Health Conditions among the Potawatomi Indians of Kansas in 1928

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Steve Corbett and Jeanne Drisko Health Conditions among the Potawatomi in 1928

Plains Anthropologist, Vol. 56, No. 219, pp. xxx–xxx, 2011

Health Conditions among the PotawatomiIndians of Kansas in 1928

Steve Corbett and Jeanne DriskoIn 1928, white Indian agents became convinced that the conditions on the Potawatomi reservation

in northeast Kansas were not conducive to good health. The agents commissioned the “PottawatomieIndian Survey”, a house to house analysis of the health status of the people on the reservation. Thisarticle examines the results of that 1928 survey. Eye maladies such as trachoma were the most commonlyreported health complaints of the people, and tuberculosis the most often reported cause of death. Thedisease pattern of the Potawatomi in 1928 was more like that of the rest of the United States in thenineteenth century, and dissimilar from that of other neighboring Kansas populations. Though theagency surveyors of the time laid the blame for health inadequacies at the feet of the Potawatomi, thisanalysis suggests that poor public health services and the imposition of an alien subsistence strategywere to blame.

Keywords: Potawatomi Indians, tuberculosis, trachoma, reservation living conditions, subsis-tence transition

Steve Corbett, MA ABD, Native Medicinal Plant Research Program, Kansas Biological Survey, 135 HiguchiHall, The University of Kansas, Lawrence, KS 66047, (785) 864-1528, [email protected]

Jeanne Drisko, MD, CNS, Professor and Director, Integrative Medicine, The University of Kansas MedicalCenter, 2057 Sudler Hall, 3901 Rainbow Boulevard, Kansas City, KS 66160

In 1928, then Superintendent of Indians C.M.Blair and Jasper Cross, Agent of the PotawatomiReservation, became convinced that the conditionson the reservation were not conducive to goodhealth. In an attempt to substantiate their convic-tions, they commissioned the “Pottawatomie In-dian Survey”, a house to house analysis of thediet, sanitary conditions, and health status of thepeople in each household on the reservation. Thegovernment agents requested that the Kansas StateBoard of Health (KSBH) carry out the collection ofinformation, and then make recommendations as tohow best improve on the observed conditions.

Photostats of the completed survey forms arehoused at the National Archives in Washington,D.C. The collection includes two-page survey data

forms for each household, and in some cases athird page with photos (Figures 1–3) and captions.Also included are the surveyors’ summary, conclu-sions, and recommendations. The year the surveywas taken was apparently not clear to the NationalArchives, as they listed the year as “ca. 1928”, andwrote “1929–1930?” on the forms. The actual yearof the survey was determined by contacting a tribalmember still living on the Potawatomi reservationwho was listed on one of the forms as a 3-month-old. This individual was able to establish the yearof the survey by providing a date of birth. Thus, itwas determined that the survey was indeed con-ducted during the summer months of 1928.

The 1910s and 1920s saw a great deal of inter-est being paid to Indian health issues by govern-

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ment agents and health professionals, after severaldecades of near neglect (Eastman 1915:49; Hoffman1920:94, 1927:544; Tobey 1922:687). Most of thesereports recognized the great inadequacy of medi-cal services to Indians, and cited the epidemic pro-portions of diseases such as tuberculosis and tra-choma among the population. This period of rec-ognition and investigation of health problemsamong the Indians likely prompted this surveyamong the Potawatomi of Kansas.

There is no record of which KSBH representa-tives actually conducted the surveys. It is not evenapparent whether or not the surveyors were healthprofessionals. The only people specifically men-tioned as being a part of the survey team are anurse from the Kansas State Tuberculosis Asso-ciation, and a Potawatomi driver/interpreter. Whileit may have seemed logical and practical at the timeto have people from the KSBH conduct these sur-veys, it is obvious that these individuals were notfamiliar with the Potawatomi. It is also apparent a

Eurocentric view of health and behavior materi-alized on the pages of the survey.

The State Board of Health held two ChildHealth conferences, and the State TuberculosisAssociation held a chest clinic to assist in de-termining the prevalence of disease. Despitethese clinics, an accurate recording of the ob-served conditions was lacking. This was madeevident by inconsistencies between the surveyforms and the statistics reported in the Board’ssummary and conclusions. Many recorded “di-agnoses” were nothing more than descriptionsof what people were complaining about. Reportsof “eye problems”, “chest problems”, “stomachproblems”, and so forth were mixed in with diag-noses of trachoma, tuberculosis (TB), goiter, andother specific illnesses.

THE PRAIRIE BAND POTAWATOMINATION

Originally from the Great Lakes region, thePrairie Band Potawatomi are one of severalPotawatomi communities variously located inthe Midwest and Canada. It is believed that thePotawatomi were once part of a single tribe thatincluded the Odawa (Ottawa) and Ojibwa(Chippewa) tribes, and were referred to by such

terms as the “three fires” or “three brothers”. Whenthe Potawatomi separated from the other twogroups, it was said that they built a new fire forthemselves. Potawatomi means “one who builds afire for himself”, and the Potawatomi people areoften referred to as the “People of the Place of theFire” (Clifton 1998:16; Connelley 1918:488; Mitchell:1997:2).

The Prairie Band Potawatomi eventually foundthemselves in Kansas due to a series of movesprompted by the demand for land by the U.S. Gov-ernment and its citizens. The removal of thePotawatomi from the Wisconsin/Illinois area coin-cided with the removal of many eastern NativeAmerican populations to west of the MississippiRiver. The Potawatomi were first relocated to thePlatte Purchase area of Missouri in the 1830s, butwhite demand for that region soon forced anotherrelocation. One faction (Prairie Band) of the tribemoved to the area of Council Bluffs, Iowa, but bythe late 1840s had to move again. Their next desti-nation was the then 48-kilometer-square (30-miles-

Figure 1. A six-year-old boy on the Prairie Band Potawatomireservation.

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square) reservation in eastern Kansas territory,and tribal members began arriving at this Kan-sas location in 1847 (Connelley 1918:492;Mitchell 1997:8–11).

The Prairie Band Potawatomi Nation’s res-ervation is located in Jackson County, north-eastern Kansas, approximately 32 km north ofthe state capitol of Topeka. Since the late 1860s,the reservation covered an area of 18 sq km as aresult of a series of “treaties” that ceded largetracts of land to railroad companies (Mitchell1997:15; Trombley 2001:2). The population onthe reservation during the early decades of thetwentieth century remained relatively constantat approximately 650 people. An additional 150people not living on the reservation were listedon the tribal roll during this time (Clifton1998:410).

By the time of the “Pottawatomie IndianSurvey,” the Dawes Act of 1887 had been work-ing for four decades to break up the more collec-tive, tribal Indian communities of the U.S. ThisGeneral Allotment Act attempted to end the ten-dency for a tribe to hold land collectively and toestablish individual tribal members as indepen-dent, land-owning farmers. Through the 1920s,

federal policy empha-sized assimilation of In-dian people into thelarger U.S. society withpreferred private owner-ship of land, intensivefarming, and the inde-pendent, nuclear familyhousehold as the basisfor living arrangements.The Dawes Act andother laws like it werepart of a concerted effortto discourage all aspectsof Indian culture and toencourage the adoptionof Euro-American idealsof subsistence, politics,social structure, and landownership (Clifton1998:422).

By 1928 the tradi-

Figure 2. Group photo. The Surveyors criticized certain peoplein this photo as being users of peyote.

Figure 3. Home on the reservation described as poor.

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tional social structure of the Potawatomi had shiftedand looked more like the Euro-American structure,emphasizing generational marriage and bilateral kin-ship. Indeed, the Potawatomi were living in some-what isolated, nuclear family-based homesteads atthe time of the survey. This was in contrast to thetraditional Potawatomi social structure that waspatrilineal and clan-based, and viewed the extendedfamily village as the primary social unit (Clifton1998:427).

White agents for the Potawatomi saw this kindof change as very positive and wanted to accentu-ate the “progress” made. Along these lines, AgentGeorge L. Williams coordinated the developmentof an annual Potawatomi fair that featured “achieve-ments” in agriculture and development among thetribe. For Agent Williams, the fair publicly demon-strated that assimilation among the Potawatomi wassucceeding in a manner consistent with the rest ofnon-Indian agricultural Kansas (Clifton 1998:416).

White tribal administrators did have some suc-cess in suppressing the traditional rituals, language,and lifestyle of the Potawatomi. During the first 30years of the twentieth century, officials noticed agreatly diminished practice of old cultural ways.However, these officials were unaware of the factthat many of the traditions were still being prac-ticed in private, or that the Potawatomi had placeda Euro-American façade on parts of their lives(Clifton 1998:415). While living in nuclear familyhomesteads, for instance, many of the householdscontained numerous extended family members.Also, many of the tribal members were involved intraditional religious practices such as the DrumDance and the Peyote Cult. Others still functionedas shamans, and belief in the powers of “MedicineBundles” and membership in Bundle societies waswidespread (Landes 1970:56). Agents tended tohave more contact with those Potawatomi that weremost assimilated and thus, what agents observedand what was actually taking place were not com-pletely consistent.

The adoption of farming by Indians was seenby government officials as being paramount to In-dian assimilation. These officials believed that landstewardship and farming would lead to the break-down of the tribal system, and at the same timecure many of the illnesses from which the Indians

disproportionately suffered. Commissioner of In-dian Affairs Cato Sells wrote that proper nutritionwas among the most important factors in prevent-ing disease (Office of Indian Affairs 1919:28). This“proper” nutrition was believed to be provided byintensive agricultural activities, which whites be-lieved to be a superior mode of subsistence to thattraditionally practiced by Native American popula-tions.

The farming adaptation during the first 25years of the twentieth century was relatively pro-ductive for many Potawatomi, showing some suc-cess by 1925. Agent and commissioner reports atthe time portrayed the Potawatomi adoption ofEuro-American agricultural methods as being a re-sounding success. In reality though, the DawesAct encouraged Native American populations toadopt U.S. family farm practices just as family farm-ing in the U.S. was on the decline. Agribusinesswas developing across the U.S., and many Ameri-cans, unable to continue farming due to financialreasons, were leaving their farms and moving tothe growing cities. Thus, in the name of assimila-tion, the government was coercing the Native Ameri-can population into adopting a lifestyle that wasfading into history (Clifton 1998:422).

