Urban on Dimas, 'Poisoned Eden: Cholera Epidemics, State-Building, and the Problem of Public Health in Tucumán, Argentina, 1865-1908'
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 Kelly Urban (University of South Alabama) Published on H-LatAm (June, 2022) Commissioned by Casey M. Lurtz (Johns Hopkins University)
Printable Version: https://www.h-net.org/reviews/showpdf.php?id=57447
In 1962, Charles E. Rosenberg published a monograph on three cholera epidemics that ravaged the United States in the nineteenth century. Breaking through the disciplinary boundaries that set medical history apart, he argued, “The following pages attempt not simply to describe three epidemics, but to understand something of America in the cholera years.” Six decades later, Rosenberg’s methods are still generating illuminating social histories of medicine, evidenced by Carlos S. Dimas’s Poisoned Eden: Cholera Epidemics, State-Building, and the Problem of Public Health in Tucumán, Argentina, 1865-1908. This book will thus appeal to historians of Argentina, but I hope for an even wider audience of Latin Americanists and historians of medicine, as Poisoned Eden is a testament to the vibrancy of the Latin American medical history subfield.
Dimas explores three cholera epidemics that reached Tucumán, a province in northwestern Argentina, in the late nineteenth century. Despite its small geographic size, Tucumán contained a complex disease landscape: its dynamic economic sector created serious health problems, earning it the title of “Poisoned Eden.” Densely populated, connected to global trade networks, site of a booming sugar industry, and deeply involved in national politics, the province serves as a productive case study. The book is organized chronologically and thematically. Part 1 sets the contextual stage, recreating the nineteenth-century worlds of Tucumán (chapter 1) and cholera (chapter 2). The remainder of the book delves into each of the three epidemics: 1867-68 (part 2), 1886-87 (part 3), and 1894-95 (part 4).
Poisoned Eden is fundamentally concerned with the relationship between epidemics and the state. In anchoring the study at the provincial level, Dimas constructs a multilevel account of state building, analyzing how the provincial state interacted with its own periphery (i.e., rural Tucumán) and with the national state (located in Buenos Aires). State responses to the epidemics, at both the national and provincial levels, were very limited and often ineffective. Nevertheless, as the state and society negotiated disease control policies during the outbreaks and then considered their failures in the aftermath, the state, especially at the provincial level, slowly grew. While Dimas often focuses on continuities across the epidemics, notable change arrived by the end of the third cholera wave. Across three decades (1860s-90s), “the province had indeed changed, and health rose to become a concern of the ruling class as a space to govern, modernize, and place the province within the broader process of the building of the Argentine state through the power of health” (p. 228). That state’s more active role in public health in the twentieth century is thus linked to nineteenth-century disease control processes. Dimas summarizes, “epidemics taught the state, provincial and national, how to govern and build itself simultaneously” (p. 4).
Poisoned Eden questions the traditional narrative of state building in Argentina, which has asserted that the national state violently and coercively imposed itself on the provinces. In focusing on epidemic events rather than the usual variables of “revolt, ... high politics, and armed conflict,” Dimas proposes a “both-and” model: the state grew through both top-down and bottom-up processes, and not only from the (national) center out but also from the (provincial) periphery in (p. 3). He makes a particularly compelling case for the latter, persuasively demonstrating “that in order for the national state to evolve, the provinces had to complete much of the foundational work within their own borders that later facilitated the state to build up from the provinces” (p. 6). Foregrounding disease as the object of study thus enhances our understanding of Argentinian state building.
The second focus of Poisoned Eden is medicalization, defined as “how medical beliefs and practices permeated into society.” Dimas studies this process through the lens of biomedical uncertainty (specifically the debate over if cholera was contagious) and the influence of the medical community on society and state (traced through such metrics as licensed physicians per capita). Throughout most of the nineteenth century, medicalization was limited in Tucumán, especially in its rural peripheries. Poisoned Eden conceptualizes medicalization as “the connector between epidemics and politics,” and Dimas contends that limited medicalization “created the epidemics into contested spaces that required state and society to negotiate public health responses that mutually assured social-state agreements and arrested the development of disease.” However, certain events covered in the book suggest that biomedical uncertainty mostly posed obstacles to disease control and state building. While Dimas does note that the epidemics “exposed many of the underlying medical and bureaucratic problems in Argentina,” a clearer articulation of the complex relationship between medicalization and state building in the introduction would have helped guide the reader (p. 7). Still, there is ample evidence throughout the monograph to arrive at one’s own conclusion.
Dimas’s nuanced historicization of medicalization is one of Poisoned Eden’s strengths, with findings that have much to offer historians of medicine. For example, he traces how competing etiological and epidemiological theories did not map neatly across space, time, or ideology in Tucumán. This contradicts the work of some historians of medicine who have attempted to establish a relationship between one’s stance on contagion theory and politics (i.e., anti-contagion and liberalism). Dimas’s fascinating recreation of the “eclectic” and “pluralistic” medical world of nineteenth-century Tucumán is a prime example of how Latin American case studies can decenter the history of medicine away from the North Atlantic (pp. 11-12, 47, 101).
Beyond these historiographical interventions, the events narrated in Poisoned Eden are engrossing. Some highlights include chapter 2, which draws on cholera dissertations written by medical students at the University of Buenos Aires and the National University of Córdoba, a fascinating source base for studying local knowledge production over time; chapter 3, which skillfully illustrates the mechanics of provincial state building in the context of an epidemic, as the national state simultaneously built itself through international warfare; chapter 5, which would make for excellent teaching material on the intersection of medical theory and political affiliation, especially because of its trove of published political cartoons; and chapter 6, which weaves a rich social history of cholera among urban laundresses and reinterprets the murder of Red Cross workers in rural Tucumán in 1887. Historians and students alike have much to glean from this richly researched and engagingly written monograph. The fact that it has been published in our own “COVID years” makes it an even more compelling read.
. Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866, 2nd ed. (Chicago: The University of Chicago Press, 1987), 4.
Citation: Kelly Urban. Review of Dimas, Carlos S., Poisoned Eden: Cholera Epidemics, State-Building, and the Problem of Public Health in Tucumán, Argentina, 1865-1908. H-LatAm, H-Net Reviews. June, 2022. URL: https://www.h-net.org/reviews/showrev.php?id=57447This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.