Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine

by Jim Downs

A sweeping global history that looks beyond European urban centers to show how slavery, colonialism, and war propelled the development of modern medicine.

Most stories of medical progress come with ready-made heroes. John Snow traced the origins of London’s 1854 cholera outbreak to a water pump, leading to the birth of epidemiology. Florence Nightingale’s contributions to the care of soldiers in the Crimean War revolutionized medical hygiene, transforming hospitals from crucibles of infection to sanctuaries of recuperation. Yet histories of individual innovators ignore many key sources of medical knowledge, especially when it comes to the science of infectious disease.

Reexamining the foundations of modern medicine, Jim Downs shows that the study of infectious disease depended crucially on the unrecognized contributions of nonconsenting subjects—conscripted soldiers, enslaved people, and subjects of empire. Plantations, slave ships, and battlefields were the laboratories in which physicians came to understand the spread of disease. Military doctors learned about the importance of air quality by monitoring Africans confined to the bottom of slave ships. Statisticians charted cholera outbreaks by surveilling Muslims in British-dominated territories returning from their annual pilgrimage. The field hospitals of the Crimean War and the U.S. Civil War were carefully observed experiments in disease transmission.

The scientific knowledge derived from discarding and exploiting human life is now the basis of our ability to protect humanity from epidemics. Boldly argued and eye-opening, Maladies of Empire gives a full account of the true price of medical progress.

Genres: History, Nonfiction, Science, Medicine, Medical, Health, Race

272 pages, Hardcover

First published September 7, 2021

About the author

Jim Downs is Gilder Lehrman–National Endowment for the Humanities Professor of Civil War Era Studies and History at Gettysburg College. He is the editor of Civil War History and author and editor of six other books, including Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction.

Reviews

[Coral Opal · Rating 3 out of 5]

I wouldn't recommend this book. It is an academic read—not dense: academic. It is wildly repetitive and I had to struggle through the last chapter so that I could say I had finished it. The thesis is undeniably important, and incorporation of theories of the marginalized into the always-dominant sciences should never be overlooked, I just don't think this is a good read.

The book should be a 200-page journal article. If that sounds interesting to you, and you enjoy Jim Downs repeating the thesis of a given chapter after every. single. piece of evidence. then give this one a read.

(Also, Jim, dear boy, I assure you, we got the point of Radcliffe's detailed descriptions. You didn't have to write SIX FULL PAGES just paraphrasing Radcliffe's analyses. I did NOT need to know how and when cholera was documented in and spread through (and these are all within six pages): Jeddah, Mecca, Makalla, southern and western Arabia, the Gulf of Aden, Bombay, Persia, Suez, Alexandria, North Africa, Malta, Greece, Turkey, Beirut, Aleppo, Syria, Valencia, Marseilles, Spain, Ancona, Pistoia, Gibraltar, Britain, Kourra, Suk-el-suk, Samava, Divamieh, Iman-Ali, Kerbellah, Baghdad, West Africa, Massawa, and Abyssinia.)

[Dina · Rating 3 out of 5]

The material is very interesting, but this book could have been twice shorter and less chaotic. This topic gives a lot of food for thought and I especially enjoyed the history of medicine. However, I am an epidemiologist and “my tastes are very singular”, so I can imagine if other people would be bored to death with this monograph. 😁 Anyway, this book explains why even in our supposedly more educated time, I find the most racist and ignorant “ethnicity/race” variable in our cohort data (and its existence in the first place) that makes me laugh and cry for these western people who couldn’t even classify themselves. 🥲

P.S. The narrator of the audiobook is the worst! Not only he sounded less natural than Siri and made the book sound dry, but he even made long pauses in the middle of the sentence or just after one word for no reason at all which just kept driving me mad. 🤦🏻‍♀️

[Ms211 · Rating 4 out of 5]

