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Virgin soil theory, boarding schools, and medical experimentation
A history of tuberculosis among Native Americans
We cannot solve the Indian problem without Indians. We cannot educate their children unless they are kept alive.
Cato Sells, Commissioner of Indian Affairs, addressing the Congress of Indian Progress in August 1915
In 1911, an Indian man walked out of the rugged foothills of Mount Lassen in northern California. The man, later to be known as Ishi, the last Yahi, devastated by exhaustion and starvation, was arrested in a butcher’s slaughterhouse near Oroville, California, for attempting to obtain some meat. Not knowing what to do with the “wild man,” the local sheriff contacted the Bureau of Indian Affairs. As Ishi was awaiting his fate in jail, the press published enthusiastic articles about this “Least Civilized Man” and “Last Lost Indian,” giving little attention to the genocide of Indigenous people in California which wiped out the Yahi and other Indian tribes (B. Lindsay 351). As Nancy Scheper-Hughes points out, “By 1860 American military attacks had taken the lives of 4267 Native Californians, but these were not the worst” (104). The worst were the assaults initiated during the Gold Rush and carried out by the civilian population. In fact, it was the fate of Ishi’s tribe: between 1865 and 1871, 5 massacres by whites killed nearly 200 Yahis (B. Lindsay 355).1
After some deliberations, the Bureau allowed Alfred Kroeber, the first professor of Anthropology Department at University of California, Berkeley, to place Ishi in the Anthropological Museum of the University of California in San Francisco and study him. Once there, Ishi was turned into an exhibit and an object of study. His medical records meticulously log measurements of his body parts and, in a gesture of erasing his agency, his activities are rendered in the passive voice: “Ishi was moved to Berkeley, where he was studied by Dr. E. Sapir” and then “he was returned to the University Hospital in San Francisco” (Pope 198; emphasis added). Throughout his life, he was observed, gawked at, poked at and continuously forced to pose for photographs. As Gerald Vizenor writes, “The spirit of this Native hunter captured almost a century ago has been sustained as cultural property” (“Mister” 363). When in 1915 he was hospitalized for tuberculosis (TB), he had been already ravaged by the disease, undernourished, and suffered from a painful cough. Yet, physician Saxton Pope, responsible for Ishi’s health, failed to notice his patient’s decline and convinced him to pose for another photograph:
In 1915, Ishi was so severely affected by tuberculosis that he was transferred to the university hospital where he died in March 1916. Despite his wishes, his body was autopsied and his brain was removed and sent to the Smithsonian Institution.
The story I am about to unfold in this chapter is not about Ishi though. Yet, Ishi’s life serves as a powerful illustration of the tuberculosis epidemic in the late nineteenth century and the first half of the twentieth century in Native American communities. According to (pseudo)scientific theories of the era, he was expected to succumb as Indians, due to their racial makeup, lacked susceptibility to TB. Thus, when social reformers and activists announced the victory in the crusade against germs and tuberculosis at the beginning of the twentieth century, Native Americans were quietly dying of the disease, not included in the discourse of triumphant statistics.
This chapter offers a historical overview of the TB epidemic among Native Americans but it is by no means a comprehensive history. Rather, it is meant to provide a context for understanding the social and political mechanism of allowing the epidemic to continue. As Cristobal Silva rightly observes, narratives of epidemics – who is susceptible to which diseases, who is immune, and why some diseases continue to afflict certain groups – reveal ideological assumptions structuring social and geographic spaces as well as criteria for national belonging (19–27).2 Similarly, many scholars have demonstrated3 how tuberculosis expanded beyond medical contexts and in the second half of the nineteenth century acquired different cultural meanings. Indeed, the consumptive myth4 dominated popular imagination and associated the disease with physical attractiveness and intellectual refinement. In the United States, tuberculosis meant different things for white middle-class and working-class Americans, the poor, immigrants, and African Americans. With a better understanding of TB as a bacterial infection along with national informational campaigns, occurrences of tuberculosis began to fall at the beginning of the twentieth century. However, this was not the case for American Indians who suffered disproportionately from the disease. To understand this phenomenon, physicians and scientists devised theories based on racial susceptibility to tuberculosis. This chapter offers a presentation of such views and emphasizes their improbable longevity, even in the face of scientific findings proving otherwise. The racialist foundation of discourse surrounding tuberculosis in Native communities is directly traced in medical publications of the era which portray Indians as not only racially prone to contract tuberculosis but also as responsible for their poor health due to unhygienic conditions on reservations. At the same, the authors of such claims downplay or completely silence historical and political contexts that led to this crisis.
The spread of the tuberculosis epidemic coincided with concentrated efforts to assimilate Indigenous population into mainstream American society. Ironically, a system of federal boarding schools created for this purpose greatly contributed to the spiking number of tuberculosis cases. As Rachel E. Wilbur and colleagues observe, “The harsh environment present in these schools often contributed to poor health and was particularly well suited to the spread of communicable disease” (106). This, combined with a lack of adequate medical facilities, fueled the epidemic. Indeed, with assimilationist agendas surpassing health concerns, Indian boarding schools became instruments of cultural and physical extermination, and constituted an important chapter in a history of tuberculosis among Native Americans.5 The alarming morbidity and mortality rates were, however, easily justified with the conviction that Native Americans are genetically inferior and thus susceptible to the disease.
