%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 14 0 R 16 0 R 18 0 R 20 0 R ] /Count 5 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R >> /XObject << /I1 11 0 R >> >> /MediaBox [0.000 0.000 595.280 841.890] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20140722170416+01'00') /ModDate (D:20140722170416+01'00') /Title (Epidemics and History: Disease, Power and Imperialism) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 12 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 4751 >> stream q 381.750 0 0 120.000 34.016 687.874 cm /I1 Do Q 0.000 0.000 0.000 rg BT 34.016 676.469 Td /F1 12.0 Tf [(Published on )] TJ ET BT 99.356 676.469 Td /F2 12.0 Tf [(Reviews in History)] TJ ET BT 190.016 676.469 Td /F1 12.0 Tf [( \()] TJ ET 0.000 0.000 0.800 rg BT 197.012 676.469 Td /F1 12.0 Tf [(http://www.history.ac.uk/reviews)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 197.012 675.075 m 357.332 675.075 l S 0.000 0.000 0.000 rg BT 357.332 676.469 Td /F1 12.0 Tf [(\))] TJ ET 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d 34.391 653.743 526.499 1.500 re S BT 34.016 615.321 Td /F3 18.0 Tf [(Epidemics and History: Disease, Power and Imperialism)] TJ ET BT 34.016 344.603 Td /F1 12.0 Tf [(Reflections on the history of medicine in the second half of the twentieth century make much of the )] TJ ET BT 34.016 330.347 Td /F1 12.0 Tf [(discipline's break with its association with the history of science, and the development of the new )] TJ ET BT 34.016 316.091 Td /F1 12.0 Tf [(approaches and interests signalled by the coming of the 'social history of medicine'. How 'new' the social )] TJ ET BT 34.016 301.835 Td /F1 12.0 Tf [(history of medicine actually was is debatable, but there can be no doubting the proliferation of work on )] TJ ET BT 34.016 287.579 Td /F1 12.0 Tf [(topics such as patients, non- orthodox practitioners, madness, and healing and disease outside of Western )] TJ ET BT 34.016 273.323 Td /F1 12.0 Tf [(cultures. Also, previously well-worked seams, such as the development of the medical profession and )] TJ ET BT 34.016 259.067 Td /F1 12.0 Tf [(medical science, have been the subject of new studies and major revisions. A characteristic of much of the )] TJ ET BT 34.016 244.811 Td /F1 12.0 Tf [(new work, following from its attempt to set medicine in its specific social context and its reaction to older )] TJ ET BT 34.016 230.555 Td /F1 12.0 Tf [(universal histories, has been its relatively narrow focus in time and place. There are many recent studies of )] TJ ET BT 34.016 216.299 Td /F1 12.0 Tf [(doctor-patient relations as revealed in casebooks or diaries, of alternative healers in particular towns, of )] TJ ET BT 34.016 202.043 Td /F1 12.0 Tf [(individual asylums, and of health and medicine in specific regions or countries. A popular theme in this vein )] TJ ET BT 34.016 187.787 Td /F1 12.0 Tf [(has been the history of epidemics, which has allowed historians to focus on a particular place and time, and )] TJ ET BT 34.016 173.531 Td /F1 12.0 Tf [(to explore the social context of disease and medicine at a moment of social crisis. In turn, this approach has )] TJ ET BT 34.016 159.275 Td /F1 12.0 Tf [(spawned a relatively new genre of the history of disease, where medical historians consider a disease over a )] TJ ET BT 34.016 145.019 Td /F1 12.0 Tf [(longer period, weaving changes in understanding and management with epidemiological and cultural )] TJ ET BT 34.016 130.763 Td /F1 12.0 Tf [(history. The emphasis in the new social history of medicine has very much been on the 'social' in medicine )] TJ ET BT 34.016 116.507 Td /F1 12.0 Tf [(and how the wider 'society' impacts upon medicine. There have been fewer studies of the 'impact' of )] TJ ET BT 34.016 102.251 Td /F1 12.0 Tf [(medicine on society, except for work around medicalisation and on how changing medical views of the body )] TJ ET BT 34.016 87.995 Td /F1 12.0 Tf [(and disease have interacted with popular and elite beliefs. Particularly thin on the ground have been studies )] TJ ET BT 34.016 73.739 Td /F1 12.0 Tf [(of the impact of medicine on morbidity and mortality, and beyond that investigations into the part played by )] TJ ET BT 34.016 59.483 Td /F1 12.0 Tf [(diseases, or medicine, or both together, in shaping wider historical changes. This situation is in part a )] TJ ET BT 34.016 584.699 Td /F3 12.0 Tf [(Review Number:)] TJ ET BT 34.016 570.443 Td /F1 12.0 Tf [(104)] TJ ET BT 34.016 556.187 Td /F3 12.0 Tf [(Publish date:)] TJ ET BT 34.016 541.931 Td /F1 12.0 Tf [(Monday, 1 May, 2000)] TJ ET BT 34.016 527.675 Td /F3 12.0 Tf [(Author:)] TJ ET BT 34.016 513.419 Td /F1 12.0 Tf [(Sheldon Watts)] TJ ET BT 34.016 499.163 Td /F3 12.0 Tf [(Date of Publication:)] TJ ET BT 34.016 484.907 Td /F1 12.0 Tf [(1997)] TJ ET BT 34.016 470.651 Td /F3 12.0 Tf [(Pages:)] TJ ET BT 34.016 456.395 Td /F1 12.0 Tf [(416pp.)] TJ ET BT 34.016 442.139 Td /F3 12.0 Tf [(Publisher:)] TJ ET BT 34.016 427.883 Td /F1 12.0 Tf [(Yale University Press)] TJ ET BT 34.016 413.627 Td /F3 12.0 Tf [(Place of Publication:)] TJ ET BT 34.016 399.371 Td /F1 12.0 Tf [(New Haven, CT)] TJ ET BT 34.016 385.115 Td /F3 12.0 Tf [(Reviewer:)] TJ ET BT 34.016 370.859 Td /F1 12.0 Tf [(Michael Worboys)] TJ ET endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Times-Roman /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /XObject /Subtype /Image /Width 509 /Height 160 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 509 /BitsPerComponent 8>> /Mask [ 255 255 255 255 255 255 ] /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 3280>> stream x[EQ㎦fVttҒ +3O{?lGDQԯDrB^.ϯ%~'0۠/2>0AG_>0j0GCfE67>rB^}@  !&y+r?INp:erc b8f=rQC!~-Wf^^zF[)G 2ޯe7V_Go3Ke GEGOo8rώ#\1ZY~N6^H}yLxS-!:412V+u\-LSO?xVvZ|GjǮT_8EYJF=Tw^ 7GxfN/S:Ʌ~ʟtt?5n÷J'JcF-GVξx{rO~tJd;#a\7}|~y'>}c2C vR}f׈**h.)_&@pfzjsx:5;S\vKhM5j=!Cn+h"u]a EUN]jn=k<,:Ք>sU!ni~6EJ)¦72?G}[y}_vc$t?iSܟ2Zݞ,VN?_`='RFK1A2qv&X_lLRWY'%:I㢖zb_UEx\>&ɆBˏ~K@ \gYØU4}$8Dv!'Q'*+Εj(UCGo[#< 2Ja(sZi9fZKE Rn`u\9r^Zmɯ׹}mstO4uc~#'jEvۼ Dx[z ޏQ4KL5,5u3>i^uÒ-53ba ~,~/pyt1fMU'CVm:qv~=Y'Es"WsφG?l_kN5}],Ow7 uh`xƫ?zMl7ٻv$A(4Dl(wwH} ?=[=S;yC]^BK>㕪9`Z'Wj;E|:bf>kCԘ#RY,iv쵗~}n'"1u" *uO΄/2^Sxr(!/DD\~mJyZ!MmrA!#u[if|99WB WΡpp}w}sh#,\ &:%˳X?D3 %W0cC?o̲^} F3XLVn]Cߖiϧ!7}yZJ#P7]=)7Ρp;>> Ye^xx{Oafw{ ;>4gfLt ʊ:q%#r/)pv!O4wGh|dS ӣݽހ-gVUC'pBxrB^} 7JA^} /'8!`:r?}}],X  }6y!`/~Br?}Q< >k7vx"] ,' .3jn{-i}|~%-};b6#U)7繎kiEw 㤳:E}[޼c"rꬊ7Dc$~"/Y&zSd:tFȌCrʙ`7u .#[-<)j ?TGS(j~oTup(hjU4PlJ=}|it.ҽ@\wʨuXÞZcx18Wo<~ikOg,ވ\^?EneyZcc0[R١z|zv7_m:_n]a?osS3~j^ hD.a_X'KfBX6w wݶ"Oa:,bvhrWH[uCF-Xfc}>x+Rz)2N-B 7y^٨;[/vg? | |2Sve}=o䑰j[vWjF0{굦?VI~}xM(_TlG__+]:#к?S} c>GŸD7 !w{S{B =x7a?oE#)+Gz:o_4Q<;n?\tt7?mGCџQGu4kņOF>F?#} hP&ђߴM#u!.СtL2^#o nIk_i.~7tr@n 1P~3?.[]=S5b߮~Yo^HFH YBi8a4iom>CKgMy*;?zqEӕ` >zB9iFzC?XF?ޟIܰ펉A}{I5ᄊx%ez#Mp@rߎpi]IOVjzuJt\۰f׺u5><,J~PTJp1)}){9N {!`/> endstream endobj 12 0 obj << /Type /Annot /Subtype /Link /A 13 0 R /Border [0 0 0] /H /I /Rect [ 197.0117 675.3895 357.3317 687.2695 ] >> endobj 13 0 obj << /Type /Action /S /URI /URI (http://www.history.ac.uk/reviews) >> endobj 14 0 obj << /Type /Page /Parent 3 0 R /Contents 15 0 R >> endobj 15 0 obj << /Length 7421 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(reaction to earlier histories of medicine that assumed changes in the medical understanding of disease )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(automatically converted into progressive preventive or therapeutic results. Also influential has been the work )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(of Thomas McKeown on population growth in modern Britain, who is generally read as maintaining that )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(medical intervention had next to no influence on the fall in death rates in industrialised countries until well )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(into the twentieth century. It should not be forgotten either that the deeply contextualised work in the social )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(history of medicine has shown the relationships between disease, medicine and social changes to be very )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(complex, even at the micro-level.)] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(However, the tide is now turning and in the last five years a number of historians have returned to the write )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [('big picture' histories. Deservedly the best known is Roy Porter's The Greatest Benefit of Mankind \(1998\), a )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(comprehensive, accessible and authoritative survey of Western medicine from antiquity to the present. )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(Synoptic accounts have been offered in collections in theCambridge and Oxford History series, and by J. N. )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(Hays