Book Review
Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. Cambridge, MA (Belknap Press of Harvard University Press.) 2021. Pp 272. Cloth. $29.95. ISBN 9780674971721
Jim Downs’s monograph, Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, is an innovative attempt to apply techniques used in colonial history to medical narratives. The creative researcher focuses on pulling threads out of the historical record representing the voiceless in colonial history. Downs’s social history starts during British colonialism by tracing the enslaved with their contribution to early epidemiologists. Downs argues that the beginnings of epidemiology occurred well before the urban sanitation treatment of cholera in Europe. Downs’s monograph has a broad timespan, from case studies in the late 1700s on slave ships to the cholera pandemic of 1865. Downs states that the origin story of epidemiology has been overlooked because the people observed were overlooked.[1] Downs’s work is ambitious in scope with a social reckoning of giving voice to the masses who helped early scientists. Jim Downs claims to follow a black feminist methodology.[2] Rarely does he succeed. Downs is more focused on the physician sources and one nurse to show the true founders of epidemiology, and the people he wants to speak for are still hidden.
Maladies of Empire has eight chapters in chronological order to build on his true forerunners to epidemiology. The first four chapters are related to case studies during British colonialism. Downs’s work revisits the false beliefs of miasma and the conflict of contagion versus anticontagion. As the reader, it is best to know the background of medical historians as his secondary sources list Foucault, Rosenberg, and Letour. His argument about the true beginnings of epidemiology is an adjunct and a challenge to Charles Rosenberg’s work, The Cholera Years.[3]His first chapter, “Crowded Places,” and his second chapter, “Missing Persons,” review multiple scientists that predate urban sanitary reform history. For example, he examines how Stephen Hales invented ventilators in 1755 to protect the financial investment, enslaved people on slave ships from dying from miasma.[4] Downs jumps from one white male observer to another, doctors researching miasma, cholera, and yellow fever. In “Epidemiology’s Voice, Tracing Fever in Cape Verde,” Downs focused on the investigator, James McWilliam, of a devasting yellow fever outbreak on Boa Vista and the British ship, Éclair.[5] In this chapter, Downs’s argument for the true beginning of epidemiology is more robust. McWilliam interviewed over a hundred colonized people to better understand the transmission of an epidemic.[6] The concluding chapter of this section, titled “Recordkeepings,” is Downs’s review of the contribution of British imperialism on epidemiology. Downs picks one leading observer, Gavin Milroy, on the cholera outbreak in Jamaica. Like any disrupter of orthodoxy, Downs notes that Milroy drew attention to the water supply before John Snow ever traced cholera from one well in London. [7]These four chapters did not voice the people observed in jails, hospitals, or slave ships. Downs explains that the incomplete, fragmented portrait of their lives is due to the doctors’ overwhelming recommendations, which Downs has failed to suppress. Downs’s work on the sources shifts to war as the transformative force in epidemiology.
In the following three chapters, Downs’s methodological technique is on firmer ground with the Crimean War and the Civil War. Interestingly, Downs neglects the contribution of all other military conflicts. Chapter five, Florence Nightingale, the Unrecognized Epidemiologist of the Crimean War and India, Downs’s purpose is to correct the historical record. Unfortunately, this chapter reads like a “Great woman history” with complete neglect of the voices of the Indian oppressed people used as statistics for Nightingale’s work.
Chapters six and seven are based on his previous work on African American health in the Civil War. Chapter six, “From Benevolence to Bigotry,” is on forming the United States Sanitary Commission. Union physicians advanced racism for the USSC that became medically codified for physicians in the United States. “During a war fought to liberate Black people from bondage in the name of equality, the USSC created reams of data purporting to show that Black people were innately inferior.”[8]
In chapter seven, “Sing, Unburied, Sing,” Jim Downs finds his black feminist method. Downs reviews the massive vaccination efforts in the South by taking variolation material from living enslaved infants who had less risk of transmitting skin infections to the Confederates who needed protection from smallpox. “The history of harvesting human lymph on enslaved children’s bodies was almost lost in the annals of history.” [9]Later in this chapter, Jim Downs discusses deadly variolation from infected adults onto prisoners of war at the infamous Andersonville prison. Downs’s evenhanded approach to the medical testimony about the death of prisoners from vaccination seems to imply agreement with their testimony. I am afraid I must disagree here with Down’s approach. By 1864, Confederate doctors would have known how festering wounds acted and were infectious. Specifically, injecting prisoners from other people with staph-infected pox wounds can be deadly in the immunocompromised, and I suspect those Confederate physicians were rightfully convicted.
In his final chapter,” Narrative Maps,” Downs jumps in time to discuss the cholera pandemic of 1865 to 1866. This chapter is an abrupt transition from war to the study of cholera transmission by physician observers. “The military and medical narratives about the 1865-1866 pandemic…advanced the development of epidemiology.”[10] Downs wants these physicians who wrote narrative observations to be remembered. Alas, the voices of the oppressed and the Muslim pilgrims blamed for the pandemic are lost.
