Health: Author Q&A: How Colonialism, Slavery, and War Changed Medicine

Jim Downs, PhD, is the Gilder Lehrman-National Endowment for the Humanities Professor of Civil War Era Studies and History at Gettysburg College.

He’s also a medical historian whose work gives us perspective on how the often overlooked, hidden histories we aren’t taught can shed light on the issues facing modern society.

His books include “Sick from Freedom: African American Sickness and Suffering During the Civil War and Reconstruction,” “Stand By Me: The Forgotten History of Gay Liberation,” and “Beyond Freedom: Disrupting the History of Emancipation,” among others.

One connective thread running through all this research is the reality that the experiences of oppressed, disenfranchised populations were driven by — and in turn shaped — the culture and norms of the times, both past and present.

Especially key is that understanding and centering the narratives of Black and brown communities is critical in documenting this history.

His latest book, “Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine,” will be released on September 7, published by Belknap Press, the trade imprint at Harvard University Press.

The book aims to look past the lauded stories of Western medical innovators like Florence Nightingale and John Snow — the man credited with tracing London’s cholera outbreak of 1854 to a water pump, not to be confused with the “Game of Thrones” character.

Downs establishes that it’s actually the people unrecognized in history books — Black and brown people enslaved by Western nations, conscripted soldiers, and those displaced by the expansion of colonial empires — who have contributed to our understanding of infectious diseases.

Some of the stories he uncovered include how slave ships proved the existence of oxygen, as well as the early records of colonized and enslaved people in Cape Verde describing an epidemic, the first “contact tracers” if you will.

Another disturbing passage has echoes of the medical racism of the 20th and 21st century, describing doctors in the Civil War-era American South harvesting smallpox vaccine matter in the bodies of enslaved infants and children.

Through each story, he highlights that modern science is what it is today because of cultivating, recording, and experimenting on oppressed people without their consent.

Healthline recently spoke with Downs about his book and what its revelations about the history of epidemiology say about our current pandemic.

How did you get started on the journey of researching this book, and what was the initial kernel of an idea or the initial inspiration to delve into this history? 

Downs: It grew out of my first book called “Sick from Freedom,” which was a book that really speaks to this moment. It was about the fact that when Black people were emancipated from slavery, they faced this enormous epidemic.

Oftentimes, when we talk about emancipation, we talk about this ability for political and legal rights. What happens at the moment of emancipation is, they enter a world where they’re faced with an unprecedented amount of infectious disease.

When we think about the Civil War-era, we realize more soldiers died from disease than from battle. They didn’t understand bacteriology or epidemiology, so the story was really just this idea of ‘Wow all of these people end up dying at the moment of ‘freedom’ and then there is a cholera epidemic.’

When I found records of the smallpox epidemic, the government would say things like ‘We don’t have the resources to get doctors from Washington, D.C. down to Louisiana, or just getting reports from Louisiana back to Washington was hard, we can’t do it.’ Then, all of a sudden, a cholera pandemic blows up in India, crosses into Europe, crosses the Atlantic Ocean, makes its way into Canada, then into New York, then down into the South, and basically the government creates this really effective plan to stop this cholera pandemic.

There’s tons of reports of what to do, and I thought ‘Wait a minute, you couldn’t do smallpox but cholera you could?’

Smallpox has been around for centuries, but cholera was relatively new. So basically what happened was I sort of resolved that in my book and said that cholera affected white people — and as far as they were concerned, ‘smallpox just affected Black people,’ so they ignored it.

I was concerned with the questions: ‘How did they understand it? How did they understand enough to stop a pandemic in 1866? What was their protocol? Where did they learn this information?”

How did people understand the idea of epidemics back then?

The beginning of epidemiology as a field is often traced to a cholera epidemic in London around the same time, to a guy named John Snow.

He was an anesthesiologist, and when he heard of the cholera epidemic blowing up throughout London in a poor neighborhood in Soho, he started interviewing people, investigating it, and looking at the number of people that died. And ultimately he says ‘Look, this is connected to the water pump; you’re all drinking from the same water pump, and thereby that is why you’re getting infected.’

A lot of historians and popular scientists tend to trace the story of epidemiology to John Snow and the water pump in London.

How did you come to look beyond this more conventional approach to understanding epidemics?

I met a very wise archivist at the Wellcome Institute for the History of Medicine who suggested I go to the National Archives in London. I soon uncovered documents of dozens of doctors that predated John Snow that were actually investigating the spread of disease. And what they were doing was going into places like India and the Caribbean, mostly into Jamaica and other places, and they were watching how infectious diseases were spreading.

I have a chapter in the book on Cape Verde, where a doctor starts interviewing washerwomen and slaves and notices they’re mostly Black people. Some are described as ‘mulatto’ — these are all 19th century terms — biracial, all colonized, some of them are enslaved. He interviews them, writes up their interviews, records it, and then starts to publish the interviews.

I found 100 pages of these interviews, and I was blown away. What that meant was that our knowledge of epidemiology didn’t come from some guy in London, and it didn’t come from some laboratory; it came from talking to enslaved and colonized people.

When the infection broke out, these washerwomen who were enslaved and colonized were watching the symptoms. They knew that if you vomited, it was black vomit, and thought ‘this vomit doesn’t look right.’ This was yellow fever. They were timing the incubation; they were trying to trace the origins.

In other words, all our tools in epidemiology can be found at the local level by ordinary people. John Snow has become this sort of hero, and this story about Africa and Cape Verde gets pushed away.

What role did colonialism play in the development of epidemiology?

John Snow and this other doctor, James McWilliam, were buddies. They were part of this thing called the Epidemiological Society of London — this society that gets developed in 1850 as a result of doctors going out to other parts of the empire to study infectious disease.

When you think of epidemiology as this science that grows out of colonialism, I think that’s something that people don’t think about. They would say, ‘Oh epidemiology grew out of Snow and what happened in the city,’ or ‘Let’s look at these statistics of white soldiers versus Black soldiers in the Caribbean in the Crimean War.’

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