in The Burdens of Disease: Epidemics and Human Responses in Western History \(1998\). Thus, in )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(many ways Sheldon Watts's Epidemics and History: Disease, Power and Imperialism is very much of its )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(time, a 'big picture' history of disease focusing on medicine and public health in non-Western countries. It is )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(major work of synthesis that develops in successive chapters histories of plague, leprosy, smallpox, syphilis, )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(cholera, yellow fever and malaria. Overall, the volume is a remarkable achievement and is packed with )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(detail on regions and the epidemics that are not well known to historians of medicine or disease. The author's )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(accounts of disease control measures in Muslim countries is particularly welcome. Epidemics and History is )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(a very ambitious volume, where the main theme is the role of imperialism in creating the conditions in )] TJ ET BT 34.016 513.605 Td /F1 12.0 Tf [(which major epidemics developed, and the weak responses that colonial governments made to these )] TJ ET BT 34.016 499.349 Td /F1 12.0 Tf [(problems. Nothing that I say below should detract from my admiration of Watts's work, but there are issues )] TJ ET BT 34.016 485.093 Td /F1 12.0 Tf [(in his approach that deserve critical comment and the accounts of the various diseases do not always match )] TJ ET BT 34.016 470.837 Td /F1 12.0 Tf [(its ambitions.)] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(Epidemics and Disease is based on assumptions that most social historians of medicine will be )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(uncomfortable with. There are three issues that are particularly troublesome and these can each be linked to )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(one of the themes in the subtitle: Disease, Power and Imperialism. The first is Watts's decidedly presentist )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(approach to medical knowledge and his wish to separate the 'true' character of a disease and 'disease )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(Constructs'. Watts defines the latter as the culturally filtered, false, even delusional, perceptions of diseases )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(that were developed by the agents of imperialism. Watts acknowledges that science and culture are rarely, if )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(ever, distinct realms \(p. 122\), but continues to work with a clear distinction between 'the real world of )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(objective fact' \(p. 139\) and culturally mediated perceptions. The objection to this viewpoint is that historians )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(have repeatedly shown that medical knowledge and practice are 'constructed' and are culturally mediated. )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(However, they make this point not in any pejorative sense, but because medicine was and is created by )] TJ ET BT 34.016 302.021 Td /F1 12.0 Tf [(humans from available intellectual and material resources, and validated through practical actions and social )] TJ ET BT 34.016 287.765 Td /F1 12.0 Tf [(interactions. One could also add, of course, that the social and cultural world was and is no less 'real' than the )] TJ ET BT 34.016 273.509 Td /F1 12.0 Tf [(material world and that medical knowledge changes historically; today's hard facts may be tomorrow's )] TJ ET BT 34.016 259.253 Td /F1 12.0 Tf [(errors. As we will see, state-of-the-art medicine on epidemics in the first half of the nineteenth- century was )] TJ ET BT 34.016 244.997 Td /F1 12.0 Tf [(miasmatist and it was the beliefs of contagionists that were said to be 'bogus' and in retreat. Second, Watts )] TJ ET BT 34.016 230.741 Td /F1 12.0 Tf [(tends to overstate the power of Western imperialist countries and their agents, and underplay their lack of )] TJ ET BT 34.016 216.485 Td /F1 12.0 Tf [(knowledge, the resistance they met to their schemes, and that contingent outcomes of many policies