Tropical Medicine (1860-1940)

The year is 1860. A Brazilian woman, a slave on a sugar plantation, begins to sicken with what we now call Chagas's disease. Despite being given whatever succor was available for one of her status, she weakens, looses her mental acuity, and is eventually deformed to a point of paralysis. Her demise is attributed to tropical degeneration, the generic explanation for various severe illnesses that seem to strike only those who visit or live in the tropics. Leading European scientists considered cases such as this (which were also common in their imperial holdings in South Asia and Africa) to be evidence that there were fundamental differences between the regions of the world that not only increase the likelihood of physical degeneration, but affected mental and moral capacities as well. Tropical medicine became the standard term denoting the treatment and classification of those ailments considered unique to hot and humid areas. Yet the phrase itself had imperialistic and pejorative connotations reflecting the assumption that tropical environments were doomed to lag behind regions of the world deemed by their own occupants to be more civilized.  Historians and public health doctors have questioned whether the plagues associated with the tropics stemmed primarily from their climatic conditions or from the prevailing social organization in those places.

Nevertheless, as Nancy Leys Stepan noted, the tropical countries of Latin America (unlike those in Asia and Africa) were politically independent by the early nineteenth century and thus free to pursue their own styles in science and medicine. To be sure, researchers in Latin America faced many obstacles, including being ignored by the world's scientific centers because they were deemed unfit to conduct advanced science, according to the same racist logic that assumed the inferiority for human habitation of tropical climates, as compared with temperate ones. In the minds of many contemporary Europeans, the dual curse of living in the tropics and not being white was simply not conducive to conducting sophisticated science (Stepan 1998).

Until recently, tropical medicine was considered to be the domain of both imperial powers that sought to protect those their settlers and administrators in tropical regions or of various philanthropic organizations, especially the Rockefeller Foundation and the Pan American Health Organization, which tried to eradicate diseases that threatened U.S. interests. Yet as early as the 1860s, researchers in Latin America began to study the diseases endemic to their region, creating centers of excellence that argued against the racism inherent in environmental determinism. The historian Julyan G. Peard pointed to Brazilian scientists who promoted the novel idea that backwards social conditions (especially the institution of slavery) created an environment in which parasites and other pathogens could thrive. By blaming tropical diseases on microbes and poverty, these researchers tried to exculpate the tropical climate itself as the cause of tropical diseases (Peard 2000).

An emphasis on sanitary and preventative measures to combat disease continued in Latin America throughout the early twentieth century, especially in Brazil where Oswaldo Cruz and Carlos Chagas established an important center for tropical disease research. Nevertheless, attempts to eradicate major diseases like malaria and yellow fever failed, and infectious diseases continue to plague the impoverished tropics to this day.  One priority of public health advocates, very difficult ot achieve, has been raising overal standards of living in order to ensure that poor citizens had clean water free from infections carried by insect vectors. Only after World War II would Latin American countries, especially Mexico, promote eradication of vectors and testing of the population to ensure that supposedly tropical conditions like yellow fever were made a thing of the past.

Despite such Latin American efforts, powerful nations continued to use environmental determinism to legitimize their right to dominate the tropics, including the U.S. Panama Canal Zone, and pour scorn on its inhabitants as racially inferior. Treatment and eradication of diseases that plague the topics still pose substantial challenges. Illnesses once considered to be "defeated," like cholera, have returned to Latin America; despite known cures and preventative measures, malaria remains one of the greatest killers on earth.

Questions for further exploration:

1. Look at the one of the efforts by Latin American researchers to conquer a tropical disease (yellow fever, Chagas' disease, Carrion's disease, etc.). To what extent did they succeed? And how do you define "success" in their case?

2. Compare the U.S. centered approach to tropical medicine seen in the video "Silent War" with how scientists in Latin America conceived of the subject. How were their emphases similar or different? How were "tropical" races (blacks, Indians, mestizos) understood by different groups of scientists? How did each approach the prevention and cure of tropical diseases?

3. Considering the contemporaneous eugenics movement in the early twentieth century, how did the differing approaches of European and Latin American scientists reflect each region's prevalent eugenic theories? See the "Eugenics" topic for more on that movement.

