Public Health and Xenophobia

One way that immigration and health were entangled and a reason why these two separate fields should connect more was the way that immigrants were disproportionately targeted in discussions of illness in the final third of the 19th century and into the 1940s. If social histories of medicine (as an international field) increasingly point to the gender, class, and racial dimensions that shaped medical knowledge and the application of health policies, this field in Argentina should pay greater attention to the xenophobic nature of how doctors and public health officials talked about disease. All countries have histories of health and medicine, but not all of them have histories of immigration the way that Argentina does. The Argentine version of the history of health and medicine (and one could, of course, say the same about places like the United States, Canada, Uruguay, Australia, and others) should take the particularities of immigration into account.

One telling example of how health and immigration were deeply connected is the writing and career of Juan Alsina, the director general of immigration for Argentina in the crucial decades between 1890 and 1911. In 1899, Alsina received a doctorate from the Faculty of Medicine from the University of Buenos Aires.¹⁴ In his thesis, titled “Brief Considerations on Immigrant Hygiene” (“Breves consideraciones sobre la higiene del inmigrante”), he became one of many elite voices who incorrectly linked immigrants to the spread of disease. One of his concerns was tuberculosis, both because it was incurable before the discovery of antibiotics and because it led to debilitating illness that rendered the infirm unable to work. As he wrote:

People infected with tuberculosis enter our country daily and, I can say, in large numbers . . . The number of those infected entering the country is so considerable that it is impossible to reject them all, but shortly after they arrive, they become a heavy burden on our hospitals.¹⁵

In this assessment, Alsina put excessive weight on arrivals in propagating what was an endemic disease. Beyond his assertion, he provided no data in his thesis about the people slipping through undetected.

Alsina was not alone. To address growing concerns about health threats in Buenos Aires (and to a lesser extent other cities), a group of doctors aimed at shaping policy and urban planning called higienistas began in the 1870s to prod the state into action, a moment that would last until the 1920s. The title higienistas should be translated as “public health officials and doctors” and understood in the turn-of-the-20th-century sense of the field that included concerns about congenital disorders and contagious disease, moral judgments, and decisions shaped by prejudices of race and class. Higienistas worked with politicians to create the National Department of Hygiene in 1880 (the precursor to the Ministry of Health) and in the capital city also an agency called Municipal Public Assistance (Asistencia Pública Municipal) in 1883.¹⁶

In Buenos Aires in particular, immigrants were often the central focus of early public health campaigns. Public debates and public policies regarding prostitution and venereal disease focused in large part on immigrants.¹⁷ A large number of both sex workers and clients were immigrants, and the heavy-handed, gendered, and classist concerns about venereal disease were another example of how immigrants were often labeled as the vectors of infection. Guy has shown that prostitution stood alongside very different social or medical ills such as tuberculosis and alcoholism as “ailments treated by social hygienists (doctors) as a result of the unhealthy environment that surrounded the daily lives of workers.”¹⁸ As Adriana Álvarez has argued:

Health professionals empowered the state with a discourse that appeared irrefutably rooted in science; they offered a diagnosis loaded with concerns about the uncontrolled presence of immigrants, diseases, plague, poor and miserable people, all the result of a cosmopolitan city [meaning a city filled with immigrants].¹⁹

One of the first concerns of Dr. Emilio Coni, the founding thinker of Argentine higienismo, was crowded housing in Buenos Aires in the 1870s, a space where immigrants were not only overrepresented but also increasingly overrepresented in the subsequent decades. Coni worked to show how cramped living and poor sanitation would lead to epidemic disease. In his writing on housing and urban space, immigrants were front and center.²⁰ Coni also pushed to create a growing state bureaucracy to police matters of hygiene and public health.²¹ Another more indirect way that higienismo became entangled with immigration was through public education. As Karina Ramacciotti shows, the rapid rise of compulsory education in the 1880s was linked to health. She notes that the 1884 Law of Common Education “stipulated that schools should encourage the inspection ‘of morality and hygiene’. With these powers, the National Council of Education (Consejo Nacional de Educación) created the School Medical Corps in 1888.”²² At the same time, another important part of this compulsory education project was to confront the cultural pluralism created by the growing presence of immigrants and their Argentine children.²³ Public education promoted a set of ideas and practices about public health, and a core part of public education was focused on the children of immigrants.