Considering the late nineteenth and early twentieth centuries as the moments of gradual institutionalization of medical knowledge and practices,6 efforts to treat tuberculosis in Native American communities reveal medicine’s entanglements with racially driven and therapeutically dubious research.7 While neglected as TB patients, Indigenous bodies became the center of attention of scientists and medical practitioners in their long journey to find a cure for the disease. A story of controversies surrounding the efficacy of the Bacillus Calmette-Guérin (BCG) vaccine and attempts to refine thoracoplasty as a surgical therapy for TB illuminate how presumed racial inferiority of Native Americans transformed them into ideal research objects.
TB: biomedical definitions
In its long medical and cultural history, tuberculosis, or TB, has accumulated a myriad of designations which shifted and changed as a more thorough understanding of the disease was being gained: consumption, the wasting disease, phthisis, graveyard cough, the white plague, and the white death. While tubercles characteristic of the disease can develop in different tissues throughout the body (e.g., tuberculosis of the lymph nodes is called tuberculosis lymphadenitis, the bones, osteoarticular tuberculosis, or Potts Disease), it is pulmonary tuberculosis that became the emblematic image of the infection. Tuberculosis is caused by the bacteria Mycobacterium tuberculosis (MTB), which is an oxygen-seeking organism and, therefore, its growth is most successful in tissues with high oxygen content, for instance, in lungs. MTB is an intracellular pathogen and it infects cells of the immune system. It is also a slow-growing organism that develops thick cell walls containing glycolipids and lipids. This unique property renders it almost impenetrable for assault. Moreover, MTB is difficult to grow in a laboratory setting and is resistant to long exposures of acids and alkalis, and more importantly, to antibiotics like penicillin, which successfully fights bacteria by precisely destroying their cell coat. Tuberculosis is contagious and is spread through airborne transmission. When an infected person coughs, sneezes, sighs, or laughs, small respiratory droplets containing MTB are released into the air. It is enough to inhale only a few droplets to become infected. The most common symptoms of pulmonary tuberculosis are well-documented and include a chronic cough, coughing up sputum and blood, pain in the chest, weakness and fatigue, weight loss, fever, and sweating at night. Untreated or when combined with other serious conditions such as HIV/AIDS, tuberculosis can lead to death. As many scholars and physicians observe, despite the widespread assumption that TB was eliminated in the twentieth century, the disease has returned with a vengeance, or rather, it has never been gone (L. Adams 123–4, Bynum 4, Yancey 46–51, McMillen, Discovering 2).
TB in the United States
In the Preface to his acclaimed A Treatise on Pulmonary Consumption published in 1835, James Clark, an expert on the condition and physician-in-ordinary for Queen Victoria, refers to pulmonary consumption as “the most destructive of all human maladies” (viii). “In this country and over the whole temperate region of Europe and America,” he continues, “tuberculosis disease of the lungs causes probably a fifth-part of the whole mortality; and in some districts, and even in whole countries, the proportion is much larger” (14). Indeed, the year 1800 saw the highest rate of deaths from tuberculosis, which was probably the main cause of death in the USA, with, for instance more than 25 percent of deaths in New York City between 1810 and 1815 attributed to consumption (Murray 1181). The interest in tracing consumption coincided with the creation of the new republic, in which good health of its citizens confirmed the newly created country’s exceptionalism (Feldberg 83). As Georgina D. Feldberg asserts, “Statistics about disease formed part of [the] efforts to construct a national identity, for healthfulness seemed as fundamental a characteristic of the country as liberty” (12). Moreover, approaches to tuberculosis treatment and prevention, as they emerged in medical and public writings and practices at the beginning of the nineteenth century, demonstrated the professionalization of American medicine, the emulation of middle-class lifestyle as a national model, and the complex interconnections among tuberculosis, race, and gender discourses.8
For a long time, as demonstrated in numerous medical publications of the era, consumption was believed to be a hereditary disease. S. W. Gold confidently asserted in the pages of the Boston Medical and Surgical Journal in 1835, “That the opinion of hereditary or family predisposition, generally entertained by writers on this subject, is correct, I have no doubt” (183). The belief was so strong that, even with Robert Koch’s identification of tubercle bacillus in 1882 as responsible for tuberculosis, American physicians remained skeptical as to the significance of this discovery. Rather than hailing Koch’s announcement as a medical breakthrough, they continued to turn for etiology of the disease to gender, race, and environmental factors, drawing on a metaphor of seed and soil. This skepticism was repeated over 40 years later with the introduction of the BCG vaccine. Despite promising research results from Europe and Canada, the medical establishment was reluctant to embrace the new medicine and instead voiced concerns about its safety. As Feldberg explains, both episodes illustrate an insistence on creating uniquely American scientific rigor and American physicians’ determination to “carve out a research style that would mold institutionalized medical science to both national and middle-class interests” (128).
With the omnipresence of infection, medical and public debates concentrated on methods aimed at eradicating tuberculosis from the social body of the nation. Since no miracle cure was available, TB prevention was to be achieved through mass education. As many scholars observe, not coincidently, embedded in the anti-TB campaign was an ideal of middle-class behavior and values, here promoted, with the help of the germ theory, as an objective and scientific method of remaining healthy (Abrams 417–20, Feldberg 81–124; Tomes, “Epidemic” 629–31; Tomes, The Gospel 113–34). Nancy Tomes strongly asserts that anti-TB campaigns served more than a medical purpose of mass-education about communicability of the disease. Through effective advertising and marketing methods, they became “a vehicle for pushing a wide range of societal reforms aimed at easing the dislocations of urbanization and industrialization” (Tomes, “Epidemic” 631).9 The intended social change clearly defined the components of the national body vis-à-vis the widely defined “other” which did not comply with prescribed regulations of private life. As Feldberg writes,
