposal also called for the hiring of full-time district medical officers to oversee the public health work in the schools. The existing medical officers, who were paid per visit, would handle only emergency cases.

Although Bryce recommended that this new regime be phased in gradually, it represented a radical restructuring of the residential school system. It struck at both the relationship between the government and the churches, and at the purpose of the institutions. If implemented, Bryce’s proposals would have transformed church-run schools into secular sanatoria, in which health care rather than education was the priority. The sanatoria would, however, continue to be instruments of assimilation, and would continue to separate children from parents. They would also be much more costly to operate.

The rejection of Bryce’s recommendations

These proposals were not acceptable to Indian Affairs. In a memorandum on Bryce’s recommendations, Duncan Campbell Scott, who had become the Indian Affairs superintendent of education in 1909, wrote that while they “may be scientific,” they were “quite inapplicable to the system under which these schools are conducted.” By system, he meant the partnership between the government and the churches. Even if the government were to accept the proposals, “the Churches would not be willing to give up their share of the joint control.” Scott said that Bryce’s and Lafferty’s work had already “caused considerable irritation and brought protests from the Roman Catholic authorities.”²¹⁷ In 1908, Indian Affairs Minister Frank Oliver had indicated that no changes would be made to the residential school system without “the acceptance by the Roman Catholic Church of the main features of the proposition and more complete harmony amongst the various local interests of the Protestant churches.”²¹⁸

Scott recognized that what Bryce was proposing would never receive such acceptance. Scott concluded, “If the schools are to be conducted at all we must face the fact that a large number of the pupils will suffer from tuberculosis in some of its various forms.” Rather than turning the schools into sanatoria, he felt, the government needed to “carry out some common sense reforms to remove the imputation that the Department is careless of the interests of these children.” His list of reforms included:

The more cautious Lafferty submitted his own proposals in June of 1910. He stressed that his proposals were “practical,” “could be carried out at a comparatively small expense,” and could be implemented “without disturbing the present system of management.” He did note that, if strictly enforced, the requirement that any student suffering “to any extent any form of tuberculosis” be refused admission would lead to the “rapid closing up of all the schools as we know that practically no children are free from it.” His proposals included the construction of sleeping galleries, open-air classrooms, and separate sanitary facilities for infected students; the use of isolation cottages; improvements in diet and clothing; and the employment of nurses and medical inspectors.²²⁰

Scott’s and Lafferty’s recommendations were reflected in the contract that was reached with the churches in the fall of 1910. That contract required that all schools have “hospital accommodation for the isolation of pupils with infectious diseases or tuberculosis” and a “modern system of ventilation in dormitories and class-rooms and sufficient air space in dormitories and class-rooms for the number of pupils accommodated.” Class A schools, which were to receive a higher level of funding, were to have “a pure and plentiful water-supply distributed throughout the building,” “a proper system of sanitary water closets, drainage, and disposal of sewage,” and “modern heating apparatus, hot water, steam or hot air.” Students were not to be admitted “until, where practicable, a physician has reported that the child is in good health and suitable as an inmate of said school.”

The contract also raised the per capita rates for all the boarding schools. With the exception of some schools in Ontario, all the schools had a minimum rate of the $100 per student that Scott had recommended. (The rate for some of the schools in central Ontario was increased to $80. Those schools in the Northern Division that were 200 miles, or 322 kilometres, or more from a railway had a rate of $125.) The government committed itself to providing the schools with medicine and to maintaining government-owned buildings “in good condition and repair and provide for proper sanitation and sanitary appliances.”²²¹ However, there was no provision for the additional medical staff Lafferty proposed. According to Scott, hiring such staff “would add considerably to the appropriations.” Scott made it clear that Bryce’s central proposal—that the schools be turned into sanatoria—had been rejected: the schools were to be “educational institutions and not Hospitals.”²²²

In the same year that Bryce published this attack on government policy, Duncan Campbell Scott became deputy minister of Indian Affairs. Although Bryce remained on the government payroll for another eight years, Scott never asked him to do any more inspection work for Indian Affairs. In 1914, when Bryce asked for access to the Indian Affairs medical files to prepare his annual report, Scott informed him that there was no need to prepare a report. He said the work Bryce was doing would be taken care of by Dr. O. I. Grain, who had been hired to oversee medical services on the Prairies. Although he continued with his work for the Department of the Interior, Bryce’s involvement in Indian Affairs had essentially ceased.²²⁶ After failing in his attempt to have responsibility for First Nations health transferred to the newly created federal health department, Bryce was forced into retirement in 1921.²²⁷ The following year, he wrote a brief pamphlet, The Story of a National Crime: Being an Appeal for Justice to the Indians of Canada. It outlined his 1907 and 1909 reports, their recommendations, and how Deputy Minister Scott had thwarted his proposals.²²⁸ The federal government did not appoint a new chief medical officer until 1927, six years after Bryce’s retirement.²²⁹

The Scott years: 1913–1932

The Old Sun’s principal, Samuel Middleton, said that Grain’s allegation that the school was “dirty” was “an absolute lie,” and that the charge that the children were “ill-clad” was one of Grain’s “flights of imagination,” based on his impressions of a few students returning from their afternoon walk.²³³ Two years later, Grain returned and gave the school a much more positive assessment, saying “everything was in splendid order.”²³⁴ That was not the case everywhere. In 1914, Grain described the Presbyterian school in Kamsack as “the worst residential school I have had to visit, for the Department, as yet.” Conditions were so bad he could see no alternative other than to close it down. In its place, he recommended the establishment of a day school and a hospital.235 That same year, he described one of the buildings at the Red Deer school as “the worst laid out affair I ever saw and I would think it almost impossible to keep it sanitary.” He recommended gutting the building and beginning anew.²³⁶

Grain’s was not the only voice of criticism. In January 1913, Dr. J. J. Gillespie reported that only seven of nineteen students were in “good general physical condition” at the Anglican school in Brocket, Alberta. Nine had tuberculosis; of those, four had “open running sores.” Going beyond medical issues, he commented that the staff was “too small and inefficient,” the clothing was unsuitable, the children were kept in a “deplorable state of uncleanliness,” and the buildings were “dirty and unsanitary.” Given this complete indictment, it is not surprising he recommended the school be closed.²³⁷ Anglican Archdeacon John Tims wrote that the principal had once waited nine weeks before the delivery of medications to treat the children’s illnesses.²³⁸ In March of that year, another government inspector said the school was dirty, all but two of the students were “very poorly clad,” and “the staff afforded no very uplifting example.”²³⁹ In 1913 and 1918, Indian Affairs threatened to withhold the school grant unless improvements were made in the operation of the school.²⁴⁰ Despite these threats, the school continued to operate.

In 1918, Dr. N. D. Steel, the medical officer for the Blood Agency in Alberta, wrote a report about the health attitudes of the principals of the Anglican and Roman Catholic schools on the reserve, saying they had demonstrated “obstinate opposition” to his proposals to improve ventilation at the schools to combat the spread of “very severe” cases of pneumonia. In frustration, he wrote that “these schools had better be closed entirely than to be operated under an improper system of ventilation and diet.” On the subject of diet, he recommended, “Less white flour and more whole flour should be used, less beef and more wild meats, less potatoes and more vegetables, less sugar and more fresh fruit, less tea and coffee and more water and milk.” The health problems he saw on reserves were not the result of any natural susceptibility to disease. Rather, he thought, they were the result of the adoption of European habits of life: “I am sorry to observe that many of these habits have been and are being ingrained into the lives of these aboriginies [sic] by their white teachers.”²⁴¹

Scott agreed. He informed Indian Affairs Minister James Lougheed, “The conditions at the Old Sun’s school are disgraceful, and the principal and medical attendant are worthy of serious censure for allowing such health conditions to exist.” The conditions at the Sarcee Reserve school were so serious, Scott wrote, that the best measure would be to turn the school into a hospital—and the reserve residents should pay for the improvement. As Scott wrote, “Those Indians have a large reserve and more of it should be turned into cash as soon as possible and used for their benefit, and the funds we have on hand should be fully used.”²⁴⁴

In the school’s defence, Anglicans again reminded the federal government that they had brought conditions at the Sarcee school to the government’s attention in the past, and had recommended that the school be closed and turned into a hospital for the treatment of children with tuberculosis.²⁴⁵ By 1922, Indian Affairs reported that the Sarcee school had been closed and turned into a hospital.²⁴⁶ In the same year, Grain was dismissed, due to what were described as his “intemperate habits.”²⁴⁷

Lack of treatment facilities and medical staff

Even though the 1910 contract required all schools to have hospital accommodation to prevent the spread of infectious disease, many schools continued to be in need of a proper infirmary. Inspector W. J. Hamilton wrote of the Chapleau school in 1915 that “the one objectionable feature in connection with my inspection was seeing the sick pupils, tubercular, mingling with the well ones in their school work as well as in their play. There has been [sic] several deaths lately in the school, yet there are no facilities for separating the sick from the well.”²⁴⁸

When, in 1915, there was an outbreak of tuberculosis at the Shoal Lake school in northwestern Ontario, the school had no “place to put them beyond the childrens [sic] dormitories,” and had requested that Indian Affairs supply the school with “Hospital furnishings.”²⁴⁹

Indian agent Alfred Lomas alerted Indian Affairs to the need to segregate “children of tubercular tendencies” at the Kuper Island, British Columbia, school in 1921. At the time, those suspected of having tuberculosis were sleeping in the same dormitories as healthy children. Lomas said he was reminded of the words of a parent who had refused to send his children to Kuper Island because “his family was free from the disease and always had been.” Therefore, “in justice to his children,” he could not send them to Kuper Island. As long as the government did “nothing to try and remedy the condition,” parents would have no confidence in the school.²⁵⁰ In 1922, school inspector R. H. Cairns noted that eleven students at the Kuper Island school were out on sick leave. “The Indians,” he wrote, “are inclined to boycott this school on account of so many deaths.”251 They had good reason: a 1919 survey of the condition of former students indicated that 66 of 190 males and 50 of 139 females had died.²⁵²

An inspection of the Round Lake, Saskatchewan, school found in 1923 that twelve of the school’s seventy-two students were sick. Inspector W. Murison noted there was “no accommodation at this school for isolation in cases of sickness.” When he pointed out that children suffering from chicken pox were sleeping in the same dormitory as healthy children, the principal responded that it was just as well that the disease be “permitted to run its course as no doubt they would get it anyway.”²⁵³

