"The red man and the white plague": Rethinking race, tuberculosis, Andamerican Indians, ca. 1890-1950

Bulletin of the History of Medicine

Volumn 82, Issue 3, 2008, Pages 608-645

  Mcmillen, Christian W ^a  

^a UNIVERSITY OF VIRGINIA   (United States)

Author keywords

American indians; BCG vaccine; Epidemiology; Race; Tuberculosis; Virgin soil

Indexed keywords

BCG VACCINE;

AMERICAN INDIAN; ARTICLE; EPIDEMIC; HISTORY; HUMAN; LUNG TUBERCULOSIS; SOCIAL PROBLEM; UNITED STATES;

BCG VACCINE; DISEASE OUTBREAKS; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HUMANS; INDIANS, NORTH AMERICAN; RACE RELATIONS; TUBERCULOSIS, PULMONARY; UNITED STATES;

EID: 58149115226     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (119)

1. For TB as the number-one killer, see H. DeLien and Arthur W. Dahlstrom, "An Ethnic Reservoir of Tuberculosis," Am. J. Public Health, 1951, 41 : 528-32. Between 1955 and 1972 TB among Indians declined from 563.2 per 100,000 to 50.9 per 100,000. See Hans L. Rieder, "Tuberculosis Among American Indians of the Contiguous United States," Public Health Rep., 1989, 104 : 653-57, p. 655; for a general picture of TB and Indians, see also T. Kue Young, The Health of Native Americans: Toward a Biocultural Epidemiology (New York: Oxford, 1992), 57-64.
2. Washington Matthews, "Consumption Among the Indians," Transactions of the American Climatological Association, 1886, 234 -41, p. 241. David Jones has recently demonstrated that in the early decades of the TB epidemic doctors and agents among the Sioux oscillated between explanations based on race and heredity and those based on environment and economics. James Walker, the physician who took TB most seriously, at first thought race was the answer but then, upon closer observation, changed his opinion and wrote race out of the equation. See David S. Jones, Rationalizing Epidemics: Meanings and Uses of American Indian Mortality Since 1600 (Cambridge: Harvard University Press, 2004), pp. 135-37. For debates over heredity versus environment in the larger crusade against TB at the same time in which environment was seen as a key factor in explaining TB, see Michael E. Teller, The Tuberculosis Movement: A Public Health Campaign in the Progressive Era (New York: Greenwood Press, 1988), pp. 95-108; for the emergence and prevalence of hereditary thinking in the Progressive era see also Philip K. Wilson, "Confronting 'Hereditary' Disease: Eugenic Attempts to Eliminate Tuberculosis in Progressive Era America," J. Med. Humanit., 2006, 27 : 19-37.
3. R. G. Ferguson, "A Study of the Epidemiology of Tuberculosis in a Primitive People," Edinburgh Med. J., 1929, 36 : 199-206, p. 203. Michael Worboys has argued that the association between race and TB grew stronger in Great Britain in the 1920s; see Michael Worboys, "Tuberculosis and Race in Britain and its Empire, 1900-1950," in Race, Science and Medicine, 1700-1960, ed. Waltraud Ernst and Bernard Harris (New York: Routledge, 1999), pp. 144 -66, esp. p. 155.
4. For an excellent introduction to the debates over the causes and control of TB, which emphasize the need for epidemiological research, see David S. Barnes, "Historical Perspectives on the Etiology of Tuberculosis," Microbes Infect., 2000, 2 : 431-40.
5. Esmond R. Long, "Constitution and Related Factors in Resistance to Tuberculosis," Arch. Pathol., 1941, 32 : 122-62, p. 148. Research on diabetes among American Indians, in terms of shifting ideas concerning susceptibility and other matters, has interesting parallels to the discourse on TB discussed here; see Margery Fee, "Racializing Narratives: Obesity, Diabetes, and the 'Aboriginal' Thrifty Genotype," Soc. Sci. Med., 2006, 62 : 2988-97. The AIDS epidemic also provides parallels. For two critiques among many, see Randall M. Packard and Paul Epstein, "Epidemiologists, Social Scientists, and the Structure of Medical Research on AIDS in Africa," Soc. Sci. Med., 1991, 33 : 771-94; Elizabeth Fee and Nancy Krieger, "Understanding AIDS: Historical Interpretations and the Limits of Biomedical Individualism," Am. J. Public Health, 1993, 83 : 1477-86.
6. For the number of X rays, see Samuel Stein to Fred Foard, 18 August 1947, Central Classified Files (CCF) 1940-57, 9698-45-705, General Service (GS); for the 17,500 figure, see Fred T. Foard to various superintendents, 29 July 1949, CCF 1940-57 3832-45-705 part 1-B, GS, both in box 1129, Record Group (RG) 75, National Archives (NA), Washington, D.C.
7. J. Arthur Myers and Virginia L. Dustin, "Albert Reifel and Tuberculosis Among the American Indians," Hygeia, April 1947, p. 322. Not everyone was convinced. It is possible, of course, to find examples of those who still wondered about the validity of taking race into account when considering Indians and TB. See Jack C. Haldeman, who wrote in "Problems of Alaskan Eskimos, Indians, and Aleuts," Public Health Rep., 1951, 66 : 912-17, p. 915, that "little scientific information is available concerning basic differences in racial pathology among the white, Indian, Eskimo, and Aleut populations."
8. H. DeLien and J. Nixon Hadley, "How to Recognize an Indian Health Problem," Hum. Organization, 1952, 11: 29-33, on p. 30.
9. Johannes Holm, "Tuberculosis: A Problem of Different Races," text of a speech before the Fourth Commonwealth Health and Tuberculosis Conference, 3 October 1955, World Health Organization/TBC/Int./28. This is not to say that worldwide speculating on the connections between race and TB had vanished. For the persistence of the view that some races were more susceptible, see Alton S. Pope, "Tuberculosis in the Tropics," in Industry and Tropical Health: Proceedings of the First Industrial Tropical Health Conference (Cambridge: Harvard School of Public Health for the Industrial Council for Tropical Health, 1950), 239-40.
10. Alfred L. Kroeber, "A Half Century of Anthropology," The Nature of Culture (Chicago: University of Chicago Press, 1952), p. 139; for an earlier iteration of anthropology's rejection of race, see Ruth Benedict, "Resolution of the American Anthropological Association," in Race: Science and Politics (New York: Modern Age Books, 1940 [originally published in Science in 1938]), pp. 260-61; for a discussion of changes in anthropology and biology generally, see Elazar Barkan, Retreat of Scientific Racism: Changing Concepts of Race in Britain and the United States between the World Wars (Cambridge: Cambridge University Press, 1992).
