Maladies of Empire

For those of us looking warily toward future epidemics, this book draws our attention to oft-forgotten sources of medical knowledge…Deserves to be read, particularly now. Few will question the salvational power that epidemiology will likely have in the years to come. -- Suman Seth * Science *
Downs has now given global context to nineteenth-century advances in medicine and public health, beyond the dominant histories rooted in Western Europe and the ancient world. In Maladies of Empire, he centers slave ships, people living in colonized countries, prisoners, and wars in the narrative of medical discovery, at the foundation of epidemiology…He recovers lost and untold stories and makes visible things that need to be seen. -- Mary T. Bassett * Nature *
[A] searching reappraisal of the origins of epidemiology…Those who lead epidemiology and public health today should read Maladies of Empire. They might wish to reflect on the origins of their discipline, the histories they choose to ignore, the myths they prefer to propagate. And they might wish to consider the debt they—we—owe to those who were, and in some cases still are, abused, mistreated, and manipulated in the name of public health. -- Richard Horton * The Lancet *
Maladies of Empire has a captivating writing style, is exhaustively researched, and is persuasive in argumentation. Jim Downs has written a game-changing book. -- Deirdre Cooper Owens, author of Medical Bondage: Race, Gender, and the Origins of American Gynecology
Maladies of Empire provides an illuminating, painstaking, yet engaging interrogation of original records and sources, filling critical gaps in the development of epidemiology. Indispensable and compelling. -- Harriet A. Washington, author of the National Book Critics Circle Award–winning Medical Apartheid
Exposes how doctors with few clues made concerted efforts to track and understand deadly epidemics at a time when the colonialist enterprise was aggressively remaking the world…[Downs] fleshes out a crucial part of a larger tapestry to help explain the onset of racial segregation in the United States. The people whose experiences he tries to recover ‘appear only as fragments’ in the historical record but they impart a crucial dimension that remains utterly germane to the present. -- John Galbraith Simmons * Los Angeles Review of Books *
Connects imperialism, enslavement, and warfare to argue that it is at the intersection of these processes that we can trace the beginnings of modern epidemiological thinking…Not only does such a narrative shed light on the violent foundations of disease control interventions and public health initiatives, but it also implores us to address their inequities in the present. At a time when low-income and middle-income countries struggle for access to vaccines in the COVID-19 pandemic, such an endeavor could not be more urgent. -- Raghav Kishore * The Lancet *
A more compelling read than any textbook, Maladies of Empire illuminates the main characters of the complex and ethically fraught story of public health’s origins. -- Kenneth W. Lin * Family Medicine *
Applying the study of history to medicine can often be uncomfortable, so I had some trepidation as I picked up Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine by Jim Downs. The title certainly grabbed my attention; did these events really transform medicine? After reading this provocative book, it is hard to argue otherwise. -- Michael L. Farrell * Journal of Medical Regulation *
If you are an aficionado of medical history, and of writers who try to set the record straight, this is a book for you. -- Patrick Skerrett * Stat *
Maladies of Empire demonstrates the benefits of scholarship that crosses national and imperial historiographies, as well as the value of recovering aspects of lives only glimpsed in the archives. Downs’s engaging prose and clear argumentation make this book accessible to an undergraduate audience, as well as informative to senior scholars. -- Sean Morey Smith * Journal of the Civil War Era *
Jim Downs has written an ambitious book…[It] is a significant achievement for the sheer number of cases of colonial medical experimentation and epidemiological studies that it brings to our attention and for shifting the focus of the social history of epidemiology to the colonies. It will become a vital text in historical and contemporary discussions on race, medicine, and decolonization. -- Pratik Chakrabarti * American Historical Review *
An engaging narrative that provides valuable insights into the emergence of modern medicine and science…By elucidating the origins of epidemiology, Maladies of Empire allows public health officials to question whether their methods have any lingering traces of unequal power and control while affording scholars the opportunity to consider the ways in which health and medicine intersected with slavery, empire, and war in the past. -- John Rankin * Journal of World History *
A must-read book for historians interested in the intersection of the history of medicine, slavery, and other forms of unfreedom. Downs’s talent for storytelling also makes this book compelling reading for students and lay readers alike. -- Christopher D. E. Willoughby * Black Perspectives *
Slavery pervades Downs’s book. This theme is presented in an accessible and emotional tone, often transporting the reader to the underbelly of a slave ship or to the shadow of the hickory tree amidst a cotton plantation, to better situate the reader in the realities of forgotten human experiences that informed their contributions to epidemiology. -- Shibani Das * Imperial & Global Forum *
A page-turner…Downs’ peer-reviewed book is an asset to novices as well as public health experts. -- Nontsikelelo O. Mapukata * The Journal for Transdisciplinary Research in Southern Africa *
True world history, ranging from India and the Crimea to Jamaica. Turning the history of epidemiology on its head, inspired by Black feminist theory and criticism, Downs argues…‘how slavery is imprinted on the DNA of epidemiology.’ * New West Indian Guide *
A compelling read for everyone interested in the connection between slavery, colonialism, and war and the advancement of medical knowledge. -- Okori Uneke * International Social Science Review *
Maladies of Empire is the best kind of transnational history—one that moves seamlessly across space and time, while drawing intricate connections about medical knowledge production in the critical field of epidemiology. Written in accessible prose, this timely book challenges readers to look closely at those hidden figures whose lives contributed to the development of modern medicine. -- Thomas J. Balcerski * Civil War History *
