Disease in the History of Modern Latin America: From Malaria to AIDS Edited by Diego Armus (Durham, NC: Duke University Press, 2003) (326 pages; $21.95 paper).
Although they are our neighbors and trade partners, Latin American countries and their public health problems do not come up often in our health discussions. Historical public health writings about Latin America are few and far between, and usually embrace the viewpoints and interventions of the United States governmental and philanthropic institutions. In Disease in the History of Modem Latin America, eleven essays cover a period from the late 19th century until the cholera crisis in 1991. They explain the sociocultural issues of public and mental health from Mexico to Argentina using primary and secondary sources from those countries. Although the histories of diseases familiar to North American public health studies, such as tuberculosis, Peruvian cholera, and malaria are discussed, but the writers also present diseases relevant to South America and Mexico without focusing exclusively on tropical medicine.
The essays are organized into three themes: (1) the socio-political aspects of epidemics in the history of medicine, (2) the development of public health policy as a result of outside influences interacting with the national state, and (3) the study of diseases from a sociocultural perspective. Supporting theme one, Diana Obregon's essay on leprosy in Colombia discusses the medical community and the state's responses to an illness that could taint the reputation of a country desirous of an appearance of modernity in order to entice foreign investors. The essay by Marcos Cueto addresses stigma and blame in his examination of the international and national responses to the cholera epidemic in Peru in 1991. Governmental inaction led to poor sewer and water systems, which were the source of the outbreak. The innovation, rapid response, and valor of the health-care workers are what kept mortality numbers low. This essay may serve as a case study for bioterrorism.
Theme two addresses outside and governmental influences on public health policy, but the essays are more about the history of medicine's response to diseases found in Latin America. Two essays on Brazil explain how physicians responded to epidemics in the early 20th century. For example, Marilia Coutinho examines Chagas disease in the story of a Brazilian physician who discovered the protozoan that causes chronic cardiac illness and related it to poverty. However, once again, the country's desire for modernity, along with petty jealousies in the medical community, led to a downgrading of the seriousness of the disease, and Chagas disease continues to cause debilitation in the twenty-first century. Malaria is another disease that was downgraded, only to reappear. An essay by Nancy Leys Stepan examines the development of medicine and science in response to virulent strains of malaria found in the Amazon. Morbidity was worsened by the migration of non-immune people to the Amazon to work in the rubber export industry. This shows how the struggle for markets affected the nations of Latin America and raises the question of the responsibility that trading nations have towards their trading partners.
Hardly the most serious public health problem in Mexico, hookworm was chosen as the problem of focus by the Mexican government with the assistance of the Rockefeller Foundation. An article by Anne-Emmanuelle Birn looks at the factors that prompted a grand public health campaign planned by two countries for a disease that was less debilitating than other epidemics in Mexico. Mexican physicians' responses to the philanthropy are discussed, as are the science, medicine, and cultural attitudes that the Rockefeller workers used against the Mexican people. …