The Province of Affliction: Illness and the Making of Early New England

By Ben Mutschler

In The Province of Affliction, Ben Mutschler explores the surprising roles that illness played in shaping the foundations of New England society and government from the late seventeenth century through the early nineteenth century. Considered healthier than people in many other regions of early America, and yet still riddled with disease, New Englanders grappled steadily with what could be expected of the sick and what allowances were made to them and their providers. Mutschler integrates the history of disease into the narrative of early American social and political development, illuminating the fragility of autonomy, individualism, and advancement . Each sickness in early New England created its own web of interdependent social relations that could both enable survival and set off a long bureaucratic struggle to determine responsibility for the misfortune. From families and households to townships, colonies, and states, illness both defined and strained the institutions of the day, bringing people together in the face of calamity, yet also driving them apart when the cost of persevering grew overwhelming. In the process, domestic turmoil circulated through the social and political world to permeate the very bedrock of early American civic life.

• Language: English
• Publisher: University of Chicago Press
• Release date: Aug 6, 2020
• ISBN: 9780226714561

Book preview

The Province of Affliction

American Beginnings, 1500–1900

A Series Edited by Edward Gray, Stephen Mihm, and Mark Peterson

Also in the series:

Trading Spaces: The Colonial Marketplace and the Foundations of American Capitalism

by Emma Hart

Urban Dreams, Rural Commonwealth: The Rise of Plantation Society in the Chesapeake

by Paul Musselwhite

Building a Revolutionary State: The Legal Transformation of New York, 1776–1783

by Howard Pashman

Sovereign of the Market: The Money Question in Early America

by Jeffrey Sklansky

National Duties: Custom Houses and the Making of the American State

by Gautham Rao

Liberty Power: Antislavery Third Parties and the Transformation of American Politics

by Corey M. Brooks

The Making of Tocqueville’s America: Law and Association in the Early United States

by Kevin Butterfield

Planters, Merchants, and Slaves: Plantation Societies in British America, 1650–1820

by Trevor Burnard

Riotous Flesh: Women, Physiology, and the Solitary Vice in Nineteenth-Century America

by April R. Haynes

Holy Nation: The Transatlantic Quaker Ministry in an Age of Revolution

by Sarah Crabtree

A Hercules in the Cradle: War, Money, and the American State, 1783–1867

by Max M. Edling

Frontier Seaport: Detroit’s Transformation into an Atlantic Entrepôt

by Catherine Cangany

Beyond Redemption: Race, Violence, and the American South after the Civil War

by Carole Emberton

A complete list of series titles is available on the University of Chicago Press website.

The Province of Affliction

Illness and the Making of Early New England

Ben Mutschler

The University of Chicago Press

CHICAGO & LONDON

The University of Chicago Press, Chicago 60637

The University of Chicago Press, Ltd., London

© 2020 by The University of Chicago

All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission, except in the case of brief quotations in critical articles and reviews. For more information, contact the University of Chicago Press, 1427 E. 60th St., Chicago, IL 60637.

Published 2020

Printed in the United States of America

29 28 27 26 25 24 23 22 21 20    1 2 3 4 5

ISBN-13: 978-0-226-71442-4 (cloth)

ISBN-13: 978-0-226-71456-1 (e-book)

DOI: https://doi.org/10.7208/chicago/9780226714561.001.0001

Library of Congress Cataloging-in-Publication Data

Names: Mutschler, Ben, author.

Title: The province of affliction : illness and the making of early New England / Ben Mutschler.

Other titles: American beginnings, 1500–1900.

Description: Chicago : University of Chicago Press, 2020. | Series: American beginnings, 1500–1900 | Includes bibliographical references and index.

Identifiers: LCCN 2020000791 | ISBN 9780226714424 (cloth) | ISBN 9780226714561 (ebook)

Subjects: LCSH: Diseases—Social aspects—New England—History—18th century. | Diseases—Social aspects—New England—History—19th century. | Public health—New England—History—18th century. | Public health—New England—History—19th century. | New England—History—18th century. | New England—History—19th century.

Classification: LCC RA446.5.N48 M87 2020 | DDC 362.10974—dc23

LC record available at https://lccn.loc.gov/2020000791

This paper meets the requirements of ANSI/NISO Z39.48–1992 (Permanence of Paper).