4. Look closely at the images in this topic. What messages are implicit in the images of people infected with tropical diseases? What messages are implicit in the images of doctors and scientific experts? And how do these fit in with the prevalent notions about tropical medicine during this period?

5. Despite being the Latin American country with the youngest tradition of universities and nationally motivated science, Brazil led the way in Latin American tropical medicine research, first in the work of the Escola Tropicalista Bahiana and later the Instituto Oswaldo Cruz. What factors unique to Brazil made research in tropical medicine so important and successful in this country?

Further Reading:

Coutinho, Marilia. "Ninety Years of Chagas Disease: A Success Story at the Periphery." Social Studies of Science. 29: 4 (August 1999): 519-549.

Cueto, Marcos. Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955-1975. Baltimore: Johns Hopkins University Press, 2007.

---. "Sanitation From Above: Yellow Fever and Foreign Intervention in Peru, 1919-1922." The Hispanic American Historical Review. 72: 1 (February 1992): 1-22.

Peard, Julyan G. Race, Place, and Medicine: The Idea of the Tropics in Nineteenth-Century Brazil. Durham, NC: Duke University Press, 2000.

---. "Tropical Disorders and the Forging of a Brazilian Medical Identity, 1860-1890." The Hispanic American Historical Review. 77: 1 (February 1977): 1-44.

Stepan, Nancy Leys. Beginnings of Brazilian Science: Oswaldo Cruz, Medical Research and Policy, 1890-1920. Sagamore Beach, MA: Watson Publishing International, 1981.

---. Picturing Tropical Nature. Ithaca: Cornell University Pres, 2001.

---. "Tropical Medicine and Public Health in Latin America." Medical History. 42 (1998): 104-112.

Carlos Chagas with Berenice

Date: 1907
Owner: Casa de Oswaldo Cruz
Source Type: Images

 

This photograph shows Dr. Carlos Chagas (1879-1934) sitting with Berenice, the young girl in whom he first discovered symptoms that he attributed to a new parasite, Trypanosoma cruzi, which he had discovered in 1909 while working for Oswaldo Cruz. The parasite lived inside the Reduviid bug, a large insect that lived in the walls of impoverished dwellings and spread the parasite while feeding on human blood. Chagas's disease was noteworthy, among other reasons, because he first identified the parasite and then the symptoms it caused, an order of operations reflecting how important microbiology had become to the Instituto Oswaldo Cruz's approach to tropical medicine.

The disease was named after Chagas and, in 1925, Chagas was elected Chair of Tropical Medicine. His greatest contribution to Brazilian public health, however, may have been raising awareness of the severity of conditions in Brazil's poor interior. Romantic ideas about rural villagers living in lush environs were replaced by images (indeed, photographs) of poor people suffering from the several manifestations of Chagas's disease, including paralysis and retardation. Exposing the harsh reality of the life of the rural poor increased Brazilian efforts to promote hygiene and fight the vectors of parasites throughout the country. Nevertheless, over five million Brazilians still suffer from Chagas's disease, and there is still no cure.

References: Coutinho, Marilia. "Ninety Years of Chagas Disease: A Success Story at the Periphery." In Social Studies of Science, Vol. 29, no. 4 (Aug., 1999), p. 519-549.

Stepan, Nancy Leys. Picturing Tropical Nature. Ithaca: Cornell University Pres, 2001.

CITATION: Casa de Oswaldo Cruz.

DIGITAL ID: 12991

 

Daniel Alcides Carrion

Date: 1885
Owner: Wellcome Library, London
Source Type: Images

 

CITATION: Portrait of Daniel Carrion, a student at Lima. Engraving. Published 6 June 1931. Credit: Wellcome Library, London. M0018848.

DIGITAL ID: 12996

 

Elephantiasis

Date: 1905
Owner: Constable
Source Type: Images

 

The people pictured here suffered from the "tropical" disease known as elephantiasis, officially renamed filiariasis in the 1870s. It is one of a number of maladies caused by parasites that thrive in unsanitary conditions; thus those most frequently infected by it were the poor.  Due to social conditions that relegated members of particular ethnic groups to poverty, diseases like elephantiasis came to be associated with those populations who were assumed to be biologically susceptible to such diseases, as member of non-Europeans races.  In Brazil, blacks, Indians and mestizos were most commonly the victims of elephantiasis.  A group of doctors working out of Brazil's Escola Tropicalista Bahiana developed a more sophisticated and distinctly Brazilian approach to so called tropical disorders.

