WEBVTT - Special Episode: On the Origin of Epidemiology 0:00:43.640 --> 0:00:47.519 Hi, I'm Aaron Welsh and this is this podcast will 0:00:47.600 --> 0:00:52.040 Kill You. Welcome to another episode in our mini series 0:00:52.080 --> 0:00:54.720 of bonus content that we've been putting out over the 0:00:54.760 --> 0:00:58.360 past few months. If this is your first time tuning in, 0:00:58.720 --> 0:01:02.200 these bonus episodes are a way of exploring more deeply 0:01:02.680 --> 0:01:05.440 some aspect of what Aaron and I talked about in 0:01:05.480 --> 0:01:09.880 our regular season episode the previous week. So, for instance, 0:01:10.000 --> 0:01:14.080 we followed up our multiple sclerosis episode with the bonus 0:01:14.120 --> 0:01:18.560 episode on the epstein bar virus, and our chlamydia episode 0:01:18.720 --> 0:01:23.080 with a bonus about other chlamydia species affecting koalas and 0:01:23.280 --> 0:01:27.600 other animals. The beauty of these bonus episodes is that 0:01:27.720 --> 0:01:30.440 we get to enlist the help of an expert and 0:01:30.800 --> 0:01:34.760 absolutely pepper them with questions, both on the topic of 0:01:34.800 --> 0:01:39.480 interest as well as their careers. I have really enjoyed 0:01:39.520 --> 0:01:43.039 putting these episodes together, and I've learned so much about 0:01:43.040 --> 0:01:47.440 an incredibly wide range of topics, and this particular bonus 0:01:47.440 --> 0:01:51.760 episode is no exception. Last week, Aaron and I told 0:01:51.800 --> 0:01:56.280 the story of tetanus, a deadly but fortunately vaccine preventable 0:01:56.320 --> 0:01:59.520 disease that is caused by this spore forming talks and 0:01:59.560 --> 0:02:05.560 producer anaerobic bacterial species Claustridium tetani. Most of you are 0:02:05.680 --> 0:02:09.440 probably familiar with tetanus, and, like me, have a healthy 0:02:09.480 --> 0:02:12.800 fear of stepping on a rusty nail. But what many 0:02:12.800 --> 0:02:16.520 of you may not know is just how prevalent neonatal 0:02:16.560 --> 0:02:20.720 tetanus used to be and still is today in places 0:02:20.720 --> 0:02:26.079 with limited access to vaccines. Neonatal tetanus usually occurs when 0:02:26.080 --> 0:02:30.280 the umbilical stump becomes infected with the tetanus bacterium, which 0:02:30.320 --> 0:02:33.200 can happen while cutting the cord with a non sterile tool, 0:02:33.400 --> 0:02:36.520 for example. And if you haven't listened to the tetanus 0:02:36.520 --> 0:02:40.400 episode yet, I recommend that you stop here, go listen 0:02:40.400 --> 0:02:43.560 to it, and then come back to this episode. But 0:02:43.919 --> 0:02:47.440 I'll give a quick recap here anyway, just to kind 0:02:47.480 --> 0:02:50.920 of preface what we'll be talking about in this bonus episode. 0:02:51.520 --> 0:02:54.960 While discussing the history of tetanus. Last week, I spent 0:02:55.000 --> 0:02:58.680 a fair amount of time talking about neonatal tetanus among 0:02:58.840 --> 0:03:02.120 enslaved people in the American South Before the Civil War. 0:03:02.960 --> 0:03:06.840 Neonatal tetanus in the South was an extremely prevalent and 0:03:06.919 --> 0:03:10.600 deadly infection, said to be responsible for up to two 0:03:10.760 --> 0:03:14.160 thirds of the deaths among infants born to enslaved people, 0:03:14.800 --> 0:03:17.560 and this led to it having a reputation of being 0:03:17.639 --> 0:03:21.640 a disease of the South, especially of enslaved people, and 0:03:21.800 --> 0:03:25.040 last week I asked whether it was indeed a quote 0:03:25.080 --> 0:03:29.640 disease of fatal frequency solely of the South, or whether 0:03:29.800 --> 0:03:34.320 northern physicians simply weren't looking for it as much. I 0:03:34.440 --> 0:03:37.600 used the example of neonatal tetanus in the South during 0:03:37.640 --> 0:03:41.760 this time to illustrate two different themes. One is that 0:03:41.800 --> 0:03:44.880 you have to consider the focus of medical studies as 0:03:44.920 --> 0:03:48.840 a factor of time and place. Southern doctors were more 0:03:48.960 --> 0:03:52.920 likely to observe neonatal tetanus because they were employed by 0:03:53.000 --> 0:03:57.280 enslavers to monitor the health of enslaved people, whereas Northern 0:03:57.320 --> 0:04:00.680 doctors lacked both the reason to look for this disease 0:04:00.920 --> 0:04:03.920 as well as the opportunity, for lack of a better word, 0:04:04.400 --> 0:04:07.520 to observe it in a larger group of people, especially 0:04:07.640 --> 0:04:10.400 those whose consent was not or could not be given. 