THE INDIAN'S HEALTH PROBLEM
The physical decline and alarming death-rate of the American Indian of
to-day is perhaps the most serious and urgent of the many problems that
confront him at the present time. The death-rate is stated by Government
officials at about thirty per thousand of the population--double the
average rate among white Americans. From the same source we learn that
about 70,000 Indians in the United States are suffering from trachoma, a
serious and contagious eye disease, and probably 30,000 have
tuberculosis in some form. The death-rate from tuberculosis is almost
three times that among the whites.
These are grave facts, and cause deep anxiety to the intelligent Indian
and to the friends of the race. Some hold pessimistic views looking to
its early extinction; but these are not warranted by the outlook, for in
spite of the conditions named, the last three census show a slight but
continuous increase in the total number of Indians. Nor is this increase
among mixed-bloods alone; the full-blooded Indians are also increasing
in numbers. This indicates that the race has reached and passed the
lowest point of its decline, and is beginning slowly but surely to
recuperate.
THE CHANGE TO RESERVATION LIFE
The health situation on the reservations was undoubtedly even worse
twenty years ago than it is to-day, but at that period little was heard
and still less done about it. It is well known that the wild Indian had
to undergo tremendous and abrupt changes in his mode of living. He
suffered severely from an indoor and sedentary life, too much artificial
heat, too much clothing, impure air, limited space, indigestible
food--indigestible because he did not know how to prepare it, and in
itself poor food for him. He was compelled often to eat diseased cattle,
mouldy flour, rancid bacon, with which he drank large quantities of
strong coffee. In a word, he lived a squalid life, unclean and apathetic
physically, mentally, and spiritually.
This does not mean all Indians--a few, like the Navajoes, have retained
their native vigor and independence--I refer to the typical "agency
Indian" of the Northwest. He drove ten to sixty miles to the agency for
food; every week-end at some agencies, at others every two weeks, and at
still others once a month. This was all the real business he had to
occupy him--travelling between cabin and agency warehouses for
twenty-five years! All this time he was brooding over the loss of his
freedom, his country rich in game, and all the pleasures and
satisfactions of wild life. Even the arid plains and wretched living
left him he was not sure of, judging from past experience with a
government that makes a solemn treaty guaranteeing him a certain
territory "forever," and taking it away from him the next year if it
appears that some of their own people want it, after all.
Like the Israelites in bondage, our own aborigines have felt the sweet
life-giving air of freedom change to the burning heat of a desert as
dreary as that of Egypt under Pharaoh. It was during this period of
hopeless resignation, gloomily awaiting--what, no Indian could even
guess--that his hardy, yet sensitive, organization gave way. Who can
wonder at it? His home was a little, one-roomed log cabin, about twelve
by twenty feet, mud-chinked, containing a box stove and a few sticks of
furniture. The average cabin has a dirt floor and a dirt roof. They are
apt to be overheated in winter, and the air is vitiated at all times,
but especially at night, when there is no ventilation whatever. Families
of four to ten persons lived, and many still live, in these huts.
Fortunately the air of the plains is dry, or we should have lost them
all!
Remember, these people were accustomed to the purest of air and water.
The teepee was little more than a canopy to shelter them from the
elements; it was pitched every few days upon new, clean ground. Clothing
was loose and simple, and frequent air and sun baths, as well as baths
in water and steam, together with the use of emollient oils, kept the
skin in perfect condition. Their food was fresh and wholesome, largely
wild meat and fish, with a variety of wild fruits, roots, and grain, and
some cultivated ones. At first they could not eat the issue bacon, and
on ration days one might see these strips of unwholesome-looking fat
lying about on the ground where they had been thrown on the return trip.
Flour, too, was often thrown away before the women had learned to make
bread raised with cheap baking-powder and fried in grease. But the
fresh meat they received was not enough to last until the next ration
day. There was no end of bowel trouble when they were forced by
starvation to swallow the bacon and ill-prepared bread. Water, too, was
generally hauled from a distance with much labor, and stood about in
open buckets or barrels for several days.
