Global health traces its origins back to a single moment in 1854 when John Snow eradicated cholera with a map. It is a nice story, but it’s a myth, a fantasy of empiricism. The modern global health approach did begin with the nineteenth-century, worldwide cholera pandemics, but cartography was not the principal form associated with this paradigm; it was the gothic. Turning back to the mid-nineteenth-century pandemics, this essay explores the contours of an emergent global health approach on both sides of the Atlantic. It demonstrates why the gothic was the form through which this approach was narrated, how the form worked, and the effects of the genre on popular and medical knowledge. Contemporary global health has been reorganized around scientific empiricism, but elements of its gothic history remain. I conclude by suggesting the value of recuperating these gothic origins for global health today.