The Tropicalistas sought to discover causes for mysterious diseases like filiariasis by rejecting the prevalent notion of environmental determinism, which blamed tropical nature and people for "degeneracy." This group of doctors, several of whom were Europeans who chose to work in Brazil, found that unsanitary conditions were at the root of diseases like filiariasis and hookworm because they allowed for the promulgation of parasites. Parasites, a tangible and preventable vector, caused the painful swelling of filiarisis, and hookworms, not racial enervation, led to anemia. The Tropicalistas used their findings to attack squalid social conditions, especially the institution of slavery, and promote public sanitation measures. Despite predating by several decades the neo-colonial efforts of the Rockefeller Foundation and the Pan American Sanitary Bureau, as well as the nationalist sanitary reforms of Brazilian medical hero Oswaldo Cruz, the Tropicalistas faced too many obstacles from Eurocentric conventions of tropical medicine. Consequently, their approach did not have a lasting influence.

Reference: Peard, Julyan G. Race, Place, and Medicine: the Idea of the Tropics in Nineteenth-Century Brazil. Durham, N.C.: Duke University Press, 2000.

CITATION: Images of Elephantiasis. In Lectures on tropical diseases: being the Lane lectures for 1905 delivered at Cooper Medical College, San Francisco, U.S.A. August 1905. by Patrick Manson. London: Constable, 1905. 

DIGITAL ID: 12989

 

Eradicating Mosquitoes

Date: 1968
Owner: Courtesy of the World Health Organization Archives.
Source Type: Images

 

This photograph from 1968 shows a Mexican sanitation worker using a horse to cross rough mountain terrain in order to spray DDT (stored in the large canister) in remote villages. In the early twentieth century, health officials in the U.S. and Europe, using the mosquito eradication techniques developed as part of Carlos Finlay's work on yellow fever in Puerto Rico, had almost completely rid their countries of malaria. It thus came to be considered an exclusively tropical malady, one most often carried by blacks and Indians, supposedly "tropical races" natural to hot and humid regions. In the early decades of the Cold War, Mexico made a concerted effort to eradicate this disease. This campaign was made necessary by the failure of late nineteenth and early twentieth century public sanitation efforts, both by international organizations like the Pan American Sanitation Bureau (PASB) and Rockefeller Foundation, as well as Latin American programs promoted by local doctors, reformers, and eugenicists.

Building largely on the Cold War political ideology of containment, Mexico adopted a similar strategy in its anti-malaria campaign. It thus tried to eliminate mosquitoes, the disease's vector, and cure those already exposed to it by administering quinine free of charge. Mexico also became a center for training other Latin American eradicators; from 1957-1962, over five hundred technicians from several South and Central American countries traveled to Mexico on PASB fellowships to learn novel techniques. Such "south to south" diffusions of scientific knowledge evince the fact that modern science is by no means always spread outwards from Europe or the U.S.

Reference: Cueto, Marcos. Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955-1975. Baltimore: Johns Hopkins University Press, 2007.

CITATION: Photograph by Peter Larsen. Courtesy of the World Health Organization Archives.

DIGITAL ID: 12992

 

Human Energy

Date: 1924
Owner: Harper & Bros.
Source Type: Images

 

This blatantly racist medical/demographic map from 1924 displays north European notions about tropical enervation and white superiority. Such early twentieth century diagrams evolved out of "disease maps," a cartographic technique used in the nineteenth century to display the prevalence of severe medical conditions in areas near the equator. Such maps were made possible by the presence of massive European empires and, by equating conquered areas with uninhabitability and racial degeneration, were able to help justify conquest and expansion. Disease maps located beriberi, malaria, yellow fever, and other "tropical" diseases exclusively in the jungles of South America, Africa, and Asia, despite the fact that many of these conditions had been only recently contained in Europe.

