The Vital Statistics 
OF AN 
Apache Indian Community 
BY 
W. C. BORDEN, M. D., 
Captain, Medical Department, United States Army. 
Reprinted from the Boston Medical and Surgical Journal 
of July 6, iBgy. 
BOSTON: 
DAMRELL & UPHAM, PUBLISHERS, 
No. 283 Washington Street. 
1893. S. J. PARKHILL & CO., PRINTERS 
BOSTON THE VITAL STATISTICS OF AN APACHE IN- 
DIAN COMMUNITY. 
Captain, Medical Department, United States Army. 
AY. C. BORDEN, M.D., 
These statistics are of a community of nearly pure- 
blooded Indians living in abnormal environment. 
As accurate vital statistics of American Indians are 
rare, if not unknown, this, and the fact that they show 
the eifect of changed environment upon a nomadic 
people, give these statistics their particular interest. 
The lack of other accurate statistics of Indian commu- 
nities gives no normal averages for purposes of com- 
parison, making it impossible to determine the exact 
amount of divergence from usual rates which changed 
environment has caused in this community. The ex- 
tent of the eifect produced must, therefore, remain 
inferential ; but that there has been a decided depart- 
ure from the normal will be plainly seen the 
statistics themselves. 
These statistics, which are for a period of five years, 
from July 1, 1887, to June 20, 1892, were compiled 
by the writer from the official records of the military 
post at Mount Vernon Barracks, Ala., while on duty 
there during the summer of 1892, and are those of 
the Apache Indians now kept there under military 
supervision and control. This Indian community num- 
bers about four hundred (men, women and children, 
see Table I), and is composed of various Apache 
bands, among them being the noted Geronimo and his 
followers, of Arizona fame. 
The Apaches have lived for generations in Arizona 
and the adjacent parts of Old and New Mexico, becom- 2 
ing thereby constitutionally adapted to the dry, rarefied 
air and clear, diathermic atmosphere of the elevated 
regions of the southwestern part of the United States. 
They are essentially nomadic and warlike in habit, 
and deserving of their appellation “ Ishmaelites of the 
West”; they have not only been notoriously hostile to 
the whites but to alien Indian tribes as well. 
This hostility to, and non-affiliation with aliens, has 
kept these Indians remarkably free from an admixture 
of foreign blood; so much so, that in this community 
of about four hundred, there are but five persons in 
whom white blood can be traced. In 1886, after nu- 
merous outbreaks and hostilities and their capture by 
United States troops, the Indians now forming this 
community were removed from Arizona and taken to 
Fort Marion and Fort Pickens, Fla. They remained 
there but a few months, and, in April, 1887, they 
were removed to Mount Vernon Barracks, where they 
now are. 
Their condition during their stay in Florida was ex- 
tremely bad. Brought in from the fatigues of the 
war-pnth and the destitution of their hunted camps, 
they were taken from the clear, dry and rarefied air of 
Arizona to the humid atmosphere and debilitating cli- 
mate of the Florida sea-coast. They were supplied 
with rations and clothing, but were crowded into damp 
and improperly ventilated quarters. 
Here the first effects of such radical change of envi- 
ronment began to manifest themselves, and clearly 
pointed to the necessity of an attempt to better their 
condition. Their removal to Mount Vernon Barracks 
effected a temporary improvement; as on their arrival 
there, they were placed in tents while a village of log 
cabins for their occupancy was being built. This vil- 
lage was completed before the end of the year; but 
the cabins were of the worst type of construction, and 3 
the site was unsanitary, being in a low, damp hollow 
so shaded by trees that free circulation of air and pen- 
etration of sunlight were greatly interfered with a 
serious matter where, as in Southern Alabama, the 
humidity of the atmosphere is great and the rain fall 
excessive. 
