As medical science progressed through the nineteenth century, the United States was at the forefront of public health initiatives across the Americas. Dreadful sanitary conditions were relieved, lives were saved, and health care developed into a formidable institution throughout Latin America as doctors and bureaucrats from the United States flexed their scientific muscle. This wasn't a purely altruistic enterprise, however, as Jose Amador reveals in Medicine and Nation Building in the Americas, 1890-1940. Rather, these efforts almost served as a precursor to modern American interventionism. For places like Cuba, Puerto Rico, and Brazil, these initiatives were especially invasive.
Drawing on sources in Cuba, Puerto Rico, Brazil, and the United States, Amador shows that initiatives launched in colonial settings laid the foundation for the rise of public health programs in the hemisphere and transformed debates about the formation of national culture. Writers rethought theories of environmental and racial danger, while Cuban reformers invoked the yellow fever campaign to exclude nonwhite immigrants. Puerto Rican peasants flooded hookworm treatment stations, and Brazilian sanitarians embraced regionalist and imperialist ideologies. Together, these groups illustrated that public health campaigns developed in the shadow of empire propelled new conflicts and conversations about achieving modernity and progress in the tropics.
This book is a recipient of the annual Norman L. and Roselea J. Goldberg Prize for the best project in the area of medicine.
|Publisher:||Vanderbilt University Press|
|Product dimensions:||7.00(w) x 10.10(h) x 0.90(d)|
About the Author
Jose Amador is Assistant Professor of Latin American Studies at Miami University of Ohio.
Read an Excerpt
Medicine and Nation Building in the Americas, 1890â"1940
By José Amador
Vanderbilt University PressCopyright © 2015 Vanderbilt University Press
All rights reserved.
Narratives of Disease, Danger, and Possibility
When in 1913 the thirty-two-year-old Cuban criminologist Fernando Ortiz published Entre cubanos, psicologia tropical (Among Cubans, tropical psychology), a short collection of essays about the political and social crisis of his country, he was participating in a conversation that had troubled intellectuals living in tropical America since the 1880s. He opened the book by offering his words to the "somnolent sons of the tropics." In a place punished by a sizzling sun, he lamented, "sleeping sickness" prevented even the most enlightened citizens from confronting national problems. The use of natural and medical imagery to represent unnecessary suffering was only one of the narrative strategies that scientifically minded writers employed to call for reform. The other strategy proposed remedial action and appeared just a few lines later when Ortiz invited both "great thinkers" and "humble laborers" to join in the "regenerative task" of the nation. While Ortiz used metaphors of decline and progress to analyze Cuban society, Entre cubanos was part of a new cluster of narratives undertaken by intellectuals preoccupied with attaining tropical modernity. Ortiz's remarks were emblematic of the ways organic analogies held a powerful sway over social thinkers who believed they were uniquely qualified for diagnosing and treating social and political pathologies. Through scientific discourse, cautionary tales challenged readers to connect their actions to the maladies of society.
The tension between demise and progress dotted the writings of physicians, lawyers, journalists, engineers, and social scientists across the tropics in the late nineteenth and early twentieth centuries. In the decades before and after the end of slavery, intellectuals in Cuba, Puerto Rico, and Brazil used various narrative forms to explore how European ideas about environmental and racial degeneration applied to—or broke down in—plantation societies. Because science provided writers with endless possibilities in terms of envisioning the progress of society, they were unwilling to accept that modernity could never be achieved in the tropics. Their challenge was to borrow and adapt from European theories while securing the possibility of redemption. To complicate matters, they had to wrestle with the unfolding effects of slave emancipation, accelerated urbanization, and rapid political change. Under these circumstances, Cuban, Puerto Rican, and Brazilian intellectuals engaged in what historian Nancy Leys Stepan describes as the "selective appropriation and re-elaboration of European theories of places, peoples, and diseases." Through the naturalist novel, the medical treaty, the criminological tract, and the hygienic manual, they employed the language of science to forge a bond between the reader who could help and the people suffering from the evils of plantation societies. By implicating readers in this suffering and warning them about the consequences of inaction, these narratives inaugurated new forms of calling for public engagement.
