Reflections on a Global History of Medicine

The current pandemic and the global efforts to understand the disease and to develop a cure made me think back to an assignment I wrote many years ago as a student. It was the starting point for some personal reflections about a global history of medicine.

When I was a master student, I participated in a seminar on European discoveries and colonisation from the 16^th century to the 18^th century. We were assigned to choose a topic with a connection to global history for an essay and a presentation in class. I decided to write about medicine and diseases during the period of European colonisation. The topic fascinated me and I thought that it had not attracted much attention in university curricula. I did not want to limit my essay to well-known histories such as the mass death of indigenous peoples in Latin America due to germs imported by European conquerors. I wanted to know how medical knowledge spread, whether there was a mutual exchange and how colonists, and if possible natives, coped with disease. Unsurprisingly, with the pandemic raging, I was reminiscing about this essay. I have not picked up on the topic since I have written that assignment, but I still think that it is underrated.

The current pandemic has incited many reflections on and comparisons with the Spanish Flu, which raged a century before SARS-CoV-2. Within this century, much has changed and our knowledge about diseases has made considerable progress. For the first time in history, we have managed to produce a vaccine within a year. These efforts were global and research about the new virus has been conducted in all over the world.

Conferences, workshops and talks directly or indirectly related to the current pandemic and past pandemics have been sprouting like mushrooms. But how many events about global history and the exchange of medical knowledge were organised? I ask this question half-seriously, half-rhetorically, because neither have I analysed the occurrence of related topics in the past year(s), nor have I seen any conference or similar event in the networks I follow. I think that the history of medicine and diseases from a global perspective can offer so many interesting insights into the past, but such a history would clearly need to embrace an interdisciplinary approach.

During the first wave of the Coronavirus pandemic and the lockdown in spring 2020, I was reading a biography by James Delbourgo of the physician Hans Sloane (1660-1753), whose collections formed the origins of what would become the British Museum. One passage struck me because I inadvertently made a connection with the situation at the time of reading:

Disease was an urgent state concern; 100,000 Britons died in the 1720s alone due to contagious fevers engendered by poverty and overcrowding. But quarantine was a sensitive matter that raised questions about the proper extent of state power, since it involved the suspension of merchants’ activities and commercial shipping from overseas. Popular pamphlets fired off salvoes against the ‘tyranny’ of the measure […]. With Sloane’s support, however, the Quarantine Act [to prevent plague reaching British shores from Marseilles] successfully passed in 1721, affirming his stature as an eminent medical counsellor in the process.¹James Delbourgo, Collecting the World: The Life and Curiosity of Hans Sloane (Penguin Books, 2018), 175.

This excerpt is immediately followed by another paragraph, which I have, curiously, not retained in my memory. In hindsight, I am even surprised that, unlike the first excerpt, I did not highlight it in the book. In said passage, Delbourgo writes about the practice of inoculation against smallpox and its spread:

Inoculation against smallpox was another controversial policy enacted at this time that also showed Sloane’s growing public influence. The practice of inoculation may have originated among the peoples of West Africa; by the early eighteenth century, it had been adopted by European slave-ship captains. Sloane had heard reports of its utility from China, Guinea, New England, Greece and especially Ottoman Turkey, via Lady Mary Wortley Montagu at Constantinople and William Sherard, then consul for the Levant Company at Smyrna (Izmir). In Britain, many regarded inoculation as a dangerous innovation.²Delbourgo, 175–176.

