Reviewed by: Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine by Jim Downs Thomas J. Balcerski Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. Jim Downs. Cambridge, MA: Harvard University Press, 2021. ISBN: 978-0674971721, 272 pp., cloth, $29.95. The science of epidemiology has been front of mind for many during the COVID-19 global pandemic. Yet before the publication of Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, the fascinating new book from historian Jim Downs, few recognized just how much the study of infectious disease has itself been attendant with the intertwined histories of slavery, colonialism, and war. Downs conclusively demonstrates how "ideas developed between 1756 and 1866 became codified into medical theories that contributed to the development of modern epidemiology" (4). The result is a sweeping global history that reveals the complicated foundations of modern medicine itself. Through a creative reading of sources, Downs expands the cast of characters deserving inclusion in the history of epidemiology. He explores Thomas Trotter's 1786 account of scurvy victims aboard British slave ships to trace how medical ideas circulated "outside of the metropole" (26). Similarly, Downs appeals to volumes by Arthur Holroyd in 1839 and Gavin Milroy in 1846 reveal how arguments against quarantine practices drew on evidence from laundresses on the island of Malta and colonial subjects in the West Indies. In 1845, an outbreak of fever in the Cape Verde Islands eventually led Doctor James Ormiston McWilliams to interview over one hundred people of color, in the process creating "the most extensive surviving record from the nineteenth century of people of African descent describing in detail the onslaught of an epidemic in the Atlantic world" (53). As a result, McWilliams's emphasis on interviews, Downs contends, became a "core epidemiological method" (62). The global span of the British Empire served to diffuse knowledge among physicians. For example, British naval surgeon James Henry investigated a cholera outbreak aboard ships in the Mediterranean Sea, enabled by a military and colonial bureaucracy. In Jamaica, Gavin Milroy reported in detail on another [End Page 210] cholera outbreak, which later influenced John Snow's pioneering study of cholera in London in 1854. The disrupting forces of war provided another avenue for the study of the spread of disease. Also in 1854, Florence Nightingale, superintendent of London's Hospital for Invalid Women, arrived at the Barrack Hospital in Scurtari, situated near the ongoing Crimean War. In her work as nurse, Nightingale came to understand better how hospitals should be designed. Taken together, these medical providers relied on colonial subjects and imperial soldiers to solidify the "foundation of modern epidemiology" (84). Perhaps most interesting to readers of this journal will be Downs's incisive analysis in a trio of chapters on the era of the US Civil War. Here, again, the category of race played a formative part in epidemiology's advance. Although the US Sanitary Commission helped to educate the public about disease transmission, it did so by focusing attention on "racial identity as a central point of investigation" (123). One commission doctor, Ira Russell, fixated on perceived differences among African Americans, simultaneously reifying the "invented racial categories as valid metrics in the study of infectious disease" (127). The resulting knowledge regime "resurrected slaveholding ideologies to amplify racial difference and to contribute to medical knowledge" (128). The Civil War created a series of unequal power dynamics that permitted doctors greater access to the study of disease among captive populations. Smallpox outbreaks especially left both enslaved and free African Americans vulnerable to invasive medical procedures at the hands of Confederate and Union doctors alike. The vaccination of prisoners at Andersonville became a key point of argument at the subsequent trial of superintendent Dr. Henry Wirz. After years of wartime study, scientific methods were becoming gradually more sophisticated. As a result, in the 1866 investigation of cholera outbreak, army physicians relied on "bureaucratic narrative reports" to trace its spread (173). Simultaneously, British doctors who studied quarantined Muslim pilgrims returning from Mecca used statistical methods to search for evidence of infectious disease. Ultimately, the increased reliance on data "enabled the federal government to see cholera in a way that local...
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