The author's hypothesis is simple enough: The frightening "fits" of accusers during the 1692 Salem witchcraft crisis were caused by an outbreak of encephalitis lethargica, a neurological disorder popularized in Oliver Sacks' 1973 book Awakenings. (A film version starring Robin Williams and Robert De Nero was released in 1990.)
As a former cell biologist, I'm well-disposed to considering microorganisms and disease as the moving force of history. (See Hans Zinsser's classic, Rats, Lice, and History: being a study in biography, which, after twelve preliminary chapters indispensable for the preparation of the lay reader, deals with the life history of typhus fever.) In this case however, the author fails to make the case.
There were a few things that prejudiced me against this book: publication by a small house (Ivan R. Dee); description of the author as an "independent scholar," somehow implying other scholars aren't; a noticeable disdain for the entire field of psychology; and, inclusion of material that is at best tangential, at worst, irrelevant. For example, there is an afterword titled Satanic Possession and Christian Beliefs outlining how to differentiate between mental illness and demonic possession. The mere possibility that there is any reality to demonic possession is antithetical to the author's hypothesis. Chapter Seven, Alternate Outcomes, recounts experiences in New Hampshire a half century after the Salem witchcraft crisis to predict how the Salem crisis might have gone. A much better example would have been the similar crisis in Stamford Connecticut that was concurrent with that in Salem. (See Richard Godbeer's Escaping Salem: the other witch hunt of 1692.)
Encephalitis lethargica is a rare neurological disorder that appeared at about the same time as the 1918 influenza pandemic. Unlike influenza which is caused by a virus, the definitive cause of encephalitis lethargica is unknown. It might even be an immunological consequence of influenza. It's symptoms are varied and vague: high fever, headache, double vision, delayed physical and mental response, lethargy, coma (in acute cases), abnormal eye movements, upper body weakness, muscular pains, tremors, neck rigidity, and behavioral changes including psychosis. (See National Institute of Neurological Disorders and Stroke.)
Like Linnda Caporeal (Ergotism: The Satan Loosed in Salem?) , Carlson tries to shoehorn symptoms like "abnormal eye movements" and "psychoses" into a physical cause. A great deal of her argument is comparing experiences reported by accusers and their observers against possible symptoms for encephalitis lethargica. In many cases, commitment to "proving" her hypothesis ignores obvious, more mundane explanations. For example, descriptions of symptoms like "some suffered only a mild affliction, perhaps a heavy weight on their chests and legs while in bed, which left them momentarily paralyzed," or "people felt sudden weights on their chests at night so that they could not breathe ... complained about weight on their chests while in bed at night, an inability to speak," are well-known descriptions of the common experience called "sleep paralysis." They do not require special explanation.
The author is sometimes overreaching, if not plain wrong. For example, page 46 states:
[Midwives] were present in Salem and in colonial settlements, but there are no references to individuals or their families seeking them out for assistance in combating an epidemic. .... Some women who were tried as witches had performed as midwives, but they were not tried for any offense connected with their vocation.
Both Mary Beth Norton's In the Devil's Snare, and Richard Godbeer's Escaping Salem report midwives did indeed serve as a kind of "nurse practitioner:"
Women like [midwife] Sarah Bates emerged as experts from those communities of mutual care, their skills endorsed by the experience and gratitude of their neighbors rather than university degrees or formal apprenticeship. Goody Bates had a finely honed instinct for discerning what ailed a sick neighbor and was widely respected for her abilities.
But what's missing from A Fever in Salem is epidemiology. This is most evident in the "touch test" used to "prove" an accused was indeed a witch. An accuser would fall into a fit - and usually faint - at the mere sight of an accused witch. If the accuser revived at the touch of the accused, it "proved" the accused was a witch. Biological epidemics are not so easily turned on and off.
In some ways, A Fever in Salem is an example of cognitive dissonance. The author continually tries to extend her hypothesis, and thereby add validity, but at each step the exercise backfires. For example, a map reprinted from Robin Briggs' Witches & Neighbors: the social and cultural context of European witchcraft, shows areas of heavy, moderate, or light "persecution or important witch-hunts." Not surprisingly, dark centers spread into moderate, then lighter areas. Two pages after, a different map, with a four-fold change in scale, shows bird migration patterns. The author's conclusion?
... we see how closely they match up. Birds migrating from sub-equatorial western Africa fly directly over these areas as they head north each spring ... Migratory birds may have brought disease from western Africa to Europe, where a virus in their blood was extracted by arboviral mosquitoes who then fed on peasants and villagers.
Not only do they not match up closely (to my eyes), eight pages later Carlson suggests the vector might have been ticks.
In all, weighed in the balance, and found wanting. I would not recommend this book.