From Siam to New York: Jacques May and the ‘foundation’ of medical geography

From Siam to New York: Jacques May and the ‘foundation’

of medical geography

Tim Browna,* and Graham Moonb

aDepartment of Geography, Loughborough University, Loughborough LE11 3TU, UKbDepartment of Geography, Institute for the Geography of Health, University of Portsmouth, Buckingham Building,

Lion Terrace, Portsmouth PO1 3HE, UK

Abstract

The history of medical geography is marked by a search for ancestors. The story usually begins in the writing of

Hippocrates before re-emerging in the works of 18th and 19th century practitioners. In recent years, historical

geographers have called for the destabilising of such assertions of lineage and descent. This paper offers a

reconsideration of the history of medical geography through an exploration of the often hidden connections and

intersections that have helped to frame the future trajectory of the sub-discipline. More specifically, we focus on

the important contribution made by Dr Jacques Meyer May and offer a complex and multi-layered account that

examines the close interweaving of his work as a colonial surgeon and specialist in tropical medicine and his role

as a medical geographer in the United States.

q 2004 Elsevier Ltd. All rights reserved.

Keywords: Medical geography; History; Imperial medicine; Colonial discourse

Introduction

‘How we formulate or represent the past shapes our understanding and views of the present’.1 The

history of medical geography is often recounted in terms of a linearity that highlights key moments,

reifying certain individuals and events and obscuring others. Stated differently, it is marked by the search

for ancestors.2 The story usually begins in the writings of Hippocrates before re-emerging in the work of

an 18th century Prussian medical officer, Leonhard Ludwig Finke.3 Following in the Hippocratic

tradition, Finke sought to demonstrate a connection between the geographical location of disease

Journal of Historical Geography 30 (2004) 747–763
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0305-7488/$ - see front matter q 2004 Elsevier Ltd. All rights reserved.

doi:10.1016/j.jhg.2003.08.018

* Corresponding author.

E-mail addresses: [email protected], [email protected]

http://www.elsevier.com/locate/jhg

T. Brown, G. Moon / Journal of Historical Geography 30 (2004) 747–763748

and the prevailing physical, social, and cultural features of the surrounding environment. That this was

medical geography was for Finke beyond doubt: ‘when one collects all that is worth knowing about the

medical condition of any country, then it cannot be denied that such a work deserves the name of a

Medical Geography’.4 Barrett, in his monograph on the history of medical geography, argues that by the

19th century the study of medical geography had been formalised as a distinct field of medical

investigation through the comprehensive accounts of individuals such as August Hirsch and Daniel

Drake.5 It was from this scholastic tradition that contemporary medical geography emerged, with a key

figure being the subject of this present paper: J.M. May.

Central to Barrett’s thesis is the argument that the development of medical geography owes rather

more to the endeavours of physicians than those of geographers. We do not dispute this conclusion.

However, in line with critically minded work in historical geography, we seek a destabilising of

assertions of lineage and descent.6 A critical history requires us to pay attention to absences and

occluded presences, to that space known as the ‘constitutive outside’.7 It is for these reasons that we wish

to offer a reconsideration of Jacques May. In this reconsideration, we do not seek, nor do we wish, to

simply replace one history with another. Rather, we offer a more complex and multi-layered account that

points to influences outside the geographical academy and argue that these, as much as May’s highly

influential work on disease ecology, helped to develop certain epistemological and ontological

trajectories within the sub-discipline.8

To this end, we open our account with a summary of May’s professional and academic career. In

particular, we locate three distinct phases: his work as a colonial surgeon and specialist in tropical

medicine, his role as a medical geographer in the United States and, latterly, his work as an expert in

global food deficiencies. Within this reading, we will draw specific attention to the middle phase of

May’s career as it offers the most obvious overlap with medical geography. However, a key motivation

for this paper is the desire to explore the many influences that acted to shape the development of the sub-

discipline in the early-to-mid 20th century. For example, we identify a strong connection between

medical geography and the United States military, an association in which May appeared to play a

pivotal role.9

It is at this point that we depart from our rather traditional reading of the history of medical

geography. In portion, we shift our attention to May’s autobiographical account of his time as a colonial

surgeon, A Doctor in Siam, and suggest that this offers important insights into the close links between

medical geography, tropical medicine and, the imperial enterprise more generally.10 At issue here are the

way(s) in which key tropes found within tropical medicine are rehearsed within May’s account of his

life. While this is largely unsurprising, particularly given May’s work in tropical medicine, it is an

important recognition because such tropes appear as the foundations upon which his medical geography

was to subsequently develop. As Pyle notes, ‘May’s efforts represent a dramatic beginning to what has

become a multi-dimensional body of knowledge’.11

There are three distinctive aspects to our exploration of May’s colonial period. First, in a theoretical

sense, we seek to challenge Ackerknecht’s contention that ‘medical geography became tropical

medicine’ by highlighting the continuing interplay between the two even after the latter was formalised

as a distinct sub-discipline of medicine at the end of the 19th century.12 In May, and other

contemporaries, we see a continuing interchange of ideas in which, we suggest, location as much as sub-

discipline played an important part. Second, in a methodological sense, we locate our argument in the

context of recent scholarship on the use of (auto)biography as source material.13 We seek to demonstrate

how a critical contextualised reading of such material as text can illuminate areas of historical interest.

T. Brown, G. Moon / Journal of Historical Geography 30 (2004) 747–763 749

Third, we contribute to the ongoing recovery of the interplay of military endeavour and the development

of geography.

Jacques May: physician, surgeon, medical geographer

As Jean-Pierre Thouez’s bibliographic account highlights, May was a French surgeon, born in Paris in

1896, who gained his medical degree from the faculty of medicine of the Universite de Paris in 1925.14

It was his surgical expertise that led him to accept the position of Chief Surgeon at the French Mission

Hospital in Bangkok in 1932. This was a post he was to hold until 1935 after which he was appointed to

the position of Professor of Clinical Surgery in the newly created Faculty of Medicine at the University

of Hanoi. In 1940, after the Japanese invasion of Indochina and the arrival of the Vichy regime in France,

May enlisted in the pro-Gaullist Free French Forces and participated in the war effort. This first phase of

May’s career was to end in the French Antilles; here, he briefly took up the post of Chief Surgeon in the

Guadeloupe Hospital before his emigration to the United States, in 1947, where he obtained his license

to practice medicine in the State of New York and embarked on the second phase of his career.

While the reasons for May’s emigration and the details of his military endeavours remain unclear,

what is apparent is the fact that his arrival in the United States coincided with a particularly active phase

in the development of North American medical geography. A central figure here was Dr Richard Upjohn

Light, a neuro-surgeon and council member of the American Geographical Society, who, in February

1944, proposed that the Society consider the publication of an ‘Atlas of Diseases’.15 The proposed atlas

followed the publication of an article by Light, in the Geographical Review, which set out many of the

key features of what were later identified as being central to May’s own approach: the role of the

environment in shaping human disease, the importance of medicine to the understanding of disease

processes and the significance of geography to the mapping of disease patterns.16 As with similar

accounts, Light drew heavily on medical geography’s ‘founding fathers’ in order to make such

connections. More significantly, perhaps, Light also drew attention to observations on medical

geography made by the medical historians, Fielding H. Garrison and Henry E. Sigerist.

