Bulletin of the History of Medicine

From the time it emerged as an epidemic in the last decades of the nineteenth century until it had become their number-one health problem in the 1950s, multiple explanations for the etiology of tuberculosis (TB) among American Indians competed for prominence. None was more debated than racial susceptibility—and none held on with such tenacity. Various race-based explanations —Indians’ inherent racial susceptibility, virgin soil theory, and degree of Indian blood—had great explanatory power. These explanations faded from view by the 1950s as a result of epidemiological research begun in the 1930s—research that for the first time filled in many of the pieces of the Indian TB puzzle and allowed TB specialists to know the unknown: who and where the disease struck and why. Combining case finding, X rays, sputum tests—all the modern methods of tracking a TB epidemic—the Bureau of Indian Affairs (BIA) was finally able to understand the Indian TB epidemic. But they also wanted to control it. To this end, the BIA and the Phipps Institute, under the direction of Esmond Long and Joseph Aronson, joined together to begin the first controlled trial of the BCG vaccine.