Carlos S. Dimas. Poisoned Eden: Cholera Epidemics, State-Building, and the Problem of Public Health in Tucumán, Argentina, 1865-1908. Lincoln: University of Nebraska Press, 2022. Illustrations, maps, tables. 348 pp. $30.00 (e-book), ISBN 978-1-4962-2919-9; $99.00 (cloth), ISBN 978-1-4962-0840-8; $30.00 (paper), ISBN 978-1-4962-2862-8.
Reviewed by Gabriel Lopes (Casa de Oswaldo Cruz - FIOCRUZ)
Published on H-Sci-Med-Tech (June, 2022)
Commissioned by Penelope K. Hardy (University of Wisconsin-La Crosse)
The Politics of Cholera in Argentina: Sanitary Negotiations and State-Building
In Poisoned Eden: Cholera Epidemics, State-Building, and the Problem of Public Health in Tucumán, Argentina, Carlos S. Dimas follows the developments of three cholera epidemics that took place in Argentina in the second half of the nineteenth century. Dimas’s approach aims to show how the challenges posed by those cholera epidemics contributed to the state-building process and the organization of medical practices. By focusing his narrative on the province of Tucumán, and on the sanitary and political tensions that resulted from the relationships among the provinces and the decisions made by the state (Buenos Aires), Dimas travels through local and international dimensions, thus intertwining the history of the epidemic with local political challenges in a skillful way.
In the first part of his book, Dimas provides the context and the conditions that favored the outbreak of epidemic cholera in Argentina and introduces the province of Tucumán, highlighting that its development was closely linked to sugarcane production throughout the nineteenth century. Moreover, the author discusses the knowledge doctors and public health authorities had of cholera morbus, based on Argentinian doctors’ theses from that period and the development of understanding of the disease, which was mostly related to the miasmatic theory.
The second part analyzes how the cholera epidemic spread in 1867-68 during the Paraguayan War, when cholera first reached Argentina. Dimas shows how the difficulties caused by the war favored cooperation among provinces in order to face the pandemic—a key element to the medicalization process in state-building, which emerged from new local associations and interventions.
The third and fourth parts are linked by the epidemics that formed the fifth cholera pandemic (1881-96), which had two outbreaks in Argentina. During the first of these, in 1886-87, as Dimas emphasizes, sanitary and medical problems posed difficulty in the coordination among the provinces and the state, revealing fragility in the medicalization process and the tensions between city and countryside. In the final epidemic (1894-95), which was not as widespread as the previous one, consolidation efforts were aimed at standardizing medical practices in Argentina. Furthermore, Dimas discusses the reorientation of medical practices in the development of bacteriology.
Dimas’s narrative style is a highlight in the second part of the book, encompassing the dramatic setting of the movement of troops in the Paraguayan War and cholera reaching Argentina. In his vivid description, swamps, rivers, local vegetation, and climate aspects are active players, along with miasmas and the spread of cholera. His narrative of cholera-related political tensions in Argentina, based on texts from the Argentinian newspaper Don Quijote, stands out through his inclusion of beautiful illustrations and his own careful analysis. Dimas succeeds in explaining the link between politics and medical practices in the public sphere, especially through the controversy over the role attributed to fruit in the cholera epidemic and the political and economic problems regarding sanitary cordons and quarantines.
Amid the sanitary uncertainty present in the period described, in some passages it is hard to know whether Dimas is reporting what the players in his plot actually said or is using current terminology to analyze the documents. I will provide two examples from the book in an attempt to clarify my point. The first one concerns the link between cholera and microbes, when Dimas mentions the “bacterium’s official arrival in Tucumán” on November 28, 1886 (p. 29). In his narrative, the identification of cholera through the bacterium cannot be confirmed. The arrival of the epidemic in Tucumán in 1886 was not evidenced by the identification of the bacterium but acknowledged by symptoms and by the arrival of soldiers’ corpses by train. That is to say, the beginning of that epidemic was largely related to assumptions regarding miasmas and the climate, not microbes. The identification of the actual arrival of the bacterium could only be confirmed through a laboratory test in the 1894 pandemic.
Another example of what seems to be a lack of clarity in his analysis, or maybe an exaggeration, is when Dimas discusses the medical thesis of Pablo María Santillán. Dimas states: “Intersecting gender and class, Santillán spent most of his work presenting cholera as an almost exclusively women’s disease” (p. 55). In 1856, Santillán observed that among the dead in the 1830 and 1849 epidemics, French records showed a much higher number of female victims, which was considered by him as exceptional (“muy singular”). To make an analysis on morbidity and mortality, Santillán based his thesis on edad (age), sexo (sex), and condiciones fisicas (physical conditions). In general, Santillán showed that there was a large number of deaths among lap children and elderly people, and that people between puberty and their thirties were more resistant to the disease. Therefore, at least from the perspective presented by Santillán’s thesis, there is no evidence that Santillán saw cholera as closely linked to women.
Dimas achieves his aim of showing how cholera epidemics played a part in the state-building process in Argentina in the second half of the nineteenth century. The whole path traced between local and international spheres is elegantly described throughout the pages of the book, with the support of well-designed maps. The epilogue contains an interesting reflection on COVID-19, and Dimas draws important parallels between this recent pandemic and the cholera pandemics. Poisoned Eden is recommended to researchers, students, and anyone interested in the history of medicine, the history of South America, and the history of cholera pandemics.
. Pablo María Santillán, Del cólera morbus en general [General points on cholera morbus] (Buenos Aires: Imprenta de la Tribuna, 1856), 20. Available at http://www.bibliomedicinadigital.fmed.uba.ar/medicina/cgi-bin/library.cgi?a=d&c=tesis&d=Tesis_00066_Santillan_Pablo_Maria_Del_colera_morbus_en_general_1856.
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Gabriel Lopes. Review of Dimas, Carlos S., Poisoned Eden: Cholera Epidemics, State-Building, and the Problem of Public Health in Tucumán, Argentina, 1865-1908.
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