Epidemics and History: Disease, Power, and Imperialism.

By Sheldon Watts (New Haven: Yale University Press, 1997. xvi plus 400pp.).

Sheldon Watts argues that the impact of epidemic disease is inseparable from the uses and distribution of power. Adopting a global approach, Watts concludes that most epidemics were made considerably more lethal because of European imperialist policies, including those ostensibly aimed at controlling and eradicating disease. These policies, imbedded in racist and self-serving capitalist rationales, had a long-term effect on the health of the formerly colonized because many of them adopted the values and methods of their oppressors when they took over local battles against epidemic disease. To make his case Watts examines epidemics of bubonic plague, leprosy, smallpox, syphilis, cholera, yellow fever, and malaria. These discussions create the context for a brief examination of AIDS and the Anglo-American advertising campaign to export tobacco products and, along with them, lung cancer and heart disease.

Watts, a social historian who teaches in Egypt and Africa, argues that it is impossible to understand imperialism, or historical process for that matter, without considering the role of epidemic disease. He also demonstrates that disease cannot be detached from the historical/political context in which it takes place. Watts never allows a political, cultural, or disciplinary border to limit his investigation. His discussion of cholera in Britain and India (Chapter 5) is a tour de force worth the price of the book. Epidemics and History is not easy reading; at times Watts' considerable grounding in history takes him on journeys that will challenge the most interested reader's memory. To his credit, however, Watts is always able to reconnect his diversions to his central point.

Watts rejects the standard narrative attributing Islamic leaders' resistance to quarantine measures to their failure to understand how bubonic plague is transmitted. Tying the European practice of quarantine to a scapegoating mentalite that identified the origin of disease in the "other," Watts explains that, from this perspective, quarantine made no sense to the fourteenth-century Mamluk elites of Cairo. Dependent on universal tax assessment, Mamluks were reluctant to single out any group as plague carriers, as the Europeans had done with the Jews. Centuries later, when Islamic leaders like Muhammad Ali adopted quarantine measures (1820s-1840s) they drew on Islamic injunctions that one should not enter or leave a country that had plague. By this time, Watts points out, Europeans were so dependent on Egyptian trade that they resisted Muhammad Ali's injunction against shipping during the plague outbreaks.

Similarly, Watts rejects the view of historians, including Foucault and his followers, who have portrayed the reaction to leprosy (Hansen's disease) as uniformly aimed at confinement of the afflicted.(1) In contrast, Watts argues that the "medieval responses to 'leprosy' were actually a heterogenous hodgepodge which left most 'lepers' wandering about at will" (p. 41). Watts is unpersuaded by Mary Douglas's claims that leprosy was constructed as a means of social control(2) insisting instead that the threat of epidemic was real. Placing leprosy in a global context, Watts finds the view of European historians "that humans everywhere regarded leprosy as a stigmatizing disease was itself a cultural construct formed by the hegemonic few in the West." In contrast, Watts examines the reaction to leprosy in Hawaii, India, and Africa, concluding that in these places "most other people tended to regard leprosy as a disease like any other" (pp. 52-53).

Watts reminds us that in Western "construct" formulations, "New World peoples" were portrayed as lacking "the mental potential to develop into rational European-type adults" (p. 84). This belief, combined with the inadvertent importation of smallpox by Columbus and his fellow travelers, devastated the indigenous population along with its entire institutional structure. Watts repeats the often-told tale of Sir Jeffrey Amherst's direction that smallpox-infected blankets be distributed to Native Americans during Pontiac's war, causing an outbreak of the disease (p. 100). However, Watts' later discussion (p. 112) that Africans in the 1770s practiced variolation (inoculation) by wearing clothing or parts of bedding containing smallpox scabs should have alerted him to the implausibility of smallpox transmission via blankets. If Europeans did attempt to infect native peoples with smallpox blankets, they may have inadvertently inoculated them.(3)

Watts' discussion of syphilis in Western Europe and East Asia offers the novel argument that Western values of sexual repression, especially as they manifested themselves in prohibitions against masturbation, led to an increase in extramarital sexual intercourse, especially with prostitutes. This, in turn, magnified the transmission of syphilis and other sexually transmitted diseases. By the mid-nineteenth century, European missionaries and physicians "exported Western moral entrepreneurship into China," including a portmanteau of sexually repressive injunctions. This process, informed by "a righteousness born of Sinophobia and power/false knowledge," uncovered a syphilis epidemic "on a scale unknown anywhere else" (pp. 124-125). European medical missionaries proceeded to attempt to limit disease transmission by attacking prostitution. However, what these Europeans had uncovered was, according to Watts, "construct syphilis," because Westerners had confused sexually transmitted venereal syphilis with two non-sexually transmitted treponema diseases, yaws and endemic syphilis, both of which also yield positive results in Wasserman tests.

Similar biases ensured that the when cholera struck India, British colonial policies would exacerbate the epidemics, which left more than 25 million dead from 1857 until independence. Although, beginning with John Snow's famous 1854 experiment, evidence increasingly suggested that cholera was imported, leaders of the British Army's Indian Sanitary Commission reinforced the beliefs of the colonial government that "cholera was caused solely by local sanitary imperfections centered on bad air, bad water, bad conservancy and all other 'filthy habits' of the local people" (p. 205, italics in original). Even after the mechanisms of transmission of the vibrio cholera were demonstrated by Koch in 1884 (through his examination of water tanks in Calcutta), British engineers continued to build canals and the colonial bureaucracy initiated land policies that guaranteed that cholera outbreaks would result in massive loss of life. When these predictable disasters occurred, the victims were blamed for habits traced "from time immemorial" (p. 202). Building on his discussion of cholera, Watts concludes that "the complex process known as Development - involving the movement of huge numbers of humans and ships - greatly assisted the causal agents of falciparum malaria and yellow fever in causing plagues of disease on both the African and American sides of the Atlantic" (p. 214).

It is impossible to do justice to the complexity of Watts' story in a short review or to raise issues with some of his interpretations without seeming petty or nitpicking. Although the totality of his claims raises a number of questions that call for deeper exploration, Watts deserves enormous credit for a pioneering work that integrates disease into the mechanisms of imperialism in a manner that both builds on and transcends the earlier contributions of McNeill and Crosby.(4)

Howard I. Kushner

San Diego State University 

ENDNOTES

1. Michel Foucault, Madness and Civilization (New York, 1965), pp 4-5.

2. Mary Douglas, "Witchcraft and Leprosy: Two Strategies of Exclusion," Man, new series, 26 (December 1991): 723-736.

3. Although the Amherst story and the purposeful transmission of smallpox to Native Americans via blankets are persistent in historical literature since Francis Parkman, my graduate student Paula Braitstein recently has shown that the evidence for both is historically questionable and scientifically unsound. Paula Braitstein, "Deconstructing History: An Interdisciplinary Examination of the Use of Germ Warfare in North American Encounter History," MA, Simon Fraser University, 1998.

4. William H. McNeill, Plagues and Peoples (New York, 1976); Alfred W. Crosby, The Columbian Exchange: Biological and Cultural Consequences of 1492 (Westport, CT, 1972); Alfred Crosby, Ecological Imperialism: The Biological Expansion of Europe, 900-1900 (New York, 1986).