J03 Colville Hospital HABS Report.pdf

Historic American Building Survey Report of the

Colville Indian Health Services Complex Nespelem, Okanogan County, Washington

Submitted to

Portland Area Indian Health Service

Submitted by

Natalie Perrin

Portland, Oregon

Heather Lee Miller, Ph.D.

Seattle, Washington

April 30, 2009

Historical Research Associates, Inc.

COLVILLE INDIAN HEALTH SERVICES COMPLEX

NESPELEM, OKANOGAN COUNTY, WASHINGTON

Historic American Building Survey Report1

Brief History of the Colville Reservation

The Confederated Tribes of the Colville Reservation (referred to here as the tribe or CCT) are descendants of twelve bands of Indians—Methow, Wenatchi (Wenatchee), Chelan, Moses- Columbian, Entiat, Nespelem, San Poil, Okanogan, (Arrow) Lakes, Nez Perce, Palouse (Palus), and Colville—that were settled on the Colville Reservation, located in north-central Washington State.2 Each of these twelve has its own unique history, with varying customs and traditional native lands.3 In general, prior to the mid-1800s, these tribes were nomadic, traveling with the seasons to occupy fishing sites, harvest berries and other plant products, and hunt game.

Trade among natives and Euroamericans was conducted relatively peacefully from 1807, when the first trading post was established on the Columbia River, to 1820, when the Hudson Bay Company established a trading post at Kettle Falls.4 By the mid-1800s, settlers, traders, and other non-natives were flooding the region. Although the Treaty of 1846 ended fighting between American and Great Britain regarding ownership of the land, the outcome had little positive effect on the Indians as neither the Americans nor the English believed the indigenous people were entitled to the valuable land they had inhabited for centuries.

Reports indicate that, “in terms of white encroachment on future Reservation lands, the next ten years were relatively calm.”5 President Millard Fillmore’s establishment of the Washington Territory on March 2, 1853, however, brought with it increased settlement and the need to regulate Indian affairs.

Major Isaac Stevens of the U.S. Corps of Engineers was appointed governor of the new territory. In 1854, Governor Stevens was directed by the Commissioner of Indian Affairs to negotiate with the Indians, “particularly in the vicinity of white settlements, toward extinguishment of the Indian claims to the lands and the concentration of the tribes and fragments of tribes on a few reservations naturally suited to the requirement of the Indians, and located, so far as practicable, so as not to interfere with the settlement of the country.”6

The relative peace of the early 1800s was “replaced by a storm of invasion by white miners and settlers when gold was discovered on the Columbia River near Fort Colville in 1855 and on the

1 Note: this report follows the Historic American Buildings Survey report guidelines. It is not, however, being submitted to the Library of Congress and is therefore not an “official” HABS document.

2 U.S. Department of Indian Health and Human Services, “Confederated Tribes of the Colville Reservation,” Portland Area Office, http://www.ihs.gov/FacilitiesServices/AreaOffices/Portland/portland-tribe-conf-colville.asp, and Camille Pleasants, The Confederated Tribes of the Colville Reservation Tribal Historic Preservation Officer, personal communication, March 13, 2009.

3 Details of the histories of each individual tribe settled on the Colville Reservation are outside of the scope of this report. For further reading, see the bibliography.

4 Confederated Tribes of the Colville Reservation [CCT], “This Is Our True Story,” A Walk through Time, 1, http://www.colvilletribes.com/past.htm.

5 Stan Gough, ed., A Cultural Resources Overview, Sampling Survey, and Management Plan, Colville Indian Reservation, Okanogan and Ferry Counties, Eastern Washington University, 1990, 3.

6 CCT, “This Is Our True Story,” 2.

http://www.ihs.gov/FacilitiesServices/AreaOffices/Portland/portland-tribe-conf-colville.asp http://www.ihs.gov/FacilitiesServices/AreaOffices/Portland/portland-tribe-conf-colville.asp http://www.colvilletribes.com/past.htm

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ation.”

Similkameen River in 1859.”7 Colonization continued to increase up to and after President Ulysses S.

Grant created the Colville Indian Reservation by Executive Order in April 1872.8 “At that time, various Indian bands maintained undisputed rights on lands embraced in the Reservation, some areas of which included extensive agricultural improvements.”9 The original reservation occupied “several million acres of diverse properties including rivers, streams, timbered forests, grass lands, minerals, plants and animals” on the eastern bank of the Columbia River.10

Within three months, however, another presidential Executive Order moved the reservation to its present location on the western side of the Columbia, diminishing the size of the reservation to fewer than three million acres.11 The mineral rich lands between the Okanogan River and the crest of the Cascade Mountain Range in the Methow Valley, and between the Columbia and Pend d’Oreille Rivers and the Colville Valley, were excluded from the second and final reservation.

