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 Sean Morey Smith (bio) Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. By Jim Downs. ( Cambridge, Mass.: Belknap Press of Harvard University Press, 2021. Pp. 272. Cloth, $29.95.) In 1854, John Snow mapped cases of cholera in the Soho neighborhood of London. His map revealed that the cases were clustered around a single water pump. This led Snow to believe that the pump's water was the source [End Page 109] of cholera, so he removed its handle, preventing Soho residents from using it. Cases of cholera quickly disappeared, Snow's theory was proved, and modern epidemiology was born. Or so the canonical origin story goes. In Maladies of Empire, Jim Downs rebuts this hagiographic narrative by arguing that earlier investigations of health and disease in places outside the British metropole led to the development of epidemiology. In particular, Downs stresses the role that a variety of forgotten informers—including soldiers, sailors, enslaved people, and Hajj pilgrims—played in revealing patterns of disease. He further argues that the data collection from these forgotten sources was enabled by colonialism, wars, and slavery. Moreover, U.S. and Confederate medical practices during the Civil War were informed by British imperial practices. Maladies of Empire is most interested in recovering the lost informants that supplied the data that allowed physicians to develop epidemiology. The book's chapters deftly narrate how various people—from British soldiers imprisoned in the Black Hole of Calcutta, to Africans enslaved in the Middle Passage, to washerwomen on Malta and Boa Vista, Cape Verde—provided testimony of their conditions and the spread of disease to physicians and surgeons who reported it in publications. As those observations were iteratively remade into theory, the identities of the informers were stripped from the medical record. Downs's revelations follow other recent efforts to name forgotten medical subjects, such as Deirdre Cooper Owens's Medical Bondage: Race, Gender, and the Origins of American Gynecology (2017), which details the forgotten subjects of James Marion Sims's gynecological surgery experiments. These efforts remind us that medical knowledge has always been made from the experience of individuals, most of them stigmatized by their illness, race, or social standing. Furthermore, as Downs points out, the forced movement of enslaved people, soldiers, and other colonial subjects precipitated many of the disease events that would spur physicians to become medical investigators and eventually develop modern epidemiology. Maladies of Empire positions medical practices of the U.S. Civil War as nationally unique versions of emerging practices adopted from Britain and Europe. The first five chapters focus on early cases of mostly British medical investigations that prefigured epidemiology, while the sixth and seventh shift to the U.S. Civil War. The final chapter then explores the 1865–66 cholera outbreak using both British and U.S. sources. Methodologically, this approach challenges historians of health and medicine in the nineteenth-century United States to break out of a national framework and contextualize their subject in terms of global European colonialism. For instance, while Charles E. Rosenberg, in The Cholera Years: The United [End Page 110] States in 1832, 1849, and 1866 (1962), explains the largely successful U.S. response to this cholera outbreak as the result of changing political, religious, and social norms, Downs traces parallel efforts by British and U.S. Army officials to track the outbreak geographically and construct narratives of its spread; this renders the response as more bureaucratic and based on colonial and military experience than in Rosenberg's telling. While Americans followed British examples in their epidemiological investigations, they also transformed the practice. Downs argues that "US doctors, unlike their British counterparts, formally classified racial difference as a key hallmark in examining the spread of infectious disease" (114). Downs allows that British physicians and surgeons collected racialized data related to diseases, but they "did not use these categories in an explanatory way" (122–23). He indicts the U.S. Sanitary Commission for injecting racial difference into a discourse that had focused on external, environmental causes of infectious disease. This conclusion is especially striking given the historiography of race and disease...