Epidemics and History: Disease, Power, and Imperialism (review)

Sheldon Watts is angry, and he is not shy about revealing it in this book on disease, power, and imperialism. He is angry that ruling elites are empowered, and that one source of their power has been both the presence of epidemic diseases and the force of Western medicine. In large part this book is a set of case studies on the abuse of medical power—particularly the ways in which disease constructs enabled those ruling elites to justify racism, imperialism, and the delegation of the “other” to the fringes of society. Watts considers the history of several epidemic diseases under this rubric, analyzing, in turn, bubonic plague, leprosy, smallpox, syphilis, cholera, and malaria/yellow fever. While with leprosy and plague his focus is on the marginalization of populations within Europe, for the latter four categories he concentrates on the global spread of European hegemony over the world’s developing nations, an area he designates by the currently popular term, the “South.”

Critical of development with a capital D, Watts repeatedly shows that the arrival of Europeans either brought new diseases to indigenous peoples (smallpox and the New World) or amplified low endemic disease rates into major epidemics (cholera, yellow fever, malaria). While the smallpox story will be familiar to most historians, his claims about the latter diseases are more novel. He argues that in Africa, for example, yellow fever and malaria became important diseases after the disruptions brought by whites, and not before; both diseases thrive on conditions of massive population movement, one of the consequences of the slave trade and colonialism. In like manner, cholera became severe in India because of the destabilizing effects of British rule. Even while grudgingly admitting that Western medicine has had a positive effect on the “South” in that smallpox eradication in the 1970s removed a major source of childhood mortality, he quickly points out that other infectious diseases such as malaria and dysentery have moved into smallpox’s niche.

Scholars will find much of interest and provocation in this book, written not by a medical historian but by a historian of Europe who has immersed himself in the medical history literature. The material on leprosy in Egypt ca. 1900 particularly stands out as original and fascinating. On the other hand, historians of medicine will note oddities as well. Watts divides all of medical history at the focal point of Robert Koch, seeing medicine before then as consisting of false knowledge and medicine after then as being modern and scientific. His view of humoral medicine in the eighteenth and nineteenth centuries lacks nuance, and his claim that physicians knew they could not cure their patients before Koch’s work is simply wrong. Further, he is so sure that any ideas about race and medicine must derive from imperialism/racism that he discounts entirely the well-established medical research on malaria immunities and geographic groups.

It is hard to pin down exactly what Watts is arguing for. He is clearly in favor of respecting indigenous medical systems, yet he also acknowledges that modern Western medicine has the power to eradicate certain diseases. In his afterword on the epidemiologic transition from diseases of poverty to diseases of affluence (and with it the prolongation of life expectancies), he points out that people in the developed world consume far more than their share of the world’s resources. From this one might assume that he is opposed to the transition taking place, and prefers that peoples continue to die at early ages from disease. Yet he also lauds the successes of Chinese and Cuban medicine in improving health without the excesses of consumerism, so this may be his model for how the world should be constructed.

This is a useful book, if only for the richness of its footnotes that often completely survey the literature on each disease Watts considers. It will make for a nice contrast with Jared Diamond’s Guns, Germs and Steel: The Fates of Human Societies (1997) in...