of infectious and contagious disease; and in order to estimate the comparative effect on Indians of such conditions it would be necessary to examine the whites living under like circumstances.

HOUSING CONDITIONS.

Prior to the subjugation of the Indians by white men, they enjoyed an open-air, roving life, living in well-ventilated tepees,' which were frequently moved from place to place. While in the uncivilized state their habits, it is true, were insanitary, the evil effects were undoubtedly minimized by the frequent moving of camps. It is also probable that in the early days the custom of leaving behind those unable to travel by reason of disease or physical disability may have had the effect of reducing the prevalence of disease.

From this roving life, however, Indians have been confined to reservations since about the middle of the nineteenth century, and taught to live in more permanent abodes. They are still generally ignorant, nevertheless, of those elementary principles of domestic hygiene and their practical application, rendered imperative by the adoption of a stationary home. It is necessary to state, of course, that this does not apply to all Indians, many being met who are of unusual intelligence and whose sanitary habits are good.

The house and the domestic life of the Indian undoubtedly play the most important rôle in the perpetuation and spread of infectious and contagious diseases among them. The more primitive the Indian, the less care is there exercised in the construction of his house, and the more filthy its condition and that of its surroundings. According to figures furnished by the Indian Office, there are 17, 188 Indian families living in permanent houses with floors, 9,201 families in houses with dirt floors, and 9,582 families living in tents, tepees, etc.

The typical Indian house of the North and Northwest is usually a small one-story frame or log structure with a common living room in which the family does its cooking, receives visitors, and sleeps. In the case of the log cabins the chinks are puddled with clay, and earth or manure is frequently banked around the house in the winter to exclude the cold. The roof in log cabins is usually made of sod laid upon poles. The floor too often consists of dirt although, from the figures above quoted, it will be seen that nearly one-half the families live in floored houses.

The windows are generally small, and in log houses placed at either end of the living room. This disposition would favor thorough ventilation were the windows kept open, but they are frequently nailed shut.

On many of the Indian reservations a number of well-constructed houses exist, put up, under Government supervision, with funds derived by Indians from the sale of inherited lands, etc. And on the New York reservations the home of the Indian compares favorably with white rural dwellings. In spite of the more commodious quarters the tendency of the Indian family to huddle together is manifest in these houses, the family occupying but one room and leaving the rest of the house uninhabited. Indian habitations peculiar to the

1 The Pueblo and Hopi Indians of Arizona and New Mexico have been house dwellers, however, for generations.

Southwest are the "hogan" used by the Navajos, the grass huts of the Apaches, and the houses used by the Hopis and the Pueblo Indians.

The "hogan".-The "hogan" of the Navajo varies in size but is commonly about 20 feet in diameter. It is built above the ground, but its sloping timber sides and flat or conical roof are covered with dirt. No window is provided, but in the center of the roof is a large smoke hole, usually about 5 feet in diameter, for which no provision is made for closing. Ventilation of this house, therefore, is by no means bad, as there is commonly a fire burning in the center of the dirt floor and around this members of the household eat and sleep.

Apache tepees.-The Apaches commonly live in huts or "tepees" made of arrow grass. No windows are provided and the ventilation is defective. These tepees, however, are burnt up by the Indians on the occurrence of death in the family, and, owing to the ease with which they are constructed, the Apache frequently changes the location of his home.

House of Pueblos.-The Pueblo Indian has been a house dweller for generations. The houses among the Zuni are of adobe and each is usually a part of the large community dwelling of which the pueblo is composed. The houses usually consist of one large living room, with a characteristic rounded fireplace and projecting wind shield. The interiors are all whitewashed and the windows of the living room large, but usually opening at one end only.

Adjoining this large room are numerous small interior apartments, very poorly lighted, usually from one small window placed high up in the wall. These rooms are usually granaries and storerooms, but some of them are used as sleeping apartments. The family eats and sleeps upon the floor, usually that of the largest room, rolling their pallets up in the morning and stacking them around the sides of the apartment, or carrying them into an inner room, to remain during the day. The floors of these houses are frequently made of flat stones, carefully laid, but often of adobe which is frequently renewed. These Indians are neat when compared with the nomadic tribes. There is little disorder or litter among their household chattels, such as is found among those tribes which have lived in houses only of recent years.

