No cases of smallpox within recent years were recorded among the Navajo Indians of New Mexico. Regarding the Zuni Indians, Smith states as follows:

No Indians have suffered more severely from smallpox than have the Zuni Indians, who in 1898 and 1899 from November to February, lost approximately 555 out of a population of about 2,000 at the time. The number of cases is unknown, but I am reliably informed that over 900 freshly pock-marked Indians were counted after the epidemic had subsided.

There were no evidences of a recent epidemic of smallpox among the Pueblo Indians.

Idaho and Washington.-In Idaho, Lloyd reports that 19 cases of smallpox occurred on the Fort Hall Reservation, Idaho, during the fiscal year ended June 30, 1912; all recovered. At the Fort Lapwai Reservation smallpox had not occurred for some time. At the Coeur D'Alene Reservation and School, Idaho, the disease had not prevailed for some time, nor had it at the reservations in Washington with the exception of the cases mentioned above as seen at the Yakima Reservation.

Minnesota and Wisconsin.-The last general epidemic of smallpox swept through the Indian population of Minnesota in 1901, the mortality being very low. Three cases of the disease developed in the Oneida Boarding School, Wis., during the present year without mortality. Clark states that the source of infection was probably Green Bay, Wis., 10 miles distant, where smallpox was quite prevalent at the time.

The Tomah School in Wisconsin had 120 cases in 1903, with 1 death. In the opinion of Clark, the general vaccination of the Indian population in these States will protect them from any general epidemic in the near future and modify the severity of such sporadic

cases as may occur.

New York.-No case of smallpox was seen. On the Allegheny Reservations there is a history of three outbreaks of the diseaseone in 1869, when there were numerous cases and deaths; one in 1892, when there were 6 cases, 4 being fatal; and one in 1904, when there were 22 cases.

Several of the recovered cases from these epidemics were seen by Leake, none of whom had been vaccinated prior to contracting the infection.

On the Cattaraugus Reservation a history was obtained of numerous cases of smallpox in 1885 and 1890, and 4 cases in 1912.

North and South Dakota.-No case of smallpox was seen nor heard of on any of the reservations visited. Smallpox was generally prevalent throughout the northwest in 1907, and outbreaks of the disease were reported as having occurred at Turtle Mountain and Fort Berthold Reservations, N. Dak., at that time. The prevailing type of the disease was mild, and but few deaths resulted.

In South Dakota histories were obtained of outbreaks in 1907 and 1911 on Pine Ridge and Rosebud Reservations. At Lower Brulé, during January and February, 1911, 24 cases were recorded. by the agency physicians, and just prior to this outbreak there occurred 6 cases of "varicella." Four cases of smallpox were recorded at the Yankton Agency between April 28 and May 20, 1912. The source of infection in these cases was not determined, but it was brought in from some neighboring town.

The contract physician for the boarding school at the Sisseton Agency reported the occurrence of an epidemic of smallpox on this reservation during the year 1903 at the time of a rather widespread outbreak in this part of the State. It was stated by this physician that about 200 cases occurred on the Sisseton Reservation, with a mortality estimated at 15 per cent. It seems probable that smallpox has not prevailed to any extent in recent years among the Indians in the Dakotas.

Oklahoma.-No_case of smallpox was seen in the State either among whites or Indians, but the disease has been prevalent in the State for some years. Since 1908 Guthrie states smallpox has been reported every month in the year until September, 1912, when no case was recorded.

The earliest accounts of smallpox among Indians that were obtained dated back to 1899 and 1900 when, from the accounts, the disease must have been quite generally epidemic throughout the State, or Territory as it then was. No records were found anywhere that would throw any light upon the severity of the epidemic, its distribution, or mortality, and the only data obtainable both for this and recent outbreaks were, according to Guthrie, "word of mouth" accounts received from superintendents, school matrons, farmers and other employees of the Indian Service, and often at great distance from the localities where the cases occurred.

From such accounts smallpox was prevalent in 1899 and 1900 among the Indians of the Five Civilized Tribes, especially in the Choctaw section; among the Caddo and Wichita Indians in Caddo County; among the Cheyennes and Arapahos on the Red Moon Reservation; and in the vicinity of Colony. Seventy-five pupils of the Riverside Indian School had smallpox in 1900. In 1899 a severe epidemic of this disease occurred on the Sac and Fox Reservation, with 115 cases and 45 deaths. At the same time there were 4 cases in the Sac and Fox School, with 2 deaths.