11. On theories concerning African American susceptibility to TB, see David McBride, From TB to AIDS: Epidemics Among Urban Blacks Since 1900 (Albany: State University of New York Press, 1991), pp. 9-30, and Katherine Ott, "Race-ing Illness at the Turn of the Century," in Fevered Lives: Tuberculosis in American Culture Since 1870 (Cambridge: Harvard University Press, 1996), pp. 100-110; for theories on Mexican American susceptibility, see Emily K. Abel, "From Exclusion to Expulsion: Mexicans and Tuberculosis Control in Los Angeles, 1914 -1940," Bull. Hist. Med., 2003, 77 : 823-49 and Natalia Molina, Fit to be Citizens? Public Health and Race in Los Angeles, 1879-1939 (Berkeley: University of California Press, 2005), pp. 133-36. For similarities between explanations of the high incidence of TB among "primitive peoples" in India and Africa, see Mark Harrison and Michael Worboys, "A Disease of Civilization: Tuberculosis in Britain, Africa, and India, 1900-39," in Migrants, Minorities and Health: Historical and Contemporary Studies, ed. Lara Marks and Michael Worboys (New York: Routledge, 1997), pp. 93-124; for theories on susceptibility in South Africa specifically, especially ideas concerning racial immunity and susceptibility, see Randall M. Packard, White Plague, Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa (Berkeley: University of California Press, 1989), pp. 194 -210; for theories on racial susceptibility in general, see Warwick Anderson, "Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900-1920," Bull. Hist. Med., 1996, 70 : 94 -118.
12. Jones, Rationalizing Epidemics (n. 2), pp. 155-56.
13. Robert A. Trennert, "The Federal Government and Indian Health in the Southwest: Tuberculosis and the Phoenix East Farm Sanatorium, 1909-1955," Pac. Hist. Rev., 1996, 65: 61-84; for TB hospitals, see also Leonard G. Wilson, "The Rise and Fall of Tuberculosis in Minnesota: The Role of Infection," Bull. Hist. Med., 1992, 66 : 43-44. On the growing awareness of TB and the efforts employed by the BIA to combat it, see Joseph A. Murphy, Manual on Tuberculosis: Its Cause, Prevention and Treatment (Washington, D.C.: Government Printing Office, 1910). For an overview, see Diane T. Putney, "The Tuberculosis Crusade Expands," in "Fighting the Scourge: American Indian Morbidity and Federal Policy, 1897-1928" (Ph.D. diss., Marquette University, 1980); for the view that little was done by the BIA to combat TB in the first few decades of the twentieth century, see also Todd Benson, "BCG and the Demand for Federal Indian Health Care," in "Race, Health, and Power: The Federal Government and American Indian Health, 1909-1955" (Ph.D. diss., Stanford University, 1994), esp. pp. 186-92.
14. Lewis Meriam et al., The Problem of Indian Administration ( Johns Hopkins Press, 1928), p. 207.
15. For "neglectful murder," see Jones, Rationalizing Epidemics (n. 2), p. 158; Fred T. Foard, "The Federal Government and American Indians' Health," JAMA, 1950, 142 : 328-31, p. 328.
16. J. C. Hancock, "Diseases Among the Indians," Southwest. Med., 1933, 17: 126-29, p. 127.
17. Commentary on how little was known concerning Indian health, and its relationship to lack of adequate care, was common. See Joseph A. Murphy (medical director of the BIA), "Health Problems of the American Indians," Ann. Am. Acad. Pol. Soc. Sci., 1911, 37 : 347-53, on p. 347. The two major reports on disease among Indians noted the lack of reliable data. See first, from 1913, Contagious and Infectious Diseases among the Indians, 62nd Cong., 3rd Sess., S. Doc. 1038, 1913, 72. Tuberculosis Among the North American Indians: Report of a Committee of the National Tuberculosis Association (Sen. Comm. Print, 67th Cong., 4th Sess., 1923) contained reports, in response to a questionnaire, from thirty-nine affiliates of the national organization, state boards of health, and public health agencies; almost none had any statistics on the incidence of TB. One hundred and seventy-eight agency physicians and superintendents responded to the questionnaire, but these responses were not included. The Meriam Report rightfully called this report, despite its length and seeming thoroughness, "somewhat cursory": Meriam et al., The Problem of Indian Administration (n. 14), p. 205. For the Meriam Report's discussion of the problem, see ibid., pp. 260, 266-70, 273-74. The Commissioner of Indian Affairs noted in 1934 that the "statistics on the tuberculosis rate have never been reliable": Annual Report of the Commissioner of Indian Affairs (Washington, D.C.: Government Printing Office, 1934), hereafter referred to as ARCIA, p. 92.
18. J. W. Levy, physician in charge at Yakima Sanitarium, to C. R. Whitlock, Superintendent, CCF 10730-31 Yakima, reel 25, Indian Health and Disease, Part 1, Reports on Medical and Nursing Activities (Lexis-Nexis, 2005); hereafter referred to as IHD, part 1. On this point see also Clifford E. Trafzer, Death Stalks the Yakama: Epidemiological Transitions and Mortality on the Yakama Indian Reservation, 1888-1964 (East Lansing: Michigan State University Press, 1997), p. 129.
19. Myers and Dustin, "Albert Reifel and Tuberculosis" (n. 7), p. 319.
20. J. G. Townsend, Joseph D. Aronson, Robert Saylor, and Irma Parr, "Tuberculosis Control Among the North American Indians," Am. Rev. Tuberc., 1942, 45 : 41-52, on pp. 41, 46.
21. Bertram S. Kraus (with the collaboration of Bonnie M. Jones), Indian Health in Arizona (Second Annual Report of the Bureau of Ethnic Research, Department of Anthropology, University of Arizona, 1954), 135-36. For a contemporary example of the importance of epidemiological research in being able to understand and treat disease, see Jon Cohen, "Haiti: Making Headway Under Hellacious Circumstances," Science, 2006, 313 : 470-73 on the GHESKIO clinic's pioneering AIDS work; see also Nulda Beyers et al., "The Use of Geographical Information System (GIS) to Evaluate the Distribution of Tuberculosis in a High- Incidence Community," S. Afr. Med. J., 1996, 86 : 40; for this point regarding TB and Alaska Natives historically, see Nicholas E. Flanders, "Tuberculosis in Western Alaska, 1900-1950," Polar Rec., 1987, 23 : 383-96.
22. For the general decline of TB and the rise of antibiotic treatment, see Frank Ryan, The Forgotten Plague: How the Battle Against Tuberculosis Was Won and Lost (Boston: Little, Brown, 1992), pp. 342-64; for an overview in the decline of TB and infectious disease in general, see Allan M. Brandt and Martha Gardner, "The Golden Age of Medicine?" in Companion to Twentieth Century Medicine, ed. Roger Cooter and John Pickstone (New York: Routledge, 2003), pp. 21-38. For decline of TB in the Navajo, see Ale Hrdli cka, "Tuberculosis Among Certain Indian Tribes of the United States," Smithsonian Institution, Bureau of American Ethnology, Bulletin 42 (Washington, D.C.: Government Printing Office, 1909), 6. For incidence of Navajo TB, see Fred T. Foard, "Health of the American Indians," Am. J. Public Health, 1949, 39 : 1403-6.
23. "Indian Massacre New Style," Am. J. Public Health, 1949, 39 : 1469-70.
