Ales Hrdlicka presents a detailed account of investigations made by him under the joint auspices of the Bureau of Indian Affairs and the Smithsonian Institution, on the tuberculosis condition of five selected Indian tribes of the United States. 34; Although the gravity of the conditions treated of in this paper, from the point of view of the physical welfare of both Indians and savages, is generally understood and appreciated by intelligent students of the subject, such difficulties are serious and often insurmountable. In some cases the difficulty is the lack of the necessary legislation; in some, the impracticability of exercising a close enough supervision even over those Indians inclined to accept the advice of the wise man;
These are briefly some of the obstacles that stand in the way of those who want to lead the Indians along the paths of civilization. 34;the amelioration of existing conditions shall be effected as rapidly as practicable." Indeed, since the accompanying paper was written, changes have been made in the service tending to improve the condition of the Indians, and there is every reason to expect continued progress towards more hygienic living among the Indians with a consequent reduction in the destructive effects of tuberculosis and other diseases.
TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES OF THE UNITED STATES
INTRODUCTION
As early as 1615 °' there are references to diseases of the "chest" - some of which may have been of an ominous nature .. among the Tarasco of Michoacan. The special study of tuberculosis among the Indians in the United States is only a matter of recent years, and dates, in fact, from the establishment, about twenty-five years ago, of the regular Indian medical service. In the same year, a report of the disease in Arizona and New Mexico, based on special reports from the agency and school doctors, by Dr.
Since 1900, inquiries about the disease have also been made by the writer among the various tribes of the Southwestern states and Northern Mexico. Office, he collected information from his doctors about the diseases due to tuberculosis among all the Indians of the United States.
SCOPE OF INVESTIGATIONS
Nevertheless, there are many indications that the proportion of tubercular cases in this tribe, where contact with whites is limited, is very small.
RESULTS OF INVESTIGATIONS, BY TRIBES The results will be presented in as brief form as is consistent with
1), were daily seen in the main street of the village, surfing on grass, which is doubtless often polluted by the expectations of health}^ as well as by the consumables. These tents are erected near the house and are occupied by the elderly, by a relative or visitor. The dry, fine dust of the floor floats easily in the air, where it is inspired by children as well as adults.
This is undoubtedly one of the main causes of the spread of the disease in this area. This profession brings a lot to the men, and also some boys and girls.
QUINAIELT
In every house, the members of the family, including the sick, expectorate freely on the floor, with only an exception a can for the purpose. A woman, far advanced in the disease, frequently coughing and expectorating, was seen in one of the houses making baskets for tourists, and this was doubtless not an exceptional case. Since the way to make these baskets is to cut the fiber in the mouth, and since there is no further disinfection of the basket that is finished, undoubtedly some" of those sold to tourists do not carry abundant and dangerous infection.
They live in frame houses, built like the whites', with lots of windows and generally more than one room. The houses are usually heated with modern stoves, only two of the old ones have been found with open fireplaces.
HRDUCKA] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 17
SYMPTOMATOLOGY
The symptoms manifested by tuberculous Indians are much more than those seen in similar cases of the disease among whites. However, there appear to be some interesting differences, and more detailed studies in the future may turn up others. Rapid cases are characterized by all the known symptoms of galloping consumption.
The fever, sweat and a rapid exhaustion of the patient are especially noticeable in the Indian. The subacute, and especially the chronic, show, as among the whites, gradual emaciation, with loss of strength; cough, irritating at night and especially in the morning; fever, especially in the evening or night; hemoptysis; night sweats, and also more. The fever is mostly irregular, and in some cases the patients complain more of chills than.
Pressure on the apex of the lungs is also painful, and occasionally there is hypersensitivity here on percussion. On auscultation, it is found that the upper lobes - right and left in approximately the same proportion - are generally affected first, and that. There is a long and audible expiration; sharp, hard, or harsh inspiration; moist or crepitant, diffuse or localized waves and pronounced bronchophony over the infected areas.
In the acute cases we saw in previous years, the dullness seemed to manifest itself to a greater extent. In a large proportion of more severe cases of consumption, a secondary infection of the larynx is evident and associated. In rare cases the ulceration becomes extensive; in a young Mohave woman the ulcers are in-.
ETIOLOGY
Subsequent cleaning is always more or less incomplete and. so eventually even the best apartments are almost certain. But the danger of infection from coughing is especially great in houses with earthen or sandy floors, such as are still common among the Sioux and Mohaves. Infection through these latter sources is sufficiently proved by the finding of numerous tubercle bacilli in most of the mouthpieces of musical instruments examined on the expedition.
On the other hand, the danger from utensils is greater than among whites, for the Indians still have here and there wooden spoons and basket bowls, which are more difficult to clean than metal or porcelain articles. All these conditions create, even among the Indians living in the most modern dwellings, chances of infection unparalleled in whole societies among the white people. HRDLiCKA] TUBEECULOSIS AMONG THE CEKTAIN INDIAN TRIBES 31. 2) Second to the preceding in seriousness in the prevalence of tuberculosis among the Indians is undoubtedly the now frequent hereditary disease among the young.
