Medical Diplomacy and the American Indian: Thomas Jefferson, the Lewis and Clark Expedition, and the Subsequent Effects on American Indian Health and Public Policy

The Lewis and Clark expedition was part of a global effort that used imperial medicine to advance colonization and the politicization of Western medicine among indigenous populations.¹ One of the primary goals of the expedition was to gain diplomatic and political access to American Indians through the applications and practices of Western, imperial medicine. The medical program was designed to serve as a diplomatic tool to convince indigenous populations of the United States' power and superiority. Besides gaining diplomatic power, the United States used imperial medicine to forward medical advances and to foster a requisite knowledge of the colonized "other." The Lewis and Clark expedition also carried forward President Jefferson's personal scientific interests and experiments with smallpox vaccinations and sought to expand Western knowledge about all phases of American Indian life. Powerful physicians, politicians, and religious leaders associated with the expedition also used imperial medicine to expedite federal policies that endangered the lives of American Indian diplomats. Native Americans sent back to Washington, D.C., by the expedition were taken into dangerous disease environments that constituted known threats to their health. Failures of the imperial medical program produced a number of untimely deaths and generated long-term armed conflicts that involved Indian nations. Misinterpretations of expedition medical records have produced a number of erroneous assumptions about American Indians and the diseases affecting them in the early nineteenth century, and the records continue to be misinterpreted by members of the Western medical community today.

Imperial medicine, defined as the "practice of European medicine [i.e., Western biomedicine]... as an instrument of empire in colonies established by conquest, occupation, and settlement,"² was practiced as a matter of global colonization before the Lewis and Clark expedition. Reports indicate that as early as 1780, Catholic missionaries used live smallpox virus to inoculate nearly seven thousand Native Americans near Valladolid, Guatemala, and that another sixty to seventy thousand were inoculated in southern Mexico. At this time, inoculation with live virus was the only effective preventive for smallpox. The method involved collecting matter from persons infected with a "mild" case of smallpox and infecting persons susceptible to the disease with this material. While developing immunities to the disease, the recipient developed a mild case of smallpox that was contagious to others.

Inoculation has long been thought to have caused significantly more deaths in Native Americans than it did in non-native populations. Death rates from the inoculations in Guatemala and Mexico, however, were reported within the 2.5 percent range of expected deaths near Valladolid, and only slightly higher death rates were reported in other areas.³ Inoculation with live materials usually reduced smallpox death rates from between 20 to 30 percent to between 0.5 to 2 percent of all cases,⁴ a situation that was very nearly replicated in the inoculated Native American populations. The missionaries, in their zeal to proselytize Native Americans, proved that American Indians were no more susceptible to inoculation-induced deaths from smallpox than were non-natives. The first recorded federal inoculation of an American Indian occurred in 1797, when Chief Little Turtle (Miami) accepted smallpox inoculation from Dr. Benjamin Rush. Confidant of Thomas Jefferson, signer of the Declaration of Independence, and future medical advisor to the Lewis and Clark expedition, Rush inoculated Chief Little Turtle with live smallpox matter at his home in Philadelphia. The Miami chief, on a diplomatic visit to Washington, D.C., stayed at Rush's home where he underwent the inoculation processes.⁵

Globalization of imperial Western medicine was further implemented with the development of Dr. Edward Jenner's cowpox-based smallpox vaccinations in England. Jenner confirmed what milkmaids, dairymen, and other British practitioners had long suspected: exposure to a disease of cattle called cowpox, or "kine-pox...