Diego Armus. The Ailing City: Health, Tuberculosis, and Culture in Buenos Aires, 1870–1950. Durham: Duke University Press, 2011. x + 416 pp. $99.95 (cloth), ISBN 978-0-8223-4999-0; $27.95 (paper), ISBN 978-0-8223-5012-5.

Reviewed by Brian Bockelman (Ripon College)
Published on H-Urban (August, 2012)
Commissioned by Alexander Vari (Marywood University)

More Than Just a Disease: Buenos Aires in the Age of Tuberculosis

As the nation’s largest metropolis and capital city, Buenos Aires has long served as the focal point and prime mover of Argentine historiography, a situation unmatched even by other countries whose political histories have been dominated by a single urban center, such as Mexico or France.  At times it has seemed that, as far as professional historians are concerned, Argentina’s history can be encapsulated by the dramas of its port city on the banks of the Río de la Plata--as if to know this vast conglomeration is to know the nation itself.  To be fair, scholars of this disposition have simply followed the written sources and social data, which have been disproportionately collected for and from the greater Buenos Aires area compared to other parts of the country. Still, their perennial insistence that we must someday look beyond the metropolis has always had the ring of a literary lament to it.  Only in recent decades have regional studies of the Argentine provinces and secondary cities begun to accumulate, though again these pale next to the proliferation of such efforts elsewhere.  While few would admit it as freely now as in the past, the sense that Buenos Aires holds the key to Argentine history remains as outsized as the sprawling port city itself.

What has changed, however, is the way that historians approach the city.  Alongside the light regionalism mentioned above, the study of Buenos Aires has diversified considerably since the 1970s, when the Argentine metropolis first emerged as a historical subject in its own right rather than merely providing the setting for the nation’s major conflicts and accomplishments.  Following several notable attempts by Anglo-American and European scholars to reconstruct the spatial and social evolution of modern Buenos Aires (c. 1880–1930) in terms of its outward growth, changing patterns of land use, and incorporation of immigrant communities, Argentine historians developed a rich and varied body of sociocultural research that made urban history one of the leading subfields of historical inquiry in Argentina after its return to democracy in 1983.  Few stones were left unturned in this new endeavor to understand the modern city from the inside and at the ground level of everyday experience, especially among the so-called popular classes (otherwise known, equally vaguely, as the nonelite).  The new urban historians examined everything from reading practices to domestic housing to sexuality to such popular entertainment as the tango and soccer, thereby rescuing the habits and haunts of urban workers, women, theatergoers, office clerks, children, and many other social groups from the previously anonymous histories of class formation, unionization, and machine politics en route to the string of authoritarian governments that plagued Argentina after 1930.

Among the pioneers of this effort was Diego Armus, whose edited collection Mundo urbano y cultura popular: Estudios de historia social argentina (1990) was the first to make the social and cultural worlds of the city--primarily but not only Buenos Aires--a conscious and deliberate research topic in Argentine history.  In subsequent decades, as Armus became a leading expert in the history and historiography of disease in Latin America, a topic that might well have driven him to explore remote and underdeveloped backlands or narrow circles of scientists and doctors, he retained his earlier interest in both the urban environment and the sociocultural approach to the past.  The result of this unique merger of specialties is his highly original book The Ailing City, a slightly revised and reorganized English version of La ciudad impura: Salud, tuberculosis y cultura en Buenos Aires, 1870–1950, first published in Buenos Aires in 2007.  While some of the stylistic features of the new monograph betray its origins as a doctoral dissertation, notably the sinuous and lengthy chapters and the occasional disappearance of the main theme behind a drove of intriguing factual discoveries, its overall accomplishment also contradicts the resigned modesty of the author, who claims at the outset that he had to give up his ambition to write a “total history of tuberculosis ... capable of opening a window from which to see how disease and health became part of life in the city through metaphors and discourses as well as through actual, concrete policies and experiences” (p. ix).  In fact, this is exactly what The Ailing City achieves, though the resulting totality is a fragmented one--more a “kaleidoscope” than a “mirror”--thanks to Armus’s open disavowal of “an overarching hypothesis” (pp. 2, 11).

