Chapter two addresses the formal relationship between literature and medicine in relation to the new sciences of medical geography and topography which developed at the end of the eighteenth century and coincided with the literary and artistic fashion for the picturesque representation of landscape. Colonial land was conceived within a medical imaginary that drew together ideas of space, health and aesthetics, grounded in the Hippocratic theory which emphasized the causal relationship between environment and health. This chapter describes the points of thematic and formal intersection between medicine and the picturesque in terms of the contemporary cultural prioritization of visual experience. It examines the well-documented crisis of diseased colonial nature imagined in travel writing and poetry of the 1780s and 1790s, presenting a new perspective on the medical context of this writing by demonstrating the powerful influence of aesthetic ideals on medical knowledge, and arguing that the meeting between medical topography and picturesque aesthetic ideals provoked changes in both literary and scientific narrative forms.