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Bulletin of the History of Medicine 74.4 (2000) 708-734

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Nineteenth-Century Medical Landscapes: John H. Rauch, Frederick Law Olmsted, and the Search for Salubrity

Bonj Szczygiel and Robert Hewitt

A fascinating period of urban design developed during the nineteenth century in America. Its course was relatively short-lived, but its underlying ideas pervaded the American mind-set and influenced the built environment through the development of what could be called a salubrious urban landscape. This new landscape was in large part the result of medical theories advocating either the elimination or the accentuation of natural and built environments, based on their disease and health potentials. Those medical theories postulated that disease-laden air--often called miasma or malaria--was produced by particular landforms, climates, animal waste, and vegetable decomposition, and was the source of epidemic disease. 1

The impact of the miasmatic theory on the landscape in the United States was felt most fully from the 1840s into the 1880s--at which time it was largely discredited by the medical profession, although it continued to be embraced by sanitarians and lay persons well into the 1890s. 2 [End Page 708] During this period the medical community had greater influence on the physical shape of the city than at any other time in America's history. The impact of this health/environment dualism was extensive and has resulted in contemporary examinations by many historians regarding its social, economic, political, and architectural consequences. 3 A brief list of some of the topics investigated includes the public health movement, the establishment of urban sanitary infrastructure and street improvement, the development of antiurban sentiment in the reform movement, the creation and modification of new building types, the rise of suburban development, and the rural cemetery and urban park movements. 4 Despite [End Page 709] these numerous investigations, limited attention has been paid to the interpretation and application of specific medical theory as applied to the design of cities. 5 The purpose of this paper is to document that correlation through an examination of the shared vocabularies of place and environmental characteristics developed by nineteenth-century physicians and urban designers. We suggest that this shared vocabulary was a result of several factors: the ascendance of environmentally based theories in nineteenth-century etiologic thought and the broad acceptance of miasma theories by American physicians; the ensuing interpretation and incorporation of those environmental characteristics within designs proposed by physicians and urban designers; and the subsequent general public acceptance and diffusion of ideas about environment's link to health and disease.

We will focus first on nineteenth-century American theoretical responses--especially the importance of environment-based theories at mid-century--and the role of medical topographies, the U.S. Sanitary Commission, and sanitary reform in the popularization of those theories. We will then examine the writings and ideas of two prominent citizens, John Henry Rauch and Frederick Law Olmsted, to determine how medical theory influenced built form. Chicago physician Rauch was a staunch proponent of miasmatic theory and a national leader in the public health movement. His medical reports and environmental analyses of Chicago resulted in specific urban interventions that ultimately affected [End Page 710] that city's form. Olmsted, the preeminent landscape architect of his century, helped to develop a design vocabulary that incorporated miasma theories and shaped urban morphology. The representative roles of physician as observer, theoretician, and advocate of environmental change, and of landscape architect as interpreter, advocate, and implementer of medical theory, are not unique to Rauch and Olmsted. While the identification of a shared vocabulary is significant in establishing the critical linkage between medical theory and its cross-disciplinary application, the particular significance of our study is the scope of the theory's subsequent effect on urban landscapes widely accepted then, and now, as the uniquely American urban condition.

Miasmatic Definitions and Influence on American Medicine

Inspiration for the miasma-based etiology was originally provided by the Hippocratic treatise Airs, Waters, Places. This treatise, in its many interpretations...