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Wednesday 24 March 2004 14:15
P-3 LAT02 Public Health and State Formation in Latin America
Room P
Network: Latin America Chair: Michiel Baud
Organizer: Kim Clark Discussant: Katherine Bliss
David Abernathy : 'A novel problem': Territoriality, public health and the preservation of order in the Panama Canal Zone
On November 3, 1903, Panama, backed by United States gunships and years of diplomatic maneuvering, seceded from Colombia and became an independent nation. Two weeks later, the Hay—Bunau-Varilla was signed, giving the United States a 10-mile swath of land that bisected the nascent republic. While not granted full sovereignty, the ... (Show more)
On November 3, 1903, Panama, backed by United States gunships and years of diplomatic maneuvering, seceded from Colombia and became an independent nation. Two weeks later, the Hay—Bunau-Varilla was signed, giving the United States a 10-mile swath of land that bisected the nascent republic. While not granted full sovereignty, the United States was given the “use, occupation and control” of the zone in perpetuity, and quickly set out to establish a territorial government to oversee the construction of a trans-isthmian canal.

At the same time, the convergence of the germ theory of disease causation and the insect-vector theory of disease transmission resulted in a new approach to public health, one that justified and rationalized the need for strict territorial boundaries and harsh measures of social control in the new Panama Canal Zone. The institutional authority of the Isthmian Canal Commission’s Department of Sanitation, buttressed by the growing scientific legitimacy of tropical medicine, provided a crucial tool for maintaining a disciplined workforce and policing the boundaries of a U.S.-occupied territory. (Show less)

Ann Blum : Medicine and Motherhood: Infant Feeding in Mexican Public Welfare, 1898-1910
In late nineteenth-century Mexico, physicians and hygienists involved in the emergent practice of pediatrics echoed their European and North American colleagues in positing that ignorant mothers, midwives, and wet nurses were responsible for the nation’s high infant mortality and that medical oversight of childbirth and lactation or artificial feeding would ... (Show more)
In late nineteenth-century Mexico, physicians and hygienists involved in the emergent practice of pediatrics echoed their European and North American colleagues in positing that ignorant mothers, midwives, and wet nurses were responsible for the nation’s high infant mortality and that medical oversight of childbirth and lactation or artificial feeding would improve infant survival. Accordingly, in 1898 federal welfare administrators at the highest level sought to eliminate the Mexico City foundling home’s century-long reliance on village wet nurses by introducing medically supervised artificial feeding of infant inmates. Most of the bottle-fed babies died. To alleviate this alarming mortality among formula-fed state wards, administrators brought wet nurses “indoors” and under strict medical supervision.
This convergence of medicine, social policy, and labor discipline enmeshed physicians, administrators, and wet nurses in a web of contradictions. Staff physicians faced the professional conundrum of administering a fatal regimen of artificial feeding. Even so, foundling home administrators argued for new facilities and increased funding based on the centrality of the artificial feeding program in late Porfirian social welfare policy. While hygienists insisted that breastfeeding was the foundation of motherhood and essential for infant survival, public policy now required prospective wet nurses to board their own babies in the countryside and submit to a labor regime of round-the-clock supervision.
Why did state officials and physicians persist in pursuing this conflicted medical regimen? The introduction of the foundling home artificial feeding program, I argue, was over-determined, as were its contradictions, but throw light on the questions: Why do states need medicine and why does medicine need states? The aggressive pursuit of the program illuminates gender dimensions of a key component of the relationships among medicine and state formation in Mexico just prior to the revolution of 1910. At the apogee of institutionalization, the Porfirian state sector offered the medical profession unprecedented resources and authority that offset dubious medical outcomes. In turn, even imperfect medical techniques offered the state rationales for circumventing the barriers between public and private erected by liberalism and for legitimating and empowering direct class-based interventions into family formations through women’s and children’s bodies. Medical rationales, moreover, also established scientific barriers between motherhood and waged labor, a central tenet of industrialized labor regimes separating sites of production from those of reproduction. Additionally, the episode reveals how women interpreted and acted upon evolving medical understandings of maternity.
This initial experiment in medically supervised infant care in a federal institution points to continuities rather than rupture between Mexico’s pre- and post-revolutionary periods. The episode and its rationales prefigured not only the centrality of puericulture in public health and the centrality of public health in the process of state formation during Mexico’s decades of revolutionary reform, but also the persistently contradictory place of motherhood in social welfare and labor regimes in the state-led process of industrialization and economic modernization. (Show less)