Tribes located on other reservations were experiencing similar displacement. Pressures from mining interests resulted in the closure of the Columbia Reservation in 1883, which bordered the Colville Reservation on the west and was roughly comparable in size, and forced the relocation of the Moses- Columbia peoples into the Nespelem Valley.12 Only a few years later, in 1887, and at the invitation of Chief Moses, the Nez Perce also settled on the Colville Reservation as refugees and prisoners of war.13 According to historian Stan Gough, “The San Poil and Nespelem Indians living on the Reservation resented the settlement of the Moses and Nez Perce peoples in the Nespelem Valley, as both groups claimed that country as traditionally their own.”14

In 1892, the northern half of the Colville Reservation was restored to the public domain of the U.S.

government, thereby depriving the tribes of more than 1.5 million acres.15 The pattern of diminishment of reservation lands continued slowly but deliberately, culminating in the McLaughlin Agreement of 1905.16 “Under this agreement, Indians on the Colville Reservation agreed to relinquish to the United States all rights and title to lands within the south half [of the reservation], in return for 80 acre allotments to each Indian having rights on the Reserv 17

By 1914, fewer than 334,000 acres remained of reservation lands.18 In 1916, approximately 418,000 acres acquired under the McLaughlin Agreement were opened to white homesteaders. By 1925, undisposed land was being sold to the highest bidder regardless of minimum value.

7 Gough, Cultural Resources Overview, 3.

8 Executive Order, April 9, 1872, and July 2, 1872, agreement made July 7, 1882, and ratified by an Act of Congress on July 4, 1884 (23:79).

9 Gough, Cultural Resources Overview, 4.

10 CCT, “This Is Our True Story,” 4.

11 Executive Order, April 9, 1872, and July 2, 1872, agreement made July 7, 1882, and ratified by an Act of Congress on July 4, 1884 (23:79).

12 Herman J. Deutsch, “Indian and White in the Inland Empire,” Pacific Northwest Quarterly. 47, no 2 (April, 1956): 44-51, esp. 49.

13 Maria Ilma Raufer, O.P., Black Robes and Indians on the Last Frontier: A Story of Heroism (Milwaukee:

Bruce Publishing Company, 1966), 238.

14 Gough, Cultural Resources Overview, 5.

15 Raufer, Black Robes and Indians on the Last Frontier, 312.

16 Ibid.

17 Ibid.

18 CCT, “This Is Our True Story,” 4.

In 1934, surplus lands of the Colville and other reservations were “temporarily withdrawn from disposal of any kind, subject to any and all existing valid rights, until the matter of permanent restoration to tribal ownership . . . can be given appropriate consideration.”19 The law, issued by the Secretary of the Interior and enacted by the Senate and House of Representatives of the United States, is often referred to as the Indian Reorganization Act and was the first step in reversing trends of federal reduction of reservation lands.

In 1938, Indians living on the Colville Reservation voted to organize themselves into a self-governing group, the present Colville Confederated Tribes. The Commissioner of Indian Affairs approved their constitution on April 19, 1938.20 In 1956, federal act 70 Stat. 626-627 restored tribal ownership of over 800,000 acres of Colville Reservation lands.21

A Comment on Traditional Tribal Health Practices

A definitive explanation of the traditional healthways of native peoples is not readily possible; each tribe would have practiced variations on medical care based on a variety of factors, including but not limited to regional availability of medicinal herbs and plants and traditions of specific tribal elders and shaman. Some references to Middle Columbia River Salishan tribal medicine exist, but these relate more to health customs than to specific treatments.22 However, it is important to remember that customs and treatments are not necessarily separate entities in native health treatments, and must be examined simultaneously when attempting to understand tribal health practices.

For example, one recorded ritual describes the combined regiment of traditions and logic to ensure the well-being of both mother and baby during pregnancy. “Often, a pregnant woman returned to the home of her mother until the birth. She undertook a regular regime of exercise by walking, running, swimming, and eating sparingly. . . . In difficult deliveries, shamans were summoned to assist by using their spirit power to ease out the baby. . . . Herbal tea was drunk by the mother to reduce bleeding.”23

Other medicinal practices have been passed down through oral histories, such as those published in Mourning Dove: A Salishan Autobiography, which describes medicinal uses for various herbs that most women knew. As Mourning Dove explains, “tanza root boiled to make a green tea settled a baby’s digestive organs. Warmed bear grease gave relief from earache, as did the application of a bag of sand. Oregon grape roots and tops strengthened the blood in the spring and made the body more

19 U.S. Department of the Interior, Office of the Solicitor, “Opinions of the Solicitor of the Department of the Interior Relating to Indian Affairs, 1917-1974” (Washington, D.C.: U.S. Department of the Interior, 1979 (Republished by Wm. S. Hein Publishing, 2003.

20 Gough, Cultural Resources Overview, 5.

21 Robert H. Ruby and John A. Brown, A Guide to the Indian Tribes of the Pacific Northwest (Norman:

University of Oklahoma Press, 1992).

22 The Middle Columbia River Salishans lived traditionally along the middle Columbia River in northwestern Washington and include the Moses-Columbian, Wenatchee, Entiat, Chelan, Methow, Southern Okanogan, Nespelem, and Sanpoil tribes. See Jay Miller, “Middle Columbia River Salishans,” Plateau, vol. 12 of Handbook of North American Indians, ed. Deward E. Walker, Jr. (Washington, D.C.: Smithsonian Institution Press, 1998), 253.