The churches were well aware of the problem of sick children mingling with healthy children, and looked to Ottawa for its resolution. The Roman Catholic principals petitioned the federal government for the establishment of sick rooms, under the supervision of a competent nurse, at each school in 1924. They also objected to the sanitary inspection of the schools by government-appointed nurses. The nurses had “ordered measures leading to the transformation of our schools into hospitals or sanatoriums; moreover, in their manners, their dress and their language, they have often forgotten certain requirements essential to the proper training and discipline of Indian children.”²⁵⁴

There was also a shortage of qualified medical staff. In 1915, the Indian agent on the Sarcee Reserve, T. J. Fleetham, recommended that the department hire a trained practical nurse to work out of the Anglican school to provide services to the students and the families on the reserve. He noted that “the Churches can only pay small salaries, the consequence is they are not able to obtain qualified nurses.”²⁵⁵ Dr. Grain, the medical inspector for the West, supported his recommendation.²⁵⁶ The lack of medical staff at the schools was underlined by an entry in the High River school journal of 1916. Echoing Shakespeare’s King Richard III, the school author wrote, “A nurse! A nurse! My kingdom for a nurse.”²⁵⁷

In other cases, sick children were not being treated. In 1915, Indian Affairs secretary J. D. McLean wrote to the Indian agent at Chapleau about “several children afflicted with eczema who had apparently not been receiving treatment” at the school. McLean was instructed to arrange for treatment and regular medical inspections of the school.²⁵⁸ In 1922, the Indian Affairs superintendent of Indian Education, Russell Ferrier, worried that Chapleau principal George Prewer was “somewhat slow to call in medical attention,” although he acknowledged that Prewer was “fairly well qualified to look after minor ailments.”²⁵⁹ Indian Affairs instructed the principal, “Call upon the services of the Medical Officer without hesitation.”²⁶⁰

Examinations and admissions: 1910–1920

The 1910 contract required that students were not to be admitted to schools “until, where practicable, a physician, to be named by the Superintendent General, has reported that the child is in good health.”²⁶² The provision, if enforced, could have played an important role in reducing the spread of tuberculosis and other diseases. As the record makes clear, it was often overlooked. As early as 1910, High River principal J. Riou was questioning the fairness of this requirement, asking, “Is this examination required in white schools?”²⁶³

Indian agent J. MacArthur had reported in 1910 that the death rate at the Duck Lake school was returning to its “high mark.” Two students had died and two others were dying. MacArthur felt the school was “not suitable for the purpose as it has altogether too many dark corners and a lack of light.” While some might argue that the children were being infected at home, he pointed out that they spent only one month a year at home. During that month, they spent “their time on the open prairie and sleep in tents.” The rest of the year, they were in the school. “No one responsible can get beyond the sad fact that those children catch the disease while at school.”²⁶⁴ Indian Affairs secretary J. D. McLean concluded,

It is possible that one cause which increases the death rate at this school is the lack of care in examining prospective pupils. If the medical attendant does not exercise great care and is not possessed of considerable experience in detecting the presence of tuberculosis, it may be quite possible that he is passing pupils who could not possibly be admitted under the restrictions laid down by the admission forms.²⁶⁵

The “where practicable” provision in the contract effectively exempted remote schools from having students examined before admission. For example, in 1911, the Beauval school in Saskatchewan was exempted from the provision when it was pointed out that “no physician can be found” to attend the school.266 Instead, the administration was instructed to have the students examined “on the first occasion that a physician visits the school.”²⁶⁷ When seeking to have children admitted to the Norway House, Manitoba, school in 1912, Principal E. Lecoq notified the federal government, “As there is no doctor, the page has not been filled. But I can certify that the children we have are enjoying perfect health.”²⁶⁸

The ongoing presence of tuberculosis in the schools was a sign that inspection was lax. In 1914, Indian Affairs attempted to place a student from the Chapleau school in a provincial sanatorium.²⁶⁹ Several more cases developed in the spring of 1915,²⁷⁰ leading departmental secretary J. D. McLean to instruct the local Indian agent to ensure that the doctor who examined prospective students took “care to see that they are in good health and show no traces of tuberculosis.”²⁷¹ By May of that year, three students had been transferred from the school to a local hospital. Two, who were recovering, were to be transferred to provincial sanatoria. McLean instructed the Indian agent to purchase a tent in which the third student, who was not likely to recover, could be housed under the supervision “of a competent person.”²⁷²

The certificate of health form in use by 1920 asked for the student’s age, height, weight, and defects (if any) of the limbs, eyesight, and hearing. The physician was also to state if there were any signs of scrofula or “other forms of tubercular disease,” describe any evidence of cutaneous (skin) disease, state whether the child was subject to fits, state whether the child had had smallpox, and report on whether the child had been vaccinated. The physician was also to judge whether the child was “generally of sound and healthy constitution and fitted to enter an Indian school.” The certificate specifically instructed physicians, “No child suffering from scrofula or any form of tubercular disease is to be admitted to school; if in any special case it is thought that this rule should be relaxed, a report should be made to the Department setting forth the facts.”²⁷³

Duncan Campbell Scott thought Indian Affairs officials were also to blame for the inattention to medical inspection, observing in 1925 that “it is our own officers, who pick up orphans, delinquents and others that are causing the difficulty, as occasionally no application forms are forwarded.” He did agree, however, that there should be a “more careful checking of the medical officers’ remarks in the case of all applicants.”²⁷⁴ Two years later, Kamloops, British Columbia, school principal James McGuire complained to Indian Affairs that the Indian agent had “sent us three children with measles in the early spring. We had over a hundred children down with them at once.” McGuire bitterly complained that not only was Indian Affairs sending him infectious children, but it was also not supplying him with a place to house the healthy ones. “Your miserable accommodation here last year for small boys, which I had to tear down, as it was condemned by the public health officer, did not mend matters.”²⁷⁵ Principals also were reluctant to discharge students with active tuberculosis. Qu’Appelle school principal G. Leonard refused to carry out a local physician’s instructions to send tubercular students to a local sanatorium in 1922, claiming they would be “better off at the school than in the sanatorium.”276

The Shubenacadie, Nova Scotia, school opened in 1930. In July of that year, Principal J. P. Mackey reported he had managed to have two of the five tubercular students in attendance admitted to a local sanatorium. Indian Affairs secretary A. F. MacKenzie congratulated Mackey on the discharge of the two students, but had concerns about the three still at the school. MacKenzie explained, “If no other means can be found to care for them [tubercular children], they must be sent back to their reserves even though that seems hard on them. In such a case they are no worse off than if they had not come to the school.”²⁷⁷

Ten years after the 1910 federal contract for residential schools came into effect, the Saskatchewan government struck a royal commission to examine the extent of tuberculosis in the province. The study examined 1,184 non-First Nations children and 162 First Nations children to see if they had been exposed to, or infected with, tuberculosis. The infection rate for the entire group was 56.6%. However, for First Nations children, the infection rate was 93.1%.²⁷⁸ With that rate of infection, all First Nations children in the province were, as Dr. Peter Bryce had previously realized and reported, potential patients. According to the prevailing views of the day, they required healthy conditions, good diets, and adequate medical treatment. They had not received those up until that point, and they still would not for many years to come.²⁷⁹ A second study, carried out between 1926 and 1928 at residential schools in Saskatchewan, underlined the role the schools were playing in completing the tubercularization of First Nations children. The study was carried out at schools that did not discharge students with active or infectious tuberculosis. These students were often referred to as “spreaders” by medical investigators. The study found that students who showed no signs of having been infected by tuberculosis at the time of their admission to these schools had been infected within the first two years of their enrolment.²⁸⁰ In short, Duncan Campbell Scott’s “common sense” measures were actually spreading tuberculosis rather than working to contain it.

Scott retired in early 1932. His departure coincided with the onset of the Great Depression. With the exception of work initiated by the Saskatchewan Anti-Tuberculosis League, the neglect of First Nations health in general and in residential schools in particular would only intensify during the 1930s.

The Depression era: 1930–1939

In 1930, Stone described the First Nations tuberculosis epidemic as the “most acute public health problem in Canada at the present time.” At that time, the First Nations tuberculosis death rate was twenty times higher than the national tuberculosis death rate. In places such as Haida Gwaii (the Queen Charlotte Islands), he said, the disease constituted a “menace to the existence of the Bands, and to the white community as well.” Dr. Stone also knew that the government’s response was inadequate. “At the present time it is being found necessary to refuse applications for sanatorium treatment due to lack of funds for maintenance.”²⁸⁴

Throughout the 1930s, the First Nations death rate from tuberculosis never fell below 600 deaths per 100,000, while the death rate from tuberculosis for the overall Canadian population fell from 79.8 per 100,000 in 1930 to 53.6 per 100,000 in 1939.²⁸⁵ In western Canada, the differences in the health conditions between First Nations people and the rest of the population could be starkly measured by the tuberculosis death rates. In 1934, First Nations people made up 2.2% of the Manitoba population, but accounted for 31% of the tuberculosis deaths. In Saskatchewan, the comparable figures were 1.6% of population and 27% of deaths; in Alberta, they were 2.1% and 34%; and in British Columbia, they were 3.7% and 35%.²⁸⁶

Stone’s negative response to Manitoba health minister E. W. Montgomery’s offer of co-operation in the establishment of a sanatorium for First Nations people in 1930 indicates just how little was being done. According to Montgomery, Stone stated that the tuberculosis problem was “almost beyond the power of the Department to meet.”²⁸⁷

He was wrong. Not only did the federal government fail to implement his proposed ten-year plan, but it also cut back on the work it was doing. In 1932–33, the Indian Affairs health budget was reduced by 20%. The Indian Affairs annual report for 1932 admitted that the government had been obliged to “limit admissions of tuberculous Indians to sanatoria and hospitals,” a measure that it acknowledged would “result in an increased spread of the disease.” The report claimed that a remedy to the crisis was “not impossible, either from a scientific or financial standpoint.” Indian Affairs placed the blame on the people of Canada. Acting Deputy Minister A. S. Williams wrote that the department was ready to go forward, but could not do so “until popular demand, as expressed in parliamentary appropriations, makes it possible to proceed.”²⁹⁰ Table 16.3 shows the reduction in government spending of First Nations health in this period, demonstrating that over a two-year period, it fell by 24.5%. This table appeared in the Indian Affairs annual report for 1933. For comparison purposes, the department had included the amount the Ontario government was spending on health on a per capita basis, although it did not specify the year to which the $30 per capita figure refers. It is clear, however, that Ontario was spending three to four times more per person on the health of its general population than Canada was spending on First Nations health.