Jim Downs's monograph, Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, is an innovative attempt to apply techniques used in colonial history to medical narratives. The creative researcher focuses on pulling threads out of the historical record representing the voiceless in colonial history. Downs's social history starts during British colonialism by tracing the enslaved with their contribution to early epidemiologists. Downs argues that the beginnings of epidemiology occurred well before the urban sanitation treatment of cholera in Europe. Downs's monograph has a broad timespan, from case studies in the late 1700s on slave ships to the cholera pandemic of 1865. Downs states that the origin story of epidemiology has been overlooked because the people observed were overlooked. Downs's work is ambitious in scope with a social reckoning of giving voice to the masses who helped early scientists. Jim Downs claims to follow a black feminist methodology. Rarely does he succeed. Downs is more focused on the physician sources and one nurse to show the true founders of epidemiology, and the people he wants to speak for are still hidden.
Maladies of Empire has eight chapters in chronological order to build on his true forerunners to epidemiology. The first four chapters are related to case studies during British colonialism. Downs's work revisits the false beliefs of miasma and the conflict of contagion versus anticontagion. As the reader, it is best to know the background of medical historians as his secondary sources list Foucault, Rosenberg, and Letour. His argument about the true beginnings of epidemiology is an adjunct and a challenge to Charles Rosenberg's work, The Cholera Years. His first chapter, "Crowded Places," and his second chapter, "Missing Persons," review multiple scientists that predate urban sanitary reform history. For example, he examines how Stephen Hales invented ventilators in 1755 to protect the financial investment, enslaved people on slave ships from dying from miasma. Downs jumps from one white male observer to another, doctors researching miasma, cholera, and yellow fever. In "Epidemiology's Voice, Tracing Fever in Cape Verde," Downs focused on the investigator, James McWilliam, of a yellow fever outbreak on Boa Vista and the British ship, Éclair. In this chapter, Downs's argument for the true beginning of epidemiology is more robust. McWilliam interviewed over a hundred colonized people to better understand the transmission of an epidemic. The concluding chapter of this section, titled "Recordkeepings," is Downs's review of the contribution of British imperialism on epidemiology. Downs picks one leading observer, Gavin Milroy, on the cholera outbreak in Jamaica. Like any disrupter of orthodoxy, Downs notes that Milroy drew attention to the water supply before John Snow ever traced cholera from one well in London. These four chapters did not voice the people observed in jails, hospitals, or slave ships. Downs explains that the incomplete, fragmented portrait of their lives is due to the doctors' overwhelming recommendations, which Downs has failed to suppress. Downs's work on the sources shifts to war as the transformative force in epidemiology.
In the following three chapters, Downs's methodological technique is on firmer ground with the Crimean War and the Civil War. Interestingly, Downs neglects the contribution of all other military conflicts. Chapter five, Florence Nightingale, the Unrecognized Epidemiologist of the Crimean War and India, Downs's purpose is to correct the historical record. Unfortunately, this chapter reads like a "Great woman history" with complete neglect of the voices of the Indian oppressed people used as statistics for Nightingale's work.
Chapters six and seven are based on his previous work on African American health in the Civil War. Chapter six, "From Benevolence to Bigotry," is on forming the United States Sanitary Commission. Union physicians advanced racism for the USSC that became medically codified for physicians in the United States. "During a war fought to liberate Black people from bondage in the name of equality, the USSC created reams of data purporting to show that Black people were innately inferior."
In chapter seven, "Sing, Unburied, Sing," Jim Downs finds his black feminist method. Downs reviews the massive vaccination efforts in the South by taking variolation material from living enslaved infants who had less risk of transmitting skin infections to the Confederates who needed protection from smallpox. "The history of harvesting human lymph on enslaved children's bodies was almost lost in the annals of history." Later in this chapter, Jim Downs discusses deadly variolation from infected adults onto prisoners of war at the infamous Andersonville prison. Downs's evenhanded approach to the medical testimony about the death of prisoners from vaccination seems to imply agreement with their testimony. I am afraid I must disagree here with Down's approach. By 1864, Confederate doctors would have known how festering wounds acted and were infectious. Specifically, injecting prisoners from other people with staph-infected pox wounds can be deadly in the immunocompromised, and I suspect those Confederate physicians were rightfully convicted.
In his final chapter," Narrative Maps," Downs jumps in time to discuss the cholera pandemic of 1865 to 1866. This chapter is an abrupt transition from war to the study of cholera transmission by physician observers. "The military and medical narratives about the 1865-1866 pandemic…advanced the development of epidemiology." Downs wants these physicians who wrote narrative observations to be remembered. Alas, the voices of the oppressed and the Muslim pilgrims blamed for the pandemic are lost.
Downs's argument that imperialism of the British Empire and Civil War contributed to the origins of epidemiology is an innovative work that hopefully will revive new research methodology in medical history. Downs illuminates Florence Nightingale, Elisha Harris, and many other doctors as important to epidemiology as John Snow. Overall, Downs's work is too broad in chronology, neglecting other European colonies or revolutionary wars. Downs loses his black feminist methodology repetitively in his quest to correct the historical originators of epidemic medicine. Downs best conveyed enslaved peoples' voices to epidemiology from the American Civil War. From Downs's eye-opening work, the next time I mark race on a medical history form, I will remember how the United States Sanitary Commission focused on race instead of contagion. Jim Downs's social history illuminates the true beginning of government-sanctioned medical racism that has impacted each generation well past the Civil War.

This is a copy of my book review in my History of Disease class, have lost formatting in this review and the footnotes.

[Erik Champenois · Rating 3 out of 5]

An interesting history of how marginalized populations (slaves, the colonized, the imprisoned, and soldiers) are the basis of much of modern day medical progress. Focuses on telling the stories of people who were, often unwillingly, the targets of medical research. Walks us through various different theaters - colonialism, slavery, and war - across different parts of the world. The book in my opinion lacks a more focused structure or core argument - it would have been interesting to focus on colonialism or slavery only rather than going as broad as the author did. Still, a good overview and helpful for understanding how modern medical progress has often been made on the backs of the underprivileged.

[Wren Worthington · Rating 2 out of 5]

I really wanted to like this book, it's full of information on several subjects I find fascinating. But god it was badly written. The sentence structure was almost always ridiculously long and meandering, and the way the author kept reiterating the same points over and over made me feel like he was trying to hit a wordcount for an essay. This could have been 50 pages shorter and conveyed the same information.

[David Schwan · Rating 4 out of 5]

A winding and twisted tale of how the science of epidemiology came about.

This book has an interesting set of haters, most of which seem to come from the author's refusal to play sides in certain controversies. A key notion is the interplay between the Sanitary people and the Germ Theory people. The Sanitary people pushed for people's surroundings to be cleaned up and espoused what we would call the "bad air" version of medicine. Contrasting are the Germ Theory people who insisted that disease was due to bacteria, viruses and fungi. Between Koch and the famous pump handle in London, germ theory won, and bad air lost. This would have dire consequences when the Covid epidemic hit. Prior to Covid it was rare for diseases to be spread strictly by airborne means (Tuberculous is one of the few exceptions), all other diseases involved touching some surface and picking up the disease from the surface, hence bad air did not cause disease. Initially, Covid was treated like the flu, and we sanitized everything in site. Soon enough some researchers showed that Covid was transmitted from breathing in contaminated air and that face masks, especially high-quality ones slowed the transmission of the disease. Many people felt betrayed by scientists for the reversal of their position. So an overcorrection regarding the bad air theory drove science for more than a decade.

The book's author walking the line between competing theories in the end shows the reader that in a sense both sides were right in the end.

[Oamiya Haque · Rating 4 out of 5]

4.5/5 -- This book made me interested in non fiction! Some parts were a bit clunky and I think the sentiment that "x researcher was racist BUT contributed to the study" is flawed. Overall, does solid justice to the explaining how medical advancement depended on ignored and abused peoples, and highlights the importance of archival efforts! I especially like the little stories told at the start of most chapters.

