Conevery Bolton Valenčius, The health of the country: how American settlers understood themselves and their land, New York, Basic Books, 2002, pp. viii, 388, illus., $30.00 (hardback 0-465-08986-0).

“How could land possess ‘health’? Why did nineteenth-century writers constantly describe places as being healthy or sickly? … Descriptions of ‘the health of the country’ belong to a world we have lost” (p. 2). Conevery Bolton Valencius wrestles with these questions to recreate that lost world, crafting in the process a book that spans the fields of environmental history, the history of medicine, and the historiography of the American frontier and borderlands. Her account is specifically about areas that would become the American states of Missouri and Arkansas, spanning the years from the Louisiana Purchase in 1803 to the American Civil War. But the story could have been told about Michigan or Minnesota or Iowa as well. Disease, especially malaria, followed settlers into the American frontier during the first half of the nineteenth century, repeatedly converting a “healthy countryside” into a fevered realm where settlers first had to endure “seasoning” before they settled down into equilibrium with the land and its denizens. Valencius recalls a time when people lived so close to the land that the boundaries between body and landscape were much more porous than in today's America, with its climate controlled environment. Her analysis is deliberately Hippocratic, with chapters three to five named ‘Places’, ‘Airs’, and ‘Waters’. These elements, and the bodies that lived within them, remained in tenuous balance if the country was healthy, or became disturbed, carrying the humans along into disarray and sickness. Cultivation was a particularly hazardous process, for the felling of trees and turning up of soil appeared to bring with it an increase in fevers. “Working the land, like healing the body, was usually neither comfortable or serene. Change in terrain and change in body were difficult, dangerous, and fraught with tension. Both were utterly necessary” (p. 192). In a chapter on ‘Local knowledge: medical geography and the intellectual hinterland’, Valencius explores the production of that most common of nineteenth-century medical treatises, ‘On the medical topography of X’. These articles, which could cover “a seemingly bewildering array of topics” including geological formation, weather patterns, topography, prevailing diseases, and local ethnicity, formed important research products for nineteenth-century American medicine. Particularly when applied to novel locations, such research answered crucial questions about “how people could live, and where” (pp. 160–1). Many of the settlers who came to Arkansas and Missouri came from areas of the United States that were colder and drier. They viewed their new homes as tropical in comparison, and worried about how the hot, wet climate would transform their bodies. In this process, “racial and individual identity were vulnerable: the changes unleashed in new territory threatened the coherence and clarity of physical differentiation demanded by the racial economy of antebellum America” (p. 230). Whites grew brown under the relentless sun; “black” children often showed signs of white parentage; and mixing with Native Americans provided further confusion. The blurring of racial boundaries created anxieties made worse by the inherent disorder of the frontier. In this sensitive analysis of antebellum frontier thought, Valencius succeeds in recreating a world in which body and land were intimately linked, a world in which metaphors of health and disease, balance and imbalance applied seamlessly to both people and their inhabited landscapes. One might quibble about the insensitivity to chronology here—did these concepts not change at all in the first six decades of the nineteenth century? But the answer may well be: “Not much.” This volume takes the historiography of American medicine in a startling new direction, a remarkable feat for any historian, not to mention for one at the beginning of her career. Having a such a blazed path before them, others will follow into this new frontier.