The focus of this paper is the analysis of the history of smallpox impacts on Native Americans. The paper includes a brief description of smallpox and its chief manifestations. A detailed review of the major smallpox epidemics among Native Americans is provided. The devastating impacts of smallpox on Native Americans are described. The paper outlines the way the smallpox vaccine was developed and the role it played in eradicating smallpox. The results and limitations of this review are evaluated. Recommendations for the future research are provided.
Keywords: smallpox, Native Americans, epidemic, impacts, vaccine.
Smallpox and Its Impacts on Native Americans
For thousands of years, humans suffered from the dangerous impacts of various infectious diseases. Many diseases quickly spread across large populations and gradually mutated to acquire their present-day form. According to Wolfe, Dunavan and Diamond, “the most important infectious diseases of modern food-producing human populations also include diseases that could have emerged only within the past 11,000 years, following the rise of agriculture” (p279). In this sense, smallpox is rightly considered as one of the most dangerous infectious problems the humanity ever faced in its history. The most tangible were the impacts of smallpox on Native Americans. As a result of their close contacts with Europeans and the overall susceptibility of their organisms to that type of virus, smallpox became one of the deadliest weapons of biological destruction in the Native American populations. Only when the smallpox vaccine was invented, Native Americans finally managed to overcome the challenge of the infectious disease and its risks. Today, the history of smallpox and its impacts on Native Americans is added to the picture of the problematic relationships between them and their European counterparts.
Goals and Methodology
The goal of this paper is to review the history of smallpox in America and its impacts on Native Americans. The paper includes an overview of the smallpox disease, the history of smallpox epidemics in America, the deadly impacts on various Native American tribes, the story of the smallpox vaccine, and the role it played in eradicating the smallpox danger in the American land. The method used in this paper is a review of primary and secondary literature. The review will cover only peer-reviewed journal articles borrowed from the following library databases: Academic Search Premier, EBSCOhost, CINAHL, Medline, JSTOR, and Google Scholar. These resources provide valid information regarding the history and progress of smallpox in the Native American populations.
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Review of Literature
Smallpox: The basics
In order to understand the seriousness of the smallpox issue for Native Americans, the fundamental features of the smallpox virus and disease need to be described. McClain (14) provides an extensive review of smallpox, its pathogenesis, clinical manifestations, and biology. According to McClain, smallpox is a variola virus that is highly stable and can remain infectious for a long period of time outside the host. Infection occurs by aerosol, but the question of whether it can spread beyond very close contacts remains open. Until present, two major types of the smallpox virus have been recognised: (1) variola major is the most prevalent in African and Asian regions; (2) variola minor has been found all over the planet, mainly in Europe and South America. The latter form of smallpox is less dangerous to unvaccinated victims and causes not more than 1% in mortality.
The average incubation period for smallpox is 12 days, and this is when the infection is travelling down the human respiratory tract to reach regional lymph nodes. The main clinical manifestations of smallpox include: fever, malaise, vomiting, rigors, backache and headache. About 15% of patients with smallpox also develop delirium. Three days after the initial symptoms patients develop peculiar rash and within 8-10 days after the onset pustules turn into scabs that leave deep depigmented scars on the skin upon healing. The main danger of smallpox is that it is highly fatal for unvaccinated individuals. Additionally, smallpox can result in numerous health complications. For instance, bronchitis and pulmonary edema are very common in patients with smallpox. For Native Americans, who had been absolutely unprepared to face the new infection, smallpox became the most serious challenge and the biggest health threat.
History of smallpox in Native American tribes
The current state of literature describes numerous instances of smallpox epidemics and their devastating impacts on Native Americans. However, the story of the smallpox tragedy in the American continent should be traced back to the sixteenth century. Given the contact nature of the disease, its story is inseparable from the story of the first European contacts with Native Americans. It is in the sixteenth century that Europeans and Native Americans met for the first time and started to interact actively in a variety of settings. For many historians and medical professionals, the sixteenth century in America was the era of revolutionary discoveries and dramatic encounters. Unfortunately, not all those discoveries and encounters were beneficial for the native peoples. Dobyns suggests that the sixteenth century was crucial for the survival of Native Americans. That was the time when the Europeans brought virgin soil epidemics across the Atlantic Ocean directly to America. “Consequently, their sixteenth century epidemiology determined the magnitude of the worst demographic disaster in the history of the world.”