Kim Clark : Female Public Health Workers and the Tensions of Ecuadorian State Formation, 1930-1950.
This paper examines the participation of female public health employees in public health campaigns in the Ecuadorian highlands in the period from 1930 to 1950. The relationship between public health and state formation is explored in three main ways. First, some of the most wide-ranging state projects to morally, culturally, ... (Show more)
This paper examines the participation of female public health employees in public health campaigns in the Ecuadorian highlands in the period from 1930 to 1950. The relationship between public health and state formation is explored in three main ways. First, some of the most wide-ranging state projects to morally, culturally, and hygienically reform Ecuadorian subordinate groups to remake them as ‘modern’ citizens and efficient labourers, were carried out through public health
campaigns. Second, as allopathic medicine was institutionalised in
Ecuador, the public health service spearheaded campaigns against alternative and informal healthcare providers. This involved a state effort to oversee and direct health-seeking behaviour, and in the process to increasingly manage some quite intimate bodily practices.
Third, I see the state as fragmented and internally contradictory, representing divergent interests and intentions. Public health
institutions lend themselves to an analysis of the tensions in and
nonlinear nature of state formation, since they often encountered funding crises, there was friction over jurisdiction among various public and private institutions, and there were also conflicts within the public health service among different branches of the service, among
individual employees within the hierarchy, and between male and female employees.
A focus on female public health practitioners provides a useful entry point into all of these issues. First, women were at the forefront of campaigns to reform the behaviour of subordinate groups, and for
instance, regularly entered private homes to supervise mothers’ care of infant children. Second, the provision of professional midwives and
nurses to rural towns was explicitly seen as a way to combat the “plague” of empirics, and to convince poor women in particular of the benefits of allopathic medicine. Third, these employees, more than any others, were magnets for varying degrees of hostility coming from within
the public health service, and therefore a focus on their experiences reveals some of the schisms and contradictory interests within this state institution. (Show less)

Paulo Drinot : Syphilis, state formation, and public health in early twentieth-century Peru
This paper examines attempts by the Peruvian state to control the spread of syphilis in the first half of the twentieth century. Drawing on a variety of sources, including reports by police and sanitation officials, medicine faculty theses and medical journals, I look at how the discourses and policies regarding ... (Show more)
This paper examines attempts by the Peruvian state to control the spread of syphilis in the first half of the twentieth century. Drawing on a variety of sources, including reports by police and sanitation officials, medicine faculty theses and medical journals, I look at how the discourses and policies regarding syphilis changed during the first half of the twentieth century. In the first two decades of the century, physicians and public health officials viewed syphilis as intimately linked to prostitution, and devised strategies to contain the spread of syphilis that exclusively targeted prostitutes. The attempts to regulate prostitution led to the creation of a red-light district in a peripheral part of Lima and to growing control over prostitutes in general. By the 1930s, in part as a result of the growing influence of abolitionist and eugenic ideas and a limited feminist critique, public health experts began to view syphilis as a broader social problem. Attempts to control and channel sexuality guided debates and state policies on syphilis in this period. Measures derived from eugenic theories were adopted, including a compulsory sanitary card and pre-nuptial health checks, and sexual education programmes for both adults and children were proposed and, gradually, implemented.
The campaigns directed at syphilis were part of a broader, if haphazard, public health programme. Physicians and public health officials believed that syphilis, like the other plagues, malaria, typhus and yellow fever, weakened the country economically and, as military doctors pointed out, militarily. Public health campaigns were fed by the belief that Peru was an under-populated country, or, in any case, populated by the wrong type of people. However, attempts in the nineteenth century to encourage European immigration had failed. If the social and racial stock could not be changed from without, it would have to be ‘improved’ from within. Sexuality would have to be controlled and channelled in order to contribute to state-building. The policies towards syphilis, then, were part of broader attempts at controlling reproduction. In a society where up to two thirds of all children were born illegitimate, special emphasis was placed on the construction of motherhood and domesticity, and thus shaping femininity. Similarly, in attempting to eradicate the lax sexuality that was associated with the spread of syphilis, the campaigns also indirectly challenged ideas of masculinity. As elsewhere in Latin America, elites sought to reform and control sexuality in order to make it fit their vision of state-building and progress. (Show less)



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