Celebrating 17 years

Native American Beliefs and Medical Treatments
During the Smallpox Epidemics: an Evolution

One important cause of Native American depopulation during European contact was epidemic disease. The sixteenth through nineteenth centuries saw many different diseases strike Native American populations with considerable frequency.

Many of the diseases, such as syphilis, smallpox, measles, mumps, and bubonic plague, were of European origin, and Native Americans exhibited little immunity because they had no previous exposure to those diseases. This caused greater mortality than would have occurred if these diseases been endemic to the Americas.

Dobyns (1983) and Merrell (1984) report several European-induced epidemics in Florida, the Carolinas, and Virginia between 1519 and 1750, including smallpox, bubonic plague, typhus, mumps, influenza, yellow fever, and measles, although Dobyns' research has been argued methodically unsound by others. Bubonic plague and scarlet fever depopulated the Senecas in the 1630s to such an extent that four village settlements were forced to amalgamate into two. Archaeologists found Seneca ceramics dating to the post-epidemic period that were characterized by rough, uneven craftsmanship, suggesting the epidemics killed a substantial percentage of skilled artisans and thus eliminated some cultural knowledge.

It is important to note, however, that these epidemics were just some of the causes of population decline during European contact. Intermarriage, slavery, wars, massacres, political disruption, economic changes, malnutrition, destruction of traditional subsistence patterns, and alcoholism also changed the composition of many Native American groups, whether they favored the changes or fought them. Eventually, these changes caused substantial depopulation and cultural change. This Native American depopulation occurred during the contact period, causing the Native American population size to decline from 1-18 million before European contact (c. AD 1500) to an estimated 530,000 by 1900.

This paper looks at social implications of the smallpox epidemics because this disease may have contributed significantly to Native American population decline. Ethnohistorical sources document smallpox's effect on Native American morale, health, social structure, and population size. Some researchers argue that the way Native Americans viewed the disease, as well as their methods of disease treatment and response to the epidemics, exacerbated mortality from the disease. Traditional indigenous medical treatments such as sweatlodges worsened smallpox mortality rates, and significant population loss from the epidemics caused drops in fertility, loss of cultural knowledge, and high suicide rates. However, Kelton (2004) argues that actions such as quarantining, burning infected sites, and incorporating the disease in their religious systems (e.g. Smallpox Dance) decreased the mortality rates.

However simple these polar arguments may seem, indigenous responses to the smallpox epidemics varied considerably by region and time. This paper reviews the ethnohistorical evidence concerning Native American ideas concerning smallpox's origin and cause, medical treatments, changes in cultural traditions, methods of coping, patterns of sociocultural change, and religion. Kelton's views on self-preservational behaviors during smallpox epidemics are tested in the details. Each section was written in rough chronological order while reviewing different geographical regions within the United States.

A Case Study: Smallpox

The smallpox virus is caused by Variola major, closely related to cowpox, monkeypox, and camelpox. Its second form, Variola minor, causes similar lesions but has a much lower mortality rate (~1%). The infection either manifests itself as hemorrhagic, in which the rash contributes to hemorrhaging of the mucus membranes and skin, or malignant, in which the rash never develops into pustules. Both infections can be fatal. Even today, no treatment is available other than management of symptoms.

Following infection with Variola, a non-infectious incubation period exists for approximately 12 days. The individual then experiences influenza-like symptoms, including fever up to 104°F, back pain, and vomiting. Approximately three days later, the fever subsides and the characteristic rash develops on the face, forearms, and hands, followed by rash on the trunk. The smallpox lesions ulcerate in the nose and mouth, releasing more virus down the throat and often suffocating the individual. The pustules form infectious scabs eight to fourteen days after the onset of symptoms. The infection is spread through respiratory contacts until the last scabs fall off, and is promoted by close contact, crowding, salivary contamination, and soiled linens. Infectious dried crusts of the virus have also been isolated from house dust a year after the infection.

In Europe and Asia, mortality rates from smallpox were approximately 30%. In the Americas, mortality rates were higher due to the virgin soil phenomenon, in which indigenous populations were at a higher risk of being affected by epidemics because there had been no previous contact with the disease, preventing them from gaining some form of immunity. Estimates of mortality rates resulting from smallpox epidemics range between 38.5% for the Aztecs, 50% for the Piegan, Huron, Catawba, Cherokee, and Iroquois, 66% for the Omaha and Blackfeet, 90% for the Mandan, and 100% for the Taino. Smallpox epidemics affected the demography of the stricken populations for 100 to 150 years after the initial first infection.

