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Rachana Kataram
Professor Harpham
HONS 3101.HN1
16 October 2018
Pox Americana and Tinderbox
In both Elizabeth Fenn’s Pox Americana and Craig Timberg & Daniel Halperin’s Tinderbox, one
idea is clear: human contact, in any shape or form, ignites an epidemic. It is only when we discover how
societies define and manipulate this human contact that we can begin to understand how to douse the
flames of the epidemics that have plagued us for centuries. Profuse with personal stories and firsthand
accounts, these two eye-opening novels are a testament to how societies react, and why they react that
way, when their lives are threatened by something they cannot see.
In Pox Americana, Fenn showcases George Washington’s quick thinking during the American
Revolution. With almost no technical knowledge of smallpox’s natural history, Washington’s proactive
measures, like quarantine and later inoculation, served as predecessors to modern containment
techniques. Before Washington’s inoculation campaign in 1777, considered the first “large-scale, statesponsored immunization campaign in American history” (260)1, inoculation or variolation was highly
opposed by the government. In 1738, the city of Charleston “imposed a fine of five hundred pounds on
anyone giving or receiving inoculation within two miles of the city” (38)2. The harsh measure showcases
the public’s resistance to inoculation, but due to Washington’s campaign and shift in attitude, variolation
became more widespread as local governments eased restrictions.
It’s safe to say that the Native American tribes across the continental US bore the brunt of the
smallpox epidemic. Due to the lack of diversity in their immune systems, their populations were
decimated in the blink of an eye. The days of agony due to rashes, scabs, and sores, followed a swift yet
painful death was enough to frighten every native American tribe. Local, ancient Indian healing
practices were their first line of defense, but it quickly became clear that “sweat baths, fasting, and
1
2
Fenn, Pox Americana, pg. 260
Fenn, 38
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jumping into cold water” only exacerbated the disease (25)3. A feeling of helplessness set in as the virus
“shattered native tribal organization” and “disrupted kinship ties” (142)4, causing a major shift in power
dynamics between various tribes in the region. Combining the devastating effects of the disease, plus the
new infusion of guns and horses brought in from colonialists, gave tribes like the Comanche and
Shoshone a huge advantage over rival tribes.
A similar picture was evident in Spanish settlements at the time, even though inoculations were
introduced early on in Mexico by Dr. Esteban Morel. As Fenn states, “much to the doctor’s chagrin, no
patients appeared” (139)5, which demonstrates the public’s fear of anything relating to the virus, even if
there was a possibility of survival. Later on, in response to a massive drop in Hispanic and Indian
populations, Governor Juan Bautista de Anza ordered a contraction of his province’s mission system;
interestingly enough, the helplessness of the people is evident when Fenn points out that “as their timehonored healing practices failed and desperation set in, [traditionalist Pueblos] apparently sought a cure
for smallpox in baptism.” (261)6
One aspect of smallpox struck fear across the globe: its potential as a biological weapon. The British
were not afraid to use it against the Indians in 1763 (88)7, and Washington kept this in mind as he
tightened the reins on his soldiers in order to prevent any biological harm. Overall, however, societal
and governmental responses to smallpox remained relatively local, as tribes and missions dealt with
their own deaths through isolation and inoculations, which worked relatively well, and George
Washington collaborated with local governments to control the epidemic on the East coast by using
similar tactics.
Smallpox’s spread across the country during this period was “as though a spark had landed in a
forest laden with thousands of years of dried timber” (23).8 The dried timber in this case was the perfect
storm of frequent human contact due to trade routes, guns, and horses brought over by colonialists,
creating a tinderbox that ended up scorching various populations of North America.
3
Fenn, 25
Fenn, 142
5
Fenn, 135
6
Fenn, 261
7
Fenn, 88
8
Fenn, 23
4
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“Tinderbox” can also be used to describe the AIDS epidemic that sparked a global crisis in the late
20th century. Craig Timberg and Daniel Halperin paint a picture similar to that of smallpox on the
surface, but as they dig deeper it's evident that conflicting cultural mores, colonialism, and the
characteristics of HIV/AIDS themselves play a much larger, much more sinister role in this epidemic
than ever seen before.
Timberg received education on AIDS on his first trip to South Africa, and his simple statement
regarding the course highlights the underlying key detail that is the axis on which this entire epidemic
revolves: “What we never talked about was sex, or culture, or the complex realities that I would soon
find in Africa”(213).9 Throughout the course of this book, every solution, every problem, every statistic
and research study have deep ties to sexual norms and practices. This singular aspect of the epidemic—
the high rate of transmission between sexual partners—kept doctors and politicians across the globe
from having a serious discussion on possible cures and solutions; instead, the West and other countries
tried their hardest to rely on “hard science”. Timberg states that Western medicine focused on solutions
that “didn’t rely on more fundamental changes in sexual behavior to work” (128),10 because “faith in
such technological solutions—pills, shots, condoms—was rooted in the deepest folds of the Western
brain” (128).11 In addition to this, Timberg states that “[2000’s] annual report on the global HIV/AIDS
epidemic celebrated vaccines, HIV testing and development strategies, without noting that none of these
had so far demonstrated much success in slowing the virus” (180).12 The notion that biomedical fixes are
enough to reverse a disease whose spread hinges upon frequent sex is naïve. It is also what sets
HIV/AIDS apart from smallpox in a big way. Whereas smallpox simply needed any sort of human
contact, intimate or not, to spread, HIV essentially needs sex between two people in order to survive.