What is important here is that Garrison had, in 1932, outlined a particular vision of medical

geography; one that saw it as the study of the relations of ‘climate and environment to disease and its

distribution in space’ and which set out a historical pathway that began with Hippocrates and continued

through the works of Finke, Drake and Hirsch.17 At the same time, Sigerist proposed a programme of

scholarly activity that he suggested should include: the founding of an international journal, one which

would include modern geographical studies, the beginning of a series of monographs that explored the

history and geography of diseases and the publication of an atlas that would geographically represent the

distribution of diseases in time and space.18 A third contributor to this envisioning of medical geography

was Maximillian Sorre. His relatively silent presence in the historical accounts is central to the story that

we unfold in this paper; Sorre arguably provides the link between May, the endeavours of Light and the

programme of the American Geographical Society.19 Thus, the agenda for medical geography certainly

predated the input of May and had been set by historians of medicine and francophone geography.

Light’s citing of observations by Garrison and Sigerist, combined with his own remarks on the

‘realignment of medical geography from a descriptive science to the role of an analytical tool’,20

suggests that the status of the sub-discipline had grown substantially by the early 1940s. Indeed, light

argued that the ‘descriptive’ science of 19th-century medical geography had been transformed into


a scientifically acceptable analytical tool through a combination of the advances in, and global

ascendancy of, western medical knowledge and through geography’s own shift from the musing of

‘travellers and explorers’ to the ‘science of geography’. This interweaving of the two disciplines was

most clearly established when Light, at the end of his paper, noted that ‘[t]he time seems ripe indeed for

the two sciences of medicine and geography to join their resources in a coordinated program to study the

influences of environment on disease’.21

A further justification for Light’s call for an invigorated medical geography came from the

experiences of the Second World War. Again taking his lead from Fielding Garrison, Light suggested

that, ‘[i]f there were no other excuse to bring forth new studies in medical geography, the experiences of

this war [World War II] would suffice’.21 Importantly, perhaps, it would seem apparent that the

connection between overseas military campaigns and medical geography was not lost on the US

military. Indeed, the records of an AGS conference on the proposed atlas of diseases reveal that a large

number of current or former military personnel attended: including representatives of the Navy’s Bureau

of Medicine and Surgery, the Office of Naval Research and the Office of the Surgeon General of the

Army.22 While we should not read too much in to this observation, it is interesting to note that one of the

conference delegates, Lt. Col. G.W. Anderson, would later recognise the importance of medical

geography to the expanding military interests of the US.23

In a small five-page article, again published in the Geographical Review, Anderson discussed the

‘achievements’ of wartime medical research in Nazi Germany. Of particular interest to him was work

carried out on the Seuchen-Atlas, an atlas of epidemic diseases that was produced by Heinz Zeiss for the

German Army Sanitary Corps.24 It was the following observation by Zeiss that was of particular interest to

Anderson: ‘[k]nowledge of the medical topography and medical geography of a region or a country is just

as important as that of its physical geography in the planning and conduct of a military operation. Soil,

flora, fauna, and inhabitants—that is, the entire biogeographical picture—are of importance to the soldier

.It is therefore the task of the sanitary corps to remove the dangerous features of regions of disease, or if

this is not possible, at least to reduce the danger. Both tasks depend on medical geography’.25

Light’s desire that the AGS produce an atlas of diseases reflects, then, both the re-establishing of a

long held connection between medicine and geography and the continuation of the close association

between geography and the military.26 Moreover, this interconnection between medicine, geography and

here the US military was founded upon a concern to understand more fully the links between

environment and disease. Thus, Jacques May’s introduction to the AGS, by Dr H.E. Meleney in 1948,27

coincided with an already well developed sense of the importance of medical geography and a clear

understanding of the research that should be undertaken in its name. Despite this, May was able to claim

a distinctive place in the direction of the sub-discipline; this he did in his capacity as Director of Medical

Studies at the AGS (1948–1960) and as a founder member of the International Geographical Union

(IGU) Commission on Medical Geography (1949–1975).28

Turning to May’s contribution to medical geography during this period, particularly between 1948

and 1961, it is apparent that he coordinated a program of research that was more wide-ranging than the

AGS had originally anticipated.27 Indeed, May’s first major publication on the subject of medical

geography, an article published in the Geographical Review in 1950,29 set out the fundamental

characteristics of his disease ecology approach.30 For May, the pathological factors of disease

or ‘pathogens’, which were ‘well-known facts widely scattered through the various branches of

medicine’,31 could only be fully understood if they were located within a broader understanding of the

geographical environment within which they occurred. Importantly May constructed a theoretical


framework that sought to understand disease patterns by correlating individual pathogens with various

geographical factors or, in his terms, ‘geogens’. In this sense, the atlas of diseases, which was published

as a series of 17 cartographic maps between 1950 and 1955,32 represented only one aspect of what was to

become a much broader project for May.

As Valencius notes, in this and subsequent works, particularly the highly influential Ecology of

Human Disease and Studies in Disease Ecology, May alerted geographers to the possibilities of

exploring the links between disease and the environment.33 Though this approach was, as already shown,

well established, it was May’s work in this area that helped to establish disease ecology and himself as

central to the development of medical geography.34 May located medical geography in the same

historical trajectory that Garrison and Light had established before him. As we have shown, this ‘project’

owed much to its (and May’s) francophone heritage and it is perhaps best, in this context, to see May as a

person who successfully codified a previously scattered but known set of perspectives. In this endeavour

he was helped significantly by the position of influence that he occupied in the AGS. He highlighted the

significant contribution that cartography could make to the study of disease patterns and disease

causality and proposed a program of research that would enable medical geographers to contribute to the

World Health Organization’s global public health initiatives through charting the interaction of

environment and health and thus providing a baseline against which World Health Organization

initiatives could be assessed. Such scholarly endeavour was also central to May’s activity within the

International Geographical Union. For example, in the first report of the newly established Commission

on Medical Geography, May proposed a definition of medical geography that stated it was: ‘the study of

the distribution of manifested and potential diseases over the earth’s surface and of factors which

contribute to disease (pathogens) followed by the study of the correlations which may exist between

these and the environmental factors (geogens)’.35

May’s research activity generated continued support from the US military establishment as he entered

his third and final career phase. In this regard, and after completing his work with the AGS in 1961, May

embarked on a series of country-by-country surveys of the ecology of malnutrition, studies that were

conducted under contract with the Quartermaster Research and Engineering Command, United States

Army.36 In highlighting this connection, we allude only to the fact that the complex interrelations

between medicine, geography and the military that were evident in the 1940s continued even after May’s

engagement with the AGS had ended. Moreover, it should also be apparent that the production of

medical geographic knowledge, or at least the disease ecology and disease mapping branches of it, was

facilitated in part by the desires of the US military. Indeed, the role of the geographer in Quartermaster

research was described by Lemons and Campbell as being two fold: to supply environmental

information and measure environmental elements and to study the total environment more generally.

