Biomedicine as a Contested Site: Some Revelations in Imperial Contexts

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Publisher: Lexington Books , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. Synopsis About this title While literature on medicine and colonialism has increased rapidly in the past nearly two decades, this volume presents yet another way of looking at ideas of medicine, health, and disease.

Review : Biomedicine as a Contested Site shows us the dialectics of power and knowledge in colonial societies of the past. Buy New Learn more about this copy. About AbeBooks. Other Popular Editions of the Same Title. Search for all books with this author and title. Customers who bought this item also bought. Stock Image.

New Paperback Quantity Available: 1. Bestsellersuk Hereford, United Kingdom. Seller Rating:. New Paperback Quantity Available: Book Depository hard to find London, United Kingdom. Published by Lexington Books Bradley and K. Last and G. For example, Gelfand examines the changes in the medical, social, and political roles of healers in colonial Zimbabwe and how these changed under white rule. Settlers became concerned that disease would diminish supplies of African labour. Randall Packard argues that throughout the developing regions of the world from the end of the nineteenth century to the late s, settler societies underwent this evolution of concern about disease.

He contends that since their initial movement outward into tropical areas of the world, Europeans had been concerned with improving health conditions in the tropics, reflecting preoccupation with the health of Europeans. Yet European interest in the health of the natives, argues Packard, like their concern for their own health, was shaped by fairly narrow economic interests. According to Fransis Dube, this was true of Manica and Mutare. However, Glen Ncube notes that the remote rural areas, health services came much later in the late s and early s as a result of among other things, economic motives.

There is no doubt that financial limitations played a significant part in this lop-sided development of health services, but this should be viewed more in terms of colonial priorities than simply the lack of funds. They held a dual mandate to serve the state and to serve science. That modern medicine, including its colonial variant, was as much driven by innovation as by colonial impulses cannot be gainsaid.

Indians, Migration, and Medicine

Colonial officials considered broad based efforts to reform social and economic conditions as both impracticable and unnecessary. Gerald Lemaine, et al. Administered with no education on the benefits of such measures, they heightened African distrust of western medicine. This was particularly so with the establishment of formal colonial rule. As Cristiana Bastos contends, in parts of Mozambique and Zimbabwe where the Portuguese had been present since the s, there were mutual borrowings for practical healing purposes before colonial rule became formalized.

Africans kept fearing and fleeing European-style hospitals and colonial medical care, leading some Portuguese doctors to argue in the s that a viable strategy to reach the natives should adopt some of their customs — or, in other words, hybridise for success. Thus when epidemics such as smallpox and other catastrophic events occurred, African authorities prohibited people from engaging in certain everyday activities, such as conjugal relationships as well as house to-house visitations.

The ruling elites may include priests, chiefs and kings, or presidents and ministers of health. Fransis Dube notes that another source of resistance to colonial public health policies stemmed from their attempt to interfere with and usurp the powers of local public health practitioners, such as kings, rainmakers, and healers.

For example, in Zimbabwe, where healers, diviners, and spirit mediums were believed by colonial authorities to have posed a threat to colonial conquest during the Chimurenga War, the colonial government jailed many of them on suspicion of inciting resistance to colonial rule. As colonial powers began to assert their authority, colonial economies and ineffective public health interventions led to the outbreaks of diseases in epidemic form. Human sleeping sickness is a case in point. The nature of colonial economies therefore led to changes in disease ecologies in many parts of Africa.

Heavy taxation and labour migration, whether voluntary or forced, greatly increased African mobility as colonial officials pressured Africans to work on mines and farms especially in South Africa, Rhodesia, and Kenya , to collect natural products, such as rubber in the Belgian Congo, to produce cash crops. Gloria Waite argues that colonial governments intended public health care in east-central Africa to increase African worker productivity. As a tool of empire, veterinary medicine made it possible for colonial farmers to overcome constraints on livestock production as well as to hold competition from African producers at bay.

Gelfand for example has documented developments in the profession during the colonial era.