By the latter part of the 1920s, farming opera-tions on the Potawatomi reservation were smallsubsistence schemes that had not incorporated thelatest mechanical and technological advancementsinto their operations. The nineteenth century farm-ing techniques pushed upon the Potawatomi ren-dered them unable to compete with the agribusinesstransformation. In addition, many Potawatomifarmed or pastured only a part of their land. Almosttwice as much of the land that they owned wasleased to Kansas farmers and ranchers at low rates.Many other Potawatomi had resorted to selling offtracks of their land for cash, a good indication thattheir agricultural activities were not providing thecapital necessary to sustain them. Such was thesituation in which the Prairie Band Potawatomifound themselves just prior to the Great Depres-sion (Clifton 1998:417).

METHODSPhotostat copies of the surveys and the find-

ings of the KSBH are housed at the National Ar-chives in Washington, D.C. The forms are listed

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with the Records of the Bureau of Indian Affairs(BIA), Record Group 75, 1793–1989, and specifi-cally catalogued under Records of the Health Divi-sion, 75.14.4. A blank copy of the survey form isshown in Figure 4. The form utilized Roman numer-als, Arabic numbers, and lowercase letters to dif-ferentiate survey questions. Those designationsare used below in parentheses to refer to the spe-cific question on the form.

The survey itself was conducted by KSBH rep-resentatives between June 14th and September 8th.They spent 26 days visiting approximately 125homes. In some cases, household members couldnot be contacted at home, and were met by thesurveyors elsewhere.

Names and ages of individuals in the house-hold were recorded (I, II, III). In addition, the “Per-cent of Indian Blood” was recorded for the motherand father of the household and their status asliving or deceased was noted. A genealogy of In-dian ancestry was not done, so the percentage was

based on what the individuals believed their levelof Indian ancestry to be. From the percents pro-vided by the surveyors for the mother and father ofthe household, individual blood quantums werecomputed for children, assuming that the childrenwere indeed the biological children of both par-ents. Sex of individuals was not explicitly recordedon the survey forms, other than for people identi-fied as the mother or father of the household. There-fore, we determined sex primarily by the gendermost likely associated with the first/given name ofthe individual. In cases where the name was notindicative of one sex or the other, sex was not as-signed.

The primary occupation of the head of the fam-ily was recorded by the surveyors (IV). The occu-pations of other wage earners in the householdwere also recorded (V). The number of people inthe household who were able to read and writeEnglish was recorded (VI). Often times it was notedin this space who in the household could and could

Figure 4. Potawatomi health survey form, 1928.

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not speak English. Our income groupings were de-veloped from the short descriptions of “Total An-nual Income of Family” (VII) recorded by the origi-nal surveyors. Sometimes surveyors entered anincome, other times they would simply make a state-ment such as “meager” or “well-off”. Based on thevarious descriptive and/or monetary responses re-corded by the surveyors, we produced incomegroups of “good”, “fair”, and “poor.” These wereused primarily to determine what impact annual in-come might have on the other social and diseasevariables.

As stated above, in some cases the surveyorsmet with the head of the household or family some-where other than at their home; thus, not all homeswere evaluated as to their sanitary condition. Forhomes that were visited, the surveyors simply chose“good”, “fair”, or “poor” for sanitary condition (VIII2 a, b, c), and often no other description was given.The number of beds available was recorded (VIII 3a). Ventilation (VIII 3 b) was generally not recordedon the survey form, though it was noted in thesummary. Homes were also surveyed as to the useof individual towels among people in the house-hold (VIII 4). This was primarily recorded on theform as a yes or a no. Additionally, the surveyorsnoted the type and location of bathroom facilitiesamong the households, whether or not these facili-ties were protected from flies, and if these facilitiesmight be contributing to soil pollution (IX 1, 2).Drinking water quality was determined by examin-ing what the surveyors wrote with regard to thesource of water, the location of the water sourcerelative to contaminants and runoff, whether or notthe water was protected from contamination, andwhether the water had ever been tested (X 1, 2, 3).Much of the pertinent information was recorded inthe “Remarks” section under “Water Supply”. Wecategorized the water quality as “good” or “poor”based on the information recorded by the survey-ors.

“Family History” recorded the name or rela-tionship, age, and cause of death of family mem-bers (XI). Current health problems, the sufferer’sname, and marital status were recorded for livingmembers of the household (XII). The frequenciesof various diseases and conditions were tabulatedfrom question XII. We also calculated a variable

that was the sum of the number of diseases perhousehold that excluded the following most com-monly reported conditions: tuberculosis, pneumo-nia, measles, “chest problems”, “heart problems”,goiter, rheumatism, trachoma, and “other eye prob-lems”. An additional variable was calculated thatequaled the total number of diseases per house-hold (each illness reported = 1), divided by the num-ber of residents of the household. This gave a mea-sure of the number of diseases experienced by ahousehold, independent of the number of peoplein the household. Serious illnesses experienced inthe past five years were recorded (XIII), as wereany bouts with tuberculosis (XIV). Availability ofmedical (XV) services, as well as dental, nursing,and midwifery services (XVI) were recorded by thesurveyors.

A survey of the food intake was conducted bythe KSBH (XVII). This was a listing of the “dailymenu” for the household. The survey itself wasvery incomplete and inconsistent across house-holds. The frequency of food intake was usuallyonly recorded for milk and meat. No attempts weremade by the surveyors to record the amount offood eaten, so a caloric analysis was not feasible.Macronutrient (those providing calories) analysiswas conducted by evaluating the foods listed foreach household. In some cases, surveyors onlydescribed the diet as “good” or “general”, with noindication as to what specifically was being eaten.

For the purposes of our analysis, groupingswere developed based on whether the householdhad an adequate or inadequate supply of a particu-lar food type (meat, milk, fruits, or vegetables). Theavailability and frequency of milk and meat con-sumption were recorded. For milk consumption, wefound that households generally either had accessto milk, or they did not. Thus, two groups wereconstructed based on whether milk was “available”or “unavailable”. With regard to meat intake, threegroups (“frequent”, “intermediate”, and “seldom”)were constructed. Households that had meat ev-eryday were placed in the “frequent” category;those that reported having meat at least once aweek to every other day were placed in the “inter-mediate” category; and those who consumed meatless than once a week were placed in the “seldom”category. Fruit and vegetable intake was also cat-

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egorized as “available” or “unavailable”, based onthe data recorded for the daily menu.

Retrospective analysis of the macronutrient(protein, fat, and carbohydrate) proportions of thedaily menus was calculated using computer soft-ware. Mosby Nutritrac for Windows Version 1.0was used to provide the macronutrient content ofeach food listed because it provided the relativeprotein, fat, and carbohydrate contents of foods.As macronutrients generally provide 100 percentof the calories consumed, it was possible to deter-mine the relative contribution of each macronutri-ent to the overall diet. This provided a basis foranalysis of dietary variation. Alcohol can also pro-vide calories and thus act as a macronutrient, butthe surveyors did not record alcohol intake as apart of the survey.Statistics

Univariate statistical methods have been usedto preliminarily determine what survey and dietaryvariables are most likely to be associated with orcontribute to particular health conditions. Correla-tions and basic descriptive statistics have beengenerated. Kendall’s coefficient of rank correlation(tau-b), a non-parametric measure of correlation, isused to determine the relationships between vari-ables and to establish what factors might contrib-ute most to the observed health conditions. TheKendall’s tau statistic may be positive (as the valueof one variable increases, the value of the secondvariable also increases) or negative (as the value ofone variable increases, the value of the secondvariable decreases), providing information on thedirection of the correlation. Kendall’s tau is bestsuited for categorical and non-parametric data, asmost of these data are. Biological variables avail-able for analysis are the degree of Indian blood ofindividuals and householders, age, and sex. Socio-cultural variables examined are income groupings,household size (number of people living in thehome), number of available beds per person for thehome, water quality, and sanitary conditions. Theseare environmental variables that reflect the socialliving conditions of the reservation. Disease con-ditions that have been tested for correlation aretuberculosis, pneumonia, measles, chest problems,heart problems, goiter, trachoma, eye disorders,rheumatism, and a variable that groups all other

conditions collectively. Surveyors describe theseas the health conditions most recently experiencedby the Potawatomi family members. Aspects of dietare analyzed for correlation with other variables,and are grouped into the macronutrients (carbohy-drates, fat, and protein). Some variables correlatewith many of the other variables, making it difficultto determine the true relationships between vari-ables. Thus, partial correlation coefficients havebeen computed for some variables in order to re-move the influence of other variables and secure abetter statistical relationship between the variousmeasures.

Because much of the data were categorical,contained missing values, and were non-paramet-ric, the data were first standardized by subtractingthe mean from each observation and dividing bythe standard deviation. Then a form of principalcomponent analysis was used to display the datain a few dimensions by constructing a correlationmatrix whose elements were the correlations thatwere determined by first running the data withoutmissing values. Thus, instead of utilizing the rawdata, the correlation matrix was used for final analy-sis. Once the coefficients for the axes were deter-mined, varimax rotation was used to maximize thecalculations of scores on the axes. Variables thatdid not load on a particular axis were removed so asto calculate scores for more individual observa-tions (Hill and Lewicki 2007). The structure was runseveral times with various numbers of factors toextract until a final model was decided upon. A varia-tion of the Kaiser Criterion was used to determinethe number of factors to retain (Kaiser 1960). Ro-tated factors with eigenvalues greater than 1.5 wereretained, indicating that a factor extract had at leastas much as 1.5x the equivalent of one original vari-able. Variables with a communality of less than 0.1were removed due to having little impact on themodel. The variables from these factors were usedto construct a general linear model.

The general linear model extends the multipleregression model by increasing the number of de-pendent variables that can be analyzed. The gen-eral linear model is expressed as YM = Xb + e whereY and M are a matrix of coefficients defining thelinear transformation of the dependent variables, Xrepresents the predictor variables, b is a column

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vector of 1 (for the intercept) + an unknown num-ber of regression coefficients, and e represents eachunknown residual value. Wilks’ Lambda {ð[1/(1+ëi)]} is used to test the significance of the modelusing a critical value at the p = .05 level. Covariatevariables are included to increase statistical powerbecause they do account for some variability (Hilland Lewicki 2007). Minitab version 10x is used formost statistical analyses because it allows for aprincipal components factor analysis with varimaxrotation, and provides the relevant output statisticfor the general linear model. This version of Minitabproduces parametric Pearson correlations by de-fault, so SPSS version 17 has been used to calcu-late Kendall’s tau correlations.