Clearly, May’s ecology studies would have helped to achieve this aim and further the military desire to

maintain soldiers at peak military agency anywhere in the world.37 The pinnacle of this connection

between May and the US military came when in 1962 he was appointed chief medical education adviser

to the US Operations Mission in Vietnam. At this point, his career came full circle.

Jacques May: a Doctor in Siam

Thus far, we have placed the story of Jacques May within the context of his arrival at the AGS in 1948

and subsequent appointment as Director of Medical Studies. Furthermore, we have referred to the key


ideas that helped to establish May as a major intellectual force within medical geography. More

importantly, however, we have sought to recover connections and intersections that are often lost in the

production of traditional histories of medical geography.38 Rather than focus on the role of individuals

within the medical geography ‘project’, we have alluded to the significant role played by others outside

the geographical academy who have helped to shape, to frame, the epistemological and ontological

trajectory of the sub-discipline. To this end, we have highlighted the significant input that the

medical historians Fielding Garrison and Henry Sigerist made to the construction of an understanding of

medical geography and we have pointed to the role of various branches of the US military in funding

many of the projects that were undertaken in collaboration or otherwise with the AGS.

As noted in the opening to this paper, we wish now to extend this reading by exploring other

influences upon medical geographic thought. More specifically, we turn to the autobiography of Jacques

May and argue that within this text we find traces of a field of vision that helps us to position medical

geography more closely alongside tropical medicine.39 A text such as May’s, which documents the time

he spent at a French mission hospital in Bangkok (1932–1936) and then at the Hanoi University Medical

School in Indochina (1936–1940), mirrors the participant histories produced by former colonial

physicians in the 1950s and 1960s.12 This is so, not simply because of the timing of its production, but

also because of the triumphalist rhetoric that we find within it. As we shall demonstrate, May’s

autobiography contributes to a form of imperial history that views the unfolding of events from the

perspective of the dominant culture; indeed, we find that May celebrates ‘the victories of civilization

over barbarism’.40

However, our interest in May’s autobiography lies also with the idea that medical geography and

tropical medicine took divergent paths from the late 19th century onward; with the latter moving away

from an environmentalist perspective and towards a more rational, scientific view of disease causality.41

This shift was influenced by the development of schools of tropical medicine, such as those in Liverpool,

London and Hamburg, and by the role of research institutes such as the Institut Pasteur, which were

distributed throughout French colonial outposts. Yet, as Anderson suggests, the power of such elite

institutions in the field was both contingent and evolving and was constrained by the recognition that

tropical medicine was a tool for defining human potential and not just eradicating disease.42

Interestingly, Marcovich makes a similar observation with regards to French colonial policy, arguing

that ‘health care played a significant role in the implementation of the French ideal of civilization’.43 It

is, perhaps, because of this that within May’s understanding of disease ecology we see the two

perspectives converge once more. The environmentalist view of disease causation, abandoned by

tropical medicine, is reconfigured within May’s disease ecology as the context within which

pathological disease processes occur. Though the scientific rationality of the surgeon may have

dominated May’s professional background, his interpretive schema harkened back to an ‘older’ place

based approach to understanding. Moreover, it can be suggested that a closer reading of May’s

autobiographical account reveals a discrete discourse, one that draws heavily on the colonial

imagination, which was interwoven within medical geographic knowledge. It is to this that we shall

now turn.

Significantly, May’s autobiography opens with the recollection that his mission in Siam was to

‘preach Western medicine to the Far East’.44 As such, we are immediately presented with a clear

distinction between western medicine and its oriental other, a dualism that emerges as a principle

organising narrative. In this sense, the text mirrors broader imperial aspirations and highlights the

significance of western medicine, and particularly tropical medicine, in helping to establish and maintain


colonial rule. As Macleod notes, ‘European medicine fostered a powerful discourse of authority and

progress’.45 Taking this point further, May’s text illustrates quite vividly the role played by tropical

medicine in the ongoing story of European global presence and authority, a process that involved the

reclassifying and renaming of tropical illness and disease and the introduction of scientific causal

explanation.46

A further feature of May’s account is the similarity it shares with the travel writing genre and with

colonial discourse more generally. As Driver indicates, travel writing is marked by anxieties about the

relationship between the adventurous explorer and the scientific traveller.47 In this regard, May’s

account is little different, as the distinction between colonial adventurer and medical scientist is often

blurred. It is for this reason that we locate the text within the broader genre of colonial discourse; defined

by Spurr as ‘a series of colonizing discourses, each adopted to a specific historical situation, yet having in

common certain elements with the others’.48 While wary of the possibility of producing too essentialised

a reading,49 we make this connection because of the similarities between May’s text and the discursive

structures associated with colonial discourse. In this sense, we trace within May’s book evidence of

European, and particularly French, imperial ambition and examine the ways in which the Far East was

‘reterritorialized according to the convenience of colonial and imperial administration’.50 However, as

with Barnett’s critique of this understanding of colonial discourse, we do not limit our exploration to

charting such projections of an imperialist will-to-power.51 Rather, we attempt where possible to reveal

the presence of other indigenous ways of knowing.

Before we embark on our reading of May’s text, it is necessary to have some understanding of the

region into which he was immersed. It is important to recognise that France, like many of its European

counterparts, had undergone a period of overseas expansion in the latter half of the 19th century which

by 1912 included large territories in Indochina as well as Africa and, after the first world war, the Middle

East.52 While never formally occupied during this period of colonial expansion, Siam (Thailand) was an

object of both British and French colonial ambition.53 It was this continual struggle for a colonial

foothold in the region that forced the Siamese monarchy to cede a zone of influence along the Mekong

river in 1893, then, in 1896, to give territorial rights to France and Britain in the central Menam valley

and, finally, to extend France’s administrative authority to the provinces of Angkor and Battenbang

(Cambodia) in 1907.53 Siam was thus something of a buffer zone between the British and French

empires. At the same time, it also had its own heritage and regional presence to safeguard. This situation

led, to some extent, to a situation in which the Thai monarchy and its advisors were able exploit the

ambitions of the imperial powers to ensure Siam’s independent survival. Alongside this geo-political

manoeuvring, was a programme of modernisation that saw significant changes in health and education

and other infrastructural provision. May’s own arrival can be understood in terms of both imperial

ambition and Thai modernisation.

