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  • Comment: Materia Medica
  • Linda Nash (bio)

Christopher Sellers calls for an environmental history of modern medicine that centers on the issue of the profession’s aspirations for “place neutrality,” inviting both environmental historians and historians of medicine to explore the evolving environments of the clinic and the hospital, as well as to investigate the persistence of place-consciousness in various medical specialties. While I agree that the issue of medicine’s place neutrality is worthy of further study, Sellers’s review remains strongly within the intellectualist mode so common to the history of medicine, focusing on medical ideas, medical specialties, and medical institutions. In contrast, I want to emphasize that the challenge, and the opportunity, that environmental history poses to the history of medicine is more far-reaching.

It is no secret that the origins of the history of medicine lay with physicians who were somewhat later joined by professional historians. By positioning themselves as historians of a profession, these historians implicitly signaled their range. Practitioners found their homes within medical schools; their milieu was the medical library with its volumes of old society proceedings and medical journals; their topics were defined by the interests of their medical colleagues. Not surprisingly, much of the focus was on the tracking of intellectual developments. With the rise of social and then cultural history, the field shifted its emphasis and adopted a much more critical perspective, but the focus remained on the profession itself: doctors, their patients, their instruments, their institutions.

Yet there were always alternative currents within the field. From the field’s inception, the more innovative histories focused not on the profession but on the phenomenon of disease and its movement. These histories were penned either by radical social historians with a commitment to narrating inequality or by those with training in disease ecology: Virchow’s social history of typhus in Upper Silesia, Hans Zinsser’s “biography” of typhus, Erwin Ackerknecht’s masterful study of malaria in the Mississippi Valley, Rene and Jan Dubos’s history of tuberculosis as a product of industrialization. The intellectual descendants of these disease historians include many of the field’s leading scholars who likewise took a disease-centered [End Page 50] approach: Charles Rosenberg, Randall Packard, Christopher Hamlin, and AIDS researcher-turned-historian Jacques Pepin.1 For these scholars, the focus was on disease and health, and doctors were but one group that entered their narratives. Moreover, in all these volumes, the focus on disease occurrence and transmission required closer attention to the biology of pathogens and the environmental and social conditions that sustained them at different moments. As a graduate student in environmental history, my encounter with Ackerknecht’s study of malaria was a revelation. Here was an environmental history of the mid-continent written in the 1940s, several decades before my own subfield had emerged. Ackerknecht discussed not only the response and ideas of medical professionals but also migration patterns, livestock populations, local agricultural practices, and changing construction techniques.

The subfield of environmental history, in contrast, began with a substantially different focus: landscape. Scholars chronicled the changes (usually negative) that particular landscapes had undergone and various attempts at management. The preferred landscapes were rural and the most common topics were concerned with resources, commodities, and wildlife. Although environmental historians initially evinced little concern with human health and disease, the connection to disease became unavoidable in histories of chemical pollution in the late twentieth century where the impacts on health were at issue, with communities themselves insisting that local landscapes were pathogenic.2

But environmental history quickly expanded its focus: to urban landscapes and industrial workplaces, to technological artifacts and manufactured [End Page 51] commodities. And this move toward a more expansive yet still material focus offers important opportunities to push the history of medicine in new directions. Brett Walker has recently written about World Trade Center “dust” and the sicknesses generated in the wake of 9/11 as a history that connects New York City emergency workers with workers in Libby, Montana. The link is monokote—an asbestos fireproofing material used in the Twin Towers that was manufactured from vermiculite mined in northwestern Montana. In Walker’s account, the movement of monokote into...

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