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Journal of the History of Medicine and Allied Sciences 57.4 (2002) 497-499

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Book Review

Pox Americana:
The Great Smallpox Epidemic of 1775–82

Elizabeth A. Fenn. Pox Americana: The Great Smallpox Epidemic of 1775–82. New York, Hill & Wang, 2001. xiv, 370 pp., illus. $25.

Elizabeth Fenn’s Pox Americana reminds us that terrible diseases like smallpox not only devastate populations, but also shape the course of events. The book uses engaging narrative writing and both European and Native American sources to tell the story of the continental smallpox epidemic of 1775–82. Fenn presents this story not just as medical history, but as military history, Native American history, and history of the Atlantic world.

Fenn begins with an excellent discussion of the biological details of smallpox. What makes this introduction so masterful is the author’s use of [End Page 497] historical documents to illustrate modern knowledge of how the disease works. She also provides chilling illustrations to drive home the point that this was a horrifying disease: from photographs of twentieth-century smallpox victims, to native American pictographs of the disease, to a helpful chart of the course of the disease from incubation period to recovery.

The rest of the chapters follow the course of the North American epidemic as it moved from the East Coast to the West. Fenn is at her best when discussing the interaction of the smallpox epidemic with the Revolutionary War. As Fenn points out, wartime conditions are ideal for the spread of epidemic disease: “The virus needed chaos, connections, and a steady supply of susceptible victims. The war. . . offered all of these in abundance” (p. 107). Yet the effects also went in the other direction. Smallpox changed the course of the war and military strategy. At first, the epidemic offered a distinct advantage to the British, since most British soldiers were immune. The Continental army, on the other hand, was made up of vulnerable men who soon succumbed to the disease. Fenn attributes several of Washington’s early defeats to the fact that his troops were weakened by smallpox. As a result, Washington soon initiated the first-ever massive, state-sponsored inoculation campaign in U.S. history. While Fenn wisely does not credit smallpox with all of the war’s victories and defeats, her discussion of the epidemic points out the importance of smallpox as one of many contingencies that shaped the course of events.

Fenn then traces the disease’s course from Boston, where it began, to the southern colonies. The disease’s effects on the army had diminished (although it had not disappeared), but the virus found plenty of victims among the civilian population. In particular, the disease victimized escaped slaves and Native Americans who had joined the British. The epidemic caused the British to abandon many of their erstwhile allies—at times as part of a deliberate strategy to spread smallpox among the Americans. For these British allies, the war and the epidemic were doubly devastating. Not only had they chosen the losing side in the war, their populations were decimated. Once again, Fenn demonstrates the ways in which biology, here in the form of smallpox, shapes history—in this case, the history of Native Americans and African Americans.

The book is less impressive when Fenn turns to the course of the epidemic across the West and into Spanish America, Canada, and the Pacific Northwest. In these chapters, Fenn does not make the tight connection between political, social, and biological history that she does in the sections that discuss the Revolutionary War. While she continues to do a good job of tracing the ways trade routes and warfare spread the disease, one wishes she had pushed some of her ideas a bit farther. For instance, she includes a brief discussion of the realignment of Native American alliances and [End Page 498] power relations after the epidemic, a result she only tentatively connects to smallpox. This conclusion seems reasonable on its surface, and a longer, more definitive discussion would...


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