HRDLicKA] TUBEECULOSIS AMONG CERTAIN INDIAN TRIBES 27 



formerly seen by the writer among the Indians, and others of which 

 he learned personally on the reservations, are of very rapid course, 

 terminating within a few weeks or two or three months. Subacute 

 cases, with more moderate symptoms and a duration beyond three 

 months, were well represented in all of the tribes. A decided majority, 

 however, of the cases of consumption encountered were of the chronic 

 type, with slow and irregular progress, and in many instances of more 

 than a year's duration. Such cases often show a tendency toward 

 recovery, and in every locality more than one individual was met 

 with in whom symptoms of the disease, after lasting for years, had 

 been followed b}^ complete recovery. The subacute cases often 

 become chronic and may progress to recovery. In many more 

 instances, however, judging from past experience and the informa- 

 tion obtained during the investigation here dealt with, such cases 

 become aggravated and speedily result in death. 



Tuberculosis of the cervical glands has been observed among the 

 Indians in individuals of all ages, from early infancy to middle age. 

 The youngest patient seen with this disorder was a girl one year old, in 

 whom the glands had already suppurated. The oldest cases were 

 two women, each about 45 years of age, and another woman who gave 

 her age as 46. In the two former the swollen glands were clearly 

 tuberculous, though not yet pointed; there were at the same time 

 other signs of tuberculous infection, one being classed with the 

 positively established cases of phthisis, the other with the doubtful. 

 In the woman of 46 the glands were still suppuratmg, while lung 

 symptoms indicated, at the same time, chronic consumption. Among 

 the Mohave two moderately enlarged cervical glands, not suppurat- 

 ing, were seen in an old man about 85 years of age. The nature of 

 these swellings could not be exactly determined, but the patient, 

 whose sputum contained tubercle bacilli, had, so far as could be ascer- 

 tained, no other disorder which might account for the glandular 

 enlargements. 



In the Indian tuberculosis of the bones usually attacks the spine, 

 hip joint, ribs, or tibiae. One case was seen in which the wrist was 

 invoh^ed, and another in which a discharging sinus led to either the 

 malar bone or the malar process of the superior maxillary bone. 



Of the other forms of tuberculosis, it was found that in the young 

 children the disease is especially apt to manifest itself in the meningeal 

 form. Intestinal tuberculosis seems to appear only as a complica- 

 tion of tubercular process in other parts of the body. 



The prevalence of tuberculosis in its various forms, among the 

 tribes visited, is especially illustrated in the last two items in the 

 tables, giving the proportions of individuals and of family groups 

 totally free from any suspicion of the disease. Such family groups 

 among the full-blood Oglala fall as low as one-third of all of those 

 examined. In at least two-thirds, then, of the families of the Oglala 

 Sioux there are some indications of tuberculous infection. 



