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

In 2007, Diego Armus published his remarkable La Ciudad Impura, a revised version of his dissertation on the history of tuberculosis in Buenos Aires. Translated as The Ailing City in 2011, the English edition reverses the order of the chapters in the original Spanish and, more significantly, carves a new chapter out of material on how the ill became patients. The resulting volume preserves the wide-ranging scope of the original, while underscoring the book’s core strength, its attention to the sociocultural meanings of the disease.

According to Armus, the identification of the causative agent of tuberculosis and the diffusion of antibiotics frame the historical rise and fall of a sub-culture of tuberculosis in Buenos Aires between the 1870s and the 1950s. It was a subculture characterized by uncertainty as to treatment, etiology, and personal and social responsibility for the disease. Amidst all these doubts, the denizens of one of the largest metropoles in the Americas came to see tuberculosis as a matter of life and death, a feared and stigmatizing condition, fodder for expert and lay publications, a touchstone of medical and policy debates and interventions, and a literary and musical trope.

One of the most interesting tensions throughout the book relates to Armus’s assertion that the sub-culture of tuberculosis was about more than Koch’s bacillus, yet provides chronological start- and end-points neatly determined by biomedical advances, ironically validating scientific change as the engine of his story. At the same time, though, the breakthrough of x-ray technology is not a strong component of the tuberculosis sub-culture in Buenos Aires, as it was elsewhere, including the U.S. Why is that?

Likewise, it is not altogether clear how antibiotics singlehandedly ground the tuberculosis sub-culture into oblivion. This veers too close to the technological determinism Armus wishes to leave behind. While he subjects the reception of the Pueyo vaccine of the 1930s to a careful analysis, for example, Armus does not do the same with penicillin, despite the fact that its supply and utilization were far from assured in developing countries in the 1940s, and that scientists debated the emergence of resistant bacterial strains in the 1950s, as Robert Bud shows.

Historians of public health will do well to heed Armus’s claim that, then as now, tuberculosis is about more than the pathology itself, making itself felt in debates and practices beyond the realm of health. Armus could have driven the point more forcefully by explaining how the strategies and discourses of past public health experts, which reflected this complexity, can illuminate contemporary biases in the debates about multi-drug resistant tuberculosis in large urban areas. Conversely, some of Armus’s conclusions are under-informed by public health knowledge about the sociomedical determinants of health. While Armus particularly blames poor living conditions and poverty for the recrudescence of tuberculosis (348), he has little to say about the role of phenomena such as transnational migration within the Americas, and about the enduring scapegoating of migrants as diseased and disorderly.

To further the conversation regarding the role of public health and medicine in this case, it would be worth asking what was distinctive about Buenos Aires relative to other cities. But, in the introduction to the book’s daunting +400 pages, Armus explains that comparison is not one of the goals of The Ailing City. This explains the rather slim list of secondary sources. The excellent chapter on race and migration, however, clearly shows Armus’s adroitness deploying existing historiography. More importantly, Armus’s unapologetical refusal to engage in comparative analysis works against his stated aim to distinguish the common features pertaining to a global history of tuberculosis (12). His other stated aim, to identify the peculiarities of the tuberculosis sub-culture in Buenos Aires, is richly accomplished. The early chapters, especially, on the ways in which the ill looked after their...