Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. Cambridge, MA: Belknap Press of Harvard University Press, 2021. Pp. 272. $29.95 (cloth).

Abstract

With Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, an ambitious, globe-crossing book, Jim Downs seeks to reframe the history of modern epidemiology. Following histories of race, empire, and medicine, Downs shifts the origins of disease study from urban metropoles and European publics to peripheral sites and dispossessed subjects. Nascent epidemiologists, he reveals, relied on data and observations drawn from bystanders subjected to the concurrent phenomena of colonialism, slavery, and war. Downs argues that this trifecta invariably shaped and enabled modern epidemiology. This is a broad argument, familiar by various degrees to historians of medicine, and the eight case studies that Downs presents within cut a wide swath. Readers interested in iconic facets of British history-from the slave ship Brookes to Florence Nightingale-find them recast alongside a cadre of lesser-known subjects such as Maltese washerwomen, Jamaican freedmen, African American soldiers, and enslaved youths. Downs begins with a focus on the eighteenth-century British world. Moving across the empire, Downs highlights how major shifts in the study of disease were enabled by the surveillance of unwitting patients and participants. Physician Thomas Trotter's reports of the necessity of fresh air relied on observations drawn from the transported enslaved. Naval surgeon James McWilliam's conclusions about the cause of a yellow fever epidemic in Cape Verde relied on testimonies provided by local colonized and enslaved subjects. Florence Nightingale's campaigns for military and public sanitation pulled from statistics collected by a far-flung colonial bureaucracy. Many of these studies, Downs argues, circulated and informed analogous work in North America. In chapters 6 and 7, Downs moves to the United States. Here, he is on his firmest ground in his account of Civil War medicine, detailing how the bodies and lymph of the enslaved, particularly children, were used by American doctors for smallpox inoculations. A final chapter on the cholera epidemic of 1865-66 brings the two medical worlds together. Downs sees the epidemic as a transnational crisis that prompted physicians to "think more globally" (173). As burgeoning military and medical bureaucracies created "narrative maps" (167) of cholera's global spread, institutions like the US Surgeon General's Office and the International Sanitary Commission could further shape the public health management of vast populations. This is a text rich in detail, though the novelty and nature of Downs's conclusions fall short of the scope promised by its title and introduction. Downs identifies this as a global history, yet it might more appropriately be framed as a study of the Anglo world. This comparative scaffold prompts interesting questions about the confluence and divergence of British and American epidemiology. At times, however, it produces unanswered questions. Downs is closely attuned to the contents of American and British studies, but illuminates less about how their diff...