Infectious Disease & Colonial Politics: A Review of The Fever of 1721

I often wonder how people living before the germ theory of disease was discovered, before the causes of illnesses were known, and before any effective treatments were available coped with infectious disease outbreaks. How did they go about their lives, continue their businesses, and plan for the future. 

A new book, gaining some attention, shows how one community coped with such an outbreak. In The Fever of 1721: The Epidemic that Revolutionized Medicine and American Politics Stephen Coss provides just such a glimpse. The etiology of this particular fever, that occurred in colonial Boston, was smallpox, the scourge of humanity that was thankfully vanquished by the bifurcated needle wielded by DA Henderson. 

What makes the smallpox outbreak notable was that it was one of the first in which people were not helpless and could, borrowing the title from another important book on smallpox, defy Providence via inoculation. As I've written before, inoculation -- as opposed to vaccination -- was a procedure long-practiced in Africa and Asia,  that involved taking the material of smallpox and scratching it into someone's skin. The mild case of smallpox that followed was protective against the sometimes fatal naturally-acquired smallpox.

In 1721, as the story goes, a fire-and-brimstone preacher named Cotton Mather -- someone who was involved (on the wrong side) in the Salem Witch Trials -- came across reports of inoculation in a scientific journal after he had also learned of it through one particular slave. This prompted a largely unsuccessful crusade to have Boston physicians adopt the practice--Dr. Zabdiel Boylston being the heroic exception. It is a mystery to me how someone could be so compartmentalized intectually that they could participate in the Salem Witch Trials also support the cutting-edge science and exemplar of rationality that was inoculation.

What was peculiar about this situation--and this is one of the underlying themes of the book--is that Mather was very caught up in the politics of the colony and drew the ire of a particular newspaper, the New-England Courant, run by James Franklin assisted by his apprentice and younger brother Benjamin Franklin. The newspaper ran diatribes against inoculation and parodies of it (labeling it was a way to spread smallpox amongst Indians) but also general political commentary that was biting, incisive, and challenging to authority. It was even associated with Satanism! 

The tension was so high in the city that Mather's house was firebombed -- something I hope the anti-vaccine movement doesn't emulate. James Franklin wasn't anti-inoculation per se, but surely published anti-inoculation material. However, after seeing the benefits of inoculation during the Boston outbreak Benjamin Franklin became the "country's foremost inoculation evangelist." 

Inoculation, based on the results in Boston and in England, became an important component of smallpox control and was embraced by many, including John Adams (a relative of Boylston) and George Washington. In fact, pre-emptive inoculation of the Revolutionary Army is considered one of Washington's most important strategic actions.

The distinct value of this book is how it expertly weaves the narrative of the outbreak and the controversies surrounding inoculation with the burgeoning of a distinctly American political conscience--the newspaper published Cato's Letters.

For those who want to understand how politics interacting with infectious disease in colonial America, there is, to my mind, no better book.