In September 1999, Martha Manuel Chacon and Pauline Ormego Murillo, two tribal elders from the San Manuel Reservation located near Highland, California, spoke of their experiences with field nurses and doctors contracted by the Office of Indian Affairs. During the course of the conversation, the eighty-seven-year-old Chacon reached into her purse and produced an old photograph from the 1930s depicting images of herself, Dr. John Evans, and field nurse Mabel Cowser. Chacon explained that the people of her tribe thought highly of both of these non-Native health care providers because of their concern for the good health of Native American children. Chacon agreed to talk at length about the relationship between the people at San Manuel and field nurses but at some future time. Unfortunately, shortly after this meeting, she became ill, was hospitalized, and ultimately died. Her remarks about the importance of Western nurses and doctors to the well-being of Indian children of the Mission Indian Agency left a lasting impression. On 30 March 2001, exactly a year after Chacon’s death, the people of San Manuel Reservation held a memorial service honoring Martha Chacon. During the course of that gathering, George Murillo shared that Dr. Evans brought Western medicine, or scientifically based medicine, to the people of San Manuel. Evans was devoted to good health and served the people from roughly 1902 until his death in 1943. When the people of the San Manuel Reservation learned of his death, they felt great sorrow and honored the good physician by assigning six young men from the reservation to serve as pall-bearers. Many Indians in Southern California held public-health doctors and field nurses in high esteem and never forgot their contribution to the health and well-being of Indian children. The work of the Office of Indian Affairs to improve children’s health developed slowly during the first two decades of the twentieth century and accelerated after 1924 with a national investigation into American Indian affairs.

In the early winter of 1980, an elderly medicine man of mixed Palouse and NezPerce blood shared many stories. He was a small, thin man with long, white hair pulled back into a ponytail. He spoke of many things and told of his own unique powers. "You come from that university where you have men and women who spend their lives studying plants and animals." The medicine man continued, saying that the scientists could see only a part of the world of living things. "I see things that they have never seen, heard things they have never heard." The medicine man was in deep earnest. He had talked to plants and animals and heard their stories and songs. Through his oral presentation about the plants and animals, he offered insights into the history and worldview of Indians living on the Great Columbia Plateau of present-day Washington, Oregon, and Idaho. The discussion of plants and animals, mountains, and rivers is an integral part of American Indian history, but often these are elements of the past that are little understood by historians. As part of the legacy of the Columbian invasion of America, Europeans have debased native beliefs in the sanctity of the natural world and have downplayed the significance of cultural forces within Native American communities as important factors influencing the course of history. The result has been historical writings based on uncritical evaluations of biased documents by scholars who have little understanding of Native American cultures.

The Yakama Indian Reservation is located on the Great Columbia Plateau of central Washington State. It is the home of fourteen diverse tribes and bands of Native Americans who once spoke several dialects of three distinct languages, including Sahaptin, Salishan, and Chinookan. These Indians form the Yakama Nation, and their health has been closely related to the creation and execution of the reservation system of the United States since 1855 when a few chiefs signed the Yakima Treaty. Beginning in the 1870s, the Office of Indian Affairs placed a large number of Indians onto a limited land base and during the late nineteenth and early twentieth centuries restricted their access to traditional foods and medicines off the reservation. Confinement on the reservation led to changes in subsistence, maternal-child care, and housing that contributed to infant deaths resulting primarily from pneumonia, gastrointestinal disorders, tuberculosis, heart disease, and syphilis (fig. 1). The modal age (the age that appeared most often) of death on the Yakama Reservation during the era from 1914 to 1964 was children under one year of age, with 631 (16 percent) of the 3,899 deaths arising from this age group. This was the largest number of deaths suffered by any age group on the reservation. The first birth and death rates of infants from the Yakama Reservation were recorded in 1914 when an infant mortality rate could be calculated. Thus, although data on deaths exist from 1888, the central focus of this work will be that fifty-year period between 1914 and 1964. The Yakama Treaty of 1855 and its ratification by the Senate in 1859 set into motion a series of events and circumstances that undermined the health of the Yakama people. As a result of the treaty, the various people placed on the Yakama Reservation secured a small portion of their traditional homelands in central Washington Territory. Other segments of their former land became part of the public domain, which the United States opened to white settlement after 1859. The government placed people from several tribes—Yakama, Palouse, Klickitat, Wishram, Wenatchee, Wasco, Wanapum, and others—on the Yakama Reservation, forcing approximately two thousand Native Americans onto the reservation where they competed for limited traditional food resources.

As dusk fell on the evening of 4 August 1989, several Indians gathered in the courtyard of Mission San Diego. They congregated on the east side of the mission grounds near a visit a that had been built earlier that day. Inside the brush lodge, a few Indians and a priest prepared to light candles and say a rosary. One of the Indians attending the ceremony wandered off to be alone and pray. He walked into a sandy, barren Indian cemetery pocked here and there with holes and piles of earth. He stood on the south end of the holy ground to pray and to place an offering into the earth for the spirits of those Indians who had been disturbed. The sacred offering of native sage, tan sinew, and blackbird feathers was left at the site of an unfortunate event-the exhumation of approximately sixty Indian people by the Catholic church to make way for a new parish hall. The evening ceremony and night-long vigil of Kumeyaay Indians and their friends marked the beginning of the end of a heated dispute between the Indians of San Diego and the Catholic church. The controversy had begun nearly a quarter of a century before, when the parish church at Mission San Diego and the University of San Diego, a Catholic institution, began an archaeological dig on mission grounds. Professors, staff, and students at the University of San Diego inaugurated an archaeological project in 1966. Over the years, many students participated in the digs, uncovering an untold number of artifacts and pieces of bone, including those of humans. However, the church and the university repeatedly denied publicly that any human remains had ever been uncovered, despite the fact that one of the first priests-probably Luis Jayme-and at least eight soldiers of the United States Army had been unearthed. Significantly, this denial would lead church authorities and some scholars associated with the University of San Diego to claim publicly that the area of the proposed building site contained no ”cultural remains.”