Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine by Jim Downs (review)

The science of epidemiology has been front of mind for many during the COVID-19 global pandemic. Yet before the publication of Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, the fascinating new book from historian Jim Downs, few recognized just how much the study of infectious disease has itself been attendant with the intertwined histories of slavery, colonialism, and war. Downs conclusively demonstrates how “ideas developed between 1756 and 1866 became codified into medical theories that contributed to the development of modern epidemiology” (4). The result is a sweeping global history that reveals the complicated foundations of modern medicine itself. Through a creative reading of sources, Downs expands the cast of characters deserving inclusion in the history of epidemiology. He explores Thomas Trotter’s 1786 account of scurvy victims aboard British slave ships to trace how medical ideas circulated “outside of the metropole” (26). Similarly, Downs appeals to volumes by Arthur Holroyd in 1839 and Gavin Milroy in 1846 reveal how arguments against quarantine practices drew on evidence from laundresses on the island of Malta and colonial subjects in the West Indies. In 1845, an outbreak of fever in the Cape Verde Islands eventually led Doctor James Ormiston McWilliams to interview over one hundred people of color, in the process creating “the most extensive surviving record from the nineteenth century of people of African descent describing in detail the onslaught of an epidemic in the Atlantic world” (53). As a result, McWilliams’s emphasis on interviews, Downs contends, became a “core epidemiological method” (62). The global span of the British Empire served to diffuse knowledge among physicians. For example, British naval surgeon James Henry investigated a cholera outbreak aboard ships in the Mediterranean Sea, enabled by a military and colonial bureaucracy. In Jamaica, Gavin Milroy reported in detail on an-