It was not only direct health spending that was cut during the Depression. Within a year of Dr. Harold McGill’s appointment as deputy minister in the fall of 1932, Indian agents were instructed that relief granted to “able-bodied Indians should be drastically curtailed.”²⁹³ Later that year, categories for sick relief were redrawn in an effort to “reduce rather than increase … expenditures on sick relief.”²⁹⁴ According to a 1934 circular, Indian agents were restricted to providing the following food items to First Nations people on relief:

Tea, sugar, salt pork, rice, beans, molasses, macaroni, rolled oats, barley, lard, baking powder, flour, canned tomatoes, salt, yeast, dried peas, the cheapest cuts of fresh meat or the cheapest kind of fish. Root vegetables or apples, of the cheapest variety, may be supplied only in cases where the Indians have had no opportunity of raising these products on their own lands.²⁹⁵

These policies had a tremendous impact on the health of many First Nations people. It is estimated that during the Depression, approximately 20% of the general Canadian population received some form of relief. For the First Nations population, the figure was 33%.²⁹⁶ The level of relief that was provided to all unemployed Canadians was meagre.²⁹⁷ However, compared to that provided to First Nations people, it appears generous. The per capita spending on relief for all Canadians in 1932 was $44.33. By 1936, this figure had risen to $61.69. Comparable per capita spending on First Nations relief for those years was $20.30 and $20.57—less than half, and then less than a third, of what other Canadians on relief were given.²⁹⁸ As noted earlier, by the 1930s, it was well known that decent living conditions and a good diet constituted the best protection against the development of tuberculosis. The government’s miserly approach to relief policy actively undermined First Nations’ health.

The situation in the schools

Tuberculosis was an ongoing problem in southern Alberta, and in 1930, of 189 students given tuberculin skin tests at the Roman Catholic and Anglican schools on the Blood Reserve, 88.3% tested positive for tuberculosis infection. Nine per cent of the students had visibly swollen glands.³⁰⁰ The study was repeated annually. By 1934, the number of students testing positively for tuberculosis was only slightly down, at 77.3%.³⁰¹ In a 1937 survey, the figure had climbed back up to 84.03%.³⁰²

In October 1933, Dr. H. K. Mitchell complained that seven of fourteen students admitted to the Sioux Lookout, Ontario, school had active tuberculosis. The doctor who had accompanied that summer’s Treaty payment expedition had approved them for admission. Dr. Mitchell, who was offering himself for the job in the future, said it took “a Physician of some experience to examine these children properly.”³⁰³ However, budget cutting also prevented doctors from using the best available technology when screening students. In 1934, Dr. J. J. MacRitchie noted that in the past, he had given all prospective Shubenacadie students an x-ray examination. However, since government had eliminated these examinations, he was forced to “depend altogether on clinical examination.”³⁰⁴

In 1933, the form that physicians were to fill out after examining students was amended. It no longer included the instruction: “No child suffering from scrofula or any form of tubercular disease is to be admitted to school.” This provision had been in the form since 1909.³⁰⁵ Instead, it asked, “Has this child active tuberculosis in your opinion?” If the answer was yes, the doctor was to describe the infection. The presence or absence of trachoma and other communicable eye diseases and syphilis were to be reported. The doctor also was to describe any condition that would make the child unsuitable for residential school or of which the principal should have a warning.³⁰⁶

In 1935, the principal of the Fraser Lake, British Columbia, school (also known as the Lejac Indian Residential School) reported that Dr. C. Pitts had not carried out a general examination of the students at the school.³⁰⁷ When asked for an explanation by Indian Affairs, Pitts claimed that because his father was the principal of a residential school, he knew that the “attention I am giving the Lejac School is as good or better than in any other place in the province.” (Dr. Pitts’s father, F. E. Pitts, was the principal of the Alberni, British Columbia, school in the 1930s.)308 Dr. Pitts could not see any benefit in a general examination of the students, since

were I to apply the standards of health to them that is applied to children of the white schools, that I should have to discharge 90% of them and there would be no school left; and when I know that they are under the constant observation of a staff who have the opportunity of reporting any ill health to me either on my weekly visit to the school or by phone.³⁰⁹

Indian agent R. H. Moore was not impressed, saying that, in his opinion, “the examination of the School children is much too casual, not only for the Application for Admission Forms but also during the time that they are in the school. It would appear as if 150 or 160 pupils are now examined in less than one hour.”³¹⁰

Two years later, Philip Phelan, the chief of the Indian Affairs training division, observed that several children who were suffering from tuberculosis had been admitted to the Fraser Lake, British Columbia, school in recent years, despite the department’s requirement for thorough medical examinations before admittance.³¹¹ He was told that the students had been recruited by missionaries who had sent them to the school without first getting authorization from the Indian agent.³¹² In 1938, Indian Affairs issued instructions that all students recruited to the school “shall be examined by the best means available at the point nearest to their homes.” The government’s preference was that x-rays be taken of their chests.³¹³ As was so often the case with the residential schools, this was not a general instruction, but a specific instruction to a specific school.

The doctor inquiring into the 1936 death of a student due to tubercular meningitis at the Kamloops school in British Columbia concluded that the “child was no doubt developing the disease before admission to the school.”³¹⁴

In 1939, Dr. D. F. MacInnis complained to Principal Mackey at the Shubenacadie school that, due to poor screening, the school was being sent “all the advanced T.B.” in the Maritimes. This, he wrote, was “very unfair to the children who are clean and well and are attending the school.” He noted that one boy was “sent to us last fall in such an advanced state of T.B. that he died before we could get him to a sanatorium.” The boy’s condition had been diagnosed by a local doctor before he was admitted but, despite this, Indian Affairs had insisted that he be sent to Shubenacadie. He urged Mackey to inform Indian Affairs that “this is not a T.B. Clinic and a syphilitic home.”³¹⁵ The chief medical officer, E. L. Stone, responded that the admission of the boy with tuberculosis was “a clear error such as sometimes occurs in the best organizations.”³¹⁶

It would be a doubtful service to him to bring him away from his people in the North and confine him in the hospital. The expense to the Department would be very considerable, and unless you can assure yourself that his life would probably be saved by treatment I am inclined to counsel you to leave him where he is.317

The case of Martina Storkerson illustrates the multiple barriers that Aboriginal people faced in getting treatment. Martina’s mother was of Inuit ancestry and her father was Norwegian. He had come to Canada as a member of ethnologist Vilhjalmur Stefansson’s Arctic expeditions of the early twentieth century. Storkerson returned to Norway alone, leaving his family to seek shelter at the Anglican residential school at Hay River in the Northwest Territories. When the school principal, A. J. Vale, was transferred to the Chapleau school in Ontario, he and his wife took Martina with them, planning to “get her accustomed to the ways of civilization.” Instead, she developed tuberculosis. The local municipality would not fund the sanatorium treatment she needed, and neither would Indian Affairs, since she was Inuk (referred to by government as “Eskimo”) and not an Indian under the terms of the Indian Act. A request to the Northwest Territories and Yukon Branch of the federal government for support was turned down because the girl was no longer a resident of the territories.³¹⁸

In 1932, the son of John Albert of the Sweet Grass Reserve in Saskatchewan was diagnosed with tuberculosis. According to Albert, despite his requests to the doctor who made the diagnosis and to the Indian agent, the boy was not placed in a sanatorium or provided with any treatment. He died in August 1933. In December of that year, two more of Albert’s children were diagnosed with tuberculosis. One child was housed in what was described as the Roman Catholic convent in Delmas (possibly the Thunderchild residential school), but neither child was given any special treatment. In April 1934, Albert wrote to Indian Affairs, pleading, “If something is not done for these children in the near future they are going to die.” The residents of the Sweet Grass Reserve and the Cut Knife municipality backed his appeal.³¹⁹ Indian Affairs responded that, due to its limited resources, it reserved “sanatorium treatment for those who had no homes.”³²⁰

School administrators often were unwilling to transfer students with active tuberculosis to sanatoria. In 1935, Bishop Guy of Alberta reiterated his opposition to the government’s sending children from the Qu’Appelle school to the Fort Qu’Appelle Sanatorium. He said that at the sanatorium, the children were “out of their atmosphere,” and, as a result, “were pining away and dying.” His preference was to have the government build sunrooms as additions to residential schools in which tubercular students could be isolated.³²¹ When instructed in 1937 to discharge all active tubercular cases to the local Anglican hospital, Cluny principal J. Riou objected. He said that in the past, the school had simply isolated active cases and placed them under the supervision of a nurse. He believed the hospital, which had no separate tuberculosis ward, offered inadequate care. Also, at the school, the patients could “receive the visit [sic] of their playmates during the recreation hours.”322 The 1935 report of the United Church’s Commission on Indian Education argued that in residential schools, “the children’s health is more carefully conserved.” They stated that surveys at the Brandon and Chilliwack schools showed that four of five children “enter Residential School with some evidence of T.B.—either active or quiescent.” The schools provided additional care for “those whose cases demand special attention.” Two girls at Chilliwack had been pronounced cured, while other students were showing “tremendous improvement.” The health section of the report concluded, “According to competent authorities, the Residential School is the key to the solution of the problems of Indian health.”³²³ While arguing for the effectiveness of the schools as treatment centres, the United Church report also demonstrated the degree to which it was common practice for schools to admit infected children. As had been demonstrated by the Saskatchewan study of the late 1920s, the infected children admitted to the school would eventually infect the healthy children.

The federal funding cuts directly affected all medical services in the schools. In April 1932, after a medical examination of the Shubenacadie school students, Principal Mackey asked for funding for treatment of forty-eight tonsil cases and eighteen students with vision problems.³²⁴ (During this period, tonsil infections were thought to be closely associated with the development of tuberculosis. Tonsillectomies were considered preventive measures.)³²⁵ Indian Affairs informed him that, “owing to orders for strict economy,” it would be possible to treat only “the more urgent cases.”³²⁶ In the spring of 1936, Indian Affairs informed Mackey that the department would not be providing a “tonsil and dental clinic for his school.” Departmental secretary A. F. MacKenzie noted that one had been held at that school the previous year, while other schools had done without such service for two to three years.³²⁷

Cuts in payments

Later that summer, Dr. D. F. MacInnis resigned as doctor for the Shubenacadie school to protest the government’s decision to cancel semi-annual medical examinations. In so doing, he drew attention to the death of a student at the school in March of that year. MacInnis wrote that when he had visited the school on March 13, he was told a child had collapsed during mass the day before. He diagnosed her with a case of peritonitis (an inflammation of the inner lining of the abdomen) and recommended her immediate hospitalization. She was sent to the local hospital that night and died the following morning. He concluded that, because the school staff did not seek medical attention for the girl immediately upon her collapse, he did not “consider the people in charge of an institution which would cause such negligence fit people to be in charge.”328 Principal Mackey argued that the doctor was simply angered by the loss of income coming from the elimination of one of the annual inspections. According to Mackey, the girl had not appeared to be seriously ill until the morning that MacInnis inspected her and had been sent to hospital on the first available train.³²⁹ She was operated on shortly after her arrival and died the next day after developing pneumonia.³³⁰ Indian Affairs did not conduct a further investigation into the matter.

