At these meetings and in this journal various phases of our situation have been intelligently and courageously discussed, and certain remedies have been suggested for the evils brought to light. These debates should at least open the public ear.

Of course the obstacles to complete success that I have referred to still exist, and there are others as well. Our people have not been trained to work together harmoniously. It is a serious question what principles we should stand for and what line of work we ought to undertake. Should we devote ourselves largely to exposing the numerous frauds committed upon Indians? Or should we keep clear of these matters, avoid discussion of official methods and action, and simply aim at arousing racial pride and ambition along new lines, holding up a modern ideal for the support and encouragement of our youth? Should we pet.i.tion Congress and in general continue along the lines of the older Indian a.s.sociations? Or should we rather do intensive work among our people, looking especially toward their moral and social welfare?

I stand for the latter plan. Others think differently; and, as a matter of fact, a Washington office has been opened and much attention paid to governmental affairs. It is a large task. The declared objects of the society, in almost the words originally chosen by its six founders, are as follows:

OBJECTS OF THE SOCIETY OF AMERICAN INDIANS

_First._ To promote and cooperate with all efforts looking to the advancement of the Indian in enlightenment which leave him free, as a man, to develop according to the natural laws of social evolution.

_Second._ To provide through our open conferences the means for a free discussion on all subjects bearing on the welfare of the race.

_Third._ To present in a just light the true history of the race, to preserve its records and emulate its distinguishing virtues.

_Fourth._ To promote citizenship and to obtain the rights thereof.

_Fifth._ To establish a legal department to investigate Indian problems and to suggest and to obtain remedies.

_Sixth._ To exercise the right to oppose any movement that may be detrimental to the race.

_Seventh._ To direct its energies exclusively to general principles and universal interests, and not allow itself to be used for any personal or private interest. _The honor of the race and the good of the country shall be paramount._

CHAPTER IX

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 pa.s.sed 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 s.p.a.ce, 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 quant.i.ties 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-c.h.i.n.ked, 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 a.s.sembly 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 ma.s.sacre 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 pract.i.tioners 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 circ.u.mstance, 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 att.i.tude, 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.