As the book convincingly establishes, tuberculosis was omnipresent in Buenos Aires as both a disease and a topic of public concern during the long era between the scientific identification of the underlying bacillus in the late nineteenth century and its general eradication in the 1940s and 1950s.  Armus emphasizes continuities rather than changes over this eighty-year period, seeking less to explain the eventual decline of the illness than the many uncertainties, ambiguities, and anxieties of an urban society living with a disease that it understood poorly and could not cure definitively.  The extent of tuberculosis’s impact on mortality, especially among workers and poor families who often found themselves in the city’s least salubrious spaces, will likely shock most readers.  Depending on the trade, some 20 to 50 percent of deaths among manual laborers were attributable to the disease in 1912, and the citywide average that year was about 15 percent.  Many more inhabitants carried the bacillus without becoming sick.  Given these numbers, the relative ease of transmission; the unpredictable patient experiences of recovery, remission, and resurgence; and the fact that doctors were better able to diagnose than treat the ailment, fears of contagion were themselves epidemic in modern Buenos Aires.  Armus sagely traces the broad cultural resonance of this dread in a wide variety of sources, including public health laws and regulations, municipal statistics, scientific papers, tracts by hygienists and other urban reformers, anarchist manifestos, school curricula, press reports, advertisements, novels, poetry, tango lyrics, and even films.  One of the real treats of the book is the author’s ability to analyze and contextualize so many different materials, drawing on his vast reservoir of knowledge about the social and cultural life of the city.

With an air of reluctance that masks his command of the subject, Armus develops three main arguments through this impressive, multilayered empirical analysis.  The first is that the obsession with tuberculosis “was a way of speaking not only about biomedical issues but [also] about other matters, matters not necessarily medical and more directly located in the social and cultural realms” (p. 11).  Translation: anxieties expressed over the shadowy but lethal disease reflected a broad range of worries about Argentina’s rapid modernization and the unsettling signs of urban modernity in Buenos Aires.  To give just a handful of the many examples discussed in The Ailing City, tuberculosis was linked to concerns about the impact of mass immigration on social order and the integrity of Argentine culture (some nationalities of new arrivals were projected as uniquely susceptible to carrying and spreading the disease), the increasing but inconsistent reach of the state into the private lives of urban residents, the surfeit of substandard housing and the lack of healthy green spaces in a rapidly expanding metropolis, the heavy toll of routinized factory work on the body, a perceived rise in vice and substance abuse amid the expansion of urban nightlife and popular entertainment, and the changing norms of gender and sexuality in the modern city.  Some of the book’s most captivating sections deal with the latter issue.  Although men were more likely to contract tuberculosis, the disease was habitually “feminized” by discourses that attributed it to the lifestyles and bodies of young women (p. 251).  Armus uses this insight to explain the frequent appearance of frail, tubercular girls as stock characters in early twentieth-century Argentine poems and songs.  He also shows that contemporary disputes over the corset often hinged on beliefs that it could either spread or contain the illness.

Such revelations are by turns tragic and amusing, though Armus goes to great lengths to treat even the most outlandish responses to the tuberculosis threat as part of a general culture of uncertainty that affected all porteños, including medical experts and public officials.[1]  He studiously avoids any suggestion that elites somehow grasped the science behind the disease while everyone else was mired in defensive superstition.  At the same time, he refuses to see popular skepticism about public health campaigns as a defiant act of class or cultural resistance, though he does illustrate how patients sometimes challenged their doctors and showcases the various ways that ordinary people circumvented the most restrictive of official hygiene rules and recommendations.  (Kissing, spitting, boozing, and breastfeeding continued despite the publicized risks.)  Along these lines, the book’s second major argument is that most Argentines willingly participated in efforts to prevent the spread of tuberculosis and actively sought to incorporate scientific knowledge and hygienic practices into their daily lives.  Far from the positivist tool of elite social control that it has seemed to be in other studies, the turn-of-the-century cult of hygiene here appears as a “lay catechism” that reflected a growing if uneven “medicalization” of urban culture (p. 346).[2]  Fear of contagion provided a powerful impetus for people of all classes and ideological dispositions to experiment with and advocate for preventative health measures.  “Such internalization” of hygienic practices, Armus explains, “was due not necessarily or exclusively to the resigned acceptance of the disciplinary initiatives of the modern state but to the recognition of evident material benefits and improvements such practices could provide.  From 1870 to 1940 hygiene became not only a sort of obligation for people who wanted to feel they belonged to society, but also a new right, one which more and more social sectors demanded” (pp. 141–142).

This contention is likely to fuel further debate about the degree to which the “civilizing” efforts to improve public health were an elitist form of state repression designed to eliminate the “barbarisms” of traditional Argentine customs and spaces.  By shifting the lens of analysis to civil society and popular culture, Armus provides an important corrective to our understanding of Argentina’s modernization process, which he sees as more than just a top-down project of social discipline.  That said, The Ailing City can be a bit too indirect at times about who or what caused the medicalization of culture in Buenos Aires.  Like the gradual eradication of tuberculosis, it appears from this account to have happened through a myriad of individual actors and actions working mysteriously toward a collective end.  It is hard to fault Armus for this, since he discusses so many of the specific anti-tuberculosis initiatives that emerged from various social groups and organizations over the extensive period of the study.  Perhaps the problem is simply that eighty years is too long for a synchronic approach to the subject.  When combined with the lack of an overarching hypothesis or plot and the occasional overuse of passive (English) or reflexive (Spanish) verbs, this method tends to downplay causation and development in favor of agency, experience, and meaning.  For all its storytelling, The Ailing City is not really a “narrative” history, as the author suggests in the introduction, but an exercise in multisided sociocultural portraiture--and a fine one at that (pp. 2–3).

