HRDLiCKA.] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 29 



nosis, it would have been impossible to base an intelligent opinion on 

 percussion alone. There is always, however, diminished or irreg- 

 ular resonance. In cases of many years' duration, and in those 

 who have recovered from clironic phthisis, there is a more or less 

 fiat sound over the apices, or over the whole of the upper lobes, 

 which differs from the dullness of consolidation. In the acute cases 

 seen in former years dullness seemed to be manifested to a greater 

 degree. 



In a large proportion of the more severe cases of consumption a 

 secondary infection of the larynx is noticeable, and is attended by 

 all the well-known sj^mptoms of that complication. 



The actual beginning of pulmonary tuberculosis is often referred 

 by the Indian patients to an attack of pneumonia, pleurisy, grippe, 

 "bad cold," and even measles; an insidious beginning was heard of 

 less frequently. 



The bacteriological examinations made during the investigation, 

 while revealing interesting conditions in special instances, did not 

 indicate the existence of any peculiar racial features. It is possible, 

 however, that more numerous and elaborate examinations may 

 show some peculiarities in the pulmonar}^ excretions of the Indian 

 consumptive. 



As a rule, the cases of tuberculous cervical glands in the Indians 

 run a mild course. In some individuals the swellings, after attain- 

 ing certain proportions, gradually diminish in size until they become 

 scarcely palpable. Suppuration is occasionall}" aggravated by a 

 secondary infection, due to uncleanliness. In rare cases the ulcera- 

 tion becomes extensive; in a young Mohave woman, the sores in- 

 volved the front of the neck, in an irregular manner, from the lower 

 jaw down to the first rib. The scars left b}" suppurated glands have 

 the same features as in the whites. Death in these cases occurs 

 only from complications. 



Nothing radically distinctive was observed in the cases of tuber- 

 culosis of the b(mes. 



VI. ETIOLOGY 



The etiology of tuberculosis among the Indians is a subject of par- 

 ticular importance. After as careful inquiry as was possible in the 

 short time available, the following may be enumerated, in the order 

 of their importance, as the causes of the disease, particularly in its 

 pulmonary form, among these people. 



(1) The most potent of all factors is the facility of infection, partic- 

 ularly during the cold or rainy season. The average Indian has no 

 idea of the real nature of tuberculosis, or of the means by which it is 

 propagated. He often lives in a good house, or in one that could 

 easily be ventilated and kept clean. But his knowledge and habits 