The defensive instinct, still strong in the Indian, leads the Pueblo Indian frequently to locate his dwelling in inaccessible places on hills, and to enter it through a hole in the roof by means of a ladder.

Summer residences. In the summer time many Indians live in tents or dwell in shelters constructed of brush. The tent may be of canvas stretched on lodgepoles in the usual conical shape or the ordinary wall tent may be employed. These tents are frequently occupied in the Northwest until well into the winter. Under such circumstances a cookstove is usually installed in the tent and the flaps closely tied in order to exclude the cold. As duck is wind proof, the ventilation under such circumstances leaves much to be desired.

Overcrowding.-Owing to the high birthrate among the Indians the average family consists of 4 or 5 individuals. It is no unusual sight to see 8 or 10 individuals living in one small dwelling. The tendency of Indian families to huddle together, even in commodious quarters, has already been adverted to. The following graphic description of Preble's gives an excellent idea of conditions too frequently met with

on Indian reservations and the opportunities for the transfer of infection which overcrowding affords:

In one such house, a well-built two-room framed building about six months old, eight individuals were found living and sleeping in one small room about 12 by 14 feet. Three of these people were between 8 months and 3 years of age. An apology for a bed occupied one side of the room and on it sat a young mother holding a 3-year-old girl suffering from advanced tuberculosis. In the center of this room was a worn-out cookstove, giving off great quantities of heat and foul odors. The air in the room was stifling. On the other side of the room, two women, about 30 years of age, were sitting on a number of extremely filthy rags and hides, both nearly blind as the result of acute trachoma. One was nursing an 8-months-old baby and, when an examination of their eyes was attempted, this mother wiped the discharges from her own eyes with her fingers and then attempted to assist in opening her baby's eyes for examination.

Interior of houses. Generally speaking, especially in the north and northwest, the interior furnishings of Indian houses may vary from a few rags and dirty hides on the floor, with a stove of some kind for heating and cooking, to the articles necessary to a fairly well furnished room. Some houses are so crowded with a miscellaneous collection of articles, useful or otherwise, as to leave but little room for human occupancy. From observations made it is apparent that rare attempts at cleansing are made in and about Indian houses, and many varieties of dirt and refuse may be seen in their homes.

The Indians sleep either on the floor or in beds. Bed linen is of course conspicuous by its absence among the primitive Indians, and the bedding consists of a miscellaneous collection of quilts, blankets, and skins, often very filthy.

Towels are but little in use, any convenient cloth serving instead, and where present they are used in common by all the members of the family. But one hand basin at most is provided for washing purposes, and like the towel is used indiscriminately.

PERSONAL AND SOCIAL HABITS AND CUSTOMS.

Personal cleanliness.-Personal cleanliness among primitive Indians, especially the older full-bloods, is rarely encountered. They are said to wear the same clothing until it is worn out, and in cold climates it is safe to assume that it is seldom removed. During the warm. weather many Indians bathe and wash their clothing simultaneously by squatting in shallow creeks. Even in this attempt at personal cleanliness the clothing may not be removed from the body.

While doubtless many Indians take a certain pride in their personal appearance, it may be safely stated that the majority are unacquainted with methods of personal hygiene. The habits of the younger generation, and especially the mixed-bloods, are, as a rule, less unhygienic. Those attending the boarding schools and day schools are under supervision, and personal cleanliness is more or less compulsory.

In addition to want of cleanliness, the Indian is very careless in other personal habits. Secretions from the nose and eyes are commonly removed with the fingers, which are not subsequently cleansed. It was a frequent experience, reported by the officers engaged in this investigation, to see a mother, afflicted with trachoma, removing secretions from her eyes with her fingers and then performing a similar function for her child. If a handkerchief was

used for the purpose it was usually in a filthy condition and used in common with the mother and the child.

The Indians are very careless about expectorating freely on the dirt floors and at most covering the sputum with a pinch of dirt. It is inevitable that the dirt floor of huts inhabited by tuberculous Indians must in time become heavily infected with the tubercle bacillus.

Among primitive Indians urine and feces are deposited in some secluded spot wherever the individual happens to be, and among the more advanced Indians the privies in use are of unsanitary construction, and many readily serve as breeding places for flies."

Once attacked by disease the stoicism and indifference of the Indian leads him to defer seeking medical relief until it is too late, as he is usually ignorant of the serious nature of his disorder, and his indifferent nature prompts him to wait in the expectation that the cause of his suffering will presently disappear and a return to health ensue. If he does seek medical aid he expects to be cured by one or two doses of medicine, and if this expectation be not realized he is apt to seek a "medicine man" for relief.

