Philippa Koch has an argument with Sylvester Graham. As a leader in the early nineteenth-century health reform movement, Graham sought to convince Americans to take responsibility for their health. He considered providentialism antithetical to this goal. When past believers attributed their ailments to God, Graham suggested, they neither “sought to find the causes of their diseases” nor took “any care to prevent disease by avoiding the causes” (The Æsculapian Tablets of the Nineteenth Century [Weeden and Cory, 1834], iv). For Graham, it was a mark of progress that antebellum Americans rejected such fatalist passivity. This account revealed more about Graham and his aspirations than his Protestant forebears, but it has endured in both scholarship and the popular imagination. Providentialism rendered early Americans complacent in suffering, the story goes, until science and secularization liberated them from this antiquated view. In The Course of God's Providence, Koch determines to expose this narrative as a polemic that misconstrues the true beliefs and behaviors of eighteenth-century Protestants in the Atlantic world. Through five chapters filled with wide-ranging case studies, Koch shows that religious and medical actions—not passivity—attended belief in providence and that this belief endured into the age of Enlightenment.

Koch devotes her first two chapters to examining one action Protestants undertook to shape and sustain their faith in providence: narrating sickness. Ministers throughout the Atlantic world published manuals instructing the faithful to plot their experiences of frailty according to redemptive history. They urged believers to use the occasion of sickness to remember human sinfulness, righteous divine judgments, and the faithfulness of God. Koch presents the private reflections of laypersons to explain how this guided retrospection cultivated providentialism. By rehearsing evidence of God working through sickness in the past, believers took courage to trust providence in their present afflictions. By narrating their own sicknesses according to the prescribed structure, they ensured their suffering worked toward their sanctification and thereby became yet more evidence of providence. All of this took work. “There is nothing passive about resignation,” Koch emphasizes. “To resign to God's providence required, in fact, active effort and a well-established narrative practice” (24).

In the following two chapters, Koch turns her attention from the theological labor that supported providentialism to the medical interventions it inspired. First, she uses examples from throughout eighteenth-century Protestantism to show how people who believed God superintended history also used medicine to improve the conditions of their communities. They did so, Koch argues, as an extension of their faith in providence. Cotton Mather, for example, promoted smallpox inoculation as a heaven-sent opportunity for Christian good works. John Wesley similarly considered the medical knowledge he compiled in Primitive Physic a divine gift to ameliorate the consequences of sin. Koch suggests these ministers understood their medical work not as a betrayal of providence but rather as participation in its manifestation.

Koch next explores her argument in the context of Philadelphia's 1793 yellow fever epidemic. Here she contends most forcefully against secularization narratives. Scholars have characterized the Enlightenment-era rise of humanitarian benevolence as a step away from God-centered Protestantism toward a deism guided by science and devoted to human happiness. Against this interpretation, Koch marshals the writings of some of the Philadelphians most active in combatting the epidemic to demonstrate that continued faith in a providential God—not an absentee rule maker—coexisted with and, indeed, motivated benevolent human endeavors. The same God who decreed the epidemic, they believed, appointed the people who ministered amid the ensuing suffering.

In her final chapter, Koch first broadens out from her tight focus on providentialism to survey the spiritual significance of motherhood in the eighteenth century. She then returns to the question of divine direction in debates about men becoming midwives and women hiring wet nurses. While participants in these debates did not explicitly cite a providential God, Koch argues that they nevertheless invoked notions of purpose “heavy with providential symbolism” (191).

With these abundant and varied examples, Koch not only proves that faith in divine control inspired actions but also describes how that faith molded those actions and imbued them with meaning. In so doing, she adds much-needed doctrinal specificity to conversations about religion and health that too often employ reified visions of religiosity as an undifferentiated universal constant. At its best, The Course of God's Providence demonstrates the value of studying how specific theologies influenced experiences of health, sickness, and medicine. When Koch departs from this approach, as in chapter 5 when she focuses on general themes of Protestant piety rather than providentialism per se, her argument becomes less compelling.

Koch deploys a synthetic methodology that excels at drawing together histories and historiographies. Building on Atlantic world scholarship, her research spans geographies, races, languages, theologies, and much of the eighteenth century. Koch unites intellectual and social history by interleaving published works of elites with manuscript writings of everyday believers. She also deftly weaves into her argument numerous scholarly conversations concerning religion, medicine, the Enlightenment, and secularization. This breadth substantiates her argument that providentialism transcended many divides and endured many changes, earning consideration as a foundational theology in eighteenth-century Protestantism.

While Koch emphasizes continuity, she also hints at change. She notes, for example, that the actions providentialism prompted evolved across the century, moving from calls for repentance oriented toward salvation to calls for service oriented toward human well-being. Similarly, providence appears in midwifery and nursing debates not as the will of God but rather as teleological visions of “nature.” In both cases, Koch stresses the perseverance of providentialism, insisting such changes did not constitute simple secularization. She leaves for future scholars, however, to explain just what those changes meant.

Koch successfully disproves polemics about providential passivity and challenges hasty declarations of secular victory. In the process, she highlights for historians of religion and of medicine the necessity of studying the intersection of their fields. Any full account of eighteenth-century Protestant theology must comprehend its implications for bodily experiences, just as medical histories of the era must understand the enduring power of belief in a God who ordains both sickness and the pursuit of healing.