Reporting of deaths

It was not until 1935 that Indian Affairs adopted a formal policy on how deaths at the schools were to be investigated.³³¹ Under this policy, the principal was to inform the Indian agent of the death of a student. The agent was then to convene and chair a three-person board of inquiry. The two other members of the board were to be the principal and the physician who attended the student. The board was to complete a form provided by Indian Affairs that requested information on the cause of death and the treatment provided to the child. Parents were to be notified of the inquiry and given the right to attend or have a representative attend the inquiry to make a statement. However, an inquiry was not to be delayed for more than seventy-two hours to accommodate parents.³³² The department would not pay parents’ transportation costs to attend the inquiry.³³³ Indian agents often required prompting to comply with the policy. For example, when two pupils died at the Sturgeon Landing school in northern Saskatchewan in 1937, Philip Phelan, the chief of the Indian Affairs training division, had to remind the local Indian agent to complete a memorandum of inquiry.³³⁴ The agent, S. Lovell, responded that it was almost impossible to meet the requirements of the reporting policy. He pointed out that he was located in The Pas, Manitoba, and the Sturgeon Landing school was sixty miles (96.5 kilometres) away. A doctor from The Pas visited the school only once every three months. Lovell thought that, at best, it would take a week for word of a death at school to get to him and then for him to get to Sturgeon Landing. He said that in almost every case, “it would be impossible to notify the pupil’s parents of the death as they live, for the most part in very remote districts, a great distance from the school.”³³⁵ When a pupil died at the Sturgeon Landing school in 1939, no formal inquiry was held, since the Indian agent, the doctor, and the parents were all unable to travel to the school. Instead, the Indian agent filled out the form, based on information provided to him by the principal.³³⁶

Overcrowding

By 1933, Canada’s residential schools were full to their capacity.337 In the coming years, many were actually at more than full capacity. In 1930, Deputy Minister Scott ordered the principal of the McIntosh, Ontario, school to reduce enrolment from eighty-one to the sixty-five students he was allowed.³³⁸ The principal’s explanation was that he had taken in the children to help relieve the destitution faced by the Grassy Narrows Band.³³⁹ He said there really was no overcrowding problem: the nuns had given up their dormitory for some students, and the weaker ones were sleeping in the infirmary. This should not be viewed as a problem, since, he claimed, the government allowed students to sleep two to a bed at certain Protestant schools. As for their health, he said the students were better fed at the school than at home. The government should, he said, either allow him to admit the students or keep an earlier commitment and expand the school.³⁴⁰ A year and a half later, the school was still housing its additional students in makeshift arrangements, and asking the government to expand the number of pupils for which it was funded.³⁴¹

When Indian Affairs sought to have a recently orphaned boy admitted to the Fraser Lake school in 1939, it was noted that although “the school is crowded to capacity with an excess number of more than ten children; the Principal will always be glad to harbour—even free of charge, such orphans as the one you are referring to.”³⁴² With a pupilage of 160, the school actually had 173 students.³⁴³ Shortly after taking over the Mission, British Columbia, school in 1939, Principal F. O’Grady informed the local Indian agent that although the pupilage was 160, the school had close to 195 students. The daily allowance was “barely sufficient to provide food, clothing, fuel and other necessary expenses. How then am I to provide for those children for whom the government allows nothing?” He said he would not provide the extra students with less than the rest of the students, or discharge them, since they were often “weak and sickly.”³⁴⁴ While the department declined to increase the overall pupilage to the amount requested by the principal, it did agree to allow the Roman Catholic Church to take advantage of the fact that the Williams Lake school had enrolled fewer students than were allowed by its pupilage. Indian Affairs transferred some of the pupilage (and the grants that went with it) from the Williams Lake school to the Mission school, thereby increasing the school’s revenue.³⁴⁵

An Indian agent’s report on a 1935 death from measles at the Kamloops school noted that “the sleeping accommodation for 285 pupils in the school consists of five dormitories, which are crowded. During an epidemic it is impossible to properly isolate the patients and contacts. The need for separate quarters to house sick children is evident.”³⁴⁶ The Kamloops school was not an antiquated mission school. It was housed in a $300,000 structure that had opened in 1929.³⁴⁷

Tuberculosis and other infectious illnesses would have spread quickly in these crowded conditions.

The Fort Qu’Appelle Health Unit

Research spearheaded by the Saskatchewan Anti-Tuberculosis League (SATL) and the staff of the Fort Qu’Appelle Sanatorium helped demonstrate both the problems with existing residential school admission policies and the ways in which the health of First Nations children could be improved and protected. With funding from the National Research Council and Indian Affairs, the SATL established a Qu’Appelle Indian Demonstration Health Unit (commonly referred to as the “Fort Qu’Appelle Health Unit”) in 1930. The unit promoted measures intended to improve living conditions, including the provision of better housing and water supply, dietary supplements, visiting nurses, and hospitalization of all active tuberculosis cases. These measures led to a 50% decline in the First Nations tuberculosis death rate by 1932.³⁵⁰

The health unit ensured that students at the Qu’Appelle and File Hills residential schools were given a tuberculin test. Students judged to be in a contagious condition were discharged. The policy had a positive impact. In 1926, before the health unit was established, 92% of the students at these two schools had tested positive for tuberculosis. By 1933, when the health unit had been in operation for three years, the percentage of students testing positive for tuberculosis had dropped to less than 60% in the two schools. This was the same percentage as was found in children being tested prior to admission to the school. Dr. George Ferguson, the director of medical services for the Saskatchewan Anti-Tuberculosis League and medical director of the Fort Qu’Appelle Sanatorium, concluded that, as a result of the strict admission and discharge policy the health unit enforced, healthy students at those two schools were protected from infection.³⁵¹

In assessing the proposal for Indian Affairs, E. L. Stone said that it was “sound in every way from the scientific viewpoint.” Stone thought the residential school cattle herds could be cleared of tuberculosis for less than $3,000. By employing a special examining officer, he thought, it would be possible to do a better job of screening out infectious students—although he did not commit himself to x-rays. But, he believed the churches would represent a major stumbling block to the other reforms Ferguson proposed. None of them would be willing to have one of the existing schools transformed into a sanatorium. Neither would they be happy with the establishment of single, government-run sanatoria. If there were to be sanatoria, there would be objections to “the Department putting Protestant children in a Roman Catholic institution, or vice versa.” As well, he thought parents would object to sending their children to a distant treatment centre.³⁵³ Stone was accurate in his surmise. In 1935, Bishop Guy of Alberta expressed his opposition to the establishment of sanatoria solely for Aboriginal students. A government-run sanatorium, he argued, would end up being a Protestant facility with “protestant staff and direction.”³⁵⁴

Although the government was not prepared to establish a sanatorium, it did agree to support a travelling clinic that examined the students in all the residential schools in Saskatchewan.³⁵⁵ In its first survey, conducted in 1933, the clinic identified twelve active cases of tuberculosis and sixty-four potentially infectious students. In his report on this research, Ferguson wrote that identification and segregation of the “spreaders” “would certainly appear to be the most important and feasible single action to be taken with regard to tuberculosis in Indian Boarding Schools.”³⁵⁶ A 1934 survey of 921 students at eleven residential schools found 67 students who needed to be removed from school. Ferguson recommended that seventeen of the students be sent to a sanatorium or hospital. He reiterated his belief that a single residential school should be dedicated to the treatment and education of the remaining fifty contagious students. Segregating these “spreaders” was the “most important action that can be taken for the reduction of tuberculosis among Indian School children.”³⁵⁷ In schools where intense efforts had been made in the past to remove infectious students, the infection rate was lower than elsewhere.³⁵⁸ Although the report did not name the schools that had taken such measures, it is probable he was referring to the File Hills and Qu’Appelle schools, since these were the two schools in which the Fort Qu’Appelle Health Unit had been undertaking preventive work.

Ferguson’s repeated recommendation that some schools be transformed into sanatoria was endorsed by D. A. Stewart, the medical superintendent of the Sanatorium Board of Manitoba, in 1934.³⁵⁹ The proposal even gained the support of some church leaders. The Anglican Archdeacon of Saskatchewan, W. E. J. Paul, wrote to Prime Minister Mackenzie King, urging the construction of a sanatorium for First Nations people in Prince Albert.360 Despite these recommendations, no such sanatorium was built during this period.

Vaccination and experimentation

The Fort Qu’Appelle Health Unit also conducted a test of the bacillus Calmette-Guérin (BCG; alternately bacille Calmette-Guérin) vaccine. The BCG vaccine is a weakened strain of tubercle bacillus that can reduce vulnerability to tuberculosis. In 1926, after successful tests of the vaccine in France, it was tested on the infants of tubercular families in Montréal. The results of nine years of testing in that city indicated that, depending on age, BCG lowered children’s mortality rates by between one-quarter and one-third. There were, however, concerns that the infection could flare up later in life. In addition, BCG was associated with the death of seventy-one children in Lübeck, Germany, in 1929–30. (The resulting court case gave rise to one of Europe’s earliest informed-consent laws.) As a result, many researchers recommended continued reliance on sanatorium treatment as opposed to vaccination. However, it was thought that where infants were very likely to be exposed to tuberculosis, the use of BCG was warranted.³⁶¹ This meant that it showed particular promise for use in First Nations communities.

