The Course of God's Providence

Philippa Koch’s The Course of God’s Providence: Religion, Health, and the Body in Early America is a significant contribution to the literature on the interconnections of religion and science in the Enlightenment era. In her assessment of both religious understandings and the vicissitudes and uncertainties of early modern medical practice, Koch shows that orthodox Christian believers and rationalists shared a sense of a divine presence in personal and social responses to illness.  Religion and science in the colonial era, far from being in conflict as secularization theories generally suggest, both employed similar assumptions and methodologies that shaped modernity.

Koch points to the contemporary relevance of her study in the first lines of her preface—and periodically throughout the book—by reflecting on the experience of completing it for publication during the COVID-19 pandemic. Pastors and physicians, evangelicals and the scientifically minded, Enlightenment elites and ordinary people all turned to narrative construction in an effort to make sense of suffering, to find hope and purpose in the throes of illness. She identifies a very flexible doctrine of God’s providence (distinct from the more precise and contested doctrine of predestination) as the common thread binding otherwise diverse ways of dealing with illness.

Then, as now, people have felt impelled to reflect on experience and construct a meaningful trajectory for their lives when confronted with mortality. To rise above vulnerability and helplessness, “narrative was an opportunity for activity in the face of sickness” (85). Practices of documenting spiritual and medical experience have taken various forms over the centuries, but with surprising consistency. The age-old discipline of journaling as a means of interpreting life during illness continues to flourish today, often facilitated through such online platforms as CaringBridge. While Koch acknowledges the transformations wrought by the Enlightenment’s elevation of reason and science, her project is devoted to exploring “continuities in the midst of change” and “our shared humanity” with historical subjects (197).

Koch’s discussion of 18^th-century religious responses to illness delves into influential works in the transatlantic Protestant world by New England pastor Cotton Mather, Methodist founder John Wesley, and German pietist Samuel Urlsperger, along with writings of women like Sarah Osborn and lesser-known pastors. All Protestants grounded their understanding in biblical theology, with sickness endemic to the human condition due to Adam’s fall. Rather than promoting passive resignation, Christian belief promoted faith that God’s providential will called for active human response to sin. This meant countering illness, first in penitential self-examination and faith, then through medical treatment. Reflection on human sinfulness and repentance for sin as a “response to sickness could, in fact, be a form of consolation . . . a framework for action at a time of disorientation” (31). That providential framework was widely embraced, as “personal narratives of sickness shared the central themes of faith and consolation found in more formal, published pastoral manuals” (85).

While Protestant leaders naturally relied on theology to interpret their experiences, they did not eschew science, and in fact “joined actively in a larger medical world undergoing key changes. They worked within multiple networks of knowledge,” including scholarly discussion of the soul’s role in bodily health, new medical theories and treatments, traditional knowledge and methods learned from enslaved persons, and “participation in medical print culture” (90). The clergy’s involvement in medical progress, including the matter of smallpox inoculation, “was motivated by their commitment to God’s providence” and the church’s responsibility in the world. Christian mission included a commitment to working for public health. At the same time, secular-minded rationalists and theological liberals who rejected doctrines such as predestination routinely still resorted to providential language of divine will in the work of combatting illness.

The book’s last two chapters serve as case studies for Koch to apply her thesis in a particular setting and to a significant development in the history of medical practice—namely, the Philadelphia yellow fever epidemic of 1793 (chapter 4) and the advent of a clinical approach to women’s bodies, with the encroachment of male practitioners and concomitant marginalization of midwives (chapter 5). Both chapters read almost like freestanding papers or journal articles, which, despite an interesting epilogue, makes for a somewhat abrupt conclusion to the book. Nevertheless, each adds valuable insights and substance to the material covered in previous chapters, demonstrating the “activating potential of providential thought” in both religious and medical approaches to illness (196). Koch shows in fascinating detail the heroic contribution of African American nurses in Philadelphia, encouraged and organized by Richard Allen, Absalom Jones, and other Black church leaders. Jones and Allen’s Narrative of the Proceedings of the Black People (1794) countered disparaging views of the nurses by some White public health officials, while adopting providential language common to all. Similarly, in a final chapter that examines transatlantic Protestant understandings of motherhood and scientific debates about women’s bodies and employment of wet nurses, Koch shows that a “romanticized image of ‘nature,’” along with “providential and moral language” rooted in traditional narrative patterns (186), continued to characterize the rising male professionalization of women’s health.

 If there is a weakness in the book, it is the author’s reliance on fewer scholarly works on the history of medicine than one would expect. Further, she neglects to engage with such works as Sarah Rivett’s The Science of the Soul in Colonial New England (University of North Carolina Press, 2012), which makes a compelling case for the connection between Puritan experience-focused “experimental” religion and the emerging evidence-based “experimental” natural philosophy, a claim that Koch’s book could have profitably engaged with. Nevertheless, The Course of God’s Providence expands our understanding of the relationship of religion and science in the pivotal eighteenth century. Faith and reason together helped create modern responses to illness and suffering.

Charles E. Hambrick-Stowe is an independent scholar.

Charles Hambrick-Stowe

Date Of Review:

April 29, 2022