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 US 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.

“Maladies of Empire has a captivating writing style, is exhaustively researched, and is persuasive in argumentation. Jim Downs has written a game-changing book.”—Deirdre Cooper Owens, author of Medical Bondage: Race, Gender, and the Origins of American Gynecology

“An eye-popping study of the history of infectious diseases, how they spread, and especially how they have been thwarted by experimentation on the bodies of soldiers, slaves, and colonial subjects…a timely, brilliant book about some of the brutal ironies in the story of medical progress.”—David W. Blight, author of Frederick Douglass

“Brilliant…Jim Downs uncovers the origins of epidemiology in slavery, colonialism, and war. A most original global history, this book is required reading for historians, medical researchers, and really anyone interested in the origins of modern medicine.”—Sven Beckert, author of Empire of Cotton

“[Sheds] light on the violent foundations of disease control interventions and public health initiatives [and] implores us to address their inequities in the present.”—Ragav Kishore, The Lancet

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 care of soldiers in the Crimean War revolutionized medical hygiene. Yet focusing on individual innovators ignores many of the darker, unacknowledged sources of medical knowledge.

Reexamining the foundations of modern medicine, Jim Downs shows that the study of infectious disease depended crucially on the unrecognized contributions of conscripted soldiers, enslaved people, and subjects of empire. From Africa and India to the Americas, plantations, slave ships, and battlefields were the laboratories where physicians came to understand the spread of disease. Boldly argued and urgently relevant, Maladies of Empire gives a long overdue account of the true price of medical progress.