In light of the last three years, it seems almost superfluous to reiterate the importance of studying a society’s reaction to epidemic disease as well as the controversies surrounding efforts to contain it. That being stated, Andrew M. Wehrman’s monograph The Contagion of Liberty: The Politics of Smallpox in the American Revolution is a work of exactly that kind of relevance. Wehrman has written a political history of the United States’ independence through the lens of smallpox and measures enacted to stop its spread. Specifically, he investigates the social and political dimensions of inoculation, the practice of intentionally infecting a person through the application of smallpox tissue to induce a mild form of the disease and thereby achieve subsequent livelong immunity. Rather than understanding smallpox – as other historians have – as a mere occurrence paralleling the North American colonists’ fight against British control, Wehrman posits public health and inoculation as a central feature, a “common cause no less radical than and no less essential to the more familiar story of America’s fight for political independence” (p. 5).

To underline his central argument, Wehrman follows the events of the Revolution chronologically, correlating them with various smallpox epidemics and the ensuing debates over inoculation. The central theme he finds and highlights throughout is book are the controversies over whether public health ought to be pursued through government action – building inoculation infrastructure and subsidizing inoculations for the poor – or through private initiative by entrepreneurial physicians and businessmen.

The first chapter outlines a broad introductory history of smallpox in North America, including its role in the settler colonial genocide against indigenous peoples and the appropriation of African knowledge, preserved by enslaved people, to develop inoculation. In chapters two through four – Wehrman argues that successful calls for broad inoculation in Boston from the 1730s onwards as discursive precursors to “no taxation without representation” claims that animated anti-British fervor in later decades. Continuing that line of argument, he interprets riots over the establishment of private inoculation facilities in Norfolk, Virginia and Marblehead, Massachusetts as examples of competing ideas of liberty contained within the movement for independence: that of free private enterprise versus the notion that liberty ought to be secured through public institutions checked by republican government. He understands the latter to be largely the expression of “the kinds of rights and liberties that motivated ordinary people” (p. 95) while associating the former with merchant and slaveholding planter elites.

Within his chronicling of the events of the Revolution, as they paralleled smallpox outbreaks throughout the future United States, Wehrman very much follows an actor-centered approach. He constructs his narrative through the words and actions of individual physicians that advocated for inoculation as a safe medical practice and efficient measure of containment (chapters one and five) as well as leading figures of the American independence movement such as John Adams, Thomas Jefferson, and George Washington, debating the merits of inoculation. Washington, especially, receives extensive treatment. His changing personal views on inoculation and the subsequent decision as commander of the Continental Army to inoculate his soldiers are discussed in chapters six through eight. Wehrman argues that smallpox became associated with the British, including frequent charges that they were attempting to use freed slaves as bioweapons to inhibit Americans’ military efforts, thereby melding the fight for independence with the fight against smallpox and, by extension, against Black people fighting for their own freedom. Unfortunately, Wehrman leaves it largely to his readers to make that last connection.

In his final chapters (eight through ten), Wehrman discusses the aftermath of the war. He argues that George Washington’s decision to inoculate the Continental Army sparked a general drive to inoculate throughout the United States that lasted into the first years of independence. Though slaveholding elites of the South resisted public health efforts as they tended to try to avoid the costs of inoculating their slaves, New England saw a near total eradication of smallpox. As such, inoculation came – for the time being – to be understood as part of a government’s duty to provide for public health. Wehrman sees this tendency receding as vaccination against smallpox entered medical practice and became a profitable business at the turn of the century. A vaccine stimulates the body’s immune system to develop immunity, rather than inducing an (ideally) mild form of the disease to immunize the body, as is the case with inoculation. For slaveholders, it offered the opportunity to selectively immunize family members and enslaved people working in close contact with their enslavers – something that the intentional infection with smallpox entailed by inoculation had made basically impossible. For commercial enterprises throughout the nation, it allowed immunization without cessation of business necessary during the period of inoculation. Therefore, Wehrman argues that whereas “inoculation compelled the same sacrifices and the same common commitments that winning the Revolution required”, vaccination afforded “the wealthy […] individual liberty in health, politics, and business” (p. 319) while governments’ responsibility for public health receded into the background.

Wehrman posits the social and cultural impact of smallpox as an important, even crucial factor in the outbreak of the American Revolution. He certainly makes a very convincing argument that the history of smallpox has to be added to the historiography of the period as it impacted political discourse and social life. Unfortunately, however, many of his specific arguments underlying that overarching claim are based on temporal and/or geographical proximity to major events leading to the United States’ independence from Britain rather than clear connections traceable in the source material he cites. That connection might well be there, but this argument would have necessitated a deep engagement with the Revolution itself. It is never quite clear what that complex and contradictory moment in history represents to the author beyond the semantic surface: Vague notions of “liberty”, “freedom”, or “common cause” appear throughout the book as connective threads to debates and events surrounding smallpox, but what is missing is an engagement with the inherent tensions between a language of individual’s rights and collective freedoms and a society built on slavery, indigenous genocide, as well as deep class and gender inequalities: Smallpox inoculation was “discovered” by white Americans through the appropriation of African knowledge carried over to the colonies by enslaved peoples and in the process of its introduction into modern US medical practice was forcibly tested on their bodies. Disease in general and smallpox in particular were crucial in the expropriation and extermination of the indigenous peoples of the Americas by European settler colonialism. When leading men of the Revolution had their families inoculated, or not, it was a clear expression of a patriarchal, heteronormative social order that provided married men with choices and denied them to everyone else. Wehrman hints at some of these dimensions in relatively few paragraphs scattered throughout the book. He also addresses the class dimensions of inoculation quite regularly. Unfortunately, however, he limits his analysis by only superficially relating smallpox to the rhetoric, events, and localities of the Revolution. Thereby, he misses the deep structural interconnections between the history of oppression and inequality at the heart of American independence and the political history of disease and medicine he is telling.

This not to dismiss Wehrman’s important contribution to the historiography of the Revolution. Rather than positioning epidemics and disease as natural phenomenon existing next to social and cultural questions, as most histories of that period do, he convincingly shows that smallpox and inoculation were part of political debates and ideas flowing through the history of the United States’ independence. In framing events like the Norfolk Riots of 1768 as the outcome of conflicts over public health and inequality rather than superstitions and suspicions over the practice of inoculation among socio-economically disadvantaged populations, he highlights the inherent class tensions of the Revolution. Thereby, he also allows for a history that moves well beyond a mythical story of the “Founding Fathers”, in which few and select men with great ideas move history forward, highlighting the agency of a wide array of people in the fight for independence. Lastly, his book is well written and engaging. Through the actor-centered narratives extracted from diaries and personal letters, he illustrates a history of ideas that reverberates through individuals’ stories as they struggle with broader questions of government responsibility, public health, and private commercial interests. As recent epidemiological and political challenges of the present and recent past remind us, and as Wehrman aptly illuminates, these debates remain as pertinent today as they were in 1776.