Modern Airs, Waters, and Places

Introduction: Modern Airs, Waters, and Places

Alison Bashford, Sarah W. Tracy

Bulletin of the History of Medicine, Volume 86, Number 4, Winter 2012,pp. 495-514 (Article)

Published by The Johns Hopkins University PressDOI: 10.1353/bhm.2012.0084

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495 Bull. Hist. Med., 2012, 86 : 495–514

Introduction: Modern Airs, Waters, and Places

alison bashford and sarah w. tracy

Summary: Twenty-four centuries have passed since the doctrine of Airs Waters Places was articulated in the Hippocratic corpus, promoting a mutually constitu-tive vision of humankind and climate. Yet the “airs, waters, places tradition” has proved remarkably resilient and adaptable as a framing device for relations among nations, natural and human resources, and human health. Redeployed in diverse historical contexts across time, the relationship between climate and humans has evolved from a dependent one in which human constitution and health are determined by climate to an interdependent one in which humans and climate influence one another. Recent scholarship extends the ways in which historians of colonial medicine, neo-Hippocratic medicine, public health, tropical disease, and race have characterized the climate–human nexus and its attendant politics. Through the exploration of the works of circumnavigators, physicians, physiolo-gists, ecologists, geographers, paleoanthropologists, and economists, contributors to this special issue offer some new and sometimes challenging interpretations of medical climatology: beyond the link between tropical medicine and colonialism, beyond temperate versus tropical, beyond latitude to think of altitude.

Keywords: climate, acclimatization, colonialism, medical climatology, race, en-vironment, holism, tropical medicine

For where the changes of the seasons are most frequent and most sharply contrasted, there you will find the greatest diversity in physique, in character, and in constitution. These are the most important factors that create differences in men’s constitutions; next come the land in which a man is reared, and the water. For in general you will find assimilated to the nature of the land both the physique and the characteristics of the inhabitants.

—Hippocrates, Airs Waters Places1

1. Hippocrates, Airs Waters Places, in Hippocrates, with an English Translation by W. H. S. Jones, vol. 1, Loeb Classical Library (London: William Heinemann, 1923), 135–37.

496 alison bashford and sarah w. tracy

Across the world scientists are examining anthropogenic climate change, asking, “What impact do humans have on climate?” Yet as historians of health and disease know, precisely the reverse question has dominated medical inquiry at least since the Hippocratic corpus: “What impact does climate have on humans?” Medical historians have been far more inter-ested in how the weather makes us (to paraphrase Hippocrates) than how we make the weather (to paraphrase Tim Flannery).2 This volte-face would seem to be one of the most sudden in the history of Western science. Yet the history of medicine also suggests that such a turnaround might be more apparent than real.

Both approaches refer to the symbiotic relationship between humans and their environments. Indeed, inasmuch as oxygen, water, and a ready supply of calories are required for our survival as individuals and as a spe-cies, the relationship between humans and the environment may be the most elemental and defining one we enjoy. It should come as no surprise then that this relationship has been a persistent focus of medicine and public health since the Hippocratic corpus was compiled. In the case of Hippocrates, however, it was seen as one of dependence: human constitu-tion and health were determined by climate. The Hippocratic physician took stock of the seasons, the waters, the prevailing winds, and the physi-cal geography and soil of a place: powerful agents of change as they were perceived to affect the body’s humoral balance in what amounted to a new secular, natural philosophy of human health beginning around 400 BC. Today, the relationship between humans and their environment is seen as interdependent. Our expanding species has in modern times—particularly during the past century—exerted an effect on the environment to the extent that a new era is being suggested: the Anthropocene.3 Whether by dint of the world’s growing population, rampant deforestation, fossil fuel exploitation, or the detonation of nuclear arms, humans have acquired the power to alter the earth’s airs, waters, and places to an unprecedented degree, in turn affecting our health and even prospects for survival. In this sense, the balance between climate and human health—the recognition of their interconnectedness—championed by the ancient Hippocratics seems today both quaint and prescient.

2. Tim Flannery, The Weather Makers: How Man Is Changing the Climate and What It Means for Life on Earth (New York: Atlantic Monthly Press, 2005).

3. Libby Robin and Will Steffen, “History for the Anthropocene,” Hist. Compass 5 (2007): 1694–719; Will Steffen, Jacques Grinevald, Paul Crutzen and John McNeill, “The Anthropo-cene: conceptual and historical perspectives,” Phil. Trans. Roy. Soc. A: 369 (2011): 842–67.

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This special issue of the Bulletin of the History of Medicine revisits the modern history of the airs, waters, places tradition.4 As a framing device for relations among nations, natural and human resources, and human health, this “tradition” has proved remarkably resilient and adaptable, redeployed in diverse historical contexts across time. These essays present a variety of episodes in the modern transformation of the ancient airs, waters, places tradition, beginning in the sixteenth century, but moving quickly into the nineteenth, twentieth, and twenty-first. They examine the evolving nature of this framework—from dependent to interdependent models of climate and health over the past four hundred years. Thus, unlike the great current discussion of climate change, our focus is firmly on the longevity of the interactions among environment and human performance, disease, and health. How, where, and with what effect have remnants of the idea that climate shapes human constitution and predis-position to disease survived into the modern period? When and under what circumstances have physicians, physiologists, ecologists, geographers, paleoanthropologists, and economists redrawn the relationship between environment and human health? That climate molds human capacity, difference, limits, health, and disease is a very old idea, but it is one that has a remarkably recent history.5 Contributors here explore aspects of this modern medical history of climate, substantively developing what is now an extensive historiography about climate and health. At the same time several counterintuitive arguments push the objects of inquiry and frameworks of interpretation in the history of medical climatology beyond those that have become somewhat conventional. Historians here look at some more unusual, if idiosyncratic, episodes that suggest additional and in certain cases challenging interpretations: beyond the link between tropical medicine and colonialism, beyond temperate versus tropical, and beyond latitude to think of altitude.

For most medical historians of the modern period, “climate” typically signals tropical medicine and the related pursuit of extra-European colo-nial medicine. In this context, medical meteorology and medical geog-raphy were linked.6 On one view this emerged as part of early modern

4. We have chosen to use the term airs, waters, places tradition to distinguish the evolving intellectual framework for considering the relationship between climate and human health from the ancient Hippocratic text.

