Confronting the Climate: British Airs and the Making of Environmental Medicine (review)

Air and environment, food and drink, exercise and rest, sleep, evacuations, and emotions: together they govern health, preventing or promoting disease according to whether they are well- or poorly managed. These “lifestyle” determinants of health are Galen’s “six non-naturals.” They are not part of an individual’s inherent constitution or “nature” (hence “non-natural”), but are vitally important and at least to some extent subject to regulation by the individual.

In the eighteenth century, the intellectual ferment of the Enlightenment and the ascendancy of a secularizing, individualistic bourgeoisie sparked renewed interest in the six non-naturals, among which air was generally regarded as preeminent. Physicians advocated active prevention of illness, and many of their newly prosperous, self-confident, and optimistic patients seemed receptive to a doctrine of activism and improvement which promised a longer and healthier life.

William Coleman told this story in 1974, with an emphasis on the French intellectual context of Diderot’s and d’Alembert’s Encyclopédie. In Confronting the Climate, Vladimir Jankovic retells it in a British context, emphasizing the parallel emergence of an awareness of physiological vulnerability and a technological project of control over air. Jankovic argues that our present-day perception of the physical environment as full of potential health hazards has its roots in the “medical environmentalism” of the eighteenth century. He further contends that the putative sensibility and delicacy of elite English bodies was not the product of technologies that insulated them from external influences. Perceived physiological vulnerability and the push for protection emerged in tandem. Status- and fashion-driven sensibility propelled “improvements” that simultaneously created the danger they addressed (the health effects of exposure to certain kinds of air) and intensified the consciousness of status and fashion that demanded improvements in the first place. Vulnerability and the possibility of protection presupposed each other.

Jankovic surveys a motley assortment of medical reformers eager to affirm their professional authority while ratifying the anxieties of the propertied classes. Lifestyles defined by leisure and luxury produced bodies that were, if not sick, “unwell.” Emotional sensitivity signaled perpetual susceptibility to the elements. Domestic comfort and protection from the outdoors created a new danger: confined, vitiated indoor air. Technologies of artificial ventilation both responded to a perceived need and helped create it; medical reformers preached that body odor and stuffy humid air were dangerous as well as disgusting. Jankovic adroitly shows how the problem of “bad air” almost imperceptibly became a problem of “defective ventilation.” The difference, he argues, was profound.

Fashions in clothing mattered as well. Fear of cold and the danger of inhibiting “insensible perspiration” made fabric choice critical. When wool ceded primacy to lighter fabrics like cotton in the late eighteenth century, medical anxiety about exposure and inhibited perspiration intensified, giving rise to a pro-flannel campaign. Meanwhile, virtually all physicians agreed that geography mattered. The climate of the British Isles could produce or aggravate illness, or it could preserve health in those bodies accustomed to it, depending on which doctors one trusted. Among those who recommended southward journeys for invalids (especially consumptives), some favored warm, coastal Mediterranean destinations, while others prescribed dry, bracing Alpine air. What all shared was the conviction that particular configurations of air, weather, and wind could restore or undermine health in powerful ways. In sum, Jankovic succeeds in demonstrating that English elites were preoccupied with the health effects of various kinds of air, and he lays out in detail many of the consequences of that preoccupation.

The book suffers at times from chronological imprecision and an absence of narrative. More explicit attention to chronology would have helped probe the interplay between the chickens and the eggs—the perceived problems and the proposed solutions. Historians of technology may wish for more evidence and narrative concerning the production and consumption of the ventilators, respirators, and fabrics that constitute an important piece of Jankovic’s argument.

The contention that today’s “environmental medicine” was born out...