They lived in this village for four years, during 
which time its condition and the health of the Indians 
became so bad that finally it was found necessary to 
build another; and in 1891, a much better village of 
framed houses was built on a hill near by, where the 
disadvantages of the old site did not obtain. In May 
of the same year, 46 of the able-bodied men were en- 
listed as privates in the United States Army, forming 
Company I, Twelfth Infantry, which was increased by 
the arrival of 32 Tonto Apaches from Arizona, some 
two mouths later. Captain W. W. Wotherspoon, 
U. S. A., who had been placed in charge of the Indians 
shortly before, and by whose efforts the building of the 
new village was undertaken, was given command of 
the company, and ably instituted reforms in the gen- 
eral and sanitary condition of the community. A com- 
modious barrack was built for the Indian enlisted men ; 
and a hospital with male and female wards was com- 
pleted the same year. By these means the condition 
of the community was greatly improved. 
In fact, as regards its sanitary condition during the 
five years for which statistics are given, there are two 
distinct periods. 
During the first period of about four years, they 
lived under the unsanitary conditions of bad location, 
wretched habitation and accumulating filth. Their 
village was on a damp and overshaded soil, and their 
cabins were of the worst construction. They were 
built of rough logs, with mud or rough board floors, 
and with windows too small to admit sufficient sun- 4 
light. The roofs leaked, and the crevices between the 
logs were imperfectly closed. They, therefore, af- 
forded but poor protection against the inclemency of 
the weather, and were damp, gloomy, dirty, and in 
every way unsanitary. The Indians being unused to 
living in permanent dwellings, allowed dirt to accumu- 
late in and about them, as they were accustomed to 
do with their temporary “ wickyups ” in Arizona. 
The latter, however, being frail structures of poles and 
brush-wood, lasted but a short time, and were generally 
abandoned before dirt had accumulated to an unsanitary 
extent, while the cabins, being permanent, gradually 
accumulated filth until they became veritable incuba- 
tors of disease. 
The Indians themselves were in no belter condition 
than their habitations. They received regular and 
abundant issues of rations and clothing; but as none 
of them were regularly employed at paid labor, they 
were without money, and, although forbidden, they 
sold all they could of both food and clothing to obtain 
it. The money so received they spent to no advan- 
tage to themselves. 
Captivity, unaccustomed restraint and enforced idle- 
ness operated to prevent the mental stimulus of per- 
sonal endeavor and combined with their unsanitary 
surroundings to produce a condition of mental and 
physical demoralization. As a result, the death-rate 
(see Table I) gradually increased until for the year 
ending June 30, 189.1, it reached the extremely high 
rate of 142 per 1,000 of living. 
During the last period of one year, beginning July 
1, 1891, the condition of the community was improved 
in all ways. 
Their new village being on the crest of a hill has 
plenty of sunlight and free circulation of air. The 
houses are of fairly good construction, are well lighted 5 
by good-sized windows, are plainly built, and are easily 
kept clean. 
The enlistment of many of the men, and the em- 
ployment of most of the others at paid labor about 
the village and garrison, removed the demoralizing 
effect of enforced idleness and gave the Indians a 
mental stimulus the effects of which can hardly be 
overrated. 
They are now well clothed and well supplied with 
the necessities of life, while cleanliness of person and 
habitation is enforced by rigid military inspections and 
method. The Indian company, in neatness and in the 
well-kept condition of its barrack, compares favorably 
with any white company in the United States Army. 
The improved condition of the community during the 
last year, over that of the preceding four years, is 
shown by the following extract from a report of an 
inspection made by Colonel Charles Page, Medical 
Director of the Department of the East, in which he 
says : “The Indian camp and hospital have been much 
improved and the quarters with surroundings occupied 
by the prisoners are as clean as those occupied by the 
soldiers. The transformation from squalor to neat 
and tidy condition of quarters and grounds is remark- 
able.” 