[Hannah]

13%

Bored :(

[Stan Prager · Rating 5 out of 5]

Review of: Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine,
by Jim Downs
by Stan Prager (5-31-22)

As the COVID-19 pandemic swept the globe in 2020, it left in its wake the near-paralysis of many hospital systems, unprepared and unequipped for the waves of illness and death that suddenly overwhelmed capacities for treatment that were after all at best only palliative care, since for this deadly new virus there was neither a cure nor a clear route to prevention. Overnight, epidemiologists—scrambling for answers or even just clues—became the most critically significant members of the public health community, even if their informed voices were often shouted down by the shriller ones of media pundits and political hacks.
Meanwhile, data collection began in earnest and the number of data dashboards swelled. In the analytical process, the first stop was identifying the quality of the data and the disparities in how data was collected. Was it true, as some suggested, that a disproportionate number of African Americans were dying from COVID? At first, there was no way to know since some states were not collecting data broken down by this kind of specific demographic. Data collection eventually became more standardized, more precise, and more reliable, serving as a key ingredient to combat the spread of this highly contagious virus, as well as one of the elements that guided the development of vaccines. Even so, dubious data and questionable studies too often took center stage both at political rallies and in the media circus that echoed a growing polarization that had one side denouncing masks, resisting vaccination, and touting sideshow magic bullets like Ivermectin. But talking heads and captive audiences aside, masks reduce infection, vaccines are effective, and dosing with Ivermectin is a scam. How do we know that? Data. Mostly due to data. Certainly, other key parts of the mix include scientists, medical professionals, case studies, and peer reviewed papers, but data—first collected and then analyzed—is the gold standard, not only for COVID but for all disease treatment and prevention.
But it wasn’t always that way.
In the beginning, there was no such thing as epidemiology. Disease causes and treatments were anecdotal, mystical, or speculative. Much of the progress in science and medicine that was the legacy of the classical world had long been lost to the west. The dawn of modern epidemiology rose above a horizon constructed of data painstakingly collected and compiled and subsequently analyzed. In fact, certain aspects of the origins of epidemiology were to run concurrent with the evolution of statistical analysis. In the early days, as the reader comes to learn in this brilliant and groundbreaking 2021 work by historian Jim Downs, Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, the bulk of the initial data was derived from unlikely and unwilling participants who existed at the very margins: the enslaved, the imprisoned, the war-wounded, and the destitute condemned to the squalor of public hospitals. Their identities are mostly forgotten, or were never recorded in the first place, but yet collectively the data harvested from them was to provide the skeletal framework for the foundation of modern medicine.
In a remarkable achievement that could hardly be more relevant today, the author cleverly locates Maladies of Empire at the intersection of history and medicine, where data collection from unexpected and all too frequently wretched subjects comes to form the very basis of epidemiology itself. It is these early stories that send shudders to a modern audience. Nearly everyone is familiar with the wrenching 1787 diagram of the lower deck of the slave ship Brookes, where more than four hundred fifty enslaved human beings were packed like sardines for a months-long voyage, which became an emblem for the British antislavery movement. But, as Downs points out, few are aware that the sketch can be traced to the work of British naval surgeon Dr. Thomas Trotter, one of the first to recognize that poor ventilation in crowded conditions results in a lack of oxygen that breeds disease and death. His observations also led to a better understanding of how to prevent scurvy, a frequent cause of higher mortality rates among the seaborne citrus-deprived. Trotter himself was appalled by the conditions he encountered on the Brookes, and testified to this before the House of Commons. But that was hardly the case for many of his peers, and certainly not for the owners of slave ships, who looked past the moral dilemmas of a Trotter while exceedingly grateful for his insights; after all, the goal was keep larger quantities of their human cargo alive in order to turn greater profits. Dead slaves lack market value.
A little more than three decades prior to Trotter’s testimony, the critical need for ventilation was documented by another physician in the wake of the confinement of British soldiers in the infamous “Black Hole of Calcutta” during the revolution in Bengal, which resulted in the death by suffocation of the majority of the captives. Downs makes the point that one of the unintended consequences of colonialism was that for early actors in the medical arena it served to vastly extend the theater of observation of the disease-afflicted to a virtually global stage that hosted the byproducts of colonialism: war, subjugated peoples, the slave trade, military hospitals and prisons. But it turns out that the starring roles belong less to the doctors and nurses that receive top billing in the history books than to the mostly uncredited bit players removed from the spotlight: the largely helpless and disadvantaged patients whose symptoms and outcomes were observed and cataloged, whose anonymous suffering translated into critical data that collectively advanced the emerging science of epidemiology.
Traditionally, history texts rarely showcased notable women, but one prominent exception was Florence Nightingale, frequently extolled for her role as a nurse during the Crimean War. But as underscored in Maladies of Empire, Nightingale’s real if often overlooked legacy was as a kind of disease statistician through her painstaking data collection and analysis—the very basis for epidemiology that was generally credited to white men rather than to “women working in makeshift hospitals.” [p111] But it was the poor outcomes for patients typically subjected to deplorable conditions in these makeshift military hospitals—which Nightingale assiduously observed and recorded—that drew attention to similarly appalling environments in civilian hospitals in England and the United States, which led to a studied analysis that eventually established systematic evidence for the causes, spread, and treatment of disease.
The conclusions these early epidemiologists reached were not always accurate. In fact, they were frequently wrong. But Downs emphasizes that what was significant was the development of the proper analytical framework. In these days prior to the revolutionary development of germ theory, notions on how to improve survival rates of the stricken put forward by Nightingale and others were controversial and often contradictory. Was the best course quarantine, a frequent resort? Or would improving the sickbed conditions, as Nightingale advocated, lead to better outcomes? Unaware of the role of germs in contagion, evidence could be both inconclusive and inconsistent, and competing ideas could each be partly right. After all, regardless of how disease spread, cleaner and better ventilated facilities might lead to lower mortality rates. Nightingale stubbornly resisted germ theory, even as it was widely adopted, but after it won her grudging acceptance, she continued to promote more sanitary hospital conditions to improve survival rates. Still, epidemiologists faced difficult challenges with diseases that did not conform to familiar patterns, such as cholera, spread by a tainted water supply, and yellow fever, a mosquito-borne pathogen.
In the early days, as noted, European observers collected data from slave ships, yet it never occurred to them that because their human subjects were black such evidence was not applicable to the white population. But epidemiology took a surprisingly different course in the United States, where race has long proved to be a defining element. Of the more than six hundred thousand who lost their lives during the American Civil War, about two-thirds were felled not by bullets but by disease. The United States Sanitary Commission (USSC) was established in an attempt to ameliorate these dreadful outcomes, but its achievements on one hand were undermined on the other by an obsession with race, even going so far as the sending out to “. . . military doctors a questionnaire, ‘The Physiological Status of the Negro,’ whose questions were based on the belief that Black soldiers were innately different from white soldiers . . . The questionnaire also distinguished gradations of color among Black soldiers, asking doctors to compare how ‘pure Negroes’ differed from people of ‘mixed races’ and to describe ‘the effects of amalgamation on the vital endurance and vigor of the offspring.’” With its imprimatur of governmental authority, the USSC officially championed scientific racism, with profound and long-term social, political, and economic consequences for African Americans. [p134-35]
Some of these notions can be traced back to the antebellum musings of Alabama surgeon Josiah Nott—made famous after the war when he correctly connected mosquitoes to the etiology of Yellow Fever—who asserted that blacks and whites were members of separate species whose mixed-race offspring he deemed “hybrids” who were “physiologically inferior.” Nott believed that all three of these distinct “types” responded differently to disease. [p124-25] His was but one manifestation of the once widespread pseudoscience of physiognomy that alleged black inferiority in order to justify first slavery and later second-class citizenship. Such ideas persisted for far too long, and although scientific racism still endures on the alt-right, it has been thoroughly discredited by actual scientists. It turns out that a larger percentage of African Americans did indeed succumb to death in the still ongoing COVID pandemic, but this has been shown to be due to factors of socioeconomic status and lack of access to healthcare, not genetics.
Still, although deemed inferior, enslaved blacks also proved useful when convenient. The author argues that “… enslaved children were most likely used as the primary source of [smallpox] vaccine matter in the Civil War South,” despite the danger of infection in harvesting lymph from human subjects in order to vaccinate Confederate soldiers in the field. In yet one more reminder of the moral turpitude that defined the south’s “peculiar institution,” the subjects also included infants whose resulting scar or pit, Downs points out, “. . . would last a lifetime, indelibly marking a deliberate infection of war and bondage. Few, if any, knew that the scars and pit marks actually disclosed the infant’s first form of enslaved labor, an assignment that did not make it into the ledger books or the plantation records.” [p141-42]
Tragically, this episode was hardly an anomaly, and unethical medical practices involving blacks did not end with Appomattox. The infamous “Tuskegee Syphilis Study” that observed but failed to offer treatment to the nearly four hundred black men recruited without informed consent ran for forty years and was not terminated until 1972! One of the chief reasons for COVID vaccine hesitancy among African Americans has been identified as a distrust of a medical community that historically has either victimized or marginalized them.
Maladies of Empire is a well-written, highly readable book suitable to a scholarly as well as popular audience, and clearly represents a magnificent contribution to the historiography. But it is hardly only for students of history. Instead, it rightly belongs on the shelf of every medical professional practicing today—especially epidemiologists!


