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Article

Heather Vrana

In Guatemala, experiences, meanings, and impacts of disability differed depending on one’s race, ethnicity, gender, social class, education, and location, among other factors. They also changed over time. Pre-Hispanic Mayan art indicates physical disability did not exclude people from the elite. In the colonial period (1521–1821), an important charity hospital system emerged. Some Guatemalans who might be identified as disabled today lived with widows and orphans in charity hospices and asylums. Disabled Guatemalans underwent cutting-edge treatments, for better or worse, owing to avid medical research by the protomedicato and faculty at the University of San Carlos. After independence in the early 19th century, Catholic charity endured and worked in tandem with state-building projects, even as disputes between the Conservative and Liberal parties churned. Guatemala’s growing hospital system relied upon this cooperation. The new century brought explosive growth in infrastructure and an expanded role of the state in everyday life. Reforms in policing, public health, and education transformed the lives of some disabled Guatemalans, often expanding confinement and surveillance alongside medical resources. The period of democratic florescence, known as the “Ten Years Spring” (1944–1954), brought reforms, including the creation of the Guatemalan Social Security Institute (IGSS) in 1946 and work-injury, illness, and maternity-benefits laws. Between 1946 and 1948, the Guatemalan and US governments conducted syphilis experiments on disabled residents of the Insane Asylum (Asilo de Alienados), as well as on soldiers, incarcerated people, orphans, and commercial sex workers. By the mid-20th century, decades—or even centuries—of inequality debilitated poor Guatemalans. Chronic illness, workplace injury, malnutrition, and other endemic conditions created temporary and permanent disabilities. Civil war (1960–1996) erupted and revolutionary groups argued that they fought to end the inequality that caused debilitating conditions. The war itself created new disabled people. Combat, torture, and trauma transformed Guatemalans. Yet the Historical Clarification Commission report neglected this topic and the experiences of disabled people in the war. Unlike their peers in El Salvador, Guatemalan veterans did not form influential advocacy organizations after the war. Since the 1990s, disability has been a serious cause and effect of widespread migration to the United States. Migrants have fled Guatemala because of inadequate access to disability-related healthcare and education. Some people have been disabled by dangerous conditions en route to the United States.

Article

Brazil’s environmental history is often told as a tale of irresponsible exploitation and societal indifference. However, a broader perspective must consider the country’s diverging traditions of environmental thought and practice. During the 19th century, several naturalists wrote about the need for the rational use of natural resources, founding a conservationist cultural tradition. In the 1920s and 1930s, a group of naturalists from the National Museum produced various initiatives related to biological research and conservationism. In the 1950s, another group of scientists, agronomists, and journalists founded the National Foundation for the Protection of Nature, active until the 1980s. Although none of these initiatives led to a continuous environmental mobilization, they shaped public policies and cultural sensibilities toward the environment. Beginning in the 1970s, a new wave of environmentalism emerged in several cities—with protests against pollution, nuclear energy, and deforestation—but also in rural areas and forests, with demands from traditional peoples. Over the years, several conservation units and federal institutions were founded to implement environmental policies. Finally, the 1992 Earth Summit gave a special boost to these movements in an era of growing NGO activism. All of these fueled the feeling that environmental activism in Brazil had entered a golden age of dialogue and negotiation. Contrary to this view, some activists claimed that major political advances were still needed. Through the lens of socio-environmentalism and environmental justice, they denounced the displacement of communities by mining companies and the construction of hydroelectric plants, as well as the unhealthy and violent conditions faced by inhabitants of urban peripheries and areas where agribusiness was expanding. Skepticism toward gradual advances was warranted following the election of Jair Bolsonaro, whose administration threatened environmental legislation and institutions and prior achievements. To confront these perils, environmental activism must become a political, scientific, and cultural movement.

Article

Alexandra Minna Stern

Eugenics emerged in Latin America in the early 20th century on the intellectual foundations of 19th-century social Darwinism and positivism, and expanded in contexts influenced by Catholicism, nationalism, and transnational scientific exchange. Although the extent and objectives of eugenic policies, practices, and organizations varied across the region, Latin American eugenicists tended to subscribe to neo-Lamarckian principles of environmental modification, foreground puericulture or infant and maternal care, and support new techniques of human measurement associated with biotypology. Overall, eugenics in Latin America was less extreme than in Anglo and Nordic countries, rarely resulting in sanctioned policies of compulsory sterilization or euthanasia. It was an integral component of programs designed to combat infectious ailments, especially sexually transmitted diseases, and to ameliorate national health indicators. This overlap meant that eugenics sometimes was less visible as a stand-alone movement, and that its tenets were absorbed with little friction into public health and social welfare infrastructures and campaigns. At the same time, eugenic racism was expressed in calls for immigration restriction that reverberated across Latin America, most notably in the 1910s and 1920s. In retrospect, eugenics in Latin America contributed both to exclusionary policies that stigmatized certain social groups and to overarching campaigns for health and wellness that were backed by a diverse political spectrum that could include feminists, Socialists, and military leaders.

