Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780–1840 by Rana A. Hogarth (review)

In September 1793, as yellow fever gripped Philadelphia, the physician Benjamin Rush wrote a letter to Richard Allen, a preacher and founder of the African Methodist Episcopal Church. Rush asked Allen to encourage those of African descent to offer their “services” in caring for the white population of the city, on the grounds that the disease “infects white people of all ranks, but passes by persons of your color” (p. 26). Members of the free black community did indeed stay in the city to aid the afflicted, yet it soon became abundantly clear that Rush’s belief in a racial immunity to the disease was faulty. In 1796 he would retract the claim, but as Hogarth notes in this smart, insightful, and well-constructed history, the idea that there were innate racial differences in disease susceptibility would cast a very long shadow. Medicine was a key site for the construction and reification of ideas of biological race.

Medicalizing Blackness makes three important contributions to the literature on medicine, race, and slavery in the Atlantic World. The first may be phrased as a negation: while the book situates its discussion of the medicalization of race solidly within the contexts of debates over abolition and the day-to-day practices of slavery, it rightly refuses to reduce medical history to politics or to read medical discourse as a mere cover for “deeper” or more authentic logics. “Physicians were not mere agents of political factions that sought to defend slavery,” Hogarth writes. “To view the medicalization of blackness as a by-product of the growing rancor over slavery is to ignore the professional stakes physicians had in investing slavery with meaning” (p. 8). The second contribution can then be understood as the positive corollary to this point, for Hogarth does an excellent job of detailing and explaining precisely what such political and professional stakes were. Careers were to be made by understanding and curing the diseases of people who were made into property. Those who argued for the distinctiveness of black bodies were also arguing for the primacy of their own forms of knowledge against those who lacked on-the-ground experience. Establishing a reputation as an expert on such matters could be profoundly lucrative, but it also came with dangers: when cures failed to materialize, for example, plantation doctors faced genuine competition from enslaved healers. The book’s third contribution also provides one of its structural logics. Throughout, the author is insistent on recovering the circulation of medical knowledge between the West Indies and the American South. This is a dedicated and consistent study of medicine in the Atlantic World, and one that pays significant dividends.

The book is divided into three sections, of two chapters each. The first section focuses on attempts to understand why it seemed to some that those of African descent were spared the worst ravages of yellow fever. Hogarth is a sensitive reader, but I occasionally found myself wishing that more time had been spent teasing apart two rather different kinds of explanation. I would argue that only a small minority of authors in the eighteenth century suggested that innate biological difference was the cause of health disparities. Most, instead, pointed to climatic, behavioral, and moral distinctions. Black slaves might suffer from distinctive diseases, in other words, but for most practitioners this was because they were slaves, not because they were black. Rather than assuming the dominance of an innatist understanding of race in medicine by 1800, then, it might be better to see the period studied here as that in which such innatist views came to be assumed. The second section discusses the wasting disease known as Cachexia Africana, an affliction characterized by the sufferer’s ingestion of dirt, and associated—as the name would suggest—with patients of a given race. One chapter explores attempts by Jamaican physicians to build “a...