24. For the inchoate state of research, see Ale Hrdlicka, "Contribution to the Study of Tuberculosis in the Indian," in Transactions of the Sixth International Congress on Tuberculosis, vol. 3 (Philadelphia: William F. Fell Company, 1908), p. 481.
25. R. H. Haas to Edgar Beaver, 4 December 1924, CCF 85487-24-700 Shoshone, RG 75, reel 19, CCF, 1907-1939, Series C: IHD, part 1.
26. "Report of Supervisor Walter G. West, Fort Belknap Reservation, July 12, 1918," CCF 61806-18-700, reel 4; J. R. Collard to CIA, 19 November 1924, CCF 85437-24 Shoshone, reel 19; on misdiagnosing Hopi children at the Phoenix Indian School as having TB, see Albert M. Wigglesworth, Senior Physician to CIA, 23 April 1925, CCF 1907-39 15668-25-700, Hopi, reel 6, both in IHD, part 1. On the unreliability of BIA data on tuberculosis, see Clifford E. Trafzer, "Coughing Blood: Tuberculosis Deaths and Data on the Yakima Reservation, 1911-1964," Can. Bull. Med. Hist., 1998, 15 : 251-56, p. 254.
27. C. C. Hickman to CIA, 7 July 1931, CCF 36518-31 Yankton, reel 26, IHD, part 1.
28. M. V. Ziegler, Medical Report on Yankton Agency, 13 June 1931, CCF 36518-31, reel 26, IHD, part 1.
29. Edgar Bates to F. E. Perkins, 10 October 1933, CCF 56071-33-700 Warm Springs, reel 23, IHD, part 1.
30. Earl Woodridge to CIA, 29 July 1931, CCF 64832-30-700 Rocky Boy, reel 16, IHD, part 1.
31. J. H. Crouch, "A Study of Tuberculosis Among the Indians in Montana," Public Health Rep., 1932, 47 : 1907-14.
32. L. R. Jones, "Report of a Tuberculosis Survey Among the Indians of the Southwest," 1 November 1935, CCF 1907-39 58532-34-705, GS, box 58, RG 75, NA.
33. For Winnebago, see W. J. Stephenson, agency physician, ARCIA, 1897; William G. Coe, "Sanitary Report, Yakama Reservation," in ARCIA, 1887, p. 306; for children succumbing to the "usual inherited tubercular troubles," see Ann Egan, "Report of Superintendent of Klamath School," 30 June 1903, ARCIA, pp. 1903, 290; see also the report of Charles C. Logan, Navajo Agency physician, who wrote that the principal disease among the Navajo was TB due to heredity and the way they lived: ARCIA, 1904, p. 142; and James S. Perkins, who wrote in "Tuberculosis Its Cause and Prevention" that children "inherit the tuberculous diathesis, which predisposes them to tuberculous infection": ARCIA, 1902, p. 422.
34. ARCIA, 1904, pp. 34, 35.
35. Woods Hutchinson, "Varieties of Tuberculosis According to Race and Social Condition," New York Med. J., 1907, 86 : 624 -76, p. 625; from the same year on lacking "resistive vitality," see "Suggestions in Tuberculosis," Med. News, 1905, 87 : 365; on Indians, evolution, susceptibility, and TB, see G. Archdall Reid, "Bacteria as Empire Builders," in The Principles of Heredity, With Some Applications (New York: Sutton, 1905), pp. 182-88, see also p. 150, where he declares Indians the most susceptible. For a similar set of ideas in circulation in Canada at the same time, see Megan Sproule-Jones, "Crusading for the Forgotten: Dr. Peter Bryce, Public Health, and Prairie Native Residential Schools," Can. Bull. Med. Hist., 1996, 13 : 212-13.
36. Carroll quoted in Isaac W. Brewer, "Tuberculosis Among the Indians of Arizona and New Mexico," New York Med. J., 1906, 87 : 981-83, p. 982. Brewer wrote to doctors and superintendents at a number of reservations and asked them for their thoughts on TB. For races, including Indians, being susceptible to TB, see also Karl Von Rouck, "General and Specific Resistance to Tuberculosis Infection," Am. J. Med. Sci., 1909, 137 : 695; for Indians being "unselected" for TB, see "Tuberculosis Among Natives of Alaska," J. Hered., 1917, 8 : 177.
37. Francis E. Leupp, "Fighting the Scourge Among the Indians," Transactions of the Sixth International Congress on Tuberculosis, vol. 4 (Philadelphia: William F. Fell Company, 1908), pp. 428-35, on p. 428.
38. Associate Committee on Tuberculosis Research quoted in Maureen Lux, "Perfect Subjects: Race, Tuberculosis, and the Qu'Appelle BCG Vaccine Trial," Can. Bull. Med. Hist., 1998, 15 : 277-95, p. 282.
39. Frederick L. Hoffman, The Health Progress of the North American Indian (New York: Prudential, 1928), p. 38; for the view that the Indian "race" had no immunity and was simply dying out from tuberculosis, see Benjamin Goldberg, "Tuberculosis in Racial Types with Special Reference to Mexicans," Am. J. Public Health, 1929, 19 : 275-77.
40. R. G. Ferguson, "Some Light Thrown on Infection, Resistance, and Segregation by a Study of Tuberculosis Among Indians," Trans. Am. Clin. Climatol. Assoc., 1934, 50 : 18-26, p. 21; for a critique of Ferguson's methods that calls into question the "virginity" of the population he studied, see Lux, "Perfect Subjects" (n. 38), pp. 282-84; for a discussion of Ferguson and Cummins and their sympathetic views, see Lux, Medicine that Walks: Disease, Medicine, and Canadian Plains Native People, 1880-1940 (Toronto: University of Toronto Press, 2001), p. 205; also on Ferguson's TB/BCG work, but which does not call into question his virgin soil theory is Georgina D. Feldberg, Disease and Class: Tuberculosis and the Shaping of Modern North American Society (New Brunswick: Rutgers University Press, 1996), pp. 162-65.
41. For a discussion of the differences among various types of immunity to infectious disease, including TB, see David S. Jones, "Virgin Soils Revisited," William Mary Quart., 2003, 60: para. 71. Available at http://www.historycooperative.org/journals/wm/60.4/jones.html (last accessed 29 June 2006).
42. S. Lyle Cummins, "Tuberculosis in Primitive Tribes and its Bearing on the Tuberculosis of Civilized Communities," Int. J. Public Health, 1920, 1 : 131-74, p. 149; for Cummins's earlier iteration of this theory, which also drew on the American Indian experience with TB, see his "Primitive Tribes and Tuberculosis," Trans. R. Soc. Trop. Med. Hyg., 1912, 5 : 245-55; on Cummins and his influence, especially in regard to virgin soil and tubercularization, see Packard, White Plague, Black Labor (n. 11), pp. 205-7, and Harrison and Worboys, "A Disease of Civilization" (n. 11), pp. 97-107 «Author: As meant?» Worboys, "Tuberculosis and Race in Britain and its Empire, 1900-1950" (n. 3). Tubercularization was applied to African Americans also. See Samuel Roberts, "Infectious Fear: Tuberculosis, Public Health, and the Logic of Race and Illness in Baltimore, Maryland, 1880-1930" (Ph.D. diss., Princeton University, 2002), 143-62. Interestingly, Cummins's theory was, in some respects, an inversion of older worries about whether the white race could acquire racial immunity to the tropical environment in the nineteenth century. See, for example, Mark Harrison, "'The Tender Frame of Man': Disease, Climate, and Racial Difference in India and the West Indies, 1760-1860," Bull. Hist. Med., 1996, 70 : 68-93.