Article

At the beginning of the 19th century, Colombian physicians thought of food as an essential factor in shaping human character and corporeality. Framed in a neo-Hippocratic system, health and racial differences were related not only to climate but also to the connection between food qualities and humoral fluids. For example, it was believed that the tendency to eat cold and moist food, as well as greasy substances, was one of the reasons why people in warm regions of Colombia were choleric, phlegmatic, and indolent. By midcentury, it was further argued that each regional type—a local racialized categorization based on geographic determinism—had certain diet habits and physiological characteristics that explained its character (sober, obedient, lazy, industrious, etc.), and that made this type “naturally” suitable for different kinds of work. During this period, the working population’s diet was not perceived to be a social problem requiring regulation, at least not by the government. In the midst of liberal reforms, the political elites were more focused on the economic and genetic integration (“whitening”) of highland Indians, and to a lesser extent blacks, than on producing a supposed “better race” through nourishment. But by the late 19th and the early 20th centuries, however, a new cultural framework that crossed the boundaries of thermodynamics, political economy, experimental physiology, and eugenics had begun to emerge in Colombia, converging in the social problem of nutrition. Centered on the analogy of the human body as a heat engine that transforms energy, local scientists began to conduct surveys of the eating habits of the “working classes,” analyses of the chemical and caloric composition of their foods, and studies on the metabolic characteristics of different regional populations. The results of these investigations were used to push the government to “restore the energies” of an impoverished population that was consistently thought to be weak and racially inferior, but capable of physiological and hereditable improvement. The cry of conservative elites for political and moral “regeneration” at the turn of the century also had a biological component—the optimization of the human motor. In the 1920s and 1930s, several campaigns and institutions were created for this social engineering, aimed at producing a modern, healthy, and industrious citizen. These campaigns gained special political force after the Liberal Party returned to power in 1930.

Article

Giuseppe M. Messina

In Argentina, the provision of health care is divided into three components: a highly decentralized universal public sector, funded from general taxation; a constellation of compulsory collective insurance schemes, financed by contributions withdrawn from the salaries of workers in the formal labor market; and a system of private insurance companies used primarily by the middle and upper classes. Regarding the delivery of medical services, the configuration is mixed, as the weight of public and private providers is roughly equal. This complex structure, which derives from the historical development of particular institutions, produces high costs and unequal access to care according to a person’s geographical residence, occupational status, and purchasing power.

Article

Paola Sesia

Today, the death of women during pregnancy, childbirth or postpartum is considered simultaneously a public health, social inequality, and gender discrimination problem. In Mexico, approximately one thousand women die each year during pregnancy, childbirth, postpartum or from an unsafe abortion, experiencing a premature and sudden death in the midst of their most productive years, often with lasting consequences for their families and surviving children. As elsewhere, the great majority of these deaths would not have occurred if women had had prompt and unlimited access to quality emergency obstetric care, as well as easy access to contraceptives to prevent unwanted pregnancies. Most deaths are related to the substandard quality of available maternal healthcare services; services that are provided for free to most Mexican women in an overly saturated and underfunded public health system that also tends to overmedicalize and pathologize normal births. Their prematurity and abruptness, their occurrence in the process of giving life, the fact that these deaths exclusively affect women, and their avoidable nature make maternal mortality unacceptable in today’s social, political, and ethical arenas. From an historical perspective, deaths in childbirth were much more common in past centuries than today; these deaths were considered inevitable and were accepted as natural occurrences until the late 19th century. However, surrounding rituals, the meaning attached to these deaths, related notions of womanhood and motherhood, and practices to prevent or avoid them, underwent changes according to broader sociocultural, political and religious transformations from Pre-Hispanic times to the 20th century. As elsewhere, in Mexico maternal deaths declined considerably in the 1930s–1950s with the discovery of penicillin and the concomitant decline of puerperal fever; they reached a plateau in the 1960s and 1970s and began to slowly decline again in the 1980s–1990s with an even steeper decrease after the signature of the United Nations (UN) Millennium Development Goals in the year 2000; time when the reduction of maternal mortality became one of eight high-priority global public policy objectives, closely monitored by UN bodies. Maternal deaths are a reflection of ingrained multiple social inequalities that characterize Mexican society at large; poor, rural, marginalized and Indigenous pregnant women face a 2–10 times higher risk of dying than the rest of Mexican women, because their access to contraception and to prompt and high quality obstetric emergency care is more limited. Today, research in the field of maternal mortality etiology, measurement and reduction includes the call for women-centered respectful maternal care, the elimination of discrimination in the provision of obstetric services and the application of a human rights perspective to health policies, programs, and care.

