The Black Death and the Transformation of the West 
by David Herlihy.
Harvard, 117 pp., £17.95, October 1997, 0 674 07613 3
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Plague, Pox and Pestilence 
edited by Kenneth Kiple.
Weidenfeld, 176 pp., £25, January 1997, 0 297 82254 3
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Epidemics and History: Disease, Power and Imperialism 
by Sheldon Watts.
Yale, 400 pp., £30, January 1997, 0 300 07015 2
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So-called World History originated in an attempt to escape from the tyrannical perspective of dead white Euro-American males, yet that ‘world’ perspective has had the effect of making those same males more dominant than ever. Thus Eric Wolf’s Europe and the People Without History (1982), however heroic in intention, ends up asserting that extra-European peoples did have a history, but it was a history of their relations with Euro-American economies. In his Age of Extremes, Eric Hobsbawm expresses his contempt for the historians who deny a past to Africa or Asia, but himself provides an account which gives all the agency to Europe.

What is to be done? The answer I have attempted myself has been to study the internal dynamics of African, or Asian, societies in such detail that it is possible to discern their distinguishing features even under colonialism and capitalism. But it would take a long time to construct a World History by aggregating such studies. Alternatively, historians can study worldwide phenomena which are not the result of Euro-American agency. The most successful attempts to do this up till now have been histories of disease, such as William McNeill’s Plagues and Peoples or Alfred Crosby’s The Columbian Exchange. Disease, epidemic disease in particular, makes the whole world one. Epidemics seem to arise from causes that are independent of human agency, while disease in general was a more effective barrier to imperial conquest than indigenous armies, exacting more ‘reparations’ for colonialism than any humanitarian movement. Western bio-medicine for a long time failed to understand epidemics and has failed even now to control them, or to prevent new forms arising. What death was to medieval men – a reminder of the vanity of earthly things – epidemic disease has been to Euro-American empires.

These books – even David Herlihy’s posthumously published account of the Black Death in Europe – are best approached as essays in World History. As Samuel Cohn makes clear in his incisive introduction, Herlihy’s argument that the plague acted as a stimulus to Europe’s technological advance and intellectual development makes sense only comparatively: ‘Were the social, political and psychological consequences of the Black Death as uniform throughout Western Europe as Herlihy’s essays imply? And how do we account for the sharp differences between Eastern and Western Europe ... or even more profoundly, between the West and the Middle East, where the plague was as virulent if not more so than in the West?’ (In the Mamluk world political control was unshaken after the plague, there was little development of agrarian technology and there were no anti-semitic pogroms.)

Kenneth Kiple’s collection, a splendidly illustrated hemlock table or coffin-side book, begins with the transition to agriculture and sedentarism in societies throughout the world and carries on by way of medieval maladies and urbanism, war, trade and imperialism up to the present day. Sheldon Watts organises his book as a series of explicidy comparative chapters, which look at epidemic disease in a European and an extra-European context, the first chapter containing the very examination of the contrasted responses to plague in Western Europe and the Middle East which Cohn calls for. Both books are full of information about almost every part of the world, but neither fulfils the potential of epidemic history to undercut Euro-American dominance. Certainly, they do not glorify Western medical or humanitarian achievement, and give short shrift to European fantasies about the dark, tropical origins of a series of diseases, from syphilis in the 16th century to Aids in our own.

Again, both books have a single organising principle. For Kiple it is the connection between epidemic and ‘progress’, by which he means the propensity of human beings to rearrange their environment. Progress entails a concentration of populations, an opening up of trade routes by sea and land, imperial conquest and a global division of labour. Kiple tackles the period before European expansion – he argues that Europe’s vulnerability to plague arose from its medieval introversion and lack of expansive dynamism – and the empire most discussed is the Roman. But he soon moves on to the age of conquest, and we are given vivid accounts of the price paid by indigenous peoples for imperial expansion: Aztecs are enfeebled by smallpox, Fijians by measles, while the institution of slavery sets up new patterns of disease. One account concerns the state visit to New South Wales of King Cakobau, Fiji’s most powerful chieftain, in 1825. He and his two sons returned to Fiji with measles. The ship carrying them did not fly a quarantine flag; the King disembarked and summoned 69 chieftains and their entourages. The result was an epidemic in which 26 per cent of all Fijians died of measles.