Indigenous Perspectives and Historical Interactions

During the early contact period (keep in mind "early contact period" represented different years throughout the many different regions of the United States), many Native Americans did not believe that disease was transmitted between individuals. Instead, they ascribed disease to supernatural forces. For example, during the early 1700s, Northern Plains groups considered smallpox to be a personification of the Bad Spirit. Disease was often thought of as punishment by the "Master of Life" for mistreatment of animals or other people. During the 1730s, the Creeks and Cherokees considered the spread of smallpox to be punishment for violations of tribal laws, such as sexual intercourse in the cornfields and village-wide violations. By 1784, the Cree attributed the epidemics to anger from God.

Animal spirits were also blamed. According to traditional Cherokee knowledge, animals created diseases to protect themselves against humans. The Kwanthum of Vancouver described a dragon that lived in a swamp and breathed upon children. Its breath caused sores to break out "…and they burned with the heat, and they died to feed this monster. And so the village was deserted, and never again would the Indians live on that spot". The Salish blamed a salmon season in which the fish were covered in sores and blotches. They reacted by killing as many of the fish as possible. These types of explanations were common before Europeans were connected with smallpox incidence.

Witchcraft was also a popular explanation throughout the contact period, often resulting in the torture or killing of accused individuals. Indigenous groups, including the New Mexico Pueblo and the Hurons, blamed members of their own communities as well as white missionaries for witchcraft. Many groups, like the Hurons, thought that the Jesuits were witches because they possessed charms and religious paintings, demonstrated much concern with how one died, and described communion bread as containing human flesh. The Jesuits were often blamed when an infected person died after having Holy water sprinkled on them. The Hurons were terrified of the Jesuits and prohibited them from entering their villages.

Substantial social interactions with the Jesuits and French traders often helped to spread the infection further. Native participation in the Canadian Fur Trade and Hudson Bay Company of the Upper Missouri River, as well as Euroamerican fur brigades, often brought infection to the main centers and carried the disease to all affiliated trading posts. Native American conversions to Christianity gave the indigenous people an acquired desire for European goods and another reason to eagerly participate in the fur trade, which increased exposure to European pathogens. The Oregon Trail also acted as an avenue for the spread of epidemics.

By the late 1700s, Amerindians in New France knew that Europeans often carried smallpox and avoided them to prevent infection. Native soldiers at Fort Presqu'ile would not proceed to Niagara after learning of the disease presence there. Those participating in the war came into contact with infected British soldiers and contracted smallpox. The Native Americans blamed the French and English and would not ally with them until the disease ran its course. As a result, the French and British blamed each other for the smallpox transmissions to the Native Americans in order to gain indigenous favor and alliances.

There are historical references of deliberate transmission of smallpox from Europeans to Native Americans. In 1763, the British general Jeffrey Amherst gave blankets taken from infected corpses to deliberately infect nearby natives. Many legends of similar instances of intentional transmission exist throughout the contact period. Written documents indicate that many Europeans were using smallpox on their side ("It has pleased Our Lord to give the said people a pestilence of smallpox that does not cease…"). Consequently, many European explorers and traders received death threats from embittered victims and relatives of the deceased.

Indigenous Treatments and Responses to Smallpox

Between 1500 and 1600, Native Americans attempted to treat the disease with traditional medical treatments. For example, when the first smallpox epidemics coursed through North America, Northern Plains individuals attempted to use "drum and rattle" incantations to ease the spread of the disease and to increase the will to survive. The most common medical treatment during this period was the sweat lodge. In the Northern Plains groups, willow bark was steamed in the lodge, acting as an analgesic, with conifer oils acting as decongestants. The Cherokees adopted a similar approach because they believed that plants decided to cure humans after they heard of animal spirits' evil plans to spread disease. However, many of the herbs were cathartics and emetics, and the profuse sweating often caused dehydration. Thomas Sydenham, suggested that heat therapy in the form of both steam and warmed blankets made sores worse. Furthermore, a stay in the sweat lodge was usually followed by plunging oneself into cold water, which often caused shock, cardiac arrest, "violent fevers", and generally lowered immune resistance to infection.

