Book Review
Diseases of Body and Soul: A Review of Philippa Koch’s <em>The Course of God’s Providence</em>

Diseases of Body and Soul: A Review of Philippa Koch’s The Course of God’s Providence

Shelby M. Balik

Forgive me for stating the obvious, but it takes a long time to write a book. It takes so long, in fact, that when a new book just happens to coincide with an eerily relevant global crisis, it presents a largely unexpected opportunity for the author to make the case for her work’s importance. All of this is to say that when Philippa Koch started researching religion and health in eighteenth-century America, she could not possibly have predicted that the resulting book, The Course of God’s Providence: Religion, Health, and the Body in Early America, would land at just the right time: during a pandemic, when much of the public discourse about health has posed big questions about how our collective handling of rampant illness reflects insidious disease in our social, political, and moral foundations. But that’s exactly how things worked out. As a result, this well-researched, engagingly written, and convincingly argued book has even more to teach us than it otherwise might have.

Koch acknowledges the chance timing in a preface that reflects on writing about disease while in quarantine. She recognizes that COVID-19 has shocked the national psyche – it has tested our resolve, exposed inequality, and reminded us of our vulnerability and mortality. In these respects, disease in early America was no different. But Koch cites an important distinction: whereas the current pandemic has unsettled a nation accustomed to mastering its own destiny (or at least convinced of its ability to do so), eighteenth-century Americans harbored no such illusions.[1] To be sure, these early Americans were active in their attempts to confront and control illness. But ultimately, they faced the challenge of disease with the understanding that their fates were not entirely in their own hands, but rather in God’s. It was that yielding of control – not a passive surrender but an admission of divine power and a mission to ascertain God’s plan – that distinguished the eighteenth-century response to illness from a modern impulse to turn first to technology and medication.

A grey background with faint cursive writing, with the book title across the top on top of a purple band
Cover of Phillippa Koch’s book, The Course of God’s Providence
Religion, Health, and the Body in Early America
NYU Press)

That assumed reliance on God is Koch’s starting point. She argues that we can understand how early American Protestants dealt with illness and health by considering the context of providentialism: a trust in “God’s oversight and governance of the created order.”[2] Providentialism (not the same, Koch is quick to point out, as Calvinist predestination) cut across denominations, making it a core element of a pan-Protestant religious culture in which people searched themselves and each other for clues to God’s intentions for their bodies and souls. The religious framework of providentialism intersected with the intellectual framework of the Enlightenment; rather than see a conflict between religion and science, early Americans sought cures, mourned losses, and accepted death with the understanding that medicine and science served divine purposes. Providentialism offered an empowering tool in the quest to reconcile oneself to God’s intentions.[3]

Koch explores how providentialism shaped people’s understanding of health and disease by examining their own narratives of illness and childbearing. As she points out, “practices of narrative and reflection” were central to working out the relationships between individual experience and God’s providence.[4] Accounts of illness, childbirth, and death resembled conversion narratives in form and function in that they embodied a theology of lived experience – a “theology on the ground,” as Koch describes it – that engaged questions about sin and redemption by interrogating pain and distress.[5] In seeking a connection between sickness and sin, authors explored the relationship between the corruption of the body and the corruption of the soul by using the power of personal experience.[6] That relationship was made more concrete by the structure of the writings themselves. These publications, which straddled the genres of autobiographical, theological, and scientific literature, suggested how sin, disease, and salvation interwove with individual life stories to create a narrative arc of redemptive suffering. And because narratives come from a broad range of authors – clergy and laity, elites and ordinary folks, Blacks and whites, men and women, representing a spectrum of Protestant beliefs – they show us just how profoundly providentialism shaped religious thought about health and medicine.

These narratives also show us how religious and scientific thought changed over time. Koch rightly rejects older interpretations that argued for religious declension or increasing secularization in eighteenth-century America, along with suggestions that scientific thought replaced religious belief during the Enlightenment. Indeed, the juxtaposition of science and religion implies a false dichotomy. Scientific and religious discourse changed in tangent with each other in a world where providentialism, too, was elastic. Whereas early eighteenth-century Americans understood sickness and pain as trials that gave afflicted souls opportunities to withstand spiritual doubt and achieve redemption, their counterparts decades later understood illness like the 1793 yellow fever epidemic as a circumstance that allowed communities to show compassion in caring for the sick and dying. Medicine did not diverge from Christianity but instead became a component of a wider Christian benevolent enterprise that included missionary work and social reform.

It is not the historian’s job to connect her subject matter to the present day, but Koch has nonetheless left us with sketches of eighteenth-century actors who seem strikingly familiar. Readers will hear echoes of anti-vaxxers in strident opposition to smallpox inoculation, and they will recognize Cotton Mather’s exasperated tone when his efforts to convince resisters fell on deaf ears.[7] Koch’s discussion of the yellow fever epidemic will also resonate, especially her descriptions of victims dying alone, religious services with socially distanced seating, and fears about the breakdown in social relations. When Lutheran pastor Heinrich Helmuth struggled to understand the collapse of reciprocal duty and mutual compassion and pushed his congregation to embrace benevolence, he might as well have been addressing today’s anti-maskers.[8] All of this evidence is well-situated in context – Koch is careful not to offer ahistorical parallels or interpretations (in fact, she limits her musings on COVID-19 to the preface). But these examples throughout the book only add to its strength; the anti-vaxxers and contrarians of old still have much to teach us about our own response to disease. Their inclusion in the book amplifies its relevance to modern readers, who can’t help but have illness on our minds.

Koch is not trying to offer a shadow argument about today’s crisis, nor should she. Her interpretation of eighteenth-century religious ideas about health is nuanced, sophisticated, and (it should go without saying) historically grounded. It stands on its own. But if we were to seek lessons in the book that apply to the COVID-19 pandemic, we might look no further than Koch’s argument that communities reveal their priorities and identities as they respond to disease. Among the new ideas that emerged from the yellow fever epidemic was the notion that compassion is a natural human instinct and essential for salvation. By the same token, if mutual compassion and duty were necessary for collective redemption, many witnesses worried that the absence thereof could lead to irreparable social fissures and alienation from God.[9] Fears of social deterioration in a time of disease reflected a widely shared eighteenth-century religious mindset. But if we are inclined to draw comparisons, we might consider the relationship between compassion, the body, and the body politic in our own time.


  1. Philippa Koch, The Course of God’s Providence: Religion, Health, and the Body in Early America (New York: New York University Press, 2021), xi-xiv.
  2. Koch, The Course of God’s Providence, 2.
  3. Koch, The Course of God’s Providence, 9.
  4. Koch, The Course of God’s Providence, 6.
  5. Koch, The Course of God’s Providence, 23.
  6. Koch, The Course of God’s Providence, 27, 57, 89.
  7. Koch, The Course of God’s Providence, 94-101.
  8. Koch, The Course of God’s Providence, 124-31.
  9. Koch, The Course of God’s Providence, 126, 28.

Featured image caption: Bloodletting procedure. (Courtesy National Library of Medicine/Flickr Commons)

Shelby M. Balik is an Associate Professor of History at Metropolitan State University of Denver. She is the author of Rally the Scattered Believers: Northern New England's Religious Geography (Indiana, 2014) and is working on a book about household religion in eighteenth-century America.

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