0:04:11.200 --> 0:04:14.400 And the other theme is how the institution of slavery 0:04:14.840 --> 0:04:18.320 is one example of a structure that led to physicians 0:04:18.400 --> 0:04:23.240 making observations of populations rather than individuals, giving them a 0:04:23.240 --> 0:04:27.520 bird's eye view of how disease spreads, and this is 0:04:27.600 --> 0:04:32.760 what basically led to the birth of epidemiology. These two 0:04:32.839 --> 0:04:36.560 themes are not at all of my own creation, but 0:04:36.680 --> 0:04:40.279 rather feature extensively in the latest book by my guest 0:04:40.360 --> 0:04:45.200 for this episode, doctor Jim Downs. Doctor Down's book Maladies 0:04:45.240 --> 0:04:50.039 of Empire, How Colonialism, Slavery and War Transformed Medicine is 0:04:50.080 --> 0:04:53.640 a new and necessary re examination of how we tell 0:04:53.720 --> 0:04:57.840 the story of the origins of epidemiology. Did this field 0:04:57.920 --> 0:05:01.320 come about during a London caller epidemic with John Snow 0:05:01.360 --> 0:05:04.520 in the broad Street pump? Or did it emerge in 0:05:04.680 --> 0:05:09.560 army hospitals, on slave ships and within colonies as physicians 0:05:09.640 --> 0:05:15.640 collected information or outright exploited non consenting subjects. Doctor Downs 0:05:15.720 --> 0:05:18.640 joins me in this bonus episode to explore some of 0:05:18.640 --> 0:05:23.120 the ideas presented in his fantastic book, and I cannot 0:05:23.120 --> 0:05:26.159 wait to dive in. So let's just take a quick 0:05:26.160 --> 0:05:28.040 break here and then we'll get started. 0:05:51.920 --> 0:05:54.680 My name is Jim Downs. I'm the author of Maladies 0:05:54.720 --> 0:06:00.240 of Empire, How Colonialism, Slavery and War Transform Medicine. I 0:06:00.279 --> 0:06:04.200 am currently the Guilder Lherman National Endowment for the Humanities 0:06:04.279 --> 0:06:08.760 Professor of History and Civil War Studies at Gettysburg College. 0:06:09.120 --> 0:06:13.320 Awesome, thank you so very very much for joining me today. 0:06:13.839 --> 0:06:17.200 I am so excited to discuss your book because I 0:06:17.240 --> 0:06:19.880 feel like it fits in really well with a lot 0:06:19.920 --> 0:06:23.560 of the themes that we discuss on the podcast, especially 0:06:23.640 --> 0:06:28.719 the importance of placing our understanding of medical or scientific 0:06:28.880 --> 0:06:33.599 developments in this broader historical context. So let's get into 0:06:33.600 --> 0:06:38.400 that context. In your book, you explore how colonialism, slavery, 0:06:38.440 --> 0:06:41.880 and war during the period of the seventeen fifties through 0:06:41.880 --> 0:06:45.960 the eighteen sixties led to this huge shift in medicine. 0:06:46.080 --> 0:06:51.320 People began to study populations rather than individuals, essentially kicking 0:06:51.360 --> 0:06:55.480 off the field of epidemiology. Can you explain what it 0:06:55.560 --> 0:06:59.440 is about this period that led to this revolution in thought? 0:07:00.400 --> 0:07:03.080 Right, So the key word there would be populations. So 0:07:03.800 --> 0:07:07.599 doctors had studied patients since the beginning of time, and 0:07:07.680 --> 0:07:11.000 there have also been scores of doctors throughout the early 0:07:11.040 --> 0:07:15.480 modern period even before then that also studied populations. But 0:07:15.600 --> 0:07:20.080 what you see happening beginning in seventeen fifty five is 0:07:20.160 --> 0:07:24.000 the rise of studies of populations, and that's not coming 0:07:24.160 --> 0:07:28.360 purely out of a medical question. It's coming out of 0:07:28.400 --> 0:07:32.480 the biggest social transformations of the mid eighteenth century, namely 0:07:32.760 --> 0:07:36.680 the rise of the slave trade and then the expansion 0:07:36.840 --> 0:07:41.119 of colonialism and the growth of empire. And then both 0:07:41.160 --> 0:07:44.600 of those forces kind of coalesce by the mid to 0:07:44.680 --> 0:07:47.680 the mid nineteenth century with the rise of war, the 0:07:47.680 --> 0:07:51.480 Crimean War and the Civil War, which again battlefields become 0:07:51.560 --> 0:07:57.040 laboratories in which populations are again studied. So ultimately it's 0:07:57.160 --> 0:08:00.440 the ways in which imagine the slave trade is about 0:08:00.440 --> 0:08:06.200 the movement, the violent, brutal transport of enslaved Africans to 0:08:06.400 --> 0:08:10.840 the Caribbean, to North America, to South America, and it's 0:08:10.880 --> 0:08:16.200 all done for economic purposes, but it ultimately created major 0:08:16.320 --> 0:08:19.440 medical crises, and so there were doctors deployed on those 0:08:19.440 --> 0:08:24.640 ships to care for the crew. But ultimately they realized 0:08:24.680 --> 0:08:27.880 that so many people were becoming sick and dying on 0:08:27.920 --> 0:08:31.600 those ships that they began this massive effort to study 0:08:31.640 --> 0:08:34.760 the spread of epidemics. And what I also noticed, and 0:08:34.800 --> 0:08:37.840 this is what I think separates my work from maybe 0:08:38.240 --> 0:08:42.200 someone who's found the doctor from thirteenth century Venice, is 0:08:42.240 --> 0:08:48.480 that these doctors are all tied together through a military 0:08:48.559 --> 0:08:53.000 network and the military is a massive bureaucracy, and the 0:08:53.040 --> 0:08:58.480 military demands these physicians to document their observations and to 0:08:58.559 --> 0:09:03.320 keep records. So now up happening is doctors are now 0:09:03.440 --> 0:09:07.920 in contact with what's happening on various slave ships throughout 0:09:08.240 --> 0:09:15.040 the Atlantic. They're trading information, they're developing preventative protocols, they're 0:09:15.080 --> 0:09:20.120 coming up with treatments. Whereas before there was no real mechanism, 0:09:20.200 --> 0:09:23.480 there was no real umbrella to knit these doctors together. 0:09:23.559 --> 0:09:25.280 And one of the things I'll say before, because I 0:09:25.280 --> 0:09:27.559 could talk about this foreveryone, ever and ever, one of 0:09:27.600 --> 0:09:30.560 the things that blows my mind is someone living in 0:09:30.559 --> 0:09:32.800 the twenty first century was that the creation of what 0:09:32.840 --> 0:09:36.559 we understand is the American Medical Association is a relatively 0:09:36.559 --> 0:09:38.959 new phenomena. It was around, it gets developed in the 0:09:38.960 --> 0:09:42.680 eighteen forty, so prior to the creation of those professional networks, 0:09:42.840 --> 0:09:45.320 Sure there were societies, Sure there was a circulation of 0:09:45.360 --> 0:09:50.120 some journals, but really the military creative bureaucracy that allows 0:09:50.160 --> 0:09:53.440 for the studies of populations that leads to the development 0:09:53.480 --> 0:09:54.439 of epidemiology. 0:09:55.480 --> 0:09:58.920 It's incredibly fascinating, and I don't think I had a 0:09:59.320 --> 0:10:04.520 true appreciate for just how much bureaucracy did in terms 0:10:04.520 --> 0:10:08.160 of the creation of epidemiology. And I also want to 0:10:08.200 --> 0:10:12.040 talk about a couple other tools that are key in 0:10:12.160 --> 0:10:15.600 studying the spread of disease and populations, and that is 0:10:15.960 --> 0:10:19.560 statistics and mapping, And can you talk about how those 0:10:19.640 --> 0:10:25.840 two tools were involved also in these aspects of colonialism, slavery, 0:10:25.880 --> 0:10:26.400 and war. 0:10:27.520 --> 0:10:30.560 So between seventeen fifty and eighteen fifty, this is a 0:10:30.600 --> 0:10:35.240 century prior to the development of germ theory and the 0:10:35.280 --> 0:10:39.920 discovery of microbes and to the understanding really of how 0:10:40.400 --> 0:10:42.680 bacteria leads to the spread of disease and even to 0:10:42.800 --> 0:10:47.320 how virus leads to the spread of disease. So oftentimes 0:10:47.480 --> 0:10:51.520 all doctors could do was count. They could count, and 0:10:51.559 --> 0:10:55.720 this goes true for the cases of field hospitals. They 0:10:55.720 --> 0:10:57.880 could count the number of people that are am in it, 0:10:58.000 --> 0:11:01.320 the number of people who die, of people who are released. 