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Although Mutizwa-Mangiza concluded that all grades of doctors in government employment exercised considerable clinical autonomy, she also noted that their clinical autonomy was constrained by severe breakdowns of essential equipment and shortages of all types of resources ranging from human and financial to professional and material resources.

Mutizwa-Mangiza concludes that the doctors enjoyed economic autonomy largely by default. Also examines the migration of junior doctors from Zimbabwe by assessing their workplace experiences. David 49 J. See also R. Gordon and S. See also J. Beinart and J. See also K. Brown and D. Beinart, K. Sanders also examines the transition from colonial to post-colonial government and the impact on public health.

He notes that extreme income inequality, inherited from a century of British colonialism, was evident in the wide disparities in the health of Zimbabwe's people. The misdistribution of facilities was matched by a concentration in urban areas of health personnel, especially professionals. David Simmons notes that Zimbabwe's independence saw the ushering in of a primary health care PHC approach designed to reduce these many disparities. After a brief post-independence economic boom, much of the population experienced a decline in economic well-being.

He however, argues that post-independence Zimbabwe saw several economic and social reforms relevant to health instituted, although some have subsequently been eroded since the implementation of an economic structural adjustment programme. Sithole and Mayamba examines the impact of the environment on disease and health. The influence of licensed doctors on those governing did not guarantee regulation.

No group achieved the monopoly intended of diagnosis or treatment. Apothecaries, barbers, midwives, bone setters, and enema appliers officiated over a mechanical and servile art, while the physician, with a dogmatic and doctrinal education, possessed the honors of the nobility, with the right to recognition in the use of arms and silks—symbolic distinctive Medical Knowledge and Professional Power 55 ornaments of noble status in the public mind.

Among the agents involved in healing practices, apothecaries and surgeons, thus, occupied a subordinate position in the professional hierarchy. The task of diagnosing, prescribing, and following the treatment of the sick person, in accordance with doctrinal learning of canonic texts in Latin, was reserved for the doctor. This liberal art—conducive to the status of free men—enjoyed supremacy over the work of the surgeon and over the preparation and sale of medicines.

Physicians were expected to supervise the preparation of all drugs that contained opium, pastes, pills, and tablets. Apothecaries were responsible for crushing and mixing the drugs previously selected and weighed by the doctors, while surgeons were expected to limit their therapeutic action to the fixing of broken bones and the treatment of certain wounds. In the colonial world, meanwhile, the rigid hierarchy between physicians, surgeons, and apothecaries proved to be innocuous. When applied, complaints were received from the representatives of the Crown in the name of colonial reality.

The exercise of medicine in Brazil up to the creation of the Royal Promedicato in in the reign of D. Initially residing in large settlements, the royal representatives were seen with commissioners in villages and cities in later years. Physicians, although numerically insignificant, were doctors to the Crown, the Council, and troops in the main cities and villages, as seen in Recife, Salvador, and Rio de Janeiro. They were responsible for examining, diagnosing, and prescribing for patients, while surgeons were assigned manual duties, considered socially inferior, that required the use of lancing tools, scissors, scalpels, cauterizers, and needles, thus limiting their activities to bloodletting, application of blood suckers, and curing wounds and fractures.

They were prohibited from administering internal remedies, the privileged domain of doctors graduated from Coimbra, Portugal. The foundation of surgical schools in broke this restricted practice, creating new doctors in Brazil, and of the faculty of the medical-surgical schools in control the issuance of diplomas for the practice of medicine. The heteroclitic cultural heritage maintained the same standard in providing medical services. With a limited scope for this chapter, 56 Flavio Coelho Edler it may not be feasible to discuss the role of the imperial medical elite and their struggle for different initiatives for alternative institutional projects.

Suffice it to mention that in the early s, an important split arose between doctors educated in the strictly clinical and climatological tradition, and representatives of the nascent medical parasitology—helminthologists and bacteriologists—who would, together with other specialists, fight for reforms in the field of public health and medical instruction, raising the banner of experimental medicine and the Germanic teaching model as an antidote to the French matrix of official medicine.

