Medicine and Nation Building in the Americas, 1890-1940

By Jose Amador

As medical science progressed through the nineteenth century, the United States was at the forefront of public health initiatives across the Americas. Dreadful sanitary conditions were relieved, lives were saved, and health care developed into a formidable institution throughout Latin America as doctors and bureaucrats from the United States flexed their scientific muscle. This wasn't a purely altruistic enterprise, however, as Jose Amador reveals in Medicine and Nation Building in the Americas, 1890-1940. Rather, these efforts almost served as a precursor to modern American interventionism. For places like Cuba, Puerto Rico, and Brazil, these initiatives were especially invasive.

Drawing on sources in Cuba, Puerto Rico, Brazil, and the United States, Amador shows that initiatives launched in colonial settings laid the foundation for the rise of public health programs in the hemisphere and transformed debates about the formation of national culture. Writers rethought theories of environmental and racial danger, while Cuban reformers invoked the yellow fever campaign to exclude nonwhite immigrants. Puerto Rican peasants flooded hookworm treatment stations, and Brazilian sanitarians embraced regionalist and imperialist ideologies. Together, these groups illustrated that public health campaigns developed in the shadow of empire propelled new conflicts and conversations about achieving modernity and progress in the tropics.

• Language: English
• Publisher: Vanderbilt University Press
• Release date: Feb 28, 2015
• ISBN: 9780826520227

Jose Amador

Jose Amador is Assistant Professor of Latin American Studies at Miami University of Ohio.

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MEDICINE AND NATION BUILDING IN THE AMERICAS, 1890–1940

MEDICINE AND NATION BUILDING IN THE AMERICAS, 1890–1940

JOSÉ AMADOR

Vanderbilt University Press

NASHVILLE

© 2015 by Vanderbilt University Press

Nashville, Tennessee 37235

All rights reserved

First printing 2015

This book is printed on acid-free paper.

Manufactured in the United States of America

This book is the recipient of the Norman L. and Roselea J. Goldberg prize from Vanderbilt University Press for the best project in the area of medicine.

Library of Congress Cataloging-in-Publication Data on file

LC control number 2014013077

LC classification number R484

Dewey class number 362.109’034—dc23

ISBN 978-0-8265-2020-3 (cloth)

ISBN 978-0-8265-2021-0 (paperback)

ISBN 978-0-8265-2022-7 (ebook)

Contents

Acknowledgments

Introduction: Intellectual Currents and Public Health Crossings

Part I: Visualizations

1. Cautionary Tales

Narratives of Disease, Danger, and Possibility

Part II: Crossings

2. Beyond Yellow Fever Eradication

Nation and Racial Gatekeeping in Cuba

3. The Pursuit of Health

Colonialism and Hookworm Eradication in Puerto Rico

4. Converging Missions

Public Health Bandeiras and Rockefeller Philanthropy in Brazil

Part III: Legacies

5. A Turn to Culture

Public Health Legacies and Transnational Academic Circuits

Conclusion: Disentangling Transnational Histories

Notes

Bibliography

Index

Acknowledgments

Completing this book has been a journey filled with rewarding encounters and unexpected crossings. For every new place I discovered and for every relationship I forged, there were unspoken moments of doubt, encouraging words of support, and countless debts of gratitude. I am pleased to thank all who added the hues of their own thinking to this project and all whose friendship encouraged me to keep at it. I am grateful to the organizations that funded this project at several stages: the Ford Foundation Fellowship, the Caribbean Exchange Fellowship of the City University of New York, the Rockefeller Archive Center Grant, and the Rackham Merit and Mellon Fellowships at the University of Michigan. I also want to thank the Altman Fellows Program of the Humanities Center at Miami University for the course releases that gave me time to finish the book.