0:11:01.840 --> 0:11:06.360 So statistics emerges as a way of trying to create 0:11:06.679 --> 0:11:10.520 a rational order to respond to what seems to be 0:11:10.600 --> 0:11:15.760 really irrational, and that is the rapid morbidity immortality. So 0:11:16.200 --> 0:11:18.920 that's part of what happens. The other part of it 0:11:18.960 --> 0:11:23.240 is that colonialism is obviously very much invested in numbers, 0:11:23.600 --> 0:11:27.840 and so there's already a built in investment in cataloging 0:11:27.880 --> 0:11:31.040 things and thinking about things in terms of numbers. There 0:11:31.160 --> 0:11:34.840 is an early science before statistics call nosology, which is 0:11:34.840 --> 0:11:37.880 a sort of branch of science that develops that again 0:11:38.240 --> 0:11:41.160 draws on quantitative and empirical analysis. So you see that 0:11:41.240 --> 0:11:44.160 at work within the medical records. But the other part 0:11:44.160 --> 0:11:47.199 of this really fascinating is that if you think about empire, 0:11:47.360 --> 0:11:53.119 empires require maps. Empires require maps to not only track voyages, 0:11:53.200 --> 0:11:57.520 but also as a way to assert power over particular geography. 0:11:58.200 --> 0:12:02.600 And so mapping is integral, it's essential to colonial and 0:12:02.600 --> 0:12:08.400 imperial endeavors. And so these maps are already situated. When 0:12:08.400 --> 0:12:11.800 an epidemic blows up, it's just coloring in the map, 0:12:12.000 --> 0:12:15.360 it's filling out the map, it's using the map to 0:12:15.440 --> 0:12:18.400 tell a different story. So today when we're thinking about 0:12:18.440 --> 0:12:21.760 outbreaks of COVID, and we're thinking about mapping and surveillance 0:12:21.800 --> 0:12:25.360 and all of these are important, critical hallmarks of epidemiology 0:12:25.679 --> 0:12:29.959 and necessary for us to understand how disease spreads the genealogy. 0:12:30.320 --> 0:12:34.000 The origin of that mapping practice, whether or not it's efficacious, 0:12:34.400 --> 0:12:37.640 originates with colonialism and empire. 0:12:38.080 --> 0:12:40.920 And the history of medicine in general, I feel like 0:12:41.040 --> 0:12:45.439 is often told as this series of discoveries and accomplishments, 0:12:45.559 --> 0:12:50.240 right with the leading protagonist as the scientist logic triumphing 0:12:50.360 --> 0:12:54.000 over superstition. But as much as we may like to 0:12:54.040 --> 0:12:58.320 pretend that there's a natural, orderly progression in medical knowledge, 0:12:58.360 --> 0:13:01.679 the truth is that it's driven by many different factors, 0:13:02.080 --> 0:13:05.600 in part by shifting incentives and opportunity. So can you 0:13:05.640 --> 0:13:10.520 talk a bit about how colonialism, slavery, and war incentivized 0:13:10.679 --> 0:13:15.440 understanding the spread of disease while also providing opportunities for 0:13:15.559 --> 0:13:21.079 physicians to study these populations of disenfranchised or oppressed individuals 0:13:21.120 --> 0:13:23.840 in a way that they hadn't been able to previously. 0:13:25.120 --> 0:13:28.600 Right, So, just to put it, like, just to give 0:13:28.640 --> 0:13:32.120 a concrete example to sort of answer your question, one 0:13:32.160 --> 0:13:35.679 of the chapters of the book looks at an explosion 0:13:35.920 --> 0:13:38.520 of what they don't know at the time. They call 0:13:38.559 --> 0:13:40.840 it fever, but it eventually this is like the sort 0:13:40.840 --> 0:13:42.880 of mystery of the chapter, so they don't know what 0:13:42.920 --> 0:13:46.520 it is. It ultimately is yellow fever. And so an 0:13:46.559 --> 0:13:50.839 outbreak of yellow fever happens and the ship there was 0:13:50.880 --> 0:13:53.280 a British vessel, and it was policing the coast to 0:13:53.320 --> 0:13:57.400 West Africa for any signs of the international slave trade. Ultimately, 0:13:57.480 --> 0:14:01.160 the ship stops at Cape Verde just as a holding 0:14:01.280 --> 0:14:05.120 place before it makes his trip voyage back to London. 