This short and elegant book explores the science, politics and institutions behind the ‘discovery, control, and eradication of malaria in Argentina from 1890 to 1950’ (p. 3). Medical geographer Eric Carter has written an insightful history that should be read by anyone interested in public health, state-building or the environment in Latin America.
The campaign against malaria proves to be a revealing window onto the making of scientific knowledge and political power in Argentina, especially in the four northwest provinces where the disease was endemic, Tucumán, Salta, Jujuy and Catamarca. Bringing Argentina into the vast global scholarship on malaria is welcome, and bringing the provinces into Argentine scholarship still largely focused on Buenos Aires even more so. But this is more than just a provincial case study.
Why did malaria gain national prominence? It was concentrated in one region, and was not the largest killer even there. Yet it became the focus of a complex, sustained and ultimately successful state campaign. The answer, Carter persuasively shows, lies in the ‘geographical imaginaries’ constructed around the disease, and the outsize influence regional elites wielded within the national government. This began with the tucumano who forged a unified national state in 1880, Julio Argentino Roca, and continued with provincial worthies such as Eliseo Cantón, dean of the Buenos Aires medical school and author of the first major report on malaria. Carter's study brings into clear view the large cast of reform-minded but politically conservative scientist-statesmen who dominated public life and government policy in northwest Argentina until the rise of Perón.
From early on, malaria was viewed as a disease of place, rooted in a particular landscape. Malaria kept the population lethargic, provincial scientist-politicians claimed, and the fear of malaria kept away the European immigrants they longed to attract. Their solution was ‘healing the land’, or saneamiento, by draining wetlands and building canals to expand usable land in the countryside and create parks in the major cities, like Tucumán and Salta. Malaria control was a strategy for regional development; healing those actually suffering was a secondary concern. This approach seemed to be decisively validated in 1902, when a malaria epidemic struck the provincial capital of previously unaffected Santiago del Estero, only to vanish with the mosquitoes after a massive saneamiento project drained swamps to make an urban park (pp. 49–50).
That same year the national Malaria Service was established. With offices in all four affected provinces, the service opted for broad and thin coverage rather than targeted efforts, saneamiento projects and (some) free quinine pills. After initial success, the Malaria Service had its budget slashed in half during World War I, then settled into a two-decade-long holding pattern under the leadership of an opthamologist. It is at this point that Carter's account gets interesting.
In the 1920s, hygienists turned increasingly nationalist, like much of the Argentine intellectual field, warning darkly of ‘the degeneration of the race’ while rhetorically exalting the virtues of creole workers of the Northwest provinces. This nationalist turn led the Malaria Service to double down on the saneamiento strategy, embracing Italian models of large-scale drainage. More promisingly, it also spurred the founding of regional medical research institutions in the Northwest. As a counterpoint, the Rockefeller Foundation also began work in the region; within a few years, their socially blinkered and politically clumsy officials would be driven out, but in that short time they also made real advances. The regional researchers and Rockefeller doctors began to focus, for the first time, on the local ecology of the insects themselves.
Looking closely at the mosquitoes led to a crucial shift. In the 1930s, Jujuy-born Carlos Alvarado took over the Malaria Service and dramatically reversed course. Drawing together evidence from previous studies, he showed that the dominant mosquito vector in Argentina, A. pseudo, behaved rather differently from what officials had assumed. Far from eliminating this kind of mosquito, Alvarado conclusively showed, saneamiento had helped it to flourish. Applying an ecological perspective, Alvarado reorganised the service around the novel strategy of foci patrols, which called for systematic data collection and targeted mosquito suppression. Shaking up the Malaria Service, Alvarado brought rigour and professionalism, ending the tradition of doctors going on vacation in summer, malaria high season, while concentrating resources where they had the greatest impact. His actions reduced the incidence of malaria and, even more importantly, laid the institutional groundwork for the next shift.
In 1947, after decades of erratic campaigns, malaria was virtually eliminated from Argentina almost overnight, when Alvarado hit upon the idea of using DDT and Perón's reformist health minister Ramón Carrillo threw his full support behind the scheme. This dramatic success built upon the ecological sensibility and institutional reforms Alvarado had developed, but also eroded them in favour of large-scale DDT spraying, which Alvarado would go on to promote evangelically in a highly influential career in international health.
Written with verve, this book is a landmark study of national institutions in provincial territory. It is strong on science, elites and institutions, but somewhat thinner on social history and subaltern groups, largely due to the sources available. Carter navigates the tangled web of Argentine politics with skill, although he makes a few small missteps, such as misdating the constitution or occasionally falling under the narrative spell of his elite subjects. Readers may well be surprised, for example, by his portrait of a conservative Jujuy strongman's concern for the poor or the ‘successful labor activism’ of late 1930s Tucumán (pp. 134–5). His overall take on Peronist health policy is subtle and persuasive. But when he strays from the malaria campaign he starts to lose control of his material, veering from recycled regime propaganda, ‘with the irreplaceable assistance of his legendary wife, Eva, Perón elicited not simply the loyalty but also the adulation of the masses’, to half-digested opposition commonplaces about ‘following Benito Mussolini’ (p. 146). These are minor glitches, however, in a well-built case.
Carter recasts our understanding of public health in this period, while opening up new avenues for comparative research and raising questions for scholars in areas ranging from federalist politics to environmental history. He is particularly suggestive on the consequences of ‘geographic imaginaries’, such as setting the state down a fruitless path of saneamiento and blinding scientists to the importance of studying mosquitoes themselves. This is a book that deserves a wide readership, a model for how to bring questions about scale and territory into studies of politics, expertise and disease.