Dr. George Ferguson had misgivings about the use of the vaccine, writing in 1931 that it was unwise to conduct human experiments on people who were wards of the government.³⁶² Despite this uncertainty, Ferguson decided to go ahead with the test on First Nations students at the health unit hospital and in the Qu’Appelle and File Hills residential schools, and, before he began, he had his own six children vaccinated with BCG.³⁶³ In the fall of 1933, fifty-one infants born in the File Hills hospital were vaccinated. An additional fifty-one infants, who were born at home, were selected to serve as the control group.³⁶⁴ Over a twelve-year period, 306 infants were vaccinated, of whom 6 developed tuberculosis, leading to 2 deaths. Among the control group of 303, there were 29 cases of tuberculosis and 9 deaths from tuberculosis. The children were still vulnerable to the health risks that arose from life on the reserve: seven years into the study, 105 of the 609 infants who had been vaccinated were dead, mostly from pneumonia and gastrointestinal problems.³⁶⁵ In the fall of 1933, Ferguson had begun the selective vaccination with BCG of children in residential schools. He also maintained a control group of students.³⁶⁶ There were no deaths among the school-children who had been vaccinated or from the control group. This may have been due to Ferguson’s policy of excluding infectious students from the schools.³⁶⁷

Provincial pressure

In a 1936 article in the Canadian Medical Association Journal, the Manitoba Sanatorium Board’s D. A. Stewart wrote that, in the past, tuberculosis among Aboriginal people had been seen as “a kind of relentless process of nature, like an earthquake that we could stand in awe of, and be very sad about but do nothing to check or change.”³⁷⁰ It was time, Stewart wrote, to recognize that preventive and treatment measures would have the same positive impacts on Aboriginal tuberculosis as they did on tuberculosis in the general population. Stewart gave two reasons for stepping up the fight against tuberculosis in First Nations communities. The first was moral. Canada owed the First Nations person treatment because “we took and occupied his country, but especially because we brought him the disease.” The second argument was based on self-interest: if left untreated, tuberculosis would spread from reserves to the rest of the country. “The province will not be clear of any disease nor safe from its menace until every group is clear and safe.”³⁷¹

“No commitment,” no program: 1937–1939

Despite the growing provincial pressure for action on tuberculosis prevention, in 1937, the federal government imposed another round of cuts on Indian Affairs. In January of that year, Dr. H. W. McGill, the director of Indian Affairs (Indian Affairs had been demoted from a department to a branch of Mines and Resources in 1936) instructed all staff that “their duty in the immediate future is to keep the cost of medical services at the lowest point consistent with reasonable attention to acute causes of illness and accident. Their services must be restricted to those required for the safety of limb, life or essential function.” Spending on drugs was to be cut in half. The list of services for which there would be no funds included “tuberculosis surveys; treatment in sanatoria or hospital for chronic tuberculosis; or other chronic conditions; tonsil and dental clinics; artificial teeth and limbs; spectacles except for prevention of blindness; dental work except for the relief of pain or serious infection.”372

On the following day, McGill informed the assistant director for medical services in British Columbia that it “may not be possible to continue the operation of the tuberculosis segregation units at Kootenay [Cranbrook], Coqualeetza [Chilliwack] and Mission Indian Residential Schools.” He expected that the budget for medical expenditures was likely to be cut by up to $200,000 in the coming fifteen months.³⁷³

The government came under considerable pressure from the Canadian Tuberculosis Association (CTA) for these decisions. In 1936, the CTA called on the federal government to hire full-time staff with expertise in diagnosing and treating tuberculosis. It also recommended that First Nations students be screened annually, and that students with contagious diseases be either segregated or removed from school.³⁷⁴ An editorial in the March 1937 issue of the Canadian Tuberculosis Association Bulletin commented that “the facilities for early diagnosis, treatment and prevention that have been used to such good advantage in the White population have never been made available for the attack on the Indian problem.” According to the Bulletin, Indian Affairs had “never developed a progressive policy for the control of tuberculosis.”³⁷⁵ In the face of a CTA lobbying campaign, the government established a Standing Committee on Indian Tuberculosis.³⁷⁶ At that committee’s first meeting in June 1937, Indian Affairs made it clear that, although Dr. McGill had managed to add $50,000 to his Indian Affairs budget for tuberculosis work in that year, the “Government has given no commitment nor has it authorized the Department to embark on a tuberculosis program.”³⁷⁷

Indian Affairs medical officer E. L. Stone recommended the $50,000 be used initially to clear “out the sanatorium cases from the schools” and isolate the infectious cases. But where to put the cases that should be isolated? According to Stone, the “Churches have shown no eagerness, so far, to offer one or two schools” for facilities for tubercular students, and Indian Affairs had “little disposition to force or argue the idea.” Stone was also opposed to establishing isolation sections within existing schools. These projects, in his opinion, had proven to be failures.³⁷⁸

He was referring to the small-scale preventoria that had been established at a number of schools. The preventoria, which served as isolation units, were more acceptable to churches than full-fledged sanatoria, since they allowed them to maintain enrolment and control over the students. The first of these facilities was opened at the Coqualeetza Institute in Chilliwack in 1935 after a survey in which 77% of the 214 students who had been given the tuberculin had tested positive for tuberculosis. Located in a converted farm building, it housed fifteen students, who were supervised by a nurse. The facility was expanded in 1936 and porches were added to the building.³⁷⁹ The Coqualeetza project was followed by similar establishments at Alert Bay and Mission, both in British Columbia.³⁸⁰ The Alert Bay preventorium, which opened in 1939, was located in a building that had previously served as the principal’s residence and had been renovated by the students as part of their manual training.381 A preventorium had also opened at the Fort Alexander, Manitoba, school in 1938.³⁸²

By maintaining infected children on the school site, however, the preventoria did not fully isolate infectious or potentially infectious students from healthy students. In the Fort Alexander preventorium’s first year of operation, officials placed students who were of below-average health, but not suffering from tuberculosis, in the special facility along with tubercular students.³⁸³ The preventorium operated in close conjunction with the school, and concerns soon were raised that the sick students could infect the rest of the student body.³⁸⁴ In the spring of 1939, Indian Affairs decided to discontinue the operation of the preventorium.³⁸⁵

The federal government increased its commitment to spending on First Nations tuberculosis to $275,000 in 1938 and $575,000 in 1939.³⁸⁶ (If the government had accepted Dr. Stone’s 1930 proposal, it would have been spending $800,000 and $900,000, respectively, on First Nations tuberculosis treatment in those years.) In February 1938, Stone and McGill informed Indian agents of the department’s tuberculosis priorities. The first was to “secure tuberculosis control of residential schools.” This would involve removing students who had active, communicable tuberculosis. They were to be discharged, and their “disposal will not be a matter of further interest to school Principals.” Those who had “a promising future,” but needed “extra care and feeding,” would remain segregated within the school under a “modified school” regime. The second priority was to apply the same level of supervision to day schools, and the third priority was to provide care for children with tubercular joints and bones to prevent their becoming crippled. Adults were the fourth priority. Sanatorium or home care would be provided to adult patients who had a “reasonable hope of recovery with a moderate term of treatment” or who represented a threat of infection to young children. Sick adults had to be “willing to accept treatment and intelligent enough to profit by it.”³⁸⁷

The policy of clearing out the infected students continued to meet with resistance from the schools. Cluny school principal J. Riou continued to maintain that the care given at his school was as good as would be received in a sanatorium. Over the previous four years, he said, he cut school hours, augmented his cattle herd, and employed a nurse with experience in treating tuberculosis. As a result, no student who came to the school in the “no disease” category had ever become an “active” case. He recognized that the proposed measures might be needed in most other schools where “nothing has ever been done to fight tuberculosis,” but Cluny was an exception. He also indicated that parents opposed a policy of sending children with active tuberculosis to distant sanatoria.³⁸⁸

In the fall of 1938, the federal government significantly expanded the number of students being tested for tuberculosis and enhanced the sophistication of the technology used to test them.³⁸⁹ The goal was to remove children with active tuberculosis from the schools.390 The fact that this was still the government’s priority suggests the ineffectiveness of the medical examinations in the past. By failing to treat each child as a potential patient, the schools had turned an increasing number of children into actual patients. The low-cost “common sense” approach that Deputy Minister Duncan Campbell Scott had adopted when he rejected Dr. Peter Bryce’s proposal to turn the schools into sanatoria had pleased the government because it was not expensive, and it had pleased the churches because it left them in control of the schools and the students. Yet, the first matter of business for E. L. Stone some twenty-five years later, in 1938, was to discharge from residential schools those students who needed sanatorium treatment. It is clear evidence that the government never had put in place a proper screening process, or developed facilities for providing students who developed tuberculosis with proper treatment. The prevention of disease and the treatment of sick Aboriginal children were a shameful failure.

Other diseases and health issues

The same conditions that left students vulnerable to tuberculosis—overcrowding, inadequate housing, poor diets, faulty sanitation, and limited access to medical treatment—also left students vulnerable to a range of other, often fatal, health problems. The most dramatic of these was the influenza pandemic (an epidemic on a global scale) that followed the First World War, which demonstrated the inadequacy of medical services in residential schools.

The influenza pandemic of 1918–19

In the spring of 1918, a deadly influenza virus, often referred to as the “Spanish flu,” swept the globe. It is thought that nearly a third of the world’s population had been infected with the illness. Estimates of the number of deaths range between 50 and 100 million. The pandemic began in March of 1918, rose to a peak in a second wave in the fall of 1918, subsided, and returned in a third deadly wave in the early winter of 1919.³⁹¹ In Canada, it left 55,000 people dead, 4,000 of whom were Aboriginal. The difference in the health conditions of Aboriginal people and the general population is apparent from the fact that the overall Canadian death rate for the pandemic was 610 deaths per 100,000 people, while the Aboriginal rate was 3,770 per 100,000.³⁹² The vulnerability of Aboriginal people to influenza is attributable in part to government social and economic policies that had left Aboriginal people impoverished, poorly housed, and lacking access to medical care.

