Avatres de la medicalización en América latina, 1870-1970 (review)

This collection of articles, most of which previously appeared in print, demonstrates the wide range of work, as well as the interdisciplinary nature, of the "new" history of health and sickness in Latin America. Instead of the more traditional emphasis on individual doctors and treatments, this new research places doctors and medicine into a social and cultural context; explores the interaction between health, politics, and the masses; and concentrates on the manner in which disease is represented. In other words instead of envisioning medicine and public health as objective disciplines, this research underlines the effect of human subjectivity and culture on issues of health. This assumption is reflected in the major sub-fields of this "new" history: the history of medicine (primarily biomedicine), the history of public health, and the sociocultural history of disease.

In his introduction, Armus provides a good general overview of the field, clearly seeing Brazil as the Latin American leader in this context. The nine articles that follow are divided by their overriding locales—Argentina, Brazil, and Mexico. The two articles on Argentina demonstrate the breath of the field. Laura Malosetti Costa's article centers on a painting by the Uruguayan artist Juan Manuel Blanes, depicting the yellow fever of 1871, and the reaction to its display in Buenos Aires' Teatro Colón. Malosetti views the overwhelming success of this painting as a sign of a new sensibility regarding disease. Armus tests Foucault's theory about the relationship between "medicalization" and modernization's need to create order and discipline by examining the participation of Buenos Aires tuberculosis patients in making decisions about the nature of their treatment.¹ He finds that patients did not hesitate to reject certain therapies and to defend their right to try others.

Susana Belmartino's article is the only contribution that has an explicitly comparative perspective. Drawing heavily on "neoinstitutional" political theory, she examines the relationship between social services, the construction of the state and politics in mid-twentieth-century Argentina, Brazil, and Chile. She hypothesizes that the overall success of medical services was related to the degree of political autonomy of governmental social services, the independence of institutions representing workers, and the particular segments of society covered by these services.

At least two of the pieces about Brazil concentrate on the way in which public-health movements affected racial ideas. The first, by Nisia Trinidade Lima and Gilberto Hochman, highlights attempts at reforming public health in Brazil during the First Republic. The authors find that public-health leaders and other intellectuals perceived illness as a key national problem, identifying Brazil as a sick nation and stereotyping the "typical" Brazilian as ailing and weak.

Sergio Carrara provides an example of the sociocultural history of disease in his examination of the relationship between syphilis, race, and national identity in mid-twentieth-century Brazil. Drawing primarily on the work of Freyre and other Brazilian intellectuals of the post World War I period, Carrara traces the gradual movement away from a negative view of racial miscegenation and tropical degeneration to a more positive vision of mestizos as ideally suited to life in the tropics.² Part of this transformation was recasting syphilis as a disease linked to Europeans, specifically Portuguese colonists.

The last Brazilian contribution, by Simone Kropf Nara Azevedo, and Luiz Otávio Ferreira, examines the complex history of tripanosomiasis americana, more commonly known as Chagas disease (for Carlos Chagas, who discovered it in 1909), within twentieth-century Brazil. Because the medical community failed to reach consensus about the nature of the disease, no systematic attempt to control it was undertaken until World War II had ended. Combining history and sociology of medicine, the authors explain the reasons for this medical failure, as well as the relationship between biomedical research and public health.

The last three articles examine late nineteenth- and twentieth-century Mexico. Claudia Agostoni focuses on the growing hygiene movement among public-health practitioners, a...