Death Stalks the Yakama: Epidemiological Transitions and Mortality on the Yakama Indian Reservation, 1888-1964 (review)

Abstract

Reviewed by: Death Stalks the Yakama: Epidemiological Transitions and Mortality on the Yakama Indian Reservation, 1888–1964 Anton P. Sohn Clifford E. Trafzer. Death Stalks the Yakama: Epidemiological Transitions and Mortality on the Yakama Indian Reservation, 1888–1964. East Lansing: Michigan State University Press, 1997. xiii + 278 pp. Ill. $24.95 (paperbound). This book’s title excites the reader’s interest. The idea behind the author’s research is solid, and his methods of gathering data are impressive. Trafzer bases his work on “Death Certificates, Death Registers, and Birth Registers” (p. 1). Unfortunately, the book is so poorly edited that its value is seriously impaired, if not completely destroyed. In fact, there are unheeded editing marks in the text (p. 110). The data analyzed in the book are presented in forty figures (charts and graphs) in the appendix, which are so poorly titled that many of them defy understanding. For example, there are two charts with the same label, “Leading Causes of Death by Gender for Yakama Children One Year of Age” (p. 227), which have conflicting statistics and indecipherable percentages in the margins. Equally frustrating is the fact that the figures and the text do not always agree. For example, at the top of page 174 the number of tuberculosis deaths is 619; on page 229 (fig. 3.11), the total is 618; in figure 1.3 (p. 219) the number is 615; and on page 220 (fig. 1.4) it is 614. Still other figures omit key words: for example, one is labeled “Yakama Miscellaneous Deaths by Age Group and Gender” (p. 224), and another is “Comparative Rates (per 100,000) for Leading Cause at Ten Year Intervals” (p. 234). This points up another problem: in numerous citations, the text and the figures do not agree. For example, the text states that the crude death rates are per 100,000 (p. 93), and refers to figure 3.12—but figure 3.12 clearly states “per 1,000” (p. 229). Much of the information in the book is interesting and probably valuable. There are comparisons to other population groups, but one has to be cautious about inferring the exactitude of the data since the numbers are flawed. The gender comparisons are of questionable merit, since there is no discussion of relative numbers of males versus females on the reservation. Did more males live off the reservation in order to find jobs in town, and did they therefore die in larger numbers off the reservation than did females? According to the author, these data are being accumulated. In addition to deficiencies in statistical editing, the book also suffers from serious deficiencies in medical editing. The statement, “Cows can also carry tubercle bacteria (mycobacterium. Bovus), and the disease may be transmitted through the milk, although this was not likely a major cause of tuberculosis” (p. 95) implies a causal relationship between human tuberculosis and bovine tuberculosis, which are two entirely different diseases. Also, the proper scientific name is Mycobacterium bovis. More confusing is the author’s explanation that TB acts in two stages, the first usually being an attack on the lungs, and the second being pulmonary TB. The discussion of pneumonia is equally perplexing. Page 97 contains the following statement: “Pneumonia is commonly characterized by inflammation of the lungs, but it includes many other inflammations.” (Pneumonia is, by definition, inflammation of the lungs!). The discussion of heart disease [End Page 342] also suffers from insufficient editing. That poor diet in “pregnant mothers” can result in children with “heart diseases,” and “heart attack was a major cause of death within this category” are statements beyond the comprehension of any informed health-care worker (p. 99). Other conditions of pregnant women are also misunderstood. The statement “hydramnios which is an accumulation of amniotic fluid inside the uterine wall” is completely false (p. 105): hydramnios is an excessive accumulation of amniotic fluid in the uterine cavity. Cancer, not to be denied, is also incorrectly defined (p. 104): the author states that it “can develop in any part of the body and result in a malignant tumor.” (Cancer is a malignant tumor!) These are just a few of the many mistakes that impair this...