0:14:05.480 --> 0:14:08.480 When it stops, when it eventually arrives in London, everyone says, 0:14:08.880 --> 0:14:12.800 this ship is infected with yellow fever and you need 0:14:12.840 --> 0:14:17.000 to be quarantined. And there's explosive debate about lockdowns and 0:14:17.080 --> 0:14:20.080 about quarantine, about all of the things that I was 0:14:20.120 --> 0:14:23.040 writing about in twenty seventeen, which I thought like people 0:14:23.120 --> 0:14:25.600 are never going to understand, Like they're not going to understand. 0:14:25.920 --> 0:14:27.480 I was like literally in a coffee shop in New 0:14:27.520 --> 0:14:29.520 York being like, how do I I can't call the 0:14:29.600 --> 0:14:32.840 chapter quarantine. No, I just want to get that and 0:14:32.960 --> 0:14:35.760 like the year twenty twenties, like hold my beer, like 0:14:36.320 --> 0:14:41.880 guess you have no idea what's coming. So ultimately what 0:14:42.040 --> 0:14:46.280 happens is there's a question of like, well, how did 0:14:46.280 --> 0:14:50.080 this originate? Where did it originate? And so the British military, 0:14:50.120 --> 0:14:52.760 the British and the government send a doctor to Cape Verde, 0:14:53.280 --> 0:14:57.920 and when he arrives there, he begins this massive effort 0:14:58.240 --> 0:15:00.880 to interview all of the p people on the island. 0:15:01.040 --> 0:15:04.320 And basically what he's doing is contact tracing, and he's 0:15:04.440 --> 0:15:09.000 drawing on the narratives and the testimonies of mostly enslaved 0:15:09.040 --> 0:15:12.200 and colonized washerwomen because they had been dealing with the 0:15:12.280 --> 0:15:16.200 quote dirty linen and this could be potentially infectious. Now 0:15:16.240 --> 0:15:19.520 what's fascinating is these women had no idea he was coming, 0:15:19.880 --> 0:15:23.560 but they understood the incubation period. They had already mapped 0:15:23.560 --> 0:15:26.240 where it spread from one place to another. They had 0:15:26.280 --> 0:15:30.280 sort of figured out this house got infected, but this 0:15:30.320 --> 0:15:34.000 house didn't get infected. And he puts together their story 0:15:34.400 --> 0:15:39.680 and he produces what I call the largest inventory of 0:15:39.760 --> 0:15:44.120 a patient narrative of black people in the nineteenth century. So, 0:15:44.480 --> 0:15:47.920 to go back to your question, we often say he's 0:15:47.960 --> 0:15:51.800 the hero. He figured this out, he traced it, and look, 0:15:51.960 --> 0:15:53.800 he did a lot of work. The point is to 0:15:53.840 --> 0:15:57.440 not discredit his work. But the point is, as many 0:15:57.600 --> 0:16:02.200 medical anthropologists have said, as many people interested in narrative 0:16:02.200 --> 0:16:05.840 medicine talking about it's about centering the patient narrative, that 0:16:06.080 --> 0:16:11.120 his knowledge, his ideas could not exist without their contribution. 0:16:11.760 --> 0:16:15.160 And so when doctors eventually figured out it was yellow fever. 0:16:15.440 --> 0:16:20.320 It wasn't just from mc williams identification of pathology. It 0:16:20.360 --> 0:16:23.200 was about washerwomen noticing the black vomit and to know, 0:16:23.360 --> 0:16:25.720 wait a second, I know these people are sick, but 0:16:25.760 --> 0:16:29.320 there's something's up here. The vomit's black, and not to 0:16:29.400 --> 0:16:32.800 just say oh, they ate something bad, like they were 0:16:32.880 --> 0:16:36.960 noticing the symptoms and then it becomes codified through his 0:16:37.400 --> 0:16:41.520 formal publication. And so my work is to try to say, 0:16:41.960 --> 0:16:46.200 how does the experience of colonialism and slavery and war 0:16:46.840 --> 0:16:51.240 create create new opportunities of knowledge production, and how can 0:16:51.280 --> 0:16:54.800 we also acknowledge patient's contribution to science. 0:16:55.720 --> 0:16:59.920 Right exactly, And because it's not just about these individuals 0:17:00.360 --> 0:17:04.639 that formerly hadn't been recognized as the sources of information 0:17:04.840 --> 0:17:08.840 themselves and like local knowledge, but also the individuals themselves 0:17:08.920 --> 0:17:12.439 whose bodies gave up this information. And so how do 0:17:12.560 --> 0:17:18.520 we incorporate that more into storytelling of the history of 0:17:18.600 --> 0:17:20.359 science and medicine. 