VOL. IX. [NEW SERIES.]

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

SCROFULA AMONG THE SIOUX INDIANS; ITS ORIGIN AND NATURE.*

BY JOSEPH B. GRAHAM, M. D.

United States Agency Physician.

The excessive disproportionate number of scrofulous cases found among the Indians is enough to incite any one who has to deal with them to an investigation of the cause and nature of the disease.

Though this investigation is as yet superficial, I trust it may appear none the less interesting. The halo of romance which once surrounded the native American has, like Hiawatha and others noted in poetry and song, with their native food, the buffalo, faded from earth and passed to the kingdom

of the hereafter. The Indian is now relegated to the realms of a common every-day being. As such I propose to deal with him, and learn what I can from the opportunities presented.

During the time (not yet two years) that I have been physician to this agency I have had under treatment thirty-two cases of scrofula in its gravest form. Those who have never been under treatment by actual count (with a less aggravated appearance of the disease) number two hundred and five, mostly under eighteen years of age. This is among a population of less than thirteen

hundred souls.

The varied forms of the disease may be

Extract from a paper read before the Dakota Medical Society, June 22, 1889.

No. 1.

met with daily in tuberculoses of lungs, membranes of the brain, mesenteric glands, peritoneum, joints, periosteum, lymphatic glands, muscle, bones, tendon, and tubercular ulcerations of intestines. Fully eighty per cent of all the diseases found among them are tuberculous in character, and tuberculosis threatens in time to exterminate the race if some steps are not taken to stay its ravages.

In this connection it would not be out of place to trace the relationship between scrofulosis and tuberculosis, as it has a direct bearing upon the subject. However, I shall not attempt a description of tubercle or definition of what has been termed scrofula.

The history of the disease among the Indians is tuberculosis in the parent, in the infant and child so-called scrofulosis and tuberculosis, and in the prime and "sere and yellow leaf of life" again tuberculosis. What are the connections? Virchow regarded tuberculosis as a possible heteroplastic or metastatic scrofula. Wagner and Schuppel discovered that in many instances scrofulous glands were tuberculous. Rindfleisch looked upon tuberculosis and scrofulosis as identical. Villemin inoculated animals with the

sputa from consumptives, and it always produced tuberculosis, and with matter from scrofulous glands, also causing tuberculosis. Kanzler has found Koch's tubercle bacilli in local scrofulous affections. Until recently

scrofula and tuberculosis were considered distinct, yet often co-existent diseases, and the theories for and against unity are too numerous to be included in a paper of this kind. However, it has been satisfactorily proven that scrofula is only a local tuberculosis, and as much due to decay of cellular structure caused by the invasion, growth,

and harmful influences of Koch's tubercle bacilli as is miliary tuberculosis of the lungs. To illustrate their unity I may cite the following, which is only a sample of many other such cases.

A mother under observation has resulting cicatrices from former scrofulous glands. Dullness on percussion was found over apex of right lung, with history of hemorrhages. The oldest daughter, aged fourteen, had cheesy and ulcerating glands of the neck and kyphosis, and has since lately died of acute miliary tuberculosis of the lungs. The second child, a girl eleven years old, in a rigid physical examination failed to show a departure from health, was stricken with tubercular meningitis and died. A baby girl aged two years succumbed to tabes mesenterica. A sister and the father of the aforesaid mother died of consumption; measles prepared the way for consumption in one, and scrofula in two immediate relatives. The husband, without a history of violence or disease of the parts, was attacked with orchitis which resisted treatment and was diagnosed tubercular testicle.

From the fact that tubercle bacilli are almost invariably found in what is termed scrofulous glands, joints, and bones, many of those affected with so-called scrofulosis are in reality victims of tuberculosis.

Supposed Syphilitic Origin. History records little and tradition is uncertain-at least what can be gained from them-regarding the early existence of syphilis among these Indians. However, it is claimed to have existed among them in the form of an epidemic lately by some, and from the earliest time by others. So, also, was it the accepted belief by many of the laity as well. as profession that their scrofula was due immediately to some change or slightly altered tertiary form of the syphilitic virus brought about by transmission from generation to generation. Able and scientific authorities have held this theory.

It can not be proven that syphilis existed among the Indians before the advent of the whites, though we are familiar with the theory advanced by Leonard Schmans and

others (from 1518 to 1521) of the American origin of the disease.

Prof. Joseph Jones has found what were pronounced syphilitic bones in the ancient mounds of the southern States, but ethnologists and scientists, among them Parot, according to Broca, have found very ancient syphilitic bones in the Old World. St. John also found syphilitic bones in America. Syphilis can not be traced from these evident prehistoric races to the Indian of today, though an identity in race, is claimed by some.