Where Siam was initially able to resist colonial aspirations, French Indochina was the product of

them. The region was established as a political entity following the creation of the Indochinese Union in

1887, a move that consolidated the regions of Cochin China, Annam and Tonkin (present day Vietnam),

Cambodia and Laos. As a French colony, the area was the concern of the Ministry of Colonies, a ministry

that held only minor cabinet status within the French government.54 This remained the case until 1941,

the year after May’s departure, when the Japanese occupied the region allowing a French (Vichy)

government to maintain administrative control until March 1945 when the Japanese eventually seized

the reins of power, albeit for a very short period. In Indochina, May is therefore a representative of the

colonial power. He is, however, also in a setting where the ties to metropolitan France are formal


and the impact of France is far more assured. Consequently, we can expect his stay in Indochina to be

rather less of an encounter with an oriental other.55

While only brief, this overview serves an important function: it highlights the different relationships

that Siam and French Indochina had with competing imperial powers. This difference in relationship is

significant because May employs it to frame his narrative. It is also time-specific; the imperial/colonial

status quo was under threat. While relevant to the entire text, this is most apparent when May describes

his arrival in each region.56 In the case of Siam, the country is constructed as a dreamy kingdom awaiting

the onslaught of Japanese imperial aspiration: ‘Siam was not yet Thailand, and no imperialistic threat

was implied in the country’s name’.57 Furthermore, May represented this transition period through the

competing images of harmony and discord: ‘This was Bangkok, as the sleepy monarchy was about to

fall, dictators about to rise, as princesses were enjoying in their palaces their last weeks of omnipotence,

the people in the streets their last years of peace’.58 However, May’s arrival in Hanoi, in November

1936, was described in very different terms: ‘Hanoi, the imperial city, struck me as an average-sized

French university town. Large avenues, cleanly lined with shadowy trees, small villas, or big buildings,

were bathed in deep unexpected silence’.59 May goes on to explain that this silence was the result of

‘the heat, the cushiony macadam of the streets, and the spontaneous segregation of native and European

quarters’.59

Clearly, there is a great deal of interest for geographers in an account such as May’s that describes in

some detail the spatial organisation of, and everyday existence in, regions such as Siam and Indochina.

By drawing on the notion of ‘enframing’ we can see how, in both cases, imperial activity was etched

onto, and reshaped, the already existing physical and social landscape.60 With regards to Siam, May

reminds the reader of the benefits that imperial activity was seen to bring: the railway running between

Singapore and Bangkok was ‘built with British, Danish and German capital’ and street lighting was

introduced to Bangkok ‘[t]hanks to the efforts of two generations of Danes, Belgians and Frenchmen’.61

May also refers to the ‘Western residential suburb and the procession of trams’, and to the presence of

European pharmacies and European doctors such as himself.

Unlike his account of Japanese imperial ambition, Western colonial presence is largely presented as

beneficent despite the suggestion that European settlement was marked by the imposition of further

layers of social segregation. Indeed, as May reveals, healthcare in Siam was organised both

hierarchically and spatially. At the pinnacle of the hierarchy were the Europeans who were treated in

private rooms with waxed floors and an ‘abundance of white lace and linen’ in their exclusive ward

located within the St Louis Hospital.62 This spatial separation was, in part, justified through the existence

of two further wards in the mission hospital, one of which accommodated second-class ‘natives’ who

were distinguished from their indigent third-class counterparts, located in a third ward, on the basis of

ability to pay.

Such traces of spatial and hierarchical segregation within May’s account serve to underline the central

dualism that he constructs between western and non-western medical beliefs and practices. When

recounting the details of his many medical encounters, May is always careful to locate individuals in

their ‘appropriate’ belief setting. Such a manoeuvre adds depth to the story being told and, more

importantly, reminds the reader of the distinctions between occident and orient. In one such instance,

May highlights this difference through reference to one adventure which made him ‘understand better

the shifting angles of things seen with the round blue eyes of the Westerner and the slanted dark ones of

the Chinese’.63 The location of this encounter was the second-class ward of the St Louis Hospital, the

patient a young Chinese male. The story, as told, finds May attempting to treat the individual who had


fallen into a coma following his use of an aphrodisiac prescribed by a Chinese doctor. Having identified

the patient’s problem as acute toxic nephritis (chronic inflammation of the kidneys), May recounts how

he went on to perform a relatively minor but successful medical procedure only for the individual to

proclaim ‘that medicine I got from the Chinese drug-store was a very good medicine! You see the result.

I am quite well’.64 The purpose of this anecdote is twofold. Firstly, it reveals May’s competence as a

medical doctor, secondly, and more importantly, it places indigenous beliefs and medical practice in

stark contrast to the rationality, and by association, superiority of its western counterpart.

To this end, we also find a series of chapters that document the constant struggle between May, who

might be seen to represent western medical authority, and the health and social systems that he

encountered in Siam. As May states, ‘Siam, just emerging from the dark ages with the help of scores of

European and American advisers, had, in 1932, a medical picture which was not too bright .The rank

and file of the people were taken care of by persons who were listed as healers;’.65 The ‘healers’ were

categorised by May according to the techniques they employed. The highest ranked were ‘healers of

reputation’ who used their knowledge of local herbs to treat patients. However, while respectful of their

talents, May was quick to discount their personal characteristics, ‘[they] were arrogant, conceited,

jealous and as secretly obnoxious as the venom they used in their preparations’.65 Beneath this category

came the boil and wound healers, seemingly harmless enough because they limited themselves to

specific treatments. Yet further down the ranking were the massage specialists who, while skilled in their

particular art, lacked the knowledge of the western physician, a point revealed by the ‘cases of ruptured

appendices [they] dutifully massaged’.66 At the bottom end of the scale, lay witches and midwives both

of whom were portrayed as placing quite challenging demands upon the skills of the western doctor. The

former, described as the purveyors of ‘dangerous love charms and toxic drugs’, required great vigilance

‘especially when a white man was involved in a love affair with a native’.66 The latter, who appear as

May’s main tormentor, required the ‘Western surgeon.to exercise his skill and ingenuity to repair some

harm’ that they had done.66

This narrative is not peculiar to May but is the product of a time when ‘Europeans began to pride

themselves on their scientific understanding of disease causation and mocked what they saw as the

fatalism, superstition and barbarity of indigenous responses to disease’.67 The most powerful example of

the superiority implied by this categorisation of local medical practice is displayed in May’s narration of

an encounter he had with a female member of the royal family. In his account, May describes being

faced with the task of treating one of Siam’s royal princesses, a task made more difficult by the protocol

surrounding access to female members of the royal family. However, what is revealed by this

recollection is the struggle, both real and symbolic, between the rational and scientific gaze of the

western medical practitioner and its indigenous counterpart. The first act of this struggle is played out

over May’s desire to perform a general medical check on the princess as she reclined in her boudoir. As

May notes, ‘I pulled out my stethoscope and my blood pressure apparatus, which elicited from my

invisible audience a sigh of admiration slightly tinged with anxiety’.68

Western medical authority was not yet established in Siam and the encounter is presented as a struggle

over the control of the sick body, here represented with the body of the princess.69 More specifically,