In the case of venereal diseases, immigrant women were often targeted as the spreaders of illness (infections which were already present in Argentina). In the case of tuberculosis and trachoma, immigrants were often accused of importing illness from abroad. This thinking, in turn, shaped the country’s immigration policies, the inspection of arriving passengers, and in some cases the deportation of the infirm. As Diego Armus writes, doctors and officials commonly spoke of immigrants carrying tuberculosis who entered the country undetected.²⁴ Spanish immigrants, and Galicians in particular, in fact did have higher rates of tuberculosis, but other scientific data from the time showed that Italians and Russian Jews in fact had very low rates of infection.²⁵ Doctors overlooked such data that suggested that immigrants (as an amorphous group) did not bring the disease and instead developed many theories about Spanish infection rates. In the early 20th century, some pointed to supposed hereditary predispositions, while others, often Spanish immigrant doctors in Argentina, pointed to the nature of the jobs that Spanish and Galician immigrants had that exposed them to the illness (a more accurate medical assessment).²⁶

In the early 20th century, trachoma emerged as another major concern for immigrant health inspection and another disease that health officials believed they could combat by focusing on international arrivals. Trachoma was a bacterial infection of the eye that led to blindness. It was highly contagious, and, indeed, it could spread rapidly on ships where passengers spent three or four weeks in close quarters and with poor sanitary conditions if there was a communicable disease. Yet trachoma was endemic to Argentina before immigration officials and doctors began targeting immigrants as the vectors of this disease.

In 1908, Alsina wrote that people with trachoma had entered the country from a neighboring country.

[T]hey became a true plague . . . They are gangs of blind people and individuals suffering from poor vision, incapacitated to work, who travel around in pain, overwhelming hospitals and planting the seed of that terrible illness along the way. It is excessively contagious and difficult to treat. Even the cured remain feeble in their vision, and they are not fit for work.²⁷

María Silvia Di Liscia and Melisa Fernández Marrón argue that trachoma was used “as an argument to deny entry to (Jewish) Russians and Poles and Syrian-Lebanese, among other groups, considered infected because of their racial origin or due to lack of hygienic habits.”²⁸ This was a change from earlier immigration policy in which “the primary objective of hygienists was to prevent future epidemics of yellow fever, cholera, plague and smallpox, similar to those that devastated the many urban centers in the second half of the nineteenth century.”²⁹

As Di Liscia and Emma Gioia have shown through a history of medicine perspective, the rise of Argentine treatment of and research on trachoma connected the country to scientific networks in Europe and that this Argentine history should be understood in terms of these international connections.³⁰ The authors make that point and engage with a central topic in the history of medicine: scientific networks and international collaboration. One could add, then, that in some countries (such as Argentina) and with some illnesses, migration was a central factor driving those networks and connections.

In the historiography of medicine and health in Argentina that focuses on the late 19th and early 20th centuries, immigrants are often mentioned, but the focus is on doctors, officials, institutions, and science. Engaging with questions defined by analogous fields in Europe (where questions of immigration are not central), scholars of health in Argentina rarely make immigration (immigrant voices, priorities, agency) a central topic of analysis. A critical reading of how the history of medicine and health was fundamentally xenophobic and that the pathologizing of immigrants was a crucial aspect of health and medicine would enrich that historiography. At the same time, scholars of migration in this period could pay more attention to how the concerns of public officials about health shaped the lives and experiences of immigrants.

Health and Immigration Policy

Health was a core feature of Argentine immigration policy and the regulation of borders. The 1876 Law of Immigration and Colonization came about in the immediate aftermath of a massive epidemic of yellow fever (1871) and several outbreaks of cholera (1867, 1868, 1873).³¹ In 1871, a total of 13,614 people in Buenos Aires died from yellow fever. Other cities and rural areas had also been scarred by both cholera and yellow fever.³² In the case of Buenos Aires, with a population of 177,787 in 1869, approximately 8 percent of the city died from the outbreak of yellow fever in 1871.³³ Both because of these experiences and broader changes in the fields of hygiene and public health, article 31 of the Law of Immigration and Colonization passed just a few years later named specifically Asiatic cholera and yellow fever, as well as “any other epidemic disease,” as grounds for exclusion.³⁴

With increasing rigor from the 1870s onward, ships carrying immigrants that arrived at the port of Buenos Aires were met by an inspection committee (junta de visita). One of the inspectors’ many tasks when they boarded a recently arrived ship was to confirm “if passengers [had] boarded where any epidemic reins.”³⁵ In an 1898 essay about the need for maritime defense against epidemic disease, Luís Agote described cholera as endemic in the Ottoman Empire and yellow fever as endemic in Brazil.³⁶ Both were places from which new arrivals in Argentina were coming. Agote warned that both could lead to epidemic outbreaks as the result of frequent maritime traffic and called for health inspection to prevent them.

Article 32 of the law added other health concerns to immigration policy beyond epidemic diseases. It stated:

The captains of ships carrying immigrants will not be able to transport to the Republic people with contagious diseases or with any organic vice [constitutional defect] that makes them useless for work; nor insane, nor beggars, nor prisoners or convicted criminals, nor anyone over the age of sixty, unless they are heads of household. Violators will be obliged to transport these passengers back at the expense of the company and will be fined in accordance with Article 35.³⁷

Article 32 lumped health concerns together with several other grounds for exclusion; in this 1870s moment, contagious disease, defect, madness, begging, and criminality were related through ideas of heredity in ways that we no longer imagine. Ignoring begging and criminality, Article 32’s inclusion of contagious disease, mental illness (dementes), and physical disability (vicio orgánico que los haga inútiles para el trabajo) made three types of health part of immigration policy.

The broad categories of the immigration law enabled state officials to include many specific ailments in their ship inspections. Moreover, a presidential decree in 1913 put in writing what had already been the practice over the previous decades. It stated:

In accordance with Article 32 of the Immigration Law, the General Directorate of Immigration must rigorously prevent the disembarkation of all immigrants with symptoms of tuberculosis, leprosy, or trachoma. In addition, it must also oblige the captains, at their own expense, to return said immigrants and to apply the fines outlined in Article 35 of the aforementioned law.³⁸

Concerns about immigrants bringing tuberculosis appeared in immigration records in the 1890s, while trachoma appeared on the radar of health and immigration officials in 1907.³⁹ Both were formally codified as a ground for exclusion in the 1913 decree.

The question of enforcement further complicates how we read this history of health and immigration. Julia Rodriguez argues that in the case of medical inspection, “Argentine modernizers’ attempts to use science and medicine to tame the forces unleashed by mass immigration were frustrated by a small and weak state. Many public health physicians realized how futile their efforts were.”⁴⁰ She also adds that “the lack of any significant immigrant exclusion at the point of entry, however, revealed a gap between rhetoric and reality.”⁴¹ In talking about the small numbers of rejections in this period, Armus writes that these numbers “indicate that none of the politico-administrative initiatives seemed capable of accomplishing their goals, largely because they were very difficult to put into practice.”⁴² There are two other possible readings that could complement Rodriguez and Armus’s points. First, the very existence of the policies had a deterring effect on potential emigrants, inhibiting them from ever boarding a ship in the first place. This point is even more relevant because Argentine sanitary inspection was enmeshed in a broader transatlantic system, and there were also controls in ports of departure. While it is true that the number of detected cases in Buenos Aires was low, sanitary inspection and rejection in European ports of embarkation were also common.⁴³

