Lecture Three: Medicine and American Geography

Medical Theory to 1900: From Place and Health to Disease

Health Orientation to Disease Orientation

1. States of health are subjectively defined on one or more continua
2. States of ill health sufficiently serious to be subjectively understood as illnesses are occasions for seeking medical help or for claiming the sick role
3. Diseases are objectively defined temporary departures from a monolithic state of health

Causal thinking in medicine

1. Pre-modern: multicausal (prevailing in California prior to around 1880)
   • Atmospheric constitution or regional character: explains beginning of epidemic or prevailing illnesses
   • Local atmosphere: explains predisposing state of health, map help to explain origin of case of disease
   • Agents, contagia: may help to explain origins of particular case
   • Personal constitution: genetic predispositions, state of immune system, any factors relating to resistance (i.e., dehydration, exhaustion, cold)
2. Modern: monocausal
   • Germ theoretic
   • Concern for agents
   • Secondarily for immune status
3. "Post"-Modern: multicausal
   • Network
   • Risk Factor (multiple regression)
   • Concern with wellness, workdays

Humoral theories

1. Hippocrates, c. 5th-4th century, B.C.
2. Galen, 2nd century, A.D.
3. Are you Phlegmatic, Sanguine, Bilious and choleric, or Splenetic and melancholic?

What happened to place-body?

1. Indoor work; climate control
2. Immediate mobility
3. Disappearance of "race"
4. Impermeable skin
5. Pharmacological post-modern self
6. Designer body

The Centrality of Malaria

1. Fevers
   • Continuous: typhus, typhoid, flu, ...
   • Intermittent: malaria
     1. Vivax: Benign tertian (U.S. North Central)
     2. Falciparum: Most deadly (U.S. South)
   • Yellow

Dealing with the problems of California's health

1. The Critics
   • T.M. Logan: the central valley is inherently unhealthy
   • Marshall Chipman: mining, canalization is destroying health
2. The Defenders
   • Boosters and the gold rush
   • Locals
     1. It's worse down the road
     2. It's getting better
     3. Civilization (my crop, my estate, my canal) is geographical health improvement
        • "Rain follows the plow"
        • "Drains save lives"