LECTURE

DATE LECTURER2/19/2013 Aaron Pascal Mauck MA, PhD

Internationalism and Health

HISTORY OF SCIENCE 148

Structure of the Lecture

I. Class Business: Primary Source Assignment

II. Summary of Last Week & Lingering Matters

III.Political & Economic Origins of Internationalism

IV. Internationalism and Public Health Research

V. Internationalism and Late Colonialism

Class Business: Primary Source Assignment

Using library or online collections find a brief (1-4 page) account in the clinical or public health literature (e.g., Lancet is online- accessible from 1823 onwards, as are a large number of late 19th century and early 20th century medical texts from Countway’s collaboration with Google books) relevant to the definition of a tropical disease, the practice of tropical medicine, or a program of tropical hygiene written between 1860 and 1914.

- Basic introduction to historical methods- how history is actually done

- Seeing tropical medicine as a historical actor might have seen it

- Place an actual historical document within the context of the secondary readings. Suggest where this document might be located within the broader history of global health.

Key Insights from Last Week

I. The emergence of tropical medicine as a specialized field required the alignment of governmental, industrial, and professional interests.

II. Tropical medicine was predicated upon conditions of a colonial expansion that took place in two stages:

1. Expansion of infrastructure increasing pace and scope of commercial flows of capital, commodities, and people (Railroads, Canals)

2. Increased corporate investment in colonial periphery for the extraction of raw materials (timber, mining, agricultural products)

III. In Great Britain, tropical medicine emerged out of conditions of “constructive colonialism,” which greatly expanded the colonial officer corps, and placed a premium on the health of British officers.

IV. In all empires, germ theory led to the abandonment of the idea that tropical climates inherently led to disease for whites, thus fostering the belief that tropical diseases could be prevented.

Origins of American Tropical Medicine

George Sternberg 1838-1915

British Tropical Medicine has its origins inColonial Control, while American Tropical Medicine has its origins in warfare (1898 Spanish-American War) and in presence of Tropical diseases on American Soil

US Army Medical School established Under Surgeon General George Sternberg In 1893

Sternberg had long experience diseaseControl in military contexts, and by 1880sHad come to be seen as an expert on Bacteriology

Focus on control of “camp problems,” coupled With training in bacteriology, leads Sternberg (and the school) to focus on bacteriology, Prevention, and hygiene

Failure of Yellow Fever control in Cuba Through sanitation measures promptsControlled experiments to identify Source of the disease

Yellow Fever experiments part of a new Experimental campaign initiated by Sternberg in 1898, reflects Sternberg’s Belief in a mosquito vector

Walter Reed1851-1902

Aedes aegypti

Through experiments exposing subjects to bodily Substances of yellow fever victims versus mosquito bites,Reed confirms mosquitoes as cause of the disease

Further confirmed by Gorgas’ success in controlling yellow Fever during construction of Panama Canal

British and US legacies of tropical medicine reflect Contingent historical conditions under which the first schoolsOf tropical medicine developed

Political & Economic Origins of Internationalism

WWI often attributed to a prevailing climate of nationalism,Coupled with the emergence of

Two large power blocs withCrosscutting political obligations

Culture of Progressivism had already Emphasized internationalism as a

key twentieth century goal

The 1919 Paris TreatyEnding WWI also establishes

The League of Nations for the promotion of perpetual Peace– reflects consensus that

WWI was the “war to end all wars”

League of Nations also promotes International Scientific and Medical

Activities through the League of Nations Health Organization

(LNHO)

League of Nation Member Nations (dark blue), Colonies of Member Nations (light blue), Mandates (orange)

The League of Nations reflected widespread political enthusiasm for internationalism, but also the challenges of

State-centered internationalism vis-à-vis issues like development and health

Internationalism & Public Health Research: League of Nations Health Organization

Initial focus on standardization:Mortality statistics, diagnostic Classification, vaccine production& dosage. Supported by RF

In the 20s-30s, Standardization often viewed as a prerequisiteFor improvements in publicHealth and epidemiology, as Researchers had limited accessTo accurate statistics.

The economic downturn inspiresShift in focus to the development ofnutritional standards, allowing the LNHO to align its scientific orientationWith explicitly social ends and toCollaborate with the ILO. New Nutritional standards encourage Member nations to raise standardsIn calculating benefits.

Internationalism & Public Health Research: The Rockefeller Foundation

Memorial Fund 1905 Russell Sage Foundation1907Carnegie Corporation 1911Rockefeller Foundation 1913

International Health Commission established at RF in 1913 with explicit interest in sanitation and disease control outside of the United States

In 1913 RF also begins support of the Bureau of Social Hygiene: research and education on birth control, maternal health and sex education

1914 Establishes China Medical Board, funds first Chinese medical school

RF also supported the creation of the first Schools of Public Health in the US at Harvard and Johns Hopkins, subsequently spends 25 million to develop Schools of Public Health in 21 other countries

Battling the “Germ of Laziness” 1909: Rockefeller Funds Sanitary Commission for the EradicationOf Hookworm Disease led byCharles Wardell Stiles and Wyckliffe Rose

Rose travels to Puerto Rico to Evaluate Hookworm eradication Program, decides to model effortsIn Southern US upon Bailey Ashford’s model in PR

Eradication consisted of a concerted campaign of education, changes in Sanitation, and treatment with thymol. In US, treatment trumped sanitation,And educational activities were given an explicitly racial cast

Hookworm eradication represented an easy alignment between science and social advocacy. Vectors for hookworm were well-understood, and the diseasewas seen as an impediment to the economic development of the South

Following success of Hookwormeradication campaign in the South,RF began an international campaignfor control of hookworm, malaria,and yellow fever using establishedsanitation and treatment methods

RF explicitly links goals of health,economic development, and social change.

International health interventions led by private foundations can be understoodin the context of the older “civilizing mission” of empire, but altered this narrativein complex ways:

- Progressivism and Faith in Science- Changing attitudes towards empire and independence of Global South

Internationalism and Late Colonialism

WWI represents an economicCatastrophe as well as a human Catastrophe– signals new realities For British Colonialism.

US settles into a new culture of Isolationism that encourages theRapid turnover of power to nationsLike the Philippines

1929 Colonial Development Act represents shift in colonial policy away fromConstructive Colonialism towards new approach aimed at economic development of the colonies themselves— improvements in health and medicine seen as central to the new development mission

National-Private collaboration becomes a principle avenue of health promotion.In the absence of governmental funding for health, private foundations shouldermost of the economic burden

Summary

New Climate of Internationalism emerges in early twentieth century linked to the Progressive Movement and the League of Nations. This internationalismEmphasizes Science as the key to a new human future. Medicine and social

Development were intimately linked in this vision.

In the absence of Governmental support for international projects, private Foundations like the Rockefeller Foundation emerged to support international

health efforts, largely shaped by the vision of their founders, but often Undertaken in collaboration with experts and governments

The economic collapse of Britain in the 20s and 30s placed new emphasis on National independence in the Global South predicated on economic and social

Development— creates new opportunities for international health