The 1918 epidemic overwhelmed medical services wherever it hit. Its impact on remote, understaffed boarding schools was devastating. Influenza struck the Shoal Lake school in northwestern Ontario in October 1918.³⁹⁵ Although no students died, the principal, Mr. Mathews, was infected. The local doctors were all ill themselves. It was several days before Indian Affairs could find a physician to send to the school. By then, Principal Mathews was beyond recovery; he died within a matter of days. The Indian agent noted that elsewhere in the region, the epidemic was severe as well: nearly the entire Rat Portage Reserve was, in his words, “laid up.” There were an additional thirty-five cases at the Roman Catholic school at Kenora, although he said those were of a “mild type.³⁹⁶

Indian Affairs instructed Kuper Island principal J. Geurts “not to allow pupils of the school to visit outside Indians, nor the Indians to visit the pupils.”³⁹⁷ The local Indian agent considered closing the Portage la Prairie, Manitoba, school and sending the children home.³⁹⁸ By the time permission was given to send the children home, the local reserves had all been placed under quarantine, so the students stayed at the school, which was also under quarantine.³⁹⁹ At the Mohawk Institute in Brantford, Ontario, there were seventy-six cases of influenza by October 24, 1919. According to the acting principal, “Most of the staff have been laid up—for days all we could do was to attend to the sick.” Despite staff efforts, one child had been lost to the epidemic.⁴⁰⁰

On October 21, 1918, the first case was reported at the Spanish, Ontario, girls’ school. Three days later, all but three girls and a few staff members were confined to their beds. Within a few days, all the boys except three at the Spanish boys’ school were also bedridden. In just over two weeks, eight girls and eight boys died.⁴⁰¹ Based on the 1918–19 school year enrolment of 112 boys and 96 girls, this amounts to 7.14% (7,140 per 100,000) and 8.33% (8,330 per 100,000) mortality rates for the boys and girls, respectively, due to the flu.⁴⁰²

By the end of October, all the students and four members of the staff at the Sarcee school in Alberta were confined to bed. According to the Indian agent, “Voluntary help has been secured from Calgary, and the situation is well in hand.”⁴⁰³ In the spring of 1919, the Indian agent reported that two Sarcee students had died from influenza and two more from tuberculosis.404 Since the Sarcee school had thirty-three pupils in the 1918–19 school year, the mortality rate there was 12.12% (12,120 per 100,000).⁴⁰⁵

In December 1918, the High River, Alberta, school was stricken with the epidemic. Former principal A. Naessens was sent to provide assistance. When he arrived, he found that “all the children, both boys and girls were in bed and many of them in a very critical condition. Then some of the staff, through overwork, were forced to retire.” The one nurse Naessens brought with him from Calgary proved to be insufficient, and he secured two additional nurses. Since the school doctor was sick, he had to arrange medical care from Calgary. Despite their efforts, three boys and the principal died.⁴⁰⁶

Although there were no deaths, all the students and staff at the Lestock, Saskatchewan, school came down with influenza.⁴⁰⁷ Eleven students at the Roman Catholic school at Onion Lake, Saskatchewan, were dead by December 18, 1918, as was one student at the Anglican school there.⁴⁰⁸ By mid-December, all the students and half the staff in the Cross Lake, Manitoba, school were in bed. Three students had died.⁴⁰⁹

Four children died at the Red Deer, Alberta, school in the fall of 1918, and a fifth died after running away from the school. When the influenza epidemic subsided, Principal J. F. Woodsworth complained to Indian Affairs:

For sickness, conditions at this school are nothing less than criminal. We have no isolation ward and no hospital equipment of any kind. The dead, the dying, and the sick and the convalescent, were all together. I think that as soon as possible the Department should put this school in shape to fulfil its function as an educational institution. At present it is a disgrace.⁴¹⁰

Duncan Campbell Scott informed Woodsworth that he regretted that the school had “been so severely visited, and especially I regret the deaths that have occurred.” He added that “all our work in connection with our educational institutions has during the past four years been greatly curtailed owing to there being no appropriation for any extensive expenditure.”⁴¹¹ At Red Deer, an undertaker was paid $130 to bury the dead—two to a grave. As Woodsworth put it, the burials were “as near as possible to that of a pauper.”⁴¹² The impact on the school was so demoralizing that it contributed to its permanent closure in September 1919.⁴¹³

The Red Deer school was not a small, church-founded, mission school. It was one of the industrial schools that the federal government established in keeping with the recommendations of the 1879 Davin Report. Since the beginning of the twentieth century, school officials had been lobbying, with little or no success, for improvements in facilities to care for sick children.⁴¹⁴

In February 1919, the flu struck again. The Shingwauk Home in Sault Ste. Marie, Ontario, was quickly placed under quarantine.⁴¹⁵ When the outbreak was over, two students were dead.416 Just as the flu was subsiding at Shingwauk, it was taking hold at the Birtle, Manitoba, school, with sixteen children reported to be running high temperatures on February 21, 1919.⁴¹⁷

The epidemic also hit British Columbia in waves. In the fall of 1918, it struck thirteen schools, sparing only the Kuper Island, Kamloops, and Lytton schools. Of the 887 students in the affected schools, 521 developed influenza and 11 died.⁴¹⁸ This amounted to a mortality rate of 1.24% (1,240 per 100,000). At the Fort St. James, British Columbia, boarding school, the epidemic struck almost the entire staff and all but two of the children overnight, sparing only the principal, two of the nuns, and two small boys. Together, the five of them cared for fifty patients. According to Principal Joseph Allard, the boys “were a great help to me for packing water from the lake to the kitchen and to the dormitories of boys and girls.”⁴¹⁹

Margaret Butcher left a vivid picture of conditions at Kitamaat, British Columbia, when influenza hit the school in 1918. Within a few days, thirty students were bedridden.

Those children were very sick and what with vomiting, dysentery, nose-bleeding & senior girls’ troubles, we had a horrible time. I never saw such nose-bleeding. We could not stop it & when it transpired that the only girl whose nose did not bleed, suffered hallucinations & was out of bed and trailing bedding or clothes crying she had killed herself or the house or her darling, or else asking me to cut her in pieces or she [was] hunting for her lungs or other parts of her body that had fallen out, I sure put up with the bleeding as a beneficent evil rather than have several crazy ones. After bleeding came congestion in varying degrees & horrible expectoration until it seemed impossible that children who a few days previously had been in good health could throw up such quantities of vile mucous.⁴²⁰

In 1919, influenza recurred at the Mission, Chilliwack, Squamish, and Sechelt schools. Of the 310 students at these schools, 298 came down with influenza and 8 died.⁴²¹ This was a mortality rate of 2.58% (2,580 per 100,000).

Even when the global epidemic had subsided, influenza remained a presence in the schools. In February 1920, thirty pupils, most of the staff, and the principal of the Chapleau school came down with influenza.⁴²²

The devastating impact of the 1918 influenza epidemic on the Aboriginal population was reflected in residential school recruiting policy. In 1919, Indian Affairs decreed that no child with living parents was to be admitted to a residential school until all the children orphaned by the epidemic had been taken into the school.⁴²³ For example, in Alberta, the Joussard school, with a pupilage of fifty students, was allowed to take in seventy-three students, and Grouard, with a pupilage of fifteen, was allowed to take in twenty-six. Indian Affairs believed “there was no other means, in that northern country” of taking care of the children who had been orphaned by the epidemic.⁴²⁴ The epidemic indirectly stimulated the development of residential schooling in Labrador (at that time part of the British colony of Newfoundland). The Grenfell Mission opened its first boarding school specifically for children who had been orphaned by the 1918 epidemic.425

The government was not prepared to let First Nations people mark the end of the epidemic according to their own traditions. In the spring of 1919, the chief and council at Onion Lake, Saskatchewan, petitioned to hold a Sun Dance to commemorate the end of the First World War and the influenza epidemic. The request was denied, but the band members attempted to hold it anyway, only to have the police appear and disperse the people who had gathered for the occasion. The police broke up similar ceremonies that year on the Piapot and Big River reserves in Saskatchewan.⁴²⁶

Measles, smallpox, diphtheria, typhoid, pneumonia, and whooping cough

Tuberculosis and influenza were the two major causes of death in the schools, but the schools were also regularly hit by smaller, more localized, epidemics of measles, smallpox, diphtheria, typhoid, pneumonia, and whooping cough. These infections could spread quickly, particularly since most schools had primitive sanitation facilities, cramped dormitories, and limited ability to isolate infected patients. All these illnesses placed tremendous strain on staff and those students who remained healthy. For students who had already been weakened by tuberculosis, they often proved deadly. For example, at the Lytton school, a combination of measles and whooping cough killed thirteen children over the winter of 1926–27. Ten years later, an influenza attack affected 170 students, 11 staff members, and 4 emergency nurses.⁴²⁷ In 1937, a similar combination of measles and whooping cough killed three children at the Shingwauk Home in Sault Ste. Marie.⁴²⁸ At the remote Beauval, Saskatchewan, school in that same year, an attack of influenza was followed by cases of measles and pneumonia that left fourteen students dead.⁴²⁹

A study of the Norway House, Manitoba, school, compiled by researcher Melissa Stoops (Table 16.4), shows the almost ceaseless rounds of epidemics the school faced. The Norway House school weathered fifteen separate epidemics over a thirty-six-year period.

We have suffered, in common with the reserve upon which we are situated, from a most virulent epidemic of whooping-cough, bronchitis and pneumonia; most suffering from all three diseases at the same time, and in addition, some had chicken-pox. Lilian Yeomans, M.D., and Miss A. Yeomans, a trained nurse, did all in their power to check and cure the troubles, but in spite of this we lost three girls and one boy from the above cause, and one girl from eating poisonous berries while out in the bush. This, however, could not be taken to indicate unhealthy conditions in or around the school, as there were about sixty-five deaths on the reserve from the same cause. Nearly all the children suffered more or less from these diseases. We gave the children and staff a week’s holidays at Christmas, which was unusual, to rest and regain strength after the long siege of sickness. With regard to sanitation, I found the cellars very wet and no drain to carry off the water. This is being remedied as fast as possible. I have also built a wharf, from the outer end of which we get much better water than was formerly secured off shore.430

As Lousley’s report makes clear, these diseases operated together. In August 1896, at the Middlechurch, Manitoba, school, Dr. George Orton reported:

During the past winter and spring an epidemic of typhoid fever broke out, and though all passed through the various stages of the fever, no less than six succumbed to consumption, induced, doubtless, by the depletion of the fever and in some by a complication of pneumonia and bronchitis. One girl died from meningitis, doubtless of a tubercular character.⁴³²

There were also problems with diagnosis. A 1901 outbreak of measles in the Roman Catholic school in Onion Lake, in what is now Saskatchewan, was initially reported as being smallpox.⁴³⁵ On November 16, 1915, the Indian Affairs office in Ottawa received a frantic telegram from the Anglican school in The Pas, announcing that twenty-six students had been stricken by gas poisoning.⁴³⁶ Nine days later, Dr. O. I. Grain visited the school on behalf of the department. He found that the children had been mis-diagnosed. They had not been poisoned by a blocked sewer, as had been originally thought; they had typhoid fever. By then, thirty people, including four staff members and the hospital matron, had come down with the illness, and more cases continued to develop. Grain thought that the milk at the school was the likely cause of infection. He noted that the school had no source of hot water, since the hot-water tank had burst.⁴³⁷

