Difference and Disease: Medicine, Race, and the Eighteenth-Century British Empire by Suman Seth (review)

Suman Seth's Difference and Disease examines how ideas concerning the relationship between environments and human bodies developed within the expanding eighteenth-century British Empire. Seth focuses on the question of when Anglophone doctors began to see "diseases of warm climates" (161) as distinct from those found in the temperate north, arguing that this idea emerged during the eighteenth century and formed the roots of the nineteenth-century tropical medicine that undergirded scientific racism. The racialized distinction between bodies emerged through debates concerning "seasoning" and "seasoning sickness" (5), he maintains. In particular, physicians emphasized the significance of yellow fever, which eighteenth-century observers considered "the seasoning sickness par excellence" (5). The book thus shows how African slavery, imperial conflicts, and the presence of "a colonial, racially mixed population" (6) shaped medical and scientific theories about race that developed in the American colonies.

Seth organizes the book into intersecting sections examining the themes of "Locality," "Empire," and "Race," each with chronological chapters that demonstrate critical intellectual changes over the course of the eighteenth century. The first section focuses on knowledge production in the colonial Caribbean, laying the groundwork for one of the book's most significant historiographical contributions: the foregrounding of the history of science and medicine in colonial contexts rather than the metropole.¹ Chapter 1 outlines ideas about health and disease held by colonial doctors prior to 1700, with a focus on the revival of Hippocratic ideas in the sixteenth and seventeenth centuries. Seth argues that the flexibility of Hippocratic texts enabled ideological constructions of the difference and similarity between European diseases and those found in colonial environments. Chapter 2 discusses the development of Hippocratic thought in the period from the 1720s through the 1760s and presents "the first detailed intellectual history" (57) of the medical writings of William Hillary, whose work on endemic diseases in Barbados and other West Indian islands was influential among doctors in Europe, North America, and the Caribbean, including Benjamin Rush. Hillary's work highlighted differences between diseases of Europe and those of the West Indies and portrayed yellow fever as particularly distinctive to the tropical environment of Barbados.

In the next section, Seth broadens his analysis to study the formulation "of an 'imperial medicine'" (16) by examining the relationship between medical knowledge produced in Britain and in colonial environments. Chapter 3 uses Edward Said's conception of "an 'imaginative geography,' a conceptual creation of a division of the world," to discuss ideas about "seasoning" (93), which formed in medical and popular British culture in the mid-eighteenth century. Seth argues that a broad and inclusive concept of seasoning emerged in response to the experiences and outcomes of midcentury wars, including the War of Jenkins' Ear and the Seven Years' War, and the growth of Britain's global empire. Seth focuses on the writings of naval physician James Lind to illustrate the complexity of British understandings of the health of colonial environments as British troops succumbed to foreign diseases in large numbers during the empire's expansion after 1740. As Seth shows, physicians employed the term "seasoning" to describe the experiences of slaves, soldiers, sailors, and settlers throughout global contexts, in the Americas, Asia, and Africa. Seth's deep analysis of the word "seasoning" raises questions about terminology, since medical and popular writers variously described this process of adaptation as "acclimation," "acclimatization," and sometimes "creolization" in the late eighteenth and early nineteenth centuries: how did the use of these terms among medical authorities reflect distinctive or different concepts of seasoning? Similarly, Seth's generalized analysis of the imperial discourse of fevers (with the exception of yellow fever) raises questions about how physicians distinguished between various fevers that they observed—most notably, how they identified malaria. This distinction is important because European doctors had been familiar with symptoms of malaria since the ancient period, but by the end of the nineteenth century they categorized it as...