May reveals how he was allowed to examine certain parts of the princess’ body, for example an

‘outstretched naked arm’, but not to perform a more intimate gynaecological examination.68 Such a

denial was, for May, both an affront to his medical authority—‘I’m not ready to ruin my reputation as a

surgeon because of the prejudices of an obsolete oriental court’—and represented the difference

between traditional and western medicine—‘I can’t be expected to act like a Siamese healer since


I am a European doctor’.70 Importantly, May resolves this dilemma; the authority of western medicine

over the sick body was established when the princess agreed to have the internal examination that May

had suggested. May, then, employs a heroic narrative as he describes the consequent journey taken by

the princess: ‘I realized that, for this poor woman, who had not once left the walls of the palace in the

course of the uncounted years of her life, the decision was truly heroic. She was plunging into an

unknown world of which she had heard much but knew nothing’.71 This was not simply a journey of

personal heroism, it was also a journey that generated feelings of ‘fame, glamour and envy’ because the

princess was exposed to the ‘surgical wonderland’ located within the St Louis Hospital with its ‘wonders

of anaesthesia’ and ‘miracle of injections’.71

Significantly, this narrative on the superiority of western medicine was interwoven with the belief that

European medical intervention would enable the region to progress towards a more ‘civilised’ social and

environmental order’.72 May seeks to establish a connection between the good health of a population and

its ability to transform into a ‘civil’ and democratic society. As he stated towards the end of his account

of Siam, ‘No modern state can be built in any tropical country, no democracy can be installed, until the

people are restored to a minimum of power and health’.73 Furthermore, for May the move towards

(western) democracy was impossible, in the case of Siam, because ‘the problems of preventive medicine

and education exceed every other. It is painful to speak of freedom and selfgovernment when the

intelligence and judgement of 99% of the population are obscured by chronic anaemia and disease’.73

Two points are of interest here. The first is that May attempts to construct a dialogue between

democracy and disease: ‘As long as the nations of the world do not co-operate in destroying these

despots [pathogens], any political structure erected in these regions will be a cynical farce of which the

people will be silent victims’.73 Thus, it is clear that for May the introduction of western medical practice

in the region was a necessary forerunner to modernisation and, by association, democratisation; without

good health and freedom from illness the people of Siam would, in May’s mind, remain open to non-

democratic forms of governance. However, a second, and perhaps more interesting, point is that May

appeared to associate his observations with Siam rather than with Indochina. In the latter, a radical

nationalist movement had emerged in the 1920s. Obviously we cannot be certain but, it would seem

likely that May was linking the nationalist challenge to French colonial rule in Indochina with the

emerging Japanese challenge to the Thai monarchy when he suggested that ‘[p]olitical agitators thrive

on such ignorance and impotence’.73 While it is possible to overstate the significance of this hypothesis it

is useful to note that May’s arrival in Hanoi came only 6 years after several attacks on French military

posts and the establishment of the Communist Party of Vietnam by Ho Chi Minh; we have already noted

the way in which he described the ‘last years of peace’ in Siam.74

The significance of May’s references to the role of western medicine in the transition to ‘civil’ and

‘democratic’ society is of some further interest when we move on to consider his role as a colonial

surgeon in Hanoi, located as it then was in the Indochinese province of Tonkin.75 In many ways, this

interest lies in the civilising power that May affords western medicine. The strength of this narrative can

be assessed if we consider May’s reference to local legend: ‘According to the oldest Annamite legend,

Le-Loi, the fisherman, cast his net into the waters of the lake. As he brought his catch to the surface he

saw that he had fished out a shining sword. With this weapon he fought the Chinese and freed the

Annamite people from oppression’.76 The purpose of this passage is not immediately apparent,

especially as it is followed by accounts of his first meeting with various colonial officials, his first visit to

the hospital where he was to be based, the Hopital du Protectorat, and of his overall impressions of the

health of the Tonkinese population. However, towards the end of the chapter, May makes an important


observation both on his role as a tropical surgeon and on the power of western medicine: ‘I too had

brought back a sword from the waters of Petit Lac. The weapon which was to free the Annamites this

time was the scalpel of the surgeon and the microscope of the physician’.77 This civilising narrative,

associated as it was with the power of freedom, was not unique to May but was a feature of the discourse

of 20th century tropical medicine that believed that rational, scientific medicine would transform the

tropics. Indeed, according to Schreuder, the transfer of medical knowledge and sanitary practice to the

tropics helped to reinforce the civilising mission that was associated with empire.78

May, thus, constructs a narrative that locates western medical practice, and by implication himself, at

the centre of a civilising and modernising process which is implicitly associated with French colonial

rule. May’s continual referencing of the impact of colonialism on the structure of the healthcare

landscape of Indochina helps to frame this narrative and also acts to distance this region from the

premodern, and independent, Siam. For example, on arriving in Indochina, May announces that he was

‘looking forward to the kind of work I had enjoyed in the earlier days of my career. I longed for a big

hospital, for laboratory facilities, for the company of learned colleagues, for the atmosphere of the

faculty of libraries, journals and equipment’.79 This statement was not one of mere fantasy but one that

recognised the changes that had taken place in the region. By the early years of the 20th century,

metropolitan France had expressed a greater moral obligation to its colonies; an obligation that resulted

in changes to colonial administration and governance. In the case of Indochina, this meant that, amongst

other things, a new system of public health was put in place and a healthcare network was constructed

that comprised of government funded hospitals, research institutes, such as the Pasteur Institutes, and

other health related agencies.80 It was this re-organised system of medical practice that May referred to

when he stated: ‘I knew that in Indo-China scientific life was very active. Besides the medical school,

there were several Pasteur institutes, laboratories of all sorts, scientific societies and numerous men of

international reputation’.80

While these passages give us some idea of the structure of healthcare under French colonial rule, it is

May’s references to the personnel employed in these institutions that provide us with the most interesting

insights. As he noted of the medical students, they were ‘all well educated according to French

standards’ and were ‘students to whom Moliere, Racine and Baudelaire meant as much as they did to

me’.79 In a sense, May’s reference to his student’s understanding of French literature mirrored the

colonial philosophy of the mission civilisatrice, a philosophy which anticipated that the inhabitants of

France’s overseas territories would become citizens of a single global community, France d’Outre-Mer.

