State Preventive Medicine: Public Health, Indian Removal, and the Growth of State Capacity, 1800–1840

Despite growing awareness of the American state's active role in the early nineteenth century, scholars have tended to ignore the early republic's public health apparatus. The few studies that do chronicle antebellum health initiatives confine themselves to programs intended to directly reward citizens—and particularly those who contributed politically or economically to the nation's founding and expansion. As this detailed study of the Indian Vaccination Act of 1832 makes clear, however, antebellum policymakers saw value in providing medical care to those outside their settler citizenry. Blending liberal, republican, and ascriptive ideas, the vaccination program joined two competing political logics: one emphasizing the humanity of indigenous people and the importance of providing for their welfare, and the other prioritizing the state's interest in an efficient “removal” process. Evidencing far more autonomy and administrative capacity than the average nineteenth-century bureaucracy, the War Department played a pivotal role in petitioning Congress for, and ultimately administering, the vaccination program. Unwilling to cede regulatory power over indigenous health to more proximate local governments or private parties, the War Department preferred its own military manpower—a decision that would profoundly shape the design and reception of subsequent Native health programs.