to Michael Worboys for the good things he has to say about Epidemics
and History: Disease, Power and Imperialism in paragraph two
of his long review: "Overall the volume is a remarkable achievement"
etc. However the comments he makes in paragraph one and from paragraphs
three to eleven invite a response. I am framing this response in
a way which I hope will help inform the historical profession as
a whole about recent developments in cultural-medical history.
As is well known, the first major contribution
to the history of disease written by a non-medical person was William
McNeill's Plagues and Peoples, published in 1976. Although
mildly Eurocentric (as most historical studies published in Europe
and America were back then), Plagues and Peoples was a major
advance on the self- congratulatory, well-intentioned antiquarian
studies written by retired medical doctors before 1976. It was
studies of the latter sort, rather than studies in the history
of science (as Worboys claims), from which historians had to break
free before an independent sub-discipline, known as the history
of medicine, could take off and be recognized by the historical
profession as intellectually respectable.
In his review, Worboys said that "Epidemics and
Disease [sic] is based on assumptions which most social
historians of medicine will be uncomfortable with." (my emp.
his para 3). Indeed yes, with the passage of time the discipline
of history moves on and develops new forms. I should point out
here that back in the early 1980s when social history seemed to
be at the cutting edge of the discipline, I wrote a Social History
of Western Europe 1450-1720 from a West African perspective.
The book went into a second printing and a Swedish (!) translation,
and so was reasonably successful. However all that was more than
fifteen years ago. As far as I can tell from reading the principal
historical journals and the Times Literary Supplement, new
style "cultural history" buttressed by insights from anthropology
and comparative literature (following Edward Said) is now one of
the most innovative and exciting forms of written history. Even
though some journals still include the term "social history" in
their title, social history as originally conceived of by late
lamented masters (such as E. P. Thompson), has grown rather long
in the teeth and has had nothing much new to say for some time.
This being the case it is rather amusing to see Worboys (a self-professed
practitioner of the social history of medicine) jumping to the
defense (if that is what he is doing) of the post-modernist hero,
M. Foucault ( his para. 8).
Worboys (para. 3) is troubled by my use of "disease
constructs", a conceptual tool which my unconscious mind probably
picked up from my readings in historical anthropology and comparative
literature. Worboys claims that that I define "disease constructs"
as "the culturally filtered, false, even delusional, perceptions
of disease that were developed by the agents of imperialism." I
confess that a disease construct is "culturally filtered", but
I fear that the rest of Worboys' definition of Watts-style disease
constructs is his own invention. It must be stressed that each
Watts-style construct is disease specific, and specific in time
and place. I first use this conceptual tool in my discussion of
"leprosy" in medieval Western Europe. In this context, only by
the wildest stretch of imagination can one talk about the use of
perceptions of disease by "agents of Imperialism" as those last
three words are commonly understood today. In short, I fail to
comprehend Worboys' definition of a Watts' disease construct.
Worboys goes on to say (para. three) that Watts
"continues to work a clear distinction between `the real world
of objective fact (p.139) and culturally mediated perceptions.'"
I have read and re-read my page 139, but have failed to locate
the accusatory phrase "the real world of objective fact" anywhere
on that page. Where I do use the phrase (my page 124) the full
sentence reads: "In the real world of objective fact, the sexual
authoritarianism that began to flower in the mid-eighteenth century
(greatly assisted by the anti-masturbation scare) led in the next
century to the near demise of literature about actual human reproductive
processes." This sentence clearly has nothing to do with the reality
or non-reality of any particular disease. It is interesting to
note here that in his magisterial study of contagion, Peter Baldwin
specifically quotes my conclusion about the 18th century medicalized
fear of masturbation which, together with other factors, "combined
to render prostitution one of the few traversable avenues of male
sexual release." [Peter Baldwin, Contagion and the State in
Europe, 1830-1930 (Cambridge U. P. 1999), 424].
Worboys claims ( para. 3) that I have "a decidedly
presentist approach to medical knowledge." This allegation presumably
relates to my decision, when writing the book, to establish the
nature of the specific disease/diseases each chapter is about.