RESULTSThis section examines the relationships be-

tween the variables with regards to the environ-mental (sanitary and living) conditions, biological/demographic parameters (blood quantum, age, sex),causes of diseases and deaths, available healthservices, and dietary intake for the reservation resi-dents. Basic statistical results are first presentedfor the various categories of variables. Correlationsbetween the variables and the multivariate analy-sis follow.

Living ConditionsHealth information was provided for 784 living

individuals from 125 households (Table 1). Amongthe 445 children (included the adult children of thehousehold’s parents) on which information exists,only 342 were regularly living on the reservation.Many attended off-reservation boarding schoolssuch as Haskell Institute or Genoa Indian School.Others had relocated off the reservation in searchof work in cities.

The mean number of people per householdwas 5.5. The average house had just over four roomsand only 2.6 beds. One home had a sleeping porch.“Beds” could be regular beds, cots, hammocks, ordavenports. Given the number of people per house-hold and the average number of beds, it was obvi-ous that some people had no bed on which to sleep.The surveyors reported that a number of people inseveral households had to sleep on the floor.

The majority of Potawatomi heads of house-hold identified farming as their primary occupation

(Table 2). The next most common method for mak-ing a living among the Potawatomi was to rent theirland to white farmers and ranchers. KSBH survey-ors recorded some information on family income(Table 3). Income groupings were developed fromthe short descriptions recorded by the original sur-veyors. Income could be described as good for 32of the households, fair for 23, and poor for 51 ofthem. Out of all 125 households surveyed, at least40 percent could be considered economically pooror disadvantaged, compared to the otherPotawatomi. In the surveyors’ summary, they statedthat over half of the Potawatomi considered them-selves poor, and that the average annual income of73 families was approximately 100 dollars. Theycharacterized four families as being “well fixed” and48 as having comfortable incomes. Unfortunately,because this information was given as a part of thesummary, there was no indication which familiesfell into which categories. Also, this summary in-formation was not consistent with how data wererecorded on the survey forms.

Sanitary ConditionsDeterminations were made with regard to the

sanitary condition of the household. Surveyorsevaluated the housing as good, fair, or poor. Littleinformation was provided regarding the criteria thesurveyors used for making their determination.Evaluations were made on 96 of the homes. Seven-teen were evaluated as “good”, 35 as “fair”, and 44and “poor” (Table 3).

The KSBH surveyors made note of the qualityof drinking water at each household. The majority(106) of the households obtained water from wells(Table 4), most of which were hand-dug. Only twohad running water in the home. Six households uti-lized natural springs for water. One household uti-lized a cistern for water. No details of the nature ofthe cistern were recorded, though it was likely noth-ing more than a pit dug to collect rainwater. Thesurveyors did note that there was no filter for thecistern. A number of households did not have theirown source of water. Among these, several obtainedwater from their neighbors. The surveyors exam-ined water quality primarily by noting the source ofwater, the location of the water source relative tocontaminants and runoff, whether or not the waterwas protected from contamination, and whether the

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Table 1. General Demographics of the People Surveyed.

Parameter StatisticNumber of households surveyed 125.0Number of living individuals on the survey 784.0Number of males 375.0Number of females 364.0Mean age 26.1Mean number of people per household 5.5Mean number of rooms per household 4.1Mean number of beds per household 2.6

Table 2. Occupations

Occupation of Number Percent Occupation of Others Number Percenta

Head of HouseholdFarming 79 63 Farming 8 42Rent land 23 18 Rent Land 3 16Labor 17 14 Labor 7 37Ranch hand 2 2 Ranch Hand 1 5Trucking 2 2Carpentry 1 1Agency 1 1a Percent based on 19 total people.

Table 3. Income Groups and Sanitary Conditions.

Income groups Number Percenta

Good 32 30b

Fair 23 22b

Poor 51 48b

Sanitary condition of housing Number Percenta

Good 17 18b

Fair 35 37b

Poor 44 46b

a Percents based only on those households in which an income group could be assigned (n = 106).b Percent based only on those households in which a sanitary condition was determined (n = 96).

Table 4: Household Water Sources.

Source Number Percent of Total Water Qualitya

Good PoorWell 106 85 33 39Spring 6 5 0 5Plumbed 2 2 2 0Cister 1 1 1 0Total 115 93 36 44a Water quality could only be determined for 80 homes, thus the totals for water quality for each source do notadd up to the total by source.

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water had ever been tested. The surveyors did nottest the water themselves. Based on what they re-corded, household water quality could be describedas either being adequate or poor. Among thosehouseholds in which a water quality determinationcould be made, more than half had a poor supply ofdrinking water. A poor supply of drinking waterwas most often due to one of two things: either nocover to protect the well from contaminants, or thelocation of the well. The surveyors criticized wellsin low-lying areas vulnerable to collecting waterrun-off, and wells located in close proximity to barnsor animal pens, where waste contamination wasmore likely.

Also of interest to the surveyors was the na-ture and sanitary condition of the toilet facilities(Table 5). Ninety-eight (78 percent) households hadoutside privies. The surveyors recorded 16 “no” or“none” for the “Outside privies?” question. It wasnot immediately clear what this meant with regardto toilet facilities, whether they had indoor plumbedfacilities or no facilities at all. Only two householdsreported having water piped into their homes, andboth of these households had outdoor privies.Given the rural and economically disadvantagednature of the area, it is most likely that those hav-ing no outside privies had no other specific toiletfacilities, other than nature itself. It is likely thathouseholds in which nothing was recorded for the“Outside privies?” question also had no toilet fa-cilities. Most (81) of the outhouse facilities werenot protected from flies. Only 12 households re-ported the use of lime in the toilet facilities. Eighty-one of the 125 households reported not havingindividual towels for each member of the home.Only two homes had individual towels for eachmember, and one home reported having one per-son that had his own towel. No answer was ob-tained for 41 households.

Biological/Demographic VariablesThere were 375 males and 364 females included

on the survey forms (Table 1). Sex was not recordedand thus could not be determined by given namefor 45 people. Mean age of the people surveyedwas 26. The age distribution (see Figure 5) showsthat the population was primarily young. Indianblood quantum of those surveyed is shown in Fig-ure 6. The largest percentage (34 percent) of res-ervation residents falls into the category reflectingthe highest Indian blood quantum, 0.8 – 1.0.

DeathsIndividuals were asked about the cause of

death of deceased family members. Deaths werereported for 370 family members. These family mem-bers were usually the parents of the heads of house-hold, spouses of the heads of household, or chil-dren. It is possible that many of the deaths werecounted more than once, since the name of thedeceased was often not included. For example, ahousehold mother’s deceased father might simplybe recorded as “maternal father.” Without a gene-alogy of the surveyed families (which was not done),it is difficult to say how many siblings living indifferent households reported on the deaths oftheir parents.

Cause of death was unknown to the familiesfor over a quarter of the deaths reported. Amongthose deaths to which a cause could be attributed,tuberculosis was most often cited, followed bypneumonia, accidents, childbirth, and heart prob-lems (Table 6). Distinctions were not made as to thenature of the tuberculosis infections (lung, gland,bone, and so forth), cause of accidents, or types ofheart trouble. The mean age at death for thosewhose ages were reported was 35.

As a part of their summary and conclusions,the KSBH surveyors discussed the numbers andcauses of death among the Potawatomi for 1926and 1927. No indication was given as to where they

Table 5. Toilet Facilities.

Descriptor Number Percent of TotalOutside privies 98 78Pits dug 82 66Use lime 12 10Protected from flies 11 9

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collected this information. They stated that therewere 28 deaths and listed the causes of death inorder of their prevalence. The most common causegiven was tuberculosis, followed by pneumonia,heart trouble, stillbirths, starvation, nephritis, sui-cide, and cancer. No figures were provided as tohow many died from each cause.

The data from the survey forms and the KSBHsummary agree that tuberculosis and pneumoniaare the most common causes of death among thePotawatomi at this time. Heart problems are also

among the top five forboth sources. Unique tothe summary are deathsdue to stillbirths andstarvation. The dataforms record stillbirths as“died at birth” and thereare nine cases. Thisranks seventh amongcauses of death listed onthe survey forms. Thereis no indication that a re-port on the survey formof “childbirth” meant“stillbirth” as it was men-tioned in the summary.The survey forms clearly

indicate who died in childbirth, and thatit was the mother giving birth who died,not the child. Starvation is never listedas a cause of death on the survey forms,so it is difficult to say anything sub-stantial with regard to its frequencyother than to report what the survey-ors wrote in their summary.

DiseaseAmong the illnesses and health

conditions that the living people com-plained of (Table 7), eye disorders aremost often mentioned, accounting foralmost a quarter of all reported condi-tions. This category consists of peoplewho reported having trachoma (3), soreeyes (8), blindness (8), and eye prob-lems in general (23). It is likely that tra-choma was the principal cause of many

of these complaints. Only one home reported hav-ing trachoma and general eye problems, hintingthat for the rest of the households these could havebeen the same malady, only reported differently,perhaps by different surveyors. There is no certainway to tell, however. Thirty-four (>27 percent) ofthe 125 households reported experiencing someform of eye problem.

Enlarged thyroid gland or goiter was the nextmost often reported malady, followed by tubercu-losis, heart problems, and rheumatism. Of the 24people reportedly suffering from enlarged thyroid,

Figure 5. Potawatomi age distribution, 1928.

Figure 6. Indian blood quantum distribution, 1928.

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23 are female and the sex of the 24th person is notindicated on the survey and could not be assignedbased on the first name.

A number of people are reported having lungor chest problems, but no other information is pro-vided as to the person’s condition. Thus, it is diffi-cult to say whether these conditions were due totuberculosis, heart trouble, pneumonia, bronchitis,or several other illnesses that manifest these symp-toms, perhaps leading to an underestimation of thefrequency of these illnesses.