Review of: Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine, by Jim Downs https://regarp.com/2022/05/31/review-...

[Tutankhamun18 · Rating 5 out of 5]

This book examines how disease shaped the expansion, governance, and moral logic of European empires from the seventeenth through the nineteenth centuries. Downs argues that imperial powers framed illness not simply as a biological problem but as a political and cultural one, using disease to justify conquest, racial hierarchies, and systems of control. Epidemics such as smallpox, yellow fever, and cholera influenced military strategy, labor systems, and colonial settlement, while also exposing the vulnerability of empires that claimed superiority and mastery. Downs shows that colonial authorities often ignored or minimized the suffering of enslaved and colonized peoples, even as they relied on their bodies and labor to sustain imperial economies.

Analytically, the book challenges triumphalist narratives of empire by centering fragility, fear, and failure rather than progress and power. Downs highlights how medical knowledge was uneven, experimental, and frequently shaped by racial assumptions, leading to policies that intensified suffering rather than alleviating it. By connecting disease history to imperial ideology, he demonstrates that medicine was not a neutral or purely humanitarian force but deeply entangled with exploitation and governance. Overall, it reframes empire as a project constantly threatened by illness, revealing how responses to disease reinforced inequality and left lasting legacies in global health and political structures.

Throughout the book Downs examines how recordings about disease outbreak excluded the circumstances under which observations were made and thereby erased the role of enslaved and colonised people including their own knowledge systems. He also highlights the difference in attitudes between Britain and America, where British doctors record their observations using racists terms, they do not put the blame on racial difference but instead focus on cramped and unclean conditions. In America recording disease outbreaks and spreads entrenched racial prejudice about heritability and succeptability into the science.

Another really interesting thing that this book brings to light was Florence Nightingale’s role as an epidemiologist.

QUOTES


“Long before medical anthropologists coined the term "structural violence" to describe how poverty, violence, and other forms of oppression increase the incidence and severity of dis-ease, Trotter recognized that the pain and anguish of enslavement could predispose people to become sick.?7 He focused on the slave trade itself rather than on individual characteristics or racial identity.”

“Trotter's analysis depended upon his observations of enslaved Africans on the Brookes, but when he published his treatise he referred to them in the introduction as "a multitude of cases."33 This phrase legitimates his study by highlighting its reliance on empirical observations, but it obscures that many of these "cases" were actually enslaved Afri-cans. Writing for an audience of his medical professional peers, he uses clinical language that erases how the conditions at the bottom of the slave ship created an unhealthy environment that enabled him to develop an argument about the cause, cure, and prevention of scurvy. As a result, enslaved Africans disappear as key players in the creation of new scientific knowledge.”

“Read in isolation, one would not know that this treatise was a more refined theoretical sequel to an analysis grounded in the material reality of slavery. One would not know that enslaved Africans' cries became proof that compelled officials to consider ventilators. One would not know that the international slave trade led to a major new advancement in the construction of naval fleets.
The elision of slavery from the title of Hales's treatise could be simply the result of popular rhetorical practice: there was no need to distinguish slave ships from others in the royal fleet. But when placed alongside Trotter's treatise on scurvy, the absence of slavery seems less accidental or even customary and more a result of a pattern: as the scientific ideas evolved from first-hand accounts to medical theories, slavery seems to fall into the category of "cases," in Trotter's book, or "trials" in Hales's case, as in the subtitle of his treatise.”

“As the empire grew, a standardized system of recordkeeping developed that involved writing medical reports and sending them to medical and government authorities in the metropole." This system formalized the process of turning observations into theories. Throughout the British Empire, physicians witnessed firsthand the outbreak of epidemics-from plague to yellow fever to cholera. Recordkeeping provided a framework for investigating. processing, analyzing, maintaining, preserving, and later archiving doctors' responses to epidemics.”

“A bureaucracy that had been established in the service of war, colonialism, and imperialism emerged as the foundation for the development of epidemiology.”

“The advances that military doctors made during slavery and the expansion of the British Empire between 1755 and 1853 affected how medical authorities on the battlefield documented, interpreted, and understood the spread of disease. Similarly, wartime medicine produced important studies that advanced the field of epidemiology and shaped how British and American physicians understood disease causation and transmission.
- Wartime medicine also alerted the general public to the problems of crowded spaces and unsanitary environments.”