Mental illness was another area of concern for immigration officials. The term “demente” (mad or insane) appeared in the 1876 Law of Immigration and Colonization, though in practice by the turn of the 20th century, legal and medical discourses about arriving immigrants generally used the labels “mental derangement” (enajenación mental) or “mental alienation” (alienación mental). For example, in January 1908, the passenger J. A. arrived on the steamer La Blanca. He was first detained on the ship on suspicion of suffering from “mental derangement.” After observation, he seemed to have “regular use of his faculties and he received a preliminary landing permit” and was interned in the Infirmary of the Hotel of Immigrants for further observation. The next day, the medical director ruled that J. A., “from the moment he entered the infirmary, was in a perpetual state of agitation and incoherence in ideas and actions. On these grounds, the doctor noted J.A. as incurably alienated (alienado incurable) and useless for work.”⁴⁴ The case concluded, “As a consequence, the Directorate ruled that he be returned to his port of departure, and it took a bond of 1,000 pesos, on responsibility of the captain.”⁴⁵ In another instance, in April 1908, a nineteen-year-old Spanish woman, traveling alone and who boarded in Almería, was described as mad (demente). She was denied entry to upon arriving in Buenos Aires, and Alsina noted, “The infraction was more severe if one considers that the captain could not claim extenuating circumstances in his declaration, because among other factors, the nudity, the extreme poverty, and the physiological misery of M is noticeable on first sight.”⁴⁶

Cases such as these were a regular occurrence in the annual reports of the director general of immigration. The number of documented illnesses were low, but their very documentation is significant. These cases reveal how mental illness was part and parcel of the system of health inspection alongside concerns about infectious diseases such as tuberculosis and trachoma. They all grew out of the connected articles 31 and 32. The efforts to detect cases of “madness,” “derangement,” and “alienation” in port sanitary inspection were important concerns.

Beyond the border, mental illness continued to be bound up with questions of immigrants and immigration. Jonathan Ablard writes that the impetus behind the creation of state asylums—there were in fact only a few and almost exclusively in the city of Buenos Aires and the provinces of Buenos Aires and Santa Fe—was “the conviction that the immigrant masses, whom many considered more difficult to control than the native poor, posed moral, biological, and political dangers to the health and well-being of the republic.”⁴⁷ As Dedier Marquiegui writes, immigrants were disproportionately interned at asylums. In 1870, at the Hospicio de las Mercedes, foreigners were two-thirds of the patients.⁴⁸ The shockingly high presence of immigrants at this state institution was likely because of a mix of prejudice, fewer social and family support networks, class dynamics, and the impact of immigration on mental health.

A new National Institute for the Alienated (Colonia Nacional de Alienados) opened in 1901 near Luján in the province of Buenos Aires, and it grew rapidly. It had 241 patients in 1902 and 390 in 1903; by 1920, it had approximately 1,250 patients.⁴⁹ At another institution, the Hospital Esteves in Temperley (just south of the city limits of Buenos Aires), foreign nationals outnumbered Argentines from the moment data was kept in 1910 and until 1948.⁵⁰ In 1914, almost exactly half of the inhabitants of the city of Buenos Aires were foreign born, yet in the same year, foreigners outnumbered Argentines at a ratio of approximately three to one.⁵¹ As Ablard notes:

many psychiatrists argued that the state of Argentina’s psychiatric health was seriously harmed by uncontrolled immigration. The presence of so many mentally ill immigrants was a burden on the ability of the hospitals to function properly, and those who remained unconfined represented a hidden threat to the nation’s health and vitality.⁵²

In a cruel vicious circle, the state and medical institutions targeted immigrants while also lamenting the burden they put on the psychiatric system. Because there were also many private psychiatric clinics, class dynamics may have pulled some Argentines out of state asylums and further tipped the balance toward immigrants in public institutions.

