Book Review

The Health of the Country: How American Settlers Understood Themselves and Their Land

N Engl J Med 2003; 348:966-967March 6, 2003

Article

The Health of the Country: How American Settlers Understood Themselves and Their Land
By Conevery Bolton Valenčius. 388 pp., illustrated. New York, Basic Books, 2002. $30. ISBN: 0-465-08986-0

The Health of the Country is an illuminating medical perspective on the settlement of the American frontier from the Louisiana Purchase to the start of the Civil War. Through the use of letters, scientific reports, and travel literature, Valenčius is able to map what she calls a “geography of health.” Settlers and travelers identified land with health or illness and improvement in the land with improvement in individual and national health. Her treatment of human interaction with the environment is not necessarily new; what is novel in her approach is her analysis of the settlers' parallel perceptions of the health of their bodies and the health of the land. Under Valenčius's guidance, “medical and environmental history come together in settlers' bodies.”

Valenčius also introduces the history of science and medicine to the growing body of literature on the history of America's westward expansion. Bringing these fields of history together, she finds new ways to advance our understanding of all of them. She also uses the best aspects of social-history analysis in her study of common people's understanding of medicine and the environment. By looking more closely at the lives of ordinary people, social historians have already expanded our understanding of the American past. In chapter 6 especially, Valenčius takes us one step further by looking at settlers' “local knowledge” of medicine. In this chapter, her analysis in earlier chapters of settlers' perceptions of medicine and the environment are brought together, and the implications of local knowledge are fully explored. Her examination of the ways everyday experiences contributed to American medical knowledge is perhaps her most important contribution.

Valenčius effectively argues that medicine in the 19th-century American West was closely connected to family and community. Few medical professionals lived on the frontier, and family members or neighbors with local knowledge were called on as healers. Family- and community-centered medicine was particularly important at the time of settlers' arrival in the West and during periods of “seasoning”— the term used by early Americans to describe acclimation to a new settlement. Seasoning was a spiritual as well as physical challenge, such that religion, as Valenčius notes, was a crucial component of medical knowledge on the 19th-century frontier.

Local people developed a medical geography of new lands in parallel with the age of American exploration and the expansion of topographic knowledge that began with Lewis and Clark. In time for the celebration of the 200th anniversary of the Lewis and Clark expedition, Valenčius presents the broader scientific and intellectual context of their exploration. Building local medical knowledge, Valenčius reveals, connected new country to the rest of the nation and medical practitioners to national scientific endeavors. Individual and family stories of health were integral to the national story of expansion. Those stories of a “healthy country” meant not only healthy bodies; they also meant a healthy nation with economic prosperity and the potential for growth.

At the same time, the creation of local medical knowledge also contributed to the development of regional identity. In the antebellum era, Missouri and Arkansas — the focus of the book — became identified less with the West and more with the South. In the process, local medical practitioners began to assert a distinctively southern medicine that was based on their empirical knowledge of the southern environment and its effects on the human body. In asserting their brand of environmental medicine, southerners called on Hippocrates and his treatise Airs, Waters, and Places in particular. (Readers should note that Valenčius pays homage to this work in her chapter titles.) She astutely observes that southern healers drew on Hippocrates, while their political and philosophical counterparts around the nation drew on other classical writers to identify the new nation with ancient civilizations. But just as southerners participated in a national project of building self-esteem, they concurrently created a southern identity that was medical as well as political in the decades before the Civil War.

Racial identity was as important to white American settlers as their growing identification with regions. In the penultimate chapter of the book, Valenčius details the racial climate that challenged and threatened many settlers in their migration to and settlement of a new place. Race and place had long been associated in the human mind, and 19th-century Americans were no exception. Many settlers expressed the fear that they were becoming more like other races, particularly Indians, in their acclimation to western regions. Their bodies were often marked by illnesses and by the seasoning associated with adjusting to their new western homes. The challenge in the minds of white settlers, Valenčius argues, was not only to survive the physical threat of a new and unfamiliar environment but also to maintain their racial identity.

Valenčius has produced an excellent, well-written book that rethinks our stories of western expansion and regional identity and that ties American medical and environmental history to larger stories of nation-building. It is a work that should not be ignored by those interested in the history of medicine and the American frontier.

Joseph Key, Ph.D.
Arkansas State University, State University, AR 72467