‘POX AMERICANA: The Great Smallpox Epidemic of 1775–82’
By Elizabeth A. Fenn, New York City, Hill and Wang Division of Farrar, Straus & Giroux, Paperback, 384 pages, $15; Hardcover, 2001, 370 pages, $25
The fire bomber left a chilling note next to the charred remains of his target, the home of a prominent government official: “You Dog, Dam you! I'll inoculate you with this, with a Pox to you!” The year was 1721, and the target was Boston's renowned minister Cotton Mather, who had thrown his support behind the controversial technique of variola inoculation to halt the spread of the smallpox epidemic sweeping the colonies.
In this new era of domestic and international terrorism, we fear the threat of intentional release of smallpox, fumigate our mail, and contemplate mass immunization campaigns to stave off epidemics that threaten the economic and military foundations of our society. Thanks to this sobering and vastly detailed book, we now know that things haven't really changed much over the last 280 years.
Far from being a uniquely 21st century problem, the threat of intentional smallpox epidemics in unvaccinated and non-immune populations was a common public health and domestic security issue throughout the decades leading up to and after the Revolutionary War.
Focusing on the great epidemic of 1775–1782 that almost certainly influenced the outcome of that War and altered the balance of power between Europeans and Native Americans from coast to coast, Ms. Fenn chronicles the devastating power of the variola virus as it wrought despair and death from Boston to Hudson Bay, across the continent to Mexico City and up to the Pacific Northwest.
The resulting narrative is a masterful assembly of primary sources like soldiers' diaries, the log books of inland fur trading stations, and the libros de entierros (burial registers) of towns along the proselytizers' routes in New Spain (soon to be California).
Along the way, we learn fascinating tidbits that give a greater measure of humanity to some of our nation's founding figures and institutions. George Washington, who suffered the Pox in Barbados in 1751, was so stricken that he stopped keeping his journal for a full 24 days. When John Adams underwent variolation in 1764, his wife Abigail moved out with their children and subjected his letters to smoke treatment to kill the contagion. By 1776, advances in variolation technique led her to undergo the procedure herself and even forced a postponement of the Harvard College commencement in order to accommodate the illnesses caused by mass inoculation, which by then was all the rage.
Lessons from the Past
Aside from one or two scientific errors (e.g., the unqualified statement that “variola can survive for weeks outside the human body,” when this duration would be the unusual exception rather than the rule1) and an understandable but rather unexciting and repetitious effort in the latter half of the book of recounting the 1777–1782 terrible toll on the Midwest, Southwest, and Northwest, the book is an excellent example of accessible historical scholarship.
With a fuller understanding of the medical trials and public health tribulations that the founders of the United States withstood in the country's formative years, we can better frame the new roles played by medical and public health professionals in our current era of turmoil.
1. Henderson DA, Inglesby TV, et al, for the Working Group on Civilian Biodefense: Smallpox as a biological weapon: Medical and public health management. JAMA 1999;281:2127–2137.
Also of Interest
Lung Cancer Myths, Facts, Choices'and Hope
By Claudia I. Henschke, PhD, MD; and Peggy McCarthy with Sarah Wernick, New York City, W.W. Norton & Company, Hardcover, 2002, 390 pages, $26.95
Dr Henschke, Chief of the Division of hest Imaging at New York Presbyterian Hospital-cornell Medical enter and a well-known pioneer in lung cancer screening, and her coauthors, Peggy McCarthy, the founder of the Alliance for Lung ancer, Advocacy, Support, and Education (AL ASE), and health writer Sarah Wernick use a “blame-free” approach in this comprehensive, easy-to-read guide about all aspects of lung cancer, including practical recommendations for dealing with insurance companies and HMOs, employers, and finances