It is not surprising that cautionary tales gained popularity as theories of disease were being tested by the new disciplines of bacteriology and tropical medicine. This convergence captured the imagination of intellectuals who popularized the lessons of science to engender a reform consciousness among the reading public. Confident that science provided the tools to expose the lineaments of causality, intellectuals identified the pathologies of society and associated them to particular people and spaces. Racialized ideas of proper behavior always hovered over these narratives, calling attention to the transgression of racial, class, and sexual boundaries. Writers registered their ambivalence toward these transgressions in texts that portrayed society as a sick organism. Their cautionary narratives thus followed the formulaic structure of a clinical case study. They began with the identification of a social malady, included a discussion of its treatment, and ended in death and devastation. These narratives also made clear that this dire outcome could be easily avoided. An enlightened narrator or character usually offered a model of ameliorative action, making intelligible the promise of redemption to readers even if within the text it was never achieved. Like the best cautionary tales, their pages warned educated readers about potential despair in order to persuade them that what the country needed was a forceful new government, one that would use science to promote stability, rationality, and the law.
Because cautionary narratives were cultural products that arose within a particular historical context, to write about them is necessarily to write about the politics of representation. The work of historian Thomas Laqueur serves to clarify how material and ideological conditions exert influence on writers who seek a politics of reform. In his analysis of the humanitarian narrative in the eighteenth and early nineteenth centuries, Laqueur argues that scientific discourse provided a way to represent both the causes of suffering—disease, pollution, exploitation—and models of "precise social action." Yet Laqueur warns that the representation of suffering bodies in itself does not necessarily elicit a "particular moral response." The humanitarian narrative achieves this objective when the possibility of positive human agency is represented in a particular social context that compels readers to reevaluate their actions. This same call to action is at the heart of cautionary tales written in societies struggling with the demise of slavery. While the primary preoccupation of Cuban, Puerto Rican, and Brazilian writers was to invalidate claims about the impossibility of tropical modernity, they still had to grapple with the reality of slavery as a recent memory, plantation agriculture as an exclusive source of wealth, and nature as a seemingly endless repository of disease. Their challenge was how to represent the possibility of building a modern, tropical society. If European theories of race and climate precluded this possibility, intellectuals in tropical America did more than simply translate and transplant those theories. Their writings reformulated those principles to transcend those determinisms and promote reformists' campaigns.
This is the story of their ideological efforts—a story of authors telling stories about the sick and corrupt character of society to open a space of possibility. These efforts were taken up by prominent and less-known intellectuals and crossed a wide array of literary genres. Cautionary tales, even at their most tragic, affirmed the survival of society because intellectuals engaged scientific and medical theories on their own terms.
Writers in Cuba, Puerto Rico, and Brazil attempted to escape the rigidity of deterministic theories originally developed in Europe at a time when economic and political unrest at home seemed impossible to avoid. Since the mid-nineteenth century, pressures from European powers, abolitionists, free people of color, and slaves themselves had cleared the way for the overthrow of slavery and the disruption of plantation economies. These efforts had culminated in the complete abolition of slavery in Cuba (1886), Puerto Rico (1873), and Brazil (1888). The abolition debate involved more than the demise of slavery. It involved a reappraisal of society and political turmoil. From the late 1860s to the late 1890s, Cubans and Puerto Ricans used abolition to redefine, through both military and political means, their colonial relation with Spain. In Cuba, the wars of independence precipitated the military intervention of the United States in 1898. The intervention resulted in an imperial transition that shifted power over Cuba and Puerto Rico from Spain to the United States. In Brazil, emancipation also led to swift political changes. One year after slavery ended, Brazilians saw the demise of the empire and the birth of a conservative, oligarchic republic. Despite the distinct dynamics that shaped the political destinies of each society, intellectuals across the region girdled their reform programs in cautionary tales that evoked social and medical anxieties to explore the merits of scientific governance.