Concerns about health were a central feature of Argentine immigration control from the 1870s and over the next six decades as more than six million foreigners entered the country. Immigration officials named contagious diseases, disability, and mental illness as three conditions to exclude.

Community Control and Contribution

In histories of health in Argentina, immigrants generally appear as the objects of concern of state officials or doctors. Yet immigrants in many parts of Argentina contributed to the development of professionalized medicine in several ways, and they also brought with them nonprofessional knowledge and practices related to health and curing. One very important part of the history of health in many Argentine cities was the role of immigrant associations in the provision of healthcare. By the early 20th century, nineteen hospitals in the country were run by nonprofit associations. In Buenos Aires in 1910, the Italian, Spanish, British, German, and French hospitals treated 20.4 percent of all hospitalized patients in the city.⁵³ There were also Italian and Spanish hospitals in Córdoba and Rosario and a Spanish hospital in Mendoza. María Liliana Da Orden writes that two other immigrant-run hospitals were in Santa Fe (in addition to the Italian and Spanish hospitals in Rosario), one in Entre Ríos, and three in Buenos Aires.⁵⁴

In addition, dotting cities from Tucumán to Bariloche, from the 19th century onward, were hundreds of mutual aid societies organized along ethnic lines whose primary goal was to pay for the healthcare costs of paying members. These mutual aid societies ran their own clinics where they often employed immigrant doctors. As Da Orden writes, “In large cities as well as in medium or small urban centers, migratory groups organized mutual aid societies.”⁵⁵ In the early 20th century, there were more than 1,200 mutual aid societies in the country and they had more than 500,000 members.⁵⁶ Because membership often but not always included wives but never children, in a country of eight million inhabitants the number of households that had health coverage through a mutual aid society made up an even bigger proportion of society.

Historians often present social welfare in Argentina and elsewhere in Latin America as a task divided between the state and the Catholic Church and a domain that the state came to dominate during the presidencies of populist leaders.⁵⁷ The health network of Argentina remains marked by the system that developed before 1945, and in the 21st century, hundreds of thousands of people receive health coverage at a hospital that retains a name like the Italian, British, or German Hospital. Furthermore, millions of people receive health coverage through an obra social (health insurance plan), which to some extent developed out of the system of mutual aid societies (in particular as they shifted away from immigrant communities and to trade unions).⁵⁸

Nineteen hospitals and hundreds of mutual aid societies, combined, made up a fundamental part of the health care system in many Argentine cities. Their relative absence in the social history of health reflects a methodological shortcoming that privileges state sources and those produced in Spanish. Yet the publications (both periodicals and annual reports) of these institutions paint a clear picture about how immigrants played a crucial role in the provision of health care in Argentina. Through hospitals and mutual aid societies, European immigrants provided health services in addition to those offered at public and Catholic hospitals or at private or public clinics.

There were many reasons for affluent immigrants, community leaders, and doctors to create and sustain these hospitals. Providing care in a foreign language and in a culturally sensitive environment was surely a factor for patients, fee-paying members, donors, leaders, doctors, and nurses. The lack of hospitals and clinics, especially in the 19th century and in secondary cities of the republic surely also motivated groups to mobilize and create both hospitals and mutual aid societies. The European status of these organizations is worth noting; there was no Indigenous, Uruguayan, or Brazilian hospital in Buenos Aires or Rosario. The communities that carved out a place for themselves in this laissez-faire system of health care benefitted from and worked to maintain European privilege. Through the strong focus on charity and free care (at hospitals, not mutual aid societies), affluent Europeans brought working-class Europeans into this system.