TO THE MEMORY OF MY PARENTS, PHYLLIS HALEVY MUTSCHLER AND LOUIS HENRY MUTSCHLER

Contents

Introduction

OVERVIEWS

1.   A Tour of the Province: October 18, 1769

2.   Illness in the Social Credit and Money Economies of Eighteenth-Century New England

COMPETENCY

3.   Family Competency: Scenes from the Life Course of Illness

4.   Household Competency: Work, Responsibility, and Belonging

DEPENDENCY

5.   Smallpox, Public Health, and Town Governance

6.   The Domestic Costs of War: Wartime Afflictions

AGENCY

7.   Colonial Pensioners, the Revolutionary Invalid Corps, and the Advent of Decisive Disability

8.   State Paupers and Patients

Epilogue

Acknowledgments

Notes

Index

Introduction

On a late summer day among one of Philadelphia’s leading families, when the thick heat in the city could rival places well to the south, young Henry Drinker happily chomped through a piece of watermelon until he ate too close to the Rine. It was an innocent enough mistake for a six-year-old to make. But as his mother surmised in her diary, that moment of youthful exuberance had been costly, the cause of Henry’s vomiting and disordered bowels and the beginning of a serious sickness. Between late August and October 1777, Elizabeth Drinker kept a vigilant record of her son’s precipitous decline and slow recovery. Henry voided 3 large Worms, and vomited one alive. He was unable to eat for nearly two weeks, reduced almost to a Skelaton, and ran a constant fever. While there were promising signs of recovery by September 6, when Henry’s appetite began to return, his mother judged his illness to be an inviterate Bloody and white flux, a worrisome condition. She confessed, "I cant help being happrehensive [sic] of his falling into a Consumption, which would be chronic and finally fatal. Henry had lived through earlier bouts of worms and bloody, mucous-laden stools—and in his sufferings and recovery, he was typical of many children of his time—but his mother had seen enough illness in her family to fear the worst. At age forty-two, Elizabeth Drinker had already lost three children, two girls and a boy. The first little Henry," named after his father, had died as an infant in 1769.¹

Drinker viewed young Henry’s progress in the coming weeks with a mixture of optimism and restraint. A promising morning was followed by a discouraging night; Henry’s appetite continued to increase but his fever remained; and his bowels could come down in a frightfull manner, as they had on September 15, when they appeared red, Bloody and inflam’d and cast a bitter smell through the room. There were continuous calls to the Pot, a steady administration of clysters (enemas) and other physic that Drinker appears to have applied both on her own and in consultation with physicians, and, above all, a good deal of careful watching and waiting. Finally able to have his britches put on and walk across the room with the help of a servant who had been charged with carrying him about the house, Henry suffered another setback at the end September, taken off his feet again by pains in his hams and a cold brought on by the autumn chill. It was not until October 26, two months after his initial sickness, that Elizabeth Drinker could signal Henry’s full return to daily affairs. On that day, Drinker joined her sister, her three healthy children, and Henry at Quaker meeting, noting with relief the first time of our little Henrys going since his recovery.²

The troubles had all started, in Elizabeth Drinker’s mind, with a few errant bites of melon. As in so many other incidents in early modern life, the thin membrane separating the workaday world and a world of perils had been all too easily punctured.

---

***

The origins of this book lie in Henry Drinker’s unfortunate encounter with that watermelon rind, in its evocation of the closeness of danger and the possibility of sudden change in everyday affairs. Elizabeth Drinker’s remarkable diary, one of the richest accounts we have of daily life in eighteenth-century America, was my first window onto the ubiquity of sickness and other misfortunes in the period. But I subsequently found that while Drinker’s diary is perhaps more insistent than other sources in its recording of illness, it is by no means exceptional.

Almost any source from the period reveals a world riddled by affliction. Letters contain polite inquiries into health and offer running accounts of the status of family, friends, and acquaintances. Newspapers and almanacs feature all manner of information about sickness: the spread of epidemics ravaging distant lands and neighboring colonies and towns, the arrival of infected goods and persons subject to quarantine and cleansing, and the sale of enslaved persons whose bodies are advertised as healthy and as already having weathered smallpox. Sermons seize on severe sickness as a warning that death might strike at any moment and as an inducement to examine the diseased state of one’s soul. The acts and resolves of colonial assemblies depict a staggering range of afflictions besetting early modern folks. War veterans and their families ask for restitution for medical care; towns press for relief in the wake of epidemics; the injured, infirm, and simply unlucky plead for special licenses and exemptions from taxes, fees, or other public obligations. Government itself is subject to diagnosis and cure, the republican remedy for the diseases most incident to republican government in Federalist No. 10 being the most prominent example of many prescriptions penned by political physicians. From the minute accounts of persons feeling unwell to the grand metaphors of a diseased society and politics, sickness has left its impress on the records of early American life.

There was nothing new, of course, in finding the regular presence of sickness in early America; widespread illness and the pain and suffering that accompanied it are often identified as key elements of the early modern world.³ But if sickness is easily detected in the records of the past, its influence on the rhythms, tempo, tenor, and structures of daily life is not readily apparent. I was less intrigued by the immediate ways in which illness was addressed through different modes of healing, or managed through public health measures, or experienced by sufferers—topics on which there is already a rich body of scholarship—than by a more general question: How did sickness figure in the larger scheme of daily affairs?