Disease maps, in a way, resembled Humboldt's notion that geography had to be considered as part of a grander study of nature, a philosophy inspiring his map of plant distribution on Mount Chimborazo (seen in the Humboldt topic). Yet, at least by nineteenth century standards, Humboldt was far from racist, and saw potential for development and civilization in the jungles of South America. This map, however, categorizes the entire equatorial region as having "low" and "very low" levels of energy; regions whose very ecology and geographic location made their denizens incapable of modernity. Although, the environment of the tropics is only partly to blame for the prevalence of 'tropical disease,' particularly one means of preventing those diseases had been discovered around the turn of the century, Eurocentric ideas about tropical health and environmental determinism were nevertheless a very real obstacle to treating and preventing diseases. Sanitation campaigns, for example, would have little support if doctors thought heat and humidity, as opposed to dirty drinking water, were what caused so many to die of these conditions. Since poor sanitation and thus disease thrived in the poor areas inhabited by "tropical races," (such as mestizos and others of mixed African, indigenous and European ancestry) the tenets of tropical medicine and racial degeneration were mutually reinforcing.

Reference: Stepan, Nancy Leys. Picturing Tropical Nature. Ithaca: Cornell University Pres, 2001.

CITATION: The Distribution of Human Health and Energy on the Basis of Climate. In Climate and Civilization by Ellsworth Huntington. New York: Harper & Brothers, 1915. 

DIGITAL ID: 12988

 

London School of Tropical Medicine

Date: 1910
Owner: Wellcome Library, London
Source Type: Images

 

This 1910 photograph shows several British scientists working in a large laboratory in the London School of Tropical Medicine. The school was founded in 1899 by Sir Patrick Manson (who is often seen as the father of modern tropical medicine), as an institution focusing on the many diseases that, by the late nineteenth century, had been relegated to the status of "tropical." In Britain, and, to a lesser degree, France and Germany, the study of tropical medicine emerged as field that focused on typically tropical maladies but had its intellectual center in Europe. The spread of European empires to tropical regions like India, Southeast Asia, and Africa, as well as neo-colonial interests in South America, encouraged European scientists to find new ways of treating these diseases and preventing their spread.

Since the early colonial period, the tropical climate itself was blamed for degenerating the health of its inhabitants, but by the mid nineteenth century, the environment had been discounted as a legitimate cause of sickness. Instead, European experts began to attribute conditions like yellow fever and malaria to poor sanitation. The fact that this paradigm shift occurred concurrently with a sharp decline in mortality rates in Northern Europe and the United States encouraged Europeans to draw a definitive distinction between "tropical diseases" and the less harmful illnesses found in more sanitary countries with temperate climates.

The laboratory pictured here is from the school's first location at the Albert Dock Hospital. In the 1920s, after receiving a two million dollar grant from the Rockefeller Foundation, the school expanded to encompass both tropical medicine and general public hygiene, both of which were important foci of the RF.

Reference: Stepan, Nancy Leys. Picturing Tropical Nature. Ithaca: Cornell University Press, 2001.


CITATION: Laboratory at the London School of Tropical Medicine at the Albert Dock Hospital (Seamen?s Hospital Society). From: Royal Society of tropical Medicine and Hygiene. Credit: Wellcome Library, London. L0026996

DIGITAL ID: 13031

 

Mexican Girl Gives a Blood Sample

Date: 1962
Owner: Courtesy of the World Health Organization Archives.
Source Type: Images

 

This photograph from 1962 shows a young Mexican girl giving a blood sample to a government worker testing for malaria. As part of Mexico's mid twentieth century malaria eradication campaign (assisted by the Pan American Sanitation Bureau), the government brought anti-malarial testing and mosquito eradication to rural parts of Mexico, taking great strides to protect the population from this disease. Sanitation officials encountered many obstacles during this campaign, the most pronounced of which was the language barrier. Much of the rural population spoke indigenous languages like Nahuatl or Zapotec, and over thirty different words existed for the disease "malaria" (bad air) alone.

Yet many of the ideologies behind Mexico's rural anti-malaria campaign were based on the racist tenets of tropical medicine. Indians, a "tropical race," were considered to be carriers of malaria and other diseases most common in hot, humid climates, and were thus targeted disproportionately. Malarial symptoms like anemia were readily associated with very old elitist stereotypes that Indians were a lazy race, and their non-modern culture was seen as an obstacle to such sanitation efforts. Thus the technicians and doctors sent to the rural villages tried to eradicate indigenous healers concurrently with malaria, disparaging their traditional medical techniques as primitive and useless. The malaria campaign was one aspect of Mexico's Cold War era effort to centralize the country and bring indigenous peoples and outlying areas into a more nationally integrated Mexico.