Demonstrates the benefits of scholarship that crosses national and imperial historiographies, as well as the value of recovering aspects of lives only glimpsed in the archives. Downs’s engaging prose and clear argumentation make this book accessible to an undergraduate audience, as well as informative to senior scholars. -- Sean Morey Smith * Journal of the Civil War Era *
Downs’ analysis is innovative and his argument is convincing, buttressed by the wealth of physicians’ reports, correspondence, and medical journals…The book is a fantastic resource for students of medicine and history at any level, as the writing is clear and accessible, and for scholars interested in the global history of disease, especially in the era of COVID-19. -- Andrew Kishuni * Journal of Colonialism and Colonial History *
Maladies of Empire puts the public health of the U.S. early republic, antebellum, and Civil War eras into global context with that of the British Empire in a transoceanic discourse about bio-power, race, and medical authority. -- Zachary Dorner * Journal of the Early Republic *
Relevant reading for historians in a wide variety of fields but especially healthcare historians. By recognizing the experience of the enslaved poor and military in the evolution of medicine, it gives in part a voice to those who usually appear as a statistic while the clinicians are lauded. -- Michael Davidson * British Society for the History of Medicine *
Using historiographical techniques developed by Black feminist scholars, Downs’ well-crafted narrative shifts the focus from the actions of individual physicians to the scaffolding that their research was built upon. It carries us from the crowded conditions on slave ships and prisons to filthy battlefields to plantations, reminding us that the data physicians used to develop theories of disease transmission, develop medical procedures, and recommend public health measures was built on a scaffolding of unacknowledged bodies belonging to soldiers, colonial subjects, and enslaved persons. -- Elisabeth Brander * The Watermark *
Downs makes a strong argument that epidemiology (and much else in modern medicine) stemmed from close observation of non-European populations under conditions of European oppression: in slave ships, on colonial plantations, and in armies. -- Crawford Kilian * The Tyee *
An impactful and innovative effort by the author to apply techniques used in critical race and ethnicity, colonial history, and black feminist critical theory to re-center historical medical narratives…will hopefully stir new conversations in the methodology and theory of medical history and narrative-forming. -- Ellen A. Ahlness * World History Connected *
Downs has succeeded in adding an important new work to medical historiography by linking colonialism, slavery, and war, topics usually examined separately, and demonstrating persuasively that in the development of epidemiology, they are not separate at all, but inextricable. -- Jennifer Paxton * Southwestern Historical Quarterly *
Maladies of Empire leaves the reader with a greater appreciation for the people left out of traditional medical histories, some unforgettable stories, and many thought-provoking questions. -- Bradford J. Wood * North Carolina Historical Review *
Downs has written an eye-popping study of the history of infectious diseases, how they spread, and especially how they have been thwarted by experimentation on the bodies of soldiers, slaves, and colonial subjects. For three centuries medicine transformed science and human longevity by knowledge garnered from battlefields, slave ships, and mass migrations of vulnerable people. This is a timely, brilliant book about some of the brutal ironies in the story of medical progress. Our health today owes so much to the blood and suffering of nameless predecessors. -- David W. Blight, author of the Pulitzer Prize–winning Frederick Douglass: Prophet of Freedom
In this brilliant and timely book, Jim Downs uncovers the origins of epidemiology in slavery, colonialism, and war. Controlling large populations through violence and burgeoning state bureaucracies allowed for new insights into the genesis and spread of human disease. A most original global history, this book is required reading for historians, medical researchers, and really anyone interested in the origins of modern medicine. -- Sven Beckert, author of the Bancroft Prize–winning Empire of Cotton: A Global History
Maladies of Empire is a major contribution to the ongoing investigation of the impact of slavery and colonialism on the modern world. Jim Downs shows how studies of exploited groups helped scientists understand the spread and treatment of infectious disease. At a time when epidemiologists are rightly lauded for their work in controlling the COVID-19 pandemic, Downs calls on us not to forget the role, without their consent, of the long forgotten enslaved, colonized, and imprisoned in the development and global dissemination of medical knowledge. -- Eric Foner, author of The Second Founding: How the Civil War and Reconstruction Remade the Constitution
Maladies of Empire shifts the site of medical knowledge from European cities to the international slave trade, colonial lands and wars, and the resulting movement of populations. This vivid and brilliant analysis of these critical sites fundamentally changes our views of the origins of epidemiology and the transnational flow of medical knowledge about disease transmission. This excellent work will surely become required reading for historians of medicine, disease, and empire. -- Evelynn M. Hammonds, coeditor of The Nature of Difference
In this meticulously researched and beautifully written work, Jim Downs transforms our understanding of the relationship between the history of medicine, colonialism, and the institution of slavery. Maladies of Empire illuminates the crucial connections between eighteenth- and nineteenth-century comprehension of disease and the evidence gathered from captive Africans, enslaved plantation workers, and soldiers throughout the Atlantic world. Charting the origins of modern epidemiology in the inequities of forced labor, Downs makes foundational contributions to the histories of medicine, colonialism, and slavery. Everyone interested in the connections between race and disease should read Maladies of Empire. -- Jennifer L. Morgan, author of Reckoning with Slavery
A powerful account of the intertwined histories of medicine and empire, within a truly global framework. Simultaneously intimate and sweeping, Maladies of Empire reveals the human side of the development of epidemiology. Inverting the traditional focus on medical men, Downs puts soldiers, prisoners, and enslaved people at the heart of the rise of scientific medicine, providing a compelling account of how our modern-day tools of epidemiology were shaped by war, slavery, and colonialism. -- Erica Charters, author of Disease, War, and the Imperial State