At that time, the Southeast became the major scene of colonisation attempts fostered primarily by Spain.Spanish explorers did not succeed in establishing any permanent settlements in that area, but they opened the way to smallpox and other epidemic diseases, to which the Native American tribes were absolutely unprepared. The Spanish changed the patterns of interactions and exchange between them and Native Americans. The latter opposed to the growing presence of the Spanish on their territories, and stole horses from the newcomers to later trade them to their neighbours. Actually, horses are often claimed to be one of the central mechanisms of smallpox transmission across the Native American tribes. Meanwhile, in the North, Iroquoian-speaking villagers were developing their first contacts with Europeans. With time, European trade and the availability of European goods became the primary vehicle of relationship building between them and Native Americans. Those were the basic factors in the series of smallpox epidemics that followed.
The first registered epidemic of smallpox among Native Americans took place between 1780 and 1782. However, even before the Europeans’ arrival, Native Americans had undergone several epidemics bearing the signs of the smallpox infection. Contemporary researchers still lack any definite knowledge of what caused those epidemics. Yet, some of them assume that, between 1606 and 1611, the Massachusetts area faced a severe epidemic that was presumably caused by a confluent form of smallpox. However, these assumptions need further analysis and validation.
The 1780-1782 epidemic owned its emergence to the smallpox virus. The exact origins of the first smallpox epidemic in the Native American tribes remain unclear, but it is possible to assume that trade and warfare greatly facilitated the rapid spread of smallpox across the Great Plains.9 The Comanche were the first to contact the virus while raiding infected settlements and the virus was later transmitted to their relatives and neighbours at home.9 The incubation period ranged between ten and fourteen days, and the Comanche, their relatives and trade partners travelled long distances without any signs of the disease, thus infecting everyone they met on their way.9 The entire Great Plains region was affected by the disease. At that time, Native Americans believed the disease was the punishment sent on them by the angry spirits.
However, the discussed outbreak was part of a larger smallpox pandemic that affected central Mexico and quickly spread to the Guatemalan Highlands, southern Chile, and Lake Manitoba and the Chipewyan in the north.8 The New Mexican Pueblos were the first to suffer the symptoms of smallpox in 1780. Later, in the north, other Native Americans experienced the same health problem. With time, smallpox crossed the Rocky Mountains. It was registered in the communities and tribes living around the Great Lakes. The picture described by witnesses was terrible: tents filled with the dead bodies that were stinking; dogs and wolves eating bodies; and survivors in the state of despondence and despair so severe that they could hardly talk to anyone. Hodge claims that, as a result of the smallpox pandemic, no tribe living in the Plains managed to escape the disaster. For example, the Shoshones lost up to 50 percent in their numbers. Assiniboines and Crees who lived much further in the north-eastern part of the Plains also lost almost 30 percent of their people. Unfortunately, that was not the last time smallpox hit Native Americans.
Dollar describes another smallpox epidemic that impacted Native Americans in 1837-1838. The most interesting is the way Dollar evaluates the conditions that could have precipitated the outbreak. Dollar refers to the massive evidence that the Native American tribes, living in High Plains and particularly at Fort Clark, were in the state of massive filth and faced serious health problems. The tribes living in High Plains at that time included the Gros Ventre, the Mandan, and the Arikara. They dwelled in semi-subterranean structures, which varied by size but were located very close together. Each structure (or lodge) had as many as forty dwellers, with dogs and horses also present there. The sanitary conditions did not match even the basic standards, and the enormous rats populations added to the gruesome picture of filth and trash. Starvation was very common. Along with the shortage of food, March of 1837 was colder than usual. Multiple rains hit the Native American land. The smoke that resulted from firing the prairies, wet weather conditions, and poor sanitary conditions created the environment very conducive to the rapid spread of various infectious diseases. The first reported death from smallpox was recorded on July 14, 1837, and that was the beginning of the end for many Indian villages.
