Review | Difference and Disease: Medicine, Race, and the Eighteenth-Century British Empire


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Suman Seth Difference and Disease: Medicine, Race, and the Eighteenth-Century British Empire (Cambridge University Press, 2018), pp. xv, 324 ISBN: 9781108418300

And you thought civility was a victim of today’s political culture.  In the eighteenth-century, differences of opinion over science could be every bit as virulently expressed, though instead of tweeting over climate chance it could be fighting a duel over the proper care in cases of yellow fever.  Two British physicians killed each other in Jamaica in 1750, essentially over whether one of them trained in Edinburgh should dare to contest the views on yellow fever of those physicians long experienced in the West Indies.  At the heart of their bloody dispute lay the question of to what extent were the diseases of the tropics really different from those of Europe? Tied in were, inevitably for that time, questions of social status.  That, as we know today, yellow fever was transmitted as a virus through the bite of mosquitoes would have made no sense to the reasoning of that time.

But the physicians then, both the gentlemen from British medical schools and the practical practitioners in the colonies, had grasped the concept of a ‘seasoning disease’ – that is, an illness which habituates the body to a particular environment or climate.  They paid a good deal of attention to what seemed diseases of ‘place,’ which affected neither natives nor those long in residence and to which strangers who fell ill and survived found themselves henceforth inured.  They paid little attention to differences in diseases distinctive to racial categories.

The author, a professor of science and technology at Cornell, explores precisely these connections, examining theories of medicine and science within a colonial, racially-mixed population. In particular, the role of eighteenth-century medicine in the construction of ‘race’ is pursued over a broad geographic scope, taking in materials derived not just from Britain’s tropical colonies, largely the East and West Indies, but also areas involved in Britain’s African slave trade, including North America.  Relationships between medicine, slavery, and abolitionism are key to his study.

At its core, the book is about the mutual shaping of medicine and the eighteenth-century British empire – what the author terms a ‘post-colonial history of colonial medicine.’  Here, he acknowledges that he is rubbing up against the grain of the recent trend in scholarship against the ‘post-colonial’ approach. Indeed, he does himself no good by citing Edward Said’s Orientalism, a work long exposed as a masterpiece in bogus scholarship.  But we can forgive this slip because Professor Seth, in some seven chapters, has produced a model work of intellectual history – in his own words, a ‘profoundly context-laden history of arguments’ drawing deeply on social histories of colonialism, medicine, and slavery.

The physicians of the time were prolific in their publications, though most did not resort to duels with their opponents.  An example was William Hillary who produced the highly influential Observations on the Changes of the Air, and the Concomitant Epidemical Diseases in the Island of Barbadoes in the mid-1700s.  Such ‘colonial’ tracts eventually produced a sea-change in which understandings of medicine in the periphery informed medical studies at home.  Similarly, such tracts effected a shift in ‘race-medicine’ (a term coined by Professor Seth) from indifference to considerations of racialized physical differences.  Did, that is, a given race exhibit a propensity towards certain diseases?  This shift, in the author’s findings, dated from the ‘hardening conceptions of race as part of a response to the abolitionist movement, beginning roughly in the 1760s.’  In other words, we have the paradox of a growing understanding of the epistemology of tropical diseases being interconnected with, if not driven by, increasing justifications of slavery.  Racial theories of the time are, accordingly, given a thorough examination and are found to arise from ‘concrete responses to abolitionist critiques,’ with the ‘race-science’ prevalent in the West Indies and other slave societies diverging increasingly from racial attitudes in Britain, especially towards slavery itself – colonial racial theorists, such as Edward Long, author of a massive History of Jamaica (1774), being impelled by concern for the maintenance of existing social relations and political systems in a slave society.  We find the same blinkered determinist theorizing in ante-bellum justifications of slavery in such American Southerners as George Fitzhugh.

But our author is concerned with such intellectual activity only insofar as it affected medical theorizing and treatment.  He finds that a growing consensus on race, from the late 1700s, reducing racial categorizing from near-innumerable ‘nations’ to a comprehensibly small number of races, was intertwined with a like grouping of ‘tropical’ diseases, micro-climatic differences giving way to a simpler overall distinction between temperate and tropical climes.  It would seem that how Britons understood their empire was conditioned by how they understood both race and disease.

A review copy of this book was received.

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