The prevalence of disease reported in the sur-veyors’ summary is inconsistent with the recordeddata. In their summary, they report 14 active casesof tuberculosis, 19 suspected cases, and 27 ob-served cases. The summary lists 28 households ashaving someone with an enlarged thyroid, a fewmore cases than what the surveyors recorded ontheir forms. The number of people suffering fromdiseased eyes is not given in the summary, but thecondition is mentioned as being very common.Despite the discrepancies in numbers for the firsttwo conditions, there is consistency between thedata and the summary in that they both indicatethat eye problems, goiters, and tuberculosis arethe most problematic diseases among thePotawatomi at this time.

KSBH surveyors asked about the incidence ofserious illness experienced by the household mem-bers in the past five years. Tuberculosis was most

often cited, followed by pneumonia and typhoid,then influenza and smallpox (Table 8). Scarlet feverand Bright’s disease, an often chronic inflamma-tory disease of the kidneys, were also reported.Data for this survey question may have been inad-equately recorded, given that the number of seri-ous outbreaks of tuberculosis (9) listed here ismuch less than the number of people suffering fromtuberculosis (19) at the time of the survey.

Health Care ServicesMany Potawatomi did not have medical ser-

vices available to them. The Potawatomi had topay for any health care services they received, andthe cost made utilizing such services prohibitive.Those that did seek medical assistance did so onlyout of extreme necessity. The number of house-holds that utilized health services is shown in Table9. The categories of health care refer primarily tothe profession of the individual providing services.Approximately 25 percent of households that re-ported having midwife services did not have thisfor every birth. Only about half of the surveyedhouseholds were able to utilize any health care ser-vices.

DietThe surveyors seemed most preoccupied with

documenting three foods in particular: milk, butter,and meat. They also emphasized to a certain extentvegetables, particularly greens. They described the

Table 6. Five of the Most Often Reported Causes of Death Where the Cause Was Thought to Be Known.

Cause Number Percent of CausesTuberculosis 48 13Pneumonia 43 12Accidents 22 6Childbirth 18 5Heart problems 15 4

Table 7. Five of the Most Often Reported Health Problems/Illnesses.

Condition Number Percent of Conditions IncidenceEye problems 44 24 5.6%Enlarged thyroid/goiter 24 13 3.1%Tuberculosis 19 10 2.4%Heart problems 14 8 1.8%Rheumatism 12 7 1.5%

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meals of the poorest Potawatomi as consisting ofdried beans, rice, potatoes, bread, and syrup, withcabbage, corn, tomatoes, wild berries, and grapesavailable in the summer.

Almost half of the households consumed vir-tually no milk (Table 10). Reportedly, this was dueprimarily to the cost of buying milk. Among thehouseholds that did have milk, 22 kept cows, and18 bought milk on a regular basis. Several house-holds reported having milk only “occasionally”.The surveyors stated that the Indian children were“unusually fond” of milk. Whether this was evi-dent to them from their survey or something theyhad heard about Indian children is not clear. Overhalf of the families (59) utilized no butter.

Most of the families had at least a variable

supply of meat. No indication of the source of meat,whether beef, pork, goat, wild game, etc., was given.Consumption of bacon and chicken was recorded,though very few families were reported as havingeither meat regularly. Only 16 of the householdswere considered as seldom having meat (Table 10).Most families had meat at least once a week, andmany (28) had meat every day. Meat intake was notspecified for 24 households. Of these, only threehad no dietary information whatsoever. Thus, itwas possible that the remaining 21 households sim-ply didn’t have meat available to them, and that thelack of meat was not recorded. Given the menu de-scribed by the surveyors for the poorestPotawatomi, it is likely that this was indeed thecase.

Table 8. Most Common Serious Illnesses among Households within the Last Five Years.

Condition Number Percent of TotalTuberculosis 9 32Pneumonia 5 18Typhoid 5 18Influenza 3 11Smallpox 3 11

Table 9. Health Care Services.

Service Number Percenta

Medical 67 54Midwife 67 54Dental 44 35Nursing 6 5a Based on the total number of households, 125.

Table 10. Dietary Intake in 1928.

Intake Number Percent of TotalMilk available 65 52Milk unavailable 60 48Meat intake frequent 28 28a

Meat intake intermediate 57 56a

Meat intake seldom 16 16a

Vegetables available 60 49Vegetables unavailable 64 51Fruits available 19 15Fruits unavailable 106 85a Percents based only on those households in which meat intake was recorded (n = 101).

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Just over half of the households consumedfew or no vegetables (Table 10). Few families ategreens or spinach. The most commonly consumedvegetables were cabbage, tomatoes, green beans,lettuce, onions, corn, and peas. The source of thesevegetables was often a household garden duringsummer, thus these foods were available only inseason.

Consumption of fruit was even less frequent.Only 19 households had any real access to fruit(Table 10). Like vegetables, fruit was available onlyseasonally. Among households that did have fruit,frequency of consumption was reported as beingoccasional at best. Gooseberries, wild berries,apples, grapes, and raisins were among the fruitseaten.

No analysis has been conducted with regardto the amounts of various foods being consumed.It is unlikely that the portions being served werevery large. Given the foods recorded, it is possibleto calculate the proportions of macronutrients pro-vided in the diet. Based on the surveyors’ data, itappears that the poorest Potawatomi ate primarilydried beans, rice, potatoes, bread, syrup, cabbage,corn, tomatoes, wild berries, and grapes. This dietwould have been very high in carbohydrates, con-tributing close to 80 percent of the total caloricintake. Protein (~14 percent) and fats (~8 percent)make up only about 22 percent of the caloric intake(Table 10). As can be expected, carbohydrate andfat intake are correlated with income (Table 11). Fatintake is increased and carbohydrate intake is de-creased among the higher income households.

For all of the Potawatomi surveyed, dietaryintake of macronutrients was less dominated bycarbohydrates. Mean carbohydrate intake as a per-cent of total energy intake was 45.8 percent. Meanprotein intake was 27.5 percent of total intake, andfat contributed 26.7 percent of the total.

Correlations between VariablesThe most highly significant correlated vari-

ables are shown in Table 11. Pneumonia and measleshave a high positive correlation, and pneumoniasufferers tended to be younger. The total illnesseshad high positive correlations with sanitary condi-tions and privies being protected from flies, and anegative correlation with Indian blood quantum.Tuberculosis is associated with having someone

in the home with the diagnosis, as well as with thenumber of beds available per person. Indian bloodquantum is negatively correlated with income andsanitary conditions and the latter two variables arehighly positively correlated with each other.

Environmental variables indicative of sanitaryconditions primarily correlate with each other, andcontrast with blood quantum and income variables.Income is additionally correlated with householdsize, dietary intake, and measures related to theprivy facilities. Water quality is correlated with anumber of variables, but is significantly correlatedwith only one health variable – heart problems.

Dietary intake patterns are correlated with in-come and parental blood quantums. Higher fat andprotein intake are associated with greater income,and a higher carbohydrate intake is associated withlower income. Milk consumption is associated withhigher income, and would have boosted fat andprotein intake. Milk consumption is also associ-ated with lower Indian blood quantum levels.

The percent of “Indian blood” of the father inthe household is positively correlated with the in-cidence of pneumonia, and negatively correlatedwith income, sanitary conditions, milk intake, andthe presence of privy pits. The degree of Indianblood of fathers and mothers in the households ishighly positively correlated. Mothers’ degree ofIndian blood is also positively correlated with theamount of protein in the diet, and negatively corre-lated with income, water quality, sanitary condi-tions, and outhouse use. As expected, individualIndian blood quantum primarily follows the samepatterns as those observed for the parents.

Variables that correlate with household sizeinclude sanitary conditions, income, beds per per-son per household, eye problems, and total ill-nesses. The beds per person variable is correlatedwith the incidence of tuberculosis, total illnesses,the father’s percent of Indian blood, and sanitaryconditions. Sanitary conditions, in turn, are corre-lated with many variables, including income, In-dian blood quantum, and total illnesses.

In addition to the correlations mentionedabove, some diseases show relationships with othervariables. Goiters are correlated with Indian bloodquantum and sex. Tuberculosis is related to thenumber of beds per person and having someone in

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Table 11. Most Significant Correlations between Variables.

IllnessesVariable Correlate Correlation p-valuePneumonia Measles 0.469 <0.001Total illnesses Protected from flies -0.201 <0.001Total illnesses Sanitary conditions -0.196 <0.001Total illnesses Indian Blood Quantum 0.168 <0.001Goiter Sex -0.158 <0.001TB TB in home 0.148 <0.001Total illnesses Income -0.145 <0.001Total illnesses Mother % Indian 0.135 <0.001TB in home Father % Indian 0.134 <0.001Total illnesses Father % Indian 0.134 <0.001Other eye problems Household size -0.115 <0.001Total illnesses Beds per person -0.109 <0.001Goiter Indian Blood Quantum 0.109 <0.001TB in home Indian Blood Quantum 0.104 <0.001Pneumonia Father % Indian 0.107 0.001TB Beds per person -0.102 0.001Total illnesses Lime use 0.102 0.001Rheumatism Age 0.095 0.001Other eye problems Milk consumption -0.105 0.003Pneumonia Age -0.077 0.009Other eye problems Water quality -0.086 0.015Biological Variablesa

Father % Indian Mother % Indian 0.348 <0.001Mother % Indian Water quality -0.279 <0.001Indian Blood Quantum Income -0.248 <0.001Father % Indian Pit dug -0.242 <0.001Indian Blood Quantum Sanitary conditions -0.227 <0.001Mother % Indian Income -0.225 <0.001Mother % Indian Protected from flies 0.223 <0.001Indian Blood Quantum Pit dug -0.222 <0.001Father % Indian Milk consumption -0.218 <0.001Father % Indian Income -0.217 <0.001Father % Indian Sanitary conditions -0.213 <0.001Mother % Indian Pit dug -0.209 <0.001Mother % Indian Sanitary conditions -0.199 <0.001Mother % Indian Outhouse -0.187 <0.001Indian Blood Quantum Total illnesses 0.168 <0.001Indian Blood Quantum Milk consumption -0.166 <0.001Sex Goiter -0.158 <0.001Indian Blood Quantum Water quality -0.148 <0.001Father % Indian Fat intake -0.145 <0.001Mother % Indian Protein intake 0.138 <0.001Mother % Indian Total illnesses 0.135 <0.001Father % Indian Total illnesses 0.134 <0.001Mother % Indian TB in home 0.134 <0.001Indian Blood Quantum Protected from flies 0.117 <0.001Father % Indian Carbohydrate intake 0.112 <0.001Indian Blood Quantum Goiter 0.109 <0.001Father % Indian Beds per person -0.108 <0.001Father % Indian Pneumonia 0.107 0.001

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Table 11. Most Significant Correlation between Variables (continued).