and )] TJ ET BT 34.016 202.229 Td /F1 12.0 Tf [(programmes. The notion that public health programmes were driven, across centuries and continents, by an )] TJ ET BT 34.016 187.973 Td /F1 12.0 Tf [('Ideology of Order' begs more questions than it answers. The third and related problem is the use of the term )] TJ ET BT 34.016 173.717 Td /F1 12.0 Tf [('Development' for the whole of Western contact with other cultures, including colonial imperialism. The )] TJ ET BT 34.016 159.461 Td /F1 12.0 Tf [(objection is not so much to the anachronistic term, but to the simplification of processes and motives that )] TJ ET BT 34.016 145.205 Td /F1 12.0 Tf [(historians of imperialism have always presented as complex and variable.)] TJ ET BT 34.016 118.949 Td /F1 12.0 Tf [(There are additional problems, many of which stem from the author's ambitious scope. Some chapters are )] TJ ET BT 34.016 104.693 Td /F1 12.0 Tf [(quite rambling and lines of argument remain implicit; thus, narratives often peter out and there are few )] TJ ET BT 34.016 90.437 Td /F1 12.0 Tf [(clearly stated conclusions. All of the important diseases have been covered, and while historical )] TJ ET BT 34.016 76.181 Td /F1 12.0 Tf [(epidemiology is very good, there is no explanation of why particular epidemics and regions have been )] TJ ET BT 34.016 61.925 Td /F1 12.0 Tf [(chosen. Also, there is little sense of epidemics as moments of crisis, hence this volume is really about )] TJ ET endstream endobj 16 0 obj << /Type /Page /Parent 3 0 R /Contents 17 0 R >> endobj 17 0 obj << /Length 7529 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(communicable diseases and history, and in my view rather the better for this.)] TJ ET BT 34.016 770.213 Td /F1 12.0 Tf [(Watts's narrative begins with the Black Death in 1347, by considering the absence of a public health )] TJ ET BT 34.016 755.957 Td /F1 12.0 Tf [(responses in Europe before 1450, why formal control policies first developed in Italian states after 1450, and )] TJ ET BT 34.016 741.701 Td /F1 12.0 Tf [(concluding with a discussion of the disease in American and British empires after 1850. The importance of )] TJ ET BT 34.016 727.445 Td /F1 12.0 Tf [(religion in initial reactions to the plague is shown well, as are medieval assumptions about disease and its )] TJ ET BT 34.016 713.189 Td /F1 12.0 Tf [(treatment. The account of plague control in fifteen and sixteenth century Europe is very detailed, but jumps )] TJ ET BT 34.016 698.933 Td /F1 12.0 Tf [(from country to country and disappointingly offers no conclusions the patterns and determinants of control )] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(measures. Then the story jumps to the Middle East and the fourteenth century and after, with fascinating )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(detail of the evolution of little known medical and disease control practices in Muslim countries. The chapter )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(ends with the story of how, in the early nineteenth century Egypt, Muhammad Ali devised a state apparatus )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(and disease control measures based on quarantines, that, despite the best efforts of the British anti-)] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(contagionist to thwart them, helped control the disease when implemented. The implicit argument here is a )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(version of Ackerknecht's linking of disease control strategies to political ideologies. Thus, Muhammad Ali's )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(regime with its 'Ideology of Order', against the advice of its wonderfully named advisor 'Dr Clot, _ a miasma )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(man' \(p. 37\), favoured contagionism, while the British, committed to laissez faire, opposed such measures.)] TJ ET BT 34.016 558.629 Td /F1 12.0 Tf [(The chapter on leprosy jumps from the Middle Ages, to fourteenth century leper hunts in Europe, and then to )] TJ ET BT 34.016 544.373 Td /F1 12.0 Tf [(Hawaii and the British colonial Empire in the nineteenth and twentieth centuries. It is with leprosy that the )] TJ ET BT 34.016 530.117 Td /F1 12.0 Tf [('Construct' versus 'real' disease theme is most fully developed. Indeed, two Constructs of leprosy are )] TJ ET BT 34.016 515.861 Td /F1 12.0 Tf [(identified: that of the 