0:17:20.600 --> 0:17:22.400 So I think it is just the word you said, 0:17:22.400 --> 0:17:25.800 they're storytelling. It's about how we narrate the story. So 0:17:26.720 --> 0:17:29.679 a colleague of mine who's a pre eminent historian of 0:17:29.720 --> 0:17:32.320 medicine whose name I won't say, but he's really smart, 0:17:32.480 --> 0:17:35.720 and he's written about the Cape Verdet incident. I actually 0:17:35.800 --> 0:17:39.280 uncovered it in the archive in twenty thirteen, and I 0:17:39.400 --> 0:17:41.520 was sitting on it because it takes a while to 0:17:41.680 --> 0:17:43.960 work on a book, and so that was going to 0:17:43.960 --> 0:17:45.880 be one chapter, and I was working on other chapters 0:17:46.200 --> 0:17:50.440 in the meantime. He uncovered it as well, and he 0:17:50.480 --> 0:17:53.719 wrote a chapter on it. But he turned the doctors 0:17:53.880 --> 0:17:57.679 into the protagonist in the story. I turned the washerwomen 0:17:57.720 --> 0:18:01.880 into the protagonist's story. Neither one of us is right 0:18:02.160 --> 0:18:05.560 at history as an interpretation, but it's about how we 0:18:05.600 --> 0:18:08.840 tell the stories. In his account, these women don't even 0:18:08.880 --> 0:18:12.680 appear in my account. They've been lifted off the page 0:18:13.080 --> 0:18:19.280 as purely just informants and cast as important contributors to 0:18:19.320 --> 0:18:23.040 the development of knowledge. And so that's how I think. 0:18:23.560 --> 0:18:27.200 That's what I think the answer is. It's talking about 0:18:27.600 --> 0:18:31.000 why and how the patients matter. There's also a new 0:18:31.000 --> 0:18:34.040 book called Medical Bondage by Deirdre Cooper Owen about the 0:18:34.160 --> 0:18:38.199 rise of gynecology in the American South that developed as 0:18:38.200 --> 0:18:43.199 a result of Jay Mary and Sims' experiments on enslaved women. Again, 0:18:43.920 --> 0:18:46.080 Deirdre Cooper Owen, a very good friend of mine, a 0:18:46.160 --> 0:18:49.800 very good colleague. Is not saying that Sims isn't important. 0:18:50.240 --> 0:18:53.080 She's actually putting in the context of many other doctors 0:18:53.080 --> 0:18:57.360 that were like Sims. But she's also giving voice and 0:18:57.800 --> 0:19:01.760 giving textual space in the man Your Script to the 0:19:01.880 --> 0:19:05.879 enslaved women not just as objects of study, but rather 0:19:06.040 --> 0:19:10.480 as interlockertors, as people who were there and who were 0:19:10.600 --> 0:19:14.000 possibly know we're contributing to this new development of ideas. 0:19:14.440 --> 0:19:16.560 Sometimes I feel like, think it's a really academic and 0:19:16.560 --> 0:19:19.320 people are like, yeah, that sounds like really cool, but 0:19:19.359 --> 0:19:20.800 I don't see it working out. And then I have 0:19:20.880 --> 0:19:24.280 one word for you, A loss of taste, of smell 0:19:24.320 --> 0:19:28.080 and taste. When the COVID pathology first came out, and 0:19:28.119 --> 0:19:30.000 I was one of the people who first got COVID 0:19:30.040 --> 0:19:32.040 in March of twenty twenty, I was actually flying from 0:19:32.160 --> 0:19:35.399 LA to New York. I felt a little tired, but 0:19:35.440 --> 0:19:37.480 I thought it was jet lag. I felt a little nauseous. 0:19:37.480 --> 0:19:39.920 I thought it was like something that in the airport. 0:19:40.119 --> 0:19:43.800 I noticed immediately I lost my sense of taste and smell. 0:19:44.119 --> 0:19:47.160 It was not reported as part of the pathology. It 0:19:47.200 --> 0:19:52.040 wasn't until Kelly Ripper on Our Morning Joe It's read 0:19:52.080 --> 0:19:54.000 an article in the New York Times, and all my 0:19:54.080 --> 0:19:59.880 friends in LA were like, Jim Kelly Rippa. Its article time. 0:20:00.160 --> 0:20:03.199 And so the question becomes, how did the loss of 0:20:03.280 --> 0:20:07.480 taste and smell become part of the pathology of COVID? 