43. George Bushnell, A Study in the Epidemiology of Tuberculosis, with Especial Reference to Tuberculosis of the Tropics and of the Negro Race (New York: William Wood, 1920). On tubercularization see p. 61, for quote see p. 162, and for Indians in general see pp. 156-64.
44. Matthews, "Consumption Among the Indians" (n. 2), p. 240.
45. "The Important Indian Health Problem," The Red Man, 1912, 5 : 126-28, on p. 127. For an earlier reference to the term and concept of virgin soil, see "Tuberculosis Among Indians," Med. Rec., 1903, 64 : 900; see also F. Shoemaker, "Prevention of Preventable Diseases," The Indian Craftsman, 1909, 1 : 27. As is clear from the work of Washington Matthews, ideas similar to Cummins's were floating around. For an early attempt at Indian medical history that argued that America was free of old-world diseases and that Indians were thus particularly susceptible to them, see Herbert U. Williams, "The Epidemic of the Indians of New England, 1616-1620," in "Pamphlets in American History" (Glen Rock, N.J.: Microfilming Corp. of America, 1978), microfilm, pp. 1-29, I285 (originally published in Johns Hopkins Hospital Bulletin, 1909, 20); for Indian (and African American) racial susceptibility and the possibility of achieving immunity, see also Thomas D. Coleman, "Tuberculosis Among the Dark-Skinned Races of America," esp. pp. 118-19 and 127-29, and Edward R. Baldwin, "Resistance, Predisposition, and Immunity," p. 83, both in Tuberculosis: A Treatise by American Authors on its Etiology, Pathology, Frequency, Semeiology, Diagnosis, Prognosis, Prevention, and Treatment, ed. Arnold C. Klebs (New York: D. Appleton, 1909); for further evidence of tubercularization theory, see Baldwin, "Immunity in Tuberculosis: With Special Reference to Racial and Clinical Manifestations," Am. J. Med. Sci., 1915, 149 : 827-28.
46. Margaret W. Koenig, Tuberculosis Among the Nebraska Winnebago: A Social Study on an Indian Reservation (Lincoln: Nebraska State Historical Society, 1921), pp. 26, 43.
47. ARCIA, 1924, p. 2.
48. M. C. Guthrie, "The Health of the American Indian," Public Health Rep., 1929, 44 : 949-50; for an example of "no acquired immunity," see A. S. Rider, "Anti-Tuberculosis Work at the Flandreau Indian School," Lancet, 1938, 58 : 175-77, p. 177.
49. Esmond R. Long, "The Rise and Fall of Tuberculosis in Certain American Peoples," P. R. J. Public Health Trop. Med., 1935, 10 : 270; for the Long quotes, see Long, "A Brief Comparison of Tuberculosis in the White, Indian, and Negro Races," Am. Rev. Tuberc., 1937, 35 : 1-5, p. 5.
50. Ale Hrdlicka, "Disease, Medicine, and Surgery Among the American Aborigines," JAMA, 1932, 99 : 1661-66, p. 1662.
51. David W. Gillick, "The Social and Community Aspects of the Indian Tuberculosis Problem," Transactions of the Twenty-Eighth Annual Meeting of the National Tuberculosis Association (New York: National Tuberculosis Association, 1932), p. 208; for Gillick's continuing to associate TB with race, see his notes on TB submitted to the Commissioner of Indian Affairs, which included a section on "persons in susceptible groups": Gillick to CIA, 2 April 1945, CCF (1940-57) 9698-45-705 General Service, box 1129, RG 75, NA.
52. Nancy R. Coleman, "Navajo Child Health: The Problem of Tuberculosis and a Nation's Survival," Reports of the Association's Health Survey No. 2 (New York: National Association on Indian Affairs, 1936), first quote on p. 6, "practically unanimous" on p. 28, see also p. 11.
53. James G. Townsend, "Disease and the Indian," Sci. Mon., (December 1938): 479-93, p. 486. For a synthesis of very similar research regarding TB's pathology among Indians that does not conclude this to be evidence of Indians undergoing a process of tubercularization but that argues that TB in Indians and whites is the same, see Wathena Myers Johnson and J. Arthur Myers, "Tuberculosis in Infants and Primitive Races," Am. Rev. Tuberc. Pulm. Dis., 1933, 28 : 381-409, pp. 385-87; for the research on which Townsend relied, see John H. Korns, "Comparative Tuberculosis Findings Among Indians and White Persons in Cattaraugus County, New York," Am. Rev. Tuberc., 1936, 34 : 550-60; Esmond R. Long and H. W. Hetherington, "A Tuberculosis Survey of the Papago Indian Area of Southern Arizona," Am. Rev. Tuberc., 1936, 33 (Suppl.): 407-33; for similar research that suggested that Indians were acquiring immunity, see Ale Hrdli cka, "The Eskimo of the Kuskokwim," Am. J. Phys. Anthropol., 1933, 18 : 102. Townsend echoed his claim four years later in "Indian Health Past, Present, and Future," in The Changing Indian, ed. Oliver La Farge (Norman: University of Oklahoma Press, 1942), p. 35. By that time, other work had emerged that also suggested Indians could resist TB but did not argue that this was a result of racial tubercularization. Rather, Indian and white bodies were the same: see Ralph M. Alley, "Tuberculosis Among the Indians," Dis. Chest, 1940, 6 : 44 -45. For the view that the "Indian has poor natural resistance" but nonetheless exhibits of evidence of having healed, see E. L. Ross and A. L. Paine, "A Tuberculosis Survey of Manitoba Indians," Can. Med. Assoc. J., 1939, 41 : 180-84, p. 184; for evidence of the prevalence of virgin soil theory and tubercularization regarding Indians in the general TB community, the data for which were derived from Bushnell and Ferguson, see David Perla and Jessie Marmorston, Natural Resistance and Clinical Medicine (Boston: Little, Brown, 1941), pp. 77-79.
54. On this point concerning the individual and the group in medical discourse, see Megan Vaughn, Curing their Ills: Colonial Power and African Illness (Stanford: Stanford University Press, 1991), p. 11.
55. On blood and private property see Melissa L. Meyer, "American Indian Blood Quantum Requirements: Blood is Thicker than Family," in Over the Edge: Remapping the American West, ed. Blake Allmendinger and Valerie J. Matsumoto (Berkeley: University of California Press, 1999), p. 239; on insurance companies, see Frederick L. Hoffman, The Indian as a Life Insurance Risk (New York: Prudential Press, 1928). For the myriad ways in which blood quantum has affected one tribe, see Circe Sturm, Blood Politics: Race, Culture, and Identity in the Cherokee Nation of Oklahoma (Berkeley: University of California Press, 2002).
