We are met here to honor the achievements of the late Dr. Eric Williams and to discuss current research on outstanding issues in British West Indian history. In recent months I have reread much of Capitalism and Slavery, together with Williams's other books and articles, critiques of his work, and especially his autobiography, Inward Hunger: The Education of a Prime Minister. In this essay I will attempt to present a biographical and historiographical study of Williams, including a sketch of the man and his time and how he was influenced by different schools of historiography. I plan to look at his sources, methods, and findings, and, in greater detail, to show how his work has been assessed by historians and others. In short, I intend to show how various conditioning circumstances helped to mold the historical mind and work of Eric Williams, and how scholars in both the First and Third Worlds have reacted to Capitalism and Slavery. More attention will be given to the reactions of British scholars than their counterparts in the West Indies, Africa, and the United States.

Eric Eustace Williams was born in Port-of-Spain, Trinidad, September 25, 1911, the oldest of twelve children of Thomas Henry Williams, a clerk in the Port-of-Spain post office, and Eliza (Boissiere) Williams. He was a precocious child, taking to his studies with exceptional talent and determination under the encouragement and guidance of his father, but not to the exclusion of active participation in sports and part-time help with his mother's bakery business. He was educated in Port-of-Spain at Tranquillity Intermediate School and Queen's Royal College, where he held a government scholarship, graduated with honors, and won the Island Scholarship in 1931.

Our task in this chapter is to investigate in some detail the nature of the plantation labor system in its agricultural and industrial aspects and on a seasonal basis, and to describe and analyze the systems of supplying the workers with food and the adequacy of their diets. Furthermore, we investigate the nature and frequency of slave punishments and show how they were related to other forms of treatment.

Cane hole digging and night work

Writers on slavery differed about how long and hard the blacks worked. Philip Gibbes, an absentee planter of Barbados who sought to reform slavery, believed that the cultivation of sugarcane, from the insertion of the plants in the earth to the packing of the sugar in the cask, was a continuous process of hard labor.

This chapter focuses attention on the Guinea surgeons who treated sick slaves on British vessels engaged in the Atlantic slave trade. Early sections of the chapter are concerned with economic and demographic aspects of the slave trade and slavery, the dimensions of the trade, and West Africa's involvement in it. Questions are raised about the Guinea surgeons, their professional credentials, motivation, and especially the medical services they supplied to slaves. Later sections deal with mortality on the Middle Passage and efforts to reform the medical and other aspects of the trade.

“To buy or to breed”

The failure to produce a self-sustaining slave population was the most striking demographic peculiarity of the slave plantation societies of the Caribbean and other South Atlantic regions.

In our investigation of plantation medical practice, we look at the doctors and other white and black people who treated slaves in the British Sugar Colonies. More specifically, we are concerned with the extent of practice, the frequency of visits to slave hospitals, methods of procuring and dispensing medicines, and doctors' compensation. Among other things, the chapter contains case studies of individual doctors and comparisons with plantation medical practices in other slave societies.

The “irregular” practitioners

West Indian medical practice in the age of slavery developed from a system dominated by urban-based doctors who mainly treated white patients on an individual basis to a system of both urban- and rural-based doctors, with the latter treating chiefly black patients who were attached to estates and plantations on an annual contract basis. The shift from a predominantly white, urban-based practice to one directed chiefly to slaves attached to agricultural units can be explained, in part, by the near-monoculture system of sugar production.

In writing this book I have investigated facets of slave life that affected their health and well-being, such as culture shock, diet, work loads, punishment, housing, clothing, sanitation, and occupational hazards. I have looked at the demographic experience of the slaves, their birthrates, death rates, sex ratios, longevity, and, above all, their failure to increase their population by natural means. I have looked at the principal diseases of the slaves, contemporary and modern theories of disease causation or etiology, and methods of treatment and their efficacy. I have looked at problems of natality and infant and child care. I have investigated the state of medical science and art in Europe and Africa; the education of doctors, midwives, nurses, and pothecaries; the nature of plantation medical practice; and the quality of health care. Because of its size and economic and political importance, Jamaica has been given central attention in this study; however, other British Sugar Colonies have been investigated to the extent that demographic and medical records permit.

My approach to slave medicine and demography has been influenced by the environmental and ecology movements of recent decades. Ecology is a term used in the biological sciences to describe a total system of interrelated populations of different species; it is the study of the relationship of plants and animals to their environment, of the relationship of plants and animals to one another, and of the influence of humans on the ecosystem.

This final chapter first summarizes the demographic and economic history of slavery in the British West Indies. It then analyzes the demographic and economic situation and seeks to weigh the relative importance of the various factors. We investigate the practice of heroic medicine in the Sugar Colonies and assess the quality of health care supplied to the slaves. Finally we compare the demographic structure and health care systems under slavery and freedom and their chief consequences.

Slave population attrition

The primary goal of this study has been first to understand why the slave population of the British West Indies suffered a net natural decrease during the period 1680 -1834, and second to ascertain the quality of health care provided the slaves.

This introductory chapter surveys the sources of our knowledge of population in the West Indies; die physical, social, and disease environments of the region; and interactions with other disease environments. Accordingly, we investigate the rise of the South Atlantic System with special reference to the spread of infectious disease through the movement of people and their microorganisms, the expansion of slave-grown sugar and other agricultural staples, the killer diseases of malaria and yellow fever, and the findings of the Army Medical Board's Report. Later sections of the chapter focus on medical writings that sought to advance rational conceptual schemes of disease causation, prevention, control, or eradication. Major emphasis is placed on the nature and incidence of slave diseases and injuries.