5. For an excellent overview of recent thinking about climate, see James Rodger Flem-ing and Vladimir Jankovic, “Revisiting Klima,” in Fleming and Jankovic, eds., Klima, Osiris 26, 2nd ser. (2011): 1–15.

6. For medical meteorology see Andrea Rusnock, “Hippocrates, Bacon, and Medical Meteorology at the Royal Society, 1700–1750,” in Reinventing Hippocrates, ed. David Cantor (Aldershot, UK: Ashgate, 2002), 136–56.


ventures into and across the torrid zones of the globe, between the Tropics of Cancer and Capricorn. This was a history of the Atlantic tropics from the seventeenth century and the Pacific tropics from the eighteenth cen-tury. But it is perhaps most squarely a history of the nineteenth century, the period when mass migrations, travel, and extra-European settlement dovetailed with increasingly biological taxonomies of racial difference.

“Place was important until the middle of the 19th century,” a current Medical Geography textbook begins.7 Historians would more likely nominate the fin de siècle as the high point for the grafting of climate, race, and physiological determinism. But as several essays here show, “climate” and “environment” shaped tropical medicine claims, geopolitical priorities, and research agendas for decades to come. Indeed even into the middle decades of the twentieth century inquiries abounded into human physi-ological and psychological capacity and limits influenced by temperature, humidity, rainfall, prevailing winds, soils, latitude, and altitude, as well as pathology affected by different environmental elements.

Perhaps more than any other factor, it was the issue of climate that drove the great historiographical connection between medical history and colonial history, now three generations old. This was an enterprise initiated by Philip Curtin’s 1964 discussion of British ideas about Africa, followed by Michael Worboys’s 1976 “Emergence of Tropical Medicine.”8

Historians have extensively studied the sciences of human acclimatization in various colonial contexts, from the seventeenth to the early twentieth centuries, and across British, French, Dutch, and to some extent German scientific and political histories.9 In the Americas, climate was a key ele-ment of U.S. territorial expansion from the late nineteenth century, and environmental factors have strongly shaped the linked medical and politi-cal histories of South American republics.10 Historical scholarship on the

7. Melinda S. Meade and Michael Emch, Medical Geography, 3rd ed. (New York: Guilford Press, 2010), 9.

8. Philip Curtin, The Image of Africa: British Ideas and Action, 1780–1850 (Madison: Univer-sity of Wisconsin Press, 1964); Michael Worboys, “The Emergence of Tropical Medicine,” in Perspectives on the Emergence of Scientific Disciplines, ed. Gérard Lemaine, Roy Macleod, Michael Mulkay, and Peter Weingart (The Hague: Mouton, 1976), 75–98.

9. David N. Livingstone, “Human Acclimatization: Perspectives on a Contested Field of Inquiry in Science, Medicine, and Geography,” Hist. Sci. 25 (1987): 359–94; Philip D. Curtin, Death by Migration: Europe’s Encounter with the Tropical World in the Nineteenth Century (Cambridge: Cambridge University Press, 1989); David Arnold, ed., Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500–1900 (Amsterdam: Rodopi, 1996); David Arnold, The Problem of Nature: Environment, Culture and European Expansion (Oxford: Blackwell, 1996).

10. For example, C. Reynaldo Ileto, “Cholera and the Origins of the American Sanitary Order in the Philippines,” in Imperial Medicine and Indigenous Societies, ed. David Arnold (New

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role of climate in the preservation of human health and the management of human affairs has for the most part appeared under the “paradigmatic colonial science” of acclimatization, to borrow Michael Osborne’s phrase. It has studied the phenomenon of people deemed out of place, focusing especially on the ways that imperialist agendas affected discussions, defini-tions, and policies regarding disease and the management of health and state in the globe’s torrid zones.11

The analytic trend in this scholarship, unsurprisingly, has been to expose a modern biological and environmental “determinism” and the racial politics driving it. In 1996 the Bulletin of the History of Medicine published a special section on the construction of race through medical climatology: Mark Harrison on the British in early-nineteenth-century India and Warwick Anderson on the Americans in early-twentieth-century Philippines. This special section, “Race and Acclimatization in Colonial Medicine,” signaled the primacy of “race” in modern medical histories of climates.12 Taking its cue from the history itself, much of the scholarship that culminated in and was generated by these essays analyzed expertise in the production of “white” physiology, the peculiar modern idea of “white-ness” as a distinctive kind of human physiology. It was the problem of white people, mainly white men in the tropics, that most exercised experts on climate and human health in the past. As many medical historians have shown, it was widely presumed that white men, and sometimes women, were physiologically out of place in tropical environments, that the cli-mate would eventually produce unwelcome bodily and mental effects.13

York: Manchester University Press, 1988); Marcos Cueto, “Sanitation from Above: Yellow Fever and Foreign Intervention in Peru, 1919–1922,” Hisp. Amer. Hist. Rev. 72 (1990), 1–22; Julyan G. Peard, Race, Place, and Medicine: The Idea of the Tropics in Nineteenth-Century Brazilian Medicine (Durham, N.C: Duke University Press, 1999); Alexandra Minna Stern, “Yellow Fever Crusade: US Colonialism, Tropical Medicine, and the International Politics of Mosquito Control, 1900–20,” in Medicine at the Border: Disease, Globalizatio and Security, 1850 to the Pres-ent, ed. Alison Bashford (Basingstoke: Palgrave Macmillan, 2006), 41–59.

11. Michael A. Osborne, “Acclimatizing the World: A History of the Paradigmatic Colo-nial Science,” Osiris 15 (2000): 135–51; Mark Harrison, Climates and Constitutions: Health, Race, Environment and British Imperialism in India 1600–1850 (New Delhi: Oxford University Press, 1999); David N. Livingstone, “Race, Space and Moral Climatology: Notes toward a Genealogy,” J. Hist. Geog. 28 (2002): 159–80; Eric T. Jennings, Curing the Colonizers: Hydro-therapy, Climatology, and French Colonial Spas (Durham, N.C.: Duke University Press, 2006).

12. Warwick Anderson, “Disease, Race, and Empire,” Bull. Hist. Med. 70 (1996): 62–67; Mark Harrison, “‘The Tender Frame of Man’: Disease, Climate and Racial Difference in India and the West Indies, 1760–1860,” Bull. Hist. Med. 70 (1996): 68–93; Warwick Ander-son, “Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900–1920,” Bull. Hist. Med. 70 (1996): 94–118.

