Liane Maria Bertucci’s Influenza, a medicina enferma chronicles the theories and lived experiences of institutions and individuals of all classes who negotiated, suffered through, recovered, and died from the Spanish flu epidemic of 1918 in São Paulo, Brazil. Worldwide, this epidemic took the lives of more people than World War I and killed 1 percent of São Paulo’s population alone. Bertucci’s analysis, the only publication of such magnitude regarding the 1918 epidemic in Brazil, contributes to a small and growing scholarly and literary writings concerning this global epidemic. Her focus on a single city leads to a narrative and analysis of unprecedented depth and breadth. She shines light on the complex interrelations and dizzying multiplicity of scientific, hygienic, and urban theories, as well as institutional responses and treatments. This focus also allows her room to delve into individual experiences of the epidemic.Bertucci contextualizes the epidemic within the broader history of São Paulo’s urbanization, industrialization, and growth from about 1910 onward. Her analysis contributes to several arguments prevalent in urban, labor, and medical historiographies. During the epidemic, government officials and medical personnel targeted the poor and working classes as most in need of public assistance but also most to blame for spreading the illness. Bertucci’s analysis, however, adds a new twist to this making of the so-called dangerous classes: during the 1918 epidemic, workers were faulted not for being lazy, but for working too hard. It contributes to a growing literature on what many scholars see as increasing government and medical institutional control over public and private life in the first few decades of the twentieth century.Clear tensions existed in São Paulo (as well as other cities in Brazil) between the state and municipal government and the newly established Serviço Sanitario regarding who should fund and manage hygienic programs, and political power stagnated or flourished depending on personal ties of clientalism or enmity. The author focuses on the tensions between medical authorities’ attempts to control where (hospitals) and how (allopathic medicines) people advertised, provided, and applied treatment for the flu. She is especially insightful in pinpointing specific moments of shifts in the articulation of such control. One of her most fascinating assertions identifies a “180 degree” moment in which “these so-called sanatoriums [nosocômias], for centuries repudiated by the population as a place of death and treatment for the wretched, transformed themselves at the end of October [1918] into the ‘great solution’ to the epidemic disaster” (p. 127). Cutting against the Foucauldian grain, Bertucci also identifies the failures of institutional control: for example, the inability to stem certain cultural practices, such as kissing, hugging, social visits, visits to cemeteries, and popular medicine.Her emphasis on the inextricable interconnections and tensions between popular and scientific medicine in twentieth-century São Paulo affirms that cultural miscegenation permeated Brazilian life. Bertucci’s sources reveal this multiplicity of cultural practices: page after page of magazine and journal ads, and pharmacy shelf after pharmacy shelf of popular treatments side by side with “scientific” medicines. Through such materials, she probes the historiographically elusive private lives of São Paulo’s residents, nearly a century ago.Bertucci presents evidence that the 1918 epidemic was the moment when—despite their continued interrelation, both cordial and contested—allopathic practitioners began to articulate a clearer separation between themselves and those they termed charlatans. She argues that a major way these doctors distinguished the microscope from the Madames was their move from fantastic promises of miracle cures to more realistic and sober cautionary descriptions.The vast multiplicity of details and voices is both the book’s most challenging aspect and its greatest strength. Bertucci analyzes dozens of official medical reports and São Paulo newspapers and magazines. This scope captures a wide range of perspectives and sympathies, from church publications to women’s magazines to journals specializing in irreverent political humor. She neither totally vilifies nor lionizes efforts at control or resistance. Her complex (and thus sometimes difficult to follow) narrative provides a deeper and more accurate account of the cruelty, selfishness, complacency, impotence, kindness, and generosity among and between people of all classes during the epidemic. Bertucci gives voice to both institutional leaders and patient-citizens.Bertucci’s prose is clear and often poetic, and the subject has relevance to not just Brazilian but to world history. Influenza, a medicina enferma is therefore not just a must-read for specialists in the field but also an excellent book for an undergraduate course and for a more general readership. Medical researchers, government agencies, and architects might use this work to help frame questions or glean details that could further their quest to understand what caused the 1918 Spanish flu epidemic, how to prevent it from recurring, and political, social, and economic strategies for negotiating future emergency relief services.
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