Thursday, June 03, 2010

Retrospective Review: Pox Americana (Part One)

The American smallpox epidemic of 1775-82, one of the most widespread outbreaks of that disease in recorded history, remained an obscure episode for more than two centuries after its subsidence. In 2001, Elizabeth Fenn, then of George Washington University (now at Duke), finally brought this event to a large readership with her deeply-researched, engagingly-written book Pox Americana. Dr. Fenn's book received much publicity when it was published, owing to its appearance in the immediate aftermath of September 11th and the October 2001 anthrax scare. I recently reread Pox Americana, to see how well it holds up now that the initial publicity has faded - and in light of nearly ten years of subsequent scholarship. The short answer is that it's even better than I remembered the first time. Over the next entry or two, I'll be reviewing Pox Americana, analyzing its findings, and suggesting why the plague at the center of Fenn's book, which spread from Hudson Bay to Peru and killed over 100,000 people, remained obscure for so many years.

Smallpox was a relentless and terrifying killer in the early modern period, and one which apparently grew in virulence between 1500 and 1800. It was particularly dangerous to isolated rural populations - like most of the white settlers in North America - and to populations with homogeneous immune systems, like American Indians. In the disease's early stages, those infected with smallpox suffered from aches, fever, and anxiety; as the disease progressed, its victims broke out in hundreds of oozing sores concentrated on the hands, feet, and face. The sores could lead to dehydration (if they appeared in the throat) or blindness; if they flowed together, they doubled the victim's chances of dying; and they almost invariably left disfiguring scars, whose only benefit was that they branded the survivor as permanently immune. There was no way to cure smallpox in the eighteenth century, and only two ways to fight its spread: quarantine and inoculation. Since inoculation actually gave inoculees a mild version of the disease and rendered them temporarily infectious, it was a controversial procedure and usually only available to the wealthy.

When the epidemic of Fenn's subtitle first broke out in the Atlantic seaboard cities of Boston, Montreal, Philadelphia, and Charleston (1775-79), Americans' first impulse was to quarantine the infected areas through controls on public movement, particularly the movement of soldiers. This proved impossible, given the cycling of volunteers in and out of the Continental Army and the movement of refugees to or from areas under rebel control. As a result the disease spread from its coastal enclaves into the hinterland, though it raged with greatest virulence on the coast, on British prison ships and in encampments of black Loyalist refugees - runaway slaves who sought freedom with British but often (in about 5,500 cases, Fenn estimates) found death instead.

As the smallpox death toll slowly grew, some white Americans came to believe that the British Army was using the disease as a weapon of war, dispatching sick Loyalist refugees to infect rebel-controlled areas. Fenn thinks this accusation was true; she presents evidence that at least one British commander, late in the war, sent infected slaves into rebel lines to spread the disease to his enemies. That smallpox posed so great a threat to American military effectiveness that the British tried to use it as a weapon helps explain George Washington's crucial decision of 1777 to inoculate all soldiers in the Continental Army against the disease (92-98). Fenn argued that this was "among [Washington's] most important decisions of the war" (134) and helped secure the rebels' eventual victory.

(To be continued...)

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