The evanescence of illness makes this sort of question difficult to answer. Sickness manifests itself in the historical record as a problem that waxes and wanes at any given moment, sometimes surging forward and trumping other concerns, sometimes fading into the background. We have the easiest time in seeing illness and thinking about its significance when it comes to the fore in spectacular epidemics, in the traumatic and swift sicknesses that devastate the stricken and alarm those around them, in the final illnesses that the living seize upon as a means of narrating the end of life. But there are many other moments when illness, though noted, sits quietly in the background, taking its place alongside many other stories. Even dramatic accounts of sickness may be mixed together with enough other kinds of information—the mundane comings and goings of neighbors, a brief note of work accomplished, accounts of the weather, and the like—that it is difficult to know how to interpret their importance. The often repetitive and terse references to persons being unwell, sprinkled through everything from letters and diaries to public records, lose meaning in their diffusion. What we lack is a sustained way of thinking about how the manifest disturbances of illness figured in daily life.

I conceived of a book that would offer a portrait of early American society and government with illness at its center. Ultimately, I decided to locate the study in New England. This would mean losing some wonderful materials, Drinker’s diary among them, and revisiting a much-studied region. But the rich primary sources in New England—including diaries, correspondence, petitions, newspapers, institutional archives, and town, church, and court records—spoke directly and in intriguing ways to the question that interested me most profoundly: the continuous, often vexed interplay between the workaday world and the world of illness.

From the earliest years of European settlement until well into the eighteenth century, New Englanders experienced an ongoing tension between a work ethic Protestantism and the providentialism that undergirded daily life. On the one hand, they felt the compulsion toward steady, sober work and resisted the delays and stoppages caused by illness. On the other hand, they believed that afflictions—not only illness, but other misfortunes such as accidents and fires—were Man’s fate to accommodate and endure. They were to act, in John Winthrop’s words, as a community of perils, in which the infirmities and misfortunes of one would be shared by all. The sick could expect the help of the good neighbor and townsperson versed in the ways of affliction but could also expect some pressure to muscle through their malaise.⁴

Equally important, the distinctive political economy of New England, and particularly of Massachusetts, offers a unique purchase on early modern social welfare. Recent scholarship has shown that, for all of its distinctive characteristics, the region was well-integrated into the Atlantic world of the early modern era. Indeed, in its provision for the poor and in its public health regulations, New England carried forward cutting-edge developments that had their origins in sixteenth- and seventeenth-century England. Town, province, and state governance became deeply integrated into matters of misfortune, offering succor (however spare to modern eyes) and demanding adherence to public health laws that privileged community welfare over the individual. Such developments were elusive elsewhere in British North America, and the generosity and intensity of social provision point to the region as being at the vanguard of social welfare provision.⁵

How did New Englanders negotiate the tension between the world of work, of striving and industry, muscle and motion, and the world of sickness, of absence, delay, and excuse, of tasks done shabbily or left undone altogether? Their struggles to manage that conflict fill the pages that follow.

---

***

The Province of Affliction sets out to explore the ways in which illness shaped the contours of society and government in New England’s long eighteenth century, from roughly 1690 through 1820. Decades of work by medical historians and other scholars investigating New England and other regions of the Atlantic world now offer many revealing angles of vision on disease and its influence on early modern life. Grand narratives map tectonic changes in world history that can be attributed in no small degree to disease, including most spectacularly the demographic catastrophe visited upon Native Americans that opened the way to European conquest.⁶ Studies of public health offer insight into the early development of medicine and public authority.⁷ Explorations of the boisterous and competitive medical marketplace reveal negotiations between patients and their practitioners.⁸ And examinations of the sick themselves—their encounters with public and private charity, their interior lives—illuminate the boundaries within which the subjective experience of illness emerged.⁹ All of these studies help us to see sickness and healing not apart from larger social, political, and cultural contexts, but rather deeply implicated within them.

This study builds on and extends this work by further integrating the history of disease into a broader narrative of early American social and political development. The central objects of study are not diseases, nor healers, nor even patients in and of themselves, but rather the social and governmental entities of early America—family, household, town, colony, state, and finally national government—as they engaged with the problems presented by disease.

Eighteenth-century New Englanders tended to refer to their ailments not as specific diseases but rather as generic fevers, agues, and disorders, or else simply noted that they were unwell, ill, or dangerously sick. This book examines the problems routinely presented by the condition of being sick, whatever the cause—the disruptions it created, the pressures it placed on the afflicted and those who cared for them. There were questions of organization to be addressed: Who would tend the sick and perform work in their stead? What tasks would be sacrificed in the name of care? And there were questions of limitation and threshold: When could sickness count as an excuse for shoddy or incomplete work? What special allowances would be granted the ailing and those who cared for them in a society accustomed to sickness?