23 Ibid., 261.

hardy. Red willow bark made into a tea cured sores on the face of a child or wounds on an adult,” and so forth.24

Mourning Dove also notes that “before whites arrived there were many fewer diseases, mostly causing stomach and eye discomfort but few fatalities. Tuberculosis and venereal diseases were unknown.”25 Jay Miller, assistant director of the D’Arcy McNickle Center for the History of the American Indian and editor of Mourning Dove, confirmed Mourning Dove’s reflection on disease in North America before European contact. According to Miller, “Diseases were limited to the stomach, senses, and skin. The cold barrier between Asia and America, scattered population, and lack of domesticated herds to act as intermediate disease hosts prohibited large epidemics until Europeans, acting as biological reservoirs, introduced devastating pandemics.”26

The Indian Health Service

In a 2004 evaluation of the Indian health care system, the U.S. Commission on Civil Rights concluded that “the toll taken by infectious disease, when combined with the effects of war, the expulsion of virtually all Native Americans from their ancestral lands, and the destruction of traditional Native American ways of life, effectively decimated the self-governance structures previously employed by Native Americans.” As a result, Native Americans “became dependent on the federal government for the provision of adequate health care.”27 In 1803, the federal government assigned responsibility for Indian health care to the Office of Indian Affairs in the War Department.28 Efforts concentrated primarily on preventing the spread of contagious diseases, with financial support given to religious groups that provided medical services.29 In 1832, $12,000 was appropriated to hire physicians and provide vaccinations. In 1849, the Bureau of Indian Affairs (BIA) transferred from the War Department to the Department of the Interior, effectively moving Indian health care from military to civilian control. By 1880, only four Indian hospitals had opened, with a total of seventy-seven physicians employed.30

By the turn of the twentieth century, the BIA was conducting comprehensive condition assessments of reservations and Indian schools. Concerned about high morbidity and mortality rates, due primarily to infectious diseases like tuberculosis and trachoma, the BIA instructed Indian schools to admit only healthy children. In 1904, Commissioner William A. Jones filed a report with the federal government noting problems of inadequate sanitation, overcrowding, and lack of proper ventilation and medical control; he also criticized Indians for their lack of confidence in available treatments.31

Adequate enforcement of sanitary conditions and provision of medical services remained underfunded until 1912, when President William Howard Taft delivered a special message to Congress on Indian health. His goal was to raise public awareness of the serious medical conditions

24 Mourning Dove (Christine Quintasket), Mourning Dove: A Salishan Autobiography (Lincoln: University of Nebraska Press, 1990), 68.

25 Ibid.

26 Miller quoted in Mourning Dove, 207n6.

27 U.S. Commission on Civil Rights, Broken Promises: Evaluating the Native American Health Care System, Washington, D.C., September 2004. 2.

28 Ibid. Throughout this report, the term Indian refers to both American Indians and Alaskan Natives.

29 Vernellia R. Randall, “A Chronological History of IHS,” in Race, Health Care, and the Law: Speaking Truth to Power! 1, http://academic.udayton.edu/health/02organ/Indian02.htm.

30 Ibid., 1.

31 Ibid., 2.

http://academic.udayton.edu/health/02organ/Indian02.htm among Indians, and to request a $253,000 appropriation from Congress to provide for Indian medical care. The request was only partially funded, although it began yearly appropriations from Congress from 1914–1917.32

In 1928, at the request of Secretary of the Interior Hubert Work and under the technical direction of Lewis Meriam, a report entitled The Problem with Indian Administration was published. Meriam and a team of nine specialists selected by the Institute for Government Research described the impoverished living conditions of Indians, specifically noting, The health of the Indians as compared with that of the general population is bad. Although accurate mortality and morbidity statistics are commonly lacking, the existing evidence warrants the statement that both the general death rate and the infant mortality rate are high. Tuberculosis is extremely prevalent. Trachoma, a communicable disease which produces blindness, is a major problem because of its great prevalence and the danger of its spreading among both the Indians and the whites.33

In addition, the report noted that the work of the government on behalf of the Indians, in general, was insufficient. In terms of health care, The inadequacy of appropriations has prevented the development of an adequate system of public health administration and medical relief work for the Indians. The number of doctors, nurses, and dentists is insufficient. . . . The hospitals, sanatoria, and sanatorium schools maintained by the Service, despite a few exceptions, must be generally characterized as lacking in personnel, equipment, management, and design. . . . Another striking need is for the development of the public health clinic, an agency extremely effective in locating cases of tuberculosis and other communicable diseases in their incipiency and thus permitting of the early treatment of the sufferer when there is still chance to help him, and also making it possible to exercise some control over contagion.34

The results of this report led to appropriations for education, health, and welfare. In 1929–1933, under the direction of Commissioner Charles James Rhoads, the BIA established the first preventative medicine program, emphasizing maternal and infant health.35 In 1934, the Johnson-O’Malley Act passed, enabling states and other political subdivisions to provide for the health, education, and welfare of Indians through contracts and grants. By 1936, ninety-one hospitals and sanatoria were in operation, and Congress appropriated over four million dollars for Indian health care.

32 Ibid., 2-3.

33 Lewis Meriam et al., The Problem with Indian Administration (Baltimore, Md.: Johns Hopkins University Press, 1928), http://www.alaskool.org/native_ed/research_reports/IndianAdmin/Indian_Admin_Problms.html#transmit.

