Disease in the History of Modern Latin America: From Malaria to AIDS
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Duke University Press Books
Disease in the History of Modern Latin America: From Malaria to AIDS

Disease in the History of Modern Latin America: From Malaria to AIDS


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Product Details

ISBN-13: 9780822330578
Publisher: Duke University Press Books
Publication date: 03/26/2003
Pages: 336
Product dimensions: 6.36(w) x 9.24(h) x 1.16(d)

About the Author

Diego Armus is Assistant Professor of Latin American History at Swarthmore College.

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Disease in the history of modern Latin America

From malaria to AIDS
By Diego Armus

Duke University Press

ISBN: 0-8223-3069-5

Chapter One


Disease in the Historiography of Modern Latin America

In the past two decades, disease has become an increasingly prominent theme in Latin American historiography as a result of efforts to renew the traditional history of medicine, historical studies of the region's population, and the spread of interpretative approaches borrowed from the humanities and social sciences.

What is emerging from this dynamic historiographic pursuit has been called the new history of medicine, the history of public health, or the sociocultural history of disease. All three quests recognize that diseases are complex processes and all of them have somewhat taken into account a very provocative and stimulating reading of that complexity offered by one of the most influential scholars in the field: "Disease is an elusive entity.... It is at once a biological event, a generation-specific repertoire of verbal constructs reflecting medicine's intellectual and institutional history, an occasion of and potential legitimation for public policy, an aspect of social role and individual - intrapsychic - identity, a sanction for cultural values, and a structuring element in doctor and patient interactions. In some ways, disease does not exist until we have agreed that it does, by perceiving, naming, and responding to it."

This book attempts to give an account of the state of historiography of disease in modern Latin America. On the one hand, the essays included here are meant to be representative of the issues that have driven, and continue to drive, the field's growth. On the other, and this is worth emphasizing, this selection also indicates problems, themes, and historiographic tendencies that are not exclusively Latin American. This book tries to avoid any temptation to conceive of a history of disease in the region as necessarily focused on tropical diseases and for that reason only marginally concerned with those maladies somehow associated with the processes of urbanization, modernization, and industrialization. Instead, it aims to contribute to a more complex discussion of the widespread modernization that has taken place in the region. In this, the book underlines both the heterogeneity and the shared neocolonial condition, with multiple and shifting metropolitan references, that have marked each national history over the past two centuries.

This book includes innovative works that underscore the concept that diseases cannot be examined outside their societal frame. Different historical times, social groups, or even individuals produce their own ways of defining the etiology, transmission, appropriate therapy, and meanings for a disease. These definitions reflect not only changing medical technologies and knowledge but also broader influences, including religious beliefs, gender obligations, nationality, ethnicity, class, politics, and state responsibilities.

The contributors to this book approach diseases as social constructions, as socially generated ways of grouping biomedical and sociocultural phenomena and endowing them with particular meaning. They represent current and innovative ways of looking at disease from a historical perspective and addressing the powerful interplay among culture, history, medicine, and society. Although all see diseases as settings marked by consensus, tensions, and conflicts, their research agendas are not necessarily similar. In fact, one of the goals of this book is to show the different and in some ways converging historiographical styles developed by senior and junior scholars, Latin Americans and Latin Americanists working in the United States, historians and sociologists of science, medical anthropologists, and social and cultural historians.

The authors frame their topics as modern problems spanning a period from the end of the nineteenth century to the end of the twentieth. Their emphases range from the production of scientific knowledge in the periphery (Coutinho on Chagas' disease in Brazil) to literary metaphors associated with a certain illness (Armus on tuberculosis in Argentina); from social control issues (Bliss on syphilis in Mexico) to medical institutions viewed as a mirror of broader national problems (Zulawski on mental health in Bolivia) and medical representations of imaginary plagues (Nouzeilles on hysteria in Argentina); from public health initiatives generated at the domestic level (Stepan on malaria in the Brazilian Amazon basin) to policies shaped along the lines of agendas of international agencies (Birn on hookworm in Mexico); from the interaction among ideas of sexuality, disease, nation, and modernity (Larvie on AIDS in Brazil) to the instrumental role of certain illnesses in state-building processes (Obregon on leprosy in Colombia); from state-sponsored welfare efforts led by the medical professions (Blum on hospitalism in Mexico) to individual and state responsibilities with respect to sickness and health (Cueto on cholera in Peru).

As with any collection of essays, this book is necessarily limited in scope; some countries, problems, and diseases had to be left out. Despite these unavoidable limitations, this volume features instructive and absorbing cases representing current scholarship bringing new - or renewed - questions to the field. Each chapter forms part of a research agenda that could be read as the product of two paths of inquiry, the first encompassing approaches that started out with the history of medicine and biosciences and ended up weaving rich social, political, and cultural narratives and analyses; the second taking the opposite path. Departing from broader problems initially defined in terms of society, politics, and culture, these studies not only discovered illness as an intriguing and contentious historical issue, but also came to make disease the organizing theme of their historical accounts.