Lack of care and treatment facilities

Government penny-pinching also contributed to the poor handling of a series of syphilis infections at the Shubenacadie school. Although syphilis is most often spread through sexual contact, pregnant women can pass the disease on to their fetus, resulting in what is known as “congenital syphilis.” From 1909 onward, the disease could be treated with repeated injections of the drug arsphenamine (also known as Salvarsan).⁴³⁸ Residential schools had the capacity to identify the disease in new students and provide them with treatment. In 1932, when it was believed that some students at the Shubenacadie school were suffering from the disease, Indian Affairs considered having all the students tested.⁴³⁹ The proposal foundered when the local doctor asked for a fee of $1 a student instead of the $50 flat rate that Indian Affairs sought to impose.⁴⁴⁰ The following year, a father complained to Indian Affairs that his three children, who had been diagnosed with syphilis, were not receiving proper treatment at the school. Department secretary A. F. MacKenzie forwarded the complaint to the Shubenacadie principal, J. P. Mackey. In doing so, he noted that Indian Affairs was familiar with the father and “not inclined to make too much of his complaints,” while acknowledging that “residential school pupils who have had treatment for syphilis should have their treatment followed up.”441 By early 1934, MacKenzie was instructing Mackey to ensure that the children received the treatment they needed.⁴⁴² He later recommended that Mackey have all new students tested for syphilis.⁴⁴³ This should not have been necessary: since 1933, the medical examination form for residential school admission had required doctors to state whether or not the student had syphilis.⁴⁴⁴

These diseases also drew additional attention to the lack of treatment facilities. A boy at the Anglican school in Onion Lake came down with smallpox in 1921. He was kept in a small dormitory with a sheet hung over the door that was regularly sprayed with disinfectant until a doctor could confirm his diagnosis and put a quarantine into effect.⁴⁴⁵ In 1924, the Mission school put up two buildings to use as an isolation hospital after an outbreak of diphtheria and smallpox.⁴⁴⁶ After a 1935 outbreak of measles at the school at Muncey, Ontario, school administrators were hopeful that the government would approve construction of a planned isolation ward in the third storey of the building. Instead, Indian Affairs instructed the principal to take advantage of the fact that most of the children were away on summer holiday and turn some of the dormitories into isolation wards.⁴⁴⁷ A few months later, forty-two students had fallen ill with German measles.⁴⁴⁸

In some cases, the staff simply resorted to prayer. When students at the Shubenacadie school came down with streptococcus infections, Sister Mary Charles, of the Sisters of Charity, arranged to have all the children in the school pray to Kateri Tekakwitha (a Mohawk woman who had converted to Catholicism in the seventeenth century). According to Charles, ten children recovered overnight and no new cases developed.⁴⁴⁹

Lack of funding

The federal government often sought to limit its financial responsibility. The secretary of the British Columbia board of health thought that all the Mission students should be immunized after an outbreak of diphtheria in 1905. The Indian Affairs medical officer, Dr. A. J. Stuart, noted, “This, of course, is true; but the expense!” Full immunization would cost $200. In the end, the decision was made not to immunize unless new cases appeared.⁴⁵⁰ In other cases, the government did vaccinate. After an outbreak of smallpox at the File Hills, Saskatchewan, school in 1916, a local doctor was hired to vaccinate all the First Nations people who were in the agency at the time of Treaty payment. He was to be paid fifty cents a person.⁴⁵¹ After an outbreak of diphtheria at Duck Lake, Saskatchewan, in 1909, efforts were made to inoculate all the students at the school. The nine students who became ill were placed in a “large isolated house.”452 After a typhoid outbreak at the Kuper Island school in 1939, all the students were inoculated.⁴⁵³

The per capita system of funding punished schools that followed policy and did not enrol children with infectious illnesses. In 1936, Blue Quills, Alberta, principal Joseph Angin complained that Indian agent W. E. Gullion, whom he described as a “hypocrite,” had undermined the school by forbidding parents to return their children to school at the end of summer holiday after an outbreak of whooping cough in the community. Angin argued that it made no sense to keep seventy-five children home from school because “only 6 or 7 were sick.” Angin was particularly concerned because Gullion’s decision would affect the amount of the school’s per capita grant.⁴⁵⁴ While Angin claimed that Gullion had acted against the instruction of the local doctors, Gullion maintained that they had supported his decision. He claimed that Angin, in contravention of his orders, had “started to urge the Indians to take their children back to school.”⁴⁵⁵

Limiting and opposing parental involvement

Into the late 1930s, parents were still expressing concern that they were not being properly informed about the health of their children. In 1931, Mrs. W. F. Dreaver informed Indian Affairs that she was refusing to return her daughter, Mary, to the Anglican school at Onion Lake because of the poor medical treatment her son had received there. She wrote that her son had returned to the school in the fall of 1930. At admission, he was examined and declared to be in good health. He became sick, but his parents were not informed of the illness until December. In response to the telegrams that the concerned parents sent the school, Henry Ellis, the school principal, assured them their boy would soon be out of bed. Eventually, the parents were able to get him back home, a trip they had to pay for themselves. The local doctor, who had originally approved him for entrance to the school, announced he was “far gone with T.B.” He died a few months later. Mrs. Dreaver said that rather than send her daughter to a school where “the children are neglected,” she would send her to the local day school.⁴⁵⁶ She apparently succeeded: the school records show that Mary Dreaver had been discharged that term and was attending the Mistawasis day school.⁴⁵⁷

Religious control over the delivery of medical services also generated conflicts with parents. In 1936, Andrew Gordon, a member of the Pasqua First Nation in Saskatchewan, tried to withdraw his older daughter, Edith, from the Qu’Appelle school. In making the request, he noted that he had attended the school as a youth for fourteen years, adding they “were 14 years of my life wasted.” He stated that he was a pagan in religion, but had sent both his daughters to the school. However, his eleven-year-old daughter had died from pneumonia at the school. He thought she was given proper treatment by the Fort Qu’Appelle doctor and the Indian Affairs nurse. His daughter had asked him to keep the nuns and priests out of her room. She said they were telling her that she

was going to die for her father’s sins, that she must get her father to join the catholic faith before she died, and many other things. The child was so earnest about this that my wife stayed with her as much as possible, but the moment she might be away for meals or a little sleep this Nun would get in and worry the child, and on my wife’s return, she would find her in tears.

Despite his requests to the school principal, Gordon said, a nun continued to visit and worry his daughter, who, after rallying briefly, died. Gordon said the school staff told him he should be glad his daughter was in heaven, where she was “praying for you to be saved from your sins.” Given these events, Gordon asked that he be allowed to have his other daughter officially discharged from the school.⁴⁶⁰ School officials denied Gordon’s allegations, saying the deceased “girl was not bothered in any way at all.” The Indian agent, Frank Booth, noted that Gordon was an “outstanding Indian,” who was convinced that his statements were true and would be able to see to the education of his daughter if she were discharged. Therefore, he recommended that the daughter be discharged.⁴⁶¹ Despite this, J. D. Sutherland, the acting superintendent of Indian Education, denied the request, saying that “it is considered that Gordon’s daughter received every possible care and attention previous to her death.”⁴⁶² As a result, the older daughter, Edith, was not discharged until the fall of 1938, when she turned sixteen.⁴⁶³

The pressure on staff

When a measles epidemic hit the File Hills school in 1912, the Indian agent ordered that a nurse attend to the sick students. But when the Presbyterian Church tried to get the federal government to pay the nurse’s $155 bill, it said no. The department said it was responsible only for the cost of medicine.⁴⁶⁶ There were other cases where the schools, either on their own or with government support, hired additional medical help. When a smallpox epidemic struck the Kuper Island school in 1920, an additional nurse was hired to help look after the thirty-five infected children.⁴⁶⁷ In response to a serious outbreak of pneumonia linked with whooping cough at the Chapleau school, Indian Affairs arranged to hire and pay for a nurse to assist at the school in 1922.⁴⁶⁸ Similarly, a nurse was hired after a serious outbreak of pneumonia at the Edmonton school in 1934.⁴⁶⁹

These illnesses sometimes led to placing the schools under quarantine. This happened at Regina in 1903,⁴⁷⁰ Alert Bay in 1923,⁴⁷¹ and The Pas in 1929.⁴⁷² In other cases, little was done to protect the broader First Nations community from infection. When smallpox broke out among the students at the Mission school in 1919, the principal sent the sick children home by train. The result was a serious outbreak of smallpox in the general First Nations population. The local Indian agent wrote, “I cannot understand the action taken by the Principal of St. Mary’s School at Mission in sending these children back onto the reserve to scatter any disease amongst the others even if they did not know what the dreaded disease was.” He said that it seemed to be a particular failing of the school to “send children home when anything is wrong with them instead of taking care of them as they should.”⁴⁷³

Trachoma

Trachoma is an infection of the eyes that can lead to blindness. Spread by bacteria, it is associated with overcrowding and limited access to water and health care.⁴⁷⁴ It deserves special discussion because of its prevalence among Aboriginal people and because of the role residential schools played in spreading the disease. As early as 1906, the Indian Affairs annual report noted that diseases of the eyes tended to spread rapidly in boarding schools, particularly if towels and washbasin water were being shared among students. The report recognized that these diseases could result in chronic trachoma.⁴⁷⁵ Dr. Peter Bryce believed the originating cause of eye disease among Aboriginal people was the “habits of life of the Indian, whether in the teepee or cabin.”⁴⁷⁶ He placed particular blame on irritation from smoke from campfires.⁴⁷⁷ These eye diseases, he wrote, could end in “trachoma, corneal ulceration and even blindness,” and were “not unfrequently seen in its chronic results in school children.”478

In the early twentieth century, there were reports of residential school students with severe vision problems. In April 1906, a Mount Elgin student’s eyes had been so sore all winter that he was not able to study. However, “he had been made to work all the same.”⁴⁷⁹ In his 1920 report on health conditions in a number of schools on the Prairies, Dr. F. H. Corbett noted that at the Cluny school in 1920, “though a few cases of ancient trachoma are found, they are all cured so far as is possible.” At the Sarcee school, he reported, “Twelve of the children have sore eyes.”⁴⁸⁰ At the time, there was no safe, effective treatment for trachoma. Common practice was to treat the eye with copper sulfate in an effort to destroy the infected tissue, rendering the disease inactive.⁴⁸¹

Trachoma was known to be rampant also among Native Americans in the United States in the early twentieth century. A 1912 survey found that 20% of all Native Americans examined had the disease; at boarding schools, the rate was 30%.⁴⁸²

