Chapter One addresses James Grainger’s efforts to endow disease with poetic form in his ‘West-India georgic’ The Sugar-Cane (1764). Grainger’s poetics of disease are voiced in terms of an emerging environmentalism and georgic organicism which reconfigures the natural and social hierarchies of colonial nation-building. His hybrid georgic form and use of African-Caribbean medical sources reveal colonial literature and medicine as deeply syncretic. Examining the connection between poetic and scientific innovation, this chapter shows that Grainger’s interest in non-European medical treatments from slaves and local sources not only gave metropolitan audiences a flavour of the Caribbean, but also shaped The Sugar-Cane as a unique example of the Atlantic production of medical knowledge in literary form.