Other early treatment of smallpox involved the formation of curing societies and village rituals, including fasting and dreaming. Bear oil was used as a natural emetic to stop the disease's spread by the Hudson Bay area Cree during the 1782-1783 epidemic. Other indigenous treatments were not recorded by Europeans because the knowledge was considered sacred.

By the early 1700s, Native Americans had begun developing additional methods to prevent infection. Southeastern Native Americans avoided diseased villages and educated others about traveling into infected areas. Another indigenous method to avoid further infection was sending the disease to an enemy via the shaman. The Cherokees performed a Smallpox Dance (the Ahtawhhungnah) in the 1830s to avoid disease, and the Aztecs made a pilgrimage to Popocatépetl to pray to the etsá (smallpox) spirit. By 1782, Cree used both indigenous and European medicinal techniques in their smallpox treatments.

By the late 1700s, there was also a major and effective change towards quarantining infected individuals. Earlier, natives viewed quarantine as abandoning family and often crowded around the sick to attend to them, spreading the disease further. Some argue, however, that smallpox did not spread so easily and had to be acquired through intimate contact. Infected individuals were quarantined and homes were either burned or cleaned. At this time, many were not nursed back to health and inevitably starved to death. Cherokees moved infected individuals to fields on the village's periphery. The switch to quarantine helped slow the spread of the disease, but curious children often contracted the disease after snooping around abandoned houses and burial grounds.

Although many vaccination attempts were ineffective at preventing smallpox, most vaccinations helped protect Native Americans. An intense debate concerning inoculations against smallpox in the Americas took place in the 1720s. Colonists in America quickly learned of inoculation efforts and spent nearly 100 years debating whether people should risk death to avoid the disease. In the early 1800s, the Spanish crown sent vaccinations to the colonial clergymen. Francisco Xavier Balmis started the vaccination program. Young children were infected with cowpox, which Edward Jenner had proved effective as a vaccination against smallpox. This program vaccinated more than 2000 individuals in Cartagena de Indias, 197,000 in Peru, and 20,000 in the Philippines. President Thomas Jefferson started an additional vaccination program during the 1798-1799 epidemic.

Some North American populations such as the Sioux embraced vaccination programs, although many were uncomfortable with the idea of abandoning their indigenous medicinal methods. Often, the efforts of traders in vaccinating Native Americans were much more intense than the Bureau of Indian Affairs' attempts, which often stalled for economic gain or pushed to protect the neighboring white settlers first. European vaccination programs in North and South America greatly contributed to Native American population recovery.

Christianity's missionaries were moderately successful in assisting with disease treatment and may have even gained a few converts along the way, but after the disease abated in their area, many Native American groups returned to their traditional indigenous beliefs, giving their earlier indigenous rituals full credit for their population's survival. However, in some instances, survival convinced individuals to believe in the Christian God. The loss of cultural knowledge aided Christian missionaries' attempts at conversion, as many rituals and sacred bundles fell into disuse when shaman and other elders died.

In the late 19th century, a mix of Christian converts and those with indigenous religious beliefs often co-existed within one village. In this case, the Christians obtained European medical treatment, but the indigenous believers would not accept it, although the European treatment by this time may not have been any more effective. Many non-Christian Native Americans kidnapped family members taken to hospitals by Europeans. The non-Christian indigenous individuals receptive to European medicine were often labeled "progressive", whereas the "conservatives" would not accept Western medicine in their treatments. Many of the "progressive" families sent students overseas to English schools, adding an additional source of infection when the student returned home.

Although smallpox treatments gradually improved over time, mortality rate was high during all years of European contact. The Native Americans had to respond to massive population loss within their own families and tribal groups. One of the most commonly cited responses to the smallpox epidemic is suicide, which also acted as another factor that increased the overall smallpox mortality rate (through associated deaths). This response reflected the failure of indigenous religious and cultural traditions to cure the disease. Individuals were horrified at disfigurement and believed that any disfigurement of the body in life would be reproduced in the afterlife. A Mandan chief, Four Bears, declared, "I do not fear death, my friends…but to die with my face rotten, that even the wolves will shrink at horror at seeing me…". Many individuals also committed suicide after losing friends and family, and often killed children along with themselves. Instances of infected husbands and wives committing suicide together by jumping off cliffs or stabbing themselves are also documented. Many individuals fled to neighboring camps or attempted to survive alone in the wild. General grief often resulted in starvation.