The book explores the ways in which the authority and urgency of illness—its ability to arrive suddenly and contort the lives of the sick and those around them for a time before vanishing—shaped and strained the ligaments of society and government in early New England. The ideal vision of the social and political order was one in which family, church, and commonwealth were integrated into an interlocking, mutually reinforcing whole. Illness could be the occasion that showed the very best that New Englanders had to offer in this regard, a shining example of what even staunch critics of the colonial world writing later in the nineteenth century would call an admirable spirit of cooperation: families tending their ill, neighbors pitching in and visiting, the church offering prayers and collections for the afflicted, the protective hand of government helping when disaster struck. But the burdens of illness exposed significant tensions as well. Illness imbued daily life with a radical sense of contingency. Like accidents, natural catastrophes, and sudden changes in the economy, sickness was understood to be a force of downward mobility. The threat not only of death, but of suffering and impoverishment, made illness an occasion to make demands on family, neighbors, and finally governing bodies at all levels. In the process, the turmoils of domestic life circulated through the social world and bubbled up into civic affairs.

After offering overviews that introduce readers to key themes and persons in the book (chapters 1 and 2), the following two sections elaborate a spectrum of responses to illness, ranging from accommodations for those who were well-positioned in community life, on the one hand, to provisions for the sick poor, on the other. While attentive to changes over time and space—particularly the precocious institutional responses to the sick that arose in the ports—these chapters focus on the durable patterns of daily life that held firm until the last third of the eighteenth century.

Even for the well-connected, illness could present serious challenges to their efforts to achieve and maintain a competency, or a middling level of subsistence. Because no farm was entirely self-sufficient, the achievement of a competency inevitably required farm households to engage in interdependent relations with their neighbors, or to produce surplus goods for sale in local and distant markets to gain the cash necessary to buy what could not be found locally. Although such strategies made farmers beholden to others, they were performed in the name of preserving a sturdy independence.¹⁰

A consideration of illness within families (chapter 3) and households (chapter 4) helps us see more clearly the physical labor that the term competency itself could elide: it was able-bodied labor that made land valuable through improvements or a crop successful through careful attendance. Illness meant the inability of workers to perform as they normally did, illuminating the extent to which physical ability was bound up in the achievement of the competency ideal. Moreover, a focus on illness—and on the severe disruptions to labor caused both by the absence of workers and by the secondary loss of those taken away from other household chores to care for the ill—highlights the collective, familial, and household basis of competency. Success required the good fortune of maintaining an able-bodied household, particularly wives, daughters, and female servants whose work in the domestic economy of cooking, cleaning, and dairying was immediately missed in its absence.

As New Englanders struggled to address the needs of the ill and manage the social and financial costs of care in support of a competency, the relations between neighbors and within families and households were defined and tested. At what point in an acute or chronic sickness did a family exceed the limits of the social credit economy that brought neighbors as nurses into their houses and workers into their fields? At what point was a son or daughter, having fallen ill while serving abroad as a helper, apprentice, or hired laborer, no longer a parent’s responsibility? And when did failures of the worker’s body dissolve the bonds of protection and benevolence that held master to servant? Both custom and law left ample room for negotiation and debate.

At the other end of the spectrum from the competent lay the sick poor and a wide assortment of persons brought into dependency through affliction. Dependency was the moral foundation of social and political relations in this world before the Revolution, something more important than the simple deference that one owed superiors and the condescension that superiors graciously bestowed on subordinates.¹¹ But during and after the Revolution, those espousing the ideal of dependency faced a host of new challenges, particularly as superiors confronted what they took to be the insubordination of those beneath them in station.¹²

Illness lets us see another set of problems confronting patriarchal authority within the matrix of dependency, by highlighting the difficulties and vulnerabilities that attended the fulfillment of patriarchal obligation. If one side of patriarchal rule was underwritten by the customary and legal access that men had to women’s bodies, labor, and property, the other side of patriarchal rule was premised on the patriarch’s protection of subordinates. It is here that we see the vulnerabilities of the patriarchal order. As protectors of their families, husbands and masters also assumed enormous liabilities, something we see clearly in times of affliction and most especially during epidemic (chapter 5) and war (chapter 6).¹³

War removed healthy persons from households and returned them injured, desperately ill, or chronically infirm. Epidemics of diseases like smallpox cut through towns where they not only killed, but also left a bevy of survivors to pay for the immense social response deemed necessary to curtail contagion. In the aftermath of war and epidemic, sick individuals and their families could be burdened with costs that were beyond their means to pay and forced to negotiate with government for help. The book explores the assumptions embedded in the narratives of affliction that ordinary people laid before government and examines the ways in which officials sorted through their stories, placing a price on suffering. In the petitions presented to the Massachusetts General Court, we see the final expression of the centrifugal force that illness as an engine of dependency exerted on society and government throughout much of the eighteenth century. The social and political costs of illness radiated outward from the afflicted to their families and towns and connected them, finally, to the highest levels of government. Protection called for no less.

The final section of the book brings the idea of agency to bear on the question of the public accommodation of the sick. Emerging most forcefully after the Revolution, the notion of agency, or the exercise of will that enabled autonomous action, implied that in a free society, the ultimate sign of liberty was one’s ability to shape his or her own destiny.¹⁴ The idea that persons might act autonomously had the potential to cast the ill, and particularly the sick poor, in a new and often unfavorable light. We see in the institutional response to the sick, in pension applications for war veterans (chapter 7) and in state provision for the sick poor (chapter 8), critical ways in which earlier patterns of accommodation began to wither or were severed altogether in the early republic.

