| From their earliest encounters with European colonization, American Indians have suffered a severe burden of disease and mortality. Disparities in health status between Indians and European-Americans have been particularly dramatic with regards to smallpox and tuberculosis, the two diseases that dominated American Indian morbidity and mortality from the sixteenth to the twentieth centuries.; Colonists, missionaries, fur traders, soldiers, physicians, and government officials all witnessed the devastating impact of epidemic disease on Indian populations. Their writings contain a remarkable record of their efforts to understand and exploit the differential mortality that they observed. Although historians have extensively studied the nature and causes of American Indian mortality, they have not adequately examined the responses of Europeans and then Americans to these disparities in health status.; This dissertation describes and analyzes the ways in which Europeans and Americans accounted for and utilized the disparities in health status between themselves and the American Indians. It is centered on four focused case studies: first, colonists' responses to the depopulation of New England, 1616 to 1636; second, the uses of smallpox on the western frontier, 1763 to 1838; third, government responses to the emergence of tuberculosis on the Sioux reservations, 1876 to 1906; and fourth, health care research on the Navajo Reservation, 1952 to 1962. Each case study uses primary source materials to identify the local contexts and concerns that motivated the responses to health disparities.; Although widely separated in time, these case studies are united by common narratives and theoretical approaches. Each demonstrates historically specific processes of rationalization initiated by the recognition of health disparities. Observers struggled to make the epidemics rational, to explain them as the consequence of predictable determinants of disease. Observers also used epidemics to rationalize specific policies and interventions. The cases demonstrate how this two-tiered process of rationalization simultaneously gave meaning to the epidemics and transformed them into opportunities for assistance and exploitation. Understanding how epidemics are rationalized provides insight into the many dilemmas of health policy in which desire and action stand alongside indifference and inaction. |
