Tuberculosis was the major cause of death among Alaska Native peoples during the first half of the twentieth century, with a crude death rate estimated at 810 per 100,000. Apart from a few medical articles, not much is known of the impact of the disease on the people. This paper reviews published articles, unpublished reports by government teachers, hospital records and other materials for several Native villages in western Alaska from the period 1900–50. These archival sources suggest that tuberculosis was prevalent at the start of the century, that tuberculosis morbidity and mortality increased until the public health efforts of the 1950s and '60s, and that highest mortality rates were found among women between the ages of 15 and 35. Traditional cultural practices that brought people together for fatiguing activities in confined areas may have contributed to the spread of the disease. Public health efforts of federal teachers aimed to improve personal hygiene, household cleanliness and ventilation. Their efforts were thwarted by environmental and economic factors, primarily the limited amount of wood. Ultimately, the comments of these public officials may have reflected more their own moral beliefs than the actual etiology of the disease.