European medicine was a powerful and controversial tool for colonization and control. Resistance to colonialism in the Danish West Indies [End Page 309] between 1803 and 1848 resulted in a clash of medical cultures that exposed the fundamental structures and processes of health-care policies. In his evaluation of colonial medical policy, Niklas Thode Jensen argues that health care created extreme tensions between sugar planters, the colonial administration, and the enslaved. While exploring the structure of health services in the Danish West Indies, Jensen examines slave health and the health-related government initiatives to promote the health of the enslaved. Employing quantitative and empirical data, Jensen's analysis shifts the focus away from the labor of slaves toward medical treatment and perceptions of slaves by Euro-Caribbean administrators. Jensen also investigates power relations between the Danish administration, planters, and slaves.

The Royal Danish West Indian Company colonized the islands of St. Croix in 1733 to produce lucrative trade goods such as coffee, tobacco, indigo, cotton, and sugar. African slaves dominated the workforce. Sugar production was a notoriously voracious consumer of slaves' lives, and as in the other sugar islands, the profits of "white gold" and the flood of slaves available through the expanding Atlantic slave trade made working the Africans to death common practice. Jensen first evaluates the structure of health services provided for slaves on St. Croix and the diseases the slaves suffered from and their causal factors. Jensen argues that between 1803 and 1848, two decisive events occurred: first, the Danish crown banned the importation of slaves. The prohibition of the international slave trade provided a strong incentive for planters and administrators on St. Croix to preserve the longevity of their slaves. Second, the outbreak of the Napoleonic Wars resulted in the British occupation of the Danish West Indies in 1807 and lasted through the end of the war in 1815, which led to steady economic decline on the island. Met with high death rates and low birth rates among the enslaved population of St. Croix, the plantation system in the Danish West Indies declined steadily until the abolition of slavery in the Danish colonies in 1848.

Using annual medical reports produced by physicians on the island, Jensen indicates that the most common causes of slave morbidity were various fevers. Slaves also suffered from joint pains, sores, and fractures as a result of their labors. Bacterial infections, intestinal worms, and respiratory diseases such as pneumonia, influenza, tuberculosis, and diphtheria led to hospitalization and death of slaves of all ages. Owing to high mortality rates, the Danish West Indian colonial administration was forced to address the inconsistent regulation of slave health. By implementing laws allowing slaves to own houses, clothes, food, and regulating the quality of living conditions in slave quarters, the administration created standards of treatment and health conditions of slaves, which would have a positive impact on the economy and ensure a healthier slave society. These health [End Page 310] policies also demonstrate the power relations between the government and the planters as the administration became more involved in the regulation of slave treatment, taking power authority from the planters in an attempt to secure a healthy labor force.

Jensen's analysis also juxtaposes the Danish with contemporary British and French West Indian colonies to provide insight into the colonial systems and the health of slaves. Within three case studies of the health policy of the Danish colonial administration, Jensen evaluates the nutrition of the enslaved population on the Danish, British, and French West Indian islands. Jensen emphasizes both the production and nutritional value of food consumed by slaves on St. Croix, finding that the amount of food provided depended on the amount of work performed. Because therewas no regulation on the minimum amount of food given to each slave, the typical slave diet consisted of yams and corn meal. In 1817, the Danish administration heard complaints from the slaves on St. Croix about undersized rations, at which time Governor General Bentzon issued a public proclamation condemning planters who instead of handing out provisions gave their workers a day off to work their own provision grounds. As a result, between 1817 and 1848, the minimum ration for an adult slave on St. Croix increased to six quarts of corn meal, or twenty-four pounds of yams or other root crops, plus six salted herrings or other fish. Younger and smaller slaves received proportionally smaller rations. This proclamation created a precedent for the colonial administration to intervene against the planters in the health care of the enslaved. Jensen also provides a quantitative analysis of the caloric intake and nutritional value of this diet and how it compared with the calories burned by the average slave on a sugar plantation. In the final analysis of the Danish, French, and British West Indian colonies, Jensen concluded that despite government intervention, slaves continued to receive inadequate nutrition, which led to malnutrition, weakened immune systems, high mortality, and low fertility rates. Administrative control of workloads was weaker on St. Croix than in French and British colonies. However, in food supply, vaccinations, and regulation of physicians and midwives, the Danish West Indian administration initiated health policies with relatively greater effectiveness than the French and British administrations. These health-care efforts, however, often clashed with the authority of the planters. The enslaved, themselves, also participated in the struggle for power over their own health.

Jensen's work provides a detailed analysis of the health-care system in the Danish West Indies and the ways in which government regulation was met with resistance prior to the end of the plantation system in 1848. More importantly, the framework and methodology that he employs provide a valuable model for interpreting the relationship between health care, government, planters, and slaves in plantation societies. The [End Page 311] organization of the book is its greatest flaw, often choppy and repetitive, at times making this a tedious read. However, in the final analysis, For the Health of the Enslaved is convincing, well researched, and a must-have for anyone interested slavery, health care, or colonial power structures.