0:20:07.560 --> 0:20:10.879 And it became part because patients started reporting it and 0:20:11.000 --> 0:20:14.320 doctors did not dismiss it as silly. I'm sure a 0:20:14.320 --> 0:20:17.960 bunch did, right, but a bunch didn't, And so then 0:20:18.119 --> 0:20:21.280 it becomes recognized as a hallmark of it. So, in 0:20:21.280 --> 0:20:25.399 other words, when I say recognizing patients, we have to 0:20:25.440 --> 0:20:28.200 say that we are in a process of recognizing patient 0:20:28.280 --> 0:20:32.320 narratives even today. So it's it's not just an academic 0:20:32.359 --> 0:20:36.040 theory that sounds good, it's actually how we understood what 0:20:36.080 --> 0:20:38.200 COVID is and how we're going to understand what long 0:20:38.240 --> 0:20:40.639 COVID is as well. Right, it's going to be patients 0:20:40.920 --> 0:20:44.879 reporting and doctors then going through that material and making 0:20:44.920 --> 0:20:47.400 sense of it and saying, okay, this works, that doesn't work. 0:20:47.440 --> 0:20:51.480 But the patient is important. The patient is a is 0:20:51.520 --> 0:20:53.600 an architect of knowledge in this in these. 0:20:53.480 --> 0:20:57.920 Moments, absolutely, and I feel like the shifting definitions of 0:20:58.000 --> 0:21:03.320 disease are the boundaries around disease classification are always changing, 0:21:03.400 --> 0:21:06.119 and it's a topic that we've talked about before on 0:21:06.160 --> 0:21:10.399 the podcast in the context of symptoms versus signs, signs 0:21:10.440 --> 0:21:13.919 being things doctors can observe, symptoms being things that patients report, 0:21:14.000 --> 0:21:17.320 and how that shift of being able to measure these 0:21:17.359 --> 0:21:21.280 signs like temperature or heart rate, that kind of took 0:21:21.320 --> 0:21:23.600 the attention away from the patient. And I feel like 0:21:24.000 --> 0:21:26.679 it's all still, but it's still happening, like we're still 0:21:26.720 --> 0:21:29.280 we still don't do a great job of it. But 0:21:29.560 --> 0:21:31.719 one of the things I thought was really interesting in 0:21:31.760 --> 0:21:34.000 your book is that it kind of went up into 0:21:34.600 --> 0:21:40.680 right before germ theory became a thing started, and yet 0:21:40.720 --> 0:21:45.720 still there were these hypotheses, or these prevailing notions of 0:21:45.760 --> 0:21:50.600 the way disease spread, namely in miasma theory or contagion theory. 0:21:51.080 --> 0:21:55.440 Can you talk about how those two prevailing thoughts influenced 0:21:55.600 --> 0:21:57.280 this birth of epidemiology. 0:21:58.280 --> 0:22:01.400 Yeah, So one of the things to think about is that, 0:22:01.880 --> 0:22:05.280 so my asthma theory would just be people would notice 0:22:05.280 --> 0:22:08.320 everyone's getting sick and they don't understand how, and they 0:22:08.359 --> 0:22:12.359 can see it as a contagious phenomenon. They could say, well, 0:22:12.400 --> 0:22:14.399 this person got sick then that person got sick. So 0:22:14.440 --> 0:22:17.359 they believe in Godasian and then they're like, well, where's 0:22:17.400 --> 0:22:23.800 the origin, and so they would turn to rotten vegetation, corpse, unsanitary, 0:22:23.920 --> 0:22:27.840 like an unsanitary mass of trash, and they would say, 0:22:27.880 --> 0:22:31.840 from that unsanitary massive trash, there would be these poisonous 0:22:31.920 --> 0:22:35.680 vapors emanating from it, and these poisonous vapors are moving 0:22:35.760 --> 0:22:39.679 through the air, and that's what's getting people sick. And 0:22:39.760 --> 0:22:45.040 then people said, no, I don't think so, and so 0:22:45.400 --> 0:22:50.600 colonialism becomes another important testing ground to figure that out. 0:22:50.720 --> 0:22:55.480 One of the places is in a Malta, which is 0:22:55.520 --> 0:22:57.920 in the center of the Mediterranean, and it's an important 0:22:58.000 --> 0:23:01.720 quarantine hub. It's an important quarantine hub for ships going 0:23:01.760 --> 0:23:05.480 from Europe to the Middle East. It's an important hub 0:23:05.560 --> 0:23:09.439 from North Africa to Europe. And so what happens is 0:23:10.640 --> 0:23:13.880 you have two populations of people that begin to be studied, 0:23:14.359 --> 0:23:17.960 Muslim migrants and washerwomen. And the first is like the 0:23:18.200 --> 0:23:19.919 washer women are sort of like they come up in 0:23:19.920 --> 0:23:21.840 the Cape Verdi chapter and they come up here again. 0:23:21.880 --> 0:23:23.919 And as a historian, I thought when I saw them 0:23:23.920 --> 0:23:25.879 at Cape Verdie, I thought, oh, it was interesting. It's important. 