This addition to the literature is especially welcome, since, compared to most of Latin America and sub-Saharan Africa, the Caribbean and circum-Caribbean is a region that is understudied by historians of healthcare and medicine. This audacious set of consistently high-quality essays aims to introduce readers to a wide diversity of issues with regard not only to the Spanish-, English-, French-, Danish- and Dutch-speaking Caribbean, but also the Yucatán peninsula in Mexico. The themes broached by the volume range from the control of midwifery and obstetrics, to environmental and occupational health in the mining sector, and from debates over control and repression of prostitution to the evolution of infant welfare.
The editors are only too aware of the risk that the book would be as fragmented as the region. They confront this problem head-on by writing an invaluable introduction that synthesises the state of the subject most effectively, and which places the evolution of the Caribbean historiography of health and medicine within a global framework, that places a special emphasis upon Latin America and sub-Saharan Africa. The bulk of the book consists of essays that examine problems in specific islands and territories, apart from one chapter that looks at the French Antilles in general. A focus on gender is one continuous theme of the book: the history of women and children in the region is approached through such topics as the evolution of health services for women in Trinidad and Tobago, and of infant welfare in British Guiana; but men are not overlooked, with one chapter addressing the production of Cuban medicine during the nineteenth century, and another inquiring into the impact of the First World War in the French Antilles and looking especially at military medicine. A second theme that is fruitfully explored throughout the book is interactions between the islands and territories of the circum-Caribbean and the dominant powers in the region. This reader found especially rewarding the accounts of tensions between local medical elites and US occupying forces in the Dominican Republic between 1916 and 1924 over the handling of prostitution, and the analysis of conflicts involving local physicians and the US colonial government over the conceptualisation and formulation of policies of professionalisation after the occupation of 1898. Fascinating, too, is an essay investigating the impact of anti-hookworm campaigns led by the Rockefeller Foundation in the Dutch colony of Suriname in the early twentieth century. It seems that the Rockefeller Foundation could count on more consistent and reliable co-operation from independent governments in Mexico and Colombia than a European colonial administration in Suriname. One underlying theme that recurs throughout the book is poverty and lack of resources. The Danes in St Croix stigmatised enslaved midwives and blamed them when deaths occurred, but failed to fund the training of either the slaves or of other women. The regional government in Yucatán went to considerable pains in 1933 to impose more legal requirements than before on titled physicians, but lacked the resources and political will to rein in the operations of ‘charlatans’ without titles who served a large part of the population. The evolution of infant welfare services in British Guiana after the abolition of slavery was so gradual as to be close to imperceptible for want of resources both material and human.
This new work is so successful that a sequel looking more closely at the period since the 1940s merits consideration. Certain themes deserving close attention in such a volume spring immediately to mind. They include epidemiological shifts from degenerative to infectious diseases, international migrations and healthcare, mental health, the role of international NGOs and local governments in the promotion of contraception and the improvement of public services. So, too, the performanceof the Cuban Revolution in healthcare from cradle to grave, the impact of the global pharmaceutical industry, and the role of international institutions, especially the PanAmerican Sanitary Bureau and the Pan-American Health Organisation, merit inclusion. Haiti – an important omission from the present book – could be approached by a medical anthropologist with historical interests,as well as comparative essays – also a significant omission from the book in review – investigating areas such as the role of political parties, professional organisations, and interest groups in fomenting debate about healthcare in the newly independent states of the region, would be instructive. The editors and contributors to this volume (who are too numerous to name here) and the excellent Routledge Studies in the Social History of Medicine are to be congratulated on a refreshing contribution to the literature.
