[Hill & Wang, New York 2001.]

In 1979, smallpox departed this earth. Let us all say Amen. Elizabeth A. Fenn's Pox Americana: The Great Smallpox Epidemic of 1775-82, is a frightening, and I mean frightening, peek into the horrors of the past. There are few history books that provoke tears and shock simultaneously, and this is one of them. After reading Pox Americana, the immediate impulse is to check the status of one's smallpox vaccination; the second is to light a candle and pray that the World Health Organization is correct.

Professor Finn's book covers all of North America, and estimates that in excess of 130,000 people died during this particular visitation of a virus (Variola) culling humans since Ancient Egypt. Most of the epidemic took place west of the Appalachians, from Alaska to Guatemala (and obviously all the way to Tierra del Fuego in the manner of horrific pandemics, but the book confines itself to North America). That part of the epidemic that involved the Colonies and Canada occupies the first half of the book. The American Revolution provided a perfect mixture of susceptible populations moving en masse to escape (or embrace) war or displacement or slavery and microbes seeking new hosts. The utterly ghastly history of the 1759 siege of Fort William Henry, and its aftermath of massacre and smallpox pouring into the Ohio Valley, was a prequeal (so to speak) of what happened in the Revolution on a grand scale.

The loss of the American Colonies has been blamed by many, including George Bernard Shaw in The Devil's Disciple, on the British War Office, but in the matter of smallpox at least Their Lordships got it right. The British Army enforced compulsory innoculation. Unlike Jenner's vaccination, innoculation is a horror story all its own, but mostly it worked, which is why the British had a significant epidemiological edge at the beginning of the conflict. America had had few "natural" outbreaks of smallpox, which meant a vast population with virtually no immunity, and innoculation was frowned upon when not actually forbidden because of the fear of contagion (with smallpox, other than vaccination there is no "win-win" situation). Washington, in a decision for which he should be given great credit but which is probably unknown beyond military history scholars, ordered all American soldiers innoculated. Thus was this particular British advantage obliterated and thousands of men freed to soldier on to Yorktown - and beyond, over the Appalachians eventually, into a vast interior whose native population was already decimated long before the big westward push.

This book explains the curious anomaly noticeable in histories of Cornwallis' southern campaign: how the British could push on while surrounded by hundreds (or thousands) of local inhabitants, black and white, sick and dying all around them. British soldiers didn't get smallpox and the ferocious spread of the disease among those they were fighting (other than Washington's Continentals) helped kill their enemies or at least kept them otherwise occupied. What the psychological toll on the British may have been is unknowable; this was an era of constant sickness and sudden death in the best of situations. There is one quote from a letter by Tarleton (page 119): "In November [1780], the infamous British colonel Banastre Tarleton noted that in the area around Singleton Mills, all the Americans had taken up arms 'except such as have the small Pox'."

The slaves who fled to British lines, however, were not innoculated, and were less military help than otherwise they might have been since they sickened and died by the hundreds, creating a medical and humanitarian crisis for the British Army from beginning to end of the Revolution. Smallpox's long incubation period meant that someone infected with Variola could be working normally one day and collapsed in agony 24 hours later. Those who moved in the wake of the British Army simply transported the epidemic along with the cannon and the baggage train. The inevitable drain on supplies, and the burden on the Army, lead to the (probably inescapable) decision by Cornwallis to abandon slave volunteers and followers, promises of freedom notwithstanding. In August of 1780, Cornwallis complained: "Our consumption of provisions is considerably increased by a number of refugees lately come to us, and by negroes that are employed in different branches of the public service". [Pages 129-130] And so they were turned out, and the closer to the end at Yorktown the more who were left to their fate. General O'Hara was appalled; so were some of the Hessians. [Page 130; O'Hara's heroic rebuke to Cornwallis is quoted in the footnote.] Thomas Jefferson estimated that of the "thirty thousand Virginia slaves he believed had joined the British 'about 27,000 died of the small pox and camp fever.'" [Page 131]

The years' long continuous contagion had an interesting side effect: the tendency to assume that the arrival of smallpox in a given area was a deliberate policy of the enemy. Fenn describes rumors of calculated infection, ranging from soldiers in Quebec in 1776 to information passed by Congressman Josiah Bartlett in 1777 to fellow delegate William Whipple: "It seems their design is, this Spring to spread the small pox through the country". [Page 91] "They" being the inevitable amorphous but omniscient enemy of all mass plots: "Leading New Hampshire patriots were 'certainly concerned and we have reason to think most of the Tories in New England are in the plan.'" [Page 91, Bartlett's letter to Whipple] Lord Dunmore, on his way out of Virginia and into infamy, was accused of deliberately spreading smallpox, too [page 91]. This sort of paranoid delusion would have a long extension into the future, reappearing in the ivy halls of academe as Americans deliberately infecting Indians with smallpox rather than the British and the evil, lurking Tories intentionally infecting Colonists.

Fenn's book is a chilling, depressing and fascinating narrative, well researched and immensely well written. Unlike many current academic works, it is straight forward, unpolitical and in the service of no theory. Pox Americana is what history books should be and often are not. It has only one fault, which cannot be attributed to the author or the subject: it is simply not possible for those of us used to life in a world where even doctors have never seen someone suffer and die from epidemic disease to understand the fear, the grief or the stench of a long gone world where a virus and not George III was the real king.