"Health and Disease in the New World" by Marc S. Micozzi, M.D., Ph.D. in "Encounters" (Double Issue No. 5-6, pp. 42-43) Dr. Micozzi is Director of the National Museum of Health and Medicine and Associate Director of the Armed Forces Institute of Pathology in Washington, D.C. The National Museum of Health and Medicine Foundation, chaired by former U.S. Surgeon General Dr. C. Everett Koop, is co-sponsoring an exhibit entitled "The Two Worlds of Columbus: Health and Disease in the New World" scheduled to go on display in Washington, D.C. in 1992. Corporations and organizations interested in co-sponsoring this exhibit may contact Dr. C. Everett Koop, Chairman, National Museum of Health and Medicine Foundation, P.O. Box 59748, Washington, D.C. 20012-9748. Telephone (202) 576-1329. Explorations by the Spanish, Portuguese, French, English, and Dutch during the fifteenth, sixteenth, and seventeenth centuries revealed to Europeans a huge continent to the south in the Old World, and massive double continents to the west in the New World. These new worlds were populated by millions of inhabitants living in complex civilizations whose existence had been previously unknown and could not be accounted for within the philosophical and religious traditions of contemporary Europe. Thousands of organized societies were diverse in size, complexity, language, and customs. The unusually large and complex societies of what is now Guatemala-Mexico and Bolivia- Peru (what modern archaeologists call "complex civilizations") posed conceptual challenges to Europeans since their social organization closely paralleled that of Europe in many ways. The discovery and exploration of Africa and the Americas were not isolated events, but were carried out for purposes relevant to European society. Exploration and exploitation initially, and trade and settlement subsequently, were projections of European cultures into new environments with the intention of directly involving Africa and the Americas with European society. Domestication had provided Europe with the horse, which was notable both for its land mobility and symbolic (and shock) effect. The early entry of Old World Europe into the Iron Age provided it with the military advantages of armor, swords, spears, long bow and mechanized crossbow, as well as the more recent percussive weapons, such as handguns, and ship- transportable cannons. This military hardware had devastating effects on Native American populations. Another major import from Europe with devastating effects in the Americas was disease. The European exploration of Africa, concomitant with that of the Americas, set up somewhat of a "triangle trade" of people and diseases brought back and forth between Europe, Africa, and the Americas. One popular view of the effects of European contact is that it brought a series of devastating new disease epidemics that led to relentless declines in population size among Native Americans. Perhaps the most dramatic example was the devastation of South America's Inca empire, whose population has been estimated as high as thirteen million in 1492, and as low as two million by 1600. In North America, the Indian population fell from approximately two million in 1492 to a low of about five-hundred thousand by 1900. The devastation of diseases such as smallpox on Native American societies are evident beginning with their first encounters with the Spanish in the southeast and continuing with the explorations of DeSoto in the Southwest. However, in modern populations around the world, epidemics and famines do not invariably lead to population declines (to which the twentieth-century history of Asia provides testimony). During a typical epidemic, the very young and the very old are especially effected, adolescents and young adults being relatively spared. Adults may also put off marriage and childbearing until the epidemic is past. The net result is often increases in population size after the epidemic is past, since the childbearing population is spared. Most populations have an ability to recover from the severe high mortality associated with even several disease epidemics. A more recent view we have developed of the effects of European contact on Native American populations shows gradual declines in population size over time, rather than catastrophic mortality patterns. These population changes may be partially explained by the resurgence of endemic diseases, those diseases which may have been present among Native American populations prior to European contact. Diseases that were present in the Americas prior to European contact have been identified by archaeologists in the study of early New World civilizations, and by physical anthropologists in the analysis of ancient skeletal remains. Historic reports also provide evidence for the presence of numerous diseases in the New World. Health status in the New World prior to European contact was probably influenced by several diseases including dysentery, common bacterial infections, salmonella and other food poisonings, viral influenzas and pneumonias, viral and rickettsial fevers, typhus, tuberculosis, American leishmaniasis (transmitted by "kissing bugs"), South American trypanosomiasis (also present in Africa as "sleeping sickness"), intestinal worms and other intestinal parasites, non-venereal syphilis, nutritional deficiency states (such as goiter in highland populations), and various forms of arthritis. Many of these diseases could have originally been brought to the New World with the prehistoric arrival of peoples from Asia across the "cold barrier" of Siberia and the Bering Strait to Alaska and thence through the New World. The existence of an extensive Native American pharmacopeia provides testimony to the presence of diseases to be treated. Many natural products traditionally used to treat diseases in the New World are now known to be effective pharmaceuticals. These include various anesthetics, astringents, antiseptics, antibiotics, cathartics, anti-malarials, vermifuges (to kill intestinal parasites), and obstetric-gynecologic preparations. A variety of natural psychoactive compounds were also known and may have been useful in the healing process. Clearly, elements of Native American health care must have been effective at minimizing the effects of the diseases that were known to the New World. Having an effective social system for rendering care when needed, and living in harmony with the environment in a way that helped people remain healthy, were important aspects of health status in the New World. The arrival of Europeans not only introduced new diseases into the New World but also brought about drastic changes in lifestyle and social structure. Emergence of chronic, debilitating diseases accompanied new epidemics, which were at least partially due to disintegration of the social system. Tuberculosis rates increased in the New World after European contact, associated with malnutrition, overcrowding, war, social upheaval, poverty, alcoholism, and smoking. Under such conditions, tuberculosis could readily be passed from older adults to adolescents. And unlike rapid disease epidemics, chronic diseases such as tuberculosis took a great toll on the childbearing population and adversely effected the ability to reproduce. Some new evidence shows European contact leading to increased mortality rates among adolescents and young adults. Thus, the eventual declines in Native American population size after European contact become easier to interpret based upon a resurgence of chronic diseases, not only epidemics of new diseases. Here, the social structure and culture of Native Americans are key to understanding the spread of disease. Today the spectrum (and spectre) of disease in Native Americans has shifted to include many of the diseases of modern industrial society, such as gall bladder diseases and cancer, diabetes and lactose intolerance, heart disease, ulcers, alcoholism, mental illness, suicide, and obesity. Tuberculosis persists as a problem of great dimensions. Vestiges of traditional medical practices remain side-by-side with elements of modern western medical technology. As in the past, we will not be able to understand and control the medical aspects of these diseases unless we address their social and cultural dimensions.