The Pox of Liberty: How the Constitution Left Americans Rich, Free, and Prone to Infection. By Werner Troesken. Chicago: The University of Chicago Press, 2015. Pp. vii, 237. $40.00, cloth.

Abstract

Book Review The Pox of Liberty: How the Constitution Left Americans Rich, Free, and Prone to Infection. By Werner Troesken. Chicago: The University of Chicago Press, 2015. Pp. vii, 237. $40.00, cloth. Should vaccinations be required by law? Why are quarantine decisions made by state governors? What role should the federal government play in public health provision? While these are questions of current importance, they are also issues that the United States has been struggling with since the Revolution. At the heart of these issues lies a set of legal judgements, rooted in the U.S. Constitution, about when and how the state can intervene in order to improve public health. In The Pox of Liberty, the author, Werner Troesken (a Professor at the University of Pittsburgh), sets out to study the complex impact of the U.S. Constitution on health in U.S. history. This is an ambitious book and a useful contribution to work in this area. By focusing on how the Constitution and the legal system influence public health, both directly and through economic growth, The Pox of Liberty illuminates a somewhat neglected aspect of public health history. While the author is trained as an economist, he has taken a narrative approach in this book which makes it approachable for a broad audience. This book is likely to be of particular interest to demographers, historians, and economists who would like to gain a better understanding of the way that legal factors influenced public health in the U.S. history. One of the central messages of this book is that the U.S. was often less healthy than comparable European countries “not despite its being rich and free, but because it was rich and free” (p. 5). Put another way, Troesken argues that many of the laws that allowed the U.S. to become wealthy, and that promoted personal freedom, also made it more difficult to fight infectious disease. Balanced against this is a feedback mechanism through which economic success improved health, by, for example, providing cities with the money needed to invest in water systems. The book begins with two preliminary chapters. The first, chapter 2, traces the origin of U.S. public health law to early townships. Following this, chapter 3 provides a review of the key legal issues that influenced public health provision. These chapters provide a useful entry point for those who are less familiar with the channels through which the legal system affects public health. The core of the book is organized into three chapters, each focusing on a major infectious disease. Chapter 4 studies smallpox, a deadly airborne disease. The development of a vaccine in the late 18 th century made this disease a natural focus for public health interventions. To illustrate the role played by the legal system in the fight against smallpox, Troesken compares the U.S. to Germany where, after unification, centralized power allowed the government to rapidly reduce smallpox rates. In contrast, the U.S. legal system’s protection of individual liberties allowed a portion of the population to resist vaccination and as a result, progress against smallpox was much slower. Perhaps the most interesting example is provided by U.S. colonies, such as Cuba and Puerto Rico, where military control allowed the U.S. government to fight smallpox in a much more effective way than was possible within U.S. borders.