Thus in Chapter 6, when writing about yellow fever and malaria,
I discuss the understandings of those diseases set forth by medical
scientists at the Cairo Conference on Tropical Medicine held in
1928. Nineteen-twenty-eight is some 69 years before Epidemics
and History went to press (i.e. hardly "the present"). Similarly,
in Chapter 2, Leprosy, I give extensive coverage to medical doctors'
ideas about the disease in the 1890s and 1920s. Perhaps by "presentist
approach" Worboys means anything which discusses the germ theory
established by Pasteur and Koch more than a century ago? Ian Hocking,
writing in general terms about differences between scientists and
social constructionists (The Social Construction of What?,
Harvard U. P., 1999) stresses the remarkable stability of scientific
knowledge since the time of Newton. In a cultural-medical history
of the epidemic diseases I deal with, I assume it is legitimate
to posit a somewhat similar stability of knowledge since the time
of Koch. To label this assumption "presentist' is to assign medical
history to the tender mercies of the antiquarians, a position from
which some of us (including Michael Worboys in his substantial
essays -my page 384) have long been struggling to rescue the sub-discipline.
Worboys (para 3) is also troubled by my use of
the trendy terms "power", "imperialism" and "Development". In the
recently published issue of Past & Present no. 165 (Nov.
1999), the great medievalist, Richard Southern, is quoted (page
221) as saying that an essential requirement for the writing of
history "is experience of menthe third quality is compassion for
the sufferings, ambitions and delusions of both the oppressed and
the oppressors." Worboys is, I understand, a long-term denizen
of a north of England university, whereas I have spent seventeen
of the last twenty years living in the Non-West (in Nigeria and
in Egypt). As an historian, I am by definition interested in sorting
out possible connections between the past actions of colonial masters
and the actions of successor indigenous regimes which, very often,
are largely staffed by descendants of earlier collaborators with
the white invaders. In short, I am interested in the consequences
of past actions. Worboys (in his north of England university) does
not seem to realize the extent of the cultural impact (to say nothing
of the disease impact on non-immunes) which even a few well-armed
colonialists could make on an indigenous culture. May I recommend
that in the absence of lived experience, he read some of the recently
published accounts of the Harrowing of the North of England by
William the Conqueror and his handful of followers? Here certainly
is an example of how the few completely transformed the lives of
Worboys (para 3) is also troubled by my use of
the concept "Ideology of Order" which I apply solely to my discussions
of bubonic plague. Peter Baldwin clearly understands what I mean
when he states: "Watts calls the quarantinist policies first elaborated
in Italy against the plague the 'Ideology of Order', an authoritarian
set of interventions that disrupted the everyday lives of citizens."
(Baldwin, Contagion, 30). Worboys thus seems to have lost
the thread of the argument when writing: "The notion that public
health programmes were driven, across centuries and continents,
by an 'Ideology of Order" begs more questions than it answers."
True enough, but the "notion" is Worboys' own creation not mine.
Similarly. I find it difficult to believe that
Worboys read my chapter on leprosy with any understanding. When
discussing the European Middle Ages, my thesis was that many (perhaps
most) alleged lepers were in fact normally put-together people,
people who did not have the shriveled hands and feet nowadays associated
with a proper leper. However these "lepers" happened to have enemies
who found it was possible to get rid of them by having them committed
to a leprosarium. Thus, Worboys' long discussion about Hansen's
bacillus is entirely irrelevant to my discussion of medieval leprosy.
As I go on to show in the second part of that chapter, in the late
19th century, the leprosy paradigm which was cobbled together by
curious readings of medieval evidence was selectively used by some
imperial regimes in some places, but not in others. To expect to
find a clear pattern in such matters is to ignore modern understandings
of history which see it as a formless mixture of contingencies,
accidents, inconsistencies etc.
At this point it would be appropriate for me
to point out that a good half of each chapter in Epidemics and
History is NOT about European colonial impacts on the Non-West
but instead is about one or other European society and the differing
perceptions of each particular disease by those who ruled and those
who were ruled. This is not apparent from Worboys' review (para.
