Epidemics, Empire, and Environments: Cholera in Madras and Quebec City, 1818–1910 by Michael Zeheter (review)

Comparative monographs are fairly rare in the history of epidemic disease. Ironically, given the global movement of disease, many modern histories remain bounded by the nation-state. The comparative perspective offered in Epidemics, Empire, and Environments is therefore welcome, for a start, for shifting our intellectual perspective on nineteenth-century cholera epidemics in Canada toward a broader awareness of empire, colonialism, and the global interconnectedness of public health responses.

Epidemic cholera emerged in India nearly fifteen years before it arrived in Quebec City in 1832 and lingered later there as well, into the twentieth century. Particularly in the Indian context, public health and medical responses were really a history of failure to contain a deadly epidemic disease that re-appeared in unpredictable fashion. Such a persistent and dreaded disease had long-term impacts on both cities, not only on the evolution of the state and disease control policies (such as quarantine) but also on urban development and the public's perceptions of their community. This book is not an environmental history of cholera per se, but it does consider how cholera empowered sanitationist arguments for human alteration of the physical landscapes of Quebec City and Madras.

Michael Zeheter argues that sanitation and bacteriology together "succeeded in banishing cholera to the margins" over the course of the nineteenth century (242). The banishment was more successful in Quebec City. The margins, in the case of Madras, mostly meant protection from the disease for the colonial enclave, while containment efforts in the Indian population were ineffectual more broadly. Colonial medicine lacked both the resources and the impulse to make it otherwise. In Quebec City, cholera became more of a threat than a reality over the course of the nineteenth century, though fear of the disease remained a potent tool for public health advocates in a struggle for resources and legitimacy. This was not necessarily a fully rational response since mortality rates from cholera "did not exceed that of other epidemic diseases" (244). But cholera was persistent, and its symptoms were, as Zeheter points out, degrading. Cholera was not a dignified death.

Banning cholera to the margins was not a smooth process. Medicine had little to offer cholera sufferers. And what it did have was often resisted, especially in Madras, where Western medicine was embedded in colonial power and social and racial inequality. Zeheter demonstrates that British attempts at medical treatment were rejected by many colonized Indians, who preferred to manage the disease in their own fashion. In both India and Canada, as elsewhere, medical agreement on causation and response was non-existent during most of the years when cholera was prevalent. Theories on these matters were controversial and were constantly revisited in endless tracts and treatises. Amid the noise, the long-term success of sanitarianism, Zeheter argues, was based partly on the states' willingness to impose a simplistic solution on a complex problem, creating the capacity for public health experts, political decision makers, and lay people to be seen to be doing something about the problem of cholera. A similar search for simplicity characterized etiological understandings of cholera, which ultimately coalesced around Koch's bacillus and pinned the blame for cholera globally on India. It is suggestive to consider how perceptions of the disease depended on whether one lived in Quebec City, where the disease was assumed to be "foreign" and brought by immigrants, or in Madras, a colonial enclave within a perceived epicentre of global catastrophe.

Medical opinion coalesced throughout the century, but it was one thing to "agree" in the metropoles of Europe and another to implement control measures in the colonies, where local administrators had to deal not only with class, race, gender, geography, and climate but also with the history of colonialism and local resistance to it. In Canada, the politics of empire had less disastrous implications–at least, for the settler population, it should be noted. In this regard...