Article

Nicole L. Pacino

During the pre-Columbian and colonial periods, Andean cosmological understandings shaped indigenous approaches to maternal health. Women typically gave birth at home with the assistance of a midwife (also called a partera or comadrona in Spanish). Birthing and post-partum care relied on local herbal remedies and followed specific social rituals. Women drank teas derived from anise or coca during the labor process, gave birth in a squatting position (toward Mother Earth, or Pachamama), and drank sheep soup after labor to replenish strength and warm the body. Rooms were kept dark because the common perception was that bright light injured newborn babies’ eyes. After labor, families buried or otherwise disposed of the placenta to keep the baby and mother healthy and facilitate lactation, as per Andean tradition. Changes in maternal health rituals began in the 18th century, as colonial rule became more consolidated. The rise of a distinct medical profession and government interest in population growth gradually shifted responsibility for maternal health from the Catholic Church and charitable organizations to the state. Throughout the 19th and 20th centuries, the growing power and authority of the state and the medical profession led doctors and urban-based reformers to attempt to change long-standing Andean birthing practices, which they considered archaic and unsanitary. These reforms emerged from a desire to reduce infant mortality rates and to replace traditional healers with medical professionals who were trained, licensed, and regulated by the state. As reformers looked to replace Andean maternal health and healing practices with new scientific understandings of the female body and birthing process, they also worked to discredit and displace midwives’ knowledge and practices. In particular, they encouraged women to give birth in newly constructed hospitals and to seek the guidance of medical professionals, like obstetricians. However, these reforms met with limited success. In the Andes today, midwives still attend to roughly 50 percent of all births, and in some remote areas, the figure is as high as 90 percent. It is also more common today to see the merging of biomedical and ritual practices to increase women’s access to and acceptance of health services and to reduce overall mortality rates.

Article

In Mexico, there were hospitals for the “demented” from the early years of the Spanish colony. It was not until the second half of the 19th century, however, that the first physicians interested in alterations of the brain published articles on the etiology, symptomatology, and treatment of mental illnesses. Within a larger context of health reforms launched during the presidency of Porfirio Díaz (1876–1911), known as the Porfiriato, healthcare officials decided to close the hospitals for the insane and construct a modern institution where psychiatry could grow as a discipline and where patients could be treated using scientific methods. Furthermore, along with the economic and cultural development that took place during the Porfiriato, there was an increase in the number of patients admitted to hospitals for the insane, while at the same time the number of doctors interested in the clinical treatment of mental illnesses increased, as well. The officials’ decision became a reality on September 1, 1910—just two months before the Revolution broke out—when La Castañeda General Asylum was opened. It was a complex of twenty-four buildings in the town of Mixcoac. In addition to being an institution for patient care, it was also where the first generations of Mexican psychiatrists and neurologists were trained. As early as the 1930s, the asylum began to have problems with overcrowding, unhealthy conditions, and deterioration of the facilities. The doctors there repeatedly called for the patient care system to be restructured. In 1944, a psychiatric reform called the “Castañeda Operation” began, seeking to decentralize psychiatric care and to use agricultural work as a therapeutic tool. The result was the creation of seven new hospitals and the permanent closure of the asylum in 1968. Recent historiography on psychiatry from its beginnings in the Porfiriato to the time of that reform have shown that it was a period marked by the rise and fall of a utopian dream, that of the therapeutic effectiveness of psychiatric internment. It was a transition from the single, large asylum in the capital city to a network of hospitals that relied on outpatient care, early detection, and medication as a way to dismantle the asylum model. As a result, La Castañeda General Asylum has held a privileged place in historical study as the stage for the beginning, the development, and the consolidation of Mexican psychiatry.

Article

The prevention of communicable diseases, the containment of epidemic disorders, and the design of programs and the implementation of public health policies went through important transformations in Mexico, as in other Latin American nations, between the final decades of the 19th century and first half of the 20th century. During that period not only did the advances in medical science make possible the identification and containment of numerous contagious diseases; it was also a time when the consolidation of formal medical institutions and their interaction with both national and international actors contributed to shape the definitions and solutions of public health problems. Disease prevention strategies were influenced by medical, scientific, and technical innovations and by the political values and commitments of the period, and Mexico experienced profound and far-reaching political, economic, and social transformations: the apogee, crisis, and downfall of the long Porfirio Díaz regime (1876–1910), the armed phase of the Mexican Revolution (1910–1920), and the period of national reconstruction (1920–1940). Thus, during the period under consideration, and alongside the consolidation of an official medical apparatus as an integral part of public power, the promotion of public health became a crucial element to reinforce the political unification and the social and economic strength of the country.