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This article takes a historical view of Dawes Era medical communication, focusing on National Archives Record Group 75 (the Bureau of Indian Affairs papers). Examinations of reports from the Pine Ridge and Nett Lake Agencies focus readers’ scrutiny on prevalent formal codes and paracolonial conventions of Indian Bureau medical reports. This article challenges writing studies scholars to forthrightly concern themselves with the ways in which discourses of power are encoded in document structures and designs.