The Lancet: John Snow Myth Hides Public Health's Roots in Slavery and Empire

The John Snow Society describes their illustrious namesake as “the pioneer of epidemiological method”. His identification of the source of cholera in Soho, London, and the removal of the handle of a water pump in Broad Street in 1854 is celebrated annually with the Pumphandle Lecture. The London School of Hygiene and Tropical Medicine named a lecture theatre after Snow. Indeed, the epidemiology community has deified Snow as a founding father of public health. But, as Jim Downs argues in his searching reappraisal of the origins of epidemiology, Maladies of Empire, western epidemiologists have invented a comforting myth, one that disguises the horrific reality of a discipline that grew out of colonialism, slavery, and war.

The Lancet shares in the guilt. Downs opens his account with the story of Robert Thomson, a London physician who, in 1839, reported evidence from Thomas Trotter, a Scottish naval surgeon on board Brookes, a slave ship, in the 1780s. Trotter was employed to guard the health of African slaves and to ensure that as many as possible would survive to be sold in the slave markets of England. He had studied how long a human being could survive without food. The person in question was an African man sold into slavery. He rebelled against the extreme privations of his journey and refused all food, despite attempts by the ship's crew to force-feed him. Over a week later, he died. What mattered to Thomson—and to The Lancet it seems—was the man's extraordinary ability to survive so many days without sustenance. Downs goes on to elaborate an alternative history of epidemiology and public health. The intensely crowded environments that African slaves were forced to inhabit were exploited by physicians to investigate the spread of disease. From such studies, these early epidemiologists recommended larger slave ships carrying fewer slaves and with improved ventilation and supplies of food and water. The vast colonial and military bureaucracies created by European powers provided standardised record-keeping systems for collecting and verifying data. The administrative infrastructure of Empire established a foundation for the new science of epidemiology. Large populations living under subjugation offered ample opportunities for investigating disease outbreaks. The poor became objects of inquiry. The dispossessed were a medium to track the evolution of epidemics. Imperialism codified knowledge. Knowledge strengthened Empire. Both fuelled war. Physicians, under the guise of science, became the instruments by which colonial ideas were exchanged, networks created, and practices refined. War provided further opportunities for these embryonic epidemiologists. Casualties occupying military hospitals became fertile human material for studying disease transmission. From the Crimean War to the Indian Rebellion, military medicine flourished as a byproduct of state-sponsored savagery. These histories were erased from subsequent scientific publications. Enslaved Africans vanished from heroic stories of exploration and discovery. Downs concludes, “I argue that part of the origin story of epidemiology has been overlooked because it resulted from studying people who suffered from war, enslavement, and imperialism—most of whom were people of color—in Africa, the Caribbean, India, and the Middle East.” “Slavery is imprinted on the DNA of epidemiology”, he writes.