Separate Beds: A History of Indian Hospitals in Canada, 1920s–1980s by Maureen Lux (review)

Separate Beds: A History of Indian Hospitals in Canada, 1920s–1980s is without doubt an important book. The history of segregated hospitals for Indigenous people is little known, and, in telling it, Separate Beds challenges one of Canadians' most heartfelt beliefs about ourselves – that our medical system, since the advent of Medicare, has been grounded in fairness. In the wake of the Truth and Reconciliation Commission's 2015 report, we are seeking more and better histories that complicate the narrative of Canada's beneficence toward Indigenous peoples. Separate Beds takes its place amid such vital scholarship.

The book opens with the powerful image of a shiny new hospital on its opening day. The Charles Camsell Indian Hospital in Edmonton, opened in August 1946, appeared as a promise – to Canadians, that medical modernity would reach all corners of the nation; to Indigenous people, that Canada was fulfilling its treaty obligations. The first reflected the era of medical optimism in which it was made. The second was one that the government never intended to uphold and which it did not even believe it had ever made. Separate Beds is thus a story of failure, duplicity, and regret.

Lux helps readers understand how Canadians came to care about tuberculosis among Indigenous peoples. Numerous studies early in the twentieth century showed status Indians to be at greater risk for the disease. Their rates remained elevated even as the disease waned among the general population. Lux notes that the reasons for these rates were poorly understood. Likely the numbers were inflated, as status Indians were more routinely and comprehensively tested than other Canadians. It was commonly assumed that they lacked immunity to the disease.

Organizations such as the Canadian Tuberculosis Association (CTA) lobbied the government to address the threat of "Indian tuberculosis" to Canadians' health. But provincial sanitaria refused to admit status Indian patients. Wealthier bands, such as the Siksika south of Calgary and the Six Nations in Ontario, built and paid for their own hospitals. The Department of Indian Affairs partnered with provincial governments to add Indian wings to existing hospitals. But the results were piecemeal and underfunded. A more systematic approach was required.

In the 1940s, as beds emptied in the provincial sanitaria, the CTA saw a chance to extend institutional care to this underserved population. Opening a system of federally funded Indian hospitals would offer treatment to those who needed it, protection from disease for the general population, and scientific advances through research – Canadians could be proud of these endeavours. To Indigenous people, the Indian hospitals represented a fulfillment of treaty promises. Treaty 6 specifically included a medicine chest clause. Oral histories and the notebooks of treaty negotiators indicate that medical care was discussed in subsequent treaties as well. Indigenous leaders had demanded tuberculosis treatment for their people for decades. The emerging system of Indian hospitals (22 had been opened by 1960) seemed to indicate that the federal government was, de facto, accepting responsibility for the health of status Indians.

The Indian hospital system represented an unprecedented investment in infrastructure, and it coincided with an era of optimism. The state, guided by modern medicine, could do anything. But there were two problems. The first was that there were always constraints on what the government was willing and able to spend and, second, there were real limits for what the federal government was willing to take responsibility. Indian hospitals were meant as an alternative to federal-funded beds in community hospitals, and so they kept per diem costs low, hovering around half that of general hospitals. They eagerly admitted patients, and the hospitals became overcrowded. By the early 1950s, Camsell had 560 patients in a physical plant designed for 475. As tuberculosis rates diminished outside the hospital, so, too, did the proportion of tuberculous patients within it – by 1957, it had shrunk to 13 per cent. By...