The journey began at a point when I could not have imagined writing a history book. At the University of Puerto Rico at Cayey, I majored in biology with the intention of becoming a physician. Fortunately, the impassioned teaching of outstanding professors inspired me, as an undergraduate, to find value in both literature and history. I extend my thanks to Carmen Adsuar de Bouret for urging me to move beyond the text and assess the political investment of writers. In ways she could not have envisioned, her class, a required liberal arts course, started me on this intellectual path. I owe an equally powerful debt to Blanca Silvestrini, Fernando Picó, and Pedro San Miguel from the University of Puerto Rico in Río Piedras. Their support and counsel came at a crucial moment and helped me decide to become a historian.

During my years at the University of Michigan’s Department of History, I was surrounded by scholars who contributed in important ways to the evolution of this project. Sidney Chalhoub, John Monteiro, Maria Helena Machado, Carol Karlsen, Michele Mitchell, Javier Sanjinés, and Frances Aparicio encouraged me to explore fully the multiple fields within which this work can be situated. I am especially grateful to the learned and inspired guidance of my committee. Martin Pernick’s insights in medical history steered me in directions that enabled me to produce a more nuanced work. Jossianna Arroyo was willing to engage in energetic, lengthy conversations that provided me with the critical tools to understand the racial politics in the works of the intellectuals analyzed here, and her guidance and friendship has been a source of continuous support. Rebecca Scott was a generous and exacting adviser whose high standards made me a far better historian than I would have been had I not worked with her. Her incisive comments pushed me to understand why people make particular choices and challenged me to pursue new questions. I also have to thank Rebecca for introducing me to a vibrant intellectual community of US-based and Cuban scholars. Finally, I am indebted to my committee chair, Sueann Caulfield, whose mentorship has been an impeccable model of intellectual integrity, rigorous critique, and enduring support. I continue to cherish her guidance, friendship, and example.

As I forged ahead in this research, many generous scholars shared their hospitality and ideas in the places I visited. In Cuba, I want to thank Marial Iglesias, Ricardo Quiza, Adrian López Denis, Blancamar León, Mitzi Espinosa, Orlando García Martínez, and Fernando Martínez Heredia for stimulating questions and enduring friendships. I owe a special mention to mis queridos amigos Pablo Riaño and Leida Fernández, whose immense knowledge, good cheer, and warm hospitality made me feel right at home. In Brazil, I had the good fortune of meeting Nísia Trindade Lima and Gilberto Hochman. Both shared their knowledge about the topic, offering valuable references and research suggestions. In Puerto Rico, I benefited enormously from the advice, critique, and encouragement of Juan Gelpí, Isar Godreau, Jorge Giovanetti, and Maite Green. Though there are too many individuals to list here, I would like to express my enormous appreciation to all the staff of the many archives, libraries, and foundations I visited in Cuba, Puerto Rico, and Brazil.

It is a real blessing to find in one’s graduate career not only enriching intellectual communities, but also lifetime friendships and traveling companions. With fondness, I thank Adrian Burgos, Aims McGuinness, Andrew Ivaska, Frank Guridy, John McKiernan-González, Zaire Dinzey, Mérida Rúa, Sarah Arvey, and Wilson Valentín for making my graduate student years intellectually exciting and fun. A fortuitous move from Ann Arbor to San Francisco led to fruitful dialogues with other Michigan transplants. I am grateful to Inés Casillas for providing me with an academic community outside Ann Arbor. Constanza Svidler, Sharwan Worsley, Jess Rihelhaupt, and Robin Li were suggestive readers and academic confidants. At Michigan, I also met friends whom now I consider family. They have been a source of intellectual and emotional support. I could always count on Pablo Ramirez to brighten my day with his laughter and wit. The sharp intellect and humor of María González, mi hermana, was a beacon of light on a regular basis. Constanza Svidler and Brent Armendinger have been my dearest friends ever since we met. We have traveled together, collected stories, and lifted each other up.