As their strength waned, they made more fire in the stove and sat over
it, drinking rank coffee and tea that had boiled all day on the same
stove. After perspiring thus for hours, many would go out into the
bitter cold of a Dakota winter with little or no additional clothing,
and bronchitis and pneumonia were the inevitable result. The uncured
cases became chronic and led straight to tuberculosis in its various
forms.
Furthermore, the Indian had not become in any sense immune to disease,
and his ignorance placed no check upon contagion and infection. Even the
simpler children's diseases, such as measles, were generally fatal. The
death-rate of children under five was terrific. I have known women to
bear families of six or eight or ten children, and outlive them all,
most dying in infancy. In their state of deep depression disease had
its golden opportunity, and there seemed to be no escape. What was there
to save the race from annihilation within a few years? Nothing, save its
heritage of a superb physique and a wonderful patience.
THE INDIAN SERVICE PHYSICIAN
The doctors who were in the service in those days had an easy time of
it. They scarcely ever went outside of the agency enclosure, and issued
their pills and compounds after the most casual inquiry. As late as
1890, when the Government sent me out as physician to ten thousand
Ogallalla Sioux and Northern Cheyennes at Pine Ridge Agency, I found my
predecessor still practising his profession through a small hole in the
wall between his office and the general assembly room of the Indians.
One of the first things I did was to close that hole; and I allowed no
man to diagnose his own trouble or choose his pills. I told him I
preferred to do that myself; and I insisted upon thoroughly examining my
patients. It was a revelation to them, but they soon appreciated the
point, and the demand for my services doubled and trebled.
As no team was provided for my use to visit my patients on a
reservation nearly a hundred miles square (or for any other agency
doctor at the time), I bought a riding horse, saddle and saddle-bags,
and was soon on the road almost day and night. A night ride of fifty to
seventy-five miles was an ordinary occurrence; and even a Dakota
blizzard made no difference, for I never refused to answer a call.
Before many months I was supplied by the Government with a covered buggy
and two good horses.
I found it necessary to buy, partly with my own funds and partly with
money contributed by generous friends, a supply of suitable remedies as
well as a full set of surgical instruments. The drugs supplied by
contractors to the Indian service were at that period often obsolete in
kind, and either stale or of the poorest quality. Much of my labor was
wasted, moreover, because of the impossibility of seeing that my
directions were followed, and of securing proper nursing and attention.
Major operations were generally out of the question on account of the
lack of hospital facilities, as well as the prejudice of the people,
though I did operate on several of the severely injured after the
massacre at Wounded Knee. In many cases it was my task to supply my
patients with suitable food and other necessaries, and my wife was
always prepared for a raid on her kitchen and storeroom for bread, soup,
sheets, and bandages.
The old-time "medicine-man" was really better than the average white
doctor in those days, for although his treatment was largely suggestive,
his herbs were harmless and he did allay some distress which the other
aggravated, because he used powerful drugs almost at random and did not
attend to his cases intelligently. The native practitioners were at
first suspicious of me as a dangerous rival, but we soon became good
friends, and they sometimes came frankly to me for advice and even
proposed to borrow some of my remedies.
Of course, even in that early period when the average Government doctor
feared to risk his life by going freely among the people (though there
was no real danger unless he invited it), there were a few who were
sincere and partially successful, especially some military surgeons.
Now that stage of the medical work among the Indians is past, and the
agency doctor has no valid excuse for failing to perform his
professional duty. It is true that he is poorly paid and too often
overworked; but the equipment is better and there is intelligent
supervision. At Pine Ridge, where I labored single-handed, there are
now three physicians, with a hospital to aid them in their work. To-day
there are two hundred physicians, with a head supervisor and a number of
specialists, seventy nurses, and eighty field matrons in the Indian
service.
SOME MISTAKES AND THE REMEDIES
Another serious mistake has been made in the poor sanitary equipment of
Indian schools. Close confinement and long hours of work were for these
children of the forest and plains unnatural and trying at best.