In the 1790s, the federal government tried to remove illness as a legitimate cause for Revolutionary War veterans to receive an invalid pension. Promoters of the new criteria for decisive disability argued that there was no way for the government to determine whether illness had been caused by constitutional debility or the poor habits of the aging soldiers themselves. At the same time, the Massachusetts General Court developed policies to address the needs of a growing class of state paupers—former Loyalists, free blacks, newly arrived immigrants, wandering laborers, widows and single mothers—none of whom had acquired legal settlement in post-Revolutionary Massachusetts. Next to legislators’ salaries, the pauper accounts soon became the single most expensive recurring item on the budget and were eventually cut across the board. The book argues that the protections formerly offered subjects in the monarchical world, their ability to place personal stories in front of their governors and ask for compassionate consideration, lay at the heart of this bureaucratic turn in governance in the early republic. The force of those earlier assumptions of monarchical protection, and their potential to expand after the Revolution, made cost-minded government officials anxious to limit the scope of individual claims to relief.

An epilogue carries the story into the 1820s. Major changes to poor relief (both at a local and state level) and the opening of the Massachusetts General Hospital (1821) created a new medical landscape in the early national period, which increasingly distinguished between the worthy and unworthy ill. Despite the championing of the almshouse by reformers as the most humane and efficient means of treating the poor, advocates for the hospital pointed to the dangers that the worthy ill faced in receiving public relief. Reformers argued that young men and women who had left behind family and community in pursuit of social advancement might find themselves bereft of the local institutions traditionally responsible for their welfare should they fall ill. The hospital and other related charities for the sick poor were designed to step into that breach, saving the worthy from the moral contagion that they would face amidst the assorted mass of unfortunates who populated the almshouse—the foreign poor, the sturdy beggar, the free African American, and the supposedly idle and dissolute. With the ability to discriminate between who was worthy of care and who could be left to the public poor laws, the hospital and other charities offered a new institutional means of restoring social order. The failures of charitable reform reflected the ongoing challenges carried over from the eighteenth century, but those enduring problems were increasingly focused on the sick themselves.

In considering the ways in which competency, dependency, and agency framed the problem of illness in early New England, a key insight from the interdisciplinary field of disability studies is especially useful: while we all labor under various shades and intensities of impairment—from those with slight nearsightedness to the totally blind, for example—it is society, through its response to those impairments, that creates categories of persons who are considered disabled. Illness is not quite the same thing as physical impairment, although chronic illness, discussed in the final section, shades into something quite close to lasting debility. But thinking about illness as a problem of ability and disability helps us to investigate the interplay between expectation and allowance that lay at the center of many negotiations and conflicts through much of the eighteenth century, and highlights subtle changes in what could be asked both of the sick and government in the early republic.¹⁵

Province as Place and Metaphor

The word province in the book’s title does double duty within these pages. The first two sections of the book focus most sharply on Massachusetts during the provincial period, from 1691 until the Revolution; the final section carries the work into the early republic. The extended time frame is necessary both to trace durable patterns of illness, carried forward from the seventeenth century and elaborated in the eighteenth, and to appreciate the ways in which the persistence of those patterns in the early republic created significant tensions, particularly in the political accommodation of illness.

If the time frame is expansive, the geographic range of the study is restricted. While I consider other places within New England and further afield for the sake of comparison and to engage especially illuminating material, the book sets its deepest roots in Massachusetts. The limited geographic focus is necessary for both practical and conceptual reasons. Illness was pervasive enough to become subject to legislation in a variety of domains—public health regulations, poor laws, the law of household governance, and provisions for soldiers and their families—and a focus on a single place makes it more feasible to follow significant changes in law in these areas over time. But more importantly, the accommodation of illness itself became deeply implicated in questions of territorial rights and obligations, making the boundaries of colony and state not simply manageable units of study, but rather essential parts of the story. While illness could arrive from outside the borders of the colony or state—in the body of the sick sailor landing in port, the beleaguered soldier returning from the theater of war, or the weary transient looking for work—the accommodation of illness was a local affair. Families, towns, and commonwealths were asked to care for their own, which led to struggles over just who rightfully belonged to these entities and what, if anything, could local society provide the stranger or foreigner in distress.

A second, metaphorical meaning of province employed in this book draws our attention to the aesthetics of illness in everyday life, the ways in which the experience of being ill set a tone, created a texture, and shaped essential rhythms in daily affairs. Perhaps more than any other element of the experience of illness, those aesthetic considerations have been lost to us. We may feel that we know intuitively something about the lives of historical subjects laboring under illness, something more immediate and visceral than we learn from reading their journals and books with their marginalia, or touching the objects they have left us, or gazing at their portraits: we know what it means to suffer with a fever, to vomit, to be sidelined by illness. We have embodied critical elements of their experience. Yet historians of the body have rightly tried to help us unlearn some of these thoughts, warning that the conception of the body—even the notion of a body as something that is discrete and contained—is an historical development. The fluid and porous early modern body is distanced in important ways from our own.¹⁶ Though we continue to cope with the problems presented by illness in our lives and those of family, friends, and acquaintances, we have no ready way to grasp the social and political meanings that early Americans attached to being sick, no ready frame of reference for the prevalence, intensity, and duration of their ills in early America. Likening the experience of illness to life in a cultural province can speak to just this problem, conveying something of the curiously blended ways of life created by the common but not continuous presence of disease.