In this way, the elite members of the local population were being educated to French standards of

civilisation. Such references to educational background were not limited to May’s students, as the

following description of May’s first assistant, at the surgical unit in the Hopital du Protectorat, reveals:

‘Le Van Ngu had of course been educated in Paris.Needless to say, his French was faultless and his

classical education as good as, if not better than that of many Frenchmen’.81 Indeed, May takes time to

establish the educational and medical backgrounds of many of his assistants at the hospital. Thus, after

his first assistant came Vu Dinh Tung ‘a bachelor of medicine, educated under the old local system’ and,

following him, Escalle, ‘Son of a French father and an Annamite mother .[who] had had .a good

French education’.81 What is important here is that May uses such references to the structure of the

healthcare system and the education of its personnel as a way of marking out the civilising and

modernising processes that colonialism was seen to bring. Furthermore, such insights reflect French

colonial philosophy of the time: ‘A colonial system cannot survive unless it is operated from within by

the natives who are supposed to benefit from it’.82


Such comments on the beneficial impact of colonial rule were made alongside occasional reflections

on the state of the population’s health: ‘Internal parasites, blood parasites, create a condition not

encountered in cool climates. In Indo-China a hundred per cent of the natives are worm-ridden and 95%

have, or have had, acute malaria’.83 This connection between the health of the population and the

ecological environment within which they were located is of some importance here. On one level, it

helps May to explain some of the more extreme surgical experiences that he encountered, whether

monstrous tumours or gigantic hernias. However, more importantly here, it helps us to establish the link

between tropical medicine and medical geography. As May goes on to state: ‘All these facts are at the

basis of a new science which is called geographical medicine and which opens up a new field of research

to the surgeon’.83 The point here is that May highlights the importance of the ecological model of disease

to tropical medicine’s understanding of disease causation which itself was mobilised in an attempt to

assert the validity of colonial system more generally.84

In the final chapter of his text, May relates the story of his last days in Indochina. For May, these are

days filled with betrayal and loss as metropolitan France surrendered to the imperial ambitions of both

Nazi Germany and Japan. It is in these final passages that we discover May’s opposition to the Vichy

administration and its supporters in Indochina, ‘I was under suspicion.I had advocated severance from

the Vichy policy; I had urged that resistance be organized in Indo-China and that immediate help from

the Chinese be sought, until further help from the British could be rendered’.85 May finally left Indochina

in August, 1940 and went on to join the Allies under the banner of the de Gaulle’s Free French forces.

The next we hear of May is his arrival in New York in 1947 and his introduction to the AGS. The silence

regarding May’s life in the period between 1940 and 1947 is effectively explained by his wartime service

and, at the end, by his brief period in Guadaloupe noted earlier. During this period, he continued to work

on aspects of surgery.86 Though it would be speculation, it is also likely that the close links between

medicine and geography, so evident in wartime, served to give further emphasis to his views. It is,

however, his arrival at the AGS that enabled the inter-connection between the colonial doctor, tropical

medicine and medical geography to become most clearly established.

Conclusion

We have presented in this paper a brief account of what is a complex story. It is true, as Meade and

colleagues suggest, that the disease-mapping project of the AGS led to disease becoming a ‘geographical

subject’ in the United States.87 However, such a statement reflects neither the complexity that surrounds

this emergence nor the imperial and military desires that often underpinned it. Therefore, we have turned

to May’s own personal and professional experiences as a way of rethinking the history of medical

geography. We have done so because we believe that it helps us to establish the connection between May

the person and the vision of medical geography that he fostered in the US. In this sense, we suggest that

May’s vision of medical geography, and that of his immediate colleagues, was one that was cast out of a

belief in the scientific hegemony of western medicine and an Enlightenment narrative of progress.

Introducing ‘western’ medical methods to Siam and Indochina was, he claimed, a way of ‘saving’ their

populations from the perceived problems of indigenous medicine and ensuring the development of the

nation in an acceptable fashion.

There are a number of main themes that have emerged in this study which help us to understand how,

and why, this particular vision of medical geography became so prominent. While they are very difficult


to untangle it is important that we conclude with an attempt in this direction. Firstly, May arrived in the

US at a time when medical geography was re-emerging as a distinct field of geographical investigation.

Under the direction of Richard Upjohn Light, the previous environmentalist perspective that had

dominated medical geography was reconfigured as the antecedent to a more rational and scientifically

based sub-discipline. These factors acted to provide medical geography with a future trajectory and to

provide it with a genealogical past or, put another way, an intellectual heritage.

With the appointment of Jacques May this vision of a ‘new’ medical geography was realised, because

May was able to carefully interweave the two ‘sciences’ of medicine and geography within his disease

ecology perspective. Here, the environmentalism associated with the ‘old’ medical geography is recast

as the quantifiable context within which disease pathogens occur. As Valencius notes, tropical medicine

and not medical geography emerged as the scientific rubric for investigating diseases in the tropics

because ‘the concept of ‘environment’ lost much of its holistic embrace, becoming instead of a unified

set of influences a more narrow harbourer of pathogens’.88 However, May constructed an intellectual

space for medical geography by presenting it as the study of the total environment within which disease

pathogens emerge. As such, May reconfigured the relationship between tropical medicine and medical

geography because the two were presented as distinct but closely related forms of scientific

investigation.

This is a point that leads us on to the second theme, the intersection of medical geography and the US

military. As is well known by now, World War II was a time in which geographers enjoyed positions of

some authority within the political sphere. In the US, as elsewhere, individuals with geographical

training occupied important strategic positions, the most prominent of which was the former president of

the AAG, Isaiah Bowman.89 This cross-over between professional training and wartime activity carried

over into peacetime operations. Particularly, it was recognised that the cartographic and environmental

knowledge of geographers, here connected to medical inquiry, would help in global military encounters.

We suggest that it was this recognition that enabled Jacques May to conduct such large-scale inquiries

into global disease ecology and, as such, establish the perspective as one that was central to the ongoing

emergence of post-war medical geography.

A third theme that we have developed in this paper is the idea that medical geographic knowledge also

needs to be understood in relation to colonial and imperial medicine. Here we have moved away from

traditional forms of historical investigation and employed the notion of colonial discourse analysis. Our

argument is that May’s vision of medical geography is implicitly intersected with western ideals and,

more specifically, that it emerged out of a strongly held belief in the civilising and democratising role

that western medicine played during the process of colonization. To this end, we have revealed, in the

latter half of this paper, key tropes that were deployed in May’s autobiographical account of his work in

Siam and Indochina. Thus, by drawing on literature from colonial discourse theory and the history of

imperial medicine, we have sought to locate May’s account within a broader field of investigation that

seeks to trace the contours of a ‘complex and situated history of western medicine and colonialism’.90

While clearly of immense significance in the early post Second World War development of medical

geography in the US, May needs to be seen in context. That context includes not only the many

intellectual antecedents to his key contribution, disease ecology, but also the colonial context of his work

before his period as a medical geographer and the military functionality of his and his colleagues’ work

and indeed the specific loci of May’s experiences. It includes the context provided by the geo-politics of

the world in which he practised medicine and the shared, but often artificially separated, disciplinary

worlds of geography and medicine. Importantly, in drawing these conclusions we do not seek to impose


present-day interpretations on the opinions and actions of may, nor do, we seek to deny May’s

positioning and impact. Rather, we argue that ‘founder-figures’ are seldom unproblematic.

