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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. Mutschler is a fluid writer, with an admirable mastery of the relevant primary and secondary sources. Mutschler capably enlarges and deepens our understanding of daily life in New England and how the health safety net may have contracted rather than expanded over time as responsibility for health care moved away the individual and home to corporate and governmental resources.

Governments determined to cut back on medical costs. Populations quarantined to stop the spread of disease. The Province of Affliction reveals a world surprisingly familiar, yet profoundly different from our own. In depicting this world, Mutschler is original, ambitious, masterful in his command of diverse sources, and a lively and fluent writer.

He also forecasts the ideological origin of our current plight: the ethos of individualism that emerged in the wake of the Revolution, which built a new world of freedom and risk without a social safety net.

Mutschler provides a poignant and pointed account of a world in which colonial settlers regularly stretched their capacities to tend to the sick and dying. While New Englanders may have lived a long time, boy, did they suffer!

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