Examines the introduction of infectious diseases among the Indians of the Northwest Coast culture area (present-day Oregon and Washington west of the Cascade Mountains, British Columbia west of the Coast Range, and southeast Alaska) in the first century of contact and the effects of these diseases on Native American population size and structure.

In a century of contact with Euro-Americans, Pacific Northwest tribes such as the Chinookans, Coast Salish, Haida, and Tlingit saw their numbers plummet from about 180,000 to 35,000 due to introduced diseases such as influenza, measles, tuberculosis, and especially smallpox. A Portland, Oregon anthropologist gives a detailed historical epidemiology and account of the social impact of this demographic disaster. Includes the extant census data and population decline for two regions, supporting the hypothesis that disease was the main cause of Indian depopulation; and photos of key Indian informants, burial sites, and a vaccinating missionary.