Biomedical fixes for smallpox like vaccinations and inoculations were enough to contain the epidemic in
the 18th century; there was no need for native Americans and American soldiers to completely shift their
sexual practices and lifestyles in order to protect themselves. Simply put, smallpox was easier to treat
and prevent because it didn’t require an overhaul of deeply rooted sexual norms.
9
Timberg and Halperin, Tinderbox, pg. 213
Timberg and Halperin, 128
11
Timberg and Halperin, 128
12
Timberg and Halperin, 180
10
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In the same vein, smallpox and HIV/AIDS share an important characteristic: both diseases cause
a seemingly harmless flu, and then lay dormant for a period of time, after which they resurface and
viciously attack the victim. While both diseases share the characteristic, it’s the period of dormancy for
HIV/AIDS that makes it much more sinister than smallpox; for HIV, it could be up to a decade after the
initial flu that symptoms of AIDS begin presenting, while it only takes about two weeks for smallpox to
show itself in a victim’s body. Timberg describes HIV as “moving invisibly through societies as little
more than a rumor…and by the time most people could see the epidemic…it was already too late”
(214).13 The disease’s slow pace made it a silent and efficient killer.
It wasn’t just the disease’s characteristics that made it deadly; the overall attitude of African
populations towards the disease exacerbated the epidemic. With smallpox, the quick deaths meant it was
feared from day one, catapulting tribes and leaders into action to prevent it. But with HIV/AIDS, the
lack of knowledge, refusal to change sexual practices, and a fatalistic attitude all combined to
significantly diminish the fear towards the disease. This attitude is perfectly captured by the words of
Sisifo, an adolescent whose prominent fear should be HIV/AIDS: “If I’m drunk, I don’t mind anything,
because I just tell myself everybody will die” (277).14 Many Africans feel the same way, opting to live
freely and without bounds rather than forfeit their adventures to a disease. It’s through this peculiar set
of attitudes that it becomes clear that fear is the most effective way to drive a human being to act. With
diseases like smallpox and Ebola, the rapid onset of infection and subsequent death strikes fear in most
everyone, sending doctors and researchers scrambling to find a cure. With HIV/AIDS, to an extent,
denial and a lack of fear keeps African populations from taking personal responsibility to end this
epidemic.
That being said, Timberg and Halperin bring up excellent examples of strategies, planned and
unplanned, that were proven to bring down the rate of infection in certain countries. The most
prominent, tangible solution was simple: the use of political and cultural figures, combined with mass
radio messages, brought down the infection rate in Uganda and Zaire. In both places, a famous cultural
icon spoke openly about the dangers of aids and actively campaigned against it. After the death of
13
14
Timberg and Halperin, 214
Timberg and Halperin, 277
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beloved Ugandan singer Philly Lutaaya in 1989, the pace of new HIV infections in Uganda tumbled
sharply downward and stayed low. As sociologist Swizen Kyomuhendo explains, “Lutaaya’s public
sacrifice was crucial to reversing what until then appeared to be an irreversible plague.” (124).15 In a
similar fashion, the death of famed singer Franco Luambo in Zaire significantly affected the number of
sexual partners a man had at one time. Examples like these show that “blunt, outspoken demands by
leaders…reminiscent of the days of village chiefs” (98)16 are key to changing the roots of the culture
that spreads HIV/AIDS.
In addition to the strategy above, Halperin repeatedly advocates for another route to defeating
this epidemic: male circumcision. According to an article by Halperin and Bailey, uncircumcised males
were eight times more likely to get HIV; dozens of other research studies reported similar results. But
once again, Western beliefs and taboos became a hurdle to jump over; after the results were reported to
the WHO, many European countries were “uniformly opposed to any alteration to male genitalia”
(178).17 Ironically, had the West not colonized Africa and influenced the population causing a decline in
male circumcision, perhaps the AIDS epidemic would not be as devastating. Tastes and values were
rapidly westernizing in urban cities, and as more Africans left their rural villages and migrated into these
cities, circumcision declined significantly.
The insights of not only the authors, but also firsthand witnesses help us understand the
devastating effects of both epidemics. The pair of diseases eradicated tribes and families alike, forever
changing the face of the world as we know it. While smallpox is defeated, and HIV/AIDS still rages on,
we continue to learn that the medicine of disease is only partially made up of actual science; instead, it’s
crucial to focus on how humans and societies interact in order to truly abolish these modern-day
plagues.
15
Timberg and Halperin, 124
Timberg and Halperin, 98
17
Timberg and Halperin, 178
16