Mimicry was also an important factor that led to the creation of both hospitals and mutual aid societies. Why did German speakers in Buenos Aires begin raising funds to create a hospital in the late 1860s? Surely the existence of a French hospital and that Italian, Spanish, and British immigrants had all just begun to organize to create hospitals of their own was a factor. In so doing, it brought a certain degree of respectability to a loosely defined community. In 1918, when the Deutsche La Plata Zeitung referred to the German Hospital as “a proud landmark of German culture on Río de la Plata, an everlasting symbol of German charity,” it was referring to an image of a respectable community where affluent members donated money and paid membership fees to support a community institution.⁵⁹

Charity and caring for working-class immigrants were the often-stated main goal of all these hospitals. For example, the monthly magazine that the Spanish Hospital published told 55,000 members in 1938:

The hospital, a magnificent work has been born and developed over the past sixty years, is a sign of the blessed and inexhaustible Spanish charity. No matter how great and immense the miracles of mutualism, they are not enough to match the enormous demands on our house of charity, which must offer an open door to everyone who comes in search of support.⁶⁰

Helping working-class immigrants in need of a common background was the officially stated main goal of all these hospitals. For example, in 1882, the German Hospital announced in a local German-language daily that “the hospital provides not only free health care to poor, indigent sick people but well off and paying patients are treated in separate pavilions.”⁶¹ In 1918, in a full-page advertisement in the Deutsche La Plata Zeitung, the Hospital Association announced: “Germans and German speakers! Become members of our association. He who does not see any advantage for himself in joining our association should consider that through his membership he supports our charitable endeavors (free care for indigents)!”⁶²

The 1887 municipal census referred to the French Hospital as an “institution of charity.”⁶³ In the early 20th century, the statutes of the French Hospital stated that its goal was to “care for all of its members, of both sexes, for free, and for indigent French people. The hospital helps as much as it can all French who are in need in the Argentine Republic.”⁶⁴ In talking about the growth of the Jewish Hospital of Buenos Aires in 1928, the editors of Mundo Israelita newspaper noted:

in addition, the “Ezrah,” as its Hebrew name indicates, is an institution with highly philanthropic aims, and it dedicates part of its activities to helping the needy who come to its doors, supporting hundreds of orphans, widows, and the poor as much as possible.⁶⁵

The commitment to charity at hospitals played out in data. At the German Hospital, 26 percent of the patients treated in 1885 did not pay, 33 percent did not pay in 1903, and 32 percent did not pay in 1925.⁶⁶ In 1909, half the people treated at the French hospital did not pay.⁶⁷ Affluent immigrants in Buenos Aires paid membership fees and made significant financial donations so that working-class and “destitute” immigrants and Argentines of a specific ethnic background could receive care. The implications of this are significant. In an era when the Argentine state played only a partial role in the provision of health care, immigrants in cities all over the country built hospitals and clinics, and they hired and, in some cases, trained doctors and nurses. The rise of modern medicine in Argentina emerged not only from the “hygienists” of the late 19th century and the Faculty of Medicine at the University of Buenos Aires but also from immigrants who fundamentally believed in notions of community, which included paternalistic relationships with workers and a belief that medical services in foreign languages and in more culturally sensitive environments mattered.

The leaders of hospital associations and mutual aid societies were aware of their place in the system of Argentine health. To mark the opening of a new pavilion at the Jewish hospital in 1928, the editors of the Mundo Israelita commented:

There is no doubt that Jews all over the republic have contributed and continue to contribute to its [the hospital’s] construction and maintenance, not only so that they can use its services in the case of need, but also because its very existence represents an undeniable testimonial of their cooperation and their relationship with Argentine society in the field of health, and it is a point of prestige for the Israelite community.⁶⁸

In 1935, the Medical Association of the hospital noted in an annual meeting that:

the Hospital Israelita participates in a visible, effective and constant way in the life of the city of Buenos Aires . . . With its hospital, our community contributes a valuable service to the municipal government. And the Jews of Argentina participate as citizens who are integrated into this land, aware of their duties.⁶⁹

The Argentine government was also aware of these institutions’ contribution to the city’s health network. The hospitals received small portions of the Lotería de Beneficencia, off and on from the 1890s onward.⁷⁰

