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

Abstract

Reviewed by: Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine by Jim Downs Zachary Dorner (bio) Medicine, Medical history, Slavery, Colonialism, Migration, War, Epidemiology Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. By Jim Downs. (Cambridge, MA: The Belknap Press of Harvard University Press, 2021. Pp. 262. Cloth, $29.95.) Quick, what comes to mind when you read the word epidemiology? For some it may be the Broad Street pump from the London cholera outbreak of 1854; others might picture Dr. Anthony Fauci. With Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, Jim Downs prompts readers to form different associations—the slave ship, prison, military hospital, lazaretto—by rooting the development of preventive medicine and knowledge about infectious disease in "imbalances of power such as those created by slavery, colonialism, and war" (148). To do so, he recovers the experiences of people "whose health, suffering, and even death contributed to the development of medical knowledge," most of whom were people [End Page 320] of color, from the reports, journals, treatises, and lectures of the time (8). The book thus provides a corrective to heroic narratives of the declines in mortality witnessed across the Atlantic world during the nineteenth century but can, at times, ignore a longer history of understanding disease via contexts of slavery, colonialism, war, and migration in its ambition to relocate the origins of modern epidemiological practice. In Downs's telling, the century from approximately 1756 to 1866 holds the key to an overlooked history of epidemiology. The narrative operates on a global scale, often removed from the typical metropolitan centers of knowledge production, encompassing Russian prisoners, laundresses in Malta, British sailors, freed people in Jamaica, Black Union soldiers, enslaved infants, and Muslim pilgrims as examples of vulnerable populations instrumentalized for purposes of public health by military and colonial bureaucracies. Empire (whether European or U.S.), in other words, is a unifying thread through these examples, so the terms "colonialism" and "imperialism" tend to do a lot of work in the narrative, which would have benefitted from more specific definitions of both. Early chapters establish that infrastructures, power differentials, and recordkeeping routines of the British Empire enabled the extraction of epidemiological data from certain people but also created the very health crises to which those efforts were responding with such urgency. Dr. Thomas Trotter, for example, gathered information aboard the slave ship Brookes in 1783 for his theories about fresh air that stood alongside laboratory experiments and observations from Europe's overcrowded prisons on the importance of oxygen. Empire's "crowded places" provided practical sites for collecting practical observations (9). Chapters in the latter half of Maladies of Empire turn to the Civil War-era United States, the author's specialty, for a closer look at the racialization of understandings of infectious disease and their afterlives through examples of the U.S. Sanitary Commission, smallpox vaccinations, and cholera-mapping in what are some of the book's most effective chapters. Maladies of Empire is also a book about the human body. People, both individually and in groups, became sources of data for the "founding generation" of epidemiologists Downs identifies (194). Though often remaining nameless and faceless in contemporaneous texts, these men, women, and children contributed to knowledge production as literal bodies of evidence and as sources of verbal or visual information akin, in some ways, to the Indigenous informants described in other histories of imperial [End Page 321] science and medicine.1 That many of these anonymous people remain so in Maladies of Empire is not a criticism of the book, but rather an acknowledgement of the challenges posed by reading against the grain in sources that are abstracting by design. Even the most crucial sources for the study of slavery have been subject to such attention in recent years.2 Throughout the book, understandings of infectious disease act dialectically whereby they reshape perceptions of the persons who provide the initial bodily data. A prominent example for the United States is the racialization of disease susceptibility and immunity described in Chapters 6 and 7 that "solidif[ied] racial identity as a central component in epidemiology and public health" (114). To some readers...