The Pox of LibertyHow the Constitution Left Americans Rich, Free, and Prone to Infection

The Pox of LibertyHow the Constitution Left Americans Rich, Free, and Prone to Infection

Werner Troesken

Print publication date: 2016

ISBN: 9780226922171

Publisher: University of Chicago Press


This book explores how the American constitutional order shaped public health in the United States from colonial times to the mid-twentieth century. Although political institutions and ideologies are the focal point of the analysis, medical and scientific discoveries play an important secondary role. The analysis focuses on three diseases: smallpox, typhoid fever, and yellow fever. Smallpox was a highly infectious disease, spread mostly through the air. Typhoid was a waterborne disease spread mainly, though not exclusively, through sewage-tainted water. Yellow fever was spread by a mosquito and was a regular visitor to large port cities, especially those in the American South. The central argument is that efforts to prevent this three diseases were shaped by an inter-connecting web of ideologies and institutions. Because some of these ideologies and institutions were distinctly American, they gave rise to a system of disease prevention that was also distinctly American. The defining features of this system were fourfold. First, it was decentralized, predicated mainly on the strategies and investments of municipal governments. Second, initially the system relied almost exclusively on individual consent and private action, though over time it increasingly appealed to the coercive power of the state. Third, it relied heavily on private property rights to induce investments in health-related infrastructure. Fourth, it was heavily influenced by market processes and commercial and business interests, and those interests had a mixed effect on health outcomes, sometimes promoting healthier environments and at other times hindering them.