From the Byzantine to British to Brazilian, empires have legitimated their rule as “humanitarian” with efforts to instill new medical regimes, alter habits of hygiene, and institutionalize public health among the people they intend to civilize and cure. Many professional historians of medicine have discarded the older view, still common outside of academia, that empires usually contributed to an enlightened expansion of public health and medical care despite their misdeeds.
Among many new historical monographs, we find instead that imperial health efforts enabled exploitation, justified cruelty, and authenticated white supremacy. Ultimately anti-humanitarian consequences of past and recent empires may drain history of progress, but the literature of this subfield continues to feel teleological as we hurdle past atrocities of soldier and doctor toward something we might well expect to be worse (see Ian Read's article “Do Diseases Talk? Writing the Cultural and Epidemiological History of Disease in Latin America,” in Latin American Perspectives, 2016). José Amador's creative and captivatingly written book is notable in how it eschews teleology, resulting in neither praise nor damnation of the “empire” that the United States built “to legitimate control over peripheral societies” in the Americas (2).
An associate professor of Global and Intercultural Studies at Miami University, Amador researches the cultural history of medicine and racial and transgender studies. His book introduces the idea of “public health crossings,” or the “uneven public health exchanges that connected US government officials, military doctors, and Rockefeller emissaries to local politicians, doctors, intellectuals, and patients through the movement of physicians and medical knowledge” (2). This idea is helpful in two ways. First, it adds to mounting evidence that medical knowledge and practice in Latin America were more generative than imitative. Marcus Cueto and Steven Palmer's Medicine and Public Health in Latin American (Cambridge, 2015) is another good example in a larger trend. Second, “public health crossings” views praxis as always mediated locally but profoundly influenced by transnational circuits, providing an ampler narrative for a wider audience.
Public health crossings and their “legacies” are presented over five chapters. Chapter 1 imaginatively interweaves literary and public health discourse to show convincingly that intellectuals and officials in Cuba, Puerto Rico, and Brazil were enormously pessimistic about health, race, and civilization in their nations in the late nineteenth and early twentieth centuries. Many scholars and officials of these nations viewed subsections of their compatriots (or themselves) as afflicted or degenerating due to the susceptibility of racialized maladies.
The second, third, and fourth chapters present three case studies of reaction to national afflictions: (1) yellow fever in Cuba; (2) hookworm in Puerto Rico; and (3) Rockefeller-funded health initiatives in the “immense hospital” of rural Brazil (102). In these cases, “scientific nationalism” contended with “US imperialism,” defining and redefining a range of diseases and behaviors associated with particular groups and places. This could either “exclude or include” people from the national project or bring them into its fold (153). Euclides da Cunha, observing his Brazilian homeland in 1902, wrote “we are condemned to civilization. Either we shall progress or we shall perish” (33).
The final chapter of Amador's book traces the careers of Fernando Ortiz, Gilberto Freyre, and Antonio Pedreira, important sociologists and authors of their nations (Cuba, Brazil and Puerto Rico). In somewhat different ways, they show how “public health furnished scientific arguments against biological explanations about race, thereby propelling new academic debates about culture” (156). The connections of these elite men to Columbia University and the Rockefeller Foundation reveal imperial ambitions, yet provided all three with a platform to challenge the United States.
Amador's book may be an intriguing outlier or a harbinger of a new shift toward ambivalence in historians’ assessment of public health of empires. Either way, these assessments rest mostly in the cultural and discursive realms, and can sometimes run the risk of forgetting that people's physical relationship with pathogenic microbes or mortal environments change radically. Epidemics come and go, microbes demonstrate their own independent “crossings,” and fleshly environmental dangers emerge or recede, but all of this is understood within and deeply affected by a cultural context of norms.
It has become popular for historians of medicine to place the “cultural production” of diseases first, especially within imperial contexts, but neither cultural nor environmental change presupposes the other. Although not highlighted as a main argument, it is plausible that a worsening epidemiological environment in the middle and late nineteenth century was exacerbated by an enormous increase in “free” trade and immigration. While this coincided with collective despair of national projects built by “mixed-race” peoples in the tropics, the eradication or control of diseases in the early twentieth century renewed the confidence that most patriots had earlier, before the region's extraordinary, but still poorly understood, modern era of epidemics. As Karen Barad argues in her Meeting the University Halfway (2007), “Matter and meaning are not separate elements,” and pathogenesis cultures disease. Placing Amador's book into a debate about empire, broadly changing environments, nationalized races or racialized nations, and public health (or microbial) crossings is worthwhile for an advanced undergraduate or graduate class on the history of medicine or Latin America, or for anyone wondering what public health means for empire.