By the mid-1940s, the eight immigrant-run hospitals in Buenos Aires had significantly expanded their capacity alongside the growth of other public and Catholic hospitals. In 1945, the Jewish hospital treated 4,285 interned patients (357 per month) and 99,727 patients in the clinic (1,918 per week).⁷¹ In 1946, the hospital employed 140 doctors and thirty-five interns, as well as 105 nurses.⁷² It had a full slate of medical services, such as general surgery, maternity, gynecology, allergies, neurology, otorhinolaryngology, skin and syphilis, orthopedics, dentistry, cardiology, children, rheumatology, massage, x-rays, and nutrition.⁷³ In 1946, the British Hospital treated 4,374 patients,⁷⁴ and the German Hospital treated 4,523 patients in the same year.⁷⁵ The two largest immigrant-run hospitals treated significantly more people, but the difference was nowhere near as much as the difference in the size of the city’s Spanish, Italian, Jewish, British, and German “communities” (broadly defined). In 1946, the Spanish hospital treated 6,184 interned patients.⁷⁶ Meanwhile, the Italian hospital treated 7,477 interned patients in the same year.⁷⁷

At stake for the prosperous immigrants who financed and ran these institutions was their social and class power not only within a community but also in Argentine society.⁷⁸ They used the cause of social welfare to construct a specific image of their community. The male leaders of these institutions paternalistically nurtured the health, stability, and growth of ethnic communities and made use of their gender and social class to position themselves as the patriarchs of those communities. In so doing, they gained social status, fulfilled self-created obligations, and attempted to solidify the place of different European ethnicities in Argentine society. Alongside these men, immigrant women raised funds and promoted the idea of a respectable ethnic community that participated in the surrounding system of class relations. The goal of creating stratified but united ethnic communities entrenched specific gender roles for female philanthropists, and gender models were constructed in relation to ethnic and class interests.

These hospitals were part of the health network in cities all over the country. This was particularly pronounced in Buenos Aires where the higher concentration of foreign nationals and where ethnic elites of many backgrounds created more and larger hospitals than anywhere else in the country. All of these hospitals saw free medical care as a core part of their mission. When considered as a whole, that means that a significant part of the health system of Argentine society was defined by immigration. Had there not been so many immigrants, the system of healthcare in Argentina would also be different. That immigrants became so involved in health care also surely fostered the arrival and retention of foreign-trained doctors in Argentina, which means that immigrant organizing had an even bigger impact on the history of health and medicine in Argentine history.

Conclusion

The histories of health and of immigration in Argentina were mutually constituted. Modern ideas about the state, hygiene, and spending came into being while hundreds of thousands of people immigrated to the country every year. The traces of this history can be seen not only in the pronouncements that doctors and public officials made about immigrants but also in the activities and goals of immigrants themselves. Immigrants were the objects of xenophobic and ill-informed health policies, but they also carved out a place for themselves and shaped health in Argentina. They built hospitals and clinics, they cared for the sick, and they helped transmit international scientific developments into Argentine medical circles.

Health care in Buenos Aires and in several other cities was provided in a patchwork manner by the state, private philanthropy, the Catholic Church, and immigrant communities. Each group had its own motivations, and from the 1870s to the 1940s, a certain equilibrium existed. Health was a domain where the Argentine state could have exerted more influence before the 1940s. The system that actually existed, therefore, tells us something about the nature of the liberal regime that shaped Argentina in this period.

Author Note

Benjamin Bryce is an associate professor in the Department of History at the University of British Columbia and chair of the Latin American Studies program. He is the author of two monographs, including To Belong in Buenos Aires: Germans, Argentines, and the Rise of a Pluralist Society (Stanford University Press, 2018). He is also the coeditor of four volumes; the most recent one, with David M. K. Sheinin, is Recasting the Nation in Twentieth-Century Argentina (Routledge, 2023).

