Book Review: The Fever of 1721

The Fever of 1721:The Epidemic That Revolutionized Medicineand American Politicsby Stephen CossSimon & Schuster, 2016The brutal disease of smallpox is at the heart of Stephen Coss's fantastic debut. Now virtually eradicated from the world, smallpox was rampant in the early years of the 18^th century (and, indeed, had been rampant for millennia), and The Fever of 1721 tells – in greater and more vivid detail than any previous account – the story of the disease's advent in the thriving port city of Boston.Coss wisely opts to tell this story through gallery of outsized personalities dominating Boston in 1721 – particularly as they lined up on either side of the most hotly-contested public health question of the year: variolation, the controversial practice of intentionally giving a healthy person a mild infection of smallpox in order to immunize them from more severe infections. The medical authorities of the day were almost unanimous in their condemnation of the practice, and naturally the spiritual authorities of the day mostly considered it an arrogant trespass into the province of the deity.Which makes it all the more interesting that Coss's two most compelling central characters are a doctor and a minister. The doctor was curt, courageous Zabdiel Boylston, a medical trailblazer who defied the censure of Boston's town elders in order to experiment with variolation – including using the most precious test subjects of all:

He knew that when the word got out that he was implanting smallpox into the skin of perfectly healthy subjects, charges that he was acting impulsively and with a cavalier attitude toward the well-being of his patients … were certain to follow. The surest way to convince the people of Boston that he was not embarking on his experiment lightly and that the procedure had merit was, he believed, to successfully inoculate his own son. Practically speaking, he could not expect parents to submit their children to a procedure he had been afraid to perform on his own.

Mather, living under the long shadow of his involvement in the Salem Witch Trials, is portrayed in these pages in all his multifaceted contradictions. On the one hand, Mather yearned with a masochist's fixation for a purifying fire to be visited upon an indolent populace he always viewed as having wronged him in some fashion or other, and few purifying fires were more Biblical than plague. But on the other hand, Mather had learned from a slave years before that successful inoculation against smallpox was possible, and when a British ship coming into Boston Harbor in 1721 brought a new outbreak of the virus, Mather's masochism warred with his messianism. It's a testament to Coss's psychological insight that he so often manages to capture this changeability, including in the very moment of change itself, when Mather first learned of the impending disaster:

His first impulse was to exult. Late the previous year, his father, enraged by the disrespect and indignity that had been visited upon his son, the clergy in general, his church, and himself, had issued a scathing jeremiad (also referred to as “an awful sermon”) warning that “an heavy judgment was impending over Boston, that would speedily be executed.” Early in 1721 Cotton Mather had followed suit with a nearly identical warning, foretelling “the speedy Approach of the destroying Angel.” Now the punishment they had predicted (and, in a sense, called down from Heaven) was at hand and their visions had been validated. But Mather quickly chastised himself for his hubris. “It becomes me,” he wrote, “to humble myself exceedingly, and ly [lie] in the Dust. Lest the Vanity of mine upon seeing my poor prediction accomplished, should provoke the holy One to do some grievous Thing unto me.” Perhaps he remembered that he had at least two children at risk of infection.

The Fever of 1721 makes the overreaching cultural claims that seem to be required of popular history volumes these days (sometimes, a virus is just a virus), but as a lively narrative of a city on the edge of modernity coping with a disease from the dawn of civilization, Coss's debut is page-turningly superb.