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How Violence Contributed to Medicine in the 19th Century
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Journal Article
How Violence Contributed to Medicine in the 19th Century
2022
Overview
Downs's subject is how, beginning in the mid-18th century, violence associated with colonialism, slavery, and war influenced the theory and practice of medicine and, allegedly, of epidemiology. In eight chapters, an introduction, and a conclusion, he presents some wellknown and some less-known evidence to justify his argument.Each chapter is a case study of one or several episodes in the relationship between violence and the history of medicine. Downs begins by presenting the speculations of doctors on slave ships and prisons about the effects of bad air in \"crowded places\" (pp. 17-18). There is a chapter on the \"decline of contagion theory and the rise of epidemiology.\" The next chapter is a detailed study of \"tracing fever in Cape Verde.\" Downs then generalizes from this study to describe \"epidemiological practices in the British Empire,\" emphasizingthe centrality of \"recordkeeping\" in imperial bureaucracies.Moving away from medicine, he then focuses on the contributions of Florence Nightingale, commonly considered to be the founder of modern nursing and hospital epidemiology,1 whom he calls the \"unrecognized epidemiologist of the Crimean War and India\" (p. 88). The book summarizes Nightingale's contribution to the conceptualization and analysis of data about populations experiencing severe infectious diseases. He follows this chapter with studies of the history of the US Sanitary Commission during the American Civil War and the subsequent influence of its work, a history he summarizes as \"from benevolence to bigotry.\" His cases conclude with a study of the \"narrative maps\" devised to document the interaction of Black troops and Muslim pilgrims duringthe cholera pandemic of 1865-1866.Downs offers many examples of clinical observations made by doctors in captive populations, but the weakness of Downs's thesis is his attempt to link these episodes that belong to the history of medicine, as the title of the book clearly indicates, to the history of epidemiology. Downs seems to believe that doctors practice epidemiology when they examine their cases within largescale \"captive\" populations such as military hospitals and camps, slave ships, prisons, and so on (p. 6). But doctors have attended large numbers of people since antiquity-that is, thousands of years before the emergence of epidemiology in the 17th century. Downs does not seem to realize that a clinical practice, even within a ship, a prison, or a concentration camp, remains a medical act as long as the multitude of individual cases itself does not become the new dimension of analysis-that is, assessed as a population, divided into groups, and compared.
