Medicine in an Age of Commerce and Empire: Britain and Its Tropical Colonies 1660-1830 (review)

Historians of the British Empire have already problematized the definitions of "center" and "periphery," showing them to be complex and permeable and the transmission or translation of ideas to be nonlinear. In Medicine in an Age of Commerce and Empire: Britain and Its Tropical Colonies 1660-1830, Mark Harrison offers an exhaustively researched set of examples from the history of medicine illustrating the ways in which the colonies acted as a location of great innovation in the classification, prevention, and treatment of diseases. By subverting the common narratives of medical innovation as originating from and directed by the home country and of early (pre-1820) colonial medical men as mere data-gatherers, Harrison provides us with a more nuanced look at the medical activity that took place in Britain's colonies, the community forged by colonial practitioners, and the nature of their interdependence with (and at times independence from) the medical schools and societies at home. Arguing that knowledge produced in the colonies "had a formative influence on the development of what came to be known as 'Western' medicine," Harrison seeks to show that nineteenth-century "modern" medicine "was as much a product of the colonies as of the infirmaries of revolutionary Paris; or, for that matter, of the hospitals and anatomy schools of Britain" (9).

The book is organized thematically and divided into three parts, each with an introduction, four chapters, and a conclusion. Part I concerns the natural-historical investigation of disease in the colonies from the seventeenth to the nineteenth century and the framework of environmental determinism it was built upon. The Hippocratic treatise Airs, Waters, Places in particular provided the basis for both the connection between climate and disease as well as the opportunity to show a continuum between ancient and modern empiricism in medicine (60). Here Harrison also begins his discussion of the unique medical men drawn to the colonies, many of whom were religious dissenters attracted by the potential for rapid professional advancement, learning broad skills in physiology and surgery (particularly opportunities for cadaver dissection due to high mortality), and lucrative opportunities of a less competitive, less structured environment.

In Part II, Harrison focuses on tropical therapeutics in order to show that from the middle of the eighteenth century, there was a divergence between treatment practices in the colonies and in England. He convincingly argues that the hospitals and sick rooms of the army, navy, and East India Company, as well as the private colonial practices in the West Indies, were important sources of therapeutic innovation. Access to new medicinals and, more importantly, the liberty afforded to colonial practitioners in forging their own intellectual and professional paths allowed for unique freedom to conduct systematic observation and clinical trials. This was part of a general paradigm shift that occurred in the eighteenth century. New etiological theories of disease causation were followed by a decrease in the popularity of bloodletting (and the humoral theory that bolstered it) in the colonies and an increase in the use of substances to counteract putrefaction, such as cinchona bark, local drugs like the Indian Tanjore pill, various antimonial medicines, mercury treatments, and nitric acid.

In Part III, Harrison brings the intellectual and professional climate of eighteenth and early nineteenth-century British medicine to the fore. He elegantly weaves strands from the first two sections on the colonial practitioners, their political and religious backgrounds, and their relationship to professional authorities at home together with the developing roles of race, class, and gender (and their attendant anxieties for the future of the British and their Empire) and the ways in which they intersected with medical theories and practices (with race playing the most significant role in his argument). While careful not to classify colonial practitioners as a consistent entity, Harrison argues that many of these men shared common approaches to the classification and treatment of diseases that were...