The Ailing City: Health, Tuberculosis, and Culture in Buenos Aires, 1870-1950 (review)

Armus has written a fascinating story about the ways by which people tried to deal with tuberculosis in Argentina from 1870 to 1950. He is adamantly modest about what he covers in the book: "I seek to provide . . . a record of the images, implications, and concrete experiences that were the stuff of a subculture which . . . gave tuberculosis its meaning and defined its role. . . . [and became] a way of speaking not only about biomedical issues but also about other matters." Thus, he sees the book as simply portraying how porteños experienced and thought about tuberculosis (TB), but it is much more. Well steeped in the international literature about the history of tb and aware that it rarely appears in cities and countries beyond Europe and North America, he claims to make no direct comparisons, but he can hardly avoid it. Similarly, he eschews many theoretical interpretations, preferring the evidence to speak for itself, but, again, he protests too much.

Armus skillfully reveals the complex social milieu of Buenos Aires at a time when doctors reveled in notions of eugenics and contagion and the hopes of cures, while everyday people struggled to deal with illness informed by notions of race and gender, bewildered by the new world of advertisements that promised cures. In the first three chapters, he focuses on documents that explain how those who had the disease coped with informal as well as institutional approaches to treatment at a time when cures were uncertain, and no one understood how to prevent the disease from infecting others. Armus refuses to interpret these documents himself, even though the selection of cases implicitly involves value judgments on his part.

Chapter 4 deals with public policies and the quest of public-health physicians to guarantee a healthy city in the midst of massive European immigration and internal migration. Chapter 5 focuses on the prejudices based on the fear of contagion and the eugenic desire to promote the ideal family. Gendered differences in the experiences of patients, as well as the effect of immigration and the desire to raise healthy children, frame the next four chapters.

Whereas public-health physicians, eugenicists, and politicians tended to blame both the poor and the tenement houses (conventillos) for the increased incidence of tuberculosis, Armus shows that statistics prove no such correlations. Indeed, tuberculosis was an indiscriminate attacker of urban inhabitants, and the tremendous growth of the urban population and the general expansion of Buenos Aires contributed to its ability to attack individuals. Furthermore, people tended to resist the kinds of public-health campaigns designed to limit the spread of contagious diseases, such as the prohibition of spitting in the subways and on the streets, the formulation of strict guidelines to care for infants and young children, and efforts to separate families from ill loved ones. These stories are poignant and resonate today regarding the efficacy of behavior modification for contagious diseases.

This work is rich in personal anecdotes and depth of field, showing the resonance of disease in music, theater, poetry, and sports. Although not a book for those unacquainted with the history of Buenos Aires, it is most welcome for those interested in the social history of disease, and specialists in the history of Argentina.