A cultural province lies outside a metropolitan center, close enough to emulate life in the metropole, distant enough that its own customs and rituals emerge of necessity. The regular presence of illness in New England opened up a social and political space in daily life that can be thought of as a cultural province, a province lying outside but still close to a state of health and of relations that depended on healthy and functioning persons to succeed. Located on the periphery of health, the cultural province of affliction in this sense resembles other cultural provinces in the eighteenth century, especially in its creativity in negotiating a world where high ambitions clashed with stark limitations, in this case imposed by illness.¹⁷

We might sharpen this second conceptual frame for thinking of illness in early modern life by contrasting it with a very different way that sickness has been conceived of in our time. Writing as a cancer survivor, Susan Sontag opens her Illness as Metaphor (1978) with a metaphor of her own, the distant and lesser kingdom of illness in which we will all, at some point, be forced to live in painful isolation.¹⁸ In early New England, the notion of illness as a foreign country or kingdom does not work well. The experience of illness was too common, too much a part of daily affairs. Between 10% and 30% of New England’s children did not live through their first year; those who weathered childhood diseases could expect to encounter another onslaught in their teens; although few women died in childbirth, the regularity of pregnancy was often a cause of indisposition and worry; and any individual might find that the diseases that they had undergone earlier in life turned chronic in old age.¹⁹

Yet if early modern illness was not foreign, neither can it be viewed as a norm that affected everyone at all times, particularly in New England. Compared to the death traps found in London, the sugar and rice fields of the West Indies and the Carolina Lowcountry, and the malarial swamps of the Chesapeake, New England was considered refreshingly healthful, especially in the seventeenth century when its isolated and thinly populated towns largely escaped the ravages of epidemic disease. By the 1720s, new concentrations in the population and more steady communication between places throughout the region and in the broader Atlantic world created an environment in which epidemics could violently erupt with deadly and terrifying force. Sailors from New England’s ports, subject to tropical diseases on their voyages, could die at astonishing rates. But even when we take into consideration those years punctuated by epidemic and the bleak mortality rates for young men in the ports, demographers have found that New England’s population was not eroded by disease in the manner of places where endemic maladies steadily claimed lives.²⁰

New England was a place where the fortunate could survive illness, not avoid it. In this respect, New England was not that different from other places in the early modern world, especially as compared with the developed world today. Historians of morbidity and mortality have suggested that the kinds of diseases that have sickened and killed humankind have changed over the course of history. Like other places in the developed world, America has undergone an epidemiological transition, from a preponderance of acute and infectious diseases of the early modern period to the chronic, degenerative maladies more characteristic of modern societies. In the eighteenth century, disease was less a constant presence in any individual’s life than an episodic one. While a person stood an excellent chance of becoming ill at any given moment, those afflictions most often resolved quickly, leading to either death or relatively rapid recovery. For any given person, the chance of falling ill was greater than the chance of being ill. This is not to say that New Englanders did not have their share of chronic ailments; the elderly, in particular, who existed in greater number in New England than elsewhere, presented the problem of more steady infirmities. Injuries, too, could lead to chronic impairment and the need for constant treatment. But the picture of society as a whole is one of continual confrontation with episodic disease that moved through families, neighborhoods, and towns. Children and the elderly were known to be especially vulnerable. But when, where, and whom sickness would strike and with what intensity were open questions. In the meantime, other dimensions of daily life continued of necessity.²¹

Because it resided neither at the fringes of daily life nor at the center of it, illness in New England created, in our second meaning of the word, a province of affliction, a place in between, where health was common enough to fuel expectation and sickness common enough to beg for allowance; where vital activity coexisted with lethargy and incapacity; where the venerable aged, having outlived their peers, would recall many seasons of distress. It is this creative tension that flourished at the intersection between illness and health, the ongoing interplay between the prerogatives of the sick and those of the well, that interests me most profoundly.

Bodies in a State of Becoming: Social and Political Implications

The medical historian Charles Rosenberg has suggested that the early modern body was always in a state of becoming—and thus always in jeopardy. He reminds us that early moderns did not consider their bodies to be static, but rather constantly changing. Health was continually altered by a person’s interaction with the natural environment, the non-naturals that she might partake in (including food, drink, exercise, and rest), and her success in moderating intake, processing, and outgo. Health consisted in a body in perfect balance but was fragile, easily disrupted, and in need of continuous adjustment and correction.²² The Province of Affliction is, in a sense, an extended exploration of the social and political implications of Rosenberg’s insight as they played out in individual lives and in the larger organization of and response to illness.

