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

• Author: Uneke, Okori

Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. Cambridge, MA/London, UK: The Belknap Press of Harvard University Press, 2021. 262 pages. Hardcover, $29.95.

With the visibility of epidemiologists in the media in the current pandemic, Maladies of Empire raises the curtain on the long-forgotten players in the development of epidemiology and advancement of medical knowledge. Historian cum Medical Anthropologist, Jim Downs meticulously scoured original records and sources ranging from Kolkata, India to Malta in the Mediterranean, from London, England to Richmond, Virginia, in highlighting the roles slavery, colonialism, and war played in the transformation of modern medicine. The author shows that the study of infectious disease relied on the unrecognized contributions of non-consenting individuals, namely: slaves, colonial subjects, and conscripted military personnel. In effect, slave ships, plantations, prisons, and battlefields provided physicians with laboratories to understand the spread of disease. For example, by monitoring Africans, parked like sardine, in the bottom of slave ships, doctors learned about the importance of fresh air. Statisticians recorded cholera outbreaks by closely observing Muslims in British colonial territories returning from their annual pilgrimage to Mecca. Military hospitals in Scutari (district of Constantinople, now Istanbul, Turkey) of the Crimean War and the US Civil War provided valuable information gathering in disease transmission. Downs explains how slavery, colonialism, and war provided built environments that contain captive populations readily available for study and the context for the theories to develop and tested. He contends that tracing the genealogy of the study of infectious disease must include military occupation, power imbalances, and violence.

In explaining the roots of epidemiology, Downs notes that between 1756 and 1866, medical authorities depended on enslaved and colonized people, soldiers and Muslim pilgrims not only to observe disease outbreaks, but also to test theories and provide empirical evidence to confirm their arguments. On-board slave ships physicians observed the brutally crowded conditions in slave holds and recognized the importance of fresh air and the benefit of ventilation systems. In addition to confining enslaved Africans to the bottom of unventilated ships, they were also poorly fed and had no space for exercise. These...