HRDLiCKA] TUBEECULOSIS AMONG CEKTAIN INDIAN TRIBES 31 



(2) Second only to the foregoing in seriousness in the propagation 

 of tuberculosis among the Indians is doubtless the now frequent 

 hereditary taint among the young. In a tribe such as the Sioux it 

 would be very difficult, if not impossible, to find a family in which 

 there have not been tuberculous individuals, some of whose progeny 

 are congenitally predisposed to the disease. 



(3) Related to the frequent hereditary taint in the Indian is his 

 apparent lesser racial immunity from the disease. The existence of 

 this factor seems to be demonstrated, but its exact value can not be 

 determined until the Indian is observed under the same conditions of 

 life as the whites. Doubtless much of what now appears to be greater 

 racial susceptibility is a result of other conditions, particularly greater 

 opportunities for infection, and malnutrition. 



(4) A favorable condition for the development of the pulmonary 

 form of tuberculosis, among the Indians as among the whites, is the 

 presence of tuberculous glands or other tuberculous processes in an 

 individual. 



(5) All exposure to heat and cold which is liable to bring on 

 abnormal conditions of the respiratory apparatus, actual disease of 

 the air passages or the lungs, and frequent neglect of such condi- 

 tions, strongly promote in the Indian the development of pulmonary 

 tuberculosis. The infection in such cases would be less frequent, 

 however, were the tubercle bacilli less numerous. Noteworthy here 

 is the fact that, since assuming the white man's dress, the Indian 

 often wears more clothing than he needs, thus making himself 

 more susceptible to the inroads of disease. 



(6) The influence of diseases other than those of the respiratory 

 tract, on the development of tuberculosis among the Indians, is not 

 certain. That of syphilis has surely been overrated; parasitic con- 

 ditions need a special study; heart disease — mitral insufficiency of 

 rheumatic origin — is very common, as stated before, among the 

 IVIenominee. But no causative relation could be detected between 

 this trouble and tuberculosis. 



(7) Dissipation, indolence, and all other weakening conditions 

 contribute, doubtless, as much to the susceptibility of the Indian 

 to tuberculous infection as they do among the whites. 



(8) Want and consequent debilitation are certainly responsible 

 for a percentage of the cases of pulmonary tuberculosis among the 

 Indians. Helpless poverty is only too apparent in many of the 

 families, particularly among the old people who are often from 

 necessity, habit, or other causes, more or less neglected by their 

 relatives. In certain localities where there is poverty not apparent 

 to the casual observer the food is ordinarily sufficient to sustain life, 

 but, owing to the quality, it furnishes little or no surplus energy. 

 Under such conditions, any extraordinary demand on the forces of 