This bettered condition produced a marked effect 
upon the mortality of the community and the death- 
rate fell (see Table I) from 142.58 per 1,000, of the 
preceding year, to 109.75. The number of deaths 
from all causes except tuberculosis fell (see Table II) 
from 35 to 18; and had the deaths from tuberculosis 
decreased in like ratio, the death-rate would have been 
lowered remarkably. Instead of this, the deaths from 
tuberculosis decidedly increased in number the germs 
of the disease having been so thoroughly disseminated 
during the preceding years. This general description of the condition of these 
Indians during the five years will make clear the cir- 
cumstances under which the following statistics were 
produced : 
6 
Table I. Showing the mean number, according to age and sex, 
of Apache Indians present at Mount Vernon Barracks, Ala., 
for each of the five years beginning July 1, 1887, and ending 
June 30, 1892; the number of deaths according to age and sex ; 
the number of births; and the birth- and death-rates per 1,000 
for the same years. 
Mean 
num- 
o 
8 
o 
ber present 
(corrected for 
Deaths. 
Births. 
time). 
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0 
3 
1887-88 . . . 
78 
170 
118 
36( 
1 
ii 
8 
20 
9 
8 
17 
54.64 
46.44 
1888-89 . . . 
86 
179 
123 
388 
2 
7 
10 
19 
7 
10 
17 
48.96 
43.66 
1889- 90 . . . 
92 
176 
124 
392 
6 
13 
24 
43 
6 
28 
34 
109.69 
86.73 
1890-91 . . . 
99 
165 
107 
371 
9 
11 
33 
53 
10 
8 
18 
142.58 
48.51 
1891-92 . . . 
122 
169 
119 
410 
10 
11 
21 
45 
16 
15 
31 
109.75 
75.61 
Totals . . 
28 
53 
99 
180 
48 
69 
117 
Mean death-rate for the five years 
93.12 
Mean birth-rate for the five years 
60.19 
Excess of deaths over births 
63 
Excess of female births over male 
21 
* Under twelve years of age. The division is made at this age, as 
official record is so kept on account of those over twelve receiving a 
full ration from the government, while those under that age receive 
one-half a ration. 
The high birth- and death-rates at once attract at- 
tention. The mean birth-rate of 60.1 is nearly double 7 
that of civilized communities. The general average 
in European countries for 1882 was 34.1 per 1,000 of 
population, the lowest rate being 24.8, and the highest 
44.6, while the lowest rate of this community during 
the five years was 43.6, and the highest 86.7. 
The mean number of women over twelve years of 
age, present during the five years, w7as 171 ; and as 
there were 117 births, the number of births during 
that time was equal to 68.4 per cent, of the mean 
number of women present, including those past and 
those who had not reached the menstrual period. 
During the year of lowest birth-rate there was one 
birth to every ten women ; and during the year of 
highest rate, one woman in every five gave birth to a 
child. 
There are two main causes for the high birth-rate : 
great freedom of union of the sexes, and the practice 
of polygamy. 
By great freedom of union of the sexes, unchastity 
is not meant, but, as most of the conditions which 
with a civilized people lead to sexual restraint, do not 
obtain with these Indians, early union of the sexes 
occurs, and the ties so formed are easily broken that 
other connections may be made. Infidelity is rare 
during their marital alliances, but these alliances are 
generally broken at the caprice of either party. The 
wife is usually obtained by purchase ; but curiously, 
the right of the parents, and particularly of the mother, 
to a daughter so disposed of, does not end with her 
marriage. The husband only retains her during their 
approval; and payments of money or other valuables 
are extorted from him under threat of taking her from 
him. Curiously, also, the right of the mother seems 
not to be questioned by the married daughter ; and 
she, obediently and apparently willingly, returns to 
her parents when, deeming that insufficient tribute is 
paid, they order her to do so. 8 
Polygamy is practised ; and as the women approach 
the menopause, the men form new ties with younger 
women. It will be seen that the family is not devel- 
oped as with civilized people, but that sexual relations 
are generally formed on the basis of sexual activity. 