I also cherish the wonderful intellectual community I have found at Miami University of Ohio. Collegiality and friendship have been synonymous, especially in exchanges with Elena Albarrán, Juan Carlos Albarrán, Ana María Díaz, Julie Minich, Roxanne Ornelas, Kelly Quinn, Nishani Frazier, Amanda McVety, Kimberly Hamlin, Yu-Fang Cho, Gail Polhaus, and Madeline Detloff. I thank Helane Androne, Shelly Jarrett Bromberg, and Mary Fredrickson for reading chapters and making thoughtful suggestions. I am especially grateful to Carla Pestana and Tatiana Seijas, who soldiered through several drafts of chapters, each time providing me with fresh critical insights and enthusiastic support. I also want to express my deep appreciation to Walt Vanderbush for much guidance during the finishing stages of this book. Though not at Miami University, Alexandra Puerto and Bridget Arce also played important roles in developing this manuscript.

For sustaining me with their affection through many years, across long distances, I would like to thank a few old friends who have accompanied me during this long journey. I am grateful to Wanda Rivera, Jorge Damian Buzainz, Fernando Pelaez, Alejandro Gil, Yanira Morales, Jessica Renta, Marisol de Jésus, and Elizabeth Romero. Crossing paths with them has been a source of pure joy.

I am pleased to publish my first book with Vanderbilt University Press. Eli Bortz offered me important editorial advice and substantial support. I am grateful for the careful editing and attention to detail of Joell Smith-Borne and Peg Duthie. They made this a more polished book.

I am at a loss for words when it comes to expressing my gratitude and love to my family. The faith and devotion of my late grandmother Ita kept me going when my energy flagged. My thanks and love go to my brother, Gerardo Amador; his wife, Tyra Perez; and my nephew, Gerardo Andre. Their embrace always provides a reason to return home. My father, Carmelo Amador, has, more than anyone, been an example of perseverance, steadfast judgment, and unconditional love. I owe my deepest thanks to Damon Scott, my intellectual companion and soul mate. In addition to editing more versions of this work than I care to remember, he has enriched my life with his kind demeanor and unyielding support. I reserve for him my most profound love and gratitude. Finally, this project is dedicated to the memory of my mother, Carmen L. de Jesús. She taught me to laugh and to see the kindness in others. Whatever goodness is in me, I owe mostly to her.

Introduction

Intellectual Currents and Public Health Crossings

In March 1914, National Geographic Magazine showcased the value of public health with an auspicious cover story by journalist William Joseph Showalter entitled Redeeming the Tropics. Showalter had joined the magazine’s editorial staff that year and devoted himself to the popular presentation of medical and scientific subjects. Showalter’s enthusiasm, espoused and encouraged by a chorus of physicians, sanitarians, and journalists around the world, stemmed from the belief that disease eradication would culminate in the successful conquest of the tropics.¹ Showalter’s story was more than just an endorsement of public health; it was a glowing appraisal of US public health achievements overseas. For countries located between the Tropics of Cancer and Capricorn, he insisted, the triumph over diseases, especially yellow fever and hookworm, mapped a new geography of inhabitable territory and commercial opportunity.² The list of medical accomplishments he assembled was impressive. Public health had rehabilitated the ports of Havana and Rio de Janeiro, made the construction of the Panama Canal possible, and restored the health of the Puerto Rican peasant. Showalter insisted that, in an age in which labor demands increased the movement of people, these campaigns would bring a wave of new immigrants to the region. To him, the possible eradication of yellow fever and hookworm heralded an era of unprecedented health, happiness, and prosperity in the tropics.

Showalter’s confidence in public health only grew after World War I. In a 1922 article entitled Map-Changing Medicine, he celebrated public health experts who worked tirelessly to control the constant crossing and recrossing of diseases through oceans, nations, and empires.³ Showalter’s confidence in enlightened scientific programs resonated within the tropics as well. In the generations after emancipation, and particularly after the imperial expansion of the United States in 1898, new campaigns to control yellow fever and hookworm disease fostered international networks of scientific exchange and promoted state modernization across the region. As North Americans celebrated the movement of US public health campaigns across national borders, intellectuals and health officials in Cuba, Puerto Rico, and Brazil took up this modernizing project, which sought to redeem tropical nations. Their writings and work negotiated, with varying degrees of urgency, imperialism and nationalism to challenge ideas about inherent tropical backwardness and malaise. For them, the attainment of modernity and civilization required first and foremost the triumph over disease.