“As a result of her work with large numbers of patients in the Crimean War, Nightingale framed her analysis like an epidemiologist, in terms of populations. She focused on how disease spread within a group. She devoted her energies not to changing bedpans or dressing wounds but to studying the structure of hospitals, analyzing statistics, and figuring out how to increase ventilation.
The war provided her the opportunity to compare mortality rates in varied settings: crowded hospitals, shabby tents, and wooden huts. It also underscored to her the importance of preventive measures, which constitutes one of the major tenets of modern epidemiology. By publishing her observations, her insights, and guidelines for hospitals to follow, she hoped to provide a set of rules and guidelines for physicians to follow to prevent the spread of disease.”

“Nightingale posited a bold, rather sophisticated argument that health conditions result from the built environment, from human decisions rather than from the natural landscape or climate. While at times she propagated negative, racist stereotypes about India as filthy and the people as savage, she saw these conditions less as a result of innate inferiority than as a product of circumstances that could be altered,?
Nightingale's arguments, which she rehearsed from her Victorian bedroom in London, only became possible because ol imperialism. ImPerialism had provided her with the data that illustrated the need for proper sanitation.”

“Unlike his British predecessors, whose interviews advanced medical knowledge and epidemiological practice by offering insights that challenged medical dogma or piloted new methods of gathering data, Russell's interviews reified the antebellum practice of using invented racial categories as valid metrics in the study of infectious disease. He drew on anecdotes from slaveholders who commodified human beings.
Their ideas in turn became his ideas, and because he was a doctor working for the federal government, those ideas became the way that the medical profession and the federal government classified Black people.
The Civil War ended slavery, but the use of racial classification in a delib-crate twist became part of how the USSC chose to frame illness.
Unlike his British counterparts, Russell further used race as a category of medical analysis when he examined Black troops under his charge.”

“The Civil War ended the institution of slavery, but the USSC resurrected slaveholding ideologies to amplify racial difference and to contribute to medical knowledge.
Drawing on additional antebellum Southern ideas that grew out of slavery, USSC officials characterized Black troops' understanding of their health as primitive. Benjamin Woodward, a surgeon with the 22nd Illinois Volunteer Infantry, argued that Black soldiers' belief systems prevented them from resisting disease, and that Black people could
"rarely rally from the attack of severe disease" because they believed that. their time had come to die.”

“Consequently, when given this platform, USSC doctors resurrected ideas from slaveholders and Southern physicians that flagrantly violated the political, legal, and social promise of the Civil War. Antebellum ideas about slavery became enshrined in the USSC's work. Without carefully following the words of specific doctors, we would not know, for example, that Ira Russell had actually gained medical knowledge by talking to slave auctioneers in the South after the Civil War.
This practice of drawing on knowledge that developed as a result of slavery continued after the war ended; in fact, some doctors became desperate to retrieve whatever information they could obtain from Southern doctors about slavery in order to understand the spread of infectious disease long after the Civil War ended.”

“In order to visualize the spread of cholera, military doctors relied on a number of terms and expressions that described the presence and movement of the disease. Both military and civilian officials who filed reports on cholera often used the verb "appear" to describe the presence of cholera. The term "appear" also became a way to mark a particular region that had people infected with cholera. For example, Woodward • wrote that cholera "appeared" in the city of Richmond among its citi-zens." While the term "appeared" served as a logic to explain the presence of cholera often not under military surveillance, many other officers continually remarked that certain individuals "carried" the epidemic.
"Woodward, for example, notes that cholera "was carried to troops in Austin) by recruits who arrived by way of Indianola" and was "carried" to Little Rock by steamboats. *2 Officials also used familiar idioms to de scribe the presence of cholera. For instance, in describing cholera in Shreveport, Lousiana, in the 8oth US "colored troops." Woodward noted that cholera cases "had been reported on plantations below's”

“BETWEEN 1756 AND 1866, the medical community depended upon Braius populations around the world in order to advance the field of epidemiology. Medical authorities relied on enslaved and colonized people as well as soldiers and Muslim pilgrims to test theories and provide evidence to buttress arguments. It was not uncommon for doctors to rely on case studies during this period, but until now no one has systematically delineated the extent to which the medical profession depended upon mostly anonymous people, many of whom were enslaved or colonized, to understand infectious disease. The evidence that appears in this book represents only a small fraction of a much larger practice and pattern.”

“For the doctors highlighted in this book, the intellectual shift from the individual to the group resulted from the international slave trade, the expansion of colonialism, warfare, and the resulting population migrations that followed all of these. These larger social transformations created the impetus for these doctors to launch investigations into the environments in which the patients lived.
During the US Civil War, scientific racism became a metric for studying infectious disease. By the end of the Crimean War, Nightingale's emphasis on statistical evidence had pushed these studies toward quantitative methods, but when US doctors began to follow in her footsteps during the Civil War, they insisted on using racial identity as a category of analysis. Although the US Sanitary Commission was founded on principles of safeguarding the public health by encouraging adherence to sanitary principles, Union doctors groped, mea-sured, and analyzed Black soldiers and in so doing infused racial ideology into the study of public health. After the war ended, they drew on Confederate doctors' medical reports to support their claims. US physicians validated race as a biological category. Today, racial identity remains a key metric used by public health authorities and epidemiol ogists to understand the spread of infectious disease. Even though slave-holders-not scientists-invented this idea, which has its institutional origins in the US Sanitary Commission, the field of public health and epidemiology remains steadfastly committed to it.”

[Jasmine · Rating 3 out of 5]

Maladies of Empire tells the usually-untold story of how epidemiological and medical advances were made directly as a result of the institutional aspects of colonialism. The “told” story usually includes Onesimus, an enslaved man who told his master, an 18th century New England priest by the name of Cotton Mather, about the practice of inoculation against smallpox using exposure to a small quantity of the virus to prevent a more severe, systemic infection. Mather tested this process on some 250 enslaved people and eventually his own son, convincing the aggressively skeptical medical establishment of the validity of this Black “folk” wisdom. Good discussion of this episode in history is usually limited to the ethicality of experimentation on enslaved people (see Medical Apartheid). But there’s sort of a comforting aspect to this narrative too: Onesimus was a relatively well-treated slave, and that his master listened to him and learned from his cultural traditions plays into the story the Anglo empire likes to tell that cultural mixing was beneficial for itself and all the civilizations it conquered.