It is interesting to note that, during smallpox epidemics, many American territories faced difficulties maintaining order and compliance. Leavitt speaks about the two major outbreaks of smallpox in America and their relation to the civic order in the damaged territories. In Leavitt’s view, a huge smallpox epidemic hit Milwaukee, Wisconsin, in 1984, leading to the breakdown of the entire civic order. One of the biggest difficulties at that time was to make the local population follow even the basic health precautions – a topic that will be discussed later in this paper. 1894 was not the last time smallpox damaged the lives of Native Americans and other American populations. In 1913, Charles V. Chapin wrote about a very mild smallpox epidemic in the South, which, with time, spread all over the country. At first, mortality rates were quite low and smallpox was even confused for chickenpox. Between November 10, 1896 and July 10, 1897, 54 cases of smallpox were registered in Pensacola, without deaths. At the same time, 48 cases of smallpox and 2 cases of death were registered in Key West. Later in May, similar cases were registered in Lowndes, Co. By the end of March, 1898, more than 3,600 cases had been registered with a total of 51 deaths. The epidemic was very unusual to the residents and medical professionals, because of low mortality rates. Still, smallpox would be wandering all over the American land until the beginning of the 20th century.
In 1901, a major smallpox epidemic broke out in the Six Nations’ reserve, which comprised mostly rural communities. Their members lived in small houses (logs) and relied on traditional agriculture. The reserve was the place of residence for many Iroquois, who were severely impacted by the epidemic. By that time, the smallpox vaccine had been invented, but the reserve failed to adopt a common vaccination measure or policy to prevent the crisis.21 Dozens of people were affected by the disease, and its effects on the life of the communities persisted for decades. No major smallpox outbreaks among Native Americans were registered since then. However, the losses experienced during the smallpox epidemics reflected the repercussions of modern development and their tragic collisions with the traditional style of life among Native Americans.
Smallpox and Native Americans: Interesting hypotheses and impacts
One of the most interesting hypotheses in relation to the smallpox epidemics and their effects on Native Americans is that the first smallpox outbreak among Native Americans was caused intentionally. Mayor elaborates on one of the most widely spread assumptions that smallpox-infected blankets were sent to Native Americans by Europeans. Mayor refers to the primary documents, which indicate that Europeans did have an intention to use the infection as warfare against Native Americans. The notorious incident when the British commander Amherst ordered his soldiers to present Indians with the gift in the form of smallpox-infected blankets is claimed to have taken place in 1763. A similar occurrence was reported in 1757, when the Ottawa Indians living around the Great Lakes received a tiny box from French soldiers, and they were not allowed to open the gift until they reached their community. Upon their arrival, they opened the tiny box and found another tiny box inside, until they reached something that resembled mouldy particles. In a couple of weeks, a major epidemic of smallpox covered the tribe, and it was certainly associated with the deadly gift received from the French.
Regardless of what exactly caused the rapid spreading of smallpox across Native Americans, it is clear that its impacts on the Native American tribes were devastating. Today, smallpox is often compared to AIDS in the magnitude of health impacts it caused during the 18th-20th centuries. Still, it should be noted, that AIDS was never transmitted by air, and it is much easier to control. By contrast, for the Native Americans who had no immunity against smallpox, the disease often became a quick and painful cause of death. Smallpox was unique in its fatality, savagery, and universality. The most epidemic were the years between 1868 and 1885, when the whole world suffered numerous losses due to smallpox. British India alone lost almost 10 percent of its population. In 1905, one percent of Togoland’s population died of smallpox. Over 400,000 Europeans died of smallpox each year at the beginning of the 19th century. In America, smallpox destroyed numerous Native American tribes and “decimated the entire indigenous population of both continents and the West Indies.”
As mentioned earlier in this review, some Native American tribes lost between 30 and 50 percent in their numbers. Among those, who suffered the most, were the Crows, the Crees, and the Shoshones living in the Great Plains. The Missouri villagers faced major losses during the 1780-1782 smallpox epidemics. Being densely populated, the western Plains fostered the rapid spread of the disease, leading to the loss of almost eighty percent of people in the Mandan, Arikara, and Hidatsa communities. Before the 1780-82 smallpox epidemic, the Hidatsa were claimed to had inhabited nine hundred lodges; by the end of the epidemic, only 130 lodges remained inhabited. Out of the four thousand warriors in the Arikara community, only some five hundred were lucky to survive the epidemic. Much less significant were the losses among the Native American communities that were mobile, as they lived in smaller groups, avoided frequent contacts with one another, and did not come close to the Native American camps that had been wiped by smallpox.
The literature on the way smallpox impacted Native Americans is abundant. Thornton, Miller and Warren developed complex mathematical models to conclude that smallpox epidemics had caused enduring changes in the Native Americans’ demographics. Smallpox had many indirect impacts on Native Americans, including reduced fertility and higher post-epidemic mortality. Reduced fertility after the smallpox epidemics could be attributed to disrupted marriages resulting from the death of a spouse. It could also become a logic consequence of the lack of social organisation following the epidemic. Post-epidemic mortality could be attributed to the problems with food. However, it is still essential to understand why Native Americans were so susceptible to smallpox and why they failed to withstand the growing smallpox risks.