Variable Correlate Correlation p-valueIndian Blood Quantum Outhouse -0.106 0.001Indian Blood Quantum TB in home 0.104 0.001Age Rheumatism 0.095 0.001Mother % Indian Carbohydrate intake -0.084 0.002Age Pneumonia -0.077 0.009Environmental VariablesSanitary conditions Income 0.460 <0.001Household size Beds per person -0.307 <0.001Water quality Mother % Indian -0.279 <0.001Income Fat intake 0.273 <0.001Income Indian Blood Quantum -0.248 <0.001Pit dug Father % Indian -0.242 <0.001Water quality Protected from flies -0.242 <0.001Sanitary conditions Outhouse 0.235 <0.001Income Carbohydrate intake -0.233 <0.001Sanitary conditions Indian Blood Quantum -0.227 <0.001Income Mother % Indian -0.225 <0.001Protected from flies Mother % Indian 0.223 <0.001Pit dug Indian Blood Quantum -0.222 <0.001Income Father % Indian -0.217 <0.001Sanitary conditions Father % Indian -0.213 <0.001Sanitary conditions Protein intake 0.210 <0.001Pit dug Mother % Indian -0.209 <0.001Income Pit dug 0.201 <0.001Protected from flies Total illnesses -0.201 <0.001Sanitary conditions Mother % Indian -0.199 <0.001Sanitary conditions Total illnesses -0.196 <0.001Sanitary conditions Lime use 0.194 <0.001Sanitary conditions Beds per person 0.191 <0.001Outhouse Mother % Indian -0.187 <0.001Income Lime use 0.186 <0.001Income Milk consumption 0.182 <0.001Outhouse Income 0.177 <0.001Income Protein intake 0.174 <0.001Protected from flies Household size -0.170 <0.001Sanitary conditions Household size -0.165 <0.001Water quality Fat intake -0.156 <0.001Water quality Outhouse 0.151 <0.001Water quality Indian Blood Quantum -0.148 <0.001Water quality Carbohydrate intake 0.147 <0.001Household size Total illnesses 0.145 <0.001Income Total illnesses -0.145 <0.001Protected from flies Lime use -0.139 <0.001Household size Income -0.130 <0.001Sanitary conditions Pit dug 0.126 <0.001Water quality Heart problems 0.123 <0.001Protected from flies Indian Blood Quantum 0.117 <0.001Household size Other eye problems -0.115 <0.001Beds per person Total illnesses -0.109 <0.001Beds per person Father % Indian -0.108 <0.001Lime use Household size 0.102 0.001

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the home already suffering from the disease. Tra-choma is not significantly correlated with any ofthe variables but is marginally correlated with diet(positive correlation with carbohydrate, negativecorrelations with fat and protein) and income (-.065,p = 0.053). Age and sex are correlated (0.94, p =0.001); the mean age of females in the survey isbelow 24 and the mean age of males is just over 29.Age is also correlated with pneumonia (-.077, p =0.009) and rheumatism (.095, p = 0.001).

Income and sanitary conditions are highly cor-related with one another, and these variables arethe most often correlated with the other variables.Somewhat surprisingly, illnesses are generally nothighly correlated with socio-cultural variables, butsometimes are correlated with each other. Only the“Total Illnesses” variable which consists of a sumof all the illnesses experienced by the householddivided by the household size, correlates with morethan two socio-cultural variables.

To further investigate the relationship of sani-tary conditions with the other variables, correla-tions have been computed for similar sanitary mea-sures, namely the nature of the toilet facilities, if

pits had been dug for outdoor privies, if lime wasused in the toilet, and if the facilities were protectedfrom flies. Sanitary conditions are positively corre-lated with the presence of an outhouse (which wasused at most households), the presence of a pit forthe toilet, and the use of lime.

A partial correlation controlling for the effectof income on fat intake and sanitary conditionsshows that a relationship exists between the vari-ables regardless of income. The same is true withregard to milk intake and father’s degree of Indianancestry, holding income constant. The relation-ship between the degree of Indian ancestry andsanitary conditions is still significant with the ef-fects of income removed.

Multivariate AnalysesPrincipal components factor analysis shows

the relationships between the variables, and indi-cates which variables have the highest loads onthe various factors (Table 12). Twenty-seven totalvariables have been included in the factor analy-sis. Varimax rotation has produced six factors witheigenvalues greater than 1.5. The first factor re-

Table 11. Most Significant Correlation between Variables (continued).

Variable Correlate Correlation p-valueLime use Total illnesses 0.102 0.001Beds per person TB -0.102 0.001Water quality Milk consumption -0.109 0.002Dietary VariablesFat intake Carbohydrate intake -0.873 <0.001Protein intake Carbohydrate intake -0.767 <0.001Fat intake Protein intake 0.639 <0.001Milk consumption Fat intake 0.286 <0.001Milk consumption Carbohydrate intake -0.280 <0.001Fat intake Income 0.273 <0.001Carbohydrate intake Income -0.233 <0.001Fat intake Sanitary conditions -0.252 <0.001Milk consumption Father % Indian -0.218 <0.001Milk consumption Income 0.182 <0.001Protein intake Income 0.174 <0.001Milk consumption Protein intake 0.168 <0.001Milk consumption Indian Blood Quantum -0.166 <0.001Fat intake Father % Indian -0.145 <0.001Protein intake Mother % Indian 0.138 <0.001Carbohydrate intake Father % Indian 0.112 <0.001Milk consumption Other eye problems -0.105 0.003a Indian Blood Quantum was determined using Father % Indian and Mother % Indian and were thus highlycorrelated at 0.782 and 0.769, respectively.

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Table 12. Factor Analysis of Variables.

Factor Label Diet Blood Quant. Crowd Illness Living Conds. Pneumo/Measles

Variable Factor1 Factor2 Factor3 Factor4 Factor5 Factor6 Comm.TB -0.033 -0.037 0.089 0.366 -0.189 0.028 0.181Pneumonia -0.031 0.075 -0.031 0.038 -0.028 -0.848 0.729Measles 0.078 -0.003 -0.023 -0.026 0.018 -0.817 0.676Heart probs. 0.025 -0.052 -0.271 0.311 0.015 0.079 0.180Goiter -0.047 0.093 -0.036 0.439 0.115 0.012 0.219Trachoma 0.209 -0.019 -0.109 0.205 0.012 0.116 0.112Eye probs. 0.119 0.185 -0.260 0.157 -0.143 -0.047 0.163Rheumatism 0.065 -0.091 -0.369 0.292 0.063 -0.053 0.241Age 0.053 0.056 -0.351 0.030 -0.001 0.215 0.177Income -0.304 -0.320 -0.326 -0.117 -0.458 0.052 0.527Beds/person -0.163 -0.071 -0.601 -0.046 -0.009 -0.133 0.413# in house 0.067 -0.109 0.714 0.275 -0.169 0.050 0.632Total illnesses 0.068 0.264 0.168 0.708 -0.140 -0.041 0.625TB present -0.099 0.155 -0.054 0.450 -0.112 -0.065 0.256Water quality 0.222 -0.422 -0.311 0.158 0.339 -0.070 0.468Sanitary conds. -0.300 -0.262 -0.448 -0.128 -0.442 0.048 0.574Out house 0.059 -0.239 -0.117 0.192 -0.318 0.065 0.216Pit dug 0.094 -0.105 0.177 -0.028 -0.537 -0.049 0.343Fly-free -0.002 0.226 -0.256 -0.477 -0.413 0.065 0.518Use lime -0.023 0.003 0.049 0.202 -0.595 -0.034 0.399Milk available -0.491 -0.256 0.153 -0.056 -0.005 0.059 0.336Carbohydrate 0.963 -0.035 0.103 -0.074 0.016 -0.010 0.945Fat -0.911 -0.027 -0.105 0.009 -0.103 0.028 0.853Protein -0.827 0.124 -0.078 0.161 0.125 -0.020 0.748Blood quantum 0.075 0.893 -0.036 0.140 0.150 -0.015 0.846Father%Indian 0.205 0.650 -0.052 0.186 0.265 -0.041 0.575Mother%Indian -0.113 0.854 0.017 0.047 0.011 -0.013 0.744

Variance 3.1093 2.674 1.8971 1.8122 1.689 1.5144 12.6961% Var. 0.115 0.099 0.07 0.067 0.063 0.056 0.47

flects dietary intake. The second is indicative ofIndian blood quantum measures. The third factorloads variables emphasizing household crowding.The fourth factor emphasizes several illnesses, con-trasted against a latrine free of flies. The fifth factoris a living conditions principal component. The fi-nal factor is definitely a measles/pneumonia princi-pal component.

The variables from these factors are used toconstruct the models tested below using a GeneralLinear Model. Variables used as the dependentvariables (Y) are #illness/home, TB, heart problems,and TB present in the home. Independent (X) vari-ables are carbohydrates, blood quantum, # in house,

and income. The remaining variables with high load-ings (≥0.4) in Table 12 have been designated ascovariates. The model is significant for all predic-tor variables. Income is the strongest predictor withan F = 43.331, followed by # in house (F = 26.091),carbohydrate intake (F = 13.701), and blood quan-tum (F = 3.555).

Individual analysis of the dependent and pre-dictor variables indicates that the predictor vari-ables best predicted the # illnesses experienced ina home as well as the presence of tuberculosis inthe home, with income being the greatest predictor.The number of people living in the home alsostrongly predicts TB present in the home. Diet—represented by carbohydrate intake—best predicts

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heart problems, as well as TB in individuals, sig-nificantly but not strongly.

DISCUSSIONWhile the average per capita income in 1929

was $750 a year for all Americans, the average an-nual income for someone working in agriculturewas only $273 (McElvaine 1984:21). It is unlikelythat many Potawatomi, including those character-ized as having “good” incomes, made more thanthis average annual income. The surveyors’ in theirsummary stated that more than half of thePotawatomi they visited were poor.