34 Ibid.

35 Randall, “A Chronological History of IHS,” 3.

http://www.alaskool.org/native_ed/research_reports/IndianAdmin/Indian_Admin_Problms.html#transmit

In 1955, health care for Indians fell under the direction of the PHS Division of Indian Health, which has since been renamed the Indian Health Service (IHS). While most scholars agree that few bright spots exist in the shared history of the American Indians and the federal government, historians Abraham Bergman, David C. Grossman, Angela M. Erdrich, and others note than one exception is the sustained campaign by the IHS to improve the health of the Indian population.36 They argue that due to IHS efforts, “the health status of Indians has been raised to approximately the level attained by the rest of the U.S. population.”37 In 1993, the IHS directly operated 41 hospitals and 114 ambulatory facilities throughout the United States.38

Contrary to these findings, the 2006 Harvard Project on American Indian Economic Development showed that, despite IHS efforts, lingering health disparities of American Indians and Alaskan Natives are still a major concern.39 Lower life expectancy and the disproportionate disease burden exist “perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences.”40 As of 2006, statistics show that Indians can expect to live 2.4 years less than any other group in the United States. Indians also die at significantly higher rates than other Americans from alcoholism (510 percent higher), diabetes (189 percent higher), and suicide (62 percent higher), to name only a few.41

In 2006, approximately 55 percent of American Indians and Alaskan Natives living in the United States relied on the IHS to provide access to health care services. Given the higher health status enjoyed by most non-Indian Americans, accounting for the health disparities means health care experts, policy makers, and tribal leaders must look at the many interrelated factors affecting Indian health. These factors include the inadequacy of funding for the Indian health care delivery system, as well as different demographic characteristics, such as rural location and age (the Indian population is younger due to higher mortality rates). In spite of continued efforts to elevate Indians’ health care status, the conclusions of today’s researchers are not dissimilar from those of the Meriam Report over eighty years ago.

36 Abraham B. Bergman et al., “A Political History of the Indian Health Service,” Milbank Quarterly 77, no. 4 (1999): 571–604, esp. 571.

37 Ibid., 571.

38 Ibid., 6.

39 Indian Health Service, “Facts on Indian Health Disparities,” Harvard Project on American Indian Economic Development, January 2006, 1, http://info.ihs.gov/Files/DisparitiesFacts-Jan2006.pdf.

40 Ibid.

41 Ibid.

http://info.ihs.gov/Files/DisparitiesFacts-Jan2006.pdf

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COLVILLE INDIAN HOSPITAL COMPLEX

MAIN HOSPITAL BUILDING

Location: Highway 155 Agency Campus (San Poil Avenue)

Nespelem, WA 99155

The Colville Indian Hospital Main Building is located within the Colville Indian Agency Campus, just south of the town of Nespelem, Washington, along Highway 155. The Main building is located approximately one-quarter mile east of Hwy 155, and fronts north along San Poil Avenue.

USGS Nespelem Quadrangle

UTM Coordinates: Zone 11, 353233 East, 5332878 North

Township: T30 R31E S06

Present Owner: Portland Area Indian Health Service

1220 SW Third Avenue #476 Portland, OR 97204

Present Occupant: Nespelem Health Center Dental Clinic Tribal Diabetes Center Tribal Health Center Offices

Historic Use: Hospital

Present Use: Largely vacant. A portion of the main floor houses a dental clinic, and a portion of the basement area has offices for the Tribal Health Center and a Diabetes Clinic.

Significance: The Colville IHS complex consists of three buildings: the Main Building, or

Hospital, the Doctor’s Residence, and the Nurses’ Residence. All three buildings were constructed in 1934-1936 by the Bureau of Indian Affairs (BIA) in an effort to improve health and sanitary conditions on the Colville Indian Reservation by providing needed medical services.

The Colville IHS complex is significant locally under Criterion A, events that have made a significant contribution to the broad patterns of history, for contributions to community planning/development, health/medical, and ethnic heritage. The complex may also be considered contributing to a larger historic district within the Colville Indian Agency, specifically including residential buildings extant to the north of the complex. These structures, along with the Colville IHS, represent developmental patterns within the reservation during the 1930s, which may help define the nature of federal and Indian relations during that time.

Colville Indian Health Service Complex Historical Information

Records regarding the Colville Hospital’s inception have not been found, but the original blueprints, which are held at the Main Hospital Building by its Maintenance Division, date the final building designs to September 25, 1934. Drawn by Schmidt Garden and Erickson, Architects of Chicago, Illinois, the designs were submitted to the Department of the Interior Office of Indian Affairs in Washington, D.C.

Prior to designing the Colville Hospital, the partnership of Richard E. Schmidt and Hugh M.G.

Garden had designed numerous public and commercial buildings, residences and other hospitals.

Their first partnership, formed with Edgar D. Martin and practicing under the name Richard E.

Schmidt, Garden & Martin, Architects, designed several hospitals in Chicago including the German Hospital, Illinois Central Railroad Hospital, Psychopathic Building for the Cook County Hospital, and Chicago Lying-In Hospital in conference with obstetrician Dr. Joseph De Lee. According to the City of Chicago Department of Planning and Development, Landmarks Division, the partnership of Schmidt and Garden designed over 300 hospital buildings throughout the country.

The September 5, 1934, issue of the Nespelem Tribune reported on the new hospital project, proposed at a cost of $180,000.42 On September 12, 1934, the Tribune reported preparations were underway for “the most modern and largest hospital in North Central Washington.”43 On October 3, 1934, an architect’s sketch was released to the public depicting the main entry of the hospital. The caption noted that the “beautiful hospital . . . will be of modern construction and an attractive addition to the present group of agency buildings.”44

The buildings appear to have been almost complete by spring 1936. Chief Nurse at Large Henrietta Miller noted several details requiring completion prior to opening of the hospital in a letter that April to Dr. Lynne A. Fullerton, District Medical Director. Miller commented on everything from the capacity of the Dining and Delivery rooms, to the necessity of a ramp for wheeling supplies and carrying the dead to the morgue. In addition, though the hospital had not yet opened, shingles were coming off the roof and the terrazzo floors were cracked and leaking water. Ventilators in the boiler room and engine room were incomplete, and other functional services were still required.45

On April 28, 1936, the Colville Indian Agency received the following telegram:

“Is new Colville Hospital open if not why not wire stop filed Washington, D.C., 1:21 P.M.”46

42 “Hospital Due Soon,” Nespelem Tribune, September 5, 1934.

