David S Jones, Rationalizing epidemics: meanings and uses of American Indian mortality since 1600, Cambridge, MA, and London, Harvard University Press, 2004, pp. xiii, 294, illus., £32.95 (hardback 0-674-01305-0).

Abstract

This is a welcome addition to the literature on epidemic disease and American Aboriginal peoples. David Jones covers a lot of territory, from smallpox among the seventeenth-century Massachuset people, to tuberculosis among the twentieth-century Navajo. But this is not simply another epidemic chronology. Instead it brings together the various explanations that contemporaries and their historians have assigned to the health disparities between Americans and Aboriginal people. This is an ambitious project and Jones has succeeded in uncovering enduring patterns despite the great changes in the meanings of disease. Jones compares four different cases: responses to the decline of Aboriginal populations in the first decades of colonization in New England; efforts to control (and efforts to spread) smallpox on the western frontier from 1760s to the 1830s; tuberculosis among the Sioux in the late nineteenth century; and mid-twentieth-century health research among the Navajo. Each case is discussed over two chapters; the first chapter of each set examines how epidemics were explained at the time, the second chapter focuses on responses to the epidemics. This approach tends to decontextualize disease and removes it from its political and economic roots. Nevertheless, the comparative approach provides a longer view of the relentless assaults on Aboriginal health over four centuries. But what is most enlightening is Jones's focus on the responses to disparities in health status between immigrants and Aboriginals. Rationalizing epidemics is a history of meanings. How did New England colonists explain dangerously high Aboriginal mortality while their own colonies flourished? Jones notes that there were more nuanced explanations than the Puritan belief in their own Providential mission. Colonists nursed the sick Massachuset and fed the dying Wampanoag in 1621. Likewise in the nineteenth century when the Sioux, confined to reservations, suffered untold misery from tuberculosis, the federal government accepted limited responsibility and sent physicians to attempt to control a situation created by government policy. Were the Sioux suffering an inevitable demise, or were they passing through a so-called “stage of civilization”? Despite the changing understanding of disease, there has always been an effort to assign meaning to disparities in health. The meanings and responses have changed over time, but Jones tells us that certain patterns have endured. Regardless of the disease, whether epidemic smallpox, endemic tuberculosis, or chronic heart disease and diabetes in the late twentieth century, Aboriginal people have suffered more severely than their European or American observers. This constant disparity does not reflect an inherent susceptibility to disease, nor does it point to the biological determinism that historians such as William H McNeill or Jared Diamond have employed. Instead consistent disparities reflect the disparities in wealth and power that have endured since contact. Jones also argues that when one group rationalizes health disparities in another group discrete responses emerge. Rationalizations give way to assignment of responsibility which can fall on the sick, or the healthy, or on some outside authority such as government or even God's will. The choice of response tends to reflect the needs of the local community. Fur traders among the Mandan and other Plains groups in the early nineteenth century worked to vaccinate the people against smallpox to preserve the trade, while settlers suggested that Aboriginal people were doomed to extinction just like the bison herds that sustained them. Jones concludes that health policy flows from these rationalizations for health disparities. Decisions whether to extend or withhold financial and political resources depend on how disparities are rationalized. This is an important book that will be welcomed by historians and their students. However, the focus on responses to epidemics privileges Euro-American voices to the exclusion of Aboriginal people themselves. Although Jones does attempt to include some Aboriginal responses, Rationalizing epidemics tells but one side of a tragic story.