'leprosy as moral impurity [and] imagined disease', and a second Construct, also )] TJ ET BT 34.016 501.605 Td /F1 12.0 Tf [(around impurity, with the added imperative towards the incarceration of sufferers. Against these two )] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(Constructs, Watts sets 'leprosy as Hansen's disease, i.e., clinically true leprosy'. \(p. 41\) The problem here can )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(be shown by looking briefly at the reception of Hansen's bacillus. In the 1860s and 1870s, up-to-date )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(medical opinion in Britain and its colonies, in line with anti-contagionism, moved towards leprosy being non-)] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(contagious and influential reports came out against segregation and isolation. Hansen's bacillus took many )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(years to be accepted, and it was incorporated into a very complex aetiological and pathological picture. )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(Leprosy was not highly contagious, hence the dominant metaphor in medicine for explaining and managing )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(the disease was 'seed and soil': the disease required both the bacillus, in sufficient numbers and suitable )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(virulence, and a vulnerable human constitution, which was dependent on general health, race, behaviour, )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(inherited vulnerability, and many other factors. The Hansen bacillus was not associated with a definitive )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(post-Koch, ontological account of the disease, that in turn defined necessary control measures. Rather, )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(different groups within and without medicine gave it a variety of meanings; for example, some doctors )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(argued for isolation to prevent the spread of the germ, while others maintained that the best way forward was )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(to work for social and sanitary improvements to strengthen the human soil. Both views, and others, were )] TJ ET BT 34.016 302.021 Td /F1 12.0 Tf [(legitimate deductions from available knowledge and debated as such. Which approach won the policy )] TJ ET BT 34.016 287.765 Td /F1 12.0 Tf [(argument depended on a host of factors \(power, interests, evidence, etc.\) and then actual implementation )] TJ ET BT 34.016 273.509 Td /F1 12.0 Tf [(might be shaped by other factors \(economics, politics, logistics, etc.\). Seen in this way, the different actions )] TJ ET BT 34.016 259.253 Td /F1 12.0 Tf [(of governments and missionary agencies can be explained not as a conspiracy, but the result of negotiations )] TJ ET BT 34.016 244.997 Td /F1 12.0 Tf [(at all levels. 'Constructs' were as much a part of medical discourse as political ideologies and cultural beliefs, )] TJ ET BT 34.016 230.741 Td /F1 12.0 Tf [(indeed, the notion of separate spheres in unhelpful. Indeed, given the switch back to contagionism at the end )] TJ ET BT 34.016 216.485 Td /F1 12.0 Tf [(of the nineteenth century, the government and missionary doctors who worked most closely with lepers, and )] TJ ET BT 34.016 202.229 Td /F1 12.0 Tf [(had the greatest chance of catching the disease, often had the greatest investment in both of the leprosy )] TJ ET BT 34.016 187.973 Td /F1 12.0 Tf [(Constructs identified.)] TJ ET BT 34.016 161.717 Td /F1 12.0 Tf [(With smallpox, Watts develops an important revisionist argument on virgin soil epidemics, that is a valuable )] TJ ET BT 34.016 147.461 Td /F1 12.0 Tf [(corrective to recent writing on the subject. It has become commonplace in global histories of disease to )] TJ ET BT 34.016 133.205 Td /F1 12.0 Tf [(explain the high mortalities of indigenous peoples after European arrival to the importation of diseases to )] TJ ET BT 34.016 118.949 Td /F1 12.0 Tf [(which indigenes had no immunity. Thus, we read repeatedly of smallpox, measles, chickenpox, etc. taking a )] TJ ET BT 34.016 104.693 Td /F1 12.0 Tf [(terrible toll, often decimating indigenous populations. The problem with such claims is the extent to which )] TJ ET BT 34.016 90.437 Td /F1 12.0 Tf [(they imply that Europeans had