43 “Indian Service to Begin Work on Big Hospital,” Nespelem Tribune, September 12, 1934.

44 “Architect’s Sketch of Indian Hospital,” Nespelem Tribune. October 3, 1934.

45 Henrietta Miller to Dr. [Lynne A.] Fullerton. April 2, 1936, memorandum, Record Group [RG] 75, Bureau of Indian Affairs, Portland Area Office, Records of District Medical Director, District #2 (Spokane), 1932-1944, Chemawa-Colville (part), Box 1884, File: Colville Agency 1935-1936, National Archives and Records Administration, Seattle. Note: all additional correspondence comes from this same collection at NARA and is hereafter cited by its box and file, e.g., PAO67-1884-02, 46 As quoted in a letter by Harvey K. Meyer, Colville Indian Agency, to Commissioner of Indian Affairs, April 28, 1936, 1, PAO67-1884-04, NARA Seattle.

In response, Superintendent Harvey K. Meyer wrote to Commissioner of Indian Affairs E. J.

Armstrong regarding additional surgical equipment still needed. In general, he noted, “what it was possible to do has been done to be in readiness for the opening of the Hospital, and that further rapid progress can now be made.”47

On May 12, 1936, Commissioner Armstrong replied with a stern letter, criticizing staff for not securing necessary equipment so the hospital could open. “This office feels that the new hospital should have been in operation for some time,” he noted, suggesting the staff “take steps toward opening the new hospital with the least possible delay.”48

On May 18, 1936, the Colville Hospital officially opened to the public. Fullerton sent three letters that day, the first to Dr. J. G. Townsend, Director of Health in Washington, D.C. In the letter, Fullerton noted, “I have the honor to report the Colville Hospital was opened for the reception of patients today.

At noon, three patients had been received and there is no reason why the hospital cannot function at capacity rate.”49 The hospital capacity included a total of 36 beds, 2 cribs, and 5 bassinets.50 Fullerton’s other two letters were both to the commissioner. One noted the hospital opening and listed several deficiencies that had yet to be addressed, including changes required in the Nurses’ Quarters, incomplete ventilators, problems with the terrazzo floors and roof, and other needs like garbage cans, dustproof coal-bin doors, and silverware for the dining room.51

The final letter commended Miller on her “very efficient work.” Correspondence between the Office of Indian Affairs and the Colville Agency indicate that without Miller’s direction and “tricks of technic,” the hospital opening would likely have been further delayed. Fullerton wrote that “before work has progressed so far on the construction of the three new hospitals in the district that corrections cannot be made, it is recommended that Miss Miller be detailed to consult with Mr. Carl A. Erickson, 104 S. Michigan Boulevard, Chicago, for the purpose of discussing these arrangements to see if they cannot be altered.”52 Less than a year later, most of the remaining problems with the hospital appear to have been resolved. An inspection Fullerton conducted from January 21–23, 1937, revealed further cracking in the terrazzo floors, as well as several other items of note. In general, however, he reported that “this modern, fully equipped, perfectly appointed hospital has only a few details requiring comment.”53

In addition to the technical aspects of the hospital, Fullerton commented on social conditions. He noted the “curious condition of graduate nurses looking upon tuberculosis somewhat as the general public looks upon leprosy,” which reflected the fear that tuberculosis engendered in the 1930s. Issues of morale, due to the hospital’s isolated location and its lack of entertainment options for female nurses, were specifically noted, as was the shortage of surgeons to give patients adequate care during major surgical undertakings.54

47 Meyer to Commissioner, April 28, 1936, 1.

48 E. J. Armstrong, Commissioner of Indian Affairs, to Meyer, May 12, 1936, PAO67-1884-03, NARA Seattle.

49 Fullerton, Medical Director Dist. #2, to Dr. J. G. Townsend, Director of Health, May 19, 1936, PAO67-1884- 01, NARA Seattle.

50 Meyer to Fullerton, July 15, 1936, PAO67-1884-10, NARA Seattle.

51 Fullerton to the Commissioner, May 19, 1936, PAO67-1884-01, NARA Seattle.

52 Fullerton to Commissioner, May 19, 1936.

53 Fullerton to Commissioner, January 27, 1937, 1, PAO67-1884-11, NARA Seattle.

54 Fullerton to Commissioner, January 27, 1937, 1.

Six months later, Assistant Supervisor of Nurses Sallie Jeffries reported that the Colville hospital was “being utilized to capacity almost continuously.” At the time of her visit in June 1937, the hospital was serving 44 patients, including eight infants born there.55 Jeffries reported that 325 surgical cases, 65 births, and 22 deaths had occurred during the fiscal year and that the daily average of patients since July 1, 1936, was:56

July–December (1936) 30.9 January (1937) 32.2 February 29.8 March 34.7 April 37.1 May 35.6

Fullerton’s January 1938 inspection report expressed that the Colville Hospital was “fully equipped and adequately staffed, and is furnishing excellent care to Service beneficiaries.” The building itself, however, “is beginning to exhibit the need of certain repairs which local funds will not handle.”57 A leaky roof, worn-out plaster, loose doorstops, painting, and ash buckets all needed to be addressed, in addition to needed floor repairs in both the Nurses’ Quarters and Doctor’s Residence.

