During the first decades of the federal government's Indian boarding schools, stories of morbidity and mortality among students were prevalent. In August 1915 Commissioner of Indian Affairs Cato Sells arrived in San Francisco to address the Congress of Indian Progress, an organization dedicated to the social advancement of American Indians. Waxing poetically about the duty of the Indian Service to protect the well-being of the American Indians, Sells noted it was the government's "chief duty to protect ... the health and constitution of Indian children." The following January, the commissioner went a step further by writing a circular letter read by every Indian Service employee, stressing: "There is something fundamental here: We cannot solve the Indian problem without Indians. We cannot educate their children unless they are kept alive." Read within the context of twenty-first-century realities, Sells's statements appear to be simplistically benign. Understood in light of turn-of-the-twentieth-century realities, however, the commissioner's comments struck at the fear that many American Indian parents experienced. Parents who, willingly or under the threat of coercion, enrolled their children in federal Indian schools were painfully aware that in so doing their children could be subject to deadly contagious diseases. This essay focuses on the decades surrounding the turn of the twentieth century. These decades were crucial in that they not only set the pattern for the Indian school system but also served as the catalyst for changes in federal Indian policy in the 1920s, when a series of studies and reports, culminating with the Meriam Report of 1928, gave credence to what by then was commonly known in Indian Country: federal policies had been a disaster and this failure was nowhere greater than in the field of education. Thus, the Indian school system between 1878 and 1918 reflects the prevailing sentiments of a parsimonious Congress and an underfunded and overtaxed Indian Service. Despite the moral concerns of reformers and the political responses of policymakers, there remained no greater disappointment in the Indian Service than student health conditions in the Indian schools. (Contains 1 table and 70 notes.)