13. One strong line of inquiry has emerged with respect to the settler–colonial Austra-lian context, driven by the particular health history of a politically “white Australia.” David


As a result of this extensive work, we currently have a good base of knowl-edge about the dominance of the broad idea of environmental determin-ism, and the specific science and politics to which it was put, especially over the colonial nineteenth century and early twentieth century that is usually understood to be the high moment of an environmentally deter-minist paradigm.14

Two other lines of inquiry sometimes dovetail with the history of medical climatology and race, but constitute a separate set of studies. Key early monographs established a tradition of disease-specific analysis, documenting research into the etiology and therapy of particular condi-tions; leprosy, bilharzia, trypanosomiasis, hookworm, malaria, yellow fever have each been explained in detailed works that consider environmental health and human health as one.15 The other trend has been to focus on place-based pathology by historicizing particular research institutions.16

Walker, “Climate, Civilization and Character in Australia, 1880–1940,” Austral. Cult. Hist. 16 (1997/98): 77–95; Dane Kennedy, “The Perils of the Midday Sun: Climatic Anxieties in the Colonial Tropics” in Imperialism and the Natural World, ed. John M. Mackenzie (Manchester: Manchester University Press, 1990), 118–40; Lorraine Harloe, “Anton Breinl and the Aus-tralian Institute of Tropical Medicine,” in Health and Healing in Tropical Australia and Papua New Guinea, ed. Roy Macleod and Donald Denoon (Townsville, Australia: James Cook Uni-versity, 1991), 35–46; Alison Bashford, “Is White Australia Possible? Race, Colonialism and Tropical Medicine,” Ethnic & Racial Stud. 23, no. 2 (2000): 248–71; Warwick Anderson, The Cultivation of Whiteness: Science, Health, and Racial Destiny in Australia (Melbourne: Melbourne University Press, 2002).

14. David N. Livingstone, The Geographical Tradition: Episodes in the History of a Contested Enterprise (Oxford: Blackwell, 1993).

15. For example, John Farley, Bilharzia: A History of Imperial Tropical Medicine (Cambridge: Cambridge University Press, 1991); François Delaporte, The History of Yellow Fever: An Essay on the Birth of Tropical Medicine (Cambridge, Mass.: MIT Press, 1991); Margaret Humphreys, Yellow Fever and the South (New Brunswick, N.J.: Rutgers University Press, 1992); Marcos Cueto, Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955–75 (Baltimore: Johns Hopkins University Press, 2007); Michelle Moran, Colonizing Leprosy: Imperialism and the Politics of Public Health in the United States (Chapel Hill: University of North Carolina Press, 2007); Diego Armus, ed., Disease in the History of Modern Latin America: From Malaria to AIDS (Durham, N.C.: Duke University Press, 2003).

16. For example, Marcos Cueto, Missionaries of Science: The Rockefeller Foundation and Latin America (Bloomington: Indiana University Press, 1994); Anne-Marie Moulin, “The Pasteur Institutes between the Two World Wars: The Transformation of the International Sanitary Order,” in Paul Weindling, International Health Organizations and Movements 1918–1939 (Cambridge: Cambridge University Press, 1995), 244–65; Helen J. Power, Tropical Medicine in the Twentieth Century: A History of the Liverpool School of Tropical Medicine, 1898–1990 (Lon-don: Kegan Paul, 1999); Jean-Pierre Dedet, Les Instituts Pasteur d’outre-mer: cent vingt ans de microbiologie française (Paris: L’Harmattan, 2000); Lise Wilkinson and Anne Hardy, Preven-tion and Cure: The London School of Hygiene and Tropical Medicine, a Twentieth Century Quest for Global Public Health (London: Kegan Paul, 2001); John Farley, To Cast Out Disease: A History

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Such histories of diseases address climatological pathology rather more than physiology. And insofar as ecology has been linked into this field, of which more below, there has also been a pathological focus.17 Many stud-ies have squarely addressed the relationship among changing etiologies, laboratory-based epistemologies, and studies of parasites, bacteria, viruses and the environments that supported or interrupted their cycles of repro-duction. “What is Malaria, and why is it most intense in hot climates?” asked just one practitioner in 1871, summarizing tropical medicine’s core business.18 And although a generation of medical historians have been trained methodologically to perceive “the tropics” discursively and as part of a global political economy,19 such a question raises matters of fact, as much as matters of interpretation. Environmental determinism is firmly out of favor, for good reasons; poststructuralist medical history that would refuse a fact/interpretation distinction, barely less so. But either way, there are still microorganisms and their mosquito hosts to take account of, in relation to their own temperature-controlled reproductive physiology. Dengue’s mosquito, for example, prefers and even, for the moment at least, needs the latitudes between thirty degrees north and thirty degrees south, and an elevation below one thousand meters—in short, where winter temperatures average above fifty degrees.20 Dengue fever’s global distribution, then, still corresponds (though not, of course, of necessity) to the tropics in cartographical terms, and, importantly, to something like “the global south” in political economy terms.21 To take another case, the

of the International Health Division of the Rockefeller Foundation (1913–1951) (Oxford: Oxford University Press, 2004); Ryan Johnson, “Colonial Mission and Imperial Tropical Medicine: Livingstone College, London, 1893–1914,” Soc. Hist. Med. 23 (2010): 549–66.

17. For example, Warwick Anderson, “Natural Histories of Infectious Disease: Ecologi-cal Vision in Twentieth Century Biomedical Science,” Osiris 19 (2004): 39–61; Randall M. Packard, The Making of a Tropical Disease: A Short History of Malaria (Baltimore: Johns Hopkins University Press, 2007); J. R. McNeill, Mosquito Empires: Ecology and War in the Greater Carib-bean, 1620–1914 (Cambridge: Cambridge University Press, 2010).

18. C. F. Oldham, What is Malaria? And why is it most intense in hot climates? An enquiry into the nature and cause of the so-called marsh poison . . . (London: H. K. Lewis, 1871).

19. Arnold raised the discursive tropics in the introduction to Warm Climates and Western Medicine (n. 9). Randall Packard has explained the political work performed by the relent-less linking of malaria to “the tropics.” See Making of a Tropical Disease (n. 17).

