HHDLiCKA] TUBERCULOSIS AMONG CERTAIN INDIAN TRIBES 33 



to the diagnosis, on the way to recovery or actually recovered. 

 Such cases, which embrace all ages except perhaps the senile, were 

 found in all the tribes, and in a number of instances had been 

 watched for years by the local physicians. They prove clearly 

 that pulmonary tuberculosis is by no means always fatal in the 

 Indian, and justify any adequate measures that may be taken for the 

 cure of the Indian consumptive. 



The writer will now briefly state such measures, particularly in 

 the line of prevention, as appear to him of especial importance. 



The first, most important, and most difficult must be the com- 

 bating of ignorance. The Indian must be taught how to live, how 

 to prepare his food, how to take care of the young, of the old, and of 

 the sick, and what precautions to use against the spread of consump- 

 tion. His antiquated, erroneous notions concerning disease must 

 be gradually dispelled, and be replaced by actual knowledge and a 

 clear understanding of the nature of tuberculosis, as of that of 

 other contagious infections. The teaching must be applied not only 

 to the Indian adults, by means of lectures, demonstrations, special 

 bulletins, and through the physicians, but, above all, by means of 

 regular instruction to the children from the time of their entrance 

 into the schools. For the children are free from many of the preju- 

 dices of the adult Indian, and what is imparted to them in a proper 

 way will become a stable part of their mental equipment, regulating 

 their actions throughout their lives. Not only that, but the children 

 thus instructed would themselves influence their parents and rela- 

 tives more than an outsider would. Care must be taken, however, 

 to make these teachings not a burden of rules to be blindly accepted, 

 but a part of the clear 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 exceedingly desirable, and 

 should be furnished as soon as possible. 



There is urgent necessity for the general introduction of a simple 

 and practicable method for the disposal of the infected sputum. 

 Make the Indian fear the sputum of the consumptives as it should 

 be feared, and then provide him, or teach him to provide himself, 

 with the simplest means possible for its isolation. Cheap and easily 

 destructible articles, as toilet paper, are far preferable to the use 

 of spittoons, the contents of which, in the absence of sewers, would 

 be apt to prove a dangerous source of infection. The Indian should 

 be taught to destroy the receptacles by burning, since fire is always 

 to be had. The exclusion of flies, which disseminate the infected 

 matter, particularly over food, is another necessity. 



A further and very important step will be the isolation of all 

 cases, under the care of the nurse and the physician. There will be 