Sloane, at Queen Caroline’s request, oversaw inoculation trials on human subjects (prisoners). The excerpt retraces an example of how a medical practice spreads throughout the world and did not originate in Europe where it was regarded with scepticism. It shows that we do not know much about how some practices developed or where they originated. Much of what we know about non-Western healing practices in colonised territories was observed and noted by European colonials and missionaries, and as such needs to be considered with the necessary critical distance. Then there is also a simple lack of sources and the fact that, even if slave-ship captains adopted the practice of inoculation, they were not interested in documenting its history and development, but above all in keeping as many of their “merchandise” alive as possible. Of course, I do not want to imply that there have not been any studies about exchange and clashes of medical practices, about the spread of diseases and the responses to them. The small research I did for this blog post showed me how fascinating these topics can be. Studies about Islamic medicine, for instance, mention the transfer of knowledge from Ancient Greek medicine, without ignoring Islamic physicians‘ own contributions and adaptations of this knowledge.³Lawrence I. Conrad, ‘Arab-Islamic Medicine’, in Companion Encyclopedia of the History of Medicine, ed. W. F. Bynum and Roy Porter (Abingdon: Routledge, 1993), 676–727; Guy Attewell, ‘Islamic Medicines: Perspectives on the Greek Legacy in the History of Islamic Medical Traditions in West Asia’, in Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, ed. Helaine Selin and Hugh Shapiro, vol. 3, Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 325–350. Others examine medical practices in Latin America, where historians are confronted with the fact that European colonisers prohibited and fought American Indian medical practice.⁴Ruben G. Mendoza, ‘Lords of the Medicine Bag: Medical Science and Traditional Practice in Ancient Peru and South America’, in Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, ed. Helaine Selin and Hugh Shapiro, vol. 3, Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 228. In the case of the Aztecs, the Spanish were impressed by the knowledge of the Aztec physicians about medicinal herbs. Indeed, herbalists could use plants grown in botanical gardens created by Aztec rulers to create new potential remedies. However, it is not possible to say whether this knowledge – or how much of it – was originally recorded. Spanish priests and soldiers destroyed all Aztec texts they could lay their hands on.⁵Lois N. Magner, A History of Medicine, 2nd ed. (Boca Raton: Taylor & Francis, 2005), 282. In Africa, exchanges with other world regions developed over millennia. The history of medicine of this continent is a testimony to this:

The medicine of Ancient Egypt shaped ideas of the civilizations around it, including the medicine of classical Greek and Roman Antiquity. This complex in turn spread to African regions, through the influence of Islamic medicine. Another dimension of Islam, “prophetic medicine”, brought notions of health and healing to Africa from Persia and Arabia. Christian faith healing, which spread first with early Christianity across North Africa and Ethiopia, later was part of European colonial expansion to sub-Saharan Africa.⁶John M. Janzen and Edward C. Green, ‘Continuity, Change, and Challenge in African Medicine’, in Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, ed. Helaine Selin and Hugh Shapiro, vol. 3, Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 1.

These exchanges were not peaceful and happened in contexts of violence. Like European attitudes towards healing systems in Latin America, Islamic crusaders and Christian missionaries dismissed and attacked African ones.⁷Janzen and Green, 3.

In my (modest) research for the present blog post, I observed two recurrent aspects of medical practices all over the world. Firstly, the use of medicinal plants, a practice that was alluded to above. Still today, four billion people resort to natural medicine, and 70% of drugs used to fight cancer have a natural or bioinspired source.⁸François Gemenne, Aleksandar Rankovic, and Atelier de cartographie de Sciences Po, Atlas de l’anthropocène (Paris: Presses de Sciences Po, 2019), 65. Secondly, the connection between healing traditions and belief systems. In pre-Hispanic Mexico, for instance, “the body was compared to the universe and was considered a microcosmos”.⁹Carlos Viesca, ‘Medicine in Ancient Mesoamerica’, in Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, ed. Helaine Selin and Hugh Shapiro, vol. 3, Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 260. It was, however, more difficult to find information about transfers from natives to colonisers, or exchanges between civilisations. One interesting case is Samoa, where Christian missionaries did not outright prohibit pre-contact healing traditions and insisted even on similarities between Samoan beliefs and the Christian gospel to facilitate Christianisation. Furthermore, “missionaries experimented with plants which resembled the ‘herbs and simples’ with which they were familiar, and Samoans also used some plants in healing”.¹⁰Cluny Macpherson and La’avasa Macpherson, ‘When Healing Cultures Collide: A Case from the Pacific’, in Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, ed. Helaine Selin and Hugh Shapiro, vol. 3, Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 199. Since the 19^th century, Samoans have incorporated elements from various health traditions – pre-Christian, European, Melanesian, and Chinese. The latter two imported by labourers working on plantations.¹¹Macpherson and Macpherson, 202.