20. See the Mayo Clinic Laboratories description of dengue’s range: http://www.mayomedicallaboratories.com/articles/hottopics/transcripts/2012/05-dengue/03.html (accessed November 11, 2012).

21. On dengue fever, see Duane Gubler and Goro Kuno, eds., Dengue and Dengue Hemor-rhagic Fever (Wallingford, UK: Commonwealth Agricultural Bureaux International, 1997); Alan Rothman, ed., Dengue Virus (Berlin: Springer-Verlag, 2009). On Ross River virus, see New South Wales Health, Ross River Fever Fact Sheet: http://www.health.nsw.gov.au/fact-sheets/infectious/rossriver.html (accessed November 11, 2012).


Ross River virus—transmitted via mosquitoes again—produces not just a “tropical” disease but also a “seasonal” disease, prevalent during the “wet season,” and dependent on, one might almost say determined by, air, water, and place. To say so does not preclude either the awareness or the claim that the prevention or cure of a disease in a given population is equally determined geopolitically and economically. This is why there are still tropical medicine institutes across the globe’s central latitudes, as well as in the world’s metropolitan centers.

It is in such research contexts that the link between human health, ani-mal health, microbiology, and climate persists most strongly. Some tropical medicine institutes are aware of their discipline’s political and colonial history. Tropical medicine engages its own history perhaps more than it used to, occasionally upfront about “old concerns and new challenges.”22

A self-conscious twenty-first-century “reincarnation” of tropical medicine is interestingly situated between the historical legacies of colonialism, reborn as international health in an age of globalization, and the legacy of medical climatology, reborn as climate-affected health in the age of the Anthropocene.23 The Bernard Nocht Institute for Tropical Medicine in Hamburg, for example, hedges its bets: “be it due to globalization or climate change,” tropical diseases are on the rise.

It is rare that twenty-first-century tropical medicine enterprises do not justify their research at least in part in terms of climate change and the geographically increasing risk of vector-borne disease transmission. It is ironic, though, that the urgency for “tropical” medicine is linked to the spread of “tropical” climate: “West-Nile virus has taken over the USA in 2004, Chikungunya virus emerged in Italy in 2007, and its vector, ‘tiger mosquito’ Aedes albopictus, moved into the Upper Rhine valley by 2007.”24

Strangely, one potential effect of climate change is to “de-tropicalize” tropical health and disease, to separate tropical medicine out from its geopolitical origins as “colonial” health or, later, “international health.” Some would welcome this bifurcation. Others would say that tropical dis-eases have become newly important because they threaten the “temper-ate” societies of the world, so to speak.

In any case, it is clear that the time is ripe for medical historians to link their own deep knowledge of medical geography, tropical medicine, and colonialism to the somewhat separate history of climate change, not

22. See the Bernard Nocht Institute for Tropical Medicine home page: bni-hamburg.de/bni/bni2/neu2/getfile.acgi?area_engl=welcome&pid=00 (accessed September 24, 2012).

23. See James Cook University’s Australian Institute for Tropical Health and Medicine: http://www.jcu.edu.au/fmhms/research/aitm/JCUDEV_018651.html (accessed Septem-ber 24, 2012).

24. See the Bernard Nocht Institute for Tropical Medicine home page (n. 22).

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least since the discipline of tropical medicine itself is doing so. History is being mobilized in the process. Tropical medicine institutes the world over engage their own uncomfortable histories just now perhaps because cli-mate change offers another, less directly incriminating history to embrace.

Another strand of scholarly inquiry into disease and climatic environ-ments has been domestic and local: humoral cosmologies explained health and illness in one’s own place, as well as in exotic places. Early modern studies have established the complexities of “airs, waters, places” for different lay and expert etiologies and therapeutics. They have also offered a base from which late-modern historians can substantiate the longevity of certain ideas and practices about seasons, winds, and bal-ances well into the twentieth century.25 “Air,” perhaps even more than “water,” came to be the privileged element in modern urban contexts: health might be manufactured, maximized, or threatened by the relation between bodies in architectural spaces, as much as humans in globally differentiated places.26 Rebuilding both domestic and public space to cre-ate environments that would promote health constituted a cornerstone of modern public health reform.27 Long a concern of early public health boards and sanitary commissions in nineteenth-century Britain and the United States, the perceived dangers of urban environments, with their poorly constructed tenement housing, street-side and waterborne sewage and animal waste, and industrial pollution—solid, liquid, and airborne—kept the relationship between environment and human health central to discussions of disease, even after germ theory carried the day.

One interpretive ambition in this context has been less to identify racial, imperial, or even national politics of human difference, and more to understand the logic and fortunes of “holism” in the comprehension of disease and the pursuit of health. A sustained project in this respect has been to examine how late modern “reductionism” emerged out of, or in response to, early modern epistemologies that presumed a connec-

25. See Mary Dobson’s Contours of Death and Disease in Early Modern England (Cambridge: Cambridge University Press, 1997), chap. 1; Andrew Wear’s recent article periodizes the Hippocratic tradition “up to the early twentieth century.” Wear, “Place, Health, and Disease: The Airs, Waters, Places Tradition in Early Modern England and North America,” J. Mediev. Early Mod. Stud. 38 (2008): 443–65.

26. For example, Vladimir Jankovic, “Intimate Climate from Skins to Streets, Soirees to Societies,” in Intimate Universality: Local and Global Themes in the History of Weather and Climate, ed. James R. Fleming, Vladimir Jankovic, and Deborah R. Coen (Sagamore Beach, Mass.: Science History Publications, 2006).

