Avatares de la medicalización en América Latina, 1870-1970 (review)

The ten articles in this collection concentrate on a century of changes and perspectives in medical practice in Latin America. Two articles focus on Argentina, three on Brazil, three on Mexico, and one is a comparative study of Argentina, Brazil and Chile. Although all but one of the articles has been previously published, they reflect the diversity of research into the history of medicine published within the last five years, and Diego Armus's Introduction provides an important overview of the historiography on disease and illness in Latin America. Collectively, the chapters concentrate on the social and political dimensions of disease and consider the national and international issues that shape public health policy.

Laura Malosetti Costa examines the Uruguayan Juan Manuel Blanes's portrayal of the yellow fever epidemic of 1871 in Buenos Aires in an effort to understand its emotional effects. Two poor quality prints provide a glimpse of death's tragedy. Diego Armus considers patients' protests against medical policies and treatment, with a special focus on individual and group protests at the Sanatorio National de Tuberculosis Santa María in Cosquín, Córdoba, where patients organized marches and went on hunger strikes against the quality of food and strict schedules. Punishments were swift and varied from expulsion and corporal discipline to limitation of privileges. Armus also looks at conflicts involving the Department of Hygiene, physicians and patients over the adoption of the Pueyo vaccine, developed by an amateur biologist for the cure of Tuberculosis. Historians have rarely considered patients' protests, a significant topic for understanding patient perspectives.

In the only article written specifically for the collection, Susana Belmartino's ambitious effort compares the health services in Argentina, Brazil and Chile. She concludes that national differences originated in the historical process of state formation, the timing of the adoption of European developments of social security and the relationship among the state and political parties and interest groups. Three articles focus on medical issues in Brazil: Nísia Trinidade Lima and Gilberto Hochman examine issues of race and medicine in the medical-hygiene movement of the First Republic; Sérgio Carrara evaluates syphilis, race and national identity in Brazil between the wars; and Simone Petraglia Kropf, Nara Azevedo and Luiz Otávio Ferreira focus on chagas, a disease caused by blood-sucking insects that live in mud walls and for which there is treatment but no cure. This latter article documents the recognition of chagas as a significant medical and social issue in Brazil from 1909-1950.

Three articles deal with Mexico. Claudia Agostoni explores why late nineteenth-century Mexican physicians, as part of public health efforts, attempted to change the activities of the poor. The efforts of the medical profession to educate the public, particularly women, on health and hygiene were linked to nationalism and the modernization of the state. Eric Van Young examines a psychiatric hospital, Manicomio General, that operated in Mexico City from 1910-1968. He views mental patients as subalterns and the institution as part of the Mexican government's modernization efforts. In a concluding essay Alexandra Stern discusses how science employed various approaches to avoid the use of "race" to characterize and describe Mexicans from 1920 to 1960. These approaches, rather than ending racism, contributed to the growth of new stereotypes.

Although the authors do not use new types of sources, their research is solidly grounded and broadly conceived, with disease considered as a social construction. As recently as the 1970s, physicians authored most of the publications concerning medicine in Latin America, in works that too often were narrowly focused. The historians in Avatares de la medicalización posit new questions and use interpretations and approaches from other disciplines to place their studies within a broader context of Latin American history. This volume would have been strengthened by an index, conclusion, and a more comparative approach, but all of the articles are significant contributions to new approaches on Latin American medical history...