On one level, I hope to illuminate, by focusing on a small cast of characters, the personal plight of sick persons and the everyday, lived experience of inhabiting a world in which bodies were always in a state of becoming—the unsteadiness of their lives, the sudden changes that could come on, their own descent into illness, and the decline of those around them. Beginning with chapter 1 and continuing through the first two sections of the book, readers will become well-acquainted with Massachusetts residents Ebenezer Parkman (1703–1782), minister and farmer in Westborough; Ashley Bowen (1728–1813), sailor, ship rigger (and sometime soldier, dreamer, and artist) of Marblehead; and Elizabeth Porter Phelps (1747–1817), goodwife and good neighbor of Hadley. Here are three generations, representing three areas of Massachusetts, and three of the best diaries we have from the period. Of these, Parkman dominates: the temporal span of the diary, the depth and consistency of his entries, and his abiding interest in the illnesses of family, household workers, and flock make his journal invaluable for this study. In addition to these individual accounts, I have explored stories of affliction as revealed in petitions to general assemblies, which fortunately exist in large numbers. Here one finds the sentiments of the elderly, the middling and poor, the widow, the soldier and veteran, the Indian, and, less often, the free African American.

On another level, I aim to shed light on the societal implications of these stories of affliction. The book focuses on four recurring problems that illness presented routinely, not just for the sick and those immediately implicated in their illnesses, but for also townsfolk, selectmen, commissioners, reformers, and officials at all levels of government. I refer to these problems, sketched below, as extremity, locality, protection, and social suffering.

That the early modern body was always in a state of becoming helps us understand why the sick were able to command attention. There was, in the first place, the fear that even seemingly innocent difficulties could be transformed into something dire. Death was always a possibility, one that New Englanders seem to have taken to heart. As Maris Vinovskis, Daniel Scott Smith, and J. David Hacker have pointed out, New Englanders were convinced that mortality in the region was far greater than what modern demographers have found. It is not difficult to understand why. The high incidence of infant and childhood death (10–30% of children did not survive the first year of life), the rituals of death (at least 10–25 funerals per year in a small village), and the emphasis placed on the uncertainty of life in funeral sermons all encouraged New Englanders to think of life as fragile, even as survivors of the diseases of childhood and youth could live into their sixties and seventies. We can see in the fine-grained language used to describe serious conditions—those who were poorly, very poorly, dangerous, exceedingly dangerous, and so on—the sense that the body in a state of becoming could move swiftly toward its end.²³

The possibility that one might fall ill—that one might be healthy today and ailing tomorrow—imbued daily life with a sense of radical contingency, which included the fear of death, but went well beyond it. Letter writers were careful, in making plans for future visits, to add the refrain provided I am in health. Public meetings were postponed when ailing officials failed to attend, or forced to new locations when contagious distempers raged. Plaintiffs and defendants pleaded illness as the cause of their missed court dates; tax collectors complained that sickness (both their own and that of those who failed to pay) had interfered with their collections; and those long absent from church claimed to be sick and abed. There was enough regularity in these claims to provoke investigations into malingering. But more often than not, the excuses and alterations occasioned by ill health stood as an accepted, if unfortunate, part of life.

I refer throughout this book to this sense of urgency and necessary allowance in confronting illness as the problem of extremity. There was a point in any given illness at which the desires and prerogatives of the workaday world were trumped by the force of extremity. Not every sickness, nor every sick person, exercised the same power, of course. Ailing soldiers were forced to forge rivers and sleep in the cold. Persons marked as inferior in law, such as enslaved and free blacks in Boston, were asked to undertake risks to their health that persons of higher station and clout were able to refuse. During the terrifying smallpox epidemic that beset the town in 1721, free blacks were made to clean up refuse strewn about the streets, this at a time in which it was unclear whether such materials harbored the dread disease. There was no absolute standard for extremity; like other aspects of early modern life, extremity was marked by power and privilege.

Yet even for those occupying the lowest rungs of the social hierarchy, extremity could confer power, demanding attention and accommodation. Sick soldiers could simply drop and bring the rhythms of expeditionary warfare to a halt. Blacks in a smallpox-ridden city could, like whites, become sick and require nursing, cleansing, and quarantine. Field hands could suffer injuries and illnesses that absented them from work. Elite gatherings could be thwarted by the indisposition of servants. One was said to be held in the grasp of a fever, gripped at the guts, made helpless by rheumatism. Illness would have its sway.