In 1904 there were 28 cases of smallpox among pupils of the Segar Indian School at Colony. In 1910, 42 or 43 cases of smallpox occurred at the Cheyenne and Arapaho School at Darlington among about 150 pupils. In December, 1910, 1 case occurred at the Segar Indian School at Colony, and during the following year there were 5 cases at the same school. In 1911, also, 1 case was reported on the Osage Reservation at Pawhuska.

From the above accounts it would appear that the disease for the past 12 years has been of a very mild type and with a very low mortality rate, with the exception of the epidemic on the Sac and Fox Reservation in 1899, and the epidemic among the Zunis in the same year.

POCKMARKS OBSERVED AMONG INDIANS.

Relatively few pockmarked Indians were seen on any of the reservations visited. This is evidence of a kind bearing on the past prevalence of smallpox or at least on its virulence. It must be remembered, however, that the type of smallpox that has prevailed in the United States during the past 15 years has been generally very mild, and many cases might occur without leaving its traces in the form of scars.

As an evidence of the great severity of the 1899 epidemic among the Zunis in New Mexico, Smith stated he was reliably informed that over 900 freshly pockmarked Indians were counted after the epidemic subsided. Eighty-seven pockmarked Indians were seen by Clark in Michigan, Minnesota, and Wisconsin, 39 of this number being at the Menominee Reservation, indicating a severe scourge of smallpox there years ago.

In North and South Dakota only a few Indians were seen who presented this evidence of having had the disease. Seventeen pockmarked Indians were seen by Schereschewsky in these States, but all were of long standing.

THOROUGHNESS OF VACCINATION AMONG THE INDIANS.

Since successful vaccination is a reliable preventative of smallpox, the thoroughness of its performance among the Indians is an evidence of their freedom from the disease in the past and an indication of their likelihood of escaping widespread epidemics in the future.

Dr. Fricks estimates that there are about 23,000 Indians in Arizona who have not been vaccinated, and mentions the possibility that the mild type of smallpox now prevailing in the United States might by its spread through such a large body of unvaccinated Indians revert to the virulent type once universally dreaded. It is known that virulent infections have recently occurred among whites in different sections of the country. Whether this is due to such reversion of type or to the existence of two strains, the one more virulent than the other, is not definitely known.

In California, Nevada, and Oregon, Billings reports almost all of the younger Indians vaccinated-probably 90 per cent-but this proportion dwindles very rapidly in Indians above 25 years of age until among the older people it is of rare occurrence.

Among the Mescalero Apaches and Jicarilla Apaches vaccination seemed thorough. Smith reported the same condition with respect to the Navajo school children in New Mexico, and he was informed that in the presence of a threatened epidemic a few years ago accessible Indians accepted vaccination without protest. He does not believe, however, that any large proportion of these Indians have received protection in this manner.

Among the Zunis in New Mexico it was evident that the community is only partially vaccinated. Out of 410 children of school age, only 150 had received protection. Among the Taos Indians, on the other hand, vaccination seemed to have been performed with a fair degree of thoroughness.

Among the Pueblo Indians of New Mexico vaccination likewise seemed thorough with the exception of Acoma, where it is resisted. At Cochiti also no vaccinating had been done for three years, and Smith believes it probable that vaccination is not very thorough there.

At the Fort Hall Reservation, Idaho, all children are vaccinated. during the first two years of school life. Few children under school age are vaccinated. Practically all of the adults have submitted to the operation, and Lloyd states that about 85 per cent of those examined by him showed successful vaccination marks. A few had been revaccinated.

At the Nez Percé Reservation advantage had been taken of allotment payments of money, etc., to enforce vaccination, and it is only the younger children who have not been vaccinated. Some had been revaccinated, but this was not general. About 85 per cent of those examined by Lloyd at the Coeur D'Alene Reservation showed good vaccination marks. About 88 per cent of those seen by him at the Tulalip Reservation, the Swinomish Reservation and day school, the Lummi Reservation and day school, and the Suquamish Reservation had been vaccinated.

At day school No. 6 on the Colville and Spokane Reservations only 5 out of 14 pupils examined had been vaccinated. At day school No. 5 none of the 20 pupils examined had been vaccinated. At the mission school at St. Marys, near Omak, 75 per cent of the pupils had been vaccinated.