Kiple’s contributors do not see all this merely as an accidental result of human contact. They are severe on the exploitation and immiseration which accompanied imperial conquest, describing yellow fever, for example, as the ‘price for the sin of slavery’. Yet this remains a profoundly Euro-American book. We hear much of European conceptions of disease and technologies of control, but nothing of African or Asian or Amerindian aetiologies. Very few non-Westerners appear in the illustrations, except as slaves or subjects. This is not World History so much as a history of the terrible impact of European ‘progress’ on the world.

At first it seems that Watts, an Africanist who has taught both at the universities of Ilorin in Nigeria and at the American University of Cairo, is going to redress the imbalance. He dismisses theories ‘based on the Europeans’ idea that their own past establishes rules applicable always and everywhere’. If sedentarism and agriculture cause epidemics, he asks, why were there none in Meso-America before the arrival of the Spanish? He also insists on the distinction between ‘construct’ malaria (or smallpox or leprosy) and the disease itself. After all, there have been plenty of non-European constructs.

Yet this comes to very little in the end. Too many of the contrasts drawn are between what has happened in Europe and what has happened in colonies dominated by Europe or in a North America dominated by whites. The single organising principle of the book is ‘Development’, by which Watts means a malign version of the progress invoked by Kiple. It involves expropriation, enslavement, sometimes extermination. (Watts cites a friar in New Spain who believed that when a plague occurs among the Indians, ‘God is telling us: “You are hastening to exterminate this race. I shall help you to wipe them out more quickly.” ’) Meanwhile the West, demonising blacks and browns and yellows, blamed conquered peoples themselves for their diseases, and turned epidemics to the purposes of segregation and expropriation. The tragic situation with which Kiple’s book ends shows post-colonial regimes in Africa and Asia buying into the same notion of ‘Development’.

Watts makes the point that whites despised African and Asian medical practices. It might have been thought, he writes, that Europeans arriving in new continents would wish to learn from native peoples about diseases and how to treat them. Instead, they ignored indigenous knowledge. Yet his book does little to help us take non-Western knowledge seriously. With the exception of brief discussions of formal medical theories, such as those of Taoism or Arab medicine, or the medical theory of scholarly India, there is nothing about the ideas or practices of the great majority of extra-Europeans. We hear of ‘African indigenous curers’ but are told nothing at all about them; we learn nothing of medical ideas in village India or among Native Americans. The closest we get to a statement of disease control mechanisms is a reference to an ‘old, ecologically sound, cholera-free rural order’. There is little here about either the transformation of African and Asian environments, or the medical consequences of internal slavery or trade. This is World History in which most of the world plays the role of victim.

Some readers may feel that I am expressing what is sometimes considered the professional deformation of the Africanist – a refusal to face facts. If historical work on epidemics focuses on Euro-America’s domination of the world and on its achievements in bio-medicine, could this be because Euro-America was dominant and that no amount of breast-beating about African agency can change that? Seemingly not: an examination of the changing stance of the World Health Organisation confirms the need to concentrate on indigenous medicine. In her paper, ‘The Needle and the State’ (1997), Luise White claimed that the WHO was established at the end of World War Two ‘to provide the health services European colonial powers were now too poor to provide’. But in those days the WHO did not aspire only to maintain colonial public health. Intoxicated by the development of insecticides and prophylactics, it aimed to eradicate malaria. DDT was held to be ‘the atom bomb of the insect world’. Spraying it in African villages and at breeding places would wipe out malaria-bearing mosquitoes. If people did get malaria, the prophylactics would destroy the parasite. That campaign was one of the last expressions of Euro-American self-confidence and of the narrow bio-medical thinking which defined ‘malaria’ as a single disease which technology could eradicate from above.

