In its treaties, the federal government routinely promised many material goods to Native Americans, as well as less tangible goods such as health care and education. Much of the government’s early health care consisted more of record-keeping than anything else: what illnesses were striking Indians in what regions, how many had died, and from what causes? Often, the precipitating factor for providing even minimal health care stemmed from concern for whites: when epidemics (like smallpox) among Indians threatened to spill over into white settlements, federal doctors often gave vaccines and provided what preventative care was available to native populations. Civilian physicians and missionaries sometimes took up the slack, but health care was primarily a federal obligation.
Though that medical care was inadequate in the extreme, the moral obligation to provide it was clear. In 1831, the Supreme Court had described the federal government’s responsibility to Indians when Chief Justice John Marshall wrote: “Their (Native American) relation to the United States resembles that of a ward to his guardian.”
Though many argued over it at the time, the Canton Asylum for Insane Indians did not represent anything outside the bounds of what the government might have been expected to provide. Clearly, provision for mental health fell under a guardian/ward relationship just as physical care did. The problem lay in whether or not a separate facility only for Indians was the answer. For the patients who traveled hundreds of miles to the asylum when they might otherwise have been admitted to a closer state hospital, the answer would probably be a resounding “No!”