The book’s third central argument raises as many questions as it answers.  Armus concludes that the dense thicket of practices and discourses surrounding tuberculosis became “a sort of subculture ... that was decisive in articulating the political worries and initiatives of the social hygiene movement and, later, the public health system” (p. 2).  If we understand “subculture” to be an alternative community that marks its difference from mainstream society by oppositional or unconventional beliefs and behaviors, then the term is poorly used here.  “Infraculture” might be more apt.  As the book shows, tuberculosis was both an ever-present and a nebulous concern for all porteños before 1950.  Always lurking in invisible microbes and in the back of the mind, it was certainly a widespread social and cultural phenomenon.  Yet the public responses were too erratic and episodic to make tuberculosis a central prism through which Argentine culture was refracted for so many decades.  Maybe this is why Armus uses “subculture”--to suggest its subterranean character.  Either way, the real historical significance of the illness lay less in its cultural centrality than in its diffuse but irresolvable presence, which helps explain why eradication efforts enjoyed greater public support than they did for such diseases as smallpox and yellow fever that could be cured by unpopular mandatory vaccination campaigns.  Since no one had full control over tuberculosis, including the state, Argentines were invited to imagine and elaborate their own defenses.  Blending medical science, pseudoscience, folk superstition, and religion (which receives surprisingly little comment in the book despite its importance to the opening and closing vignette), their reactions were arguably too idiosyncratic to constitute a “subculture.”  Thus while Armus claims that a common “antitubercular code” emerged over time, he also shows that it was often ignored or subverted (pp. 1, 345–347).

In the end, The Ailing City offers a sophisticated new interpretation of Buenos Aires as an urban world in the throes of modernization.  It is simply fascinating to observe how medical science developed as a social and cultural phenomenon of broad relevance to the citizens of the city.  It was indeed a crooked path, propelled by much speculation, trial, and error.  Since Armus eschews direct comparisons with other modernizing societies wracked by similar fears of tuberculosis and other diseases, we are left to wonder just how unique the experience of Buenos Aires was.  Urban historians and Argentine historians alike will be keen to determine if the popular participation in the culture of hygiene was replicated elsewhere--not just in other cities but in rural environments.  The Buenos Aires case may have more in common with Chicago and São Paulo, for instance, than with the interior Argentine provinces of Salta and Tucumán, where the state played a much more forceful role in combating local conditions to eradicate malaria.[3] Perhaps the city itself helped nurture the “lay catechism” of disease prevention, or perhaps Armus’s methodological challenge to the “social control” thesis needs to be exported to other locales.  Whichever proves to be true, The Ailing City is a testament to the achievements of the sociocultural approach to urban history and a good example of why the study of Buenos Aires continues to push the boundaries of Argentine historiography.

Notes

[1]. Porteño means “inhabitant of the port city” and is the most commonly used nickname for a resident of Buenos Aires.

[2]. For a strong version of the social control argument, see Julia E. Rodriguez, Civilizing Argentina: Science, Medicine, and the Modern State (Chapel Hill: University of North Carolina Press, 2006).  Similar, if subtler, is Kristin Ruggiero, Modernity in the Flesh: Medicine, Law, and Society in Turn-of-the-Century Argentina (Stanford: Stanford University Press, 2004).  Unlike The Ailing City, both locate the cult of hygiene within a broader field of elite criminological discourses and positivist state projects designed to control an array of social problems in the modern city.  Such elite medical-legal-social concerns about the new metropolis also resonated in the naturalist novels of the late nineteenth and early twentieth centuries.  For an expert analysis, see Garbiela Nouzeilles, Ficciones somáticas: Naturalismo, nacionalismo y políticas médicas del cuerpo (Argentina 1880–1910) (Rosario: Beatriz Viterbo, 2000).

[3]. Eric D. Carter, Enemy in the Blood: Malaria, Environment, and Development in Argentina (Tuscaloosa: University of Alabama Press, 2012).

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Citation: Brian Bockelman. Review of Armus, Diego, The Ailing City: Health, Tuberculosis, and Culture in Buenos Aires, 1870–1950. H-Urban, H-Net Reviews. August, 2012.
URL: http://www.h-net.org/reviews/showrev.php?id=35777

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