As shown by Table I, the women are about double 
the men in number; but the practice of polygamy and 
of the men taking younger wives when the older are 
past the child-bearing period, gives as great oppor- 
tunity for all the women to bear children as there 
would be in a community where there was an equal 
number of each sex. In consequence of the excess of 
women, it must be borne in mind, when comparing 
the birth-rate of this community with that of a civil- 
ized people, that an increase of men would not in- 
crease the births, but would decrease the birth rate. 
At the same time, consideration must be given the 
probability that this condition is a normal one for this 
and other uncivilized people the greater exposure 
of the men from warfare and other conditions of life, 
probably tending constantly to keep their number 
reduced below that of the women. 
It may be well to state, that it does not follow, be- 
cause of their practice of polygamy and the ease with 
which their marriages are made and broken, that these 
Indians are immoral. Their standard of morals is 
different from that of a people of higher civilization. 
It is in keeping with their conditions of life and stage 
of race development; and judged by it, they have al- 
ways been considered virtuous. They are quite free 
from venereal diseases. During the five years there 
were treated but two cases of syphilis, one case of 
urethral stricture, one of gleet, and thirteen cases of 
gonorrhoea. As before stated, there are but five in- 
dividuals of mixed (Indian and white) blood in the 
community. 9 
It is claimed by persons having long acquaintance 
with these Apaches, that they have always practised 
infanticide of all infants of mixed blood ; but as they 
have never well affiliated with the whites, it is proba- 
ble that occasion for such practice has been infrequent. 
During the five years of close observation at Mount 
Vernon Barracks no instance of such practice has 
been observed ; and but one half-breed child has been 
born. 
What effect, if any, their changed environment has 
had upon the birth-rate of these people, is difficult of 
determination. 
Their enforced idleness daring the first four years, 
so different from the activity of their former nomadic 
life, may have had a tendency to increase the rate; 
but, on the other hand, it would seem that a decreased 
rate would be produced by the high death-rate and the 
increased amount of sickness which would necessarily 
accompany it. 
How high the death-rate was will be seen from Table 
I, which shows a minimum rate of 48.9, a maximum 
of 142.5, and a mean of 93.1 per 1.000 of living; so 
that in spite of the very high birth-rate, the deaths ex- 
ceeded the births by 63. 
The following table shows the causes of death which 
produced this high rate, and the relative frequency of 
each cause (see next page) : 
This table shows at once that tuberculosis, diar- 
rhoea! diseases, and malnutrition of children were the 
great causes of death. 
Of the total of 180 deaths, 78, 43-J- per cent, were 
caused by tuberculosis alone; while malnutrition of 
children and diarrhceal diseases together caused 49 
deaths, or 27£ per cent, leaving but 53 deaths, or 29f 
per cent, for all other diseases. It is plain from these 
figures, that the high death-rate of these Indians is Table ll. Showing the causes of death, the number of deaths 
from each cause during each year and during the five years, 
and the percentage of deaths from each cause to the total num- 
ber of deaths. 
Causes of death. 
Number of deaths each year. 
cc 
u 
lO 
O 
H 
Per cent. 
’87-88 
’88-89 
’89-90 
’90-91 
’91-92 
Tuberculosis 
11 
4 
18 
18 
27 
78 
43.33 
Scrofula 
1 
1 
.55 
Chronic rheumatism . . 
2 
2 
1.11 
General debility, adults . 
1 
1 
2 
1.11 
Old age 
2 
4 
2 
8 
4.44 
Malnutrition, children . 
1 
3 
5 
1 
10 
5.55 
Acute diarrhoea .... 
3 
7 
13 
3 
26 
14.44 
Chronic diarrhoea . . . 
1 
1 
5 
4 
2 
13 
7.22 
Obstruction of bowels . . 
1 
1 
2 
1.11 
Peritonitis 
1 
3 
1 
5 
2.77 
Stomatitis 
1 
1 
2 
1.11 
Asphyxia of new-born 
1 
1 
2 
1.11 
Croup 
2 
2 
1.11 
Capillary bronchitis . . 