Thus, when the Academia Imperial de Medicina was created in , hygiene and anatomo-clinical medicine were given a strategically placed position that would weaken the influence of the old Portuguese surgeons and of those from Medical-Surgical Schools of the Court and of Bahia. Through the Academia de Medicina, the medical elite produced original knowledge regarding Brazilian pathology akin to the program of the nascent medical geography. From its creation to the middle of the century, it monopolized itself as an instrument of imperial policy for public health, and became the principal arbiter of medical-scientific innovations, sanctioning innovations in diagnosis and therapy, concerned with Brazilian pathology.

Like the Academy of Medicine of Paris, it offered prizes in annual competitions, collected and examined epidemiological information, administered smallpox vaccinations, and assisted the government in the subject of medical education, hygiene policy, and public health. The comparison between the two can be extended to some of their successes and failures. In the two institutions, the production, coordination, and arbitration of medical knowledge, oriented toward public health, resulted in the organization of the medical profession much more precarious in the Brazilian case , seeking to constitute a network of information and data collection that had to be processed, analyzed, and eventually applied by the academics.

Thus, regional inequalities were geared to the benefit of the medical elites of the capital, the direct beneficiaries of their proximity to the sources of state power. On the other hand, both were equally defeated in their intent to centralize policymaking power in the health field.

A corps of modest experts would be useful to the government, while one having excessive administrative pretensions could become a political embarrassment. The academics wanted administrative powers, but only obtained Medical Knowledge and Professional Power 57 an advisory role. The creation of a Central Public Hygiene Board in did not represent the apex of political power of Brazilian hygienists, as some historians believed. A group of medical professionals, almost all military doctors who practiced in regions politically, culturally, and economically subordinated to the principal European colonial powers, headed this enterprise.

They were responsible for defining medical-hygienic problems and establishing the parameters for their solution in the inhabited zones peripheral to the main centers of medical culture. The experience of colonial armed forces doctors generated an intense interchange of facts and medical theories, among the scientific centers of the Old World and the emerging medical communities of the periphery. The dominant version in the historiography of tropical medicine claims that medical geography was based on a body of fossilized knowledge climatological theories and ancestral raciologies , with no reference to scientific practice and anchored on a scientific criterion that was displaced by contemporary currents of investigative medicine.

It was a dynamic medical force that motivated a research program involving doctors practicing anatomo-clinical and statistical medicine—incorporating parasitology—at the periphery of the main centers of European medical culture. The history of the genesis and development of medical knowledge under the aegis of medical geography in the middle of the nineteenth century was inseparably linked with the expansion of contemporary European medical culture to the periphery of the empires, and to the post-colonial regions.

The construction of the idea of the singularity of tropical pathology and therapeutics was not limited to doctors that practiced there. A similar epistemological discourse 58 Flavio Coelho Edler with the same basis of pathological causality and representations on the rules that ought to produce and validate medical knowledge, governed the clinical practice of academic medicine in the main European medical centers.

Thus, the effort to redefine the medical problems of the tropics, based on an appreciation of environmental factors of endemicity, was broadly conditioned by jurisdictional competition internal and external to the medical profession. A number of hygiene doctors, who occupied administrative positions21 and were responsible for institutionalization of the techniques of statistics in French medicine in the s, delineated the initial bases of a research program that sought to establish a nosographic map of the world.

They were succeeded by doctors of the French navy, prominent agents in the construction of this discipline in the second half of the nineteenth century. This also enabled them to defend their professional status against other hierarchically superior institutions—the hygiene chairs and clinics of the principal European colleges, the Academy of Medicine of Paris, the Annals of Public Hygiene and Legal Medicine, the National Committee of Public Health of France, and the classical treatises of general pathology.

Encouraging research on tropical nosology, constructing a global nosological map, and coordinating the new knowledge was fundamental for achieving this objective. An assessment of the activities of the Academia Imperial de Medicina reveals a lack of justification in the interpretation that identifies medical climatology with a fatalistic determinism.

