so as not to endanger their health: Public Health in the Antebellum Native South

Julie Reed

Article 8 of the 1835 Cherokee Removal Cherokee, also known as the Treaty of New Echota, which stipulates that physicians will accompany removal detachments. Courtesy of the Smithsonian Institution.

Public health crises within the United States and the policies enacted to manage those crises are inextricably linked to Native peoples, as our current moment lays bare. We need look no further than how hard Covid-19 has hit communities like the Navajo Nation and the Mississippi Band of Choctaw.[1] Covid-19 responses also demonstrate how tribal sovereignty and advocacy by Native leaders can mitigate potential damage to Native people, but not always without obstacles and recalcitrance on the part of some non-Native leaders.[2] Within the antebellum Native South, over the course of the long removal era, the Five Tribes confronted destructive policies that produced public health crises, which then triggered calls by non-Native officials for more control over Native peoples. Yet, as the individual Native nations’ responses to the multiple crises of the removal era demonstrate, Five Tribes leaders proved adept at managing public health emergencies, maintaining their dignity, and defending their sovereignty even when the odds were stacked against them.

By the first decades of the nineteenth century, even the Fives Tribes’ individual relationships to Euro American medical practices had unique contours based on each community’s sustained contact with missionaries, governmental agents, white settlers, and enslaved people of African descent. By 1806, not only were Cherokees seeking the services of medical doctors to administer smallpox treatments but they specifically sought the newer cowpox treatment as opposed to the older and more prevalent practice of variolation. When a doctor showed up to administer variolation, Cherokee people rejected his services and sent him away. This did not stop him from charging a wildly inflated price for the services he didn’t render and that Cherokee annuities ultimately had to cover.[3] Individually, some Native people identified themselves as “Doctor” on official rolls.[4] This suggests that Native people, who practiced traditional medicine that drew from local pharmacopeias, wished to assert their professional skills and their official titles to non-Native people. Additionally, it also suggests that Native people had some understanding of the services provided by Euro American doctors and saw their treatments as equivalent. At least one pre-removal missionary among the Cherokees, Elizur Butler, had some medical training prior to entering his service as a missionary.[5] In mission journals, it becomes clear most Cherokee people continued to rely on the medical services provided by local healers. However, Cherokee people who interacted with Butler regularly came to rely on his medical knowledge and skills as another option available to them. They didn’t abandon their local care; they supplemented it.

By the 1820s, Native men who attended Choctaw Academy sought training at medical schools in the United States.[6]Medical school education was not the norm even for doctors in the United States; apprenticeship still prevailed, yet multiple Native men sought more formal education. This suggests that historians need to take a much deeper look at how everyday Native peoples across the Americas responded on the ground to new medical information provided by non-Native people. It matters who provided the medical information, in what context, and with what level of coercion.

By the time the federal government passed its 1832 Indian Vaccination Act, largely aimed at southern tribes targeted for removal, those tribes were demanding better medical services from federal officials. The Choctaws, who had already faced a smallpox outbreak in 1826 during earlier removal treaty negotiations, sought increased access to care in 1831 during their removal process, which was rife with disease and sickness.[7] Four years and many deaths related to Five Tribes’ removal later, the 1835 Cherokee removal treaty explicitly required that physicians be provided to each group of Cherokees removed, “so as not to endanger their health.”[8] In her recent article on the 1832 Indian Vaccination Act, Ruth Bloch Rubin argued that “the administration of the Indian Vaccination Act is . . . important to understanding American state development.” Similarly, as Native peoples forged their own nations, negotiated treaties, and enacted laws, they demonstrated to non-Native officials that they too were responsible for providing for the health and well-being of their members.

Even resistance to removal became bound up with resistance to the medical interventions provided by strangers. The Seminoles in Florida, who had waged military resistance against removal, resented the interventions of medical professionals during removal and resisted the care they offered. Their experiences had been far more hostile throughout. They lacked relationships with the doctors whose services the federal government obtained.[9]

Covid-19 Public Service Announcement launched by the Cherokee Nation as its profile cover on Facebook.