This introduction does not attempt to present an exhaustive and detailed account of what has been written, or to suggest a program for what should be done in the future. Its main goal is twofold: first, to frame the essays in this book within the history of medicine, the history of public health, and the sociocultural history of disease; second, to underscore the most imaginative and productive topics in the history of disease in Latin America: the social and political dimensions of epidemics, the development of public health policies vis-a-vis external influences and state-building processes, and the cultural uses of disease.

Writing the History of Disease: The New History of Medicine, History of Public Health, and Sociocultural History of Disease

Traditionally, the subject of disease has been a kind of boundary controlled by historians of medicine who wrote histories of changes in treatments and biographies of famous doctors. Beyond their specific contributions, these histories appear to have attempted to reconstruct the "inevitable progress" generated by university-certified medicine, to unify the past of an increasingly specialized profession, and to emphasize a certain ethos and moral philosophy that is presented as distinctive, unaltered, and emblematic of medical practice throughout time. The new history of medicine, by contrast, tends to see the development of medicine as a more irregular process. Engaging in dialogue with the history of science, it discusses the social, cultural, and political context in which certain doctors, institutions, and treatments "triumphed," making a place for themselves in history; and it also examines those that have been forgotten. It strives to understand the tension between the natural history of the disease and some aspects of its social impact.

The history of public health, for its part, emphasizes political dimensions, looking at power, the state, the medical profession, the politics of health, and the impact of public health interventions on mortality and morbidity trends. To a large extent it focuses on the relations between health institutions and economic, social, and political structures. It is also a history that regards itself as useful and instrumental, seeking in the past lessons for the present and future because it assumes that health is an open-ended process. Thus, historians should research the past in order to reduce the inevitable uncertainties that mark every decision-making process in public health, thereby facilitating in general rather than specific ways interventions in the contemporary scene. This approach continues two overlapping legacies, from late-nineteenth- and early-twentieth-century research and hygiene practices, and from certain national histories of public health written since the 1950s. Both efforts, which recognized and underlined the social character of disease, are important antecedents when evaluating scholarship on public health issues from a historical perspective. These, then, are the points of departure for studies that in some cases do nothing more than celebrate the first public health physicians and practitioners. Other studies attempt to analyze the issue of health and medicine in structuralist code as epiphenomena of the relations of production. Either way, the emphasis of this history of public health is not so much on the health problems of individuals as on those of social groups, and on the study of political interventions to preserve or restore collective health. This history focuses on moments in which the state - based on considerations that go beyond the strictly medical and are shaped by political, economic, cultural, scientific, and technological factors - has promoted actions intended to combat a particular disease. Public medicine usually appears in a positive and progressive light in such histories, as the fortunate outcome of the association of biomedical sciences with a rational organization of society in which certain professionals - public health doctors above all - offered solutions for the diseases of the modern world. While this association is seen as potentially beneficial, its concrete achievements are found wanting. This unhappy result is presented as a reflection of the dependent condition of the region, without regard for any temporal or national distinctions. This dependency determined the existence of a ruling elite and a structure of economic power that was unable or unwilling to create and distribute public health resources and services in an equitable and efficient manner. Other studies react against the schematic use of the dependency model and summarize the achievements and failures of national or municipal projects aimed at creating or modernizing the basic sanitary infrastructure and reducing mortality. Despite the peripheral condition of Latin America, they claim, in certain countries or cities, at least, the balance was not that negative.

The sociocultural history of disease is more recent, the product of studies by historians, sociologists, anthropologists, and cultural critics who have discovered the complexity and possibilities of disease and health, not only as problems in themselves but also as excuses or tools for discussing other topics. This approach barely skims across the history of a given etiology; rarely is there any attempt to set up a dialogue between sociocultural history and the history of biomedical sciences. Instead, it spreads out over topics such as the sociopolitical or sociodemographic dimensions of a particular disease, medical professionalization processes, welfare and social control instruments and institutions, and the state's role in building health infrastructure. Some of these histories do not go beyond gathering relevant data and basic information, but others, in their critical analysis of health and disease, argue for a small set of overriding explanatory factors, with uneven success. These studies tend toward top-down and somewhat conspiratorial explanations: the poor have always been wretched because the elites and middle classes lack political will; every public health initiative resulted from an effort to increase the productivity or guarantee the reproduction of labor; elites got involved in sanitary reforms for their own security; pioneering initiatives were the product of a new professional state bureaucracy interested in imposing public health measures; or dependent capitalism needed those changes. There have also been Foucauldian interpretations of medicalization - an undoubtedly inspiring line of thinking, especially for certain Latin American intellectuals who found an arsenal of the normalizing resources of modernity in medicine and state public health interventions. This view understands medicine as one of the rationalization enterprises that, having developed particular disciplinary languages and practices, aimed to control bodies, individuals, and society. In this context diseases and medical interventions attempting to address them have been seen - often overlooking mediations and particularities - as instruments for regulating society, labeling difference, and legitimizing ideological and cultural systems.

