Doença de Chagas, Doença do Brasil: ciência, saúde e nação, 1909-1962 (review)

Three dominant and oftentimes overlapping ways of writing define the tone of the recent and fast-growing Latin American historiography of medicine, diseases, and health. The first one, the social and cultural history of diseases, is mainly focused on material living conditions and changing ideas and representations about the normal and sick body in ordinary quotidian times as well as in epidemic outbreaks. The second narrative, the history of public health, centers its attention on the consolidation of the medical profession and health agencies, the influence of international players on national health agendas, and the political economy of health.

The third one is the history of biomedicine. As the oldest one and currently the least cultivated, this way of writing continues to produce not only self-celebratory accounts aimed at reconstructing national medicines and doctors' biographies but also more historically contextualized historical narratives. Doença de Chagas is probably one of the most accomplished examples of the latter. Kropf's book could be read as an individual effort that effectively enhances a quite systematic collective endeavor mainly but not solely based at the Casa Oswaldo Cruz in Rio de Janeiro, the academic institution that publishes the excellent Brazilian journal História, Ciênçia, Saúde—Manguinhos.

Inspired by the disease framing approach proposed some time ago by Charles Rosenberg, the book deals with a biological event and the array of constructs that tried to explain, it facilitating its transformation into a disease. Doença de Chagas does not pretend to be a total history of the Chagas disease in Brazil, nor a history of a regional disease affecting many Latin American countries. Rural poverty and public health policies are present in the text but only as a backdrop. The experiences of the sick are not discussed. Nor are disease metaphors, with the exception of the Chagas disease as a pathology of the nation. Empirically sound and engaged with the biomedical historiography of this disease, Kropf's aim, explicitly, is to study the interplay among nation-building processes and public health discourses with the complex detours that culminated on the biomedical agreements about the existence of the disease.

Kropf's book deals mainly with two periods in the historical framing of this insect-transmitted zoonosis that is endemic in many poor rural areas of Latin America and in the last decades and as a result of domestic migrations has also been affecting urban settings. The first one, between 1909 and 1934, discusses Carlos Chagas's early identification of the pathology as endocrinological and neurological. Associated with other endemic diseases of poor rural Brazil, Chagas's initial assertions were strongly contested in their epidemiological as well as social dimensions. The second period, between 1934 and 1962, focuses on Evandro Chagas and Emmanuel Dias's redefinition of the disease as cardiac and mainly chronic. They followed the contributions made by Argentine colleagues who built their own assertions regarding the early and contested Carlos Chagas findings. This time Chagas's disease became an epidemiological problem, a recognition that Kropf discusses in connection to a new political and economic climate marked by industrialization efforts, the expansion of the productive western frontier, and the post-World War II developmental ideas and policies about the need of forging a healthy population.

Taking note of the peripheral condition of the region, the most renovated Latin American biomedical historiography has been studying processes of negotiation and adaptation on the periphery of science produced in the center. Doença de Chagas offers something different: it unveils through a jargon-free and sophisticated narrative a peculiar and quite unusual case in which tropical medicine reveals itself not as an imperial enterprise but as evidence of the production of scientific knowledge on the periphery.