Where Maladies of Empire goes beyond this is to document how the very processes through which the British Empire colonized much of the world also enabled the medical field to understand the spread of diseases. The story starts with slave ships:market forces drove slavers to keep costs down as much as possible without hurting the sale price of their human wares. This captive population was carefully documented and experimented upon, and from here, the medical establishment learned about the minimum fruit or vegetable intake required to stave off scurvy.

The mechanisms of the spread of infectious disease, however, necessitated the aggregation of records from across the world. Who was living where? Where did these ship passengers come from? Where did they go? After how many days did symptoms start? The meticulous records through which the British Empire tracked their ships and military and subjects allowed medical doctors to track the spread of yellow fever and cholera. For the first time, scientists were analyzing data that others had collected, possibly from the other side of the globe. 

The birth of epidemiology is therefore also, in a sense, the birth of data science, and the dark sides of data science were present from the start. The individual names and stories of the people who contributed the data — often racialized or institutionalized or poor — are lost to the sands of time, while the knowledge gleaned from their data goes on to benefit the wealthy and white. Downs’ story-telling is up for a challenge: how do you bear witness to these lost narratives and humanize the individual subjects whose suffering taught us how to cure or prevent disease, without getting mired in details? I don’t think the result is fully successful — there were some episodes where I felt the main themes became a little lost in the weeds of names and locations. But the work is excellent for understanding how intimately linked the development of science was with imperialism.

We see similar beats today: the bureaucracy of institutionalized people supports medical advances. For example, the link between the Epstein-Barr virus and Multiple Sclerosis was shown quite definitively only because of the mandatory monitoring and testing of American military recruits (themselves an imperializing force).

Downs contrasts the racism of the British Empire in the 19th century with that of the United States. In general, the British were certainly white supremacist, but more accepting of belief systems that allowed for similarities between races. For example, see Florence Nightingale and some of her peers’ views of racial differences in disease susceptibility:

Although Florence Nightingale believed in racial difference, regarding the English as the finest race on the planet, she did not use race as an explanation for the spread of cholera or other infectious diseases. Even after germ theory became widely accepted, she insisted that unsanitary environments led to disease. She did not believe that the source of disease transmission could be found in innate characteristics of the patient (...). Similarly, while Gavin Milroy and other doctors working in the Caribbean certainly harboured racist beliefs, they too searched for the cause of disease in the natural and built environment. Milroy condemned Black people’s living conditions and blamed their high rate of illness on their failure to maintain clean homes, but he did not focus on racial difference as the cause of disease spread.

Because their economic system depended on enslavement (and later, subjugation and segregation) of the Black race, American doctors approached medicine quite differently, and sought to reify the impact of race in health. The answer to “why is disease more prevalent in slaves?” could not be that they were oppressed, and forced into terrible living conditions, since that was a threat to the social order:

Many doctors in other parts of the world were turning to the physical world and the built environment to understand how disease spread; they observed symptoms in a patient and then turned outward to housing, sewers, drainage, and crowded conditions to understand why patients were sick. USSC surgeons did the opposite. They turned inward to the patient, trying to find the answer to the illness within or on their body. While they considered the natural or built environment, they emphasized racial identity as the cause. 

This approach had a long-lasting impact on the medical establishment: while slavery ended with the Civil War, “the USSC resurrected slave-holding ideologies to amplify racial difference and to contribute to medical knowledge.” These were not the first scientists to seek to justify their pre-existing beliefs with “evidence” and refuse to consider alternative explanations, and they were certainly not the last.

A challenge with books of this sort is where they stop. The British Empire is no more, but the world is still scarred by imperialism. Science has developed into a far more robust practice, but is still often racist, and the fruits of its research are unequally distributed. The author set out to tackle this topic for a reason, and I would imagine it is because he saw similarities between this part of history and our world today. If so, I agree, and I have highlighted some of these themes above. But Downs never goes so far as to explicitly draw out the link, to comment on practices of the twentieth century and beyond. I suppose it is the careful conservative nature of most academics, who don’t dare step outside their field of expertise — but that just leaves me, with my considerably smaller extent of expertise, to apply what I’ve learned on my own.

[Eric George · Rating 3 out of 5]

Epidemiology as a field which has taken a complete hold on today's 2021 government policies, past Covid-19, has some of it's origin in the trans Atlantic slave trade and the enslavement of humans, the imperialistic war and the US civil war. The British military doctors used examples from the spread of diseases to hypothesie about theories, within the academic field. This is one analogy author J. Downs bring forth in the written work published in 2021.
The author has the ambition to bring forth the voices behind the reports used by British medical scholars to make theories about epidemiology. An attempt to rewrite history and channel the echoes of unheard voices who suffered under imperialism, and free enslaved people, counting at least 180 000 who fought as soldiers in the US civil war.

The view point from the first big field study is from a Scottish doctor who did a case study on scruvey on slave ships. In confined spaces, without much sunlight, poor nutrition and poor fresh air quality scurvy was a common disease that caused many deaths. It was noticed by the physician that the prefered guavas, where the none riped ones. The guavas would maybe have a more sour taste and reminiscent about more C- vitamin. The enslaved people unvoulantary participated in a field study. They where fed lime, not riped guavas and riped guavas, where the latter fed group of people dindn't improve from scurvy. Not knowing the link between vitamine deficency, especially D-vitamine and C-vitamine, the doctor was onto something, and also pointing out contributory human made factors as in diet, to epedemilogical studies.

The author tries to validate the link between case studies and papers written by medical doctors on deseaced enslaved people during the ship trasportation crossing the Atlantic ocean. He dose so by refering to the cases where ventilators where buildt in the cargo or in the transportation spaces of enslaved people. But there are no links or references to ship drawings, meta studies or other kind of publications, or second opinions that give or function as a source to back up or validate proof that the ventilators became a new practice in ship building during the trans atlantic slave trade. Mind the time gap, over 400, yes four hundred years! And no source that verifies a change of practice, leaves then all doubt to the question was there ever a change?

The death to contigation ment maybe the birth to epidemiology, and excluding the thought that diseases caused by e.g bacteria in water like Cholera was transmitted from person to person. Epidemplogy is the study of a the spread of a disease within a population.