Reports filed by Fullerton, Miller, and others describe the functional operations of the hospital in the first few years of its opening. Absent, however, are reactions from patients and the larger community the hospital served. As Commissioner Jones noted in 1904, native tribes were suspicious of Euroamerican medical treatments. Native people endured years of epidemic diseases, which directly contributed to a decline in native populations from at least the late fifteenth century onward.58 How the Colville tribes reacted to a new, federally funded hospital filled with Western medical techniques is largely unknown.

In October 1926, an article written by Edward F. Stevens entitled “The Small Hospital” appeared in the Architectural Forum. Stevens defined a small hospital as having from twenty to fifty beds and noted that hundreds had been built in the early 1900s throughout the United States. Among his suggestions for “proper” construction of a small hospital was to build separate living quarters for staff. In addition, he paid special attention to creating a welcoming front entrance, noting that “we should not forget to make the entrance to our hospital just as attractive as possible. It is here that the patient gets his first impression of an institution of this kind, which often has much to do with the effect of the treatment received in the hospital . . . a generous, well planned, carefully decorated entrance . . . is worth while and should not be considered extravagant.”59 Stevens argued that the

55 Sallie Jefferies to Commissioner, June 24, 1937, 1, PAO67-1884-12, NARA Seattle.

56 Jefferies to Commissioner, June 24, 1937, 2.

57 Fullerton, “Inspection Report: Colville Indian Reservation,” January 15, 1938, PAO67-1884-13, NARA Seattle.

58 A number of scholars have addressed this issue from various points of view and in different eras. See, for example, Noble David Cook, Born to Die: Disease and New World Conquest, 1492-1650 (Cambridge:

Cambridge University Press, 1998); William H. McNeill, Plagues and Peoples (New York: Bantam, 1976);

Nancy Shoemaker, American Indian Population Recovery in the Twentieth Century (Albuqerque: University of New Mexico Press, 19990; David E. Stannard, American Holocaust: The Conquest of the New World (New York: Oxford University Press, 1993); E. Wagner Stearn and Allen E. Stearn, The Effect of Smallpox on the Destiny of the Amerindian (Boston: Humphries, 1945); and Russell Thornton, American Indian Holocaust and Survival: A Population History since 1492 (Norman: University of Oklahoma Press, 1987).

59 Edward F. Stevens, “The Small Hospital,” Architectural Forum 45, no. 4 (October 1926): 229-48, esp. 232.

http://en.wikipedia.org/wiki/William_McNeill http://en.wikipedia.org/wiki/David_Stannard http://en.wikipedia.org/wiki/Oxford_University_Press http://en.wikipedia.org/wiki/University_of_Oklahoma_Press physiological effects of decoration were especially important in the design of the hospital administration department, which needed to embody concepts of comfort, trust, traditional values, and dependability.60

The Chicago architects who designed the Colville Hospital buildings were likely familiar with the Architectural Forum and Stevens’s article on small hospitals. Stevens was a particular fan of the work of Schmidt, Garden & Martin, and specifically referenced four of their hospital designs in his 1928 publication The American Hospital of the Twentieth Century. Familiarity between the architects and agreements in regards to architectural treatment may explain the special consideration given to the entryway of the Colville Hospital, which is arguably the only exterior element that displays any hint of tribal affiliation: the loggia and unique wood sash windows give an air of native cultural influence (see Figures 2 and 4). Inside the Colville Hospital, murals painted by Native American artist Edgar Disautel fill the waiting room with scenes of Indian legends. Current tribal members report that other rooms in the hospital also once had murals; however, only the waiting room and one interior office display them today.

The Colville IHS has operated continuously from its opening in 1936 through the early twenty-first century, when a new facility was constructed next-door. The buildings that once housed a bustling community of nurses, doctors, and patients are now largely vacant. A portion of the eastern wing of the hospital building now houses a dental clinic and the basement is occupied by a diabetes clinic.

Physical Description

The Colville Indian Health Service (IHS) complex is composed of three buildings: the Hospital, the Doctor’s Residence, and the Nurses’ Quarters (Figure 1). All three buildings were constructed in 1934–1936 by the Bureau of Indian Affairs (BIA) in an effort to improve health and sanitary conditions on the Colville Indian Reservation by providing needed medical services.

The IHS buildings were designed by Chicago architects Schmidt Garden Erickson in a streamlined, neoclassical revival style, also known as modern or stripped classical. The buildings are visually connected by a poured concrete wall with decorative gateposts, although the original gates are no longer extant.

As a complex, the three buildings physically represent the dissonance evident in the early twentieth century between the United States federal government (exterior architectural style) and Native tribes (physical use). Public buildings constructed with federal funds during this time were almost universally designed in the stripped classical style. These included post offices such as those built in Reno, Nevada (1934) and Longview, Washington (1934), federal courthouses like the Gus J.

Solomon United States Court House in Portland, Oregon (1931), and hospital buildings like the U.S.

Marine Hospital in Seattle, Washington (1931). Regardless of scale, use, or location, federal buildings of the Depression era sought economy through unification of design and limiting of ornamentation.

