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

Abstract

Reviewed by: The Province of Affliction: Illness and the Making of Early New England by Ben Mutschler Sarah E. Naramore The Province of Affliction: Illness and the Making of Early New England. By Ben Mutschler. American Beginnings, 1500–1900. Chicago: University of Chicago Press, 2020. 374 pages. Cloth, ebook. Ben Mutschler begins The Province of Affliction with a deceptively simple question: “how did sickness figure in the larger scheme of daily affairs” (3) for New Englanders during the long eighteenth century? The answer requires a consideration of the social and economic disruption that illness brought to individuals, families, and communities. Disease in this world was not simply a biological condition or medical matter between doctor and patient; the temporary absence of one person spiraled to affect those who nursed them back to health, limited the economic productivity of a family, and forced a community to assume responsibility for those who could not care for themselves. Mutschler suggests that New England’s community-based care eventually morphed into formal state-level care systems in the nineteenth century. His book thus roots large structural transformations in the history of small communities by drawing important connections between the response to illness and the shifting role of the state. Throughout the book, Mutschler maintains a central metaphor: that the state of illness (or affliction) should be understood as its own province. He writes that illness was “a cultural province . . . lying outside but still close to a state of health” and “resembles other cultural provinces in the eighteenth century, especially in its creativity in negotiating a world where high ambitions clashed with stark limitations” (11). The book’s opening scene demonstrates Mutschler’s approach by exploring the illness of young Henry Drinker in Philadelphia. Drawing on the entries in the diary of his mother, Elizabeth, Mutschler highlights how Henry’s weeks of sickness and recovery altered family relationships and expectations. During this time, Henry was removed from the normal pattern of life in the Philadelphia household, while also creating additional responsibilities for those around him—he thus inhabited a distinct place outside the daily life of his family while simultaneously remaining part of it. Duties of care fell especially to his mother, and Henry’s ill health took a heavy emotional toll on her until he started to convalesce. His illness also shaped the very community he was detached from: though the Drinkers had the resources to manage most of Henry’s care, they did call on the assistance of friends and family to support the household in Henry and Elizabeth’s absence. This domino effect of illness touching multiple lives, Mutschler argues, lies at the heart of eighteenth-century responses to disease. Mutschler uses the Drinker episode as an introduction to his broader discussion. As he argues, the ability to care for the sick acted as a mark [End Page 163] of family competency—the ability to support a household through the labor of that household—which was the social and economic goal of many eighteenth-century families. But at the same time, he stresses, even the most functional families relied on the broader community to fulfill additional requirements of care. Such interactions were more evident in New England than Pennsylvania, according to Mutschler, due to the former region’s “cutting-edge developments . . . , [which demanded] adherence to public health laws that privileged community welfare over the individual. Such developments were elusive elsewhere in British North America” (4). The collection of people and institutions within New England’s province of affliction forms the core of Mutschler’s analysis and allows him to break down historiographical barriers between histories of medicine, family, society, and economics; as he argues, illness cannot be separated from social and economic life, and ignoring illness impoverishes our understanding of the era. Mutschler divides his eight chapters into four sections, with each section highlighting different levels of family and community involvement in illness and moving from the smallest social circles to the largest. While the first chapters orient the reader in the language and experiences of the eighteenth-century patient as well as the economic lives of small communities, subsequent chapters discuss how families, communities, and ultimately the state responded...