Notes

1. E. Said, Culture and Imperialism, London, 1993.

2. C.B. Valencius, Histories of medical geography in: N.A. Rupke (Ed.), Medical Geography in Historical Perspective,

London, 2000, 3–28.

3. F. Barrett, A medical geographical anniversary, Social Science and Medicine 37 (1993) 701–710.

4. Cited in G. Rosen, Leonhard Ludwig Finke and the first medical geography in: E. Ashwood Underwood (Ed.), Science,

Medicine and History: Written in Honor of C. Singer, Oxford, 1953 186–193.

5. F. Barrett, Disease and Geography; The History of an Idea, Toronto 2000. For other geographical essays on Daniel Drake

see F. Barrett, Daniel Drake’s medical geography, Social Science and Medicine, 42 (2000) 791–800; M.L. Dorn

(In)temperate zones: Daniel Drake’s medico-moral geographies of urban life in the Trans-Appalachian American West,

Journal of the History of Medicine, 55 (2000) 256–291.

6. F. Driver, Submerged identities: familiar and unfamiliar histories, Transactions of the Institute of British Geographers 20

(1995) 410–413.

7. C. Barnett, Impure and worldly geography: the Africanist discourse of the Royal Geographical Society, Transactions of the

Institute of British Geographers 23 (1998) 239–251; J. Sidaway, The (re)making of the western ‘geographical tradition’:

some missing links, Area 29 (1997) 72–80.

8. See for example J.M. May, Ecology of Human Disease, New York 1958; J.M. May, Studies in Disease Ecology, New York

1961.

9. According to C.B. Valencius Valencius histories of medical geography in: N.A. Rupke (Ed.), Medical Geography in

Hisotircal Perspective, 2000, 15; this connection has also been established C.B. Valencius J. Cassedy, Medicine in

America: A Short History, Baltimore, 1991.

10. J. May, A Doctor in Siam, Jonathan Cape, 1949.

11. G.F. Pyle, International communication and medical geography, Social Science and Medicine (1977) 679–682, emphasis in

original.

12. E.H. Ackerknecht, History and Geography of the Most Important Disease, New York, 1965, 4–5; cited in R. Macleod,

Introduction in: R. Macleod M. Lewis (Eds), Disease, Medicine, and Empire: Perspectives on Western Medicine and the

Experience of European Expansion, London, 1988, 4; W. Anderson, Colonial pathologies: American medicine in the

Philippines 1989–1921, unpublished PhD Thesis, University of Pennsylvania, 1992.

13. See for example J. Aldridge, The textual disembodiment of knowledge in research account writing, Sociology 27

(1993) 53–66; D. Amigoni, Victorian Biography: INtellectuals and the Origins of Discourse, London, 1993; L.

Anderson, Autobiography, London, 2001; S. Busse E. Ehses and R. Zech, Collective research in autobiography as a

method of science of the subject, Forum: Qualitative Social Research [On-line-Journal], 1 (2000) [data of access:

12/6/03]; L. Stanley, On auto/biography in sociology, Sociology 27 (1993) 41–52; J. Swindells, The Uses of

Autobiography, London, 1995.

14. J.-P. Thouez and J.M. May, 1896–1975 in: T.W. Freeman (Ed), Geographers: Bibliographical Studies, Vol. 7, 1983,

85–88; May’s thesis was submitted to the Salpetriere and consisted of case reviews and reports on operations. See J. Meyer,

La lithiase du choledoque d’apres 122 cas-operes et 50 cas-revues, Paris, 1925.

15. J.K. Wright, Geography in the Making: The American Geographical Society, 1851–1951, New York, 1952.

16. R. Light, The progress of medical geography, The Geographical Review 34 (1944) 636–641.

17. Garrison presented a paper entitled ‘Medical geography and geographic medicine’ to the historical group o the Medical

School at Yale University, NewYork in 1932. In this presentation he outlined his vision of what medical geography or

alternatively geomedicine should entail, the details of which can be found in F.H. Garrison, Contribution to the History of

Medicine, 1966, 39–58. On the legacy of Hippocrates, see D. Cantor, Reinventing Hippocrates, London 2001.

18. H.E. Sigerist, Problems of historical-geographical pathology, Bulletin of the Institute of the History of Medicine 1 (1933)

10–18.


19. Learmonth notes that ideas, later associated most strongly with May, had also been articulated by Max Sorre. See A.

Learmonth, Disease Ecology, Oxford, 1988; M. Sorre, Complexes pathogenes et geographie medicale, Annales de

Geographie 235 (1933) 1–18. See also R. Akhtar, Has, J.H. May borrowed M Sorre’s 1933 concept of pathogenic

complexes, Cybegeo 236 (2003) 1–8 [date of access 12-6-03].

20. R. Light, The progress of medical geography, The Geographical Review 34 (1944) 639.

21. Light, The progress of medical geography, 641.

22. A. Anon, Proposed atlas of diseases, The Geographical Review 34 (1944) 642–652.

23. Anderson received the Legion of Merit for his wartime service as director of the Division of Medical Intelligence of the

Office of the Surgeon General. The activities of this division are recorded in J.S. Simmons T.F. Whayne, G.W. Anderson

H.M. Horack et al., Global Epidemiology: a Geography of Disease and Sanitation, New York, 1954.

24. G.W. Anderson, A German atlas of epidemic diseases, The Geographical Review 37 (1947) 307–311; H. Zeiss (Ed.),

Seuchen-Atlas, Berlin, 1942-25.

25. Anderson, A German atlas of epidemic diseases, 307–308.

26. See for example M. Heffernan, Geography, cartography and military intelligence: the Royal Geographical Society and the

First World War, Transactions of the Institute of British Geographers, 21 (1996) 504–533; B. Hudson, The new geography

and the new imperialism: 1870–1918, Antipode, 9 (1977) 12–19; J. Kirby, What did you do in the war daddy?, in:

A. Godlewska, N. Smith (Eds), Geography and Empire, Oxford, 1994, 300–315; N. Smith, Isaiah Bowman: political

geography and geopolitics, Political Geography Quarterly, 3 (1984) 69–76.

27. J.K. Wright Geography in the Making: The American Geographical Society 1851–1951, New York, 1952, 268.

28. Jacques May was one of three founding members of the IGU Commission on Medical Geography in 1949, the others were

Max Sorre and Arthur Geddes. He was chairman from 1950 to 1964 and again from 1972 until his death in 1975. G.F. Pyle,

International communication and medical geography, Social Science and Medicine 11 (1977) 679–682; Learmonth,

Disease Ecology, 13.

29. J.M. May, Medical geography: its methods and objectives, Geographical Review 40 (1950) 9–41.

30. As noted earlier, the principles of the disease or pathogenic complex which underlay May’s approach had been outlined by

Max Sorre in an article published in 1933 and were more fully established in his Les fondemonts de la geographie humaine,

Paris, 1951.

