Epidemic Invasions: Yellow Fever and the Limits of Cuban Independence, 1878-1930 (review)

Until a few years ago histories of tropical medicine concentrated on the sending side (usually imperial) and paid little attention to what was thought or done by local medical doctors or local political authorities. However, recently a number of works have tried to transcend the emphasis on how "metropolitan" doctors framed "natives" and "native diseases." This book is part of the departure from this unilateral approach, a sophisticated account of the encounter of global and local medical and political motivations, activities, and ambitions.

The organizing principle of the book is that during the late nineteenth century controlling yellow fever in Cuba—at the time a colony of the Spanish Empire—was a priority for U.S. commercial and political interests because there was an intense traffic of people and goods with Florida, and Cuba was blamed for yellow fever epidemics that attacked the U.S. South. A growing conviction among American politicians, medical doctors, and newspapers was that for the U.S. South to prosper yellow fever had to be controlled at its source in the Caribbean, namely Havana. Consequently, the American military intervened in the process of Cuban independence, and after the defeat of the Spanish army in 1898 they occupied the island, on two different occasions, to—among other objectives—eliminate the menace of the fever and protect U.S. maritime commerce. According to the author, the American armed forces were not even much interested in protecting their own occupying forces or doing something with regard to other illnesses widespread among Cubans but were solely obsessed with ensuring that the disease would not make it ever again to American cities or ports. The occupation was partly validated with the argument that Cubans might not be able to contain the fever without the help of the Americans because they did not care much about a disease that mainly attacked foreigners and because they had a lousy sanitation system.

When the American military returned definitively to their home country in 1909 sanitation became a major concern for Cuba's leaders who realized that maintaining the island free of yellow fever was crucial to keeping their political independence and avoiding a new U.S. occupation. The book offers an original and compelling discussion of the negotiations to inscribe in laws the obligations of Cubans to maintain sanitary conditions to the satisfaction of the U.S. government. The United States became dependent on Cuba to keep yellow fever epidemics away from cities and ports of the U.S. South where sanitary regulations were not strictly enforced (as in Havana).

This book also sheds new light on the history of the etiology and transmission of yellow fever in the Americas during the turn of the twentieth century, a favorite topic for historians of tropical medicine. Who should be correctly credited for the landmark discovery of the mosquito vector that transmits the fever has been long debated. According to Cuban history of medicine, local medical doctor Carlos Finlay came up with the idea and performed a series of relevant studies, though American historians credit Walter Reed with directing the definitive experiments and writing the academic report that validated the finding in international science. According to the author, other—sometimes overlooked—characters played a crucial role in linking yellow fever to the mosquito. Most notably, the American physician Jesse Lazear was the first to work experimentally on the hypothesis of the mosquito before Reed got interested in the hypothesis. It was only after the death of Lazear, who allowed himself to be bitten by yellow fever-infected mosquitoes, that Reed began to work in this direction and later took credit for the discovery. The discussion of the nationalistic and political meanings of the "heroes" in the...