56. D. A. Sanford, "What Is Killing Our Indians?" The Indian's Friend (September 1901): 10-11, on p. 10. Sanford wrote that the main cause of the high rate of TB is that it had been "inherited from past generations. It is in their blood"; Roy E. Thomas, "The Influence of Mixed Blood Upon the Susceptibility to Infection in the American Indian," Southern California Practitioner, 1910, 25 : 576-77; for the connection between degree of Indian blood and TB, as well as Indians' lifestyle causing the disease, see Martha A. Waldron, "The Indian Health Question," Lend a Hand 5, 1890, 11 : 766-74.
57. On the fear of "full bloods" not supporting the Indian Reorganization Act, among other reforms, see Thomas Biolsi, Organizing the Lakota: The Political Economy of the New Deal on the Pine Ridge and Rosebud Reservations (Tucson: University of Arizona Press, 1992), pp. 80-83; for the related issue of progressive vs. traditional Indians, which was often synonymous with blood quantum, see David Rich Lewis, "Reservation Leadership and the Progressive-Traditional Dichotomy: William Wash and the Northern Utes, 1865-1928," Ethnohistory, 1991, 38 : 124 -48; for a brief discussion in the context of the New Deal of the importance of blood quantum in determining who was and was not eligible to be considered an Indian by the government, see Elmer R. Rusco, A Fateful Time: The Background and Legislative History of the Indian Reorganization Act (Reno: University of Nevada Press, 2000), pp. 267-69.
58. H. Hamlin, "A Health Survey of the Seminole Indians," Yale J. Biol. Med., 1933, 6 : 155-77, on p. 155.
59. H. J. Warner, "The Incidence of Tuberculosis Infection Among School-Children on Five Montana Indian Reservations," Am. Rev. Tuberc., 1932, 26 : 507-15, on p. 511.
60. Esmond R. Long, "A Brief Comparison of Tuberculosis in the White, Indian, and Negro Races" (n. 49), p. 2; see also Crouch, "A Study of Tuberculosis Among the Indians in Montana" (n. 31); R. G. Ferguson, "The Indian Tuberculosis Problem and Some Preventive Measures," Transactions of the Twenty-Ninth Annual Meeting of the National Tuberculosis Association (New York: National Tuberculosis Association, 1933), p. 101. Interestingly, in an unpublished study on the Pine Ridge reservation done in 1939, Charles Davis found that although TB infection increased among "full-bloods," pathology did not; that is, degree of blood had nothing to do with whether one's infection became active: Charles Davis, Report on TB, 13 June 1939, CCF 55599-37-705 Pine Ridge, RG 75, reel 2, IHD, part 2.
61. Townsend to L. R. Jones, 22 January 1937, CCF 9962-35-705, part 1, box 59; for the research that revealed this, see L. R. Jones, "Tabulated Report of Intracutaneous Tuberculin Tests Done at Turtle Mountain Agency," no date, but tests were done in August and October 1936: CCF 1907-39, 13223-36-705, Turtle Mountain, reel 3, IHD, part 2.
62. Forrest Clements, "Racial Differences in Mortality and Morbidity," Hum. Biol., 1931, 3 : 397-492, first quote on p. 418, second quote on p. 406.
63. The 1932 study is Warner, "The Incidence of Tuberculosis Infection Among School- Children" (n. 59); the 1945 study, from which the quote is drawn, is J. R. McGibony and A. W. Dahlstrom, "Tuberculosis Among Montana Indians," Am. Rev. Tuberc., 1945, 52 : 104 -121, on p. 109. It is worth noting that during discussions in the first decades of the twentieth century concerning tribal membership on the Colville reservation, Indians considered blood to be more a mark of Indian cultural traits than a quantifiable amount of actual blood. See Alexandra Harmon, "Tribal Enrollment Councils: Lessons on Law and Indian Identity," West. Hist. Q., 2001, 33 : para. 52, available at http://www.historycooperative.org/journals/ whq/32.2/harmon.html (last accessed 13 July 2006).
64. For an example of how difficult accurate blood quantum data were to procure and the resulting confusion, see Frederick Hoffman, "Are the Indians Dying Out?" Am. J. Public Health, 1930, 20 : 609-14.
65. Charles H. A. Walton, "Racial Incidence of Tuberculosis in Manitoba," Am. Rev. Tuberc., 1935, 32 : 183-95, quote on p. 187. For the ways in which blood quantum operated within medical discourse, especially in regard to the notion that those with less Indian blood were healthier, see Mary Ellen Kelm, "Diagnosing the Discursive Indian: Medicine, Gender, and the 'Dying Race,'" Ethnohistory, 2005, 52 : 392-96; on the importance of blood quantum in constructing Indian identities, see Biolsi, "The Birth of the Reservation: Making the Modern Individual among the Lakota," in Frederick E. Hoxie, Peter C. Mancall, and James H. Merrell, American Nations: Encounters in Indian Country, 1850 to the Present (New York: Routledge, 2001), pp. 110-40, esp. 125-28. For how blood quantum is related to the question "Who is an Indian?" see Meyer, "American Indian Blood Quantum Requirements" (n. 55), pp. 231-49. See also Pauline Tuner Strong and Barrik Van Winkle, "'Indian Blood': Reflections on Reckoning and Refiguring of Native American Identity," Cult. Anthropol., 1996, 11 : 547-76. There are interesting parallels with studies done in the 1930s to determine whether sickle cell anemia was truly a black disease when cases began to turn up in whites. See Melbourne Tapper, "Interrogating Bodies: Medico-Racial Knowledge, Politics, and the Study of a Disease," Comp. Stud. Soc. Hist., 1995, 37 : 83-88; for work in the 1930s that called into question the utility of blood for determining racial type, see also McBride, From TB to AIDS (n. 11), p. 50; for a brief history of changes in thinking regarding blood and its relationship to, among other things, disease, see Michael G. Kenny, "A Question of Blood, Race, and Politics," J. Hist. Med. All. Sci., 2006, 61 : 473-78.
66. For an excellent demonstration of how complicated and ever-shifting ideas about blood quantum were, see Harmon, "Tribal Enrollment Councils" (n. 63).
67. Aronson had some experience with Indians and TB. He did a TB study in Michigan that included 176 Indians: Joseph D. Aronson, "Incidence of Tuberculous Infection in Some Rural Communities in Michigan," Am. J. Hyg., 1935, 21 : 543-61.
68. Aronson to Townsend, 5 May 1937; Townsend to Aronson, 22 May 1937; for Aronson wondering about the proof of blood quantum, see his remarks in "Conference-B.C.G. Program," 13 October 1936, p. 3, all in CCF 9962-35-705, part 1, box 59, RG 75, NA.