These three lines of inquiry undoubtedly reflect an effort to escape the limitations of the traditional history of medicine. All of them - the new history of medicine, the history of public health, and the sociocultural history of disease - take medicine to be an uncertain and contested terrain where the biomedical is shaped as much by human subjectivity as by objective facts. All three approaches discuss disease and illness as problems that have a biological dimension but are also loaded with social, cultural, political, and economic connotations. This volume offers an overview of these historiographical developments. While maintaining their own emphasis and agendas, the contributors to this book try to be attentive to the rich mediations between the state, medical knowledge, public health policies, the requirements of the economic system, perceptions and representations of illnesses, and responses of ordinary people. They also attempt to approach disease in a creative, interpretative way, taking into account both the disciplining and the progressive dimensions of medical initiatives.

Writing on Epidemics as a Historical Problem

The most prolific theme in the new history of medicine has been the social and political dimensions of epidemics. This work focuses on contagious diseases such as smallpox, yellow fever, bubonic plague, influenza, and cholera that attacked communities by surprise and with intensity. Some of these histories emphasize the social conditions in which the epidemic emerged, the state policies used to combat it, and the reactions of elites and common people. Others include a careful examination of biological and ecological factors, opening a dialogue between social history and the history of the biomedical sciences. Thus, the Latin American cases add to a kind of dramaturgy common to all epidemics, interweaving themes of contagion, fear, stigma, blame, salvation, and individual and social responsibility. But this dramaturgy, it is worth stressing, merely defines the framework for an epidemic event, not its specific cultural, religious, or political features. It also does not speak to the ways societies and certain social groups give meanings to the experience of the epidemic, or the availability and use of certain strategies and resources to combat it.

Epidemics lay bare the state of collective health and the infrastructure of sanitation and health care. They can facilitate initiatives in public health, and in this way accelerate an expanding state authority, both in social policy and in private life. Nevertheless, society's familiarity with a certain illness might well lay the ground for ignoring it, either because its persistent presence makes it less extraordinary and surprising or because the political, social, or geographic context does not allow it to become a public, political issue, even though, by definition, it is a collective matter.


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Table of Contents

Preface vii

Disease in the Historiography of Modern Latin America / Diego Armus 1

“The Only Serious Terror in These Regions”: Malaria Control in the Brazilian Amazon / Nancy Leys Stepan 25

An Imaginary Plague in Turn-of-the-Century Buenos Aires: Hysteria, Discipline, and Languages of the Body / Gabriella Nouzeilles 51

Tropical Medicine in Brazil: The Case of Chagas’ Disease / Marilia Coutinho 76

Tango, Gender, and Tuberculosis in Buenos Aires, 1900–1940 / Diego Armus 101

The State, Physicians. and Leprosy in Modern Colombia / Diana Obregón 130

Revolution, the Scatological Way: The Rockefeller Foundation’s Hookworm Campaign in 1920s Mexico / Anne-Emanuelle Birn 158

Between Risk and Confession: State and Popular Perspectives of Syphilis Infection in Revolutionary Mexico / Katherine Elaine Bliss 183

Dying of Sadness: Hospitalism and Child Welfare in Mexico City, 1920-1940 / Ann S. Blum 209

Mental Illness and Democracy in Bolivia: The Manicomio Pacheco, 1935–1950 / Ann Zulawski 237

Stigma and Blame during an Epidemic: Cholera in Peru, 1991 / Marcus Cueto 268

Nation, Science, and Sex: AIDS and the New Brazilian Sexuality / Patrick Larvie 290

Contributors 315

Index 317

What People are Saying About This

David Rosner

This book is an extraordinary contribution that brings together the very best scholars of Latin American public health and social history. Its emphasis on the social conditions that lead to epidemic disease as well as the political and social forces that shape practice is a welcome corrective to a literature still too often dominated by positivist traditions.
— director of the Center for the History and Ethics of Public Health, Columbia University

Daniel James

I was fascinated by all the essays in Disease in the History of Modern Latin America. They are theoretically aware and sophisticated while they remain accessible and oriented to the complexity of historical experience. This collection is a powerful argument for the richness of an interdisciplinary approach to cultural history.
— author of Doña Maria's Story: Life History, Memory, and Political Identity

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