from 'Will you live to be 100? A Retrospective on Health and Wellness in Chaska'
Sources and Additional Information on Dakota Natives and Diseases
From the University of Minnesota: https://cla.umn.edu/chgs/holocaust-genocide-education/resource-guides/us-dakota-war-1862
Another nearly 1600 Dakota women, children and elderly were held during the winter of 1862-63 on Pike Island, not far from the Bdote and within sight of Fort Snelling. Disease quickly spread, killing hundreds in the camp. In April 1863, Minnesota voided its treaties with the Dakota and sent those living in the camps to Nebraska. Soon after, Congress passed legislation making it illegal for the Dakota to live in Minnesota. It remains a law to this day.
From the National Institute of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698152/
The reservation system, which was imposed between the 1830s and the 1870s, transformed patterns of morbidity and mortality. Smallpox, measles, cholera, malaria, venereal diseases, and alcoholism remained common but were reportedly mitigated by government physicians with vaccination, fumigation, and quarantine.43
These problems, however, were dwarfed by tuberculosis. Consumption and scrofula had been present but rare among American Indians for centuries.44 They quickly became the leading cause of death, especially on the Dakota reservations, where they dominated annual mortality reports, often causing half of all deaths.45 Physician Z. T. Daniel believed that “it is practically the only disease that causes their large death rate.”46 Although the burden of disease had shifted from acute to chronic infections, the disparities persisted. The surgeon general reported that the consumption hospitalization rate for Indian soldiers in 1892 was more than 10 times the rate for White soldiers.47 Sioux mortality from tuberculosis alone exceeded the mortality rates from all causes in most major cities.48
Observers had little difficulty explaining the prevalence of tuberculosis among the Sioux. Many blamed the reservation system and the terrible living conditions imposed on the confined tribes. Damp, poorly ventilated log cabins and inadequate government rations set the tribes up for disaster. However, as had happened before, they also were quick to blame the Sioux for specific behaviors, from unhygienic cooking to religious dances, pipe smoking, and cigarettes that made bad conditions worse.49 O. M. Chapman stated these punitive sentiments most clearly: “The excessive mortality is but the sum total of all these influences combined—is the measure of their transgressions.”50
A broad consensus accepted these problems as the proximate causes of Sioux tuberculosis. The crucial debates of the late 19th century instead confronted the ultimate causes of the disparities in health status, specifically the roles of racial differences and socioeconomic conditions. Ideas of racial hierarchy were firmly entrenched in the national consciousness. Influential works, such as Josiah Nott and George Gliddon’s Types of Mankind, argued that although American Indians had once thrived in America, they could neither compete nor coexist with “Caucasians”: “It is as clear as the sun at noon-day, that in a few generations more the last of these Red men will be numbered with the dead.”51 Some doctors saw these theories as compelling explanations for the disparities in mortality. Daniel believed that Indians could only be saved by mixing with other groups: they will “die everywhere they go, of tuberculosis, until the race is so thoroughly crossed by ‘foreign blood’ that it will stamp out the tubercle bacillus, and when that is done the Indian race in its original purity will be no more.”52 For those who believed that extinction was inevitable, the reservation system became little more than palliative care for a dying race.53
Other observers rejected these pessimistic visions and argued that the outbreak of tuberculosis was not the inevitable result of hereditary inferiority. Rather, it was the contingent product of the difficult transition from primitive life to civilization. Physicians who observed the Sioux before and after their confinement saw how quickly the native health of the Sioux deteriorated. George Bushnell, for example, observed Sioux prisoners who were brought to live among Sioux already settled on a reservation in 1881. He described “scrofulous youths from the Agency, their fleshless limbs fully clad, looking on wistfully at the dances of the warriors in the summer twilight … revealing in many instances a magnificent physique and a boundless vitality, which contrasted cruelly with the listless aspect of some of their spectators.”54
Although they knew that reservations had fueled tuberculosis, many physicians and officials maintained their faith in the fundamental value of civilization. Tuberculosis existed not because the civilizing process was wrong but because it had been implemented badly. Indians were “reduced to the condition of paupers, without food, shelter, clothing, or any of those necessaries of life which came from the buffalo; and without friends, except the harpies, who, under the guise of friendship, feed upon them.”55 The government had to intervene: “We have no right to assume that they are a race given over to God to destruction, and we have less right to doom them ourselves.”56 Health would be restored when the government enabled the Indians to enjoy the full benefits of White civilization.