Downs’s argument that imperialism of the British Empire and Civil War contributed to the origins of epidemiology is an innovative work that hopefully will revive new research methodology in medical history. Downs illuminates Florence Nightingale, Elisha Harris, and many other doctors as important to epidemiology as John Snow. Overall, Downs’s work is too broad in chronology, neglecting other European colonies or revolutionary wars. Downs loses his black feminist methodology repetitively in his quest to correct the historical originators of epidemic medicine. Downs best conveyed enslaved peoples’ voices to epidemiology from the American Civil War. From Downs’s eye-opening work, the next time I mark race on a medical history form, I will remember how the United States Sanitary Commission focused on race instead of contagion. Jim Downs’s social history illuminates the true beginning of government-sanctioned medical racism that has impacted each generation well past the Civil War.
[1] Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. (Cambridge, MA. Belknap Press of Harvard University Press. 2021.) 5.
[2] Downs. Maladies of Empire. 7.
[3] Charles Rosenberg. The Cholera Years: The Unites States in 1832, 1849, and 1866. (Chicago: University of Chicago Press, 1962).
[4] Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. (Cambridge, MA. Belknap Press of Harvard University Press. 2021.) 30.
[5] Downs. Maladies of Empire. 53.
[6] Downs. Maladies of Empire. 66.
[7] John Snow. On the Mode of Communication of Cholera. 1855. Digitized. Mode of Communication of Cholera (John Snow, 1855) (ucla.edu).
[8] Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. (Cambridge, MA. Belknap Press of Harvard University Press. 2021.) 135.
[9] Downs. Maladies of Empire. 152.
[10] Jim Downs. Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine. (Cambridge, MA. Belknap Press of Harvard University Press. 2021.) 194.
PROJECT REFLECTION
- Reflection/retrospection: What does this all mean? Why is this site important? What are the lasting effects of the events?
The Battle of Monterrey was the first battle won on foreign soil using almost as many volunteers as the regular army. These volunteers were not trained, disciplined, or ready for the rigors of occupation and battle. But the Mississippi regiment under Jefferson Davis was an exception. This site was the first successful urban warfare, going house to house, fortification to fortification to demoralize the Mexican Army. Focusing on Jefferson Davis, who is a controversial figure and later traitor does not change how he rigorously and harshly trained his regiment to the point where the constant letters in the media recommended his removal. But the regiment became effective and as successful if not more so than the regular infantry in this specific battle. I picked this segment of the battle of Monterrey as it challenged the history of the volunteer regiments as being ineffective and just randomly trained in the Mexican American War. There were no further criticisms of Jefferson Davis and his Westpoint training of his volunteers after this battle. The win of this battle fueled Zachary Taylor and Jefferson Davis’s popularity. Songs were written, and poems and beautiful lithographs were done of the town at the foothills of the Sierra Madre. Culturally, the win at Monterrey fueled a further pro-war sentiment in the early days of the war. Zachary Taylor and Jefferson Davis both wrote that they thought the war was now over. I focused on the Mississippi Rifles on the success of taking La Teneria by Jefferson Davis, but this should be countered with the lack of Taylor’s directives on the first day of battle that caused significant loss of life to his regular infantry as well as the Mississippi companies. General Taylor did not take his heavy artillery pieces, and he had minimal light artillery to bombard the fortifications as he had in the previous battles to this one. Nevertheless, the persistent fighting, the less effective Mexican cavalry instead of infantry, and the pressure to prevent civilian deaths caused General Ampudia to surrender the town. Unfortunately, Jefferson Davis and Zachary Taylor were wrong, and this battle was not the end of the invasion of Mexico. The Mexican army leaves and regroups under Santa Ana. They march to Saltillo but are turned away by the populace not to become another Monterrey. They must march to San Luis Potosi before being welcomed by the civilian population. The lasting effects lead to a two-year occupation of Monterrey. The volunteer regiments, especially the Texas Rangers, commit significant atrocities against the civilian population. While there are reports of the regular army also committing atrocities, it was not at the same level as the volunteer regiments. The Mississippi rifles while there may have been some of them who did also commit atrocities, there are no reports of this. When the next battle does occur in Northern Mexico, the battle of Buena Vista, the Mississippi Rifles and Jefferson Davis are still with Zachary Taylor, unlike the majority of his regular army who had been stripped from him to fight in the Siege of Vera Cruz. The Mississippi Rifles are again successful in the Battle of Buena Vista and again with Jefferson Davis as their Colonel. The long-lasting effects were many from this battle and the Mexican-American war. This battle, for the first time, taught the regular army how to take a city using urban warfare, which both sides will use again in the next Civil War. The urban training will be used again at the Battle of Fredericksburg. The city of Monterrey recovers and becomes a large hub for cotton exports to Britain during the Civil War due to the blockades at the southern ports. The Mississippi Rifles are still in existence today as the 1st Battalion,155th infantry National Guard Unit based in Tupelo, Mississippi. Ironically, this was one of the units called up June 8, 2020 to Washington, DC to assist law enforcement in the Black Live Matter protests. They were there for five days before being recalled.