0:23:25.920 --> 0:23:27.520 When I saw them again in Malta, I was like, 0:23:28.000 --> 0:23:32.760 these are an important group of people that are central 0:23:32.840 --> 0:23:35.879 to the development of knowledge and medicine during this period 0:23:35.920 --> 0:23:39.920 and have not really been cast as leading thinkers or 0:23:40.040 --> 0:23:42.639 leading actors. And so what happens is the ship's go 0:23:42.680 --> 0:23:46.320 into port, the ship's quarantined, it's isolated, no one can 0:23:46.359 --> 0:23:48.399 come on and off. They have to wait two weeks 0:23:48.680 --> 0:23:51.840 in order for whatever's there to eventually not be there. 0:23:52.359 --> 0:23:56.840 And so these washerwomen ultimately are going on the ship 0:23:56.880 --> 0:23:59.560 to collect the dirney linens and then return the linens, 0:24:00.119 --> 0:24:03.359 and some doctor recognizes they're not becoming sick, and so 0:24:03.720 --> 0:24:08.760 automatically this sort of like they become the subjects to 0:24:08.880 --> 0:24:12.600 actually prove that contagion doesn't work, and they become the 0:24:12.640 --> 0:24:17.880 subjects for doctors to launch these massive investigations into what 0:24:18.000 --> 0:24:20.439 causes people to become sick, because it can't just be 0:24:20.680 --> 0:24:23.960 it can't be miasma and it can't be contagion. And 0:24:24.040 --> 0:24:27.040 so the washerwomen are definitely part of the medical treatise. 0:24:27.080 --> 0:24:30.199 But the other major group are Muslim migrants. Muslims who 0:24:30.240 --> 0:24:34.879 are returning from the annual pilgrimage the haj are in ships, 0:24:35.400 --> 0:24:38.400 they're in Egypt, they're in Malta, they are in other places. 0:24:38.920 --> 0:24:42.040 And again going back to your first question, it's a population. 0:24:42.800 --> 0:24:45.760 They start realizing that these ships are quote and infected, 0:24:45.880 --> 0:24:49.480 they say they're infected, they place them into quarantine, and 0:24:49.520 --> 0:24:54.639 then they realize plague or cholera or another epidemic is 0:24:54.680 --> 0:24:58.960 not spreading it, so that the sort of it sort 0:24:59.000 --> 0:25:02.720 of undermines this argument that contagion is there. And again, 0:25:02.800 --> 0:25:05.359 think about it, like if you're in a small town 0:25:05.440 --> 0:25:07.800 or you're in a big city and you're trying to 0:25:07.800 --> 0:25:11.399 figure out if contagient works, there's no real mechanism to 0:25:11.520 --> 0:25:17.000 actually figure it out. But think about how colonialism around 0:25:17.080 --> 0:25:22.360 the sort of movement of Muslims creates a massive bureaucracy 0:25:22.400 --> 0:25:27.320 within those ports that allows doctors to record copious information 0:25:27.920 --> 0:25:30.600 about who's on the ships, what they're doing on the ships, 0:25:30.800 --> 0:25:34.520 if they're and how they're being under constant surveillance. And 0:25:34.560 --> 0:25:37.000 so all of a sudden, now these are major test 0:25:37.119 --> 0:25:42.640 subject populations that begin to undermine contagion theory and lead 0:25:42.720 --> 0:25:49.080 to epidemiology, meaning leading to a more investigative method of 0:25:49.359 --> 0:25:53.919 understanding outbreak. And so just one of the points that 0:25:53.960 --> 0:25:56.480 happens is that these doctors are stationed all throughout the world, 0:25:56.800 --> 0:25:59.640 these British doctors. They're in the Ports and Malta, they're 0:25:59.640 --> 0:26:03.720 in Jamaica, they're in the Caribbean, they're in India, they're 0:26:03.760 --> 0:26:06.439 in South America. And what happens is when they return 0:26:06.560 --> 0:26:10.480 to London, they say, we've learned a lot and they 0:26:10.520 --> 0:26:15.840 create the Epidemiological Society in eighteen fifties. So that the 0:26:15.920 --> 0:26:19.040 actual deployment of these physicians throughout the Empire and their 0:26:19.119 --> 0:26:25.080 arrival back to London to create the epidemiological field proves 0:26:25.200 --> 0:26:29.000 how this was a global practice and it grew out 0:26:29.040 --> 0:26:31.040 of these key moments. 0:26:32.240 --> 0:26:36.760 And that's kind of where the classic story of epidemiology 0:26:36.880 --> 0:26:40.720 usually begins, right with John Snow and the Broad Street 0:26:40.800 --> 0:26:44.480