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Reviewed by:
  • Difference and Disease: Medicine, Race, and the Eighteenth-Century British Empire by Suman Seth
  • Harold J. Cook
Difference and Disease: Medicine, Race, and the Eighteenth-Century British Empire. By Suman Seth (New York, Cambridge University Press, 2018) 336 pp. $39.99

The history of medicine and empire is a robust subject that has drawn the attention of several first-rate scholars over the past three decades, with fresh approaches in ever-more abundance. Although the medical entanglements of many imperial regimes—as well as local resistances and “alternatives”—are now much in evidence, the British Empire continues to dominate the English-language literature, most especially in its “Atlantic” form, much of which is about the Caribbean. To that branch of the literature Seth brings an approach cultivated in the history of science, arguing that the responses of medical authors to the problem of disease and its treatment in the British West Indies gave rise to conceptual distinctions that enabled empire, including what he terms “race-medicine.” From a close reading of the several books written by eighteenth-century English physicians who had experience practicing on the sugar islands, he produces a “postcolonial history of colonial medicine” that is at the same time a self-conscious “history of arguments” about “medical theories” based upon “close reading.” Seth therefore spends two chapters examining how the development of a concern for the “seasoning” of newcomers was not classical Hippocratism, two chapters about how “conceptions of [End Page 274] empire” affected ideas such as “putrid air” as a cause of disease, and two chapters about the emergence of race-medicine.

Despite many clear and sensible accounts of the texts at hand, a deeper appreciation of the history of medical ideas would have aided Seth in making distinctions. For instance, the powerful views of Thomas Sydenham, the “English Hippocrates,” who advanced coherent notions of specific (species-like) diseases, and the “mechanistic” teachings of Herman Boerhaave of Leiden, who instructed so many Scottish and English physicians, are reference points for the authors that Seth quotes but not always fully grasps. Their views on the material commonalities of human bodies, and on medical specifics (remedies that acted in all cases against disease species) would have clarified some arguments. Seth also evinces a few mis-directions, as when he argues that Hans Sloane— one of Sydenham’s protegés—wished to depict the environment of Jamaica as being like England’s but instead quotes Sloane about the botanical similarities of Jamaica and “Guinea” (the West African coast) (27).

Given our own current moment, Seth’s last two chapters, about the formulation of race medicine, will undoubtedly draw the most attention. As in the rest of the book, Seth’s own voice is clear but only occasionally in conversation with other scholars who have studied racialized medicine within imperial regimes. He is intent on arguing that his category of race-medicine is distinct from the much-studied “race-science” of the European Enlightenment—the “boundary-making” of which had its foundation in anatomical classification whereas race-medicine arose, he says, from thinking that kinds of people responded differently to the same diseases. For instance, Seth’s description of eighteenth-century ideas of polygenism sets the stage for support of the view that Immanuel Kant’s essays about racial difference simply expressed an interest in defending monogenism under the umbrella of “classification.”1 “Common lay beliefs” may now assume that racial science was meant as “a justification for slavery and a rapacious colonialism,” but they would be mistaken (247), even though Kant wrote that black bodies “stank.” Instead, race-medicine did the work.

Seth holds that following the judicial Somerset judgement of 1772—which held that chattel slavery was illegal in England and Wales—and the growing abolitionist sentiment in the metropole, planters were placed on the back foot; thereafter, physicians in their employ began to advance new ideas about race. Their arguments had three aspects: Proper medical practice could keep the enslaved healthy; the unhealthy bodily responses of enslaved people were often socio-cultural in origin; but apparent differences in bodily responses to the same diseases and conditions of life also gave evidence of physiological difference. In...

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