69. For the Arapahoe and Indian identity, see Loretta Fowler, Arapahoe Politics, 1851-1978 : Symbols in Crises of Authority (Lincoln: University of Nebraska Press, 1982), pp. 164 -66. Other work on blood quantum bears out the claim that it is more a social, and not biological, construction. See William T. Hagan, "Full Blood, Mixed Blood, Generic, and Ersatz: The Problem of Indian Identity," Ariz. West, 1985, 27 : 309-26; David L. Beaulieu, "Curly Hair and Big Feet: Physical Anthropology and the Implementation of Land Allotment on the White Chippewa Reservation," Am. Indian Q., 1984, 8 : 281-314; Melissa L. Meyer, "Signatures and Thumbprints: Ethnicity among the White Earth Anishinaabeg, 1889-1920," Soc. Sci. Hist., 1990, 14 : 305-45.
70. Allan K. Krause, "Pathogenesis of Tuberculosis," Am. Rev. Tuberc., 1928, 18 : 208-48, pp. 224 -25. He believed that if living conditions were more thoroughly investigated, the cause of TB's rapid spread among "primitive" peoples would be explained. See also Weston A. Price, "Some Causes for Changes in Susceptibility of Eskimos and Indians to Acute and Chronic Infections Upon Contact with Modern Civilization," J. Dent. Res., 1934, 14 : 230. Using evidence derived from dental research, he argued that malnutrition increased susceptibility. For worries over the troubling dominance of "virgin soil," see also R. J. Collins and G. L. Leslie, "The Treatment of Tuberculosis Lymphadenitis Among American Indians," Am. Rev. Tuberc., 1926, 14 : 647. For another dissenting view, see E. L. Stone, "Tuberculosis Among the Indians of the Norway House Agency," J. Public Health, 1925, 16 : 79. Stone noted that "these Indians have a remarkable resistance to tuberculosis." While he argued that Indians were more susceptible to TB, he also argued that Indians resisted active disease as well as anyone unless they lived under conditions conducive to its progress.
71. Albert M. Wigglesworth (n. 26). For Cummins's and Bushnell's influence regarding virgin soil, see the various editions of Maurice Fishberg's Pulmonary Tuberculosis (Philadelphia: Lea and Febiger, 1922), 67-69.
72. Murphy, "Health Problems of the American Indians" (n. 17), p. 508. Efforts to find the causes of TB in patients' behavior are still common. See Paul Farmer, "Immodest Claims of Causality: Social Scientists and the 'New' Tuberculosis," in Infections and Inequalities: The Modern Plagues (Berkeley: University of California Press, 1999), pp. 228-61.
73. Hrdlicka, "Tuberculosis Among Certain Indian Tribes of the United States" (n. 22), quotes on p. 31, sanitation explanation on pp. 30-31. For other examples of the importance of heredity, see Merrick A. V. Smith, "Tuberculosis vs. the American Indian," Indian Leader ( January 1917): 6. For blaming Indians for their own state of ill-health, and attributing it at least in part to race, see the joint U.S. Public Health Service/BIA study Contagious and Infectious Diseases Among the Indians (n. 17). When discussing the effects of diet on health, the report had this to say: "While naturally robust, owing to his indifferent nature, his improvidence, and his aversion to agricultural pursuit, the Indian, as a race, is under rather than over nourished."
74. James R. Walker, "Tuberculosis Among the Oglala Sioux Indians," Am. J. Med. Sci., 1906, 132 : 600-605, p. 600.
75. Laffer to CIA, 1 December 1910, CCF 98384-10-700 Warm Springs, reel 23, IHD, part 1.
76. Tuberculosis Among the North American Indians (n. 17), p. 4.
77. Myers Johnson and Myers, "Tuberculosis in Infants and Primitive Races" (n. 53), p. 381. For an early example of research that argued that Indian children, based on the study of tuberculin testing, were as resistant to TB as non-Indian children, see Homer Davis, "Mantoux Observations in 629 Children," Nebr. State Med. J., 1932, 17 : 100.
78. Herbert A. Burns, "Tuberculosis in the Indian," Am. Rev. Tuberc., 1932, 26 : 498-506, p. 498.
79. The role of the public health nurses is outside the scope of this article, but for their specific role in combating TB, see Clifford E. Trafzer, "Medicine Circles Defeating Tuberculosis in Southern California," Can. Bull. Hist. Med., 2006, 23 : 489-92.
80. Elinor Gregg to Joseph D. Aronson, 26 October 1936, CCF 9962-35-705, part 1, GS, box 59, Record Group 75, RG 75, NA.
81. Aronson and Long to CIA, 11 November 1935, CCF 9962-35-705 GS, box 59, RG 75, NA. The interest in studying and preventing TB was part of a newfound interest on the part of the BIA in basic medical research, most of which was actually carried out under contract with research physicians affiliated with universities. See Annual Report of the Secretary of the Interior (Washington: Government Printing Office, 1937), 237-38.
82. For an example of such research, which led to a more accurate picture of TB among the Kiowa, see L. R. Jones, "List of Names of Tuberculous Patients and Report of Their Disposition; Number of Their Contacts and Their Disposition, Kiowa Agency; Miss Abbruzzese District," 27 November 1939, CCF 1907-39 16096-38-705, Kiowa, reel 1; on locating spreaders and getting an accurate picture of TB as a route to treatment, see also Esmond Long to Townsend, 11 July 1938, CCF 55599-37-705, Pine Ridge, reel 2, both in IHD, part 2; on increased sophistication in the epidemiology of Indian TB generally, see Long and Hetherington, "A Tuberculosis Survey of the Papago Indian Area" (n. 53), p. 407.
83. For the effectiveness and accuracy of X rays in helping to find cases, see Long to Townsend, 2 August 1938; for mapping, see Esther M. Sandstrom and Violet L. Sobers, Memo on Tuberculosis Spot Map, 12 April 1940; for home visits and mileage, see "Tuberculosis Case Finding Survey, 1938," all in CCF 19333-38-705, Navajo, reel 2, IHD, part 2.
84. For tattooing Navajos, see Memo from Medical Director, Navajo Area to Navajo Area Physicians, 17 July 1935; W. W. Peter to Joseph Aronson and Esmond Long, 31 July 1935, both in Surveys/Tuberculosis Control BCG, Correspondence Relating to Health Surveys, Phoenix Area Office (PAO), RG 75, NA, Laguna Niguel. Linus Pauling famously suggested that carriers of the gene for sickle cell anemia be tattooed across the forehead. See Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health in America (Chapel Hill: University of North Carolina Press, 2001), p. 186.
85. Aronson to Townsend, 6 August 1936, CCF 9962-35-705, part 1, GS, box 59, RG 75, NA.
86. Ibid.; "rural slum areas" in Joseph D. Aronson, Robert M. Saylor, Erma I. Parr, "Summary of Tuberculosis Control Studies as of January 1, 1940," CCF 9962-35-705, part 2, GS, box 59, RG 75, NA. "Bionomic" factors in Townsend, Aronson, Saylor, and Parr, "Tuberculosis Control Among the North American Indians" (n. 20), p. 46. Aronson had earlier considered racial susceptibility in relation to African Americans but came to no firm conclusion. See Joseph D. Aronson, "Incidence of Tuberculosis Infection in Some Communities of the South," Am. J. Hyg., 1931, 14 : 374 -93, p. 390. Aronson, while largely denying race as a factor, could not let it go entirely. In 1953, he speculated that the difference between the Arapahoe and Shoshone rates of TB both tribes lived on the Wind River reservation under what he considered similar conditions might be due to race or degree of exposure. Samuel C. Stein and Joseph D. Aronson, "The Occurrence of Pulmonary Lesions in BCG-Vaccinated and Unvaccinated Persons," Am. Rev. Tuberc., 1953, 68 : 695-712, p. 700.
