Studies on health, disease and medicine constitute a well-established subfield in current Argentine historiography. As in other Latin American countries, scholars from many disciplinary backgrounds – historians, medical anthropologists, public health scholars, sociologists and cultural critics – have unveiled a domain where those topics are contestable, debatable and subject to controversy. Most of them discuss diseases as complex entities, constructed and framed historically.
Three ways of writing with plenty of overlaps have been trying to make sense of disease as a historical problem: the new history of medicine, aiming at going beyond the inevitable progress brought about by official medicine and celebratory biographies of famous doctors; the history of public health, focusing its attention on health institutions and state policies and their impact on morbidity and mortality trends; and the sociocultural history of disease, dealing with material living conditions, illness metaphors and experiences of the sick as well as of health care practitioners. In Argentine historiography, the new history of medicine is quite modest. Nevertheless, both the history of public health and sociocultural histories of diseases are more dynamic, in some cases innovative, and openly committed to discussing disease and illness as problems that have a biological dimension loaded with social, cultural, political and economic connotations. Weaving public health, cultural and social arguments, Del alcanfor a la vacuna Sabin: La polio en la Argentina provides a persuasive example of the latter approach.
The first chapter studies the early efforts – mostly on the part of female volunteers – aimed at assisting and rehabilitating the sick at a time of medical uncertainty, when no effective responses to poliomyelitis were available. The second chapter discusses the 1936, 1942, 1953 and 1956 epidemics, drawing attention to similarities and differences in the agendas for coping with issues of contagion and prevention. The third chapter focuses on the public health initiatives resulting from the crisis brought about by the 1956 epidemic, namely the creation of the National Commission for the Rehabilitation of the Crippled. Chapter 4 deals with the challenges of carrying out the massive 1956, 1963, and 1971 immunisation campaigns, paying particular attention to the tensions between city, provincial and national state authorities. Chapter 5, finally, discusses the post-poliomyelitis syndrome that has afflicted many of the former sick who, following some temporary rehabilitation, have begun lobbying and pressuring the state in order to arrive at an official acknowledgment of it as a disease.
The narrative is, at times, very historical, and at times very sociological. The focus is mainly on Buenos Aires, but there is an obvious effort to deal with at least some areas of the Argentine interior. I find several notable achievements in this book. Firstly, it avoids the celebratory tone that has quite frequently imbued narratives about poliomyelitis in Argentina and elsewhere, namely, depiction of the fight against the disease as a complete success, suggesting that the cycle of poliomyelitis is over, with no tangible consequences in contemporary times. Secondly, the book correctly stresses the existence of rehabilitation efforts before the epidemic of 1956, usually interpreted as a watershed year in the history of poliomyelitis. Thirdly, the author does not follow the periodisation offered by political history, a recurrent problem which some historiography of public health and disease seems to be unable to avoid. Instead, Daniela Edelvis Testa adopts a temporality of poliomyelitis free of democratic, authoritarian, socially inclusive or socially exclusive political regimes. Fourthly, poliomyelitis allows the author to deal with the historical construction of disability. Delving into the slow expansion of social rights for polio sufferers, Testa examines the role of the state as a space of negotiation among different actors who, over time, have been able to move the issue of disability from the world of philanthropy to the world of social security. Discussing these changes, she underlines that over time the state has become more active and able to concentrate specific infrastructure and agencies at the centre. Yet the presence of the state could not displace civil society actors, both religious and secular, represented by mainly upper-class women, who continue to receive state subsidies for their endeavours.
As with any book, different readers might identify issues that deserve more attention and could have made the narrative even more compelling. The following are some of mine. Considering the rich available historiography, I would have appreciated a more contextualised discussion of public health and civil society initiatives against poliomyelitis, particularly those that have been present in the fights against other diseases. This contextualisation would have allowed for stressing differences and similarities in matters like the role of female volunteers, the agendas towards the rehabilitation of sick and the concepts of biological as well hygienic citizenship.
The always very challenging task of exploring the tensions between discourses and applied policies is another issue. This happens with the discussion of Health Minister Ramón Carrillo, who served in the first Peronist government: here the narrative is more focused on discourses and less on the implementation and results of his policies. Another example is provided by the erratic policy of the 1976–83 dictatorship: after revoking a 1974 law which legislated a mandatory hiring quota of 2 per cent of disabled people in state enterprises and agencies, in 1981 the same authoritarian government approved a further bill raising it to 4 per cent.
And a final example of these issues, this time related to polio vaccination initiatives: after a 1959 ruling in which the federal state delegated epidemiological vigilance to provincial governments, and responding to a poliomyelitis outbreak in Tucumán province, a national system of epidemiological vigilance was created in 1971. This new context, in which vaccination became mandatory and centrally organised, produced remarkable but nationally uneven results. Yet soon Argentina had a much lower rate of poliomyelitis than that indicated as acceptable by the Pan American Health Organization. Launched by a government with its origins in a coup d’état and uncommitted to improving social outcomes, these unexpected public health initiatives definitely deserve more detailed analysis.
In the last third of the book, Testa examines the concept of ‘biological citizenship’, where issues of human value, social underestimation and biology converge. The body, technologies aimed at healing and improving it, changing perceptions of deficiency and changing therapies and social benefits are the dimensions that allow the author to deal with disability as a historical construct. In so doing, she discusses the exclusion of specific individuals from the world of work as the result of a perspective that deals with deficiency as synonymous with disability. Like many other authors in the field of disability studies, Testa underlines that abilities and disabilities are concepts that societies and cultures have shaped and reshaped over time. For that reason, they could be – and, in fact, were – ways to oppress and exclude those labelled as disabled individuals. This very radical approach does not prevent the author from carrying out a careful examination of the more traditional approach of individual rehabilitation from poliomyelitis. With different and, by and large, palliative resources, official medicine responded to the needs of those who got the disease and also to the needs of those who were able to survive it.
Many decades later, however, some of those sufferers are confronting new challenges resulting from a set of non-specific symptoms known as post-poliomyelitis syndrome. This syndrome is the subject of the last chapter of the book, where, again, Testa successfully weaves the individual and social dimensions of this new phase in a larger and broader history of poliomyelitis.
Del alcanfor a la vacuna Sabin: La polio en la Argentina is, as I said, an outstanding contribution to the literature that has been contextualising public health initiatives and diseases as historical problems. There is another and so far unique feature the reader will find in this book: it is the first study that successfully connects the history of disease and health with the emerging field of disability studies. It is a pioneering, readable and very commendable work that will appeal to scholars, students and health professionals.