The older Indians and their traditions say that scrofula, syphilis, and consumption were little or almost unknown among them until within the last fifty years. Alex. Rencountre, whose observation among them covers half a century, and is entitled to credit, says the first case of syphilis he saw or heard of among them was in 1867. However, in 1858 he saw a case in the Yankton tribe of Sioux.

The Medical Analectic, November 1, 1888, contains an article from the Medical Press, August 22, 1888, on "Syphilis and Tuberculosis among the American Indians," which says "During the past five years but very little primary syphilis has occurred among the Indians. It would seem that the Indian woman was no longer susceptible to the contagion of syphilis, for all other forms of venereal disease have been of late years very prevalent among them. Previous to forty years ago syphilis among the Indians was a very rare disease, but about that time it became epidemic, and hardly a family escaped the ravages. It is possible that the disease has become so incorporated into the blood of the race that each new generation is protected as by inoculation. In place of syphilis scrofula and tuberculosis seem to flourish, and to-day they are the most frightful causes of death among them. It seems very probable that tubercular disease may originate from syphilis in preceding generations."

While this in part may hold true of other Indians, it will not apply to the Sioux or Dakotas, for if syphilis came among them. as late as forty years ago, there would un

doubtedly be some tertiary symptoms in the older people, and some hereditary symptoms among the younger, at least in some of its forms. From an observation of several thousand Indians, both personal and by letter from other agency physicians in the Sioux service, I find that syphilis in any form is almost a rare disease. I have not seen a case of hereditary syphilis, Hutchinson's notched teeth, or the peculiar appearance described by him. True, the lymphatic glands of the groin and arm-pits often are found enlarged or ulcerated, but, in absence of any history of primary lesion and without any syphilitic symptoms, I am led to class them as scrofula or local tuberculosis, though without close study and history of the patient one would be inclined to call such cases syphilitic. This mistake I have This mistake I have seen made by the profession.

"Syphilis is always transmitted as syph ilis," though the cachexia induced by the disease predisposes children to scrofulous. affections. Hutchinson says that "hereditary syphilis does not predispose to scrofulous nor tubercular affections."

As regards the transmission of syphilis itself, "it is almost an acknowledged law that parents in the late tertiary stages do not transmit taint. It is certainly the rule that when parents have fully reached the tertiary stage that children born to them are free from all signs of syphilis." The demonstration of the bacillus of syphilis by Dr. Lutzgarten, in Weigert's laboratory at Leipsic, and also the study of it by Marcus and Tornéry, shows a distinction between. the bacilli of the two diseases. If Lutzgarten's bacillus prove as true of syphilis as Koch's has of tuberculosis, no relationship can exist between the two diseases.

"Syphilis is a distinct disease and can only be reproduced as syphilis," but by lessening resistance and lowering vitality syphilis may predispose an individual to tuberculosis when placed under favorable condi tions to contract the disease, or, in other words, when exposed to an atmosphere containing tubercle bacilli, or by eating the meat and drinking milk of tuberculous animals.

Furthermore, it is a well-known fact that syphilis protects an individual and his offspring from future attacks, and the tendency of the disease is to die out. As tuberculosis appears among them the disease is alarmingly on the increase, and the tendency of the disease is toward death in the individual affected.

Acquired Origin. In the nomad and uncivilized state the principal diet of the Dakotas was buffalo meat, the supply of which, only in exceptional times, was very plentiful. Their "tipis" were made of buffalo skins, were well ventilated and offered ample protection from the weather. Their clothing of the same material was sufficient for their needs. How do we find the Indian of to-day? Instead of the comfortable skin tipi, they now inhabit one of unbleached cotton which offers no protection from the cold of winter or dampness of the rainy season. Or to the other extreme, a log cabin with dirt floor, which is plastered till almost air tight. Light is admitted through a single window without any ventilation what

room.

Thus it may be seen that these houses are the very gravest source of danger, veritable culture soils and hot-beds, they furnish the best possible condition for the spread of tuberculosis when the bacilli lodge in the soil prepared for them by exposure, underfeeding, and malnutrition. Not only is death lurking in the air of these places, but as the raw beef sliced is hung there to dry in winter, tubercle bacilli or spores may lodge on the beef, and, as this is often eaten raw, another most formidable source of danger to others and of self infection presents itself.

According to Alex. Rencountre and others, the first case of scrofula (particularly)