The Treatment or Mistreatment of Disease?: Comments on Ronn Pineo’s “Misery and Death in the Pearl of the Pacific: Health Care in Guayaquil, Ecuador, 1870-1925”

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I read with considerable interest Ronn Pineo's article on health care in Guayaquil, Ecuador, between 1870 and 1925 (HAHR, November 1990). Pineo provides a succinct discussion of the institutional difficulties in providing health care in a rapidly growing and overcrowded urban center in the tropics. However, the author's characterization of medicine and his notions of the social history of disease control are incomplete and provide only a partial understanding of the causes and responses to the unlhealthy conditions in the city. Medicine in the eighteenth and early and middle nineteenth centuries was, as Pineo points out, still based on the humoral and miasma theories (p. 62o). However, despite a lack of understanding of the origin of disease, doctors and public officials developed effective measures to control the two greatest killers in preindustrial Europe, bubonic plague and smallpox. According to historical demiiographer Michael Flinn, evidence from Europe in the seventeenth and eighteenth centuries suggests that quarantine measures gradually eliminated bubonic plague by limiting its spread. In the early eighteenth century smallpox accounted for some 1015 percent of all deaths in Europe. The use of inoculation by variolationand later the Jenner cowpox vaccine reduced the impact of smallpox. For example, between the late eighteenth century and the i8ios smallpox mortality in Sweden dropped from 278 per ioo,ooo population to 15 per 10,0ooo population.' Control of disease, either through quarantine measures or vaccines, took effect gradually. One of the most important aspects of the social his-