Medicine and Nation Building in the Americas is not a monolithic tale of state formation or of US overseas expansion. It tells the story of a fascinating set of public health circuits that began in colonial settings and became increasingly, and unevenly, transnational.⁴ While US public health sought to legitimate control over peripheral societies by linking disease control efforts to US imperial governance, public health leaders in Cuba, Puerto Rico, and Brazil put forward their own ideas about disease and nation. The extensive reach of these early campaigns offers new insights about the cultural and ideological implications of what I call 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. As the campaigns moved from one place to another, local processes of signification transformed public health models and ideas about the management of racialized populations. The widespread appeal of these early campaigns amplifies the significance of this story, for its central findings reveal how public health models, despite their imperial origins, were constructed and revamped in distinct tropical locales through crossings, borrowings, and engagements. Seeing how different people in different places were enmeshed in specific transnational networks, even if they did not always partake in border-crossing practices, forces us to rethink the broad regional significance of public health across the Americas in the first decades of the twentieth century.

Unlike historical accounts of US empire that have rendered local public health efforts largely invisible or national histories that have overlooked broad transnational processes, this study of public health crossings takes tropical America as a shared space in which medical experts and disease control models circulated within and across imperial and national boundaries. While formal and informal forms of US imperialism provided a powerful boost to the campaigns against yellow fever and hookworm across the region, an eclectic group of social actors came together in asymmetrical relations of power to advance public health and change the perception of the tropics from a region filled with dangerous health risks to one where modern societies could develop. This book tells the story of the groundbreaking public health campaigns that precipitated these broad regional transformations—of how these initiatives emerged out of narratives of environmental and racial danger, how they unfolded dramatically in the shadow of US empire, and how they shaped intellectual debates about race and nation along the way. By examining the trajectory of selected public health campaigns as well as the currents of ideas that gave them meaning, it reveals the public health structures that bound tropical America together at a moment of increased US influence in the region.

The Promise of Tropical Medicine

Beginning in the 1500s, ideas about tropical difference evolved alongside new theories about disease and race, prompted by European colonization. As imperial rivalries intensified and plantation economies expanded in the tropics, medical treaties described the diseases common to the region as more dangerous and fatal than those in Europe. Miasmatic theories of disease transmission reinforced this alleged difference since they held that the heat, humidity, and rapid temperature changes of tropical America, as well as the quick process of decay that characterized warm climates, produced dangerous miasmas (air vapors) on a scale unmatched in Europe. Even as miasmatic theories gained scientific authority among sanitary reformers, Europeans still feared that the tropics would weaken their physical and mental forces, giving them reason to pause before deciding to travel or settle in the region.⁵

While mortality rates fell by the second half of the nineteenth century, the emergence of race science during this period hardened racial distinctions by fusing biological ideas about race with deterministic ideas about the environment. Established hierarchies of superiority and inferiority were linked to widely accepted beliefs about tropical degeneration and malaise. The merging of these lines of scientific thought became a dominant fixture among social thinkers. An exponent of this kind of thinking was Count Joseph Arthur de Gobineau. In 1853, he published The Inequality of Human Races, which argued that the world was divided into superior and inferior races, and that the superior white race inhabited the temperate zones of Europe, while the racially diverse populations inhabiting Asia, Africa, and South America were inferior because of racial and environmental degeneration.⁶ In 1869, when he arrived in Rio de Janeiro as head of a French diplomatic mission, Gobineau was predisposed to confirm his pessimistic views about race and the environment and complained about the dark-skinned, lazy people who lived in Brazil.⁷

By the late nineteenth century, more sophisticated versions of tropicality emerged as advances in biomedical science fostered new mechanisms of disease control. Developments in the field of bacteriology proved that germs, and not deadly miasmas, caused diseases like cholera, diphtheria, and tuberculosis.⁸ The emergence of tropical medicine as a field in the late 1890s advanced knowledge concerning the specific causes—parasites, insect vectors, and germs—of diseases associated with the region.⁹ Gradually, physicians began to accept that public health could prevent epidemic outbreaks by identifying and eradicating a disease’s etiologic agent or intermediary vector. This change in explanations of human sickness translated into a newfound confidence about mastering the tropical environment.