2). Indeed some of Worboys' phrases lead me to wonder if he was
reviewing two or three books at the same time and got mixed up
about which author said what. Thus in his comments on my chapter
on bubonic plague (para. 5) he says that I conclude "with a discussion
of the disease in American and British empires after 1850." In
fact, the second half of the chapter deals with Egypt under the
Mamluks, the Ottomans and Muhammad Ali, ending in 1844.
Egypt was not part of the British or the American empires at that
time: the British shelling of Alexandria and conquest of Egypt
did not take place until 1882.
Still on the topic of the bubonic plague, Worboys
takes me to task for not coming to definite conclusions about "the
patterns and determinants of control measures" and for not coming
to definite conclusions about how they fit into E. Ackerknecht's
typologies (formulated in the l940s). On these particular issues
Worboys should turn to Peter Baldwin's 580 page book on contagion.
There he will find that although Baldwin specifically set himself
the task of testing Ackerknecht's typologies, in the end he found
he could not come up with definitive answers about whether they
were appropriate or not.
In his discussion of my readings of cholera,
and of yellow fever and malaria, and my Afterword, Worboys fails
to understand the extent to which colonial medical doctors and
medical scientists were not free agents. Instead they were pawns
in the great game of power politics being played out by the ruling
elites in the metropole. In the case of cholera and quarantine
policies in India, and the sea lanes leading from India to West
Europe, further research in the recently re-opened India Office
(at the British Library) has convincingly shown that as of 1867,
when dealing with an outbreak of cholera among 3 million pilgrims
at the Hardwar Fair, the officiating sanitary officer with the
government of India, James McNabb Cuningham, zealously established
cordons and emergency isolation hospitals to block the movement
of pilgrims, who he suspected of harboring the disease in their
guts, from the great cities of the North. Then in mid-1868, on
the eve of the opening of the Suez Canal, Cuningham was persuaded
by those in Authority in London to adopt a new cholera ideology
which was l80 degrees at variance with policies he himself had
used in 1867. This radical alteration in policy and ideology (cholera
now seen as a locally generated disease, not brought in by human
intercourse, hence there was no need for the quarantine of shipping
from Bombay) was a political decision, based on commercial considerations,
which had nothing to do with the medical finding of north German
or pre-1869 British scientists (my paper on this forthcoming) .
And as for S. R. Christophers (para. 10) and his call for segregation
in West Africa based on his claim that black African children harbored
the malaria parasite but that white children and white adults did
not harbor the disease, in Epidemics and History (p.263)
I point out that that Christophers' own contemporary, Dr. William
MacGregor, Governor of Lagos, publicly and repeatedly stated that
the rapid expansion of malaria-blighted regions was not due to
racial characteristics of blacks, but was instead largely due to
the behavioural patterns and Development policies of white invaders-such
as himself. MacGregor's statements did not go down well with Authority
back home in England who saw to it that he was transferred to Newfoundland-where
there was no malaria. But Authority saw to it that Christophers,
the Social Darwinist, was sent to India where in one capacity or
another he remained in charge of the investment-friendly British
malaria programme until 1932. [for an update, see my paper in Past
& Present no. 165 (Nov. 1999), 141-181].
Worboys (para 3) sees my use of the word "Development"
as "anachronistic". He obviously did not understand why I always
used the capital letter "D" and why I defined my understanding
of this conceptual tool at the first possible opportunity (my pp.
xiii-xiv). In common with Peter Baldwin (who in Contagion
coined quite a few words I had not seen used before), I accept
that English (on both sides of the Atlantic) is a living language,
rather than a fossil preserved by some learned Academy. My use
of the capital "D" was a signal that I was using the word Development
in a special way. Taking the broad view appropriate to what Worboys
terms "big-picture" history, I---as a denizen of a still imperialized
Non-Western country----fail to see any essential difference between
the Development processes Columbus and Co. had in mind (golden
treasure to pay for the liberation of Jerusalem, slaves to work
European-owned primary product plantations, personal wealth, and
personal status enhancement) and the processes put in motion in
the long-19th century Age of European Imperialism, and the processes
being managed by the agencies of Globalization today-the multi-nationals,
the World Trade Organization, the I.M.F, the World Bank. In all
instances, wealth, power, longevity and glory ended up in the possession
of the few.