The chapter on Florence Nightingale is remarkable and her approach to hospital sanitatation, treatment and nursing of Crimean war soldiers, logging and sytematical approach to numbers and figures, understanding of healtcare and it's social responsibility and how she buildt her arguments to make her points are prolific from within her field. Nightingale's work as an hospital statisician is recognised and her achievements are repeated and brought to light in a dedicated chapter in the book. And you can see how the debate to prevent disease almost divided into a germ theory up against sanitary concerns, and in many ways shaped the modern view on professional health care. A debate that evolves around theory versus practise and in what order they appear and what came first. The germ as lack from propper sanitation or the was the germ always present, regardless of the sanitation! Some criticism on both the racism and the imperialism is also broth forth by the author, but he is a bit short, and brief in his commentary. Maybe for the reader to go figure out for him self? The problem with handling the topic this way is that it may seem as racism is a point of view or an opinion one is entitled to hold. If you want to make a point out of racism you also have to illustrated how that system lead to lesser life quality for people affected by it! Not enough just to point out that the the people were made to numbers, their stories was left untold and the train of method's and thoughts legitimised an objectification of people in science. And what knowlegde about human kind, sanitation and hospital routines can be extracted from Nightingale? As it is said Nightingale didn't use skin tone or race as an explanation for the spread of disease, but sadly she was a beliver in the idea that the British people were a specialty and of the finest class or race of humans!

All in all well written, bringing clarity, treating the race topic a bit lightly and maybe a little toned down as regarding consequences of the imparted.
The subject of racism is brought to light in e.g in the chapter from benevolence to bigotry, with physicians racist statements and medical practise.

The USSC broth forth many formalities about collecting data based on physicians observations and field work with clear racist intent. The cause and effect of the epidemiology of tuberculosis among the black Americans during the civil war and in the years after the abolition act. The pseudo science was thoroughly and widespread an unfortunate ex Benjamin Gould was cited by Darwin, who also believed in sub divisions of the human race. Darwin is though this day, can we teach his findings without his perspective on his own theories and the human kind?

Another disappointing important fact left out, is the lack in the broadness in the investigation on the writing about cholera epidemics. It is not mentioned that an Italian pysichan named Filipo Pachini recognised the bacteria causing the disease already in 1854. This is not incorporated into the narrative and would have given a nice perspective on how off the american pysichans were during the period of the civil war in the States.

[heptagrammaton · Rating 2 out of 5]

Maladies of Empire looks at how imperialism and the modern state enabled and informed the study of and approaches to disease. It throws light onto the way the dispossessed and otherized played an often crucial but silent/silenced role as subjects of study in the birth of epidemiology - in that, it also kind of disappointed me as a work of critical examination.

At its core, the book takes the form of examining several moments of in space and time, bounded to specific studies and the physicians that compiled them, harranguanging governmental institutions (often to no effect - now, ain't that familiar?) and innovating techniques along the way (a specific a handful of Great Men (and one woman) of History Proto-Epidemiology, if you will). I imagine a greater contextualization of their developments within the default medical mode of thought of the time or, at least, of their eventual impact would have been profoundly helpful, especially to novices unversed in the history of medicine (such as yours truly). In that, the magnitude of significance of Downs' meticulously laid out evidence is made difficult to discern. But, much more importantly, I think the monograph's method and content undercut the heart, raw and still bleeding, of the thesis: though Downs accentuates him using a black feminist framework, there is not much of it I could really discern and little attempt to give voice to the dispossessed more than the reiteration that history and data quantification has robbed them of one. All in all, Downs does over-rely on leaning on and pointing to external sources for his socio-political analysis; which makes for a fascinating bibliography and footnotes well worth reading and following into a citation research rabbit hole, but it is severely disappointing that this university canteen meat and two veg doesn't come with more philosophical hot sauce. Bring your own condiments.

This is also a very anglophone-centric work of history: understandable and by no means inherently wrong, but some focus onto other imperial powers and their relationship with epidemics would have been interesting.

It is also repetitive. Severely, annoyingly so, beating you over the head with its thesis, in a way that could only be imagined as remotely useful if you've been assigned a chapter in a class, or something. Definitely enough to downgrade it to a 2-star read.

P.S. Cover design? Minimalist, for sure, yet subtly, bitingly inventive and with a well-balanced composition. Especially for academic publications, graphic design doesn't have to got hard, but it's so nice when it does. Oliver Munday eats.

[Andy · Rating 2 out of 5]

Maybe there's some value in this content for completing the narrative for historians, but then there should be more concern to get the history right, regardless of who the neglected people are. For example, the scurvy story starts long before Lind, namely with Capt. Lancaster in 1601. Similarly, the idea that Florence Nightingale is not recognized as an important figure in the history of epidemiology and public health seems whacko to me. The thirty-year-old epidemiology book on my shelf features her prominently, as do more general books on science communication.

Also the writing needed some editing. The following idea is repeated many times in the book as if repetition makes it meaningful: "Colonial expansion placed doctors in new locations where they devised medical theories about the cause and spread of infectious disease." I agree that making doctors famous is not the point of epidemiology or public health. The point is preventing disease and improving health. I'm not sure what this treatise adds to that. I don't think the author proves the argument that horrible imperialist exploitation of people has been necessary for medical progress, and the implications of that seem awful, so I don't know why one would want to make that case anyway. The idea that war is the way to improve medicine has always bothered me. If the main argument is that doctors glorify themselves as opposed to their patients and research subjects, that sounds right but not very earth-shattering.

Alternatively:
Investigating Disease Patterns: The Science of Epidemiology

[Paula · Rating 1 out of 5]

Seriously annoyed by Maladies of Empire.

Downs shatters his credibility on page 1 (actually, page 9) by relating John Zephania Holwell’s account of the 1756 tragedy of the Black Hole of Calcutta. Holwell was there and survived to report that 146 British soldiers were imprisoned in a cell no more than eighteen cubic feet. Of these, only 23 survived.

Downs does not point out that this is impossible. Eighteen cubic feet is the size of a refrigerator. Downs does not say that Holwell’s details have been repeatedly questioned. Google Black Hole of Calcutta and three of the links that pop up relate the event and the fact that historians have discounted Holwell’s account.

How to believe the parade of facts that follows? I’m sure that much – or even most – of Downs's book is accurate, but which parts?

Downs does show that epidemiology got to a robust start in the 1700s, long before John Snow and his famous pump. He also shows that enslaved peoples, the colonized, and soldiers provided distinct populations that facilitated the study of disease. Is this remarkable? Other distinct populations did, too. Until well into the 20th century, most of the world could be divided into distinct populations that lived in what we would call misery today.