1 
1 
2 
1.11 
Chronic pleurisy .... 
1 
1 
.55 
Pneumonia 
1 
1 
3 
5 
2.77 
Asthma 
1 
1 
.55 
Acute nephritis .... 
1 
1 
.55 
Chronic nephritis . . . 
1 
1 
2 
1.11 
Convulsions 
1 
1 
2 
1.11 
Erysipelas 
1 
•• 
1 
.55 
Poisoned, Ind’n medicine 
2 
2 
1 
5 
2.77 
Suicide 
1 
1 
.55 
Unknown, infant . . . 
2 
2 
2 
6 
3.33 
Totals 
20 
19 
43 
53 
45 
180 
100.00 11 
due, primarily, to the prevalence of tuberculosis among 
them, and secondarily, to diseases of the alimentary 
organs. The reasons for the prominence of intestinal 
disease as a cause of death are readily ascertained. 
Most of the deaths from diarrhofeal diseases were of 
children, as will be seen from the following, which 
gives the number of adults and of children dying of 
these diseases: 
Acute diarrhoea 
21 
5 
26 
Chronic diarrhoea , 
11 
2 
13 
Totals 
32 
7 
39 
Infants. Adults. Total. 
So that of the 39 deaths from diarrhoeal diseases, the 
large number of 32, or 82 per cent., were of children. 
These 32 deaths added to the 10 deaths of children 
from malnutrition account for 42 of the 180 deaths. 
The infant mortality of civilized people is notoriously 
high ; and it is naturally to be expected that with 
these people the rate would be still higher, as the 
great causes of infant mortality, namely, ignorance in 
regard to the proper care and feeding of children, 
would exist in greater degree. Improper care exists 
at all times; improper feeding generally does not 
begin until the time for weaning approaches. It is 
rare to find an Indian mother who cannot nurse her 
child, for in the past, in those cases where the child 
could not be nursed, it died, so, gradually, through 
the law of the survival of the fittest, a race was pro- 
duced whose women can nurse their children a con- 
dition general with uncivilized people the resources 
of civilization being necessary to produce the common 
occurrence of deficient mammary function by saving 
the lives of non-nursing mothers and so transmitting 
the tendency. But, when weaning occurs, the Indian 
children pass directly to the diet of the adults; and as 12 
the diet range of the Indians is limited, and their 
knowledge of cooking very imperfect, children with 
weak digestion are almost sure to contract acute bowel 
complaints, which, aggravated by continued improper 
feeding, generally prove fatal. 
The improper feeding of children was undoubtedly 
as common with these Indians previous to their re- 
moval from Arizona as it has been since, but other 
disease-predisposing factors have been added by their 
change to their present place of abode, which have 
helped to produce a high infant mortality. In the hot 
and moist air of summer, which prevails in Southern 
Alabama during seven months of the year, putrefac- 
tive changes quickly occur ; the improperly kept and 
poorly cooked food of the Indians is apt to take 
such change, and is, consequently, often given to the 
children when in anything but proper condition. From 
the elevation of Arizona and New Mexico, the air 
there is dry, and putrefactive changes are much less 
apt to occur. There the Indians habitually preserve 
their meat by drying in the sun and air; but in South- 
ern Alabama meat so treated (and the Indians from 
habit still attempt to so cure it) almost invariably 
spoils, and is frequently eaten by them and fed to the 
children after it has begun to decompose. 
To improper feeding is added improper clothing. 
During the first four years the clothing of the children 
was insufficient to protect them against the ill effects 
of temperature changes ; and this, together with great 
dampness of the ground from frequent rains, had 
great effect in producing, or predisposing to, intestinal 
catarrhs. 
It is probable, therefore, that the change of climate 
from Arizona to Southern Alabama, together with the 
unsanitarv conditions of the first four years, produced 
a decided increase of infant mortality from intestinal 13 
diseases. But, while the death-rate from these dis- 
eases was very high, that from tuberculosis was still 
higher; and the effect of changed environment in pro- 
ducing a high death-rate from this disease was most 
marked. How fatal tuberculosis was, and that it was 
the main cause of death, is shown by Table II and by 
the following table or tabulated comparisons: 
Table 111. Showing comparative death-rate for 1,000 Jiving. 
