Abstract: Scholarly debate persists about the role of disease in the European colonization of the Americas. Were human pathogens the shock troops of conquest or a by-product of colonial incursions? Biological warfare or an accident of ecology? Historians and other scholars have recently raised the stakes on this 500-year-old debate by questioning the received narrative of Native American disease and depopulation after 1492 – in particular, the notion of “virgin soil” epidemics. This article reviews that new literature and makes a case for understanding the Native health past in all its complexity. Departing from a growing consensus about the contingent role of disease in the colonial process, the article suggests ways to develop the broader history of Native American health.