Jim Downs, Maladies of Empire: How Colonialism, Slavery and War Transformed Medicine

Abstract

In Maladies of Empire, Jim Downs looks beyond John Snow’s London to rethink the violent structures of knowledge that created modern epidemiology. He does so by marshalling an array of sources across eight case studies. Though distinct to their populations, aetiologies, and environments, they have several things in common. Namely, most of them served as precedents for the US Sanitary Counsel’s response to a smallpox epidemic during the US Civil War. Downs argues that these episodes ‘changed the medical profession's understanding of disease transmission,’ by which he means the medical profession in much of the United States and Britain (p.6). Though framed as a global history of medicine, slavery, and empire, Downs’ arguments hold greater purchase when read through this narrower analytical scope. Indeed, many of the interventions he claims in this regard are well established, if uncited in the book. A notable omission is the work of Philip Curtin, who argued over fifty years ago that epidemiology has its beginnings in the slave trade.1 By staking this claim, Curtin paved the way for medical historians of slavery, explicating the centrality of disease to the operation of the slave trade and the racialization of both by medical practitioners and slavery advocates. Yet Curtin’s understanding of epidemiology was narrowly framed through a demographic and statistical approach to disease. A wealth of sources and studies has since prompted historians to examine the very epistemological assumptions, values, and logics of seemingly self-contained fields like epidemiology. It would have been exciting to see how the social historical approach that Downs brings to his rich source material might challenge and build on this canonical study.