As early as 1969 the WHO realised that its campaign was not working. DDT and other insecticides turned out to be enormously damaging; technical interventions from above turned out to be enormously expensive; where malaria control campaigns broke down, newly non-immune populations became vulnerable to devastating epidemics. Since 1969 it has become clear that international organisations, let alone the governments of the new nation states, would not be able to afford a new eradication campaign even if one were desirable; 80 per cent of the population of the developing world has no access to prophylactics.

So the WHO has turned to indigenous medical systems and to complex definitions of malaria; and it has focused on containment and reduction of its effects rather than on eradication. It recommends the study of indigenous medicines and collaboration with indigenous healers. It seeks not only to discover new herbs and trees which are effective against ‘malaria’ but also to understand the disease as a complex of symptoms and stages, each of which can respond to a different treatment. There is now a Natural Products Alert on the Internet, and a Global Initiative for Traditional Systems of Health whose aim, as Gerard Bodeker wrote two years ago in Tropical Doctor, is ‘to strengthen existing health systems as part of an integrated system of health care rather than to replace them with Western biomedical services’.

Around 1990, large-scale trials were started to compare quinine with artemether, a compound derived from the sweet wormwood tree, Artemisia annua. It was found that ‘artemether is as effective as quinine in reducing case fatality of cerebral and severe falciparum malaria ... Artemether is more convenient to administer than quinine, lacks quinine’s hypoglycaemic side-effects, and will become particularly valuable as quinine resistance emerges.’ A wonderful discovery. And yet, under its Chinese name of ‘qinghao’, artemisia is prescribed for fever in Hang dynasty tomb inscriptions dating back two thousand years. Its efficacy was described in Ge Hong’s ‘Handbook of Prescriptions for Emergencies’ in the fourth century AD. Clinical studies in China, carried out in the Seventies, demonstrated the value of artemisinin derivates. Clearly there has to be some room in the history of epidemics for dead yellow men.

Other recent research shows that room will also have to be found for dead black men, even though Africans were working in much less formalised systems of medicine than the Chinese. It turns out that plural definitions of malaria allowed for a holistic approach, involving not only many different herbs but also diet and ritual, and it turns out, too, that the severity of the impact of Aids in Eastern and Southern Africa can be reduced by focusing on sexually transmitted diseases and by employing traditional healers to control them.

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Vol. 21 No. 5 · 4 March 1999

Terence Ranger (LRB, 4 February) has succumbed to the temptation to criticise me for not writing the book he himself would have written. I would have thought that the very title, Epidemics and History: Disease, Power and Imperialism, makes it clear that I am not writing about indigenous African, American or Asian medical systems. He criticises me for saying little about the transformation of African disease environments before and after extensive contact with whites, overlooking a controversial section in the book on this very subject. Ranger has also fallen prey to two fallacies. One is that any historian living in Africa is necessarily an Africanist; not so, I am a European/British/Northumbrian historian who happens to find inspiration in living in Cairo while writing about cultural misunderstandings and conflict. The second fallacy is to accept the old colonialist idea that ‘epidemics seem to arise from causes that are independent of human agency.’ It is true enough that disease types may evolve without human agency; but I think it is clear by now that epidemics are spread by human agency. The current issue of Nature strongly suggests that Aids is an ancient disease, but that it was human agency in the last few decades that led to an epidemic. This last point (applied to malaria) might encourage Ranger to temper his romanticising about indigenous cures. It is my understanding that before the onset of the slave trade and extensive contact with Europeans along the coast, most Africans would not have been exposed to the deadliest forms of malaria; they could not, therefore, have effective ‘traditional’ cures against what would be essentially a new disease.

Sheldon Watts

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