Reference: Cueto, Marcos. Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955-1975. Baltimore: Johns Hopkins University Press, 2007.

CITATION: Photograph by Paul Almasy. Courtesy of the World Health Organization.

DIGITAL ID: 12993

 

Oswaldo Cruz

Date: 1908
Owner: Casa de Oswaldo Cruz
Source Type: Images

 

This cartoon depicts Dr. Oswaldo Cruz (1872-1917) as a national hero lionized for his contributions to Brazilian medicine (and a germ cowering away from him). Cruz was on the cutting edge of microbiological research, a field that promised to exculpate the tropics as a whole from the idea that tropical diseases were inherent in the people and climate of Brazil. By working with bacteria and parasites, doctors like Cruz could identify tangible sources of many illnesses that explained the population's supposed laziness (the result of anemia). Within a few years of Carlos Finlay's and Walter Reed's identification of mosquitoes as yellow fever's vector, the Brazilian government hired Cruz to lead the nation's first public health campaign. By 1906, Cruz and his team had eliminated the Aedes aegypti mosquito responsible for the disease from major urban areas in Brazil and thus dramatically reduced the spread of yellow fever.

His success made Cruz a medical celebrity and he used his influence to found a modern laboratory to fight tropical diseases. Later renamed the Instituto Oswaldo Cruz, the research center predated the first Brazilian research universities by over twenty years and was instrumental in giving Brazilian scientists a sense that they were even more qualified to deal with local maladies than European specialists in tropical medicine. In the early twentieth century, the Cruz institute merged applied science with research while training a new generation of scientists and promulgating modern scientific practices throughout Brazil. It remains an important center for public health research and education to this day.

Reference: Stepan, Nancy Leys. Beginnings of Brazilian Science: Oswaldo Cruz, Medical Research and Policy, 1890-1920. Sagamore Beach, MA: Watson Publishing International, 1981.

CITATION: Casa de Oswaldo Cruz.

DIGITAL ID: 12990

 

Silent War

Date: 1945
Owner: Prelinger Archive
Source Type: Videos

 

This 1945 film says much about how the U.S. understood the international "war" against yellow fever. Much of the rhetoric is highly militaristic, significant not only because this video was made during World War II, but also indicative of the neo-colonial campaigns to eradicate tropical diseases in Central and South America, diseases that could prove devastating to commerce and potentially spread to the U.S. Yet, perhaps surprisingly, the narrator never fails to give credit to Colombian doctors for their role in the campaign, calling the war a struggle by "men of the western hemisphere," a very pan-American outlook. This same language, however, is extremely gendered. This may be due in part to the film's emphasis on seeing the eradication as a war, an exclusively male event at the time, but it also ignores the presence of women, who are visible and active in the laboratory scene (though not in the heroic march through the jungle).

Another interesting facet of this film is the contrast drawn between the villagers and the scientists. The Colombians are racially homogenized as a "mixed people" while the white doctors are lionized as heroes "bringing blessed medicine" to a grateful people. Recent historical work, however, has shown that there was often much tension between neo-colonial attempts to impose bio-medicine as necessary and superior to more traditional local practices. The fact that the yellow fever vaccine was still being lauded as a safeguard against "the special dangers of the jungle" underscores the persistence of Eurocentric ideas about the inherent insalubrity of the tropics well into the twentieth century.

CITATION: Silent War: Colombia's Fight Against Yellow Fever. Documentary Film Productions. 1945. Courtesy of the Prelinger Archive.

DIGITAL ID: 12854

 

Source References

Web Sites

Pan American Health Organization (World Health Organization)

Publications

Adams, David P. "Malaria, Labor, and population distribution in Costa Rica: A Biohistorical Perspective." Journal of Interdisciplinary History. 27: 1 (1996): 75-85.

Alchon, Suzanne Austin. A Pest in the Land: New World Epidemics in a Global Perspective. Albuquerque: University of New Mexico Press, 2003.