One star. I found interesting stuff in the book, but I can’t use it as research material or teach it without laboriously checking to see if it’s true.

Who is this book for? Can’t say.

[R.J. Gilmour · Rating 3 out of 5]

Downs' book examines how the growth of empire and the record keeping that was part of it, specifically for the British empire in the 19th-century, helped concepts of medicine develop. Downs' argues that epidemiology owes a great deal to the records collated by colonial doctors and how these records were used to develop policies of public health.

"While doctors and others had documented health conditions in earlier periods, Maladies of Empire explains how ideas developed between 1756 and 1866 became codified into medical theories that contributed to the development of modern epidemiology. It traces how these ideas began first as observations, then as official reports, and finally as arguments and theories in medical journals, lectures, and treatises." 4

"Empire, war, and slavery established bureaucracies that collected reports on disease, which made it visible." 5

"Imperialism had disembodied knowledge production; the person who collected the information was no longer the one who analyzed it....More specifically, statistics served as a tool of empire; it facilitated the aims of imperialism by offering a narrative of the people and place that seemed, from the vantage point of British authorities in England, unwieldy." 105

[Jesse Field · Rating 4 out of 5]

I endorse this review by Stan Prager, with the possible exception that I didn't always find the work "readable." It's account of the imperious nature of epidemiology is clear enough, but it does run long, for me. And one has to do mental work oneself to understand the tremendous implications, such as the idea that various national responses to COVID-19 can be shown to have the after-effects of a public health practice erected at the height of American slavery and British colonialism, i.e. much work needs to be done to ensure a public health response that views the public and all its members with respect and dignity. An even deeper question lies beneath all these archival accounts of diseases observed, treated and recorded, too: is public health inherently imperious? Do what solutions we have developed, from vaccines to quarantines and so forth, follow only from the authoritarian impulse? How would a more democratic and practical regime of public health practice might have evolved, or evolve in the future, as one might hope?

[Keith Kernes · Rating 3 out of 5]

While I realize the politics are right in the title, I liked this book a lot more when the author was focused on the history of medicine and epidemiology in particular rather than politics. It should and may with some reflection warrant an additional star. But, for now, I'm sticking with three.
I loved the discussions about how the medical individuals in the book were striving to come up with theories on why things were happening. Reminds me that even with all we think we know, we could be wrong and the future will laugh or cringe at our choices too.
I sometimes use the example of Ignaz Semmelweis who figured out the benefits of handwashing for surgeons and tried to spread the practice only to be ignored for the better part of 70 years. There are biases and habits that can be very hard to break even in the most philanthropic undertakings.
This book focuses on the often wrong, but usually rightfully motivated doctors, nurses, and governments in the 19th and 20th centuries with some musings outside that time frame.
If you're interested in the spread of knowledge, data management, and statistics driving human behavior over time, this is a fairly good book.

[S. · Rating 4 out of 5]

"Given these conditions, there was little Black children could do to prevent a Union doctor from using their bodies to produce vaccine lymph."

A sickening but much needed treatise which analyzes how our understanding of disease, public health, and vaccination today was violently built on the infected bodies of people oppressed by slavery and imperialism. Should be a must-read for COVID-19 policymakers and medical practitioners.

The book is repetitive in places, but the point is well made.

[Susan Dietz · Rating 4 out of 5]

An important read looking at power structures, colonialsim and slavery on the development of medical practice and epidemiology in the 19th century. Downs delineates evidence on how colonialism, war, and slavery allowed the built environments that contributed to the spread of infection and the embeddedness of race as a category for biologic differences in health and health outcomes that led to our contruct of scientific racism.

[KC · Rating 4 out of 5]

This informative and well-researched book shifts the focus off of those credited with medical and epidemiological discoveries(usually privileged white men) to slaves, the colonized, soldiers, and women, who all impacted medicine in enormous amounts. I thought the narration and storytelling were engaging and easy to follow. I also thought this book would talk about the modern impacts of colonialism, slavery, and war on the medical system but it was still good nevertheless.

[Scott Bolick · Rating 5 out of 5]

As our world seems to be trying to once again bury the contributions of people other than white males in history this is a very important book to read. Using records from historical empires the author highlights how many important medical breakthroughs are due to the efforts and/or exploitation of people from around the world. I found the greatest educational value when reading about well known medical breakthroughs I was already familiar with and going deeper into those discoveries.

[Kerry Gibbons · Rating 3 out of 5]

This book was a bit dry to be honest. The content was interesting but very much I would not recommend this book to many people. It contains graphic, if clinical, descriptions of disease, forced vaccination harvesting of children, and quotes and other depictions of people as belongings/statistics/etc.

It was honestly a bit surprising to learn upon a bit of googling that the author is white.

[shejuti · Rating 3 out of 5]

writing was monotonous and repetitive. very interesting and understudied thesis about the development of epidemiology as a field that was only achieved through colonialism and exploitation across the globe. learned things about medicine that I had never heard before and untold stories. glad that this book shifted the framing of medical discoveries to the populations that they were reliant on.

[G Collerone · Rating 5 out of 5]

"Even though slaveholders not scientists invented [racial identity] the field of public health and epidemiology remains steadfastly committed to it" @jimdowns1

Maladies of Empire. Amazing book. Putting people in front of numbers, a face to a number.

[Zoe Hemez · Rating 3 out of 5]

A bit dry. Was initially a little worried to see that this history on the role of racism in the development of epidemiology was written by a white man, but ultimately was pleasantly surprised by his determination to shed light on the experiences of marginalized communities.

[Rachel · Rating 4 out of 5]

A very informative book with a great thesis on how ordinary people have been used fr the development of medicine but not credited for their contributions. Really touches on some of the sources of the institutions that contribute to medical racism.

[Kate · Rating 4 out of 5]

Yeah. Books like this are a lot. But the sooner we can reckon with our racist roots and tendrils in society, including in epidemiology, the better!

[Gabriel · Rating 4 out of 5]

Great book on the history of epidemiology. I really enjoyed Florence Nightingale's chapter.

[Daniel Farabaugh · Rating 3 out of 5]

This was a solid book that does a good job with it topic. It makes its point although, some of the writing is a bit stodgy. He keeps repeating his thesis to drive home the point.