31. J.M. May, Medical geography: its methods and objectives, Geographical Review 40 (1950) 9.

32. Interestingly the ‘Atlas of Diseases’, initially funded for two years by a grant of US$30 000 from the Upjohn

Light Company a Michigan based pharmaceutical company set up by the grandfather of Richard Upjohn Light who

was its Director from 1937–1968 was later supported by the Office of Naval Research. See the Geographical Review

47 (1957) 266.

33. Valencius, Histories of medical geography 22; May, Ecology of Human Disease; Learmonth, Disease Ecology

7–8.

34. See for example L.D. Stamp, The Geography of Life and Death, London, 1964; J.M. Hunter, The challenge of

medical geography in: J.M. Hunter (Ed), The Geopgraphy of Health and Disease: Papers of First Carolina

Geographical Symposium Studies in Geography, Chapel Hill, Vol. 6, 1974, 1–31; G.F. Pyle, Applied Medical Geography,

London, 1979.

35. J.M. May, History, Definition and Progress of Medical Geography: A General Review. First Report of the Commission on

Medical Geography of the International Geographical Union, London, 1952, 1–9.

36. This series of publications was produced between 1961 and 1974, partly in collaboration with his wife Donna McLellan,

and included studies into the Far and Near East, Eastern and Central Europe, West Africa, Mexico and Central America and

into Eastern and Western South America.

37. H.T. Lemons and R. Campbell, The role of geography in quartermaster research, Annals of the Association of American

Geographers 37 (1947) 40.

38. A point that Driver makes about Whiggish accounts of the history of geographical thought more generally. See F. Driver,

Moral geographies: social science and the urban environment in mid-nineteenth century Britain, Transactions of the

Institute of British Geographers (1988) 275–287.

39. The problematic issue of (re)presenting autobiographical accounts within research writing has been raised within literary,

historical and sociological studies. While we recognise the problems raised our own approach has been to treat May’s


autobiography as a source of colonial discourse writing and as such, our interest in the text refers to the narrative procedures

that he adopts rather than with the question of self-writing per se.

40. A. Marcovich, French colonial medicine and colonial rule: Algeria and Indochina in: Macleod, Lewis, Disease, Medicine,

and Empire 103–117.

41. W. Anderson, Colonial Pathologies 2–3.

42. W. Anderson, Colonial Pathologies 3–5.

43. A. Marcovich, French colonial medicine and colonial rule 103.

44. J. May, A Doctor in Siam, London, 1949, 20.

45. R. Macleod, Introduction in: Macleod, Lewis, Disease, Medicine, and Empire 6.

46. According to Farley, medical problems encountered in the tropics ‘were defined and imposed by practitioners of western

style medicine without involving the indigenous populations’ J. Farley, Bilharzia: a History of Imperial Tropical Medicine,

1991. A rather fuller, though African, coverage of the imperial theme is afforded by M. Lyons, The Colonial Disease: A

Social History of Sleeping Sickness in Northern Zaire, Cambridge, 1992, 1900–1940.

47. Driver, Submerged identities 1.

48. D. Spurr, The Rhetoric of Empire: Colonial Discourse in Journalism. Travel Writing and Imperial Administration, Durham NC,

1993 1–2.

49. Driver, Submerged identities 8.

50. D. Harvey, The Condition of Postmodenity Oxford, 1989, 264; cited in Barnett, Impure and worldly geography 240.

51. Barnett, Impure and worldly geography 239–251.

52. C. Andrew and A. Kanya-Forstner, France Overseas: The Great War on the Climax of French Imperial Expansion, London, 1981.

53. On Thai history and the project of modernity in Thailand T. Winichakul Siam Mapped: a History of the Geo-Body of a

Nation, Hawaii, 1994.

54. In contrast, France’s North African possessions were the responsibility of other ministries: Algeria was the responsibility of

the Ministry of the Interior, whereas Morocco and Tunisia were the responsibility of the Foreign Ministry.

55. E.W. Said, Orientalism, London, 1978, 218.

56. According to Pratt, nearly all travel writing employs the ‘arrival scene’ as a way of framing the relations of contact with a

particular imperial setting M.L. Pratt, Imperial Eyes: Travel Writing and Transculturation, London, 1992.

57. May A Doctor in Siam, 21–22.

58. May A Doctor in Siam, 23.


60. According to Myers, the notion of ‘enframing’ refers to the ways in which the indigenous landscape was divided up and

contained by the everyday practices of the colonial powers, G.A. Myres, Intellectual of Empire: Eric Dutton and hegemony

in British Africa Annals of the Association of American Geographers, 88 (1995) 127; See also T. Mitchell, Colonizing

Egypt Cambridge 1988; J. Crush, Power of Development, London 1995.

61. May A Doctor in Siam, 21–23.






67. D. Arnold, Introduction: disease, medicine and empire, in: D. Arnold (Ed), Imperial Medicine and Indigenous Societies,

Manchest, 1988, 1–26.


69. M. Vaughan, Curing their Ills: Colonial Power and African Illness, Oxford, 1991, 9.

70. May A Doctor in Siam, 43, 45.


72. Arnold Introduction: disease, medicine and empire, 3.


74. R. Betts France and Decolonisation 1900 1960, London, 1991.

75. For a comprehensive account of medicine in French Indo-China in this period, see L. Monnais-Rousselot Medecine

et colonisation: l’aventure Indochinese 1860–1939, Paris, 1999, L. Monnais-Rousselot, Developing Health Care in


Indochina: In the Shadow of the Colonial Hospital, 1860–1939, in: G. Bousquet P. Brocheux (Ed.) Vietnam Expose: French

Scholarship on Twentieth-Century Vietnamese Ma Society.



78. D. Schreuder, The cultural factor in Victorian imperialism: a case study of the British ‘civilising mission’, Journal of

Imperial and Commonwealth History 4 (1976) 283317; cited in H. Power, Tropical Medicine in the Twentieth Century: A

History of the Liverpool School of Tropical Medicine 1898–1990, London, 1999.


80. Monnais-Rousselot, Medecine et colonisation.


82. M. Moutet, Minister of Colonies, 1936; cited in Betts, France and Decolonisation, 1900–1960, 31.


84. Power, Tropical Medicine in the Twentieth Century; W. Anderson, Immunities of empire: race, disease, and the new

tropical medicine, 1900–1920, Bulletin of the History of Medicine, 70 (1996) 94–118.


86. J. May, Anesthesie Moderne en Chirurgie, Maloine, 1946.

87. M. Meade, J. Florin and W. Gesler, Medical Geography, New York, 1988, 72–73.

88. Valencius, Histories of medical geography, 20.

89. Heffernan, Geography, cartography and military inelligence, Godlewska, Smith, Geography and Empire, 300–315; Smith,

Isaiah Bowman.

90. W. Anderson, Where is the postcolonial history of medicine?, Bulletin of the History of Medicine 72 (1998) 525.

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From Siam to New York: Jacques May and the ‘foundation’ of medical geography

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