Income had a major impact on aspects ofPotawatomi life and having a greater degree of In-dian ancestry generally guaranteed a lower income.The imposition of a foreign lifestyle from the out-side likely caused a less than enthusiastic responsefrom the Potawatomi towards farming. The resultwas a group of people, already starting out eco-nomically disadvantaged, having even less as theywere forced to adopt a subsistence strategy theyknew or cared little about (Clifton 1998:422). Lawslike the Dawes Act placed the Potawatomi in a po-sition to lose their land without adequate compen-sation. The Dawes Act also encouraged Indianpeople to become U.S. citizens. Prairie Band lead-ers vehemently opposed the Dawes Act and at-tempted to thwart its implementation on the reser-vation (Clifton 1998). These leaders fought againstthe breakup of the tribe by resisting the white insti-tutions of education and Christianity, and workingagainst those who supported allotment (Herring1990).

In 1890, against the wishes of the Prairie Band,the reservation was ordered allotted with any re-maining acreage to be sold. Over 800 such allot-ments had been made by 1904. Those who opposedallotment often ignored the orders. But the IndianAgent filed the paperwork in the names of theallottees regardless. Of the allotments made, nearlyhalf of the first 100 were sold to outsiders, effec-tively taking the land out of the hands of the PrairieBand. By the early twentieth century the allotmentprocess was considered completed, and the U.S.government no longer recognized the Prairie BandPotawatomi as a tribe (Clifton 1998; Connelley 1918).Potawatomi land holdings had shrunk leaving themlittle to show for the loss of their land.

Indian Commissioners saw a direct positiverelationship between farming and better health(Putney 1980:138). Commissioner Cato Sells wrotethat farming would lead to better nutrition for theIndians and would be a principle tool of preventivemedicine (Office of Indian Affairs 1919:28). Indeed,there is evidence to suggest that more food andimproved nutrition played a significant role in theeventual reduction of tuberculosis on Indian reser-vations (Putney 1980:140). But the imposition ofthis subsistence strategy upon Native Americansprovided them with foods now implicated in con-tributing to high modern rates of obesity and dia-betes (Neel et al. 1998:45). Farming also tended tokeep them poor relative to other segments of thesociety (McElvaine 1984:21).

A low income contributed to crowded livingconditions, and negatively affected sanitary con-ditions, dietary intake, and the number of illnessesexperienced per household. Some of these variables,in turn, affected not only the total incidence of dis-eases per household, but some particular illnesses.Thus, being poor had a devastating impact onhealth and well-being. The diseases affecting thePotawatomi at the time of the survey were primarilyinfectious. Tuberculosis, pneumonia, measles, in-fluenza, trachoma, typhoid, and smallpox were re-corded or mentioned as infecting the Potawatomi.One non-infectious condition that afflicted manyPotawatomi was goiter. Not normally seen in theU.S. today, goiter is the result of a nutritional defi-ciency. The prevalence of these conditions indi-cates that the Potawatomi in 1928 had not yet be-gun the epidemiologic transition that much of theU.S. population already was undergoing. That is ashift from primarily infectious diseases to primarilychronic diseases. The primary reason for this ap-pears to be poverty.

The National Center for Health Statistics re-ported diseases of the heart as being the numberfour cause of death among the U.S. population in1900 and becoming the number one cause of deathby 1910 (Linder and Grove 1947:253). Between 1900and 1928, tuberculosis went from the number onecause of death in the U.S. to the sixth ranked causeof death. But among the Prairie Band Potawatomi,tuberculosis was the most common cause of deathfor 1926 and 1927, and the most reported cause of

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death on the 1928 survey. The Prairie BandPotawatomi did not resemble other non-Indian resi-dents of Kansas with regard to disease prevalence.In 1928 in the state of Kansas, diseases of the heartwere the number one cause of death. Tuberculosiswas the seventh leading cause of death in Kansas,and even less prevalent than in the rest of theUnited States (Table 13). Among the Prairie Band,heart disease was only the fifth leading cause ofdeath. In Kansas, the major cause of deaths duringchildbirth was puerperal sepsis, which accountedfor less than 1 percent of deaths. Among the PrairieBand, maternal deaths during childbirth were thefourth leading cause of death, and accounted for 5percent of all deaths. Chronic diseases such as heartdisease and strokes had become the top two killersin Kansas, whereas the top two causes of mortalityamong the Potawatomi were still infectious dis-eases, tuberculosis and pneumonia.

According to studies on epidemiologic transi-tion among U.S. populations, by the 1920s circula-tory system diseases had begun to overtake infec-tious diseases as the primary causes of mortality.These studies attributed the transition to bettersanitation, water supplies, and public health pro-grams (Levison et al.1981:92; Omran 1977:35). Mor-bidity and mortality among the Potawatomi in 1929resembled that of most of America in the nineteenthcentury. The better sanitation services, water sup-ply, and public health programs were not beingimplemented on the reservation to the degree thatthey were being applied to non-Indian communi-ties.

The KSBH surveyors investigated the waterquality on the reservation because contaminatedwater can cause such diseases as typhoid fever,cholera, and dysentery. Flies can also spread thesediseases, and as early as 1914, Indian CommissionerSells had instructed superintendents to render allreservation privies fly-proof (Putney 1980:184). Flieshad also been implicated by the Commissioner inthe transmission of trachoma and tuberculosis (U.S.Public Health Service 1913:65), providing the moti-vation for surveyors to note whether or not thetoilet facilities were protected from flies. Despitethe fact that the surveyors judged most of the wa-ter sources to be poor, and that outhouses werenot protected from flies, only a few households

had experienced typhoid fever in the last five years.No cases of typhoid were observed by the survey-ors, nor were there any cases of cholera. Six casesof diarrhea were reported to the surveyors. Thus,the water and toilet facilities could have contrib-uted to the occurrence of illness among thePotawatomi. Yet the incidence of water and wastecontamination diseases was not high, suggestingthat drinking water and toilets were not major con-tributors to disease on the reservation. It is pos-sible that flies could have contributed to the highincidence of tuberculosis and trachoma among thePotawatomi. However, other fly-borne diseaseswere not significantly common, suggesting thattuberculosis and trachoma were being spread byother means, such as crowded living conditions.

Tuberculosis began to pose a significant threatto Indian morbidity and mortality in the nineteenthcentury and continued to do so into the early partof the twentieth century. Confinement on reserva-tions and unsanitary, crowded living conditionscontributed to the high rate of tubercular infection.Along with cholera, dysentery, typhoid fever, andtyphus, tuberculosis has been termed a filth dis-ease (Keller 2002:152). These are diseases gener-ally associated with crowded living conditions, poorsanitation, and urban poverty. As in other Indiancommunities, tuberculosis was a significant prob-lem for the Potawatomi in the late 1920s. Thoughnot an urban population, living conditions for manyof the households could be described as crowded.The mean number of people per household wasgreater than both the mean numbers of rooms andbeds per house. Also, the KSBH surveyors de-scribed the sanitary conditions of almost half ofthe homes as being poor. The income of mostPotawatomi was also well below that of most Ameri-cans. Thus, conditions on the reservation were ripefor tuberculosis. While tuberculosis was commonamong the Potawatomi, it did not vary betweenhouseholds that differed with regard to sanitaryconditions or income. Among the Potawatomi, tu-berculosis was an equal opportunity infectious dis-ease. A possible explanation may be that the varia-tion in sanitation and income was not great enoughto confer protection for some or greater risk forothers. Poor public health resources for all on thereservation may have been a contributor to the

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prevalence of tuberculosis across socio-economicgroups. Health services were utilized by only halfof the Potawatomi households, and most reportedusing these services only when absolutely neces-sary, long after the illnesses had become estab-lished. There was no indication that any kind ofpublic health effort was undertaken on thePotawatomi reservation. It was often the practiceof government officials to utilize Indian boardingschools as settings for teaching students goodhygiene and health practices. It was believed thatthe newly enculturated students would take thesepractices back with them to the reservation andteach their families what they had learned. Thiswas likely the extent of any health education on thePotawatomi reservation. Research suggests thatwhile campaigns such as those of the NationalTuberculosis Association may have succeeded inIndian schools, they failed on the reservations. Infact, more and better food has been implicated incausing the eventual reduction of tuberculosis onIndian reservations (Putney 1980:140).

Tuberculosis is seen more often in homes thathad more overall people. An obvious explanationis that a larger household allowed for a larger poolof people for the disease to be infective. Anotherexplanation is that more people simply increasedthe chance of at least someone in the home con-tracting tuberculosis. Despite the historical rela-

tionship between sanitary conditions and tubercu-losis, sanitary conditions, no matter how they maywere defined by the surveyors, were apparentlynot a factor for tubercular infection among thePotawatomi.

Correlation analysis shows a relationship be-tween measles and pneumonia. No other relation-ship between these diseases and the other vari-ables could be determined. The likely cause of therelationship between these two diseases is the rolethat pneumonia plays as a secondary infectionfollowing a bout with measles. A primary infectionof measles may render an individual’s lungs vul-nerable to a pnuemococcus bacilli infection (Keller2002:124). Thus, there may have been a tendencyamong households that suffered measles infectionsto then experience pneumonia. Some currentPotawatomi elders remember pneumonia as beingamong the most common causes of death. Diseasessuch as pneumonia and tuberculosis would havebeen particularly deadly to an individual alreadyimmunologically compromised by a previous dis-ease.

Trachoma was among the most common afflic-tions among Native Americans in the early part ofthe twentieth century (Putney 1980:141). Eye prob-lems were the most often reported health problemamong the Potawatomi in 1928. Eye problems werereported in a variety of different ways: blind, eye

Table 13. Top Fifteen Causes of Death in Kansas, 1928.

Cause Number PercentDiseases of the heart 2972 14.19Cerebral hemorrhage 2102 10.04Nephritis 1632 7.79Influenza 1472 7.03Other external causes 1061 5.07Pneumonia 1254 5.99Tuberculosis of the respiratory system 644 3.07Diabetes mellitus 376 1.80Automobile accidents 364 1.74Diarrhea and enteritis [under 2 years] 309 1.48Suicide 243 1.16Other puerperal causes 158 0.75Diarrhea and enteritis [2 years and over] 121 0.58Bronchitis 113 0.54Puerperal septicemia 103 0.49Note: Data from Bureau of the Census (1930:350).