Among the most popular cautionary tales were those that animated fears about close social contact and shifting social boundaries: slaves turned citizens, illiterate masses turned enfranchised constituents, disaggregate workers turned union members, and suspicious immigrants turned respectable bourgeoisie. These narratives reflected concerns about contact among the so-called races to explore changing family structures and sexual mores. They amplified these anxieties through stories of disease, destitution, deception, neurosis, betrayal, seduction, crime, alcoholism, and abandonment that crossed racial and class lines. Thus it is not surprising that questions of representation became a pressing political issue: pressing in terms of national well-being, political in terms of inclusion and exclusion. Confronted with the challenge of securing their own privilege, white intellectuals turned to science and writing not only to develop a moral commitment for action, but also to test the limits of liberalism in racially and geographically heterogeneous societies. Their depictions derived their power not from within the text, but from the response they were expected to elicit in elite urban readers.
Whether they were accurate or unduly harsh in their portrayal of social worlds, cautionary tales borrowed from a wide array of scientific discourses. Naturalist writers, obsessed with the influence of the tropical environment in determining human actions, found their chief inspiration in the triad of "race," "time," and "milieu" popularized by French literary and art critic Hippolyte Taine and the evolutionary models proposed by English philosopher Herbert Spencer. Other writers adopted different scientific discourses, including neo-Lamarckian doctrines of human heredity, which assumed that acquired characteristics could be altered depending on the surrounding environment; miasmatic theories, which posited that disease had its origins in noxious emanations coming from the environment; and theories of contagion, which held that disease could be transmitted from person to person. Still others were swayed by criminology, basing their accounts on the theories of Cesare Lombroso and Enrico Ferri on criminology and of Gabriel Tarde, Scipio Sighele, and Gustave Le Bon on crowd psychology to explore different manifestations of criminality. Despite their different perspectives, the authority of science enabled writers across the region to harness a medicalized vision of society that defined both the reform agenda and the limits of social change.
Besides the "reform or perish" impulse, cautionary tales also exposed the hypocrisy of the respectable and the wealthy. On their pages, readers descended into worlds hidden under the grandeur of plantation houses or the splendor of modern cities. Corruption and decay lay behind the façade of reason and virtue. In literary and scientific terms, this denunciation allowed authors to generate plots so convoluted that they moved beyond stark oppositions of rich and poor to emphasize instead fragmented but interdependent social universes. Within each text, writers deliberately included didactic sections that functioned to offset their tragic endings. Optimism entered these stories via commentaries about the abolition of slavery, labor discipline, public schooling, hygienic education, disease eradication, and the individual and collective transcendence of race. By weaving the tension between demise and possibility into the story, cautionary tales introduced scientific experts who would mediate between the sick population and the well-being of society.
The preferred genre of cautionary narratives in tropical America was the naturalist novel. What the reading public encountered were the desperate attempts of writers to reinterpret the conventions of the European naturalist novel to depict the problems of forging a coherent national identity. In general, intellectuals living in plantation societies like those of Cuba Puerto Rico, and Brazil viewed slavery and its aftermath as the principal obstacle of modernization.
One precursor of Cuba's naturalist novelists was Cirilo Villaverde. He was a masterful storyteller, and in 1838 he published the fictional travelogue Excursión a Vueltabajo (Excursion to Vueltabajo), which chronicled the author's voyage from Havana to Vueltabajo, his birthplace. An early abolitionist and independence leader, Villaverde's mythical excursion reflected the search for origins pursued by a small group of Cuban reformers known as Círculo de Domingo del Monte (the Circle of Domingo del Monte). Geography, natural sciences, and history all blended together in the author's desire to unify heterogeneous populations and regions. Yet what began as a personal voyage of discovery culminated in the realization that the birthplace of nationality was plantation slavery. This recognition takes place when Villaverde, perched on a mountaintop, admires a beautiful vista of rivers, hills, trails, towns, and people. This harmonious scene is interrupted by the sight of the Big House, the most conspicuous symbol of the plantation complex. Completely in ruins, the Big House represents the cruelties and backwardness of slavery. Cubanness, Excursión a Vueltabajo suggests, did not arise from the relationship between people and nature or the link between urban and rural economies, but began in Africa with the taint of the wealth slavery produced. Slaveholding elites, Villaverde railed, had sacrificed the well-being of the nation for self-interest and profit.