There is a wide range of positions that would analyze the epistemological and ideological bases of the beliefs sustained by the sources of disciplinary authority identified during the period. Another work23 played a crucial role as an alternate route to scientific legitimation for emerging medical groups in the Brazilian medical panorama.

Such an epistemology presupposed the existence of institutions, such as the Academia de Medicina, that regulated a territorially defined collective practice, for data on clinical observations encompassing the description of the diagnoses, etiologies, and therapeutics and post-mortem anatomo-pathological examinations. This necessarily presupposed the commitment of the local corporate medical body to produce knowledge limited to its own environmental jurisdiction.

In addition to other endemic diseases discovered by medical professionals, including filarasis, leprosy, and hemorrhoids, several other diseases, including smallpox, influenza, chickenpox, and tetanus, to name a few, became noticeable in their weekly sessions. Nevertheless, the overall evaluation in the first half of the s was that the country enjoyed good health conditions. Wishing to monopolize the dialogue on national medical problems before the Imperial Government and European medical-scientific centers, the Academia de Medicina undertook the task of translating and updating the contemporary European hygienic and anatomo-clinical agenda, to legitimize the interpretation of Brazilian pathology.

In the face of these issues, consecrated by medical geography, Brazilian doctors presented responses, opposing the old racial stigmas circulated in European medical compendia. They also produced a positive evaluation regarding Brazilian pathology, where some of the most feared diseases, such as yellow fever, the plague, and cholera had no claim to call their home. Some of these original solutions were gathered together by one of the founders of the Academia de Medicina, a doctor of French origin, Xavier Sigaud. Meanwhile, according to the medical consensus of the time, the decisive morbiferous factors were related to hygienic habits.

The presentation of a hygienic prescription book, adapted to the new climatic conditions, should be interpreted as a victory credited to national doctors in their efforts to revise European treatises on pathology and hygiene and create a local medical culture.

Yaws, imported from Africa, the syphilis of the indigenous people and smallpox from Europe were identical to what they had been three centuries before. Despite being polemical in some aspects, description of the nosographic map of the Empire was a spectacular triumph of the Academia Imperial de Medicina. By adapting European medical knowledge to Brazilian climatic-telluric conditions, it came to control the nosographic map, monopolizing all dialogue with hegemonic medical institutions until the middle of the nineteenth century.

Meanwhile, three events jeopardized the social position that the Academia Imperial de Medicina had achieved in its first quarter century of existence. First, the unexpected eruption of two outbreaks of the most feared epidemics known to man, namely yellow fever and cholera , afflicted the capital of the Empire Medical Knowledge and Professional Power 61 and other important coastal cities.

Yellow fever, which had last appeared in the seventeenth century, soon became the main public health issue in Brazil. The Board restrained the administrative pretensions of the Academy, making it subservient to government directives during the increased political centralization of the Empire following the short liberal experience of the regencies — The third event was the epistemological dislocation caused by experimental medicine, which resulted in the appearance of competing societies and medical publications of the s.

These new avenues of scientific legitimation would break the monopoly enjoyed by the official medical publications of the Academia de Medicina. In Bahia and Rio de Janeiro, medical journalism enabled the growth of scientific interchange and consolidation of a research agenda directed mainly to knowledge of national medical material phytotherapy , pathology, and therapeutics. This stimulated incipient individual medical research initiatives, setting the stage for the legitimation of new disciplinary fields demanded by the reformers of medical teaching.

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Beginning in the s, an inflection would occur in the medical research program now captained by the above-mentioned publications. New groups of doctors began to pursue pari passu, the institutional reform movement that, under the impact of the dynamics of experimental research, subverted the medical hierarchy headed by clinical medicine and hygiene. The emergence of disciplines that were labeled experimental medicine, and new clinical specialties, made the curricular reform of medical teaching imperative. This contemplated a redefinition and expansion of the old body of knowledge.

