By the end of the 18th century, most Native communities in what would eventually become the United States had been exposed to smallpox. Nevertheless, as smallpox recurred in the 19th century, its impact correlated not with a lack of prior exposure, but with the presence of adverse social conditions. These same conditions would also make Native communities susceptible to a host of other diseases, including cholera, typhus, malaria, dysentery, tuberculosis, scrofula, and alcoholism. Native vulnerability had—and has—nothing to do with racial inferiority or, since those initial incidents, lack of immunity; rather, it has everything to do with concrete policies pursued by the United States government, its states, and its citizens.
Consider the impact of the Indian Removal Act. Formally adopted in 1830, this policy called for the relocation of Native peoples east of the Mississippi River to “Indian Territory” (what would eventually become Oklahoma and Kansas). Most everyone has heard of the Cherokee Trail of Tears, but it is seldom considered a U.S.-caused health crisis. The expulsion of the Cherokee from their homeland in Georgia, North Carolina, and Tennessee had three phases. In the first, the U.S. Army forcibly evicted Cherokees from their homes and held them for several months in concentration camps with inadequate shelter, insufficient food, and no source of clean water. The camps became death traps. Of the 16,000 people held in them, about 2,000 died from dysentery, whooping cough, measles, and “fevers” (probably malaria). In the second phase, the journey west, an additional 1,500 perished, as people, already sick and further weakened by malnutrition, trauma, and exposure, succumbed to multiple pathogens. In the months after reaching Oklahoma—the third phase—an additional 500 died from similar causes. The death toll was 4,000, or 25 percent of the original 16,000 forced from their homes.
Although the Cherokee Trail of Tears is the most well known, there were dozens of other such forced removals. Creeks, Seminoles, Chickasaws, Choctaws, Senecas, Wyandots, Potawatomis, Sauks and Mesquakies, Ojibwes, Ottawas, Miamis, Kickapoos, Poncas, Modocs, Kalapuyas, and Takelmas represent only a partial list of nations that suffered trails of tears. Not all experienced the same mortality as the Cherokee, but many did, and for some, the toll was even higher. The allied Sauks and Mesquakies were forced to move four times from their villages in western Illinois—once to central Iowa, once to western Iowa, once to Kansas, and finally to Oklahoma. In 1832, the time of the first expulsion, the Sauks and Mesquakies numbered 6,000. By 1869, when they were finally sent to Oklahoma, their population was only 900, a staggering loss of 85 percent. Year after year, unrelenting diseases, including an outbreak of smallpox in 1851, took many lives. Low fertility and infant mortality, the result of malnutrition, sickness, and trauma, hindered population replacement. The Sauk and Mesquakie catastrophe was not an accident. It was a direct and foreseeable consequence of decisions made by the United States and its citizens to dispossess Native people of desirable lands and shove them someplace else.