The effects of the smallpox epidemics are preserved in historical and archaeological records. Hernando de Soto, Lewis and Clark, Jedediah Smith, and many others described seeing overgrown, abandoned villages. Archaeological evidence of village abandonment exists for the Southeastern United States. Stylistic sharing of the Pensacola Complex in the Southeast indicates interaction between groups during later periods of European contact that may also have contributed to new infectious pathways. A mass burial at the 16th century King site in Tennessee probably indicates a post-epidemic burial since mass burials are not common for ritual purposes in the Southeast. There are also increases in "multiple burials" (two bodies together) in this area, with ethnohistorical evidence confirming the use of multiple burials during times of epidemic diseases. Often, abandoned camps were raided for useful belongings, but the newly amalgamated populations were still too culturally fragmented at this early stage to organize raids against neighboring populations. The Iroquois, stricken by grief, participated in Mourning Wars, in which individuals from other groups were taken to replace lost family members.

Effects of Smallpox

The greatest impact of the smallpox epidemics was sociocultural change. The loss of so many individuals within a population hindered subsistence, defense, and cultural roles. Families, clans, and villages were consolidated, further fragmenting the previous societal norms. The population loss also forced the fusion of different residential groups. For example, eighteen Arikara villages were amalgamated into one group of three villages in the Middle Missouri River Valley. By 1862, Mandan, Hidatsa, and Arikara were sharing one village. This cultural amalgamation caused the diffusion of culture across different populations and new definitions of personal and populational identity. The amalgamation of nearby villages required strong leadership skills for the least traumatic and most efficient transition. One language and set of rules had to be agreed upon by individuals from several villages with different perspectives. Often these logistics were not decided upon by the chief(s); with the amalgamation of so many different chiefs, their status became devalued. The loss of many individuals within a population also reduced the collective knowledge of history and ceremony. Indeed, one early 18th century Charleston, North Carolina Native American stated, "they keep their festivals and can tell but little of the reasons: their Old Men are dead".

Another long-term effect of smallpox was decreased fertility in those who survived. Smallpox epidemics and behavioral responses certainly increased the mortality rate, but subsequent decreases in reproduction assisted in keeping population numbers low long after the epidemic ended. Many suitors were rejected due to poxmarks and blindness caused by the disease, and many were left impotent. Poxmarks plagued around 65 and 80% of smallpox survivors. Blindness affected many; 33% of all reported blindness in 18th century Europe and 90% of blindness in 1898 Vietnam was attributed to smallpox.


Researchers such as Jones (2005), Starna (1992), Taylor (1977), and Axtell (1981) argue that indigenous disease treatment and epidemics responses exacerbated mortality, however, Kelton (2004) believes that Native Americans actually ameliorated their symptoms and decreased mortality. This survey of Native American responses to smallpox epidemics suggest that Native Americans both exacerbated and ameliorated smallpox symptoms in different places and at different times. Early responses in treatment, such as sweat lodges, support the hypothesis that cultural theories and practices exacerbated smallpox mortality. However, later responses developed after more extensive contact with Europeans, such as vaccination and quarantine, and helped to prevent or slow the spread of infection.

In reviewing the temporal trends to smallpox reaction, it is important to remember that smallpox did not mean the tribe in question was doomed, nor was it the only cause of population loss during the contact period; the epidemics were just a portion (albeit a major portion) of the mortality of the Native Americans. In addition to this, wars, massacres, economics, malnutrition, destruction of traditional subsistence patterns, and alcoholism all contributed to lowering immunity to many diseases throughout contact period. Many populations throughout the Western Hemisphere were stricken with smallpox, but each had different environmental and cultural circumstances that contributed or lessened mortality rates.

After assessing both arguments, it appears that each side was examining different time periods. Native Americans who experienced the early smallpox epidemics did not know how to respond effectively and did exacerbate mortality rate; however, as time progressed and interaction with Europeans increased, indigenous knowledge of the disease increased, enabling them to avoid the disease as effectively as was possible. Different tribes did have differential survival rates, and it should not be assumed that "virgin soil" populations were destined to die; in fact, the large Native American population today suggests otherwise.



I dedicate this paper to all Native Americans, past, present, and future. Your spirit during adversity will never be forgotten. An early version of this article appears in my masters thesis, ABO Blood Group Frequencies in Pre-European Contact America: An Ancient DNA Analysis, housed at the University of Texas at Austin. I would like to thank Drs. Deborah Bolnick and Sam Wilson for their helpful comments on this paper.