Despite all this evidence, Indian Affairs appears to have downplayed the risk of trachoma. In 1928, Deputy Minister Duncan Campbell Scott reported that trachoma was “very rare among Canadian Indians, if indeed, it exists at all.” It was noted, however, that there did appear to be a condition in Alberta consisting “of an acute inflammation of the eye, with a small ulcer on the eyeball, and often leads to impairment of vision. It occurs chiefly among undernourished children, and is probably to a large extent a deficiency disease.”⁴⁸³ At that time, there were no national statistics on the prevalence of trachoma in Canada in the general population.⁴⁸⁴ By 1929, Indian Affairs medical officer E. L. Stone was concerned by reports of trachoma at schools and hospitals in Saskatchewan, noting that “this disease is one of the worst pests which the American government has among Indians.”⁴⁸⁵

The depth of the problem was finally brought to light by Dr. J. J. Wall’s 1930 study of the incidence of trachoma among First Nations people in the prairie provinces and the interior of British Columbia. He concluded in his report to Indian Affairs that “25 to 30 per cent of the Indian population were afflicted with trachoma in its various stages. Pupils of the residential schools showed a high incidence of the disorder.” As Indian Affairs acknowledged, up to that time, “no organized effort had been undertaken to eradicate the disease.” According to the 1937 Indian Affairs annual report:

Many of the schools at that time, unknown to the school authorities, were serving as centres for the spread of this eye disease. The principals and other officials were entirely unaware even of its existence. Casual observation of the external appearance of the eye certainly did not suggest anything amiss with the lids, which had to be everted [turned over] for proper examination. Most of the corneal ulcers and other eye diseases in the children were attributed largely to tuberculosis. No suspicion was aroused at that time that the greater number of these disorders were due to extension of a trachomatous process from the lids into the transparent portion of the eye. This extension is most insidious and slow in character.486

There were measures that could have been taken to control the spread of trachoma. Dr. Gordon M. Byers, professor of ophthalmology at McGill University, had been calling for improved detection and prevention of trachoma since 1901. In 1932, he wrote, “If through the years the Department of Indian Affairs had maintained even one whole-time oculist for the detection and correction of visual defects alone among the Indian children of Western Canada, the presence of trachoma among its wards would long ago have been discovered.”⁴⁸⁷

In October 1931, Indian Affairs did issue instructions to residential school principals on controlling the spread of the disease. Under these guidelines, each pupil was to be provided with an individual towel and soap, and taught to use no other.⁴⁸⁸ However, in March 1932, Indian Affairs instituted a 10% cut to the school per capita grant, retroactive to January.⁴⁸⁹ The cut in the grant rendered the advice to improve sanitary supplies meaningless.

Dr. Wall was hired as a full-time specialist to organize clinics and provide treatment for trachoma for First Nations people. Residential schools were given particular attention. Under Wall’s direction, students were treated with copper sulphate and measures were put in place to reduce the spread of the infection. In 1939, Indian Affairs reported that although trachoma remained a menace to the First Nations population in western Canada, its incidence among residential school students had been reduced by 50% since 1934.⁴⁹⁰ Birtle principal E. Lockhart reported in 1939 that Dr. Wall had concluded that his school was making “good progress” in dealing with trachoma. “Four cures, and eight arrests since the last visit. None of the old cases are more than Plus 2 [a measure of severity].”⁴⁹¹ However, when poor health forced Wall’s retirement in 1939, he was not replaced.⁴⁹²

Effective treatment for trachoma was finally developed in 1938, when Dr. Fred Loe began treating trachoma patients on the Sioux Reserve in South Dakota with a new antibiotic drug, sulfanilamide.⁴⁹³ After this development, Indian Affairs used sulfanilamide successfully for the treatment of residential school students.⁴⁹⁴

Accidental deaths

Students were also at risk of accidental death, particularly by drowning, since many of the schools were located on lakes, rivers, and even, at times, oceans. In some cases, the students died while they were engaged in prohibited activities. In other cases, they were participating in school-organized events. Herby Gabourie, believed to be either five or six years old, drowned in late December 1898 at the Kuper Island school. The circumstances of his death were unknown. After it was apparent that he was missing from the school, a search party found his body in the water near the school pier.495 Two weeks after the girls’ school in Spanish, Ontario, opened in 1913, a group of students was taken out for a picnic, travelling by boat up the Spanish River. The boat capsized and two girls, Anna Lahache from Kahnawake and Jennie Robertson from Garden River, drowned.⁴⁹⁶

On June 29, 1919, twelve boys from the Moose Factory, Ontario, school were in a canoe, crossing the Moose River on a berry-picking expedition, when it overturned. Seven boys, Alfred Loutitt, Thomas Loutitt, Arthur Sutherland, James Sutherland, Harry Wesley, John Sailors, and Sinclair Nepaneshkum, drowned. One fourteen-year-old boy, John Carpenter, kept an eight-year-old boy afloat until Archie Sailor, a local First Nations man, could remove them both from the water.⁴⁹⁷ Although the local Indian agent, H. N. Awrey, found the principal blameless for the accident, department official A. J. MacKenzie felt “that to allow such a large number of boys in a canoe should not have been permitted. It is hoped that this accident will not result detrimentally to the future recruiting of pupils for the school.”⁴⁹⁸ Principal W. Haythornthwaite said he did not agree with “Mr. Awrey’s most charitable opinion regarding our responsibility.”⁴⁹⁹

Four men from the Moose Band, Chief Woomastoogish, George Hardisty, Andrew Butterfly, and John Dick, also did not agree with Awrey. They wrote the following submission to the government. (It was written in syllabics and translated by Thomas O. Moore of Moose Factory.)

There were twelve children in the canoe and the children were alone, and the canoe which they were using was very bad. A canoe which was not fit for anyone to use. The canvas of the canoe was half ripped.

Now these children were allowed to go crossing the river every day in it and very often twice one evening. The canoe was that far gone that the thwarts were just nailed on top of the gunwale.

There was not one boy big enough to have any sense.⁵⁰⁰

On a March morning in 1929, the gardener at the Mohawk Institute in Brantford, Ontario, took two boys out in a canoe to go hunting for muskrats. The canoe tipped over, and one of the boys, Edgar Smith, fell under the ice and was not recovered. The trip had been undertaken without the approval of the principal.⁵⁰¹

Twenty-one students from the Hay River school in the Northwest Territories went swimming at a lakeside bathing beach in July 1929 (the lake is not named in reports on the drowning). There was only one staff person supervising them. At the end of the swim, one boy’s clothing was not claimed. It was only then that it was realized he had likely been swept into the lake and drowned.⁵⁰²

Other, non-drowning, deaths raised questions about supervision and building safety. John Alexander, a student at the Anglican school in Brocket, Alberta, died when the roof of a root cellar collapsed on him in October 1895. The local Indian agent said he believed that no one was to blame for the death.⁵⁰⁴ At the same school in January 1899, two boys died when a snow slide swept down a hill on which they were sledding. No inquest was held.⁵⁰⁵ According to Principal W. R. Haynes, “The Indians behaved exceedingly well, seeing that it was the boys [sic] own fault, and that the boys had constantly been warned by them as well as by us of the danger.”⁵⁰⁶

In 1939, Courtland Claus, a five-year-old boy who had been left alone in the dormitory with an infected ear, fell from a second-storey window at the Mount Elgin school. Although he survived the initial fall, he died in hospital later that day. The principal took the body home in a casket to the boy’s father.⁵⁰⁷ The Indian Affairs superintendent of Welfare and Training, R. A. Hoey, commented that the accident underscored “the fact that young children confined to the infirmary should not be left alone unless every precaution has been taken to prevent any accident. In this particular case it would appear that if there had been a proper screen in the window the boy would not have fallen out.”⁵⁰⁸

There are also reports of suicides from this period. In her memoirs, Eleanor Brass spoke of a boy who had hung himself for fear of discipline at the File Hills school.⁵⁰⁹ A later chapter in this report will discuss the relationship between discipline at the school at Williams Lake, British Columbia, and what may have been a suicide pact among a group of boys in 1920.⁵¹⁰ In 1930, the local doctor was not able to determine the cause of death of two boys at the Fraser Lake school. It was later reported that the boys had been seen with water hemlock prior to their becoming ill.⁵¹¹

Appropriation for 1931–32	$1,050,000
Appropriation for 1932–33	839,000
Appropriation for 1933–34	793,000
Number of Indians, 110,000
Cost per capita per annum, 1931–32	10.00
Cost per capita per annum, 1932–33	7.60
Cost per capita per annum, 1933–34	7.20
Cost per capita per annum for the population at large, as estimated by the Ontario Provincial Department of Health	30.00

Disease Outbreak	Year
Whooping cough, bronchitis, pneumonia	1902/1903
Chicken pox	1902/1903
Scarlet Fever	Fall/winter 1904/1905
Measles	Fall/winter 1904/1905
Mumps	Fall/Winter 1904/1905
German measles	1906/1907
Diphtheria	1906/1907
Diphtheria	Winter 1908/1909
Erysipelas	1911/1912
Spanish Influenza	Winter 1918/1919
Diphtheria	Fall 1923
Influenza	Winter 1928/1929
Whooping cough	1933/1934
Chicken pox	Fall 1935
Colds/pneumonia	1937/1938

CHAPTER 16

The deadly toll of infectious diseases: 1867–1939

The background to the tuberculosis crisis in the schools

Tuberculosis

The tuberculosis epidemic of the eighteenth and nineteenth centuries

The tuberculosis epidemic in Canada

The tuberculosis epidemic and First Nations in the late nineteenth century

The failure of the federal government

Tuberculosis in the residential schools

The initial period: 1867–1904

The schools were not prepared to provide adequate health services

Parental response to poor quality of care

Staff concerns

The epidemic takes root in the schools

Crowding exacerbates the problem

Pre-enrolment examinations

Treatment or conversion?

The nursing experiment

The Bryce years: 1904–1914

The Bryce report of 1907

The Lafferty report of 1908

The Bryce report of 1909

The rejection of Bryce’s recommendations

The Scott years: 1913–1932

Ongoing problems in southern Alberta

Lack of treatment facilities and medical staff

Examinations and admissions: 1910–1920

The Depression era: 1930–1939

Federal inaction

The situation in the schools

Cuts in payments

Reporting of deaths

Overcrowding

The Fort Qu’Appelle Health Unit

Vaccination and experimentation

Provincial pressure

“No commitment,” no program: 1937–1939

Other diseases and health issues

The influenza pandemic of 1918–19

Measles, smallpox, diphtheria, typhoid, pneumonia, and whooping cough

Lack of care and treatment facilities

Lack of funding

Limiting and opposing parental involvement

The pressure on staff

Trachoma

Accidental deaths

Conclusion