Dormitories especially have been shamefully overcrowded, and undesirable
pupils, both by reason of disease and bad morals, allowed to mingle
freely with the healthy and innocent. Serious mishaps have occurred
which have given some of these schools a bad name; but I really believe
that greater care is being taken at the present time. It was chiefly at
an early period of the Indian's advance toward civilization that both
mismanagement and adverse circumstance, combined with his own
inexperience and ignorance of the new ways, weakened his naturally
splendid powers and paved the way for his present physical decline. His
mental lethargy and want of ambition under the deadening reservation
system have had much to do with the outcome.
He was in a sense muzzled. He was told: "You are yet a child. You cannot
teach your own children, nor judge of their education. They must not
even use their mother tongue. I will do it all myself. I have got to
make you over; meanwhile, I will feed and clothe you. I will be your
nurse and guardian."
This is what happened to this proud and self-respecting race! But since
then they have silently studied the world's history and manners; they
have wandered far and wide and observed life for themselves. They have
thought much. The great change has come about; the work has been done,
whether poorly or otherwise, and, upon the whole, the good will prevail.
The pessimist may complain that nothing has come of all the effort made
in behalf of the Indian. I say that it is not too late for the original
American to regain and reestablish his former physical excellency. Why
should he not? Much depends upon his own mental attitude, and this is
becoming more normal as the race approaches and some part of it attains
to self-support and full citizenship. As I have said, conditions are
improving; yet much remains to be done; and it should be done quickly.
An exhaustive inquiry into health conditions among the tribes was made
in accordance with an act of Congress in 1912, and the report presented
in January, 1913, was in brief as follows:
1. Trachoma is exceedingly prevalent among Indians.
2. Tuberculosis among Indians is greatly in excess of that estimated
for the white population.
3. The sanitary conditions upon reservations are, on the whole, bad.
4. The primitive Indian requires instruction in personal hygiene and
habits of living in stationary dwellings.
5. The sanitary conditions in most Indian schools are
unsatisfactory.
6. There is danger of the spread of tuberculosis and trachoma from
the Indian to other races.
7. Due care is not taken in the collection and preservation of vital
statistics.
8. The medical department of the Indian Bureau is hampered by
insufficient authority and inadequate compensation.
As a result of this and other investigations, increased appropriations
have been asked for, and to a limited extent provided, for the purpose
of preventing and treating disease, and especially of checking the
spread of serious contagious ailments. More stress is being laid upon
sanitary precautions and hygienic instruction in Indian schools, and an
effort is made to carry this instruction into the Indian home through
field matrons and others. Four sanatoria or sanitarium schools have been
successfully established in suitable climates, and it is recommended by
an Indian Service specialist that certain boarding-school plants be set
apart for trachoma pupils, where they can have thorough and consistent
treatment and remain until the cure is complete. Much larger
appropriations are needed in order to carry out in full these beneficent
measures, and I earnestly hope that they may be forthcoming.
It is interesting to note that whereas a few years ago the Indians were
reproved for placing their sick in canvas tents and arbors, and in every
way discouraged from any attempt to get out of their stifling houses
into the life-giving air, sleeping-porches are now being added to their
hospitals, and open-air schools and sanatoria established for their
children. The world really does move, and to some extent it seems to be
moving round to his original point of view. It is not too late to save
his physique as well as his unique philosophy, especially at this moment
when the spirit of the age has recognized the better part of his scheme
of life.
It is too late, however, to save his color; for the Indian young men
themselves have entirely abandoned their old purpose to keep aloof from
the racial melting-pot. They now intermarry extensively with Americans
and are rearing a healthy and promising class of children. The tendency
of the mixed-bloods is toward increased fertility and beauty as well as
good mentality. This cultivation and infusion of new blood has relieved
and revived the depressed spirit of the first American to a noticeable
degree, and his health problem will be successfully met if those who are
entrusted with it will do their duty.
My people have a heritage that can be depended upon, and the two races
at last in some degree understand one another. I have no serious concern
about the new Indian, for he has now reached a point where he is bound
to be recognized. This is his native country, and its affairs are
vitally his affairs, while his well-being is equally vital to his white
neighbors and fellow-Americans.