The problem of locality takes us to the concrete places where persons actually fell ill. If the body in a state of becoming helps us access a dimension of lived time in early America—the on-again, off-again rhythms of persons moving into and out of health—the question of where the sick fell ill directs our attention to the connections between space and authority in early American life. Although historians often treat this question on a grand scale, addressing the tensions of westward expansion and the creation of territorial boundaries, illness illuminates a more intimate and immediate aspect of the relation between space and authority, and territorial boundaries, in particular—the problems that ensued when persons with bodies in a state of becoming fell ill where they did not belong.²⁴

Illness was ideally conceived as the proper charge of local society. Families, neighbors, and towns were asked to take care of their own in times of need. Problems arose when persons fell sick away from those local sites of care. Early modern society was a world in constant motion. Daily routines revolved around visiting and exchange; apprenticeships took youths from their houses and placed them with others; trade, commerce, and warfare called persons even further afield. In all of these instances and more, persons could fall ill far from those properly charged with their care, which led to two problems. On the one hand, the local institutions responsible for care might have to stretch well beyond their daily borders. Families were obliged to retrieve members working in other households, to fetch ailing sons from the theater of war, or to rush to the scene in the aftermath of a daughter’s difficult pregnancy or illness. Towns received notices from places far afield claiming that one of their own had fallen sick and needed to be retrieved. Even provinces and states could insist that the ailing be returned to where they properly belonged. On the other hand, if the sick lay in extremity, care was an immediate necessity. Bills and obligations easily piled up before the final seat of responsibility could be determined.

New Englanders wanted to have it both ways. They depended on a continuous movement of people to sustain everything from local economies to the successful prosecution of imperial warfare. But they also insisted on local responsibility for affliction. The result inevitably fueled disagreement. Despite indentures that specified that masters were to care for their servants, poor laws that carefully defined criteria for local inhabitancy (and so rights to town coffers should one become impoverished or ill), and provisions for government to pay for diseases visited upon soldiers in war, when persons fell ill away from their proper localities, confusion and contest ensued.

Although the problems of extremity and locality associated with illness can be found throughout the Atlantic world, they had special resonance in New England because of its commitment to protection. Beginning with its origins as a refuge from the corruptions of the Old World and as a shining example of a godly society, New England had promoted the need for community to protect its own. In A Model of Christian Charity, John Winthrop suggested that New England’s City Upon a Hill would have to act as a community of perils, requiring extraordinary liberality from its members. There is a time, Winthrop explained, when a Christian must sell all and give to the poor, as they did in the Apostles’ times. And there were other moments, as in ancient Macedonia, in which Christians would have to give beyond their ability, although not all that they had. The community envisioned by Winthrop, in which persons of different stations were knit together in brotherly affection, required an exquisite sensibleness and sympathy of each other’s conditions, a desire and endeavor to strengthen, defend, preserve and comfort the other. By the eighteenth century, Winthrop’s sense of the immediate possibility of failure, of the peril of the utopian undertaking itself, had waned. But the sense of New England’s special role as a place where the vulnerable would be protected continued. In the claims during the imperial crisis that English society had lost its moral footing, in the claims after the Revolution that the nation should be as New England writ large, the region promoted its special virtues in attending to local need. And like Winthrop, who made it clear that there were times and seasons for different kinds of giving, the abiding question remained just how much was required of the suffering and their protectors alike.²⁵

The idea that neighbors should be their brother’s keepers and that government was finally responsible for protecting the people became a link between society and politics in the colonial period that was especially evident in times of affliction. From the outset of settlement, New England’s town state, as Barry Levy has dubbed it, was remarkably active in its conception of social welfare. Towns became central governing bodies, carrying forward and amplifying cutting-edge reforms prompted by the traumas of Elizabethan and early Stuart England, most especially widespread poverty and plague and the social dislocations that emanated from the two. Public health measures, and quarantine efforts in particular, were promoted with a vigor in New England that flagged elsewhere. Drawing on Elizabethan Poor Laws, New England’s warning out system, which demanded that those without legal settlement in a town post bond (or have it posted for them) and stand ready to be removed, not only ensured ready employment of town residents through its careful control of local labor markets, but also offered financial security in the event that outsiders fell ill. The imperative of protection fueled an activist local government in New England that became deeply implicated in social relations.²⁶

And yet, the pervasive presence of sickness was not so readily accommodated. The quarantine measures meant to protect the public’s health achieved a success that was finally ironic: the advent of large pockets of the population left unexposed to contagious diseases, such as smallpox, became fodder for epidemics that burned through the region. The warning-out system, so elegant in its assignment of responsibility for misfortune to the localities in which a person had legal settlement or to those who sponsored outsiders in town, could not keep pace with the swift descent of maladies. Strangers who had been warned but remained in town (a not uncommon occurrence) fell ill and their condition demanded attention in its extremity, leaving caregivers and others to petition their towns for relief and towns to engage in protracted court battles with one another over rightful settlement. The steady integration of New England within empire only amplified the difficulties: commerce and Atlantic travel increased the possibilities for contagion, as did the four wars for empire fought between 1689 and 1763.

In the end, the pressures placed upon the sick and those implicated in their afflictions radiated outward in eighteenth-century life, from family, to neighborhood, to town, to provincial and later state government. Approaching their governors with their heads down and hands out, the people asked for relief. In this sense, the political culture of the colonial period was one in