Convulsed by the demand for new specialized professionals, the academic territory saw its old jurisdictional borders fragmented. However, it was realized that the new clinical and statistical knowledge of the coroners, toxicologists, physiologists, pathologists, and hygienists—concerned with new subjects, such as specific pathologies, limited areas of the human organism and certain age groups—would have to be adapted to Brazilian medical problems, as one of the leaders of the victorious movement for reform in medical teaching in the s stated, 62 Flavio Coelho Edler applying experimental means, the illumination we receive from development of the art, we must study the illnesses that afflict us, according to the modifications our customs and the special character of our race imprint upon them, not only in terms of topography, but also of climatic influences.

The shift from scientific facts to beliefs or myths at the end of the nineteenth century corresponded to an alteration in the rules for producing facts, which meant a change in the status of practices in the groups that sustained them, and in new definitions of hierarchies and socioprofessional values. The nuclear problems covered here include those related to the center-periphery relationship, concretely translated as the relationships between metropolitan and colonial medicine and between popular medical knowledge and academic medicine, respectively, in the postindependence period The discussion also reveals the forms by which sustained medical knowledge, by the Portuguese Empire, or by its successor, the Brazilian Imperial State, interacted with popular therapeutic practices, trying to circumscribe them within strict limits when they could not eliminate them.

Tensions were generated by the monopolizing tendencies of the official medical knowledge over medical assistance, and in maintaining the legal prerogatives conferred upon the doctor, pharmacist, and surgeon. In both contexts, such privileges were contested by various groups, from religious representatives of the various ethnic groups that comprised the multi-cultural environment of the age to curandeiros, barbers, priests, midwives, and innumerable popular therapists.

In the field of therapeutic arts, knowledge, skills, and institutions were constantly supplied and rejected by the diverse heteroclitic groups of the imperial Brazilian society. At this juncture, the rhetoric against charlatanism ran up against the pragmatism of the political elites that sought to accommodate the diverse interests in play to the imperative of law, Medical Knowledge and Professional Power 63 in a context of little capacity to supervise and limited punitive power, making sanitary legislation a legal fiction.

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In the field of public and private hygiene, imperial academic medicine developed a specific political and epistemological policy, seeking to legitimize itself before the State and model European medical institutions. The description of the nosographic map of the Empire was hailed as a major success for the Academia Imperial de Medicina, when it acclimatized European medical knowledge based on a nucleus of universal medical disciplines anatomy and physiology to Brazilian climatic-telluric conditions, becoming its guarantor and controller, practically monopolizing the dialogue between central medical institutions.

In order to impose a monopoly of dialogue on Brazilian medical problems before the imperial government and European medical-scientific centers, the Academia strove to translate and update the contemporary European hygiene and anatomo-clinical agenda, which would make it the legitimate interpreter of Brazilian pathology. Given the issues sanctified by medical geography, Brazilian doctors, thus, presented original responses, some of which opposed the old stigmas supported by racial and climatic determinism.

On the disbarring of popular therapists in the first half of the nineteenth century, see T. Unicamp, , — On the lack of popularity of academic medicine in the same period, see L. For a more extensive evaluation of the conflicting relationships between surgeons, doctors, apothecaries, and curandeiros in the nineteenth century in the province of Minas Gerais, see B. The most significant works on the topic of the medicalization of imperial society are those of R.

Machado et al. Sul Americana, , Maria B. Lisboa: Editorial Estampa, , — Flavio Coelho Edler org. Rio de Janeiro: Casa da Palavra, Vera R. Campinas: Unicamp, Machado, et al. Sul Americana, , 40—41, and A.

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Martins Fontes, , Ch. Boudin was chief doctor of the Marseille hospital. On the topic, see: Bernard P. On the opposition between social statistics and the notion of natural region, see Roger Chartier, Au Bord de la Falaise Paris: Alban Michel, , See L. On yellow fever, see the works of J. The parasitologist Julio de Moura — , still in the s, in Edler, , Cuba was the gem of this diminished empire—the pearl of the Antilles. Following the Haitian revolution, the island had experienced an economic boom as a sugar supplier.