The contact nature of the disease suggests that it is due to the close interactions between Europeans and Native Americans that the rapid spread of the disease became possible. However, close contacts by themselves would never bring Native Americans to such tragic ends. Crosby hypothesises that American aborigines had genetic predisposition to certain kinds of diseases, which made them inherently vulnerable to the dangers of smallpox. Those weaknesses could be readily traced to the pre-Columbian times, and they were later passed to the American Natives’ offspring. Yet, the genetic hypothesis of Native Americans’ vulnerability to smallpox and other contagious diseases lacks valid proofs. To a large extent, it is just a legend created in an attempt to explain the complex consequences of smallpox for the Native American populations. These genetic hypotheses do not explain why exactly smallpox was so devastating to Native Americans and why the losses in their populations continued to persist through the decades following the last smallpox case.
The main factors of increased vulnerability to smallpox and other virgin soil epidemics can be divided into two broad categories: the first category refers to the nature of the disease itself, and the second category covers the way particular societies and individuals reacted to various diseases. In terms of the former, when faced with smallpox for the first time, Native Americans simply had no immune defence. Smallpox was what is usually called a “virgin soil epidemic”, a disease that faces the population for the first time in its history. In this situation, infants appear absolutely unprotected against the disease, due to the absence of any antibodies that could have been passed to them by their mothers. Adults have no immunity to withstand the pressure of the virus. High fatality rates were directly associated with the severity of the symptoms. Unfortunately, few, if any, primary resources ever described the symptoms of smallpox experienced by the natives.
Higher rates of smallpox fatality among Native Americans against Europeans can also be explained by the life those populations were living. The communities inhabiting the Great Plains had been known for their shared beliefs about cooperation and support. They spent their lives close to one another, often sharing shelter and food. Such closeness greatly facilitated fast transmission of smallpox among Native Americans. In addition, the first incidents of smallpox greatly influenced Native Americans’ ability to participate in hunting; this, in turn, increased the probability of hunger and eventually resulted in high fatality rates. This relationship between fatality and hunger was also mentioned by Thornton et al. Finally, very important was the way Native Americans dealt with smallpox: many natives were reported to have jumped into cold streams, while others used the native sweat lodge. Both methods only worsened patients’ physical and emotional condition. At the end, the Indian communities that had gone through a smallpox epidemic experienced serious disruptions in their relationships with the neighbouring non-Indian communities; those impacts of smallpox on the relationship aspect of Native American life were described by Weaver.
Vaccine creation and evolution
The growing number of fatal cases during smallpox epidemics among Native Americans suggested that only a major shift in the medical science would give the natives a chance to survive and overcome the disease. Smallpox has a very long history and, before the disease hit America, inoculation had been the primary method of prevention. America did have some knowledge of inoculation, and it was very popular among the higher English classes. The procedure was also called “variolation” and became popular in the New World in 1721. The process usually involved instilling the smallpox virus subcutaneously into non-immune individuals. According to Riedel, during inoculation, a lancet wet with the matter taken from a sick person was used to introduce it on the legs or arms of the non-immune person. Yet, what was available to the New England residents could not be available to Native Americans. Even today, the health disparities impacting Native American populations continue to persist, let alone the times when the newcomers were fighting with the natives to get another piece of their land.
Edward Jenner became the person who released the planet from the smallpox epidemic and stopped the rapid spread of the infectious disease. It is Jenner who, after a series of experiments, invented the smallpox vaccine. Jenner had a remarkable talent for science, but he rejected the opportunity to make a prominent scientific career; instead, he opened a small practice in his home village and focused on serving the needs of his fellow countrymen. Several years later, Jenner created a cowpox vaccine and, afterwards, published the results of his experiments in his Inquiry into the Causes and Effects of the Variolae Vaccinae.Until present, the book has been considered as one of the most essential works in the history of medicine and vaccination. Today, Jenner is regarded as the discoverer of vaccination and the first person to have proved to the whole world that vaccination should become an indispensable element of people’s daily lives.
