# Popular Science Monthly/Volume 86/January 1915/The Indian's Health Problem

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* THE INDIAN'S HEALTH PROBLEM
By CHARLES A. EASTMAN, M.D. (OHIYESA)
AMHERST, MASS.
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 30 per thousand of the population—double the average rate among white Americans. From the same source we learn that about 70,000 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 censuses 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, moldy 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 ware-houses 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 takes 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 of 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 that 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 store-room 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, by reason both 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 has had much to do with the outcome.
He was in a sense muzzled. He was told: "You are yet a child. You can not 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 re-establish 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 sanitoria 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 the red man's 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. 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. I have no serious concern about the new Indian, for he has now reached a point where he is bound to be recognized.