Men. 
Women. 
Children. 
Totals. 
Mean number present during 1 
the five years . . .) 
95.4 
171.8 
118.2 
385.4 
Died of tuberculosis 
21 
29 
28 
78 
Died, all other causes 
7 
24 
71 
102 
Died, all causes 
28 
53 
99 
180 
Death-rate from tuberculosis, 
42.53 
32.67 
46.1 
40.45 
Death-rate, all other causes . 
14.17 
27.03 
116.8 
52.65 
Death-rate, all causes 
56.7 
59.7 
162.9 
93.10 
Death-rate, England and Wales, all causes, 1881-90 . . 19.15 
Death-rate, England and Wales, tuberculosis, 1881-90 . 2.15 
The death-rate of the men, women and children 
from tuberculosis is remarkably similar for so small a 
number of observations, and shows how uniformly 
fatal the disease has been. While the mean death- 
rate of the world from tuberculosis is not far from 2 
per 1,000 of living, the average death-rate of this com- 
munity from it has been 40.35. This rate shows the 
virulency and epidemic quality of this disease in this 
community ; for the rate exceeds that of cholera in 
the worst infected districts during an epidemic, and is 
more than four times greater than was the rate from 
small-pox in London during the years from 1771 to 
1781, when the latter disease was at its height. 
The high death-rate of the children, from causes 
other than tuberculosis (116.8), is accounted for by 
the prevalence of diarrhoeal and malnutrition diseases, 
before referred to. 
The death-rate of adults, from causes other than 14 
tuberculosis, 14.17 for the men, and 27.03 for the 
women, is not high, being a mean of only a little 
over 20 per 1,000 of living, which is about that of 
the world at large ; so that, so far as the adults are 
concerned, had their mortality-rate from tuberculosis 
been the usual one of 2 per 1,000, their rate, while 
high for adults, would have been but 22 per 1,000 of 
living. 
It is generally accepted, however, that the death- 
rate of Indians from tuberculosis is always greatly in- 
creased whenever they are confined to given localities 
and their usual habits of free life interfered with. Nor 
can such increased death-rate be considered strange, 
for, in their natural state, an unconscious adaptation of 
themselves to their environment has taken place for 
them by which a normal balance of life is obtained. 
The Apaches have lived for generations in the 
clear, dry, rarefied air of the Rocky Mountain up- 
lands. Their habitations are of the frailest kind, 
open to the drying air and penetrating sunlight of 
those regions. From their nomadic habits, they move 
frequently from place to place, leaving behind them 
the dirt accumulated by living, and abandoning their 
frail and soiled habitations for new ones. When one 
of their number dies, the habitation in which the death 
occurs is burned, and the belongings of the deceased 
person are also burned or buried. In this way, by 
abandonment and burning natural disinfection meth- 
ods— communicable diseases, of which tuberculosis 
is one, were in large part avoided. 
Only through long generations of gradual adapta- 
tion and natural training can a nomadic people adjust 
themselves to the living requirements of permanent 
habitation. With these Indians the experiment was 
made unintentional as an experiment, it is true 
of taking them suddenly from nomadic life and thrust- 15 
ing them unprepared by previous natural training into 
a life of quiescence and permanent habitation. The 
result is shown by the extremely high death-rate, par- 
ticularly from tuberculosis. The relative frequency 
with which this disease in its different forms caused 
death among the men, women and children is given in 
the following table: 
Forms of 
Tuberculosis. 
Deaths from each form. 
Totals. 
Per cent. 
Men. 
Women. 
Children. 
Pulmonary . . . 
19 
27 
11 
57 
73 
Enteric . , , , 
1 
2 
11 
14 
17.9 
Meningeal . . . 