Although many in Cuba were loyal to Spain, and economic stability encouraged political stability, most Cubans wanted a different relationship with their colonial ruler. Spain was economically strapped after losing wars both in Europe and abroad, but when unrest in Cuba erupted in the Ten Years War in , Spanish authorities fought hard to quell the disturbance.

By the war was over, with the Spanish government promising the Cubans some autonomy and representation in the Spanish courts. However, the peaceful situation did not last long. Some in Cuba refused to recognize the end of the war and continued to fight for complete independence. Eventually, it became apparent that Spain was unwilling to fulfill its promises of Cuban autonomy, and in war broke out again on the island. This time, the Cuban insurgents refused to accept Spanish promises, and the war was fought ruthlessly on both sides. In , the United States intervened in the conflict.

Spain lost Cuba along with the rest of its empire, and the United States became the dominant force on the island. Yellow fever played a crucial role in these events. During the nineteenth century, the disease was frequently epidemic in the Caribbean and around the Gulf of Mexico, and it was always present in Cuba. For the victim, it begins like any tropical fever, with a sharply elevated temperature. The high fever is accompanied by severe body pain, headaches, weakness, and muscle and joint pain.

The victim also suffers chills, nausea, and very low blood pressure. After a few days, most victims begin to improve, with full recovery in 67 68 Mariola Espinosa about a month. However, in the worst cases, the fever returns and internal organs begin to fail. Internal hemorrhaging begins, and the victim bleeds from the nose, eyes, mouth, and stomach, vomiting black coagulated blood uncontrollably, and eventually succumbing to the disease. Between 20 to 40 percent of yellow fever victims typically die this horrible death.

Later scientists would learn that yellow fever is caused by a virus transmitted by a mosquito, but at the time of the Cuban fight for independence from Spain, this was still not known. A lack of understanding of yellow fever precipitated the collapse of Spanish imperial rule in Cuba.

Ignorance of the causes and behaviors of the diseases endemic to the island led to high rates of morbidity and mortality among the troops sent to put down Cuban insurgency during the Ten Years War and the War of Independence of Spanish garrisons were stationed in the centers of Cuban cities, where they were easy prey for the housebound mosquitoes that were later confirmed to transmit yellow fever.

The lack of segregated wings for yellow fever patients in Spanish military hospitals further ensured that nearly all of the sick and wounded soldiers would quickly also become infected with yellow fever. Spanish neglect of basic sanitation during wartime only provided additional breeding places for disease-carrying mosquitoes. The Cuban insurgents, the majority of whom were immune to yellow fever through childhood exposure, knew of this Spanish weakness. During both conflicts, they quite successfully made it a central component of their strategy to combat their more disciplined and far better equipped foe.

The insurgents, already in control of the countryside, avoided large engagements with Spanish troops and attempts to capture the cities they held. Instead, they allowed yellow fever to be their principal weapon. In contrast, the U. Even without knowledge of the exact mechanism by which the disease was transmitted, U. Troops, they understood, must never be quartered in urban areas susceptible to yellow fever. They also knew that, in the event of an outbreak among the ranks, relocating the encampment to higher ground would prevent any additional cases.

These two insights kept U. Some historians of colonial public health argue that advances in medical understanding during the late nineteenth century reduced the mortality in European armies caused by disease and thereby allowed the maintenance of empires in the inhospitable environment of the tropics. Others contend that it was the successful establishment of colonial rule that brought improvements in public health and so the decline in death rates among European troops. This chapter demonstrates that ignorance of disease prevented the Spanish from maintaining colonialism in Cuba, and public health measures, rudimentary but effective, allowed the United States to quickly achieve domination of the island.

In the Cuban experience through , it was improvements in public health that enabled empire, not the other way around. They will need it to become acclimatized so that they can equal the rebel negroes in endurance. With the Spanish army unable to provoke the Cuban insurgents into a decisive confrontation and the war dragging on, more and more soldiers were sent to the island during from 90, at the beginning of the year, the Spanish forces numbered , by April, , by September, and , by November.