Because the campaigns against yellow fever in Cuba and hookworm in Puerto Rico occurred during this transitory moment, and in societies that in the past had seemed irreparably doomed, their success defied the expectations of even the most enlightened intellectuals. Since the 1870s, yellow fever had relentlessly attacked port cities in Cuba, Brazil, and the United States, claiming hundreds and sometimes thousands of victims every summer. The persistent anemia and pallor suffered by tens of thousands of poor rural dwellers in Puerto Rico, Brazil, and the US South had baffled physicians for most of the nineteenth century. Physicians of the period had little to offer in preventing or treating yellow fever and hookworm disease until the successes of these early campaigns promised to identify and eliminate diseases commonly associated with the environment, generating a confidence that spurred calls for more scientific governance in matters of education, public health, and social welfare. The success of these campaigns reached a public beyond the shores of the new US possession in the Caribbean. Images of the campaigns circulated around the world in medical textbooks, scientific articles and reprints, conference proceedings, popular magazines, educational films, and international expositions.¹⁰ Paradoxically, these images did not lead to the end of tropicality. On the contrary, the spectacular publicity of these campaigns redefined the idea of the tropics as a place of essential difference, a region where environmental conditions needed special management to prevent the proliferation of insect-borne and parasitic diseases.

Physicians in Cuba, Puerto Rico, and Brazil were both marked by and contributors to this public health frenzy. While the United States tested the campaigns against yellow fever in Cuba and hookworm in Puerto Rico, and the Rockefeller Foundation later extended them to South America, beginning with Brazil, physicians from these countries saw themselves at the forefront of this public health movement.¹¹ Cubans, Puerto Ricans, and Brazilians did not simply adopt imperial public health projects; their participation made them possible and remade their meanings. They envisioned new futures for their nations, with waves of European immigrants, increased agricultural productivity among peasants, and an extended and efficient public health apparatus. They engaged in international research collaborations and popularized the campaigns within and across national borders. Many of the physicians who served in these initial campaigns were later recruited by the Rockefeller Foundation, transferring public health lessons from the colonial periphery to more extensive and challenging locales.

Intellectual Currents

The interconnected world created by public health crossings was never entirely autonomous from the broad currents of thought that informed the work of intellectuals and physicians. Ideas about disease, race, and nation in the tropics flowed through public health campaigns as well as a wide array of reformist cultural texts. It is not surprising that, as heirs to the reformist spirit of the Enlightenment and close followers of discoveries in the new fields of bacteriology and tropical medicine, physicians in Cuba, Puerto Rico, and Brazil forcefully embraced public health as a vehicle for reform. Because the emergence of these new fields offered different ways of seeing the relationship between disease and the environment, their writings were imbued with a politicized mission to change the habits, environments, and morals of the population. They were joined in this project by novelists, lawyers, engineers, and politicians who also found inspiration in medical science. This diverse group of ambitious professionals shared an abiding belief that science was essential for progress. When we consider their work, it becomes clear that public health transformed more than ideas about disease; it entered public consciousness to shape attitudes about race, plantation life, urbanization, spaces of sociability, and personal responsibility.

In the pages that follow, the inextricable link between public health and intellectual currents—and between physicians and writers—comes into focus in the evolution of literary and social science genres in which health and disease play a key role. At the heart of this evolution lie two major intellectual currents: the first consisted of the determinisms of the 1880s and 1890s that set the stage for public health campaigns, and the second comprised the cultural nationalisms of the 1920s and 1930s. At the end of the nineteenth century, racial and environmental determinism grew out of the convergence of two seemingly opposing ideas: that traits could remain stable across generations, and that environmental pressures change the physical characteristics of an organism. Many European and American thinkers combined these two lines of thought to claim that the very capacity for civilization and social order developed among the superior Nordic races. These assumptions began to be questioned in the first decades of the twentieth century with the rise of cultural anthropology, a new field whose methods cast doubt on both the notion of fixed racial types and the Eurocentricisms those categories were based on. During the 1920s and 1930s, leading Cuban, Puerto Rican, and Brazilian intellectuals embraced the idea that the national character was determined not by heredity or race but by culture. They were concerned with tracing the particular origin and development of the national character, finding its defining elements in language, history, and social institutions. This book opens and closes with an analysis of these distinct intellectual currents to underscore three points: that public health concerns dominated debates about national destiny across the region; that ideas of race and nation shifted over the years as a result of public health campaigns; and that, despite the extensive reach of these currents, the cultural politics of these reformist texts were tied to both local contexts and transnational networks.