In Montana vaccination was reported by White to be generally performed.

Among the 6,997 Indians examined in Michigan, Minnesota, and Wisconsin, 2,067 had been vaccinated over seven years before and 2,932 within seven years. Over 70 per cent of those examined had, therefore, been vaccinated at some time during their life.

In North and South Dakota vaccination had been generally performed in the past. Recently, however, according to Schereschewsky, vaccination has not been thorough, particularly among children below school age. At the Pierre school, South Dakota, Preble states that only about 22 per cent of the children had been vaccinated, while at the Flandreau and Pipestone schools practically all showed good vaccination scars.

In Oklahoma all the Indians on the Sac and Fox Reservation were vaccinated at the time of the severe epidemic in 1900. A large percentage of the Indians on the Osage Reservation have been vaccinated according to the agency physician. With these exceptions Guthrie says vaccination "has not been carried out among many of the grown Indians and children who remain out of the schools." He further states that practically all children attending the schools are vaccinated at the time of or shortly after admission, but that among the Five Civilized Tribes this rule is not strictly enforced in a number of boarding schools.

It is evident from the foregoing that smallpox has not prevailed to any considerable extent among the Indians in recent years, but the incidence of this disease should be practically nil in any community depending on the thoroughness of vaccination. It is probable that vaccination has been as thorough among the Indians as among whites in the average community exclusive of cities, but that it is not thorough enough is evidenced by the occurrence of cases of smallpox among Indians. Obedience to sanitary laws is as much the duty of the Indian as anyone else, and superintendents and physicians should be held strictly accountable for the control of smallpox among the Indian population.

THE PREVALENCE OF OTHER INFECTIOUS AND CONTAGIOUS DISEASES AMONG THE INDIANS.

TYPHOID FEVER.

While typhoid fever is widely and inexcusably prevalent in nearly all the civilized communities of this country, and, on a priori grounds, therefore, should be relatively common among the Indians, we find, on the contrary, that the disease is rare on Indian reservations. All the officers engaged in the investigation agree as to its infrequence, and many of them comment on this seeming paradox.

Arizona.-Fricks reports that "typhoid infection among Arizona Indians is extremely rare. There was no evidence of typhoid infection having developed or spread on any reservation. Three cases of typhoid fever were seen, all in Indians, off the reservations, and nine cases were reported during the year away from the reservations, either in school or at work in and around Globe, Winkleman, or Needles."

Of the 32 deaths from typhoid fever reported in Arizona during 1911 only 1 occurred in an Indian, while over 21 per cent of the population of Arizona belong to that race.

California, Nevada, Oregon.-Typhoid fever seems very infrequent among the Indians in these States. According to Billings, 10 cases with 4 deaths were found in the records, for the past 20 years, of the Klamath Lake (Oregon) Reservation; 7 cases with no deaths in the past 15 years at the Western Shoshone (Nevada) Reservation; and 30 cases with 2 deaths in the last 20 years at the Round Valley (California) Reservation. Billings met with no case of the disease in the course of his inspections.

Colorado and New Mexico.-In commenting upon the sanitary conditions among the Zuni Indians, Smith states that "it seems inconceivable that this pueblo can long escape an epidemic of this disease." Though there is no reason to suppose that the Indian is immune to typhoid fever, yet he met with no case of this infection either in this pueblo or on the other reservations visited by him in these two States, although one case was recorded in the Cochiti pueblo in the last two years.

Idaho and Washington.-No case of typhoid fever is reported by Lloyd among the Indians he examined."

Michigan, Minnesota, and Wisconsin.-According to Clark, typhoid fever does not prevail to any extent among the Indians of Minnesota and Wisconsin, although cases of the disease do occasionally occur among the Indians of the Mackinac Agency. The source of infection is the city water supply. The Indians, however, are infected in no greater proportion than the white population. Some years ago an outbreak took place among the Indians of the La Pointe Agency at Odanah, Wis. The origin of these cases seemed to be derived from contamination of wells by the frequent overflows of Bad River. Since deep wells have been bored typhoid fever has disappeared from among these Indians.

Montana. Typhoid fever seems to be as infrequent among the Indians of this State as in other States. White found records of one small outbreak only, in 1910, at Polson, on the Flathead Reservation. Polson in an incorporated town under the jurisdiction of the State.