In delving into late eighteenth- to mid nineteenth-century medical literature, Rana Hogarth was prescient, writing a book whose implications about medical authority, treatment of infectious disease, and race have direct bearing on some of the most tragic and dramatic events of the past few years. She examines evidence from the Greater Caribbean, broadly construed, opening up many sources dealing with people, places, and events in Jamaica and the Carolinas and British-trained medical and scientific practitioners.

Hogarth's elucidation of the racial foundations of medical knowledge is an excellent complement to the work of Pablo Gómez, Andrew Curran, James Sweet, and others. She carefully and compellingly argues that “physicians’ objectification of Black people's bodies in slave societies became an essential component to the development of the medical profession in the Americas” (2). A profession attuned to “visually distinct physical and physiological traits,” medicine in the fledgling United States rewarded practitioners who promulgated observations and interpretations that made racial inequalities seem objective: “More than simply validating the existence of racial differences, they spoke about them with great authority, transforming the knowledge of managing black health into a medical specialty of sorts” (xiii). Claims of such knowledge by specialists naturalized racial difference in the face of contrary facts about disease mortality and morbidity. Hogarth calls attention to how this bias is insidiously entrenched, informing some practices and attitudes today.

Before the COVID-19 pandemic, there was the periodic scourge of yellow fever, the topic for the two chapters in Part I. Race was an inflection point—either Black people were exceptionally tough (in contrast to those with fragile white constitutions; Chapter 1), or they became susceptible—and thus characterized as weak—due to white mismanagement of what physicians and military evaluators argued were innately different needs in diet, ability to endure suffering, and suitability for specific kinds of labor and climate (Chapter 2). These contradictory interpretations shared the concept that “black and white peoples’ bodies lacked physiological parity.” (23)

Yellow fever can infect anyone, but a scheme of biologically distinct races invites ideas of uniquely Black pathologies, the focus of Part II (Chapters 3 and 4). Hogarth explores an example that has long been a particular interest of mine: geophagy, the consumption of soils, usually particular kinds of clays. Geophagy is fairly common in different world regions and within a variety of social groups. Some equate soil with filth or uncleanliness, a view that does not recognize the specific substances, the manner of their consumption, and their measurable health effects, for bad or good. Anthropological studies show that rather than an attempt to satisfy nutritional deficiencies, general hunger pangs, or irrational compulsions, eating the clays people most often favor creates a coating in the gut that protects against infections and disease—a practice especially beneficial to pregnant women and young children. In the nineteenth century, influential white medical practitioners vilified geophagy as a severe illness, Cachexia Africana, one they claimed afflicted only Black people and occurred across the Greater Caribbean. Hogarth shows that the negative fiction of Cachexia Africana was a convenient way for white physicians to stifle competition from Obeah practitioners, codify claims about Black mental and corporeal insufficiencies, disparage Black women in particular, demonstrate the superiority of white medical expertise, and emphasize the importance of white supervision of Black bodies.

The last section of the book, Part III, turns to the places of treatment, showing how they facilitated white supervision, correction, and discipline, as well as race-based spatial segregation. These facilities, a public one in Kingston (Chapter 5) and a private one in South Carolina (Chapter 6), provided a steady supply of Black bodies for career-building clinical experience and lucrative economic gain. In contrast to the example Hogarth provides from Jamaica, slave hospitals in the US South gradually transitioned from business enterprises to medical training grounds. Hogarth points out that “the pervasive beliefs about Black peoples’ distinctive physiology did not deter their use as clinical specimens,” particularly for dissection (181).

The white supervision and control of Black bodies in these facilities often blurred the line between prison and hospital. Rana Hogarth's pivotal study is heartbreaking, horrifying, and revelatory; I keep returning to it as I ponder questions of race in other contexts.