The infection in such cases, however, would be less frequent if the tubercle bacilli were numerous. is the fact that the Indian, since assuming the white man's dress, often wears more clothes than he needs, and thus makes himself. more susceptible to the onset of disease. The syphilis thing has probably been overrated; parasitic conditions require special investigation; heart disease — mitral insufficiency of gouty origin — is very common, as previously stated, among IVIenominee. Helpless poverty is only too evident in many of the families, especially among the old, who often come from. necessity, habit, or other causes, more or less neglected by their relatives.
32 BUREAU OF AMERICAN ETHNOLOGY [bull. the body is likely to be followed by excessive tissue wasting which does. the individual an easy victim of tuberculous infection. As the meat is not always cooked through, the tubercle bacillus is introduced into the system through this source. In the non-reservation schools, an important factor is the depressing effect on the newly arrived child, from a radically different environment.
THERAPEUTICS
They clearly prove that pulmonary tuberculosis is by no means always fatal in Indians, and justify any suitable measures that can be taken to cure Indian consumption. His antiquated, erroneous notions of disease must be gradually put to rest and replaced by actual knowledge and a clear understanding of the nature of tuberculosis as of other contagious infections. Because the children are free from many of the adult Indian prejudices and what is given to them in a proper.
Care must be taken, however, that these teachings do not become a burden of blindly accepted rules, but part of the plain understanding and common sense of the Indian. It is believed that instruction in this line, on most of the reservations and in the larger schools, is extremely desirable and should be given as soon as possible. There is an urgent need for the general introduction of a simple and practical method for the disposal of infected saliva.
Make the Indian fear the sputum of consumables, as it ought to be feared, and then give him, or teach him to supply himself, with the simplest means possible for its isolation. In continuation of the line of prevention, it is encouraged that the earthen floors in the homes, where possible, be replaced by those made from. In a few localities, visited during the author's previous travels, it was noticed that some of the field.
It is felt that the Indian police could be made excellent use of in this work under the direction and supervision of the agency doctor. Weekly weighing of all students should be practiced, as constant weight loss is one of the first and most important signs of deteriorating health. The school-rooms are generally good, but the open-air schools to be introduced by the India Office authorities must certainly be regarded as a further step in the right direction.
BIBLIOGRAPHY
Speaking of the Yakima in 1857, the writer says: "Their prominent diseases are phthisis, catarrhal and rheumatic affections, fevers, scrofula, smallpox, and venereal diseases." Includes the writer's previous observations on tuberculosis among Indians; a detailed description of the 1904 report of doctors in the Indian Service on the incidence of tuberculosis among various tribes and bibliography. Page 917: "It appears that the Indian was free of tuberculosis before his contact with the whites, 'living ashedid and without alcohol.'
But it is rarely observed, except in those addicted to intemperance, and even in these it is not so common as in whites, which I have never known to affect a man before puberty, and very rarely under 20 years of age." his the neck and the whole throat was eaten away; while the girl was suffering from bleeding which changed her skeleton.'" Regarding the full-blooded Hurong girl who was to become a shadow in the monastery, the writer says: "He (the Lord) visited her from a disease quite common among the Savages, being a sort of weakness, together with a slow fever; and this so exhausted her that she disappeared before our eyes from an inflammation, attended with a violent cough, which affected her whole chest basket to the extent that her lungs were gradually destroyed.
Page 102: "In New England the Indians are afflicted with pestilent fever, pestilence, black-pox, lung consumption, falling disease, malice of kings, and a disease called by the Spaniards, the plague of the back, with an empyema." Page 549: We "had a number of patients afflicted with scrofula, rheumatism, and sore eyes. The scrofulous affections, we may easily suppose, arise from the long confinement to a vegetable diet." Page 347, Appendix: Referring to the Indians east of the Rocky Mountains and north of the Missouri, the author states that they are “generally subject to new diseases.
Page 312: "Consumption is a disease known to all with whom I have had any personal acquaintance; and I also think I may go further, and declare, without fear of contradiction, that it is common among all the natives of the northern part of our continent." Page 412: "Of those above ten years of age who have suffered from disease, I think I am quite half dead from consumption, I do not think it was much more common among the Indians than among our white population; while from the fact that they were infected with scrofula, their mode of life, etc., it might be expected that it would be much more so."
INDEX
46 INDEX
48 INDEX
MENOMINEE HOUSES
MENOMINEE HOUSES AND FARM
OGLALA DWELLINGS
OGLALA TENT DWELLINGS
OGLALA LOG HOUSES
HUPA DWELLINGS
HUPA LARGE FRAME HOUSES
HUPA DWELLINGS OF THE POORER CLASS
MOHAVE SHELTERS
MOHAVE DWELLINGS
MOHAVE DWELLINGS AND SWEAT HOUSE