27. See Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, Mass.: Harvard University Press, 1998); Harold Platt, “From Hygeia to the Garden City: Bodies, Houses, and the Rediscovery of the Slum in Manchester, 1875–1910,” J. Urban Hist. 33 (2007): 756–72.


tion between a macrocosm and the microcosm of an individual embodied subject. Microorganisms and germ theories were long argued to trump the former views, along with the hot-cold logic of humoralism. But such a teleology no longer holds. Often enough, microorganisms continued to be understood in relation to an environmentally shaped human physiol-ogy. Tuberculosis is the standout disease here, its contraction, prevention and cure connected to winds, temperatures, humidity and altitude well into the twentieth century. Medical men continued to gather and assess meteorological data in minute detail long after microorganisms were known to be necessary and sufficient to cause the disease. And as soon as microbes appeared on the aetiological scene, their behavior as organisms in environments also surfaced intellectually as disease ecology.28 Account-ing for the contemporary “epidemic” of asthma in industrialized nations, likewise, reminds us that environment and health continue to be assessed in toto, as immunologists in the “hygiene hypothesis” camp believe that the absence of germs and traditional childhood diseases within the devel-oped world may have impeded the development of children’s immune systems, rendering them susceptible to asthma.29

Perceiving and comprehending the necessary relations between parts and the whole, a specifically nominated “ecology” was just one manifesta-tion of a broader intellectual and methodological tendency toward holism that Christopher Lawrence and George Weisz have argued characterized the early to mid-twentieth century in particular.30 Sometimes this was fig-ured explicitly as Hippocratic revival, sometimes it incorporated the long tradition implicitly. Either way, such integrative scholarly approaches to human health and disease at various scales clearly sat alongside the much-analyzed germ theories that isolated necessary and sufficient cause in a microbe. The airs, waters, places tradition was part of a revived constitu-tional medicine and a neo-humoralism of the twentieth century.31

28. See chapters in Gregg Mitman, Michelle Murphy, and Christopher Sellers, eds., Landscapes of Exposure: Knowledge and Illness in Modern Environments, Osiris, vol. 19 (Chicago: University of Chicago Press, 2004).

29. See Kevin G. Becker, “Autism, Asthma, Inflammation, and the Hygiene Hypothesis,” Med. Hypoth. 69 (2007): 731–40; A. B. Fishbein and R. L. Fuleihan, “The Hygiene Hypothesis Revisited: Does Exposure to Infectious Agents Protect Us from Allergy?” Curr. Opin. Pediatr. 24 (2012): 98–103.

30. Christopher Lawrence and George Weisz, eds., Greater Than the Parts: Holism in Bio-medicine, 1920–1950 (Oxford: Oxford University Press, 1998). See also George Weisz, “Hip-pocrates, Holism and Humanism in Interwar France,” in Cantor, Reinventing Hippocrates (n. 6), 257–79.

31. Sarah W. Tracy, “George Draper and American Constitutional Medicine, 1916–1946: Reinventing the Sick Man,” Bull. Hist. Med. 66 (1992): 53–89; Tracy, “An Evolving Science of

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Both nineteenth-century sanitary scientists and twentieth-century epidemiologists thought systemically, as they assessed the relationship between disease and environmental assaults. And the mid-twentieth-cen-tury emergence of the field of social epidemiology made plain that the environment was socially and politically mediated, its practitioners advo-cating for the consideration of sociocultural and psychosocial “climates,” and focusing explicitly and prescriptively on the social inequalities that shaped human health.32 The “moral universes” that framed disease and its prevention were and are enduring.33

n

The articles in this special issue consider the diverse ways in which sci-entists from a range of disciplines (physicians, physiologists, ecologists, geographers, paleoanthropologists, and economists) as well as laypeople (circumnavigators, military personnel) engaged climate. Together, they extend the interpretive agenda of medical histories of climate.

There is always a tension between ecumenical and climate-specific visions of humans, but the great interest in “race” has perhaps neglected their coexistence. Moreover historians’ focus on physicians’ epistemolo-gies has at times obscured lay visions of human sameness. The scholarly focus on epistemologies of human difference is nuanced, perhaps even challenged by Joyce Chaplin’s perception of ecumenical understandings of human sameness. In “Earthsickness: Circumnavigation and the Ter-restrial Human Body, 1520–1800” (pp. 515–42), Chaplin takes a longue durée approach, reflecting on three centuries of circumnavigators—sailors, captains, and physicians—as they conceived and treated the problem of scurvy. During a period when climate-specific ideas of human constitu-

Man: The Transformation and Demise of American Constitutional Medicine, 1920–1950,” in Lawrence and Weisz, Greater Than the Parts (n. 30); David Cantor, “The Name and the Word: Neo-Hippocratism and Language in Interwar Britain,” in Cantor, Reinventing Hip-pocrates (n. 6), 280–301.

32. Nancy Krieger, “Theories for Social Epidemiology in the 21st Century: an Ecosocial Perspective,” Internat. J. Epidemiol. 30 (2001): 668–77; Krieger, “A Glossary for Social Epide-miology,” J. Epidemiol. Commun. Health 55 (2001): 693–700. Sue Estroff and Gail Henderson, “Social and Cultural Contributions to Health, Difference, and Inequality,” in The Social Medi-cine Reader: Social and Cultural Contributions to Health, Difference, and Inequality, 2nd ed., ed. Sue E. Estroff, Gail E. Henderson, Larry R. Churchill, Nancy M. P. King, Jonathan Oberlander, and Ronald P. Strauss (Durham, N.C.: Duke University Press, 2005), 4–26.

33. Charles E. Rosenberg, “Florence Nightingale on Contagion: The Hospital as Moral Universe,” in Explaining Epidemics and Other Essays in the History of Medicine (Cambridge: Cambridge University Press, 1992), 90–108.


tion figured importantly within medicine, the guiding dichotomy for mariners, Chaplin argues, was not temperate versus torrid zones, but ter-restrial versus marine environments. Humans—all of them—were at core terrestrial creatures. The most important place was terra firma. Confined to an ocean-bound existence for months, even years, Chaplin’s circumnavi-gators paid little, if any, heed to the racial or climatic origins of afflicted seamen. Instead, they treated scurvy-stricken seamen by putting in to port, regardless of location, or offering patients “fresh” food still endowed with the vital force of the land. Chaplin’s article reinforces the need to “update” our understanding of the airs, waters, and places tradition, and to look beyond tropical medicine and medical practitioners in terms of location, periodization, and conceptual framing.

In “The Physiology of Extremes: Ancel Keys and the International High Altitude Expedition of 1935” (pp. 627–60), Sarah Tracy also reverses sev-eral standard objects of “climate” history. She explores not latitude, the classic axis for medical climatology and its historiography, but altitude. And her historical actors were experts less of hot and humid climates, than of cold and dry. Tracy examines the ways in which extreme altitude, with its attendant hypoxia, mattered to experimental physiologists and physicians who pursued the relationship between climate and humankind during the first half of the twentieth century. Her essay extends a recent interest in historical examination of altitude. The effect of high mountain air has captured historians’ attention, as it captured that of earlier physi-ologists.34 But more modest elevations were also medically significant, as Pratik Chakrabarti shows in his recent study of the design and habitation of laboratories in the hills of India.35 Altitude became the companion to latitude, sometimes offsetting the latter’s apparent effects, at other times creating a whole new set of physiological problems.

