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The American Public Health Association estimates the probable number of “contact cases,” or persons directly exposed to tuberculosis, as being three times the number of active cases. This method would indicate 29,052 “contacts”? among Indians on the various reservations.
In 1922 a somewhat cursory study of tuberculosis among Indians was made by the National Tuberculosis Association. The statistics were obtained from the Indian Office. They indicated that 29 per cent of all deaths were from tuberculosis, and that the average number of estimated cases each year during the period 1911-1920 was 23,705.
The types of tuberculosis included in these estimates are not known, but all inquiries made on the reservations themselves indicate that a large percentage of the cases are of the pulmonary form. In visits to reservations and schools, a large number of glandular cases were seen, and obviously they also constitute a very considerable proportion of the total. The prevalence of this form of infection is of the greatest interest, as it is ordinarily associated with a contaminated milk supply, and yet milk when provided at government schools is usually obtained from clean herds, and the Indians on the reservation rarely use milk. Most Indians consume large quantities of beef, and the supply generally does not come from tuberculin tested stock. This fact may supply a hint in the solution of this important problem.
Kober has pointed out that tuberculosis was no more prevalent among Indians than among whites during the early colonization days. From all available data, it would seem that there has been a progressive increase in its prevalence with a more intimate contact with the whites. In any case, in their present mode of life the Indians do not seem to possess the same degree of immunity as the whites. The course of the disease is more acute and fulminating, with less evidence of fibratic changes in lung pathology. Tuberculosis appears to take much the same course in the Indian as in the negro.
The Indian in all probability would respond as well to early care as a member of any other race, but in most instances a diagnosis is not made until the disease is well advanced. Although the disease usually takes a more rapid course in the Indian, perhaps making diagnosis more difficult, there seems to be no reason why the