Medical Geography in Historical Perspective (review)

In a thoughtful epilogue to this multiauthor volume, Ronald L. Numbers signals the significance of the whole enterprise: what we have here is nothing less than a sustained effort to recover the history of the dominant medical science before "scientific medicine" achieved its ascendancy in the 1880s and 1890s. What was this scientific medicine avant la lettre, avant le Pasteur? Medical geography was a suite of diverse theories and practices—neo-Hippocratic in flavor, spatial in perspective, cartographic whenever possible—that worked to make sense of health and disease in terms of place, migration, chthonic, and atmospheric influence, in short, in terms of the whole array of features we might now call "environmental conditions." If one closes this handsome and well-illustrated book with a good many questions, this is no failing on the part of Nicolaas A. Rupke and his authors, but rather an indication of the importance, complexity, and novelty of the issues left on the table after the 1996 conference that generated it.

Eleven essays and two brief tailpieces make up the present work. Conevery Bolton Valencius provides a useful historiographical introduction that supercedes available bibliographical surveys of medical geography in the nineteenth century and reaches for the current relevance of a recovered history of early "environmental" medicine. She emphasizes American perspectives, but this is consistent with her area of interest—her second essay in the volume details popular conceptions of health and place in the settlement of the trans-Mississippi West—and is suitably balanced by the first full section of the book, which groups five essays under the banner "European National Practices." Rupke's own contribution on Adolf Mühry, Gottingen's "Humboldtian Medical Geographer," anchors this section, though the subsequent piece on Mühry's critic and rival, August Hirsch, which ought to have added continuity and scope to the volume's coverage, turns out to be weak and preoccupied with all-too-contemporary (if seemingly perennial) definitional problems among modern disciplinary geographers. To its credit, it will certainly remind most readers how difficult it is to read nineteenth-century German academic prose.

Shorter sections on "Colonial Discourses" and "Cartographic Representations" round out the volume. The latter section serves as an engaging forum on the scope and limits of "Humboldtianism" as a term of analysis. Rupke joins Karen E. Wonders in presenting a gallery of the distinctive Humboldtian graphical innovations (isolines, hypsometric charts, etc.) as they were borrowed by medical theorists and practitioners in mid-century middle Europe; Jane R. Camerini takes up the cartographies of disease in the Berghaus atlas and its English-language progeny, Johnston's Physical Atlas. Her close analysis of transmission and publication history shows what is too often missing from other efforts in the volume to deal with graphical material, and though she has taken on classically "Humboldtian" works here, she uses them to press a point she has been developing in other contexts for several years—namely, that the category of "Humboldtian" science has come to be used too loosely by historians of nineteenth-century science, who, in the process, both miss the specificity of Humboldt's work and obscure what she takes to be larger changes in thematic mapping and its broader politico-cultural significance in the "Age of Revolution." She is surely onto something here.

More critical, however, is the light that Medical Geography in Historical Perspective sheds on that heart of darkness where medicine, race, and colonialism run together in the nineteenth century, with world-historical implications that reverberate to the present day. If at times "medical geography" seems nearly a synonym for emergent tropical medicine, there remains a sense that attention to the medical science of place offers new lines of approach to the pressing issue of medicine and empire. As...