This is the first of three chapters concerned with the health care system on West Indian slave plantations. This chapter takes up the dreaded plague of smallpox, its destruction of both white and black inhabitants, the great importance of preventive medicine in the form of variolation or inoculation and vaccination, and campaigns against smallpox in other New World colonies. Subsequent chapters will deal with slave hospitals and plantation medical practices.

Introduction

Smallpox or variola is an eruptive fever that was probably the deadliest of the early epidemic diseases of the Americas. It is an acute infectious virus disease characterized by vomiting, pain in the loins, fever, and eruptions that spread over the body; the eruptions are converted into pustules, which dry up into soft, yellow crusts that have a peculiar offensive odor. In the final stage the scabs fall off, leaving pitted scars or pock marks. Before Jenner's discovery of vaccination, smallpox reputedly killed, crippled, and disfigured one-tenth of all humans. The virulence of the disease varied according to conditions of poverty, overcrowding, migration of peoples and their microbes, as well as the ratio of immune to nonimmune inhabitants of a given community.

Smallpox was introduced into the West Indies in 1518-19, twenty-six years after the European discovery of America by Columbus, and contributed to the extermination of whole peoples.

The slave hospitals on sugar plantations played an important role in the health care system. In this chapter we look at such features of these hospitals as their siting, construction, interior arrangements, equipment, personnel, and the care and treatment of patients and prisoners. We look especially at the slave hospitals of Jamaica and British Guiana, and compare them with their counterparts in Cuba and the United States. Critical analysis reveals the strengths and weaknesses of slave hospitals.

Introduction

A hospital is a place that provides medical and/or surgical care and treatment for the sick and injured. Traditionally, hospitals have served as both medical schools for practitioners and resting places for patients under observation and treatment. In the Middle Ages hospitals were often constructed adjacent to monasteries, and members of religious orders devoted much of their time to nursing the sick. As Europe expanded overseas, new and often lethal disease environments were created as a result of war, migration, commerce, and natural disasters. Soldiers and sailors were the first to stimulate the building and staffing of hospitals in colonial territories. Military hospitals pioneered new medical knowledge and skill, as well as nursing and custodial procedures.

This is the first of two chapters concerned with the physical and social environments in which most of the Afro-West Indians lived during the slavery era. This chapter focuses on the sugar plantation and on how newly imported Africans were treated, how the slaves were clothed and housed, how they were assigned to labor groups and tasks, and how they were affected by the system of absentee proprietorship. Chapter 6 is concerned chiefly with the labor, diet, and punishment of slaves.

The sugar plantation

Caribbean plantation economies and societies were remarkable for their production of wealth and notorious for their treatment of slave laborers. “From the perspective of post-Roman European history,” writes Sidney W. Mintz, “the plantation was an absolutely unprecedented social, economic and political institution, and by no means simply an innovation in the organization of agriculture.”

From our concern with morbidity and mortality in Chapter 7 we turn now to problems associated with slave reproduction. The diseases and disorders of infants and children and pregnant and lactating women are treated in greater depth, as are the pro-natal policies and practices of planters and the difficulty of reconciling these policies to an economy and society that had long regarded women as primarily work units rather than breeding units.

Patterns of reproduction

Despite the great natural fecundity of the African race, the female slaves in the British West Indies were less fertile than their sisters in Africa and North America. Both contemporary and modern writers have sought to explain the basic differences of slave demography in terms of the cultural and psychological shock of enslavement, the survival of African mating and child-rearing customs, pro- and anti-natalist policies of slaveholders, disease environments, conditions of labor and livelihood, and economic factors related to the Atlantic slave trade and plantation slavery.

It is our task in this chapter to show how the patterns of morbidity and mortality were related to age, sex, occupation, and mode of life, as well as to the physical environment. We analyze the relationships between malnutrition and disease and how contemporary and modern authors have contributed to our understanding of these interrelationships. Separate sections are devoted to the diseases and disease patterns of infants, children, and adult slaves.

“Disorders peculiar to the Negroes”

Slave morbidity and mortality were the most vital and sensitive issues that confronted the West Indian planter class. Bryan Edwards admitted that the “grand and most plausible” accusation against the general conduct of the planters arose “from the necessity they find themselves under of having an annual recruit of slaves from Africa, to fill up the numbers that perish in the West Indies.”

In this chapter we examine the medical culture of West Africa, the extent to which it was carried by the slaves to the West Indian colonies, and how it was modified and, in part, suppressed when it came into contact with the white medical establishment on sugar plantations. Separate sections focus on the treatment of yaws, the slave medical attendants on plantations, and the role of women in Afro-West Indian medicine.

The two medical cultures: Africa

Two medical cultures – one African, one European – have dominated the British Caribbean territories during the past three centuries. African medicine, which combined mystical beliefs and rituals with herbal remedies and poisonous substances, was brought to the New World by the slaves. Telling the story of African folk medicine in the colonies is difficult. White colonials were so convinced of their cultural superiority that they dismissed African medicine or “white magic” as mere superstition.

Given the harsh disease environment and the heavy investment in slave laborers in the Sugar Colonies, it was expected that the planters would employ physicians and surgeons to supply medical services to the blacks. In this chapter our attention is first centered on the recruitment of white doctors and efforts to upgrade the medical profession. After a brief survey of medicine in Cuba and North America, we look at the doctors who held diplomas from European medical schools and especially the doctor-scientists and authors. The conclusion attempts to assess the strengths and weaknesses of the white medical profession from the standpoint of their black patients.

Recruitment of doctors

Increasing the number and quality of medical practitioners was a concern to inhabitants and governments from the foundation of colonies. New settlements needed physicians and surgeons not only to treat diseases imported from Europe and Africa but also to cope with diseases that were indigenous to the New World.