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problems, sore eyes, poor eyesight, and trachoma.The only real diagnosis given is that of trachoma;the rest are more similar to a patient’s complaintthan a health professional’s diagnosis. “Sore eyes”is a phrase most often interpreted as trachoma, andthe term was used quite often in the early part ofthe twentieth century. It is possible that trachomawas a principal cause of eye problems. Why thesurveyors were unable to provide this diagnosis isunclear, though it is an additional indication thatthose conducting the survey were neither doctorsnor nurses, and were completely unfamiliar withthe symptoms indicative of the common maladiesof the time and of the population.

The Office of Indian Affairs recognized tra-choma to be a significant health problem by 1908.Trachoma caused irritation and a great deal of painto the eyes of the afflicted, hence the common name,“sore eyes”. The disease is caused by the microor-ganism Chlamydia trachomitis and is communi-cable through eye-to-eye or eye-to-hand contact,use of infected bedding, towels, or handkerchiefs,and flies (Keller 2002:186–187). Trachoma is char-acterized by the appearance of coarse granules onthe inner surface of the eyelids causing great irrita-tion and scarring that can eventually lead to blind-ness.

Given the prevalence of and supposed famil-iarity with trachoma in Indian country, it is quitepossible that “eye problems” also referred to otherdisorders similar to conjunctivitis. This inflamma-tion of the conjunctiva can be caused by viral andbacterial infections, as well as by chemical con-tamination or physical intrusions by dust or debris(Richards and Guzman-Cottrill 2010). Other poten-tial eye disorders recognized at the time includepinguecula, chalazion, and entropion.

The lack of correlation of the incidence of tra-choma and eye disorders with most other variablesmay be due to the fact that eye problems were soprevalent among the Potawatomi that variability inwealth or living conditions was insufficient to pro-tect people from the disorders. Surveyors did in-quire as to the use of individual towels amongpeople, and probably did so due to the alreadyrecognized incidence of trachoma on Indian reser-vations and at Indian boarding schools. Virtuallyno household that answered the question had in-

dividual towels for each family member (3 out of81). This lack of variability may explain both thelack of correlation between eye problems and othervariables and the high prevalence of eye problems.Eye problems are correlated with milk intake (-.105,p = .003) and may reflect symptoms of lactose intol-erance among the population. Lactose intolerancecan cause diarrhea which when severe enough canresult in the loss of vitamins important to good eyehealth. Whether or not this was really the case isonly speculative.

Today, a number of Native Americans sufferfrom eye problems associated with diabetes. Dia-betic retinopathy is a leading cause of blindness,and Native Americans now suffer disproportion-ately from diabetes. Diabetics are 25 times morelikely to suffer from blindness than those withoutthe disease. Diabetes among Native Americans isoften diagnosed in the late stages of the disease,only after symptoms become problematic for theindividual (Gohdes 1995:690).

Among the Potawatomi of 1928, diabetes wasmentioned only rarely and recorded twice as thecause of death of a family member. No one living onthe reservation at the time was diagnosed with dia-betes. However, it is possible that no attempt wasmade to diagnose diabetes, which at the time wouldhave involved an examination of the urine. There isno indication that the surveyors ever went to greatlengths to diagnose any disease. With the popula-tion only rarely able to utilize professional medicalservices, it is likely that more Potawatomi sufferedfrom the disease than were ever diagnosed with it.The high rate of eye disease among the Potawatomimay reflect diabetes becoming more prominentamong the population. Perhaps this is an early in-dicator of diabetes becoming prominent amongNative American populations, in general. Unfortu-nately, the KSBH surveyors also did not bother torecord the height and weight of individualPotawatomi, which would have been a useful indi-cator as to whether or not people suffering fromeye disorders might be diabetic, as diabetes is cor-related with a tendency toward being overweightor obese.

Enlarged thyroids, or goiters, were commonamong the Potawatomi. The condition is due pri-marily to a lack of iodide in the diet (Maberly

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1994:1474S). Other risk factors include being fe-male, over 40 years old, residence in an endemicarea, ingestion of large amounts of goitrogenicfoods, and a family history of goiters. Regions whereiodine concentrations in the soil are low result incrops and wild plants that have low levels of io-dide, thus conferring upon their consumers defi-cient amounts of iodine. Geographical areas withiodine-depleted soil are usually away from the sea-coast. The Great Lakes, Intermountain regions, andthe Midwest are the most iodine-deficient regionsin the U.S. Among the Potawatomi reportedly hav-ing enlarged thyroid glands, all of those whose sexwas recorded or discernable are female. As statedabove, being female is a general risk factor for goi-ters. This is definitely the case with Potawatomifemales.

Goiters can also be caused by goitrogens,which are substances in foods that interfere withthyroid gland function. Goitrogenic foods includeraw broccoli, brussel sprouts, cabbage, cauliflower,cassava, rutabagas, and turnips (Greer 1957:440).Cabbage is one of the few vegetables that was avail-able to even the poorest Potawatomi. Cooking candestroy the enzymes involved in the formation ofgoitrogenic substances in plants, and generallylarge amounts of goitrogenic foods must be con-sumed before thyroid gland function is impaired.Thus, goitrogenic foods are a less probable causeof goiters among the Potawatomi than a simple lackof iodine in the foods they ate. The low iodine con-tent of the Kansas soil resulted in crops and plantsthat were deficient in iodine, leading to goitersamong a number of Potawatomi women. Today,consumption of iodized salt is the primary methodfor avoiding goiters. Iodized salt was not likelyavailable to the Potawatomi at the time of the sur-vey. Research on the efficacy of iodized salt in pre-venting goiters (see Olin 1924, Kimball 1928a, 1928b)had only recently begun and was focused prima-rily in the Great Lakes region.

Food recommendations of the time were basedon USDA food guides originally developed in 1916,and modified slightly in 1917, 1921, and 1923. Theseguides categorized foods into five different types:meats and milk, cereals, fruits and vegetables, fattyfoods, and sugary foods. Recommendations werethat meats (10 percent) and milk (10 percent) to-

gether constitute 20 percent of the total diet. Cere-als, consisting of grains and other starchy foods,were recommended for 20 percent of the total diet.Fruits and vegetables were to make up 30 percentof the diet, and the remainder of the diet was toconsist of fatty foods (20 percent) and sugary foods(10 percent; Davis and Saltos 1999:35).

Modern food recommendations emphasize thecereals group (~41 percent), followed by vegetables(~20 percent), fruits (~15 percent), meats (~12 per-cent), and dairy (~12 percent). Sweets and fats arerecommended to be used only sparingly. The shiftsince the 1920s has obviously been to emphasizecereals and to minimize fat and sugar intake. It isnow recommended that about 55 percent of thediet consist of carbohydrates, 30 percent consistof fats, and 15 percent consist of protein.

The Potawatomi diet on average was 46 per-cent carbohydrate, 27 percent fat, and 27 percentprotein. This is a high protein diet by today’s rec-ommendations. It is believed that the traditionaldiet of many Native American populations was highin protein due to their reliance upon hunting wildgame for food (Price 2003:260). Pre-contactPotawatomi subsistence consisted of maize horti-culture, gathering of a variety of wild plants, andextensive hunting and fishing. Even as corn agri-culture became more complex and productive, meatwas still the primary source of protein and was ad-ditionally valued for ritualistic purposes (Clifton1998:28).

The relationship between the degree of “In-dian blood” of household mothers and protein in-take may reflect a Potawatomi woman’s cultural foodpreferences, and the tendency for more traditionalPotawatomi families to rely on wild sources of meat.Meat was not the only major source of protein forthe Potawatomi on the 1928 survey. Beans, anotherhigh-protein traditional Indian food, were widelyconsumed by the Potawatomi. Wild sources of meathave to be considered as significant given the re-ports of some older Potawatomi who grew up onthe reservation. They have stated that hunting wasa frequent source of food when they were young.Animals hunted include rabbit, squirrel, raccoon,quail, pheasants, prairie chicken, fish, frog, turtle,muskrat, and skunk. These sources of meat seemto have been overlooked by the surveyors. Per-

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haps it is because these wild sources of food didnot fit into the Euro-American scheme of subsis-tence being pushed upon the Potawatomi.

Also not recorded adequately by the survey-ors was the variety of wild plants utilized by thePotawatomi for food. Wild plants mentioned byPotawatomi living at the time included milkweed,wild onions, nettles, strawberries, plums, goose-berries, grapes, chokecherries, pawpaws, blackber-ries, raspberries, dewberries, black walnuts, acorns,hazelnuts, and hickory nuts. Among this list offoods, only “wild” berries, gooseberries, and grapeswere mentioned by the surveyors, and they re-corded very few families as having these foods.Though also not mentioned by the surveyors, manyPotawatomi annually grew, dried, and stored a maizecrop of the traditional type (Clifton 1998:419). Tra-ditionally grown and prepared maize undoubtedlycontributed to the caloric and nutritional intake ofsome of the people. The surveyors did recognizethe contribution of the summer gardens to dietaryintake. Perhaps this was because a garden con-formed to their view of subsistence more than didgathering wild plants or growing traditional foods.

Potawatomi elders report that they usually hadplenty to eat. Only rarely do they recall going tobed hungry. They state that winter months werethe most likely to see periods of shortage, primarilydue to the seasonality of plant foods. The mixedstrategy of hunting, gathering wild plants, and gar-dening supplemented the unreliable and not tooproductive agricultural scheme introduced by Euro-Americans. Despite interference from the outside,the Potawatomi were able to develop a successfulsubsistence strategy that generally supplied themwith the food they needed.

The adoption of the Euro-American style ofagriculture was supposed to provide Native Ameri-cans with a better nutritional intake. Some researchhas suggested that nutrition did play a key role inthe reduction of the incidence of tuberculosis onIndian reservations during the early part of the twen-tieth century (Putney 1980:140), though this con-clusion seems speculative. Dietary intake amongNative American populations on reservations is notwell documented for this time period. Some NativeAmerican populations received food rations of beef,sugar, and flour from the Office of Indian Affairs.

