Book excerpt: The Coming of the Spirit of Pestilence examines the introduction of infectious diseases among the Indians of the Northwest Coast culture area (present-day western Oregon, Washington, and British Columbia, and southeast Alaska) in the first century of contact and the effects of these new diseases on Native American population size, structure, interactions, and viability. The emphasis is on epidemic diseases and specific epidemic episodes. In most parts of the Americas, disease transfer and depopulation occurred early and are poorly documented. The many quotations from contemporary sources underscore the magnitude of the human suffering. The Coming of the Spirit of Pestilence is the definitive study of introduced diseases in the Pacific Northwest.