Allende, Salvador. La Realidad Medico-Social Chilena. Santiago: Ministerio de Salubridad, 1939.

Armus, Diego. "Disease in the Historiography of Modern Latin America," in Disease in the History of Modern Latin America: From Malaria to AIDS. ed. by D. Armus. Durham: Duke University Press, 2003. p. 1-24.

Armus, Diego. Disease in the History of Modern Latin America: From Malaria to AIDS. Durham, NC: Duke University Press, 2003.

Arnold, David. Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900. Amsterdam: Rodopi, 1996.

Balick, Michael J. and Elaine Elizabetsky and Sarah A. Laird. Medicinal Resources of the Tropical Forest. New York: Columbia University Press, 1995.

Birn, Anne-Emanuelle and Armando Soloranzo. "The Hook of Hookworm: Public Health and the Politics of Eradication in Mexico." Western Medicine as Contested Knowledge. Andrew Cunningham, ed. Manchester: St. Martin's Press, 1997. pg. 147-171.

Birn, Anne-Emanuelle. "A Revolution in Rural Health?: The Struggle Over Local Health Units in Mexico, 1928-1940." Journal of the History of Medicine and Allied Sciences. 53:1 (1998): 43-76.

Blake, Stanley S. "The medicalization of nordestinos: public health and regional identity in northeastern Brazil, 1889-1930," The Americas. 60: 2 (2003): 217-248.

Bordi de Ragucci, Olga. Colera e Inmigracion. Buenos Aires: Leviatan, 1992.

Briggs, Charles L. and Clara Mantini. "The Indians Accept Death as a Normal, Natural Event: Institutional Authority in a Venezuelan Cholera Epidemic." Social Identities. 3: 3 (1997): 439-469.

Chalhoub, Sidney. "The Politics of Disease Control: Yellow Fever and Race in Nineteenth Century Rio de Janeiro." Journal of Latin American Studies. 25: 5 (1993): 441-463.

Cirillo, Vincent J. "Fever and Reform: The Typhoid Epidemic in the Spanish-American War." Journal of History of Medicine and Allied Science. 55 (2000): 363-397.

Clement, Jean Pierre. "El Nacimiento de la Higiene Urbana en la America Espanola del Siglo XVIII," Revista de Indias. 49 (1983): 77-94.

Colson, Audrey Butt and Cesareo de Armellada. "An Amerindian derivation for Latin American Creole illnesses and their treatment," Social Sceince and Medicine. 17: 17 (1983): 1229-1248.

Coutinho, Marilia. "Ninety Years of Chagas Disease: A Success Story at the Periphery." Social Studies of Science. 29: 4 (August 1999): 519-549.

Cueto, Marcos. "Andean Biology in Peru: Scientific Styles on the Periphery." Isis. 80 (1989): 640-658.

Cueto, Marcos. "Sanitation from Above: Yelow Fever and Foreign Intervention in Peru, 1919-1922." Hispanic American Historical Review. 72 (1992): 1-22.

Cueto, Marcos. "Social Medicine and 'Leprosy' in the Peruvian Amazon." The Americas. 61: 1 (July 2004): 55-80.

Cueto, Marcos. "Stigma and blame during an epidemic: Cholera in Peru, 1991." In Diseases in the History of Modern Latin America. D. Armus, ed. Durham: Duke University Press, 2003. p. 268-289.

Cueto, Marcos. "Tropical Medicine and Bacteriology in Boston and Peru: Studies of Carrion's Disease in the Early 20th Century." Medical History. 40 (1996): 344-364.

Cueto, Marcos. Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955-1975. Baltimore: Johns Hopkins University Press, 2007. 

Cueto, Marcos. El Regreso de las Epidemias: Salud y Sociedad en el Peru del siglo veinte. Lima: Instituto de Estudios Peruanos, 1997.

Cueto, Marcos. Salud, Cultura y Sociedad en America Latina. Lima: Instituto de Estudios Peruanos y Organizazion Panamericana de la Salud, 1996.

Cueto, Marcos. The Return of Epidemics, Health and Society in Peru during the Twentieth Century. Aldershot, UK: Ashgate, 2001.

Cumper, G.E. "Jamaica: A Case Study in Health Development." Social Science and Medicine. 17: 24 (1983): 1983-1993.