But these rations were being cut during the firstdecade of the twentieth century (Clifton 1998:416).Indian Commissioner Sells’ “Save the Babies” cam-paign during the second decade of the twentiethcentury authorized additional rations, includingsweetened condensed milk, to be given to NativeAmerican mothers to help their children duringweaning. These additional calories may have con-tributed to a drop in infant mortality at the time(Putney 1980:183). Yet while perhaps providingmore calories, rations generally did not provide awell-rounded diet. The Prairie Band Potawatomisupplemented their diets with gathered and huntedfoods, a fact primarily ignored by the KSBH sur-veyors. So it is difficult to say whether the govern-ment-supported agricultural schemes contributedsignificantly to a reduction in illness due to betternutrition. More likely, the Potawatomi were gettinga more balanced diet because they continued toutilize more traditional subsistence activities, andincorporated rations into their diet, thus supple-menting total caloric intake. This was evidencedby a lack of correlation between dietary intake andillnesses such as tuberculosis among thePotawatomi.

The Potawatomi were being pushed to aban-don their traditional ways and to adopt the cultureof the larger U.S. society. This included changes insubsistence and dietary practices. Milk was oneprimary food that the Indians were being encour-aged to adopt. Health officials of the time believedthat a proper diet could prevent illness, and thatdairy products in particular could facilitate recov-ery from tuberculosis (Keller 2002:56).

The surveyors reported that Indian childrenwere particularly fond of milk, when they could getit. Expense was reported as a barrier. That milk con-sumption correlated negatively with the degree ofIndian ancestry of household fathers may reflectthe fact that milk is not a traditional Indian foodand, thus, is not utilized widely in households wherethe father is predominantly Indian. Due to this situ-ation and the cost of milk, only a little more thanhalf of the households had milk available to them.What the surveyors did not know was that up to 80percent of Native Americans are lactose intolerant(Flatz 1987:38). The inability to digest lactose afterinfancy is common throughout many of the world’s

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populations. Without sufficient lactase enzymeactivity, lactose cannot be digested. Symptoms oflactose intolerance include gas, bloating, abdomi-nal discomfort, and diarrhea. The diarrhea can besevere enough to cause dehydration, and expelessential nutrients from the body before they canbe absorbed (Beers 2005:712; Beers and Berkow1999:298). Milk consumption by Indian children andadults could have contributed to a reduction intheir health and rendered them more vulnerable toinfection from other diseases (Keller 2002:57).Among the Potawatomi in 1928, milk consumptiondid not have an impact on the incidence of tuber-culosis, positively or negatively. There is a correla-tion between milk consumption and eye problems,but without more information on the nature of theeye problems, it is difficult to make a definite con-nection between the two variables. Lactose intol-erance that resulted in severe diarrhea could haveimpacted the absorption of nutrients important foreye health, such as vitamins A, C, and E. As statedpreviously however, diarrhea is not reported to bea major condition among the Potawatomi.

Though presented as an assessment of health,the survey was as much about assimilation as itwas about health. In their summary, the surveyorscriticized the Potawatomi for not enthusiasticallyembracing the agricultural lifestyle forced uponthem. Surveyors blamed the poverty seen amongthe population primarily on the Potawatomi them-selves. Criticism was leveled at the managementskills of the Potawatomi men as farmers. Their wiveswere criticized for their level of industry in domes-tic affairs. Children were described as “incorrigible”,and parents were blamed for the lack of disciplineof their offspring. Potawatomi adolescents werecriticized for their immorality and irresponsibility.All of this criticism exposed among the surveyors adeep ethnocentric view of the Potawatomi. It is evenpossible that the relative determinations by thesurveyors regarding the living conditions of theindividual Potawatomi households were biasedagainst those who claimed to have a high degree ofIndian ancestry or appeared to be more traditional.Those Indian people most often viewed by Euro-Americans as able and competent were usuallythose of mixed Indian and European blood (Tyler1973:97, 104).

Euro-American expectations of morality, re-sponsibility, industry, child rearing, and genderroles were different from that of the Potawatomi.Efforts to enculturate Native American populationsinvolved raising children in boarding schools thatsuppressed all things Indian and taught the kidshow to live as whites. “Kill the Indian, save theman” was the philosophy of assimilation (Pratt1973:261). This meant that Indian culture was to bereplaced by white culture, and the replacementwould be complete. Not only was a new subsis-tence method to be forced upon the Native Ameri-cans, they were expected to adopt the social ar-rangements, religion, behavior, and attitudes of thedominant U.S. society (Prucha 1976:5).

But the Prairie Band Potawatomi were not togive up their culture so readily. Always among themost traditional of the various Potawatomi groups,the Prairie Band was not enthusiastic about adopt-ing the white ways. Many continued their old sub-sistence practices as best they could, and also prac-ticed traditional religious and social customs in pri-vate. Adoption of white farming practices was asmuch done for the purpose of appearance as forsubsistence. After generations of learning thatopenly resisting U.S. government wishes was fu-tile, the Prairie Band Potawatomi realized that theycould maintain their cultural identity if they acqui-esced just enough to keep the whites satisfied. Thiswas an adaptive strategy that would allow the Prai-rie Band to maintain aspects of their heritage andidentity throughout future events of the twentiethcentury, when other Kansas Indian tribes were be-ing relocated and/or disbanded.

The subsistence and dietary practices beingpromoted and considered superior by white soci-ety were actually detrimental to the Potawatomi.Already economically disadvantaged due to yearsof subjugation and unscrupulous manipulation bythe U.S. government, attempts to enculturate thePotawatomi into white society only left them at agreater disadvantage as most of the rest of Americamodernized.

The negative effects of enculturation continuetoday. Research in the twentieth century indicatesthat adopting a Euro-American lifestyle has had anegative effect on the health of Native Americans(Price 2003:91). Today, Native Americans suffer dis-

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proportionately from conditions such as diabetesand obesity (National Center for Health Statistics2003:19). Unlike people of European descent, Na-tive Americans have only had two or three genera-tion by which to adapt to the high carbohydrateagricultural diet of the Old World. The diet andlifestyle that was supposed to “civilize” the Indi-ans has in fact caused them great harm. Only re-cently have dieticians and researchers begun torecognize the value of the traditional Indian diet tohealth not only for Native American populations,but for other populations as well.

The foods pushed upon Native Americanswith assimilation are currently viewed as contrib-uting to the high rates of obesity, diabetes, andother chronic diseases found among Indians to-day. These chronic diseases are likely not the onesthat significantly affected the Potawatomi in 1928,but the process that would eventually lead to thesediseases had already begun, and early signs mayhave been apparent. For chronic conditions suchas diabetes, obesity, and gall bladder disease, ge-netics has been implicated as a significant con-tributor (Shaffer 2005; Wendorf 1989). A “ThriftyGene” hypothesis has been presented as an expla-nation for the rapid appearance of chronic diseasesin Native American populations (Neel 1962, 1982).Knowler et al. (1983) cites the Thrifty Gene hypoth-esis in explaining the high rates of diabetes amongthe Pima (Akimel O’odham) Indians. The ability tostore energy as fat in response to cycles of feastand famine would have been an adaptive advan-tage for the ancestral Pima. But this ability is nowseen as a maladaptation, because without the peri-odic famines, the plentiful nature of food todayleads to high rates of obesity, insulin resistance,and diabetes among the Pima. The occurrence ofmultiple conditions in Native American patients hasled to the development of a concept called “NewWorld Syndrome”. High rates of comorbiditiesamong Native Americans such as gallbladder dis-ease, obesity, diabetes, high blood pressure, andhigh cholesterol are seen as being genetic, likelyassociated with lipid metabolism (Weiss et al. 1984).

An alternative to the Thrifty Gene hypothesissuggests that nutritional intake early in life may bea factor in the development of insulin resistance.Studies have directly related low birth weight to

high Basal Metabolic Index (BMI) and central obe-sity later in life (Oken and Gillman 2003). This hasbeen sometimes referred to as the Thrifty Pheno-type hypothesis, or Barker hypothesis. This hy-pothesis proposes that the observed relationshipbetween poor fetal and infant development and theappearance of diabetes mellitus later in life are theresult of inadequate nutritional intake early in life.This nutritional inadequacy causes lasting changesin glucose metabolism, including a reduction in in-sulin production as well as cellular insulin resis-tance (Barker 1994, 1997; Hales and Barker 1992,2001).

Continued research into the Thrifty Genotypeand Thrifty Phenotype hypotheses has led to anew hypothesis that attempts to account for theirlimitations, called the Thrifty Epigenotype hypoth-esis. This hypothesis suggests epigenetic effectsare the links between early prenatal and postnatalenvironmental events and the later manifestationsof disease in adulthood (Stöger 2008). Minorities(Stöger’s study involved African Americans com-pared to whites) suffer from not only a dispropor-tionately high burden of cardiovascular diseasescompared to whites, but also from higher rates ofthe prenatal and postnatal health conditions nowalluded to as the precursors of these chronic ill-nesses. An environmental/social origin to prema-ture births and low birth weight among minoritiesreflects such things as poor prenatal care and theeffects of maternal stress due to discrimination.Considering the correlation between birth weightand cardiovascular diseases in adulthood, epige-netic mechanisms provide the links between pre-natal environmental factors and adult racial healthdisparities in chronic diseases such as diabetes,hypertension, strokes, and coronary heart disease.The socially constructed and imposed racial iden-tities and circumstances influence the developmen-tal process and manifest as biological configura-tions that affect health, and can be passed down tosubsequent generations, maintaining health dis-parities (Kuzawa and Sweet 2009). Whatever themechanism or process, there is no question thatNative Americans in the past suffered from pov-erty and related conditions due to the imposed res-ervation system. Health disparities that persist to-day may be a legacy of past and continued eco-

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nomic disparities.It appears that the KSBH surveyors in 1928

laid the blame of health problems at the feet of thePotawatomi, when in fact the imposition of a for-eign subsistence strategy and lifestyle, and the lackof any public health infrastructure or education weremore contributive to illness among the Prairie BandPotawatomi. In fact, the continuation of traditionalPotawatomi subsistence practices despite theirbeing discouraged by Indian Agents likely buff-ered the Potawatomi from experiencing greater nu-tritional deficiencies and higher rates of diseaseand death.

ACKNOWLEDGMENTSThis study was supported by the Reclaiming a Healthy

History Project, funded by Patton Family Foundation.

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Health Conditions among the Potawatomi Indians of Kansas in 1928

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