Pox Americana , by George Washington University history professor Elizabeth A. Fenn tells the story of the effect of smallpox (Variola) on American society and history around the time of the American revolution. As you may know, smallpox was spread in ancient times from Asia and Africa to Greece and Persia, and then to Europe. This new book by Fenn considers only the transmission through the U.S., Mexico, and Canada. It isn't a source book for medical knowledge about the disease, but an insightful account of how the epidemic changed, and might have changed further, the revolutionary struggle and the Native Americans' loss of population and power. 
First, a word about the difference between inoculation and vaccination, and how and when the two medical skills were acquired. Smallpox inoculation (deliberate infection with the same virus) was discovered long before smallpox vaccination (deliberate infection with a different but related virus). Inoculation was part of the tribal knowledge of some African people. Kidnapped Africans taken to North America as slaves inoculated each other in strict secrecy. The white population couldn't figure out why the number of smallpox cases among the slaves was lower than the incidence rate among their enslavers. In 1716, Onesimus, a slave "owned" by Cotton Mather, a Puritan minister in Boston, broke the secret and told his "owner" about the procedure. If one makes a small incision in the arm and deliberately introduces smallpox, the individual usually becomes moderately ill, and only for a short time. Upon recovering, he or she is permanently immune to smallpox. [Fenn, pages 31-32] The inoculation itself has a measureable fatality rate. In 1721, there was an outbreak of smallpox in Boston. The inoculation process itself killed 2 percent of the patients who requested it, while 15 percent of the people who acquired the disease without having been inoculated died from the virus. [33] Vaccination, however, was invented in 1796 by James Jenner, a physician in England. In Jenner's experiment, he infected an 8-year-old boy with cowpox. Jenner later tried to give the boy a smallpox inoculation, but was unable to do so, because the infection required to perform an inoculation wouldn't appear. The previous experience with cowpox had made the boy immune to smallpox. Jenner published his results in 1796. [33] Due to the dangers of the inoculation, as well as for religious reasons, the process was politically and medically controversial when smallpox spread throughout all of North America during 1775 to 1882, as it was equally controversial in Europe. Many cities banned, or hesitated to adopt, the new procedure of inoculation against smallpox (variolation). The more pragmatic leaders considered the fact that the inoculation itself can kill, and the fact that inoculees who avoided the disease were still capable of transmitting the virus to others. In addition, many of the devoutly religious considered inoculation to be unnatural, a rebellion against the will of God.
Unlike the leaders of other cities, the authorities in Philadelphia decided not to ban or even regulate the procedure. This decision had several effects. It caused people from other colonies to travel to Philadelphia to seek the inoculation, including Thomas Jefferson and Martha Washington. The market forces of supply and demand made the treatment become very expensive, until it became unavailable to the working class. Most of the victims of the epidemic were the children of the poorest families. The influx of so many visitors also caused the city to have a much greater than average incidence of the disease. [83] George Washington was infected in 1751. Based on the incubation period of about 12 days, historians can calculate that he picked up the virus while visiting Barbados. He survived; he did, however, stop writing his diary for 24 days. [15] Having been once infected, he was permanently immune to the virus which later endangered his troops, particularly in Boston. After July 4, 1776, General Washington had to consider the British empire to be the primary enemy, but the virus among his troops was a close second. He made it a direct order for all of his troops to be inoculated, without which decision (as Fenn explains with cogent reasoning) the British force probably would have defeated the Colonial army. He called his inoculation initiative "outflanking the enemy." [82] John Adams performed an experiment on himself. He underwent the inoculation treatment, then, to lessen the likelihood that the inoculation would kill him, he consumed a mercury solution to kill the virus. Finally, he had to recover from mercury poisoning. In the end, he was left with every tooth in his mouth being loose, the result of the mercury, but could at least go on with his life with the knowledge that he was immune from smallpox. [33-35]
The native people of North America were hit hardest by the epidemic. By the 1790s, the tribes along the Missouri River -- the Mandans, Pawnees, and Arikaras -- who lived in crowded agricultural towns, suffered deaths of whole towns. Lewis and Clark, who stayed with the Arikaras for a time, commented in their journals about this diseases which causes the extinction of entire towns. [262] This left these tribes incapable of defending against attacks by the Sioux; hearing of this, the Sioux invaded. However, in the process of invasion, the Sioux were infected also. [217-218] Similarly, it cannot be verified, but it is probable, that the Comanches were infected because they attacked the Apaches.[213] The way economics was arranged among the tribes, the epidemic made the Blackfeet more powerful. It had been mandatory for them to acquire the goods of traders by way of middlemen among the Crees and Assiniboines. When smallpox killed the middlemen, the Blackfeet dealt with the traders directly. This provided them with such an abundance of guns and other goods that they took a considerable amount of land away from the Shoshones. [263] The advantage was temporary. The Blackfeet didn't understand the concept of a contagion, as one named Saukamappee later explained, "We had no belief that one man could give it to another, any more than a wounded man could give his wound to another." [221] Therefore, when the disease attacked this tribe as well, there was no explanation but that the Good Spirit had forsaken the people, leaving them at the mercy of the Bad Spirit. [221] The illustrations in the book are to a purpose, not merely to decorate. The map on page 7 indicates the documented paths (solid arrows) and probable paths (dotted arrows) of the travels of the virus from Mexico City to northern Canada. A map on page 216 shows the Shoshone-Comanche trade routes. The table on page 19 cross references days to communicability and symptoms. Page 274 tabulates mortality rates for ethnic groups, e.g., the Ojibwas, and for places, e.g., Wilmington, North Carolina. In all, there are 38 black & white illustrations.
The appendix of notes provides a full set of references to primary sources, fact-by-fact, following scholarly style. 12-page 2-column index. |