Before the overseas imperial expansion of the United States during the last decades of the nineteenth century, a proliferation of novels, medical tracts, and sociological essays introduced readers to the perils of disease and the virtues of science.¹² Influenced by European naturalism, these texts sensationalized social ills to popularize medical theories, inculcate hygienic principles, and propose reform projects. Their authors warned against competing forces that hindered the formation of a coherent national identity: the opposition between the white elite and the racially mixed population; the enlightened urban professionals and the uneducated masses; and the modern citizen and the dangerous immigrant. The authors of these texts constructed new racial and social boundaries based on what they believed were universal laws of science. Their influence did not derive from the celebratory representation of the nation, but rather from the pathological construction of dangerous others.¹³ Writers in Cuba, Puerto Rico, and Brazil usually represented racial others as mentally or physically ill in cautionary tales intended to rehabilitate a particular social world.¹⁴ This book begins with narratives of caution that attempted to catalyze national reform prior to the arrival of US-led public health campaigns.

By the 1920s and 1930s, after the consolidation of public health projects and institutions, nationalist intellectuals began to question the validity of racial and environmental determinism in order to affirm the possibility of developing a modern tropical nation. The success of early public health campaigns provided them with arguments to base their attacks on scientific racism. At the same time, a new generation of literary critics, sociologists, and ethnographers turned to relativistic theories of culture to critique the political and racial divisions US imperialism produced. These intellectuals took advantage of new opportunities created by the growing status of Pan-Americanism in academic institutions in the United States. In particular, rising and established scholars from Cuba, Puerto Rico, and Brazil were attracted by the resources and research opportunities offered by Columbia University, which, driven by this hemispheric experiment, reformed its curriculum to emphasize Latin America and helped develop academic units in universities across the region. Working to develop narratives of national affirmation and equality, Cuban, Puerto Rican, and Brazilian intellectuals appropriated and reinterpreted changing theories of cultural formation and turned them to their own uses.

As these currents swept across the enormous reaches of tropical America, intellectuals and public health experts adopted new reformist projects to create a political order not dictated by environmental conditions but inspired by the universal promise of scientific progress. Medicine and Nation Building in the Americas is the first cultural and social history of public health that analyzes archival sources from Cuba, Puerto Rico, Brazil, and the United States within a broad regional configuration. It examines separately and together broad intellectual currents and specific public health crossings that began to link tropical America after the war of 1898 and had become fully institutionalized by the interwar period. By seeking to understand encounters that shaped these campaigns in different contexts, the book also illuminates the formation of racial meanings as these campaigns radiated in multiple directions: from empire to colony, from colony to metropole, from nation to nation, and from urban to rural. If in the 1880s and 1890s intellectuals in Cuba, Puerto Rico, and Brazil mobilized narratives of racial and environmental danger to promote reform in the tropics, in the 1920s and 1930s they drew on public health knowledge to challenge those narratives as part of a new hemispheric-wide movement of cultural affirmation.