PERSISTENT DISPARITIES
Faith that civilization would eventually bring health to the American Indians prevailed in the debate about the ultimate causes of tuberculosis. Some government officials committed themselves to improving reservations through education, economic reform, and health care. However, their paternalistic policies, which were based on the assumed superiority of White culture and religion, rarely led to improvement and often made matters worse. Medical campaigns, for example, suffered from inadequate funding. Commissioner of Indian Affairs T. J. Morgan compared the salaries paid to government physicians in the Army, Navy, and IHS and divided these sums by the populations served. He then calculated a crude estimate of how the government valued people: $21.91 per soldier, $48.10 per sailor, and $1.25 per Indian.57
The enthusiasm of the Progressive era brought new interest and new funding to the problem of Indian tuberculosis. During the International Congress on Tuberculosis in 1908, Commissioner of Indian Affairs Francis E. Leupp identified tuberculosis as “the greatest single menace to the Indian race.”58 President William Taft committed the government to new action. Congress responded in 1912 with an emergency appropriation of $12000. The Bureau of Indian Affairs (BIA) organized campaigns against tuberculosis, trachoma, infant mortality, house flies, alcoholism, and tooth decay.59 Annual appropriations grew steadily and reached $350000 by 1917. That year, for the first time in more than 50 years, more Indians were born than died. Physician George Kober celebrated the progress: “Thanks to the progress of medical science and the splendid humanitarian efforts of our Government, a noble race of people has been snatched from the very jaws of death.”60 The 1921 Snyder Act strengthened the mandate for government action, and congressional appropriations continued to grow: $596000 in 1925, $2980000 in 1935, $5730000 in 1945, and $17800000 in 1955.61
Disparities, however, persisted. Tuberculosis mortality in 1925 was 87/100000 among the general population, 603/100000 among Indians overall, and 1510/100000 among Arizona Indians.62 During World War II, between 10% and 25% of Navajo soldiers and workers had to be returned to the reservation because of active tuberculosis.63 Postwar surveys confirmed the problem: in 1947, tuberculosis mortality among Arizona Indians (302.4/100000) dwarfed both the rate among Indians in general (200/100000) and the national population (30/100000).64 The problem was not confined to tuberculosis. Incidence among the Navajo exceeded that of the general population by a factor of 15.8 for tuberculosis, 101.6 for pneumonia, and 1163 for trachoma.65 The Navajo also had the country’s highest infant mortality rate.66
Explanations for the persistent tuberculosis disparities followed the framework of the late 19th century. Environmental theories were common; the new challenge was to explain how tuberculosis could thrive in the arid southwest, where the climate was recommended for many convalescing White patients. Physicians who were still critical of American Indian cultures found much to blame in Navajo living conditions: “Benefits to health from an outdoor life are over-balanced by the ill effects of overcrowding, lack of sanitary provisions, and the poverty which leads to a poor, inadequate supply of food.”67 They moved easily from blaming the conditions of poverty to emphasizing behaviors that the Navajo adopted while living in those conditions. Both the healthy and the sick expectorated freely without disinfecting their sputum. The Navajo ate meals irregularly and prepared food poorly. Intemperance, apathy, indolence, and hopelessness all weakened the people. No one sought proper medical attention. As physician Sydney Tillim complained, they lacked “intelligence in all things medical.”68
The Navajo expressed both interest and skepticism in these explanations. When Manuelito Begay, a prominent medicine man and a member of the Navajo Tribal Council, saw a microscope slide of the tubercle bacillus, he was impressed but not convinced of its relevance: “They tell me that it is inflicted by a person coughing in your face—that is the way you get tuberculosis in your system. Right away I disagree with it. A person should not be that weak to be susceptible to a man’s cough.”69 Other Navajo also scoffed at medical explanations of tuberculosis. One woman argued that if infected sputum sowed tuberculosis within Navajo homes, then chickens, which constantly pecked at the infected dirt floors, should have been devastated by the disease.70