While the concept of unified federal design of public buildings may have been more advantageous due to the streamlining of the production process, it did little to reflect the individuality of the communities in which the buildings were constructed. Instead, public art projects were often commissioned after construction was completed. In general, artists would be called upon to illustrate

60 Annmarie Adams, Medicine by Design: The Architect and the Modern Hospital, 1893-1943 (Minneapolis:

University of Minnesota Press, 2008), 128.

local histories or legends as a way to both create jobs and personalize the public spaces. In the case of the Colville IHS, the Main Building was treated to the artistic expressions of local artist Edgar Disautel, who painted murals of native Indian legends to personalize the interior spaces.

The Hospital, or Main Building, fronts north along San Poil Avenue, and has a central “H” plan with projecting wings centered off the “H” running east-west (Figure 2 and 3). The building is one story with a basement, and is constructed of board-formed, poured-in-place concrete (both the foundation and the exterior walls). The exterior of the building expresses this construction technique, and is clad only in paint. Board-forming marks are clearly visible in the concrete, lending a modular feel to the exterior walls. This design treatment may have been a precursor to the popular international style of architecture, which first appeared during the 1930s and thrived in the 1950s; the white, undecorated, hard-edged architectural forms associated with the international style represent the increasingly scientific medicine practiced in the twentieth century.61

The use of concrete as the primary building material also represents a trend in hospital design that had been developed over centuries, and which culminated in several books and articles by noted hospital architect Edward F. Stevens. Briefly, the desire for safety inspired architects to specify incombustible materials, specifically concrete walls and terrazzo floors in the case of the Colville hospital, to thoroughly fireproof the buildings.62 These materials were also thought to be more resistant to the spread of contagions, a concern prevalent since the end of the eighteenth century, and the suffering wards of the Hôtel-Dieu in Paris.63 Also, in 1835, incidences of erysipelas at the New York Hospital resulted in the building itself being blamed on the spread of the disease, the hospital itself becoming “an infected district, the same endemic cause producing the disease in all the patients.”64

The floor plan, a modified “H” with projecting wings, was also a by-product of the developments of hospital architecture through the centuries. The pavilion plan, which was the standard design for hospitals from the time of Florence Nightingale, encouraged large, open wards with windows on either side of the room to promote cross-ventilation. This plan allowed for efficiency of staff to monitor multiple patients at once, and was also thought to promote a healthy environment through the continual movement of air. However, modern understanding of germs and contagious diseases resulted in the need for compartmentalization of patients.

According to historian Annmarie Adams, “The debate between the so-called block plan, this arrangement of smaller rooms along double-loaded corridors, over the older pavilion-plan type raged [during the first part of the twentieth century] . . . focusing on the question of how to balance the efficiency and economy of the ward with the comfort and protection of the private room.”65 The Colville hospital has a double-loaded central corridor, with projecting wings originally leading to various exam room, wards, and nurses and doctors offices, making it an example of a hybrid between the historic pavilion, or ward, design and the more modern block plan.

61 Ibid., 129.

62 Ibid., 111.

63 For more information on the Hôtel-Dieu and its influence on hospital architecture, see John D. Thompson and Grace Gouldin, The Hospital: A Social and Architectural History (New Haven, Conn.: Yale University Press, 1975), 118.

64 Edward Delafield to George Newbold, June 25, 1835, quoted in Jeanne Kisacky, “Restructuring Isolation:

Hospital Architecture, Medicine, and Disease Prevention,” Bulletin of the History of Medicine 79, no. 1 (Spring 2005): 1-49, quotation on 12.

65Adams, Medicine by Design, 113.

The building was designed with minimal neoclassical revival detailing on the exterior, including engaged fluted pilasters at the projecting corners of the building (Figure 4). The capitals of the pilasters also act as eave returns, another element of neoclassical revival buildings. The mostly intact window openings are trimmed in fluted wood, which mimics the pilasters. Most of the original wood sash double-hung windows have been replaced by metal sash. There are some exceptions, however, notably the three unique windows with elaborate “tribal” geometric mullion details, which are extant on what was historically the exterior loggia (now enclosed).

The original operating room, located in the northwestern-most corner, is the one room that may retain the original wood-sash windows, now concealed behind plywood on the exterior. Though the operating room was originally designed to be lit with a combination of electric and natural light, the popularity of electrically lit operating rooms after World War II may have contributed to the decision to cover the windows. This was part of a larger trend in hospital architecture, which altered operating rooms from publicly recognizable spaces to windowless rooms invisible from the exterior of the hospital.66

Although no original doors remain, entryways are largely intact. Transom windows over entry doors are extant over original entryways to the building. The former “Emergency Room” ambulance entry on the southwestern corner has been covered by a porte cochere supported by hollow, fluted wood pillars designed to mimic the engaged pilasters on the building corners. The date of the porte cochere is unknown, but the fluted pilasters are an appropriate complement to the exterior of the building.

The gable roof of the building intersects at the central “H” of the plan, and is home to a few chimneys from the original boiler system (no longer used). The original gable roof is mimicked by the new entryway on the northern elevation, comprised of rough-hewn logs in the Pacific Northwest style.

This entryway was added in the late 1990s, and is not historic fabric. The addition enclosed the original exterior loggia, inadvertently protecting the last three remaining wood sash windows with decorative patterning in a “tribal” design (see Figure 4). The original concrete reflecting pool, which was located in the center of the main entranceway walk-up on the northern elevation, is no longer extant.

