Book excerpt: In The Province of Affliction, Ben Mutschler explores the surprising roles that illness played in shaping the foundations of New England society and government from the late seventeenth century through the early nineteenth century. 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.