Rarely was this kind of physiological research “pure” and not applied. In Tracy’s article, we see the symbiotic relationship that obtained between

34. For historical scholarship exploring the connections between high altitude and the history of science, technology, and medicine, see Charlotte Bigg, David Aubin, and Philipp Felsch, “Introduction: the Laboratory of Nature—Science in the Mountains,” Sci. Context 22 (2009): 311–21. See also Felsch, “Mountains of Sublimity, Mountains of Fatigue: Towards a History of Speechlessness in the Alps,” Sci. Context 22 (2009): 341–64; Michael Reidy, “John Tyndall’s Vertical Physics: From Rock Quarries to Icy Peaks,” Physics Perspect. 12 (2010): 122–45; Reidy, “From Oceans to the Mountains: Spatial Science in an Age of Empire,” in Knowing Global Environments: New Historical Perspectives on the Field Sciences, ed. Jeremy Vetter (New Brunswick, N.J.: Rutgers University Press, 2011): 17–38. See also Jorge Lossio, “Life at High Altitudes: Medical Historical Debates, Andean Region, 1890–1960” (Ph.D. diss., University of Manchester, 2006).

35. Pratik Chakrabarti, Bacteriology in British India: Laboratory Medicine and the Tropics, Rochester Studies in Medical History (Rochester: University of Rochester Press, 2012).

Introduction 507

neocolonial mining and aviation industries on the one hand and Ameri-can respiratory and exercise physiologists on the other. Finding that both sea-level natives and higher dwelling Andeans could adjust equally well to altitude, members of the high altitude expedition, like Chaplin’s circumnavigators, promoted an ecumenical vision of humankind adapt-ing. In this case, climate mattered, but it mattered equally to all. Such physiological findings not only furthered American business interests in Latin America, but also demonstrated the effectiveness of a scientific methodology well suited to the interests of the American military during the Second World War, namely how to optimize human performance in the extreme climates of the South Pacific, the Arctic north, and the Sahara Desert. The Harvard Fatigue Laboratory (HFL), where the International High Altitude Expedition (IHAE) was planned, became the centerpiece of climatic physiology research as the United States braced for the battle abroad.

As Tracy shows, the laboratory, as well as the field, held central impor-tance in twentieth-century explorations of “the man-environment unit.” (p. 655). Indeed, the boundaries between lab and field became blurred, with the mountain affording a “natural laboratory” for testing human adaptation to altitude and the HFL furnishing temperature and pressure-controlled hyperbaric chambers for shorter-term studies. Under the rubric of “human biology,” the IHAE scientists employed new climate-control technologies to determine the boundaries of human performance, and the “extreme” frequently also became “normal.” Recording and aiding the body’s ability to maintain homeostasis in extreme climates, the HFL scientists attempted to preserve human health and functioning, much as the Hippocratic physician strove to maintain the humoral balance of his patient. As Tracy observes, Keys’s own career trajectory from high-altitude physiology, to exercise and nutritional physiology, to the epidemiology of chronic disease, reveals the central importance of climatic physiology to the development of the biomedical sciences in America.

The historical examination of medical climatology has involved as many geographers as historians in recent times. Some see a “geographic turn” energizing the history of science.36 If this is so, then it is not just “outdoor” places, or “natural” climate that require analysis. Interior envi-ronments become the object of scrutiny as well. Some of these—more intriguingly still—were simulations of outdoor climates. By the twentieth

36. David N. Livingstone, Putting Science in its Place: Geographies of Scientific Knowledge (Chicago: University of Chicago Press, 2003); Diarmid A. Finnegan, “The Spatial Turn: Geographical Approaches in the History of Science,” J. Hist. Biol. 41, no. 2 (2008): 369–88.


century, pathological and physiological studies were increasingly taking place in controlled indoor laboratory simulacra, often far removed from the original. Such simulated environments became the “field:” the fatigue laboratory; the tropical heat “sweat box”; or the enclosed spaces for alti-tude, starvation, and cold experiments.37 Foregrounding the key role of the simulated experimental environment that reached its high point in mid-twentieth-century biomedical sciences, links physiological inquiry with environmental and ecological history.

By the same token, the environment of nonclinical interior and domestic spaces were subject to “therapeutic” analysis: they could be more healthfully managed into the twentieth century. This was the age of technological optimism, as David Livingstone observes in his essay, “Changing Climate, Human Evolution, and the Revival of Environmental Determinism” (pp. 564–95). In the twentieth century, the development of air conditioning and heating technologies led many to believe that humans could master extreme natural environments, or even moderately uncomfortable ones. Air could be “conditioned” to optimize comfort and efficiency. Potentially, interior climates could be regulated and standard-ized the whole world round. For Harvard meteorologist Robert G. Stone, to take just one example, the high modern project to normalize “comfort zones” brought physiologists and climate scientists into close research contact with the American Society of Heating and Ventilating Engineers. All this was to further the goal of “tropical settlement,” as he put it.38 It is no wonder that tropical medicine and hygiene have given rise to such a vast historiographical field that one way or another has signaled the airs, waters, places tradition as core to the modern colonial enterprise.

Alison Bashford takes a different tack, however. In “Anticolonial Cli-mates: Physiology, Ecology, and Global Population, 1920s–1950s” (pp. 596–626), she explores twentieth-century manifestations of climatic and physiological determinism as key not only to colonialism but occasionally to anticolonialism as well. The distinguished human ecologist and econo-mist Radhakamal Mukerjee put the canon of tropical medicine to work, but counterintuitively, in the interests of Indian anticolonial nationalism. Indian physiology optimized labor and agriculture in certain climates he

37. On climatic simulation under laboratory conditions, see Matthew Farish, “Creating Cold War Climates: The Laboratories of American Globalism,” in Environmental Histories of the Cold War, ed. J. R. McNeill and Corinna Unger (New York: Cambridge University Press and the German Institute, 2010): 51–83; Sharon Kingsland, “Frits Went’s Atomic Age Green-house: The Changing Labscape on the Lab-Field Border,” J. Hist. Biol. 42 (2009): 289–324.