As the institution of slavery became obsolete in intellectual circles, the portrayal of the plantation system as a dismal institution became a prevalent trope in cautionary tales. In 1890, Manuel Zeno Gandía, a Puerto Rican physician and writer, completed Garduña (which was not published, however, until 1896), a novel in which villainy and corruption spread, like the venereal disease of the main female character, to every stratum of society. The first installment of the series Crónicas de un mundo enfermo (Chronicles of a Sick World), the novel takes place on Mina de Oro, a sugar plantation in the coastal town of Paraiso—a town that stands in for Zeno Gandía's birthplace, Arecibo. Garduña tells the story of its title character, an unscrupulous lawyer who, through deceit and bribery, cheats Casilda, the illegitimate child of the owner of Mina de Oro, of her rightful inheritance. Seduced and abandoned by a usurping cousin, Casilda then moves from lover to lover until she is solicited by a pimp and leaves for San Juan, the capital of Puerto Rico. Meanwhile, Garduña, with the help of the colonial legal system, blackmails Casilda's cousin until Mina de Oro is completely ruined. Unknowingly deprived of her fortune, and unable to inherit the sugar plantation, Casilda inherits her father's syphilis. Punished for her own sexual transgressions, Casilda's "body suffered the destructive flagellation of desire." In the final passage of the novel, she becomes an outcast who departs Paraiso in destitution and shame. As her caravan reaches the summit of the nearby mountain, Casilda views her village not as a haven of possibility, but as paradise lost in the "infectious slough of the land." The implications of this panoramic gaze in Garduña, like in Excursión a Vueltabajo, are evident: the social pathologies created by the plantation system are to blame for degradation of life. Like Casilda's venereal disease, these entrenched maladies are passed on to future generations.
Brazil's foremost naturalist writer exposed the crippling effects of the racial hierarchies derived from the plantation system. An abolitionist, a caricaturist, and a writer, Aluísio Azevedo introduced naturalism to Brazil with his 1881 novel O mulato (Mulatto). The novel opens with a long, vivid passage describing an "oppressive day" in which the "poor city of Sao Luís do Maranhao lay sprawled in heat," like someone ill and unable to move. The narrative then moves through swarming streets until it reaches the foot of a mango tree at the Guardian Angel estate—the mythical place of origin. On this estate, Raimundo, the enlightened and racially mixed protagonist, discovers the workings of moral decay. After studying in Portugal at Coimbra University and living in Rio de Janeiro for a year, Raimundo returns to Maranhao as a cosmopolitan and educated young man—a model of positivist reason. Raimundo quickly finds out that in Maranhão everything is not as it seems. Elegant women are revealed as vulgar and prosaic, Portuguese merchants as corrupt and selfish, clergymen as adulterers and murderers. Even his identity is false. The illegitimate child of a planter and a slave, Raimundo learns that he is a mulatto after his uncle rejects his proposal to marry his cousin Ana Rosa. He later asks himself: "Was there no value, then, in having been well raised and educated? Did being decent and honest count for nothing?" These were the very questions that bedeviled Brazil in the 1880s. Tradition, slavery, and discrimination, the novel insists, are the obstacles of enlightened republicanism, stunting development and progress.
Excerpted from Medicine and Nation Building in the Americas, 1890â"1940 by José Amador. Copyright © 2015 Vanderbilt University Press. Excerpted by permission of Vanderbilt University Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction: Intellectual Currents and Public Health Crossings 1
Part I Visualizations
1 Cautionary Tales: Narratives of Disease, Danger, and Possibility 15
Part II Crossings
2 Beyond Yellow Fever Eradication: Nation and Racial Gatekeeping in Cuba 39
3 The Pursuit of Health: Colonialism and Hookworm Eradication in Puerto Rico 68
4 Converging Missions: Public Health Bandeiras and Rockefeller Philanthropy in Brazil 95
Part III Legacies
5 A Turn to Culture: Public Health Legacies and Transnational Academic Circuits 121
Conclusion: Disentangling Transnational Histories 151