Underlying cultural assumptions are notoriously difficult for any historian to establish. However, Rana Hogarth's recent work Medicalizing Blackness offers an adept insight into how such rarely enunciated thoughts might be teased from the historical record. Hogarth uses these insights to argue that ‘investing racial difference with practical medical use’ (p. xv) helped to solidify the position of the medical profession in the late eighteenth and early nineteenth centuries. In doing so, she maintains that physicians had professional rather than political reasons for medicalizing blackness. Unlike Andrew Curran's The Anatomy of Blackness (2011), this work separates the medicalization of racial difference from concurrent debates over the continuation of the slave trade. As such, Hogarth demonstrates that the othering of black bodies within medical literature was conducted without reference to pro-slavery and abolitionist stances.
Beginning with a focus on yellow fever, Chapters 1 and 2 explore the idea of innate black immunity to tropical diseases. Chapter 1 traces the initial development of the concept of innate black immunity and examines the ultimately disastrous consequences of using such a claim to inform disease management. Hogarth then explores the different ways in which physicians reconciled instances of yellow fever within the black community with the concept of black immunity. Here it becomes clear that physicians perceived a weakening of black immunity as a phenomenon, perhaps resulting from external environmental factors, but not of black immunity as a concept. Consequently, Chapter 2 reveals that when yellow fever was acknowledged in black populations, black suffering was characterized as fundamentally different and less severe than that of white populations. Hogarth asserts that this persistent idea that black bodies either suffered less from or were immune to tropical diseases set ‘expectations about black people's bodies’ (p. 75), informing both colonial policy and the handling of black slaves.
Chapters 3 and 4 explore the alternative and contradicting narrative of black susceptibility to disease. Examining the diagnosis and treatment of cachexia africana (‘dirt eating’), Hogarth draws attention to the paradoxes within medical portrayals of black bodies as simultaneously physically strong and psychologically weak, suited for heavy labour in harsh conditions and at the same time mentally fragile. Importantly, these differing portrayals of blackness could be used interchangeably in order to exert power in different medical situations. In the case of cachexia africana, physicians emphasized the psychological weakness and decision-making incompetence of black persons as a means of gaining control over both slaves and slave healers. As such, this work argues that medical authority was established both by constructing a specialized form of knowledge about blackness and by criticizing opposing healing practices. Chapters 5 and 6 complete the work by examining how this medical authority over black bodies was exercised through institutions of treatment. Hogarth demonstrates the role that hospitals played in controlling free and enslaved black bodies in Jamaica, depicting them as institutions of surveillance and incarceration. She then scrutinizes the ways in which slave hospitals in South Carolina were advertised to slave owners. In doing so, she examines the ways in which medical practitioners directly profited from the deliberate subjugation of black people.
Throughout, Hogarth forms a comparison between medical practice in the Caribbean and in the southern states of America. This not only reveals similar assumptions about racial physiology in these different contexts but also contributes greatly towards our understanding of how medical knowledge travelled in the late eighteenth and early nineteenth centuries. In an excellent example of scholarship ensuing from James Secord's seminal article ‘Knowledge in transit’ (Isis (2004) 95(4), pp. 654–672), Hogarth uses publications and citation analysis to trace the movement of information about black bodies between physicians in the two locales. Chapter 4 examines the publication of information on cachexia africana in journals and books. Here, library records confirm that works on this subject from abroad were actively sought by the medical profession in America, whilst Chapter 1 demonstrates how concepts like innate black immunity became embedded within medical literature through citation of the original claim by those with little practical experience. Medicalizing Blackness therefore represents an important contribution not only to the histories of race, medicine and medical professionalization, but also to our historical understanding of the movement and validation of knowledge.
Appropriately, Hogarth closes by drawing readers’ attention to current medical epistemological practices. In doing so, she raises questions not only about how the medical profession came to be but also about how it continues to operate. Offered recent examples of medical research which rely upon the concept of racial physiological difference, the reader is encouraged to consider the methods by which we validate modern medical knowledge (pp. 190–193). As such, Hogarth demonstrates that this research is of more than just historical importance. Overall, Hogarth convincingly demonstrates that racial bodily difference was originally constructed as a tool to further medical professional authority. Medicalizing Blackness is both eminently readable and an invaluable addition to the growing historical scholarship on the relationship between race and medicine.