38. Robert G. Stone, “Comfort Zones and Acclimatization,” in White Settlers in the Tropics, A. Grenfell Price, with Robert. G. Stone (New York: American Geographical Society, 1939), 284.

Introduction 509

argued, tropical medicine texts in hand. This gave Indians political claim to regional territory, as their own physiologically endowed and racially fitting “living space.” He even argued for “Asiatic Lebensraum,” a surpris-ing cadence of ideas about humans and places that Bashford explains. Actively seeking to synthesize Eastern and Western knowledge of “man and his habitation,” Mukerjee’s work was in many ways idiosyncratic. But Bashford suggests that it reveals the impact of early-twentieth-century ecology on the period’s rethinking of human difference in relation to environment. “Regional ecology” and “world ecology,” as Mukerjee devel-oped the fields, functioned through an economy of natural and human-mediated inputs and outputs; a global economist’s neo-Hippocratism. Through ecological ideas, he strove for healthy “balance” in a manifestly unequal and imbalanced world. While “ecology” as an idea has had a phe-nomenally successful public relations track record, vindicated by climate change-driven environmental orthodoxy, it has also carried some more problematic, even darker elements of twentieth-century history. There is, or at least was, a determinism that ecology facilitated. One effect of ecological thinking, Bashford argues through the case of Mukerjee, was to renaturalize humans in relation to the airs, waters, and places to which they purportedly belonged.

Even as the germ theory of disease, the bacteriology laboratory, and medical parasitology transformed Western medicine in the first half of the twentieth century, and promoted an ontological understanding of disease, Neo-Hippocratic ideas that linked specific climates with health and disease, figured importantly in diverse contexts. As David Cantor and colleagues have shown, everything signaled by “Hippocrates” has long been in a process of reinvention.39 That reinvention has itself been partly dependent on place. In their article, “Medical Climatology in France: The Persistence of Neo-Hippocratic Ideas in the First Half of the Twentieth Century” (pp. 543–63), Michael Osborne and Richard Fogarty reveal the rich airs, waters, places tradition that held sway in late-nineteenth- and early-twentieth-century Lyon. Through analysis of the physicians Marius Piéry and L.-F.-A. Kelsch, Osborne and Fogarty highlight the importance of “place” itself in nurturing a Neo-Hippocratic approach: Lyon’s colo-nial and military institutions with their connections to the tropics, as well the nearby spa waters and the rugged Alpine terrain, made the city an environment where medicine and meteorology operated “in a symbiotic relationship” (p. 558), encouraging physicians to recognize the diverse climates of the globe as “active and primordial therapeutic agents”

39. Cantor, Reinventing Hippocrates (n. 6).


(p. 558). Indeed, while Lyon physicians such as Piéry worked at an indi-vidual level, attempting to cure their patients with a change in environ-ment, so too did Lyon military men such as General F. Ruby attempt to “heal,” or at the very least alter, the climate itself by firing cannonballs or airborne shells into storm clouds to minimize hail damage to the Lyonnais. Through their actions they also helped launch the modern interactionist airs, waters, places tradition, where humankind exerted a notable effect on climate. A place-based brand of technological optimism guided these diverse efforts. Likewise, the resonances between Osborne and Fogarty’s study of French colonial and military French “climatists” and Tracy’s fatigue lab scientists are clear, as military and colonial activi-ties in diverse climates demanded new knowledge of the parameters of human performance under alien, often extreme, conditions. Moreover, as Bashford and Tracy show in their essays, such data could serve colonial, neocolonial, or anticolonial agendas.

Osborne and Fogarty also remind us that diseases such as malaria, tuberculosis, and a host of psychological disabilities, were not necessarily amenable to an ontological framework, remaining polymorphous condi-tions seemingly susceptible to therapeutic changes in climate. The spa waters of Vichy and Mont Dore and the dry mountain air of the Alps, championed by Marius Piéry, offered patients restorative climatic treat-ments. Piéry not only advocated the use of climatic therapies, but also promoted a neo-Lamarckian evolutionary vision of humankind shaped by environmental agency. In many ways a climatic determinist, he believed that sustained climatic action was responsible for both a distinct Lyon-nais race and a unique Andean race. Here, his ideas echoed those of indigenista physiologist Carlos Monge, who was consulted by members of the International High Altitude Expedition to Chile discussed by Tracy. Monge, like Mukerjee, was steeped in anticolonial politics.

The high point of such climatic determinism in the early twentieth cen-tury and the revival of similar strains of “environmental reductionism” at the century’s end is the subject of David Livingstone’s essay, “Changing Cli-mate, Human Evolution, and the Revival of Environmental Determinism.” Livingstone examines the rise of climate as the “critical determinant in the evolutionary narrative” (p. 566) and the crystallization of climatology as a new discipline that explained, among other things, human migrations in both the deep and recent past. His analysis of the affinities among the ideas of William Diller Matthew, Griffith Taylor, Ellsworth Huntington, and Henry Fairfield Osborn highlights the importance of cartographic imagery in furthering visions of climate-driven evolution, especially at continental and oceanic scales. William Diller Matthew’s early images

Introduction 511

of radial waves of migration out of the holarctic zone toward warmer climates promoted a racial hierarchy favoring “adaptable,” “resourceful” northern peoples over those who migrated south. The geographer Griffith Taylor’s conclusions were different, but overall, his as well as Huntington and Osborn’s climate-driven images and explanations of the migration of humans across and around the globe, reinforced a Eurocentric view of race and place that helped justify colonial and neocolonial enterprises.

Yet if climatic determinism faded from view following the Second World War, by the end of the century it had returned, buoyed by the politics of global climate change, new technologies for collecting paleoclimatic data, and heightened concerns about a planet hanging, in the words of Al Gore, “in the balance.” Humans’ newfound ability to master their climates gave way to doubts about environmental sustainability. In this new light, technological mastery appears something of a Faustian bargain. Thus, as Livingstone examines the new climatic reductionism that characterizes much evolutionary theory today, he explores the affinities and discontinui-ties between early- and late-twentieth-century visions of humans affected by and affecting the environment writ large. Livingstone’s analysis—past and present—provides a sense of the utility, versatility, and dangers of climatic determinism in accounting for humankind’s historic and future development. His article also offers an important context that allows us to see Piéry’s views about a Lyonnais race and Ruby’s efforts to alter the Lyon-nais climate for improved agriculture as of a piece; to better appreciate Carlos Monge’s belief in a Andean race shaped by altitude; and to more fully interpret Radhakamal Mukerjee’s physiologically based anticolonial land annexation program.