87. Alley, "Tuberculosis Among the Indians" (n. 53), p. 44.
88. Crouch, "A Study of Tuberculosis among the Indians in Montana" (n. 31), "assumed" on p. 1907, "customary" on p. 1908.
89. Albert Reifel, "Tuberculosis Among Indians of the United States," Dis. Chest, 1949, 16 : 237. On the five hundred reprints, see DeLien to Reifel, 23 September 1949, CCF 1940-57, 9696-45-705, GS, box 1129, RG 75, NA. As late as 1955, R. G. Ferguson, the leading authority on First Nations and TB at the time, still held fast to racial susceptibility and virgin soil as being the primary explanations for epidemic TB among Indians: R. G. Ferguson, Studies in Tuberculosis (Toronto: University of Toronto Press, 1955), pp. 5-9.
90. First two quotes in H. F. Schrader to J. G. Townsend, CCF 60794-35 Blackfeet; "discarded" in H. F. Schrader, "Notes on a Study of Death Certificates, Blackfeet Reservation of Indians, with special attention to Tuberculosis," CCF 61267-35-700, no date, both in reel 1, IHD, part 1. For the notion that the TB rate was "naturally" high among Indians and that it "naturally" subsided without intervention, see Ferguson, "Some Light Thrown on Infection" (n. 40), p. 24; for racial susceptibility leading to lack of treatment, see Emil Bogen, "Racial Susceptibility to Tuberculosis," Am. Rev. Tuberc., 1931, 24 : 527; Sproule-Jones, "Crusading for the Forgotten" (n. 35), pp. 212-13; Packard, White Plague, Black Labor (n. 11), pp. 203-4.
91. J. A. Carswell, "Poverty and Tuberculosis with Particular Reference to the Economic and Social Significance of High Death Rates Among Alaskans," Transactions of the Thirty- Fourth Annual Meeting of the National Tuberculosis Association (New York: National Tuberculosis Association, 1938).
92. David A. Stewart, "The Red Man and the White Plague," Can. Med. Assoc., 1936, 35 : 674 -76, p. 675.
93. W. A. Abbot and H. A. Burns, "Result of Collapse Therapy in an Indian Sanitorium," J. Lancet, 1932, 52 : 611-13, p. 613. See also Burns, "Tuberculosis in the Indian" (n. 78), p. 501, in which he states that "Heredity exerts no known control over tuberculosis."
94. Louis I. Dublin, "The Mortality from Tuberculosis Among the Race Stocks in the Southwest," Am. Rev. Tuberc., 1942, 45 : 61-74, p. 70.
95. J. F. Worley, memo on TB, no date but filed with papers in 1946, in CCF 1940-57 9698-45-705, GS, box 1129, RG 75, NA; See also E. R. N. Grigg, "The Arcana of Tuberculosis," Am. Rev. Tuberc. Pulm. Dis., 1958, 78 : 151-72, p. 167.
96. Esmond R. Long, "The Decline of Tuberculosis as the Chief Cause of Death," Proc. Am. Philos. Soc., 1948, 92 : 139-43, p. 140.
97. DeLien and Dahlstrom, "An Ethnic Reservoir of Tuberculosis" (n. 1), p. 529.
98. Fred Loe to George C. Van Dyke, 9 April 1946; Van Dyke to CIA, 30 April 1946, both in CCF 19333-38-705, reel 2, IHD part 2.
99. DeLien and Dahlstrom, "An Ethnic Reservoir of Tuberculosis" (n. 1), p. 530.
100. Roger Davis, "Health and Tuberculosis Problems Among Indians: Highlights of the Tuberculosis Problem Among the Navajo People," Trans. Nat. Assoc. Stud. Tuberc., 1953, 49 : 479-487, p. 483.
101. Joseph D. Aronson and Carroll E. Palmer, "Experience with BCG Vaccine in the Control of Tuberculosis Among North American Indians," Public Health Rep., 1946, 61 : 802-20; Joseph D. Aronson and Helen C. Taylor, "A Twenty Year Appraisal of BCG Vaccination in the Control of Tuberculosis," Arch. Intern. Med., 1958, 101 : 881-93. See also Naomi E. Aronson et al., "Long-Term Efficacy of BCG Vaccine in American Indians and Alaska Natives: A 60-Year Follow-Up Study," JAMA, 2004, 291 : 2086-91. For the BCG research leading to mass vaccination, see Townsend to William A. Brophy, 11 March 1946, CCF 1940-57 3832-45-705, GS, box 1129, RG 75, NA. A thorough discussion of the efficacy of BCG, among Indians and others, is beyond the scope of this paper. For a review, see Graham A. Colditz et al., "Efficacy of BCG Vaccine in the Prevention of Tuberculosis: Meta-Analysis of the Published Literature," JAMA, 1994, 271 : 698-702; for a history of BCG generally, see Feldberg, Disease and Class (n. 40).
102. Mable C. Head, Semi-Annual Report, July 1-December 31, 1939, folder: tuberculosis, box 473, subject files, N-V (1932-1952), PAO, RG 75, Laguna Niguel, NA.
103. Aronson to Townsend, 25 June 1937, CCF 1907-39, 9962-35-705, part 1 GS, box 59, RG 75, NA.
104. J. G. Townsend, "Report on the Tuberculosis Program in the United States Indian Service," August 1943, CCF 1907-39 4405-34-705, GS, box 58, RG 75, NA.
105. This point about McDermott is made by David S. Jones in his superb article, "The Health Care Experiments at Many Farms: The Navajo, Tuberculosis, and the Limits of Modern Medicine, 1952-1962," Bull. Hist. Med., 2002, 76 : 749-90, p. 760.
106. Foard, "Health of the American Indians" (n. 22), pp. 1403-6.
107. Jones, "Virgin Soils Revisited" (n. 41), para. 71; Alfred W. Crosby, "Virgin Soil Epidemics as a Factor in the Aboriginal Depopulation in America," William Mary Q., 1976, 33 : 289-99.
108. This point is important for two reasons: first, to use as proof of virgin soil theory Indian people who were by no measure "virgin" is inappropriate; second, the bulk of work done on the susceptibility of indigenous people to European pathogens is generally restricted to the contact and immediate post-contact periods, which includes epidemics of recently contacted peoples in the twentieth century. See, for example, Francis L. Black, "An Explanation of High Death Rates Among New World Peoples When in Contact With Old World Diseases," Perspect. Biol. Med., 1994, 37 : 292-303; A. Magdalena Hurtado et al., "Longitudinal Study of Tuberculosis Outcomes Among Immunologically Näve Ache Natives of Paraguay," Am. J. Phys. Anthropol., 2003, 121 : 134 -50.