specific inherited or racial immunities to these diseases. The way the human )] TJ ET BT 34.016 76.181 Td /F1 12.0 Tf [(immune system is currently understood to work is that humans are born with no specific immunities, but )] TJ ET BT 34.016 61.925 Td /F1 12.0 Tf [(with a general immune capacity, which allows them to respond to the billions of potential chemical and )] TJ ET endstream endobj 18 0 obj << /Type /Page /Parent 3 0 R /Contents 19 0 R >> endobj 19 0 obj << /Length 6558 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(biological dangers that might enter the body. In this sense, every human is born a virgin soil baby. Specific )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(immunities are acquired from exposure to pathogenic matter from birth onwards, aided initially as Watts )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(points out with maternal antibodies. With some diseases, specific immunities can be 'stored' and give )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(lifelong protection, with other diseases this capacity is relatively weak. Thus, if there was differential )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(immunity between European colonists and indigenes, say, in the American colonies in the sixteenth century, )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(this was due to the prior exposures that Europeans had to pathogens and the extent to which they had )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(acquired immunities. It should not be forgotten either that European children continued to die in large )] TJ ET BT 34.016 696.677 Td /F1 12.0 Tf [(numbers from the very same diseases that were killing indigenes. Also, many indigenes survived imported )] TJ ET BT 34.016 682.421 Td /F1 12.0 Tf [(diseases, not as a result of a Darwinian survival of the fittest, but because time they were able to combat )] TJ ET BT 34.016 668.165 Td /F1 12.0 Tf [(infections and acquire immunity. In this context, it is worth stating that many factors led to the high death )] TJ ET BT 34.016 653.909 Td /F1 12.0 Tf [(rates amongst indigenes, such as, social dislocation, displacement, loss of lands, starvation, direct killing and )] TJ ET BT 34.016 639.653 Td /F1 12.0 Tf [(diseases. All of this better informs the central paradox of the story for Watts, namely, that the conditions that )] TJ ET BT 34.016 625.397 Td /F1 12.0 Tf [(led to the poor health of indigenes had been created by European imperialism, yet, the dominant assumption )] TJ ET BT 34.016 611.141 Td /F1 12.0 Tf [(in European medical and lay beliefs was this that it was due to other factors, their racial weaknesses, cultural )] TJ ET BT 34.016 596.885 Td /F1 12.0 Tf [(backwardness, ignorance and immorality.)] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(The chapter on syphilis covers the debate on its supposed importation from the New World, how its )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(incidence was affected by changes in social relations and urbanisation in Europe, anti-masturbation in the )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(eighteenth century, the controversies over the regulation of prostitution, and the disease in China. It is in this )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(chapter that the Construct - Reality distinction leads Watts to claim to be less historical than Foucault!)] TJ ET BT 34.016 501.605 Td /F1 12.0 Tf [()] TJ ET BT 64.016 475.234 Td /F1 12.0 Tf [(But in my hands, unlike those of Foucault, the word)] TJ ET BT 64.016 460.834 Td /F1 12.0 Tf [("knowledge" is usually synonymous with false)] TJ ET BT 64.016 446.434 Td /F1 12.0 Tf [(knowledge of "the earth flat" variety. Sometimes,)] TJ ET BT 64.016 432.034 Td /F1 12.0 Tf [(when drawn from the fount of ancient wisdom \(Plato,)] TJ ET BT 64.016 417.634 Td /F1 12.0 Tf [(Aristotle, Galen\), this false, flat-earth knowledge)] TJ ET BT 64.016 403.234 Td /F1 12.0 Tf [(was well-intentioned ignorance. On other occasions)] TJ ET BT 64.016 388.834 Td /F1 12.0 Tf [(it was an act of duplicity deliberately practised to)] TJ ET BT 64.016 374.434 Td /F1 12.0 Tf [(reinforce authority. \(p. 124\))] TJ ET BT 34.016 348.149 Td /F1 12.0 Tf [(Fortunately, such assumptions only intrude now and again into the main narrative of the chapter, as the )] TJ ET BT 34.016 333.893 Td /F1 12.0 Tf [(author continues to his usual synthetic aplomb.)] TJ ET BT 34.016 307.637 Td /F1 12.0 Tf [(The final chapters are the best in the volume, being more focused and set in specific imperial contexts. )] TJ ET BT 34.016 293.381 Td /F1 12.0 Tf [(Cholera and Civilization: Great Britain and India, 1817 to 1920 tells the story of cholera in India before and )] TJ ET BT 34.016 279.125 Td /F1 12.0 Tf [(after the Rebellion on 1857 and links this with the experience of the disease in the metropole. However, )] TJ ET BT 34.016 264.869 Td /F1 12.0 Tf [(much of this chapter is concerned with the social and economic history of each country, which unfortunately )] TJ ET BT 34.016 250.613 Td /F1 12.0 Tf [(are only erratically linked to specific epidemics and their management. For example, when discussing the )] TJ ET BT 34.016 236.357 Td /F1 12.0 Tf [(disease in India after the Rebellion, Watts details deteriorating social conditions and other changes that made )] TJ ET BT 34.016 222.101 Td /F1 12.0 Tf [(the spread of cholera much easier, but these are not linked to specific cholera outbreaks or new issues such )] TJ ET BT 34.016 207.845 Td /F1 12.0 Tf [(as pilgrimages. My reading is that the reluctance of the Anglo-Indian medical community to accept Koch's )] TJ ET BT 34.016 193.589 Td /F1 12.0 Tf [(cholera vibrio was well-grounded in the 'facts' and that the choices between different sanitary policies were )] TJ ET BT 34.016 179.333 Td /F1 12.0 Tf [(openly debated.)] TJ ET BT 34.016 153.077 Td /F1 12.0 Tf [(The discussion of yellow fever and malaria in chapter 6 is very detailed, and prefaced by an interesting )] TJ ET BT 34.016 138.821 Td /F1 12.0 Tf [(account of the modern understanding of the aetiology and pathology of both diseases. This information is )] TJ ET BT 34.016 124.565 Td /F1 12.0 Tf [(very useful in the reconstruction of the epidemiology of both diseases, though there must always be doubts )] TJ ET BT 34.016 110.309 Td /F1 12.0 Tf [(about whether seventeenth century 'Yellow Jack' equates exactly with the modern disease. The juxtaposition )] TJ ET BT 34.016 96.053 Td /F1 12.0 Tf [(of the discussion of both diseases in Barbados, Haiti, the United States, Brazil and Cuba is fascinating and )] TJ ET BT 34.016 81.797 Td /F1 12.0 Tf [(brings together well recent work by Margaret Humphrys, Ilana Lowy, Marcos Cueto and many others. What )] TJ ET BT 34.016 67.541 Td /F1 12.0 Tf [(these show, of course, is that the nature of the disease underdetermined human responses, and that public )] TJ ET BT 34.016 53.285 Td /F1 12.0 Tf [(health policies were highly politicised. Indeed, political problems increased after the achievements of Carlos )] TJ ET endstream endobj 20 0 obj << /Type /Page /Parent 3 0 R /Annots [ 22 0 R ] /Contents 21 0 R >> endobj 21 0 obj << /Length 5223 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(Finlay, Walter Reed, and William Gorgas massively raised expectations in colonies and the metropolis over )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(what tropical medicine could achieve. In discussing tropical medicine in West Africa, Watts rightly points to )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(the role that medical advice played in the establishment of residential segregation, though fear of malaria )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(was not the only factor. Moreover, it is ahistorical to suggest this advice was based on 'bogus science' \(p. )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(261-2\) as John Cell has shown it reflected one reading of the contemporary understanding of the aetiology of )] TJ ET BT 34.016 725.189 Td /F1 12.0 Tf [(malaria and was never exclusive, but linked with other measures as quinine prophylaxis, netting, screening )] TJ ET BT 34.016 710.933 Td /F1 12.0 Tf [(houses and drainage.)] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(The 'Afterword' is exactly what it says it is and not the concluding discussion I had hoped for. However, )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(implicit in the 'Afterword' are the two main themes of the book: \(i\) that Western colonial imperialism created )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(or has worsened many of the disease problems of the what is now the Third World; and \(ii\) that the disease )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(control measures deployed directly or indirectly by Western agencies to meet these problems have in many )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(instances been inappropriate. Few historians of Empire or medicine would disagree with either claim, though )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(they would want add many qualifications and make the points in a less judgmental way. First, ideas and )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(policies are only obviously 'inappropriate' with hindsight and from particular viewpoints; when introduced )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(they were based on the best knowledge available, not 'pseudoscience' or 'bogus science'. Second, public )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(health policies were developed in terms of judgements of what would 'work' and be 'appropriate' to political, )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(economic or social objectives at the time. Thus, it is hardly surprising that late nineteenth century doctors, )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(convinced of the superiority of white European civilisation and in West Africa to support the development of )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(an export economy, developed the disease control policies they did. It is too easy and inappropriate to )] TJ ET BT 34.016 513.605 Td /F1 12.0 Tf [(ridicule individuals and the agencies they worked for, the point for historians is to understand their )] TJ ET BT 34.016 499.349 Td /F1 12.0 Tf [(circumstances and what made their choices 'appropriate'. It is perhaps worth emphasising that there were )] TJ ET BT 34.016 485.093 Td /F1 12.0 Tf [(choices. Western medicine had within it many competing and changing ideas, which were given many )] TJ ET BT 34.016 470.837 Td /F1 12.0 Tf [(different meanings, and could in turn be used to support distinct programmes and policy objectives. For )] TJ ET BT 34.016 456.581 Td /F1 12.0 Tf [(example, from the 1900s it has been understood that malaria control could concentrate on attacking the )] TJ ET BT 34.016 442.325 Td /F1 12.0 Tf [(parasite in humans, trying to kill mosquito vectors, breaking mosquito-human contact by anything from )] TJ ET BT 34.016 428.069 Td /F1 12.0 Tf [(netting for individuals to resettling peoples, removing the environments where mosquitoes breed and live, or )] TJ ET BT 34.016 413.813 Td /F1 12.0 Tf [(improving general levels of health, sanitation, diet and well-being. Also, what was 'appropriate' also varied, )] TJ ET BT 34.016 399.557 Td /F1 12.0 Tf [(not just between colonisers and colonised, but between centre and periphery, government and private )] TJ ET BT 34.016 385.301 Td /F1 12.0 Tf [(ventures, between different private ventures, between missionaries and governments, and between experts. )] TJ ET BT 34.016 371.045 Td /F1 12.0 Tf [(Which returns me nicely to my initial points about the complexity of the histories of disease, power and )] TJ ET BT 34.016 356.789 Td /F1 12.0 Tf [(imperialism.)] TJ ET BT 34.016 330.533 Td /F3 12.0 Tf [(Other reviews:)] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [([2])] TJ ET 0.75 w 0 J [ ] 0 d 34.391 311.551 526.499 1.500 re S BT 34.016 293.771 Td /F3 12.0 Tf [(Source URL:)] TJ ET 0.000 0.000 0.800 rg BT 104.672 293.771 Td /F1 12.0 Tf [(http://www.history.ac.uk/reviews/review/104)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 104.672 292.377 m 322.316 292.377 l S 0.000 0.000 0.000 rg BT 34.016 267.400 Td /F3 12.0 Tf [(Links:)] TJ ET BT 34.016 253.000 Td /F1 12.0 Tf [([1] http://www.history.ac.uk/reviews/item/671)] TJ ET BT 34.016 238.600 Td /F1 12.0 Tf [([2] http://www.history.ac.uk/reviews)] TJ ET endstream endobj 22 0 obj << /Type /Annot /Subtype /Link /A 23 0 R /Border [0 0 0] /H /I /Rect [ 104.6717 292.6915 322.3157 304.5715 ] >> endobj 23 0 obj << /Type /Action /S /URI /URI (http://www.history.ac.uk/reviews/review/104) >> endobj xref 0 24 0000000000 65535 f 0000000008 00000 n 0000000073 00000 n 0000000119 00000 n 0000000349 00000 n 0000000386 00000 n 0000000563 00000 n 0000000645 00000 n 0000005448 00000 n 0000005557 00000 n 0000005667 00000 n 0000005776 00000 n 0000009337 00000 n 0000009465 00000 n 0000009549 00000 n 0000009614 00000 n 0000017088 00000 n 0000017153 00000 n 0000024735 00000 n 0000024800 00000 n 0000031411 00000 n 0000031495 00000 n 0000036771 00000 n 0000036899 00000 n trailer << /Size 24 /Root 1 0 R /Info 5 0 R >> startxref 36994 %%EOF