Cartographies of Disease: Maps, Mapping, and Medicine (review)

This book is an important contribution to the history of medical geog-raphy in general, and more particularly the evolution of nineteenth- and twentieth-century cartographic strategies to understand and combat the diseases of contagion, both very ancient and quite new. Tom Koch, a medical geographer and bioethicist, brings the skills of a working cartographer to those of a historian of cartography to present and analyze a wealth of materials that both illustrate and construct shifting and contentious theories of disease origins and dispersion in recent Western culture, wherever that culture went.

The scientific response to contagious diseases has been driven, always, by the progress of the diseases themselves. Koch references the general history of contagion during the last several thousand years, but his major emphasis is on diseases of the previous two centuries: plague, cholera, yellow fever, and flu pandemics in the nineteenth century, and hepatitis and AIDS in the twentieth, along with a variety of more localized diseases in the non-Western world that Westerners acquired along with their colonies.

Maps, charts, and other graphics are at the heart of this profusely illustrated and well-designed volume, but they are presented and analyzed not as illustrations of the history of epidemiology, but rather as among the critical tools that both advanced and retarded the discipline. This reflects major changes in the history of cartography. In the new view, as Denis Wood notes in the introduction, "maps are not presentations of facts but the graphic marshalling of selective propositions into arguments about the nature of reality" (p. xv).

At the heart of the book are the epidemics of cholera in nineteenth-century Britain and their encounters with the burgeoning enterprises of the practitioners of new sanitary sciences, the accumulators of masses of "moral statistics," great changes in the printing and distribution of maps, and the celebrated Dr. John Snow. Snow (1813–58) was a talented and ambitious scientist-physician who, earlier than most of his peers, came to believe that cholera was introduced to cities by an unknown water-borne contagion that then spread by direct person-to-person contact. This was in contrast to the then-prevalent theories that cholera and much else erupted "miasmatically" from the sordid living conditions of the poor and marginal in the Dickensian cities of Britain. All these competing theories were grounded in profoundly social perspectives on the relation of race and class to disease, and their arguments were quite graphic.

Maps as investigative as well as illustrative tools were at the heart of the cholera debate, and Snow, like many other researchers, mapped his argument. More specifically, in 1854 in the second edition of On the Mode of Communication of Cholera, he mapped the distribution of recent cholera deaths arranged around the water pump on Broad Street in London's Soho. The clustering of deaths around this pump was evident; Snow had correctly identified the disease-vector relation between the pump and the populace. During the late stages of the epidemic he ordered workmen to remove the pump handle.

Only months later, however, did he create his map. A great myth lay waiting to be born. Over the next century-and-a-half, Snow's story was reconstructed so that he crafted the map during the outbreak, and the evident clustering of deaths itself yielded his breakthrough insight into the nature of cholera. He became the father of medical cartography, and his compatriots' maps disappeared from the story (as did the rest of his own maps, along with the first edition of his cholera treatise). Over time, his map evolved from an analytical tool to an effective cartographic communication device. Snow's graphic became less suitable as its supposed purpose changed—so others redrew his map, dozens of times. Koch presents seven different versions of "the map." The deconstructions of these reconstructions have...