I fear that yellow-fever will be epidemic. During the year, some thirty thousand Spanish soldiers contracted yellow fever. Two large warehouses in Regla, across the harbor from Havana, were converted into a military hospital. The army even appropriated an orphanage, turned out the children, and crammed it full of beds for the sick troops. Cases treated elsewhere were not included in the official casualty count, but if they suffered a similar mortality rate, then the disease claimed the lives of roughly 2, additional soldiers that year.

Brunner, the inspector of the U. This appearance is not real. South for decades. With the army beginning to evacuate the island in August, few new troops arriving before then, and most of the Spanish soldiers still present in Cuba having already contracted the disease, the size of the vulnerable population was dramatically smaller than in the preceding two years.

The destructive power of yellow fever broke the Spanish army and doomed its efforts to keep Cuba under the Spanish flag. THE U. Although they did not know exactly how it spread, the U. Army officers did understand that relatively simple measures could keep yellow fever out of the ranks. Their experience with yellow fever in in Veracruz during the Mexican-American War, and across the U. South in the latter half of the nineteenth century, had demonstrated that yellow fever was a disease of cities and towns and so could be kept at bay by keeping troops stationed outside of cities and, when possible, at higher elevations.

This knowledge allowed the United States to take and occupy Cuba with few losses from yellow fever.

The U. The initial invasion from Texas had met with great success on the battlefield but had not compelled the Mexican government to surrender the northern half of the country.


Determined to force this outcome, the Polk administration ordered a second invasion, this one to strike from the Gulf of Mexico and take Mexico City. The threat of yellow fever was his foremost consideration. Scott pointed out to his superiors: To reach the heart of the country, from the gulf coast, there is a difficulty in three quarters of the year, more formidable than the artificial defences [sic] of other countries; I allude to the vomito.

The city would have to be taken quickly, he warned. The troops landed without incident and quickly encircled the city, and after a brief siege, a joint bombardment by army and navy guns prompted the surrender of Veracruz on March As Scott had planned, the U. Cases of yellow fever slowly multiplied through April and May in Veracruz, and by early June a full-fledged epidemic had erupted that raged throughout the summer. The fate of these soldiers further demonstrated to the U. Army the importance of keeping troops outside urban areas susceptible to the disease. After the war, this point was scrupulously observed among Army officers stationed in those parts of the southern United States where yellow fever was often epidemic during the summer months.

Even during the terrible Mississippi Valley epidemic of , which sickened , people and claimed over 20, lives, the army suffered just 5 cases and 2 deaths—all within a single man detachment left behind to guard the barracks in New Orleans when its regiment relocated. In fact, the commander of the U. Army, Major General Nelson A. Miles, initially argued against an invasion of Cuba on the grounds of yellow fever. Instead, he proposed a naval blockade of Cuba; the navy, he argued, could compel the surrender of the Spanish while keeping U.

Although these arguments proved correct, the U. Army did not remain free of disease during the war. Inadequate sanitation in the camps established to quarter the troops waiting to embark for Cuba led to a major epi- 74 Mariola Espinosa demic of typhoid in which over 20, soldiers fell ill and more than 1, died. The troops besieging the major port city of Santiago de Cuba—the first and only substantial U. Although the epidemic initially caused panicked reports that yellow fever had struck the army, the malaria at Santiago mainly incapacitated the soldiers and was very rarely fatal.

Fortunately, for the U. The sickened U. The extent of the malaria epidemic was publicized after the surrender of Santiago de Cuba in the infamous Round Robin letter written by Theodore Roosevelt and signed by all of the U. Hostilities effectively ended after the fall of Santiago de Cuba, and peace was made within a month. There was one small outbreak of yellow fever among U.

Army doctors knew that yellow fever could only spread in an urban setting. Strategic considerations prevented the removal of U. A short-lived exception occurred in Santiago de Cuba. That city was initially occupied by specially formed volunteer regiments made up entirely of men who had declared themselves immune to yellow fever due to previous exposure. Not surprisingly, a yellow fever epidemic swept through the troops the following summer. Even in , the worst year for yellow fever during the U. Army to seize Cuba from the Spanish and establish U.