In the wake of removal, all of the Five Tribes increased their national and individual engagement with medical services. The Chickasaws disbursed funds to doctors for their services in their annual expenses. The Choctaws financed the medical education of some of their citizens.[10] By the 1850s, at least one Cherokee doctor regularly attended the American Medical Association’s meetings.[11] When the Five Tribes opened national social-welfare or educational institutions, they often provided medical services and sometimes assigned medical superintendents to the facilities.[12]And in the post-Civil War period, the Cherokees and the Chickasaws required licensing of non-Native doctors entering the Nation. Not only did this limit quackery and illegal settlement, but the fees also generated revenue for the tribes.[13]Despite increasing engagement with EuroAmerican medical care, that did not mean older medical spiritual practices dissipated. Access to medical doctors trained in Euro American settings was not universal, nor was it universally desired.

In the antebellum United States, professionalized medicine did not exist; therefore it is unsurprising that few Native Nations relied solely on the services of Euro American doctors. And yet, because of the actions of the federal government, the activities of missionaries, and the educational attainments of individual Native people, southeastern tribes invited discussions about the efficacy of treatments, whether those were administered by Indigenous people trained in Indigenous or United States methods or by Euro American doctors. Within the Native South, older medical practices circulated side-by-side with the treatment prescribed by missionaries and the occasional doctors who floated in and out of their communities. Those who interacted with missionaries often saw Euro American medical treatments as an option available to them. All of the tribes, whether through active resistance to Euro American doctors, as in the case of the Seminoles, or through mediation of services through negotiations or educational opportunities, reminded the federal government that public health matters were not only their responsibility, but also their sovereign right to oversee. It should not surprise us at all to see the lengths to which Native nations across the country stepped up to advocate for their communities in the wake of Covid-19.


[1] “Vulnerable Navajo Nation Fears a Second COVID-19 Wave,” accessed Sept. 13, 2020,; Navajo Times | Mar 22 and 2020 | Coronavirus Updates |, “COVID-19 Across the Navajo Nation,” Navajo Times, Mar. 22, 2020,; Erin Kelly, “‘It’s Very Devastating’: COVID-19 Ravages Mississippi Band of Choctaw Indians,” Clarion-Ledger, accessed Sept.r 13, 2020,

[2] “South Dakota Governor Tells Sioux Tribes They Have 48 Hours to Remove Covid-19 Checkpoints— CNN,” accessed Sept. 13, 2020,

[3] Julie L. Reed, Serving the Nation: Cherokee Sovereignty and Social Welfare, 1800‒1907 (Norman, OK, 2016), 23–28.

[4] Trail of Tears Association, Oklahoma Chapter, 1835 Cherokee Census (Park Hill, OK, 2002); “American State Papers,” Apr. 8, 1834,

[5] Reed, Serving the Nation, 28.

[6] Christina Snyder, Great Crossings: Indians, Settlers, and Slaves in the Age of Jackson (Oxford, UK,, 2019, 74.

[7] Arthur H DeRosier, The Removal of the Choctaw Indians (New York, 1972); Ruth Bloch Rubin, “State Preventitive Medicine: Public Health, Indian Removal, and the Growth of State Capacity, 1800‒1840,” Studies in American Political Development 34 (Apr. 2020), 24–43.

[8] Charles J. Kappler, Treaty with the Cherokee, 1835, Indian Affairs: Laws and Treaties, Vol 2. (U.S. Government Printing Office), accessed Sept. 13, 2020,

[9] Grant Foreman, Indian Removal: The Emigration of the Five Civilized Tribes of Indians (Norman, OK,  1982), 332–33.

[10] Constitution and Laws of the Choctaw Nation.Together with the Treaties of 1855, 1865 and 1866. Published by Authority and Direction of the General Council by Joseph P. Folsom … Chahta Tamaha, 1869 (New York, 1869), 180,

[11] Reed, Serving the Nation, 232.

[12] Reed, Serving the Nation; Constitution, Laws, and Treaties of the Chickasaws (Sedalia, MO, 1878),

[13] Reed, Serving the Nation, 227–28; Constitution, and Laws of the Chickasaw Nation,Together with the Treaties of 1832, 1833, 1834, 1837, 1852, 1855, and 1866. (Parsons, KS, 1899),; Constitution and Laws of the Choctaw Nation.Together with the Treaties of 1855, 1865 and 1866. Published by Authority and Direction of the General Council by Joseph P. Folsom … Chahta Tamaha, 1869, 180.

24 September 2020

About the Author

Julie Reed is associate professor of history at The Pennsylvania State University.

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