This paper focuses on the relation between medical geographic expression
and therapeutic practice in a locale undergoing extreme economic and social
dislocation. As the fastest growing city of the west of the Appalachians
in the second quarter of the nineteenth century, Cincinnati assumed a leading
position in the training of Western physicians. During the 1840s, a decade
of rapid industrialization and intensified reform activity, Ohio was a
battleground for medical practitioners of different sectarian affiliations.
In the volatile medical marketplace, the authority of physicians became
more closely associated with the reputation of their medical systems. Their
medical and moral authority in the West depended upon claims to therapeutic
effectiveness and responsibility.
Medical geographic writings of the period exhibit preoccupations that can only be explained with reference to these struggles. For example, the 1840s writings of the West's leading 'regular' medical spokesman, the editor, educator and geographer Daniel Drake, depict the millennial vision of urban society under occupation by the votaries of heresy and quackery. Just as Drake's competitors in the 1840s medical marketplace were compelled to contest his depictions, so have succeeding generations of Ohio Valley medical reformers traded on Drake's writings and reputation. In order to demonstrate how the Drake legacy is continually being reread in response to each new wave of reform, I will also briefly visit the debates that surrounded the introduction of full-time scientific medicine to Cincinnati General Hospital in the first decades of the twentieth century, and the era of health alliances and the privatization of the University of Cincinnati hospital at the close of the twentieth century.