Most earlier works on the topic maintained that it was advances in the understanding and treatment of disease that made the conquest and colonization of tropical lands possible. The most prominent example given was the gradual adoption of regular doses of quinine as a prophylaxis against malaria in the s, which these works credited with allowing the expansion of European empire in Africa in the latter half of the nineteenth century.

The diligent use—and, therefore, the effectiveness—of quinine was vastly overstated, at least outside the British military. Even late in the nineteenth century, disease often took a terrible toll on would-be colonizers. But because nonfatal cases of yellow fever convey lifetime immunity, and the often-deadly strains of malaria common in tropical Africa provide to survivors some temporary resistance to the illness, soldiers suffered the highest death rates from disease during their first year in the tropics.

Establishing a colonial foothold created a seasoned body of troops who did not suffer as much from disease as new arrivals would have, and these men were deployed to conquer additional territory.

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Moreover, it provided a source of indigenous laborers who served as soldiers and porters, greatly magnifying the strength of even small imperial forces. Even when death rates were initially high, the actual numbers of imperial troops involved were relatively small, so the price of empire was modest. Once colonies were established, garrisoned soldiers enjoyed better food and housing than they did while they were on campaign.

In short, this new view maintained, successful conquest generated improvements in tropical medicine, not the reverse. Weakened in this way, 76 Mariola Espinosa Spanish forces were unable to put down the Cuban rebellion and, ultimately, unable to maintain control of the colony. On the other hand, the understanding of the disease gained by the U. Larra y Cerezo estimated that six to seven thousand cases of yellow fever were treated outside of the military hospitals.

The The Invincible Generals 77 Josiah Gorgas to his mother, August 6, , quoted in Frank E. Nicholson, , — Surgeon John B. Nelson A. Walter Reed, Victor C. Vaughan, and Edward O. Military Camps During the Spanish War of , 2 vols. Washington, D. For the reforms triggered by this epidemic, see Vicent J. William C. See, among many others, Philip D. These counterarguments were first introduced by William B.

Philip D. Curtin, Disease and Empire, Control over human reproduction is eternally contested, in zones ranging from the comparative privacy of the conjugal bedroom to the political platforms and programs of national polities. In those zones in which the distribution of power is asymmetrical and unjust, as in colonial and postcolonial societies, struggles over reproduction are particularly intense, yet often indirect and subversive, not confrontational. This chapter examines the troubles that contraceptives caused in one such zone—the commercial farms of white-ruled Rhodesia during the s and s.

Mariola Espinosa, PhD

On the white-run commercial farms, the racial 79 80 Amy Kaler relations of ruling were intensified by the near-absolute power that farm owners had over their African workforce, thus providing a particularly appropriate setting to examine power and trouble as they coalesce around contraception; for they were saturated with asymmetries of power, extending and deepening the asymmetries that characterized most social settings under the Rhodesian Front. These asymmetries occurred along many intersecting axes. Superficially, the most obvious axis is race, as the white minority who owned and ran the farms were legally, politically, economically, and in nearly every other way dominant over their African workforce.

However, racial polarization does not exhaust the complexity of power relations on the farms. Outside the enclosed world of the farm, the political hierarchy of white-dominated colonialism was being shaken by insurgent African nationalist forces, and the reverberations from this political struggle echoed in the lives of farm owners and workers alike. In the s, oral contraceptives were introduced into this complex mix.

They were brought in by the Family Planning Association of Rhodesia FPAR , a white-run charitable organization with close, though sometimes conflicted, relations with the government Ministry of Health. Nonetheless, the FPAR itself took as its official line the argument that effective contraception was a benefit to the physical and social health of African families, enabling women to avoid unintended, undesired, and potentially debilitating pregnancies, and enabling parents to have children in a quantity and configuration that fit their means.