Medicine and Nation Building in the Americas, 1890–1940 by José Amador (review)

The field of Latin American medical studies has made leaps and bounds within the last decades. An overview of the literature reveals that scholars are excited to utilize disease, medicine, public health, and science as platforms to explore medical and non-medical moments. Similarly, the often alluring, albeit vague, transnational turn has paralleled the growth of medical history. However, a number of these studies become comparative analyses rather than discussions of ideas, things, or people in more regional or global terms.

José Amador's masterfully written study, Medicine and Nation Building in the Americas, 1890–1940, puts these two methodologies into fruitful conversation. Analyzing primary sources from libraries and depositories in Brazil, the Caribbean, and the United States, Amador shows that debates, ideas, agreements, and disagreements over public health influenced the relationship within Latin America and with the United States. The author reveals, through a series of case studies on yellow fever, hookworm, and rural hygiene, that within the context of public health and disease eradication, foreign monolithic and hegemonic medical systems were adapted to and rearticulated for local conditions. In short, medical moments exposed "asymmetrical relations of power" in the Americas. Corroborating the most recent literature on North American medical humanitarian aid in Latin America, Amador shows that foreign doctors were dependent on the participation and willingness of local medical and non-medical actors.

At the close of the nineteenth century, Brazil, Cuba, and Puerto Rico found themselves at a crossroads. In the rear-view mirror stood a history of slavery, dwindling economies, anxieties over race, and the medical perception that tropical areas were unhealthy and backwards. Looking forward, Latin American elites, intellectuals, and medical officials desired to ease internal tensions, increase national prestige, and rid the region of diseases. In Cuba, for instance, the anti-yellow fever campaign became an opportunity for leaders to strive for the whitening of Cuba, dealing with its freed slave population, and Cuban sovereignty. Indeed, in each case study, Amador lays a building block for his central argument: public health was the key to national development.

Amador's first chapter connects health to nation building. The chapter examines Latin American literature that represents how elites understood their budding nations. In each novel, unemployment, insalubrious environments, over-sexualized bodies, racial impurity, and rural backwardness were all common themes. In response, local officials passed restrictive laws, often under the guise of hygiene, to regulate societies and address underdevelopment. These laws, however, were taken from local experiences and not North American models.

The three middle chapters are case studies. The first examines the anti-yellow fever campaign in postcolonial Cuba. Cuba's long history with the disease frustrated local and North American officials alike. Following the Spanish-American War and Cuban independence, yellow fever took on new meanings: racially purifying/whitening Cuban society and extending foreign influence. Distrustful of the large former-slave population inhabiting the island, local elites hoped that eliminating the disease would put to rest the notion of the island being "a white man's grave." A healthy nation would attract foreign immigrants and prosper. Under the intention of "gatekeeping" yellow fever from Cuba, local doctors developed a system of sanitary cordons and medical regulations that closed off the nation from people and races deemed a threat to national health. The chapter shines when Amador shows that yellow fever was both a source of frustration and national pride. It allowed local officials to openly question the presence of North American doctors. Indeed, yellow fever's story is plagued with instances of North American doctors overlooking their Cuban colleagues. Centering on the work of Carlos Finlay—who discovered that yellow fever spread through mosquitoes and not from trash and poor sanitation (miasmas)—Amador shows how this contribution to the medical sciences was ignored. Finlay, in the end, became a national hero and joined the Cuban nationalist movement.

In the hookworm historiography, Puerto Rico has not received sufficient attention. Unlike...