Reviewed by Brian Odom

On October 25, 2009, President Barack Obama declared the H1N1 flu pandemic (swine flu) a national emergency. As fear set in, so did the scramble for information that would provide some idea of both the areas affected and numbers infected. As the disease retreated, taking with it more than 18,000 victims worldwide, maps reflected its withdrawal and indicated that the crisis had indeed passed.

In Disease Maps, Tom Koch, professor of medical geography at the University of British Columbia and author of Cartographies of Disease, takes readers once again inside the incredible history and evolution of medical cartography. Koch reveals in stunning detail both the science behind the maps and the technological innovations and bureaucratic institutions that make such maps possible, whether discussing outbreaks of plague, cholera or yellow fever.

The techniques that produced these disease maps were a part of a larger paradigm shift in scientific thinking. Koch begins with Andreas Vesalius, whose great 1543 work on anatomy, De Humani Corporis Fabrica (On the Fabric of the Human Body), challenged the established authority of the physiological theories of the early Greek physician and philosopher Galen by presenting the dissected human body, with the “flesh stripped away,” as the locus of disease. Through the use of these new maps of the human body, as well as careful observation, students and medical practitioners could come to understand the body’s mysterious inner workings. Vesalius was not operating in a vacuum but within a well-established framework provided by both the Scientific Revolution and the Age of Discovery. The same networks that sustained mercantile trade and exploration, and through which pandemics traveled, were the subject of new maps of the world that allowed man to reconceptualize the globe and his place within it.

Simultaneously a fundamental shift was underway, from the natural philosophy of “close observation and a careful logic” championed by Thomas Hobbes to Robert Boyle’s more modern conception of science, characterized by an experimental method in which evidentiary arguments would be “judged by the agreement of one’s peers.” All of these transformations and innovations cleared the way for a revolutionary approach to the quest for knowledge and the study of disease.

State bureaucracies in early modern Europe demanded improved techniques in data collection and mapping in an effort to better understand the diseases that continued to lay waste to their populations. Ideally these measures would provide officials with the proper knowledge to begin public health initiatives such as quarantines and sanitation measures, all of which came at great cost. As an example of these efforts, Koch examines the 1690 quarantine issued by military governor Filippo Arrieta in the Italian province of Bari. Arrieta produced two maps of his cordon sanitaire that detailed his containment strategy and, according to Koch, “created the field on which the portable disease was to be restrained.” Koch argues that what made further organized responses possible by the end of the eighteenth century was both a growing professionalism in the medical establishment that turned from simple disease treatment to disease study, and a growing awareness on the part of civil bureaucracies that disease was a “thing lodged not in the individual alone but in the population at large.”

It is in his examination of the world’s, and particularly Britain’s, 19^th-century experiences with cholera, however, that Koch’s efforts are truly remarkable. As cholera epidemics continued to devastate England’s industrialized cities, maps of epidemics, such as those by Edwin Chadwick, Reverend Henry Whitehead and John Snow, provided public health institutions with usable information by which effective measures could be developed. For the British Board of Health, understanding the disease, locating its origin and rectifying the situation became top priority, as in the case of the Broad Street Pump, the contamination of which in 1854 lead to a deadly cholera outbreak (recently examined in Steven Johnson’s The Ghost Map). In the face of an overwhelming wealth of data, maps became the “essential medium … in which tables of data were transformed into arguments” and allowed for “the construction of disease events like cholera.”

Koch argues that whether we are confronting epidemics of the 16^th or the 21^st century, disease maps transform individual pathologies “into a public health event affecting communities and nations.” In constructing these maps, “boundaries are set and the content within those boundaries organized to create the context in which disease theories are proposed and tested.” Communities, by seeing these epidemics, are given the ability to make decisions and marshal all available public health resources to combat deadly outbreaks. In the realm of disease epidemics, “we want it to be simple — a straightforward something we can see and therefore know, and in the knowing, control.” But as Koch makes clear “disease is rarely simple.”

The real stars of Koch’s work are the multitude of vibrant maps, charts and graphs that place before the reader the evolutionary nature of how societies represent and understand the accumulation of data that enable the construction of valid arguments. From Ortelius’ Theatrum Orbis Terrarum to John Snow’s map of South London’s water supply, these maps have something important to tell us about the geography they represent. They inform, insist and argue complex problems in a straightforward fashion, with an internal logic that is sometimes impossible to deny.

In Disease Maps, Koch has produced a remarkably edifying account, accessible to non-specialists, that forces us to not only to consider the importance of medical cartography to the field of public health but also reconsider how we understand the complex and deadly nature of diseases.

Brian Odom is a graduate of the University of Alabama with master’s degrees in history and library science. He teaches history at Jefferson State Community College, outside of Birmingham, Alabama, and is a reference librarian at Pelham Public Library.