Social habits.-The Indians are a sociable race, extremely fond of visiting each other. Many of the Indians pass a great deal of their time on rounds of visits. Houses, overcrowded by the number of their usual occupants, frequently have their scanty accommodations further strained by the advent of visitors who may stay days or even weeks. The practice among Indians of loaning children to each other for long visits is of common occurrence. The opportunities this habit affords for the introduction of diseases, such as trachoma, into uninfected families is only too obvious.

The Indian having lived for generations under communistic conditions, still regards property as belonging to the tribe and not to the individual, hence pipes, articles of wearing apparel, bedclothing, and the like are freely interchanged, thus facilitating the transmission of communicable disease.

The habit of "passing the pipe" in gatherings is doubtless sometimes responsible for the transference of disease, as well as their custom, in rolling cigarettes, of closing the tobacco bag by drawing the string with the teeth before passing it to the next individual.

Indians are fond of gatherings of every description. On the days rations are issued, and during the summer, many families gather at the agency for rations or near the day schools in order to be near their children. These temporary gatherings and their various fairs offer them an opportunity for visiting, and may exert considerable influence in the spread of any communicable disease that may exist among them.

Dance halls.-The custom among the Indians of holding dances prevails to a considerable extent on many of the reservations visited. One of these dances is held usually after each ration day. The issuing of rations is an occasion which brings together the aged and infirm, those incapacitated by disease and unable to provide for themselves, and they are usually accompanied by their families.

The dance halls are usually single room, old frame or log buildings, about 30 by 50 feet, often with dirt floors. The Indians crowd into these halls and spend a night of dancing and feasting. The rations which are to last some Indians for a month are soon eaten by their

friends, leaving them to fend off starvation as best they can until next ration day.

These dances offer many opportunities for intimate personal contact among the sick and the well. Besides ration day dances, other dances are held at varying periods. Notice of a dance spreads rapidly among the Indians, and whenever some member of the tribe contributes provisions sufficient for a feast a dance is held. Many of the more intelligent and better educated Indians recognize the harm wrought by the dances upon the health of the participants and deprecate the custom.

Singing gatherings.-Besides the dances just mentioned, another custom which brings varying numbers of Indians together is that of holding "singings" at Indian houses. Whenever sufficient food of any kind is provided by some Indian, word goes out among his friends and they gather at his house and spend a night of singing and feasting. The same conditions favoring the spread of trachoma, tuberculosis, and other affections exist as in the dance halls. Many superintendents have prohibited these gatherings, but they continue to be held in some localities.

All these customs which bring together a large number of Indians of all ages, both the sick and the well, must be factors in the spread of trachoma, tuberculosis, and other infectious and contagious disorders.

"Medicine men."-The Indian medicine man is still altogether too influential among the Indians. The adoption of a more sanitary mode of life and a greater utilization of the medical facilities and knowledge of the white race, on the part of the Indian, would naturally have the effect of destroying the medicine man's prestige. As a consequence he opposes the introduction of sanitation and resists, so far as in him lies, the spread of modern doctrines as to the origin and dissemination of disease and their proper treatment among the Indians. Moreover, in many instances, his own efforts at the treatment of the sick have the effect of propagating, rather than limiting, infection.

Flies. Many of the reservations were visited after the onset of cold weather. It was, therefore, impracticable in numerous instances to determine the prevalence of flies by direct observation. At the reservations visited where the weather was still mild, officers engaged in this investigation reported flies to be a veritable pest, and it was obvious, on other reservations, that conditions were very favorable for their propagation. The potentiality of the fly as a disseminator of contagious and infectious diseases has been the subject of much discussion of recent years. The agency of the fly as a possible factor in the transmission of trachoma and tuberculosis has been admitted, and, in the Orient, the fly is believed to be an active agent in the spread of the former disease. Flies are attracted to bodily discharges of all kinds and are frequently seen swarming about the faces of those afflicted with diseased eyes.

Recently, also, it has been shown that the stable fly may be an agent in the transmission of infantile paralysis. Indian reservations contain many stables and temporary shelters for horses and cattle. These are usually maintained in a filthy condition and can not fail to furnish favorable breeding places for the stable fly.