Race, Place, and Medicine: The Idea of the Tropics in Nineteenth-Century Brazilian Medicine (review)

Julyan G. Peard. Race, Place, and Medicine: The Idea of the Tropics in Nineteenth-Century Brazilian Medicine. Durham, N.C.: Duke University Press, 1999. x + 315 pp. $54.95 (cloth, 0-8223-2376-1), $17.95 (paperbound, 0-8223-2397-4).

Let me begin by saying that I found this book captivating--partly because it is centered on the scholarly project I term "the invention of tropical disease," and also because it is set in Salvador da Bahia, the former colonial capital of Brazil founded in 1549. It was in locales like Bahia that Europeans began to construct the idea of the tropics. Located at 12° S, Bahia was the initial hub of the Brazilian sugar agriculture economy, where African captives became plantation slave laborers, haphazardly imported African insects and pathogens took up residence, and common European diseases erupted regularly in epidemics. This confluence of factors dramatically altered the region's physical landscape, demographic profile, and disease ecology. Over time the seemingly benign, even salubrious environs--especially according to the Hippocratic tenets found in Airs, Waters, Places--deteriorated into a far riskier locale from the perspective of public health. With the advent of naval medicine and medical topography in the eighteenth century, the latitudes between the Tropics became increasingly suspect, and entrepôts such as Bahia came to be viewed as moribund, and insalubrious by nature.

When Julyan Peard picks up the story in the mid-nineteenth century, there is a new plot twist: a change in the dominant paradigm of European medical thought brought about by microscopy and incipient parasitology. Peard focuses on the introduction into Bahia of the emerging paradigm and its role in transforming the practice, teaching, and science of medicine in Brazil. The key actors were three physicians, born and trained in Europe, who arrived in Bahia in the 1840s. These three outsiders--Otto Wucherer, James Ligerwood Paterson, and João Francisco de Siva Lima--formed the nucleus of a group of local physicians who from 1865 on met regularly to discuss their own clinical cases, and to stay abreast of medical news from abroad. The group became known as the "Tropicalistas," and their gatherings and discussions led to the establishment of the Gazeta Médica da Bahia, which published biweekly for almost seventy years. While Peard's archival research is most thorough, it is fair to say that this journal serves as the anchor for her study: she uses it as a window onto medical practice and politics in a newly independent tropical country. This allows her to document the Tropicalistas' opposition to slavery, their efforts to publish and to connect with the scientific community in Europe, and their call for reforms in medical education in Brazil.

The Tropicalistas emphasized the medical distinctiveness of practicing medicine in the tropics. Peard argues that they retained core environmental assumptions, while believing in the possibility of progress through sanitation and new knowledge drawn from parasitology. Challenging the negative image of "warm climates" held by medical authorities in Europe as well as in Rio de Janeiro, they attempted to Brazilianize the local practice of medicine. In Professor Peard's handling, they come across very much as heroes struggling to define accurately the medical landscape of Brazil. They were also striving for professional recognition at home and abroad. Ultimately the school withered, and by the late nineteenth century it had disappeared, as the original founders died and others were absorbed into the mainstream.

What is particularly noteworthy about this story is the advance of medical knowledge about tropical environs without the attendant military involvement so well represented in the British, French, and American experiences. So much of the recent historiography in this field has focused on European military forces, colonial policies, and tropical medicine in relation to empire-building. Professor Peard offers a very fresh perspective that illuminates the...