Discussion of the Literature

The history of health and the history of immigration in Argentina, even when covering the same period, are almost completely unaware of one another. The questions that animate the history of health continue to be state power, modernization, and scientific and medical developments.⁷⁹ A recurring theme is the weakness of the Argentine state in the early 20th century and the aspirations of doctors and public officials to change this.⁸⁰ In histories of specific ailments such as trachoma, tuberculosis, venereal disease, and mental illness, immigrants are often mentioned, but questions of foreign citizenship, ethnicity, and race are not central to the analysis nor are the voices of migrants.

Many doctors were immigrants themselves, and many others were the children of immigrants who completed some of their studies in Europe (almost always in the foreign language that they learned from their parents and as a result of their upbringing in a society where bilingualism and cultural pluralism were common). One of the first female doctors in the country, Petrona Eyle, was the child of Swiss immigrants and went to her parents’ country in 1887 to study medicine.⁸¹ Eyle returned to Argentina just four years after the first female doctor in Argentina, Cecilia Grierson, began practicing medicine.⁸² Grierson, the granddaughter or Scottish and Irish immigrants, was not only a prominent Argentine feminist but was also involved with an English-speaking immigrant and the Anglo-Argentine community all her life. Two other prominent doctors from the turn of the 20th century were themselves immigrants. Alicia Moreau de Justo was born in London and immigrated to Argentina as a child and received a medical degree from the University of Buenos Aires in 1907. José Ingenieros had a similar trajectory; born in Palermo, Italy, and a child immigrant, he received his medical degree in 1900.⁸³ Would we learn something important about professional medicine if we asked some questions about these doctors’ correspondence with doctors in England, German-speaking Europe, and Italy and their ability to read medical texts in foreign languages? Is that not all that much more important considering there was a large Italian, British, and German Hospital in Buenos Aires, all of which were central organized around fostering bonds of community among immigrants?

Research on the history of immigration to Argentina, since its boom in the 1980s, continues to remain focused on ethno-linguistic groups and asks questions about topics such as language, political engagement, education, transnational connections, notions of community, religion, and belonging. How a few dozen public health officials talked about immigrants has not been of particular interest for most scholars of immigration. Analyzing how doctors or officials blamed immigrants for the spread of a range of diseases would not have much of an impact on the themes central to the historiography of immigration. Even the disproportionate presence of, for example, Italians at state-run mental asylums or Galicians’ higher rates of tuberculosis were still a small part of the Italian or Galician story in any given place in Argentina.

Mutual aid societies have long been a central area of inquiry in studies of different groups in Argentina. Yet the primary function of providing health care has been less relevant to researchers, who instead have focused on how workers organized. While paying for health care was the main goal (and most expensive activity) of almost all mutual aid societies, leaders often talked about health alongside work placement services. Being healthy was about getting back to work. The community activities of mutual aid societies (such as social events and fundraisers) have mainly fit into a broader historiographic focus on topics such as ethnic nationalism or community identity. Yet as was mentioned in the introduction, hospitals and mutual societies were the largest immigrant-run institutions in Argentina. They had more members and larger donations than any other kind of association. Their biennial or triennial fundraisers received frontpage coverage in immigrant-run newspapers, and on a weekly basis they had small advertisements in newspapers calling on people to join a given hospital association or mutual society.

The “Community Control and Contribution” section of this article, which focuses on immigrants as active agents in making the system of modern health care in Argentina, is part of a new historiographic trend. Beyond Guy’s 2007 article about the Jewish Hospital of Buenos Aires and Benjamin Bryce’s 2011 article in Estudios Migratorios Latinamericanos about the German Hospital of Buenos Aires and 2024 chapter in an edited volume about the city’s Jewish Hospital, historians Pilar González Bernaldo de Quirós and Da Orden published excellent studies in 2013 and 2020 in Revista de Indias about mutual aid societies (writ large) and the Centro Gallego.⁸⁴ Other Argentine historians have also taken interest in the intersection of health and immigration, from the perspective of the state rather than community organizing. Di Liscia, Marrón, and Gioia, all focusing on trachoma, and Armus, focusing on tuberculosis, have done much to foreground immigration in histories of health.⁸⁵