Public Health Crossings

The circulation of public health models in the early twentieth century was neither unique to tropical America nor was it used exclusively by the United States to justify colonial expansion, but there is no doubt that the public health crossings inaugurated by the United States provide a particularly useful way for understanding the region.¹⁵ After 1898, the United States sought to showcase imperial benevolence through public health initiatives extended to its new colonial possessions in the Caribbean. By 1901 the campaign to eradicate yellow fever from Havana had finally succeeded, and in the years that followed, that eradication model circulated throughout port cities in the Americas, from New Orleans to Colón to Rio de Janeiro.¹⁶ Similarly, the campaign against hookworm mounted in the small coffee towns of Puerto Rico during the 1900s inspired comparable efforts elsewhere in the hemisphere, especially after the Rockefeller Foundation launched anti-hookworm campaigns in North, Central, and South America.¹⁷

Public health, then, bred a culture of exchanges in which people and ideas circulated within and across porous imperial, national, regional, and linguistic boundaries. In this manner, tropical America became entrenched in a rapidly expanding network defined not only through North-to-South interactions, but also through horizontal exchanges among nations, and vertical ones within them. Be they a Cuban physician using yellow fever to rally support for the independence movement in the United States, a Puerto Rican peasant in the highlands demanding that US colonial authorities provide hookworm treatment, or a Brazilian intellectual conflating regional and imperial ideals of uplift to revise his portrayal of the people of the interior, the individuals in this network all reshaped their local worlds based on a common concern with disease treatment and eradication.

To illustrate the range and scope of these exchanges, this book examines selected public health crossings that brought people together to create an immensely complex but interconnected world. Imperial agents, national reformers, and the popular classes were bound up in a complex set of negotiations, interactions, and entanglements as they responded to both the national politics of public health and the scientific orthodoxy of US empire. Medicine and Nation Building in the Americas is about a set of US-led public health campaigns that emerged in the colonial periphery and later circulated throughout the Americas. Chronicling their varied story foregrounds the ways intellectual and public health networks influence each other and how these campaigns spilled across political and cultural boundaries. The story presented in these pages does not attempt to capture all the networks radiating from these particular campaigns; instead, it aims to reveal diverse public health engagements that brought different people together in a large regional configuration. Following the methodological challenge posed by historian Heidi Tinsman and anthropologist Sandhya Shukla, this study is concerned with persistent crossings that have defined the cultural and political nature of an imbricated Americas.¹⁸

The challenge for historians of transnational phenomena, as Jeremy Adelman has pointed out, is to reconstruct the contingencies and heterogeneous paths of social exchange and integration.¹⁹ The notion of tropical America that informs this book attempts to demarcate a broad, albeit manageable, geographical region shaped by large-scale patterns whose meanings were contingent on local developments.²⁰ The scope of this study was determined by my access to a wide variety of sources housed in archives in Cuba, Puerto Rico, Brazil, and the United States, and published in Spanish, Portuguese, and English.²¹ Government documents, policy tracts, medical journals, ethnographies, autobiographies, novels, and short stories provide specific evidence of cross-national exchanges. These sources map tropical America as a regional configuration connected by the advance of medical discourses and disease eradication programs. This configuration differs from that of earlier studies, which defined the tropics by the movement of people and agricultural commodities resulting from the slave trade and the formation of plantation societies.²² Without discounting the importance of that definition, this book expands on it by tracing the interests of public health advocates after emancipation. Cuba, Puerto Rico, and Brazil were the last three societies to abolish slavery in the hemisphere, and concerns about race and nation were at the center of public health debates throughout the early twentieth century. In this context, tropical America was defined by the wonders of modern medicine, which many believed would turn its inhabitants into productive citizens, create an environment suitable for progress, and fuel the development of modern state bureaucracies.

While this definition of tropical America seeks to account for diverse public health crossings, it is best illustrated by the itinerant careers of two individuals whose work inspired this book. Following the War of 1898, US Army physician Bailey K. Ashford arrived in Puerto Rico as part of the US military occupation. He married, raised three children, wrote a memoir, and ended his days in Puerto Rico. After rooting his career and family life on the island, he crisscrossed the Atlantic on multiple occasions in several directions. In the early 1900s, Ashford discovered that hookworm caused the anemia suffered by a majority of Puerto Ricans and organized the first large-scale campaign against the disease. In 1910s, he visited the US South and Brazil as part of the hookworm eradication efforts led by the Rockefeller Foundation. After a brief stint in France during World War I,