Cunningham, Andrew. "La Transformacion de la Peste: El Laboratorio y la Identidad de las Enfermedades Infecciosas." Dynamis. 11 (1991): 27-72.

Delaporte, Francois. The History of Yellow Fever: An Essay on the Birth of Tropical Medicine. Cambridge: MIT Press, 1991.

Farmer, Paul. Infections and Inequalities: The Modern Plagues. Berkely: University of California Press, 1999.

Fowler, Murray E. and Zalmir S. Cubas. Biology, Medicine, and Surgery of South American Wild Animals. Ames, IA: Iowa State University Press, 2001.

Gomez-Dantes, Hector and Anne-Emanuelle Birn. "Malaria and Social Movements in Mexico: The Last 60 Years." Parassitologia. 42 (2000): 69-85.

Guy, Donna J. "Emilio and Gabriela Coni: reformers, public health, and working women." In The Human Tradition in Latin America: The Nineteenth Century. edited by J. Ewell and W.H. Beezley. Wilmington, DE: Scholarly Resources, 1989. p. 233-248.

Kapeluz-Poppi, Ana Maria. "Rural Health and State Construction in Post-Revolutionary Mexico: The Nicolaita Project for rural medical services." The Americas. 58: 2 (2001): 261-283.

Kropf, Simone P. and Nara Azavedo and Luiz O. Ferreira. "Biomedical research and Public Health in Brazil: the case of Chagas' Disease (1909-1950)." Social History of Medicine. 16: 1 (2003): 111-130.

Laurell, Asa Cristina. "Crisis, Neoliberal Health Policy and Political Processes in Mexico." International Journal of Health Services. 21: 3 (1991): 457-470.

Leonard, Jonathan: "Research in the Argentine Outback: The Health Quest of Salvador Mazza." Bulletin of the Pan American Health Organization. 26: 3 (1992): 256-270.

Loncarica, Alfredo G. Kohn and Abel Aguero. "Carlos Alberto Alvarado y los planes de salud rural: las condiciones del exito y del fracaso en tecnica medica." Saber y Tiempo. (1997): 489-496.

Lowy, Ilana. "What/who should be controlled? Opposition to yellow fever campaigns in Brazil, 1900-1939." Western Medicine as Contested Knowledge. New York: Manchester University Press, 1997. pg. 124-126.

Lowy, Ilana. "Yellow Fever in Rio de Janeiro and the Pasteur Institute Mission (1901-1905): The Transfer of Science to the Periphery." Medical History. 34 (1990): 144-163.

McNeill, J.R. "Yellow Jack and Geopolitics: Environment, Epidemics, and the Struggle for Empire in the American Tropics." In City, Country, Empire: Landscapes in Environmental History. Pittsburgh: University of Pittsburg Press, 2005.

Musgrove, Philip. "The Economic Crisis and its Impact on Health in Latin America and the Caribbean." International Journal of Health Services. 17: 3 (1987): 411-441.

Navarro, Vicente. "The Underdevelopment of Health or the Health of Underdevelopment: An Analysis of the Distribution of Human Health Resources in Latin America." Imperialism, Health, and Medicine. Farmingdale, NY: Baywood Publishing Company, 1981, 

Obregon, Diana. "Building National Medicine: Leprosy and Power in Colombia, 1870-1970." Social History of Medicine. 15: 1 (2002), 89-108.

Obregon, Diana. Batallas contra la lepra: Estado, medicina y ciencia en Colombia. Bogota: Banco de la Republica, 2002.

Packard, Randall M. "Malaria Dreams: Postwar Visions of Health and Development in the Third World." Medical Anthropology. 17 (1997): 279-296.

Parker, David S. "Civilizing the City of Kings: hygiene and housing in Lima." In Cities of Hope: People, Protests, and Progress in Urbanizing Latin America, 1870-1930. Edited by R. Pineo and J. Baer. Boulder: Westview Press, 1998. p. 153-178.

Payne-Jackson, Arvilla and Mervyn C. Alleyne. Jamaica Folk Medicine: A Source Of Healing. Jamaica: University of the West Indies Press, 2004.

Peard, Julian G. "Tropical Disorders and the Forging of a Brazilian Medical Identity, 1860-1890."