Jim Downs - Maladies of empire : how colonialism, slavery, and war transformed medicine

T HE SHIP HAD sailed for over a day from the west coast of Africa. All he could hear was the sound of men speaking foreign languages; the water crashing on the hull; the pitiful cries coming from below decks; the wind powering the sails to the Americas. All he could see was the sky.

He had gotten into an argument with a chief, who, in an act of revenge, had accused him of witchcraft and then sold him and his family from Ghana into slavery, to be taken to the New World. He refused to accept his fate. And so, when the members of the ships crew came along to feed the enslaved Africans with a sticky paste made of beans, rice, oil, and pepper, he did not lift his head to the ladle hovering above him and open his mouth. A crew member noted that he refused all sustenance. Somehow, he managed to get a knife. And then, in an ultimate act of resistance, he slit his own throat, choosing to die rather than be enslaved in the Americas.

Members of the crew noticed his bloody body and notified the surgeon on board, Thomas Trotter, who sewed up the wound and applied a bandage to his neck. That night, the man ripped off the bandage. He yanked at the stitches, trying to wrench them from their hold on his skin. He pulled out all the stitches. Then he dug his fingernails into the other side of his neck, where he tore a ragged hole in the skin. His fingernails turned red, and he bled profusely.

The next morning the crew discovered him, still alive. They dragged him up to the deck. Still able to speak, he declared that he never would go with white men. He then became incoherent and looked wishfully at the skies. The crew restrained his hands again and tried to force food down his throat, but after eight to ten days of refusing to eat, he died. His name is not known. Other details about his life have not survived. We do not know if his family members, who were also aboard the ship, witnessed his act of self-mutilation.

Decades later, in 1839, Robert Dundas Thomson, a physician in London, recounted the story of the anonymous man dying on the slave ship in the Lancet, a leading British medical journal. Thomson had not observed this man himself; he was relating a story that had been told by Trotter during his testimony before Parliament on the slave trade, in the 1790s. Thomson used this account as one among several examples to determine how long a human being can survive without food. It wasnt the brutality that mattered to him, though he did recognize it. It wasnt the violence of the slave trade, though he did detail it. It was that the enslaved African man had survived for over a week without eatingthat was what mattered to Thomson.

In addition to the story of the enslaved man, Thomson reported other case studies to illustrate that insufficient nourishment caused disease and to document how long the human body could survive without food, a condition he called inedia. Thomson included two other accounts from the slave trade: he wrote of an enslaved African man who held his teeth shut when the crew tried to pry open his mouth with a metal instrument to feed him, dying after nine days without food, as well as of a captured African woman who was flogged for refusing to eat and died after about a week. He concluded that inhabitants of Africa can only live without food for ten days when confined in a crowded, unventilated environment. Case studies that he gathered from Europe showed that life could be preserved longer under better circumstances; these examples ranged from a London plasterer to a group of miners and a pregnant French woman to a mentally disabled Scottish man (Thomsons own patient) who lived for seventy-one days on water and small beer alone.

While it is widely known that physicians drew on patient case studies, it has been less often recognized that the slave trade also provided them with examples. Thomson was able to use examples that developed from the international slave trade to form conclusions about how long humans could live without food under different conditions. The slave trade placed large groups of people in crowded conditions that led to medical disorders and provided doctors with valuable information. It created the extreme circumstances in which people refused to eat, contributing to Thomsons ideas about inedia.

Thomsons article was published at a time when medical knowledge was undergoing a major revolution. As Maladies of Empire shows, military hospitals and camps, slave ships, and large-scale population movements created crowded conditions that helped physicians visualize the spread of disease and provided different kinds of information from what they learned from observations of cities, prisons, and hospitals.

Understanding the spread of disease took on special urgency as doctors responded to medical crises that erupted from the international slave trade, colonial expansion, and warfare. In treating the populations that were created by these conditions, military and colonial doctors developed theories about the cause, spread, and prevention of disease. The process of centralizing and analyzing medical information about the health of large populations unfolded during the same period that governments in the West were developing mechanisms to wield authority over populations based on new understandings of biology.

Maladies of Empire reveals how slavery, colonialism, and war, often treated separately in scholarly studies, had common features from the vantage point of medical professionals. These episodes produced large captive populations. Slave ships, plantations, and battlefields created social arrangements and built environments that allowed physicians to observe how disease spread and prompted them to investigate the social conditions that led to the outbreak of disease. The increased appearance of these settings around the world between 1756 and 1866 gave way to a proliferation of medical studies that contributed to the emergence of epidemiology. This book begins in 1756 with the story of British soldiers dying in an overcrowded jail cell in India, which served as a touchstone example throughout the medical profession of the need for fresh air. It concludes with efforts made by various countries around the world to track the spread of the 18651866 cholera pandemic.