Disease Maps: Epidemics on the Ground [Hardcover]

When there was a recent lethal breakout of e-coli in Germany, the great question was, "Where is the germ coming from?" It was time for epidemiological maps, tools that would chart disease and place so that we could get some answers. It was tough to do; such maps require data from many sources. Even so, good maps could do nothing to prevent nationalistic finger-pointing; remember the Germans initially blamed Spanish cucumbers? Eventually, the maps, and countless other data from clinicians and researchers with microscopes, helped find an answer that was scientifically sound. We count on the maps of disease and have done so for 300 years, though we did not know what we were doing at first and we still have to relearn basic lessons when something new comes up. Those are among the themes of _Disease Maps: Epidemics on the Ground_ (University of Chicago Press) by Tom Koch. The author is a professor of medical geography, who in this work has focused on the development and problems of map theory. The book is extensively illustrated, from engravings that show sailing ships and mermaids on the seas all the way to modern, computer-generated maps, all representing tools that have been armaments against disease.

The first maps shown here are from 1690 and have to do with plague. The rise of yellow fever in the eighteenth century was mapped when the disease came to New York. A map from 1796 shows wharf areas and locations of death from the illness, and demonstrates a false explanation: the illness was shown to be caused by bad smells. The most fascinating chapters of Koch's book are a rewriting the lessons from the most famous medical map in history. John Snow was an anesthesiologist, one who had assisted Queen Victoria in her deliveries, but he had a passion for combating cholera. He was impatient with the standard explanation that the illness was from airborne miasmas. The story goes that he mapped the houses around the Broad Street pump, showing how people near to that pump got cholera, and those nearer to other pumps did not. The story goes that he heroically removed the handle of the pump so that lives were saved. It's a good story, and when epidemiologists in the first decades of the twentieth century needed a heroic story, they resurrected the one about Snow. The only problem is that the story is not true. The pump handle part is complete fiction, and Snow never really proved, by map or otherwise, that cholera was caused by a waterborne agent. The fact is that other people were making maps of the outbreak, too, and the maps convinced them that yes, the disease might be at least partially waterborne, but without finding the germ that caused it (_vibrio cholerae_ would only be discovered and indicted in 1883), the maps were only suggestive. Snow was crankily and dogmatically insistent upon his waterborne theory (and in the end he was right), but his maps were inconclusive as were the maps of everyone else. As Koch writes, "Science is not about being proven right _someday_," but is rather about demonstrating evidence of your explanations at the time you make them.

The final chapter of Koch's book focuses on maps that have shown the disease that scares us most now, cancer, first the elegant statistical maps of the first half of the twentieth century, and then the computer-generated ones. We are still having problems with maps which seem to show causality, as Koch's remarks on the putative link between power lines and increased cancers and on the problem of citizens who are sure that cancer clustering in their neighborhoods is something more than a statistical anomaly. Now that smartphones can get that data in from every house, maps may become messier, or they may become more explanatory. Koch wisely explains that seeing diseases on all scales, worldwide or microscopic, is going to help us map wisely. In the meantime, here are many beautiful maps, with lovely calligraphy and illustrations, that are esthetic treats, if you can overlook that all are presenting mass deaths in graphic fashion.

This is a fascinating look at the evolution of mapping as a tool for fighting disease. It clearly discusses the various assumptions behind different approaches to disease mapping, their evolution over time, and the necessary "bureaucracies" that evolved to support increasing statistical sophistication.

Having said that, it is a bit disappointing. The maps are too small to see, and the enlargement call-outs often confusing or mis-labelled. For a book about graphics, it is just not up to standard in its own graphics. The text also has some confusing typos in it, enough to disrupt the flow of thought fairly often. Someone should have proofed this better before publishing.

The writing style is pedagogical and quite repetitive. The major emphasis of the story is on cholera in London, which is explored in great detail. The book would have benefited from a broader array of examples, especially modern GIS examples, with some URLs so readers could see some recent maps in their original sizes and colors.

This book would do with a bit more of edition. It has several typos, most of them in the figures, which by the way sport a quite obsolete look. The maps, which are beautiful, are too small. The text refers to details in the maps that cannot be identified because the maps are undersized.
The order in the text is not easy to understand. The author brings up names of critics or writers that he will use in a single trivial sentence and never again. These two elements do not help make the book a compact unit.
This being said, the maps are beautiful to see and the book itself is a beautiful object, colorful and delightfully heavy. The book is informative on how cartography developed and on the relation between cartography and mapping the human body.