6 
6 
7.6 
Acute 
1 
1 
1.2 
Totals . . , 
21 
29 
28 
78 
The frequency of pulmonary tuberculosis as a cause 
of death with adults, and of enteric and meningeal 
forms with children, is noticeable, and in keeping with 
general observations upon this disease. 
The great frequency in children of mesenteric tu- 
berculosis has been frequently observed before, and 
the ingestion of infected milk has been considered as 
the main cause. This view seems to be supported by 
these statistics, as the prevalence of tuberculosis among 
the mothers would, in this way, produce many cases 
other than pulmonary even were the children not in- 
fected when born. 
The great predominance of pulmonary tuberculosis 
among the adults is also in keeping with general ob- 
servations the infection with them generally occur- 
ring by way of the lungs. 16 
It is not so plain why deaths from this disease have 
been proportionately so much greater among the men 
of this community than among the women, unless it is 
that the somewhat less active life of the women has 
given them a certain degree of immunity. It is more 
probable, however, that this is not the case, and that 
no such difference would be found if the numbers from 
which the statistics are derived were larger. In fact, 
the whole question of immunity to tuberculosis, and 
of the different susceptibility of different races to this 
disease, is not yet settled. It is well known that cer- 
tain races, as the nomads of Persia, Syria and Arme- 
nia, and the inhabitants of certain localities, as those 
of Iceland and the islands of Faroe, Shetland and the 
Hebrides, are almost, if not entirely free from the dis- 
ease ; while among negroes in this country, and In- 
dians, when under restraint and in contact with civili- 
zation, it is particularly prevalent. It is also known 
that under changed conditions the same race exhibits 
an apparently varying susceptibility to the disease, as 
is shown by its appearance among the nomadic races 
above referred to as soon as they abandon their wan- 
dering life. 
Also, it is known to vary according to differences in 
locality or climate; its spread being favored by viti- 
ated and damp air and a moist soil, and retarded bv 
purity and dryness of the air, and a large amount of 
sunshine. In view of these facts, it seems probable 
that tuberculosis acts as does any other infectious dis- 
ease, -being most prevalent where the conditions favor- 
ing its spread most obtain ; and that the presence of 
these conditions, more than racial or individual suscep- 
tibility, are the important factors favoring its preva- 
lence. This view is supported by the death-rate from 
this disease of the community under consideration. 
For some months previous to their arrival at Mount 17 
Vernon Barracks, and during the first four years of 
their stay there, all the conditions most favorable to 
the spread of the disease existed ; and the deaths from 
it ran as follows : First year 11, second year 4, third 
year 18, fourth year 18, fifth year 27. 
During the fifth year, though the condition of the 
Indians was greatly improved, the number of deaths 
from this disease was greater than before, as the dis- 
ease had gained such a foothold during the preceding 
four years that no decrease could be looked for in so 
short a time. The disease is so slow in development 
and in running its course, that when unusually preva- 
lent in a community, no sudden return to ordinary 
rates can be expected, but only a slow decline made 
possible by most thorough sanitary measures. 
Whether the system of disinfection and enforced 
cleanliness now being carried out in this community 
together with its bettered condition, will be effective 
in staying the ravages from this disease remains to be 
seen, for the unfavorable conditions of changed climate 
and altered modes of life still remain. 
It is to be hoped, however, that this most insidious of 
diseases can be controlled by the means taken and not- 
withstanding that the past five years have shown a 
steady increase of the disease, due to the presence of 
all the conditions most favorable to its spread, that the 
following years, through the absence of many of these 
conditions and the use of suppression methods, may 
show a steady decline. 
Should such decline occur, it will be of interest in 
that it will show the adaptation of the community to 
its new environment, and the effectiveness of modern 
■sanitary methods, when enforced.  THE BOSTON 
Medicaland Surgical Journal. 
A FIRST-CLASS WEEKLY MEWCaTnEWSPAPER. PUBLISHED EVERY THURSDAY. 
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