In these essays, then, the modern trajectory of Hippocratic ideas on the relationship between climate and humans is related to environmental medicine, climatic determinism, human biology, anthropology, ecology, economics, military medicine, and physiology.40 As Charles Rosenberg observes in his epilogue, far from fading from view or returning in its classical form, “Airs, Waters, Places” has been redeployed with regularity in a range of new contexts, and to diverse ends over the past century. The articles in this special issue point to several important factors that have

40. Similarly in KLIMA, the most recent issue of Osiris, James Fleming and Vladimir Jankovic present a diverse collection of essays that analyze the evolving definition of climate, humankind’s relationship to climate, and the multidisciplinary study of climate between the seventeenth and twenty-first centuries. Especially relevant to this volume is Mark Carey’s discussion of changing notions of the Caribbean climate between 1750 and 1950, “Inventing Caribbean Climates: How Science, Medicine, and Tourism Changed Tropical from Deadly to Healthy,” KLIMA, Osiris 26, 2nd ser. (2011): 129–41.


prompted the redefinition and redeployment of climate and its relation-ship to humankind in modern times. Among these factors are the devel-opment of new technologies (new forms of fossil-fuel-dependent trans-portation, the development of laboratory-based life sciences, intensive agricultural practices, to name three), war (especially World War I with its air-and life-destroying gassing and World War II with its global theater and deployment of nuclear weapons), and the ongoing (colonial, neo-colonial, and post–Cold War) competition for earth’s natural resources. Political sciences and earth sciences have come together as medical his-tory before.41 Climate change is making them do so again.

These essays offer several ways forward for scholarship on the medi-cal comprehension of humans in place. They show a number of modern transformations and effects of the airs, waters, places tradition, and they collectively press for its longue durée assessment and its consideration within changing colonial-global modern politics. Climate is clearly polymorphous and has many actual sites. Climates can be inside and immediately around the body, Charles Rosenberg notes, as epigenetics, as microclimates, or as gut ecologies. It is in “nature” on the one hand, and in the laboratory on the other. Climate has affected and created domestic as well as industrial workplaces over the modern period, introducing a critical architecture of health and hygiene. The increasing indoor simulation of outdoor environments to study their effects on human physiology, pathology, and psychology, is clearly part of this history, one that invites not least a his-tory of technology.

Climate has been defined by altitude as much as by latitude, in high countries and low countries as well as in temperate and torrid zones. And height and depth have not just been on terra firma; humans in air, humans in water, and humans in space, as well as humans in places, all have been important objects of scrutiny, for both biomedical and atmospheric sci-ences. Air travel (originally in balloons), submarine exploration, and subsequently space travel each have medical histories in the physiology of humans in extreme environments. At what heights and depths—at what atmospheric pressures—can human life exist? Where does life expire? And how does this study of extreme physiology set the standards for nor-mal physiology? Both military medicine and the medical experimenta-tion done under military dictatorships (not least the Nazi high altitude experiments) are part of the twentieth-century trajectory of “airs, waters,

41. L. J. Jordanova, “Earth Science and Environmental Medicine: The Synthesis of the Late Enlightenment,” in Images of the Earth: Essays in the History of the Environmental Sciences, ed. L. J. Jordanova and Roy S. Porter (Chalfont St. Giles, UK: British Society for the History of Science, 1979): 119–46.

Introduction 513

and places.” The medical history of climate and humans has been benign, progressive, and dangerous in equal measure.

Twenty-four centuries have passed since the doctrine of “Airs, Waters, Places” was articulated in the Hippocratic corpus, promoting a mutually constitutive vision of humankind and climate. Yet, if Western medicine has evolved to a degree that might not be recognizable to the ancient Hippocratics, the influence of “environmental factors” on health and disease remains no less relevant to our lives today. Whether one speaks of anthropogenic climate change or the “microclimate” of the human gut, the interactionist dynamic of the body (or its individual parts) and place are as pertinent now as they were in 400 BC. This special issue of the Bul-letin of the History of Medicine presents arguments about the evolving nature of this relationship, analyzing a diverse set of modern manifestations of the airs, waters, places tradition, from the sixteenth to the twenty-first century.

As in the Hippocratic corpus, climate in the modern period is seen to predispose to disease, to be a proximate cause of disease, and to cure dis-ease. In this sense, climate is itself an actor in medical history. Moreover, it changes—even anthropogenically in the modern period—as do our perceptions of it, and this constitutes a significant argument for writing histories across centuries. The integrated microcosms and macrocosms of humans in place is the longue durée business of the history of medicine. Although climate change and the idea of an Anthropocene make all this pressing, and the inclusion of medical historians in the discussion important, the fact is that in our field, environment and climate never went away. The multiple scales of ancient cosmology continually return in new forms and with new effects.42 But if the world is currently focused on the question of humans as agents of climate, it is important to remember the medical history that for millennia has placed humans as subject to, even objects of, climate.

alison bashford is professor of history at the University of Sydney, author of Purity and Pollution (1998) and Imperial Hygiene (2004), and editor of Contagion (2001), Medicine at the Border (2006), and Oxford Handbook of the History of Eugenics (2011). She is currently completing “Life on Earth: Geopolitics and the World Population Problem,” contracted to Columbia University Press. In 2009–10 she

42. Climate has an “intimate universality,” as atmospheric historians have put it recently. See Fleming, Jankovic, and Coen, Intimate Universality (n. 26).


was E. Gough Whitlam and Malcolm Fraser Chair of Australian Studies, Har-vard University, where she taught in the Department of the History of Science.

sarah w. tracy is associate professor of the History of Medicine at the Uni-versity of Oklahoma Honors College and College of Medicine, where she also directs the Medical Humanities Program. She is the author of Alcoholism in America from Reconstruction to Prohibition (Baltimore: Johns Hopkins Univer-sity Press, 2005) and co-editor with Caroline Jean Acker of Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800–2000 (Amherst: University of Massachusetts Press, 2004). She is currently complet-ing a biography of physiologist and epidemiologist Ancel Keys (1904–2004).

Documents

Modern Airs, Waters, and Places