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Pox Americana    by Elizabeth A. Fenn order for
Pox Americana
by Elizabeth A. Fenn
Order:  USA  Can
Hill & Wang, 2003 (2001)
Hardcover, Paperback

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* *   Reviewed by Hilary Williamson

Given the current daily news reports on bio-terrorism, I approached this story of Variola major (about the great smallpox epidemic of 1775-82) with a great deal of interest and with some apprehension. A fascination with the unfolding story quickly took over. Though my knowledge of this period of history is spotty, I had no inkling at all that smallpox, or Variola, played such a large part in the Revolutionary War, and though I was aware of the decimation of the Native American population by European disease, I had not realized that it was still a major factor around 1780.

Pox Americana is a history book, but one that is accessible to more than academics. It is brought to life by many individual voices that emerge from the general statistics, for example that of David George, a Southern slave who had smallpox, later preached in Nova Scotia and ended his life in Sierra Leone, Africa. An aspect still of great interest to us is how a community copes with a highly contagious disease, for which there is no cure. Apparently quarantine was practiced by Anglo-Americans in 1647 and by some Indians also. Unfortunately others simply fled carrying the contagion with them and this panic, along with unknowing carriers, did enormous damage.

Fenn explains to the reader the difference between inoculation, the process of 'deliberately implanting live Variola in an incision', and vaccination, which is infection with the related but milder disease of cowpox. Vaccination was discovered by Edward Jenner in 1796 and gives immunity without the patient having to undergo the disease. Though inoculation resulted in a lower fatality rate than occurred naturally with the disease (two rather than fifteen percent), people still died from it and, at the very least, were incapacitated for weeks.

This resulted in an ongoing controversy - to inoculate or not to inoculate. The peacetime dilemma was that inoculees, usually the richer folk who could afford it, often spread the disease to people around them. The wartime issue was whether to incapacitate soldiers through inoculation, with the possibility of the enemy exploiting the situation, or risk an eruption of the disease at a critical time. The European soldiers tended to have immunity from prior exposure, so the pox became an 'American affliction'. Given the vulnerability sickness causes to a standing army in wartime, decisions on inoculation were strategic ones.

One group badly hit by the pox were freed slaves who joined the Virginia governor's Ethiopian regiment. Here are some other interesting facts from the book. The 1775-82 epidemic killed more than 100,000 people (a conservative estimate) and maimed more. Variola can survive for weeks outside the human body (infection was often passed on clothing and blankets), has an incubation period of between 10 and 14 days, and the disease runs its course in about a month. Its lowest (dramatically) fatality rate is for those between the ages of 5 and 14 and its highest amongst the very old and very young. Effects of the disease are magnified by genetic homogeneity, which is why it was most severe amongst Native Americans.

Fenn traces its paths, from one group to another, through the course of the Revolutionary War and then shows us how it travelled via waterways on fur trade routes. They carried 'pox as well as pelts' across the continent, left many empty villages and changed the balance of power amongst Indian nations. The Americans during the Revolutionary War, feared 'that the British might use smallpox as a weapon of war', and some colonists believed that they had done so. In 1812, an empty threat of unleashing smallpox terrified Indians of the Northwest Coast, who were well aware of what the pestilence had already done to their people.

Pox Americana is a fascinating account that fills a remarkable hole in the history books. Read it if you're interested in the Revolutionary War in the United States, or in societal impacts of a highly contagious epidemic. One point that came across strongly to me was the degree to which the spread and impact of the disease was assisted by ignorance and fear; a risk that is still with us today.

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