Empty Beds: Indian Student Health at Sherman Institute, 1902-1922 (review)

Empty Beds presents an institutional history of health care at an Indian boarding school. The Sherman Institute opened in Riverside, California, in 1902 as "one of the last nonreservation boarding schools built by the Indian Office" (p. 103). Jean Keller argues persuasively that Sherman, unlike the late nineteenth-century Indian boarding schools, was not a "death factory" (pp. 1, 8), and that it maintained "a healthy living environment" (p. 8) through the first two decades of the twentieth century.

Keller begins with an overview of the school's history and organization. Sherman had a stable structure and relatively consistent health practices from 1902 to 1922, largely because it was administered by only two superintendents, both of whom placed a strong emphasis on health care. Chapter 2 describes the preventive health measures established by the administrators. The description of medical care in chapter 3 reveals some unique features at Sherman. There was no designated health-care facility until three years after the school opened. In 1912 a one-hundred-bed hospital was completed; it served the general population of southern California reservations as well as the students. Unlike many large boarding schools, Sherman did not have a resident staff physician: one contract physician served from 1902 to 1909, another from 1909 until the 1930s. Nurses provided the majority of daily care, and turnover among nurses was high. In 1907 Sherman began a nurse's training program; about ten students per year participated in the program, providing some health care to their fellow students.

In chapters 4 and 5, Keller reviews mortality and morbidity rates and examines epidemics and accidents. Between 1902 and 1922, Sherman was beset by epidemics of measles, diphtheria, chickenpox, smallpox, typhoid, and Spanish influenza. Nearly 65 percent of the students contracted influenza during the 1918-19 pandemic, but only eight students died; thus, mortality "was significantly less than the national average" (p. 135). Apart from epidemics, morbidity rates at Sherman were initially quite low. Keller attributes this to the general good health on the southern California reservations from which the first student cohorts were drawn; morbidity rates increased, especially for tuberculosis and trachoma, as students from other populations were recruited to Sherman.

Tuberculosis and trachoma, the two most prevalent problems at the school, are the subjects of chapters 6 and 7, respectively. Keller has adeptly placed the discussion of trends at Sherman within the context of the changing policies and practices of the Indian Service regarding these diseases. She notes that Indian Service physicians during the period were uncertain about the etiology of tuberculosis and generally held "racialist attitudes" about its causes (p. 157). The Indian Service policy of sending afflicted children home complicates the analysis of the significance of tuberculosis at Sherman.

Keller posits that as students from different reservations enrolled at Sherman, morbidity rates shifted to reflect the incidence of the diseases on the reservations from which the students were drawn—but as she notes, the thesis cannot be fully supported, because there is considerable uncertainty about diagnosis of the entities at Sherman, and the data on the incidence of the diseases on the reservations are ambiguous. Furthermore, there is no cross-classification of morbidity rates by students' tribal affiliation. Nevertheless, Keller's hypothesis is worth further inquiry.

Empty Beds is a useful case study of health status at a single boarding school. As a case study, the strength of the work lies in its detailed treatment. The lack of comparative context, on the other hand, is a potential weakness; this is addressed by a synchronic comparison to morbidity at other boarding schools for the 1911-12 school year. Moreover, a review of the policy shifts in the Indian Office provides some context for understanding Sherman's...