When I was writing my essay for the above-mentioned seminar, I could only find two examples where medical practices of indigenous people made a contribution to European knowledge. From the writings of Jacques Cartier, a French navigator in Canada, we know that the Amerindians shared knowledge about a liquid obtained from leaves of a specific tree that helped fight scurvy. It turned out that the same medicine could be used to heal patients of smallpox.¹²Ramsay Cook, Voyages of Jacques Cartier (Toronto: University of Toronto Press, 1993), 80. The second exchange occurred in Latin America. To fight malaria and alleviate fevers and pains, the peoples in the region of contemporary Peru used quinine, which they obtained from a medicinal plant known as Cinchona officinalis. The Spanish used it since 1640 and exported it to Europe, where it was sold at a high price. Some scholars denied its effects, but it was still consumed in great quantities. The demand grew to a degree that the Dutch created quinine plantations on the island of Java to satisfy it.¹³Kari Köster-Lösche, Die grossen Seuchen: von der Pest bis Aids (Frankfurt am Main: Insel, 1994), 89; Jean-Charles Sournia, Histoire de la médecine, La Découverte poche. Sciences humaines et sociales 41 (Paris: La Découverte, 2007), 166; Magner, A History of Medicine, 342–343. There might be other examples of Europeans adopting practices from indigenous peoples. In any case, as these examples show, populations build knowledge based on the environments they live in and look in their surroundings for remedies to ailments they suffer. Such knowledge is accumulated and passed on for generations. It does not necessarily fit the Western epistemology. This knowledge has not necessarily been recorded in written form, or it has been simply ignored or dismissed by colonisers. A global history of medicine could help to bridge the North/South divide, to include what Boaventura de Sousa Santos calls the “epistemologies of the South” and to move to a “postabyssal thinking”.¹⁴Boaventura de Sousa Santos, Epistemologies of the South: Justice Against Epistemicide (Abingdon: Routledge, 2016); Boaventura de Sousa Santos, The End of the Cognitive Empire: The Coming of Age of Epistemologies of the South (Durham: Duke University Press, 2018). It would also teach us more about societies we are not familiar with, because, as I said above, healing systems were often linked to belief systems. In this sense, anthropology, history of science, cultural history and other disciplines intersect.

Returning to the current pandemic, it will be interesting to see how future historians will analyse it. The development of a vaccine is a global effort, but it is also a geopolitical and an economic issue. This pandemic certainly will not be the last one. Maybe the frequency of such pandemics will increase (it has already), due to climate change, to the invasion of animal living space and the growth of human settlements.¹⁵Some of these issues have recently been the main topic of a Last Week Tonight episode: https://www.youtube.com/watch?v=_v-U3K1sw9U. Here, environmental history will need to be considered and integrated. In any case, a global – and I might add interdisciplinary – history of medicine and disease reveals a lot about human nature and its complexity.

References

• Attewell, Guy. ‘Islamic Medicines: Perspectives on the Greek Legacy in the History of Islamic Medical Traditions in West Asia’. In Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, edited by Helaine Selin and Hugh Shapiro Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 3:325–350.
• Conrad, Lawrence I. ‘Arab-Islamic Medicine’. In Companion Encyclopedia of the History of Medicine, edited by W. F. Bynum and Roy Porter (Abingdon: Routledge, 1993), 676–727.
• Cook, Ramsay. Voyages of Jacques Cartier (Toronto: University of Toronto Press, 1993).
• Delbourgo, James. Collecting the World: The Life and Curiosity of Hans Sloane (Penguin Books, 2018).
• Gemenne, François, Aleksandar Rankovic, and Atelier de cartographie de Sciences Po. Atlas de l’anthropocène (Paris: Presses de Sciences Po, 2019).
• Janzen, John M., and Edward C. Green. ‘Continuity, Change, and Challenge in African Medicine’. In Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, edited by Helaine Selin and Hugh Shapiro Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 3:1–26.
• Köster-Lösche, Kari. Die grossen Seuchen: von der Pest bis Aids (Frankfurt am Main: Insel, 1994).
• Macpherson, Cluny, and La’avasa Macpherson. ‘When Healing Cultures Collide: A Case from the Pacific’. In Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, edited by Helaine Selin and Hugh Shapiro Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 3:191–207.
• Magner, Lois N. A History of Medicine. 2nd ed. (Boca Raton: Taylor & Francis, 2005).
• Mendoza, Ruben G. ‘Lords of the Medicine Bag: Medical Science and Traditional Practice in Ancient Peru and South America’. In Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, edited by Helaine Selin and Hugh Shapiro Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 3:225–257.
• Santos, Boaventura de Sousa. Epistemologies of the South: Justice Against Epistemicide (Abingdon: Routledge, 2016).
• ———. The End of the Cognitive Empire: The Coming of Age of Epistemologies of the South (Durham: Duke University Press, 2018).
• Sournia, Jean-Charles. Histoire de la médecine La Découverte poche. Sciences humaines et sociales 41 (Paris: La Découverte, 2007). Viesca, Carlos. ‘Medicine in Ancient Mesoamerica’. In Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures, edited by Helaine Selin and Hugh Shapiro Science Across Cultures: The History of Non-Western Science (New York: Kluwer Academic Publishers, 2003), 3:259–283.

Featured image: Photo by Anna Shvets from Pexels.