In the introduction to Born to Die, Noble David Cook poses the often-asked questions about how a few hundred Europeans succeeded in conquering the Aztec and Inca empires and why some Indian societies survived while others completely disappeared.

The answer to these questions has changed over time, and in his introduction Cook traces the history and reviews the historiography of the two most widely accepted explanations—the actions of the Spaniards as vilified in the so-called Black Legend, and the decimating effects of Old World diseases. Cook concludes that while warfare, overwork, and cruelty claimed the lives of many native Americans, epidemic disease was by far the most important factor in explaining the rapid expansion of European colonialism and the precipitous decline of Indian populations. The rest of the book then presents a thorough synthesis of current knowledge regarding the introduction, spread, and impact of various infectious diseases on Indian societies up to 1650. Beginning with the second Columbus expedition to the Caribbean in 1493, Cook methodically reviews all pertinent accounts. He provides conclusive evidence that epidemic disease arrived in that region in 1493, long before the well-documented outbreak of smallpox in 1518, and suggests that this fact explains the early and rapid decline of Caribbean populations often noted by the first settlers and Spanish officials.

In later chapters, Cook traces the origins and effects of the first pandemics in Mesoamerica and the Andes, the timing and impact of epidemics in the rest of the Americas, and regional outbreaks to 1650. Based primarily on the earliest written accounts —including codices, government documents, and the letters of colonists and conquistadors as well as the recent scholarship of others —Cook pays particular attention to points of entry and to the spread of disease along pre-Columbian trade routes. In addition, he details the periodicity of outbreaks, determining that major epidemics occurred every 25 to 30 years for several generations, after which time some diseases established themselves as endemic in particular areas. Cook concludes that within a century of contact with Europeans, most native populations had declined by more than 90 percent, that native responses to introduced diseases were not effective, and that Europeans were able to use the threat of disease, represented as a form of divine punishment by the Christian god, to keep Indians under control.

In working his way through the massive amounts of scholarly literature published over the past 20 years on the subject of disease and depopulation, Cook has performed a most valuable service. His book is clearly written and argued. Except for the sections on North America, which are not as fully developed as those on Mexico and Central and South America, the author has provided the most thorough review and synthesis of the literature to date. This is an important book, one that should be read not only by historians but also by students and general readers.