The southern elevation features a central balcony accessed via the main floor. The balcony was originally uncovered, but was altered in the 1990s, when a pediment porch was added over the space.

The balcony features the original metal railing, with a delicately tapered and flattened curl pattern.

Although the building’s basic plan remains unchanged, its interior has been significantly altered over time. Murals depicting Indian legends, painted on the interior of the main hospital building by Native American artist Edgar Disautel, are still extant in the entry/waiting room and one of the offices. If, as some local people report, other murals existed, they have since been painted over. This is a major concern for the remaining murals as well, as new painting, electrical work, and exposure have already damaged some of the remaining panels.

Original terrazzo floors appear to be intact beneath modern carpeting. Terrazzo was common flooring for hospital designs, used primarily for its cheapness, durability, and fireproof qualities.67 Other original elements remaining include night-lights, located along the main-floor hallway about a foot above the floor.68 The night-lights were part of the original design for the hospital, to provide low-

66 Ibid., 127.

67 Ibid., 117.

68 Night-lights were also used in Edward F. Stevens’s design for the hospital at Royal Victoria. See ibid., 120.

Historical Research Associates, Inc.

level lighting during late hours without the use of overhead ceiling lights. Although the night-lights have been painted over numerous times, they could likely be restored.

Original room doors have been largely replaced, although some closets and bathrooms retain what appear to be original wood doors. A few original, in-room bathrooms still exist, but most have been converted to storage space and their fixtures removed. The stairwell between the main floor and the basement has been completely replaced with a modern stair (Figure 5).

Character-Defining Features

Most of the Colville IHS Hospital’s character-defining features remain intact. These include:

1. The site of the main hospital building, along with its companion Doctor’s Residence and Nurses’ Quarters, within the larger built environment of the Colville Agency Campus. Fronted north along San Poil Road, the hospital complex maintains the southern end of a residential area surrounding a rectilinear park.

2. The plan of the hospital, a central “H” plan with projecting wings, illustrates the advances in hospital design from the pavilion plan of the nineteenth century.

3. The mode of construction, with poured-in-place, board-formed concrete foundations and walls, illustrates both advances in concrete technologies utilized in the 1930s, as well as the need for fire-and germ-resistant materials for hospital buildings.

4. The gable roof, engaged fluted pilasters with capitals that act as eave returns, and decorative details along the window trim are character-defining elements of the neoclassical revival style, also known as modern or stripped classical, popular with federal buildings constructed during the Great Depression.

5. The decorative loggia windows with “tribal pattern” mullions (now enclosed within north entry) and the interior murals of Edgar Disautel represent the personalization and individuality of the community that the Colville Hospital served.

Figure 1. Location of Colville Indian Health Services Complex. The large building in the center is the Main Building, or Hospital, and is flanked by the Nurses’ Quarters to the east and the Doctor’s Residence to the west.

Figure 2: Elevations of the Hospital, as drawn by Schmidt Garden and Erikson, Architects, September 25, 1934.

Figure 3. First-floor electrical plan, as drawn by Schmidt Garden and Erikson, Architects, September 25, 1934. Note the concrete pool on the northern elevation.

Figure 4. Detail from the original drawings for the Hospital, as drawn by Schmidt Garden and Erikson, Architects, September 25, 1934.

Figure 5. Current main floor (above) and basement (below) plans for the Hospital Building. As drawn by L.A. Olsen & Associates, Inc., September 15, 1995.

Historical Research Associates, Inc.

DOCTOR’S RESIDENCE

Location: Highway 155 Agency Campus (San Poil Avenue)

The Colville Indian Hospital Doctor’s Residence building is located within the Colville Indian Agency Campus, just south of the town of Nespelem, Washington along Highway 155. The Doctor’s Residence building is located approximately one quarter of one mile east of Hwy 155, and fronts east toward the Main Hospital Building.

USGS Nespelem Quadrangle

Township: T30R31ES06

Present Owner: Portland Area Indian Health Service

Present Occupant: Tribal Health Center Offices

Historic Use: Single-family Residence

Present Use: Offices

Significance: The Colville IHS complex consists of three buildings: the Main Building, or

Hospital, the Doctor’s Residence, and the Nurses’ Quarters. All three buildings were constructed in 1934-1936 by the Bureau of Indian Affairs (BIA) in an effort to improve health and sanitary conditions on the Colville Indian Reservation by providing needed medical services.

contributions to community planning/development, health/medical, and ethnic heritage. The complex may also be considered contributing to a larger district within the Colville Indian Agency, specifically including residential buildings extant to the north of the complex. These structures, along with the Colville IHS, represent developmental patterns within the reservation during the 1930s, which may help define the nature of federal and Indian relations during that time.

The Doctor’s Residence for the Colville Hospital was built simultaneously with the Hospital and Nurses’ Quarters. There is almost no historical information regarding the Doctor’s Residence, such as who lived there or whether the property performed as was initially intended. A report to the Commissioner of Indian Affairs, dated June 24, 1937, notes that “the other hospital employees (women) are housed in the building formerly used by the physician. This building has been remodeled and new bedroom furnishings installed. A furnace has been provided. Running water is supplied to each room. The living room is not used and had little furniture at the time of the visit.”69 This suggests that, although a physician was housed in the Doctor’s Residence at some point in time, within two years of the hospital’s opening, the space had been requisitioned for the overflow of nursing staff.