Tom Koch, Disease Maps: Epidemics on the Ground, University of Chicago Press, Chicago, 2011. 344 pages, 106 colour plates, 43 other illustrations. $ 45.00, £ 29.00, ISBN-13: 978-0-226-44935-7, ISBN-10: 0-226-44935-1.

In the history of science, a few iconic items tend to catch the popular imagination: Newton’s apple, Fleming’s mould, Crick and Watson’s double helix. In epidemiology, a contender would be a simple pump handle (still recalled on coffee mugs in at least one medical common room). It is the handle on the water pump in Broad Street, Soho, whose removal in September 1854 is popularly supposed to have halted the devastating cholera epidemic sweeping that crowded corner of England’s capital city that year.

Tom Koch is adjunct professor of medical geography in the University of British Columbia and author of Cartographies of Disease (2005). In his latest book, he could well have chosen the Broad Street pump handle as a colophon for each chapter for, despite its broad title, the central theme of the book is the nineteenth-century concern with understanding and halting the spread of cholera. The book is divided into three sections.  Part 1 (chapters 1 to 5) looks at general ideas of disease and their cartographic representation in the period up to 1800. Part 2 (chapters 6 to 11) studies cholera in the nineteenth century, beginning with its Indian origins and then focussing on west European cities in general and London in particular.  Part 3 (chapter 12) considers the implications of cholera mapping for other diseases such as cancer.

Text books and disease lore tend to portray a heroic John Snow mapping cholera deaths on Soho streets, and having a ‘eureka’ moment when the link to the infected Broad Street pump was made. Koch’s careful analysis of contemporary documents shows a much more complicated and uncertain story. Snow was one of several observers (including William Farr in London, William Budd in Bristol, and Thomas Shapter in Exeter) who worried about sewage contamination and its implication for disease spread. John Simon’s studies in south London and the Reverend Henry Whitehead’s mapping of Soho each played a critical part. Snow too had other concerns than cholera and left important legacies in anaesthetics and gynaecology as well as epidemiology.

While a majority of Koch’s maps are concerned with cholera he extends beyond this corpus to include a range of other infections. Plague maps from Italy include Filippo Arrieta’s of the province of Bari, Italy, showing how nested quarantine areas manned by troops were created in an attempt to form a cordon sanitaire to halt the progress of plague during the 1690-92. Modern maps include the United States experience of West Nile Virus introduced into New York City in 1999, Peter Gould’s classic maps of the bushfire-like spread of AIDS in the United States in the 1980s, and diarrhoea outbreaks in Vancouver in 2000.  Between these historical extremes, a chapter on Yellow Fever traces its spread into the Caribbean and US coastal cities in the eighteenth century.

Throughout the book, Koch stresses the subtle role of cartographic scale in the mapping and understanding disease. His examples run the full gamut from global, through continental, to national, regional and local. Most striking are those where individual buildings are identified: polio in a small Iowan town, cancers in an English village, typhoid in an Appalachian town, infected houses along Sycamore Street in Cincinnati, yellow fever along the wharves of the East River in New York City. Koch’s concept of mapping extends well beyond conventional geographic scales and he devotes much of an early chapter to considering Andreas Vesalius’s sixteenth-century De Humanis Corporis Fabrica as a ‘map’ of human anatomy.  He could well have carried his argument further and regarded the optical microscope and electron microscope as a further scale extension.

Koch writes extremely well with a minimum of fuss. He strives hard to communicate with his readers and keeps medical terms to a necessary minimum. But two quibbles remain for this reviewer. First, given the emphasis of the book on cholera, it would have helpful for potential users if the author had included the word ‘cholera’ squarely in the subtitle: specialists in this field may miss this book. This disease is the focus for half the chapters and over half the illustrations. Second, I would have liked more biographical information (either in text or footnote) on the main ‘actors’ in Koch’s story. Important figures float on and off stage in a disconcerting way and it would have been good to know more about them and set them in context.

To assemble his chest of treasures, Koch has drawn on the resources of several great map collections; the British Library in London, the National Library of Medicine in Bethesda, Maryland, and the Newberry Library in Chicago head the list. For those of us who have spent hours trying to track down the location of a map from an incomplete caption or footnote, Koch’s ‘Notes on the Illustrations’ section is a welcome addition. In it, he makes clear the provenance of most of his maps, both in the original and facsimile forms.

The University of Chicago Press deserves the thanks of all book lovers for its splendid design and production. A clear typeface, uncluttered pages and a weight and quality of paper which allows justice to be done to Koch’s choice of beautiful maps. While volumes like Disease Maps continue to be produced, the siren attractions of Kindle or internet publication will long be resisted. The book deserves to be read for both for profit and pleasure by cartographers, historians of science and epidemiologists alike. 

References

Koch T (2005) Cartographies of Disease: Maps, Mappings and Medicine. Redlands, CA: ESRI Press.