109. For an earlier critique of the use of Ferguson, see George A. Clark et al., "The Evolution of Mycobacterial Disease in Human Populations," Curr. Anthropol., 1987, 28 : 46-7. As early as 1941, Esmond Long called into question Ferguson's studies, noting that Ferguson did not take into account environmental conditions. See Long, "Constitution and Related Factors" (n. 5), p. 149; see also Lall G. Montgomery, "Tuberculosis Among Pupils of a Canadian School for Indians," Am. Rev. Tuberc., 1933, 28 : 502-15, in which he noted that when the Indian children he studied were removed from infectious conditions, they did not develop active TB; this, he noted, was in contradiction to the impression Ferguson gave that all Indians lacked resistance equally and that environment was unimportant.
110. Alexandra O. Sousa et al., "An Epidemic of Tuberculosis with a High Rate of Tuberculin Anergy among a Population Previously Exposed to Tuberculosis, the Yanomami Indians of the Brazilian Amazon," Proc. Nat. Acad. Sci., 1997, 94 : 13227-32, p. 13229.
111. Richard Bellamy, "Genetic Susceptibility to Tuberculosis in Human Populations," Thorax, 1998, 53 : 588-93, p. 588. It should be noted that Bellamy cites, in fact almost repeats verbatim, Arno G. Motulsky's citation of Ferguson. See also A. G. Motulsky, "Metabolic Polymorphisms and the Role of Infectious Diseases in Human Evolution," Hum. Biol., 1960, 32 : 28-62, p. 35. Motulsky noted in a table that Indians upon first exposure were the most susceptible to TB; the Irish "race" was seventh.
112. William W. Stead, "The Origin and Erratic Global Spread of Tuberculosis: How the Past Explains the Present and is the Key to the Future," Clin. Chest Med., 1997, 18 : 65-77, p. 70; see also Stead et al., "Racial Differences in Susceptibility to Infection by Mycobacterium Tuberculosis," N. Engl. J. Med., 1990, 322 : 422-27; Stead, "Genetics and Resistance to Tuberculosis: Could Resistance be Enhanced by Genetic Engineering?" Ann. Int. Med., 1992, 116 : 937-41. For other citations to Ferguson's work as evidence of virgin soil epidemics, which is then embedded in a larger argument about the possible racial basis for TB infection, as well as TB's effect on natural selection, see Marc Lipsitch and Alexandra O. Sousa, "Historical Intensity of Natural Selection for Resistance to Tuberculosis," Genetics, 2002, 161 : 1599-1607. There are valuable critiques of the acceptance of racial susceptibility that come from the biomedical community. For a sensible critique of race-based theories, see, for example, Masahiro Kushigemachi, "Racial Differences in Susceptibility to Tuberculosis: Risk of Disease After Infection," J. Chronic Dis., 1984, 37 : 853-62. See also Barry Bloom's editorial in the New England Journal of Medicine, in which he says: "Establishing genetic susceptibilities to infectious diseases in humans poses formidable scientific obstacles because of variations in the prevalence of infection among populations and the confounding effects of social and economic factors": Bloom, "The Evolving Relationship Between Humans and Mycobacterium tuberculosis," N. Engl. J. Med., 1998, 338 : 667-78. For a study that considers a range of factors that might contribute to susceptibility, including genetics, see A. Magdalena Hurtado, Inés Hurtado, and Kim Hill, "Public Health and Adaptive Immunity Among Natives of South America," in Lost Paradises and the Ethics of Research and Publication, ed. Francisco M. Salzano and A. Magdalena Hurtado (New York: Oxford University Press, 2004), pp. 164 -90.
113. Crow Reservation Health Council, minutes of meeting, 25 January 1935, CCF 7400- 35-700 Crow, reel 3, IHD, part 1.
114. "Dr. W. A. Russell on the 'Indian Menace,'" Hardin Tribune, 18 July 1919.
115. Jay S. Kaufman and Richard S. Cooper, "Commentary: Considerations for Use of Racial/Ethnic Classification in Etiologic Research," Am. J. Epidemiol., 2001, 154 : 291-98, p. 291.
116. For an example of this type of research that argues for the validity and continued use of race because of clear genetic differences based on race, see Neil Risch et al., "Categorization of Humans in Biomedical Research: Genes, Race, and Disease," Genome Biol., 2002, 3 : 1-12; for a strong refutation of research based on race, see Richard S. Schwartz, "Racial Profiling in Medical Research," N. Engl. J. Med., 2001, 344 : 1392-93; for a critical view of the persistence of "race talk" in modern biomedicine, especially in light of recent discoveries in genetics, see Lundy Braun, "Race, Ethnicity, and Health: Can Genetics Explain Disparities?" Perspect. Biol. Med., 2002, 45 : 159-74; for the view that race/ethnicity is still a category with great purchase among geneticists, see Simon M. Outram and George H. T. Ellison, "Anthropological Insights Into the Use of Race/Ethnicity to Explore Genetic Contributions Disparities in Health," J. Biosoc. Sci., 2006, 38 : 83-102; for an excellent analysis of the flawed thinking involved in genetic/evolutionary approaches to disease susceptibility, see Gilles Bibeau and Duncan Pedersen, "A Return to Scientific Racism in Medical Social Sciences: The Case of Sexuality and the AIDS Epidemic in Africa," in New Horizons in Medical Anthropology: Essays in Honour of Charles Leslie, ed. Mark Nichter and Margaret Lock (New York: Routledge, 2002), pp. 141-71. For reasons of space, citing all the research and commentary on contemporary studies of race and medicine is not possible.
117. Bellamy et al., "Genetic Susceptibility to Tuberculosis in Africans: A Genome-Wide Scan," Proc. Nat. Acad. Sci., 2000, 97 : 8005-9; Celia M. T. Greenwood et al., "Linkage of Tuberculosis to Chromosome 2q35 Loci, Including NRAMP1, in a Large Aboriginal Canadian Family," Am. J. Hum. Genet., 2000, 67 : 405-16; Yung-Hsiang Hsu et al., "Association of NRAMP1 Gene Polymorphism With Susceptibility to Tuberculosis in Taiwanese Aboriginals," J. Formos. Med. Assoc., 2006, 105 : 363-69; Jodene Fitness et al., "Large-Scale Candidate Gene Study of Tuberculosis Susceptibility in the Karonga District of Northern Malawi," Am. J. Trop. Med. Hyg., 2004, 71 : 341-49. For the trouble geneticists run into when trying to tie ethnicity to genetics, see Scott MacEachern, "Genes, Tribes, and History," Curr. Anthropol., 2000, 41 : 357-71.
118. For this point, see Mike Bamshad, "Genetic Influences on Health: Does Race Matter?" JAMA, 2005, 294 : 937-46.
119. There are several studies that investigate this question. They are summarized in Daniel Elias et al., "Are Intestinal Helminths Risk Factors for Developing Active Tuberculosis?" Trop. Med. Int. Health, 2006, 11 : 551-58; see also Zvi Bentwich et al., "Can Eradication of Helminthic Infections Change the Face of AIDS and Tuberculosis?" Immunol. Today, 1999, 21 : 485-87.