Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since 1600 (review)

Traditionally, most studies examining the past health of the aboriginal people of the Americas have focused on the spread of infectious disease or on its impact. With this innovative book David Jones changes the focus, placing it on the history of disparities in mortality between Indian and non-Indian people. In essence, he seeks to identify the many ways in which both groups accounted for these unmistakable disparities, and the influence that their beliefs had on their actions. Although others have taken a similar approach, it is Jones's ambitious attempt to search for such meanings across the grand sweep of American history that sets this work apart.

As Jones notes (pp. 11–12), the complex relationships between Europeans, Americans, and Indians, which were shaped in large part by the needs and interests of each group, created a multitude of responses to the health disparities, and these explanations evolved over time. He has selected four case studies, each of which illustrates a different context for his analysis. He begins, logically, with the coming of the first American colonists, and he argues convincingly against the conventional wisdom that these settlers saw the early depopulation of aboriginal people solely as divine intervention to empty the land for their benefit. Instead, he presents a picture of a much more intricate, and evolving, relationship, in which the colonists rationalized epidemics (including those among themselves) by referencing God, natural causation, or both—while the Indians attributed their precipitous depopulation, initially at least, to the influence of the newcomers and their God.

The second case study focuses on a single disease, smallpox, during the eighteenth and nineteenth centuries. By this time, belief in a religious etiology for smallpox had declined in favor of a bewildering array of naturally informed theories, centered on Indian behavior and their environment, which encouraged greater intervention by non-Indians. Such interventions included negative actions—such as the British plan in 1763 to purposefully infect the Delaware and Shawnee around Fort Pitt—but also the positive, marked by the vaccination efforts of the American government in the western regions. Over time, positive interventions became increasingly common.

By the late nineteenth century, tuberculosis emerged as the dominant cause of the mortality gap, and the mortality among the Dakota Sioux due to this disease serves as the third case study. Fueled by a failed government policy in the mid-1870s of enforced economic transition from bison hunting to agriculture, tuberculosis exploded among the Sioux. While Sioux healers turned to traditional etiologies to explain the resultant high mortality, non-Indians placed the blame on the decline of the bison, poor rations and housing, local environmental conditions, the behavior of the victims, or inherited weakness. Critically, and in contrast to government policy in Canada at about the same time,¹ the American government did not universally accept the latter, racially based, explanations, which could have been employed to justify a policy of nonintervention and inaction—instead, government physicians and bureaucrats attempted to combat the disease, accepting some responsibility for the epidemic.

Finally, Jones turns his attention to the health of the Navaho who, as of the mid-twentieth century, continued to suffer terribly from tuberculosis and other diseases due to the failure of the Bureau of Indian Affairs to address the underlying causes of their poor health. From this crisis emerged Walsh McDermott's Health Care Experiment at Many Farms, which sought to test the efficacy of both the new antibiotics and a holistic view of health. Although this program met with mixed success, it was able to demonstrate the limitations of Western medicine in combating the mortality gap, and the value of working in partnership with, rather than in opposition to, traditional Indian understandings of disease and health care. As the author notes in his conclusion, such lessons continue to be critical in the fight against the global mortality gap.

In Rationalizing Epidemics, David Jones demonstrates both considerable...