Jim Downs' new book Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine extends such insights by focusing on the birth of epidemiology as a discipline from the mid-18th century to the mid-19th century. Indeed, Downs' book goes further. Maladies of Empire connects imperialism, enslavement, and warfare to argue that it is at the intersection of these processes that we can trace the beginnings of modern epidemiological thinking. His main thesis is that it was the bodies of people who were enslaved and dispossessed across the globe that were used to study the distribution, spread, and control of diseases. As Downs writes in his introduction: “part of the origin story of epidemiology has been overlooked because it resulted from studying people who suffered from war, enslavement, and imperialism—most of whom were people of color—in Africa, the Caribbean, India, and the Middle East”.
The interior of the Brookes, which shows how enslaved Africans were packed into the hold
Downs' work is first and foremost an effort to decentre our understanding of the origins of epidemiology. Rather than focus on European or American cities or locate the foundations of epidemiology in John Snow's work on mapping cholera transmission in mid-19th-century London, UK, Downs examines how white (predominantly but not exclusively male) physicians, surgeons, and other medical personnel made use of the possibilities opened by empire, war, and slavery to study patterns of disease in the dispossessed. Maladies of Empire shows how expanding imperial frontiers and military engagements across the world enabled the creation of large bureaucracies and the concomitant collection and transmission of data on the spread of diseases in subjugated populations. Downs is at pains to stress that his story is not about the accuracy of early epidemiological theories, but the methods that accompanied them. Doctors became “investigators”, exploring and learning about how the physical and natural world influenced the cause of diseases and their spread. The records they kept show that interviews were used as a form of disease investigation and tracing and early forms of disease “mapping” included a reliance on written narratives to track the spread of disease. All of this information grew out of a study of captive and subjugated populations, in prisons, on slave ships, plantations, and in military hospitals.
To take an example, in his intriguing and yet equally disturbing account of smallpox, Downs examines how enslaved children were used to cultivate smallpox vaccine during the US Civil War in the 1860s. The war created difficulties in producing vaccine and although physicians initially obtained material from vaccinated soldiers, they encountered complications such as the inadvertent transmission of diseases like syphilis and looked for new sources to harvest vaccine matter. Slavery remained in place in Confederate states and the bodies of Black infants and children were exploited for this purpose. As Downs writes: “From an epidemiological perspective, slavery created an unprecedented built environment that confined hundreds of Black children to plantations where they could easily be targeted as objects to be used to produce vaccine material and then to be studied.” Thus, slavery and war provided opportunities to learn about the effects of vaccination and develop theories of disease transmission, all at the expense of enslaved and subjugated populations, including their children.
Downs' account is animated by the question of agency and the challenges posed for historians in reconstructing the voices of the subjugated. For example, he writes of James Ormiston McWilliam, the Scottish naval surgeon who went to Boa Vista, Cape Verde, in 1845 looking for evidence to explain the outbreak of yellow fever that occurred after the arrival of the British ship HMS Eclair. McWilliam interviewed those who survived the disease, including enslaved Africans, Black soldiers, labourers, and washerwomen, for the purpose. Their accounts provided him with knowledge of how and when the fever spread and he went on to argue—based on his understanding that yellow fever was contagious—that the Eclair did bring the disease to the island. Yet, Downs is rightly attentive to unequal power relations that characterised this process. He writes that the voices of those subjugated and marginalised and their contribution to the understanding of disease transmission are only made available to us through McWilliam's questionnaire and the format of his interview. As he explains, there exists “no opportunity to capture a crack in the voice, a momentary silence, tears in the eyes, a disruption in the narrative”. This broader point that the creation of epidemiological knowledge was simultaneously a process of elision of the voices of the subjugated is made persuasively throughout the book and Downs does well to recognise both the possibilities and limitations of the extensive archives he uncovers.
Another issue that warrants attention in Downs' account is the transformation of race and racialised understandings of disease. Downs argues that British epidemiologists during this period began challenging long held assumptions that infectious diseases resulted from tropical climates and foreign environments. The Victorian reformer Florence Nightingale, whose “vast archive of publications makes a powerful case for her role as an epidemiologist” argues Downs, believed that the built environment in places such as India was a source of infectious diseases. If racist stereotypes of India as filthy were ubiquitous in her accounts, Downs contends Nightingale also saw these conditions “less a result of innate inferiority than as a product of circumstances that could be altered”. In other words, the circumstances that Indians found themselves could be changed with proper sanitary management.
Interestingly, Downs suggests that we might see a difference between British epidemiological thinking and ideas that developed in America, where “scientific racism became a metric for studying infectious disease”. For example, Union Army doctors affiliated with the US Sanitary Commission (USSC), which was created during the US Civil War, were of the opinion that the source of disease lay in the patient. Downs discusses the work of doctors such as Ira Russell who used the networks created by the USSC to develop and promote their racialised ideas of disease transmission by observing large groups of Black soldiers and by carrying out autopsies on the bodies of Black people. One argument voiced was that Black soldiers were more susceptible to pulmonary diseases such as tuberculosis because of their supposedly “weak” lungs. “By arguing that weak lungs caused high mortality among Black troops, rather than the inadequate housing, clothing, and other conditions that defined Black soldiers' experience during the war, physicians blamed the Black troops themselves for their pulmonary problems”, Downs writes. Because of the medical authority of the USSC, such racialised theories of disease and Black inferiority gained scientific credibility after the war. Indeed, Downs goes further and suggests that the USSC'S insistence on racialised data collection is one of the reasons why epidemiologists and public health specialists create statistics that classify human beings into racial categories to understand the spread of diseases. While Downs' narrative focuses on the differences between the British and American epidemiological underpinnings, historians may question the divide he presents. Given that race and sanitary environments were intertwined in medical discussions even within British circles at the time, the differences between the two camps are perhaps overstated in his account.
Nevertheless, Maladies of Empire is a powerful and timely reminder that the advancement of medical knowledge about infectious diseases could not have been possible without the suffering of people of colour. Not only does such a narrative shed light on the violent foundations of disease control interventions and public health initiatives, but it also implores us to address their inequities in the present. At a time when low-income and middle-income countries struggle for access to vaccines in the COVID-19 pandemic, such an endeavour could not be more urgent.
Raghav Kishore
Published: October 16, 2021 DOI:https://doi.org/10.1016/S0140-6736(21)02216-9
No comments:
Post a Comment