White doctors shared Begay’s puzzlement about the specific causes of Navajo susceptibility. Ill-defined genetic explanations remained popular. In 1923, the New Mexico State Department of Health went so far as to assert an ongoing process of natural selection: “Resistant race has not been bred as yet. Now undergoing process of weeding out the nonresistant strains.”71 Genetic explanations were used just as easily to explain the surprisingly low incidence of noninfectious diseases among the Navajo, including hypertension, cancer, heart disease, and baldness.72 Most doctors, however, rejected genetic determinism. The National Tuberculosis Association argued in 1923 that “tuberculosis attacks without any racial preference.”73 Studies found that “the character of tuberculous lesions, as determined roentgenologically, is not significantly different from that observed among the white population.”74 Although the reservations clearly suffered severely from tuberculosis, “identical” epidemics existed among populations “living under like conditions among people of the White and Yellow races.”75 These writers believed that socioeconomic conditions, when severe enough, could destroy the health of any population.
Minnesota Territory, 1850
Area in square miles: 166,000
Non-Indian population: 6,077
Indian population (est): 31,700
State of Minnesota, 1860
Area in square miles: 84,068
Non-Indian population: 169,654
Indian population (est): 19,600
From the Minnesota Historical Society: https://www.mnhs.org/fortsnelling/learn/us-dakota-war
The Dakota who traveled to Fort Snelling beginning November 7, 1862, numbered 1,658. The vast majority were children, women, and elderly. The Dakota non-combatants arrived at Fort Snelling on November 13, 1862, and encamped on the bluff of the Minnesota River about a mile west of the fort. Shortly after, Marshall and his soldiers moved the Dakota to the river bottom directly below the fort. In December soldiers built a concentration camp, a wooden stockade more than 12 feet high enclosing an area of two or three acres, on the river bottom. More than 1,600 Dakota people were moved inside. A warehouse just outside the camp was used as a hospital and mission station. Throughout the camp's existence, soldiers of the Sixth, Seventh, and Tenth Minnesota Volunteer Infantry Regiments guarded the stockade, controlling movement in and out. It is estimated that between 130 and 300 Dakota people died over the winter of 1862–63 [alone], mainly due to measles, other diseases, and harsh conditions.
From the Dakota historical website: https://dakotawicohan.org/dakota-of-minnesota-history/
Thousands of Dakota flee to Canada seeking political asylum. Any remaining Dakota are arrested. 1,200 women and children are forced marched 120 miles to a concentration camp built at Ft. Snelling, near St. Paul MN. Hundreds die in the camp from starvation and disease. The remaining survivors are shipped by boat to the Crow Creek reservation in South Dakota.
The Role of Public Health in Longevity:
More on Longevity:
Life expectancy over time in the United States:
Most of the improvements in life expectancy have resulted from reductions in infectious diseases among infants and children. The decline in mortality rates for these major killers has been attributed to improvements in public health efforts, medical technologies, and standards of living and hygiene. Today, the leading causes of death are cardiovascular disease (heart disease), malignant neoplasms (cancer), and cerebrovascular disease (stroke).
Data on long-term mortality trends have to be used with caution because, in the early decades of the 20th century, not all states participated in national death registration. Also, coverage was incomplete, especially for the poor and for racial minorities. Classification of causes of death depends on the medical knowledge and qualifications of the people attending the death. Historians have argued, for example, that many of the deaths ascribed in the early years of this century to other causes, or to indeterminate ones, were actually hard-to-diagnose cases of cardiovascular disease. The categories change over time, but the trends shown in these data for the overall risk of death and the major groups of causes are considered valid.