Epidemics and History: Disease, Power and Imperialism

The relationship between disease and historical change has received increasingly close scholarly attention in recent years. Challenged by the paradigms presented by William H. McNeill and Alfred W. Crosby in the 1970s, and stimulated by new research findings on the nature and spread of disease by epidemiologists and the discovery of new documentary texts, as well as reevaluation of the mechanics of imperialism, past and present, a series of important new books have been produced. Some authors have examined, in the fashion of microhistory, a single epidemic episode and its impact. Others have looked at the changing nature of the impact of a specific disease, such as malaria or yellow fever, over a long chronological period. Meanwhile, several historians have taken a spatial approach, looking, for example, at the seeming ease of the conquest of the Americas or the long, unsuccessful European attempts at colonizing sub-Saharan Africa.

What sets this book apart from most others is the author’s attempt to situate each epidemic episode into two distinct cultural settings: European and non-Western. How did peoples of different cultures view and attempt to control or cure the illnesses that newly afflicted them? In successive chapters Watts analyzes the differing conceptions of plague and controls to check its spread in Western Europe and the Middle East, from 1347 to 1844; the case of leprosy and lepers in modern Europe and the tropics colonized by Europeans; and the course of smallpox in the Americas from its supposed introduction in 1518 to eradication in the 1970s. In chapter 4 he looks at the varied experience of the impact of syphilis in Western Europe and East Asia from 1492 to 1965; then examines cholera in Great Britain and India from 1817 to 1920; and finally considers yellow fever and malaria, and the development of Atlantic Africa and America in the period 1647–1928. As one might expect from the chapter organization, with substantial chronological overlap, the text grew from a series of discrete lectures prepared by Watts over a period of several years. Yet to the credit of the author, and to the benefit of the reader, the bibliography is largely up to date and quite useful for the specialist as well as the novice.

For the student of world history this book provides an excellent demonstration of the uses of the comparative approach. The plague of medieval Europe, for example, has been scrutinized by a host of historians. Its impact on the peoples of the continent was so immediate and dramatic that it clearly is critical to our understanding of the cultural and religious, as well as the social and economic dynamics of the period. But what of the nearby Middle East? In Western Europe plague mortality generally decreased after 1450, but in Egypt it continued high until the middle of the nineteenth century. How does one explain this sharp difference? In Watts’s explanation, the Mamluks tended to stay put as the plague appeared, as did the Christian Copts and the Jews. Religious concepts played an obvious role. The real shift in mortality began under Mohammed Ali, after 1805. By mid-century quarantine, separation of victims, the burning of infected clothing, and frequent bathing helped reduce the number of plague patients, and hence the number of deaths. But what of other nearby sections of North Africa and the Levant? This reviewer wishes that the author had devoted more than fourteen of thirty-nine pages of the chapter to the issue of plague in the Middle East. In this chapter, as in many subsequent ones, the reader is challenged to go beyond, to search for the answers to the questions posed by Watts. Fortunately, the bibliography provides a competent guide.

There are occasional errors that specialists will discover. When discussing the survival of the smallpox virus in scabs, the author states, in part incorrectly: “They survived longer in a warm dry climate (such as that of the Pacific coastal plateau of the Andes) than in a cool damp place” (p. 86, parenthetical remark in original). His suggestion that Spanish physicians were not interested in native “cures” for disease is incorrect (Nicholas Monardes is a prime example), and he further misses the comparative high quality of Spanish medical knowledge of the sixteenth century. Slave labor (p. 91) was not the primary mode of labor organization for the mines in colonial Peru. Further, there are some misleading quotations from the texts that Watts used. The passage of a compound epidemic series that hit the Arequipa district of Peru in the late 1580s and early 1590s did not leave “more than a million dead” there (p. 102). The number might be argued for the entire viceroyalty, but not Arequipa.

In spite of some imperfections, this new work on the relationship between disease and European imperialism is a valuable one, quite readable for the nonspecialist, and one that provides new insight. More important, the book should serve as a reminder that there is much new work that needs to be done on the issue, using both archival and nonarchival non-Western sources. The author’s final chapter, “To the Epidemiologic Transition?” is in a sense a call for readers to understand, then act to counter or redirect current trends in medical practice, population growth, and resource depletion that are environmentally unsustainable and therefore threaten human survival.