Reasons why Jenner, not anyone else, became the discoverer of vaccination are numerous. First, he had extensive knowledge of the local traditions and customs, and he noticed that those who had been infected with cowpox at least once managed to withstand all infectious risks during numerous smallpox epidemics. Second, Jenner was medical generalist and, therefore, possessed wide knowledge of medicine and science. Third, Jenner was well-known for his sharp interest in human-animal interactions, which further facilitated the analysis of the most prevalent infectious diseases, including smallpox, and their transmission patterns. Unfortunately, even the presence of the newly invented vaccine could not protect Native Americans from the smallpox risks. Health disparities, affecting native populations, were not resolved. Many citizens, due to the lack of professional knowledge and disease awareness, simply refused vaccination. For example, in 1820, Vermont residents proposed instating a tax to pay for smallpox vaccination of all residents, but not everyone was willing to pay. The legal battle that resulted could expose the entire population to unnecessary health dangers. Such incidents are numerous and do not have to be cited here. Despite numerous barriers, Jenner’s vaccine became a real salvation for the millions (or even billions) of people beyond Native American populations.
The end of smallpox
Vaccine seems the only suitable explanation to the fact that the humanity managed to eradicate smallpox and minimise its risks and consequences. Really, since the beginning of the 19th century, the smallpox vaccine has been gradually implemented in the U.S. and later in the rest of the world. However, vaccination alone could have hardly led to such remarkable results. The story of smallpox and its impacts on Native Americans uncovers the complex relationship between the disease, new medical technologies, and society’s changing attitudes to the infection. Small & Small even suggest that changing attitudes were a much more important variable in the eradication of the disease than other factors. For many years, the developed world did not believe in the efficacy of Jenner’s vaccine. His experiments were surrounded by gossip and speculations. It was not until the middle of the 19th century that the idea of compulsory vaccination became widespread. Still for many years, vaccination and other public health activities were carried out at the local, not federal, level. Only changes in the public attitudes towards health and vaccination helped to stop the historical domination of smallpox over the lives of Native Americans and other populations. Today’s researchers and medical professionals no longer imagine the life in the developed societies without mandatory vaccination and numerous vaccines. These vaccines work to reduce the individual and collective vulnerability to the most common types of infections.
The current state of literature provides sufficient information regarding the history of smallpox in Native American populations and the way numerous smallpox epidemics impacted the lives of the Native American tribes in the 16th-19th centuries. The central theme of many studies is that, being a contact disease, the tragedy of smallpox was the direct result of the numerous close contacts between Native Americans and Europeans. Europeans came to the Native American land for unfriendly reasons, but their effects on the lives of native populations turned out to be much more devastating than anyone could ever expect. One of the most interesting hypotheses is that smallpox was brought by Europeans intentionally to attack Native Americans and reduce the force of their opposition to foreign violence: the most popular is the infected-blanket-hypothesis, which states that Native Americans were given infected blankets that later resulted to a series of major disease outbreaks. Yet, the overall natives’ susceptibility to smallpox should not be disregarded. For Native Americans, smallpox was a “virgin soil epidemic” that faced them for the first time. They had no immune defence to fight with its symptoms, and the sanitary conditions of their life further facilitated the rapid spread of the virus.
Contemporary researchers are almost unanimous in that Jenner made a revolutionary discovery, which later allowed for the successful eradication of smallpox. Yet, it would be fair to say that vaccination alone would have never been enough to stop the virus. A complex combination of factors, including changes in society’s attitudes towards vaccination, helped to eradicate the major smallpox risks and reduce its negative consequences. Compulsory vaccination has become part of many developed societies’ lives, although health disparities affecting Native Americans continue to persist. Apparently, future researchers need to focus on the analysis of genetic predispositions to various infectious diseases and analyse the relevant mutations, affecting the most common infectious diseases today.
Two major limitations have been noted in this study. First, the paper involves no primary research, mainly due to the specificity of the topic itself and the overall closeness of Native American communities to any intrusions from the outside world. Second, contemporary research also lacks an empirical perspective, which means that the risks of scientific bias should not be ignored. Carlos and Lewis write that few primary documents offer detailed accounts of the smallpox symptoms experienced by Native Americans in the 17th-18th centuries. This, in turn, complicates the analysis of the major smallpox epidemics affecting the natives at that time. Marr and Catey12 also mention the difficulties of analysing various epidemics and infectious diseases that had impacted Native Americans before the 16th century. Consequently, tracing the history of smallpox among Native Americans is extremely problematic. Despite these limitations, it seems obvious that Europeans played the central role in the development of the smallpox epidemics and the devastating impacts they had on the natives.