Health beyond prescription: A post-colonial history of Puerto Rican medicine at the turn of the twentieth century.

Abstract

This dissertation explores the effects of late-nineteenth and early-twentieth century colonialism on seemingly apolitical and scientific institutions in Puerto Rico, namely those surrounding medicine and disease. I argue that understanding colonialism in Puerto Rico means taking Puerto Ricans' agency seriously. In the case of medicine, disease, and public health, this agency was reflected by the shifting and competing debates of a variety of groups who sought to bolster their claims to alternate visions of Puerto Rico's modernity and progress. This dissertation focuses on the class, ethnic and geographic bases of Puerto Rican physicians' debates on medicine, disease and public health. In the late-nineteenth century, urban <italic>criollo</italic> elite physicians saw Spanish colonialism as a threat to Puerto Rico's modernity and used disease and medicine as explicitly political institutions to bolster their claims. These elite physicians initially welcomed the U.S. colonial intervention that followed the Spanish-American War. However, they were faced with increasing exclusion from both control over their profession and political, or even administrative, participation. Under U.S. colonial authority, elite physicians also found an opportunity to modernize Puerto Rican medicine, even if this modernity implied the U.S. ideal of an explicitly depoliticized medicine. Puerto Rican physicians adopted what they believed would be a long-term strategy of working from within the U.S. colonial administrative bureaucracy. This dissertation, therefore, challenges the idea that the Puerto Rican elite simply accommodated U.S. colonial power. After discussing the efforts of Puerto Rican physicians to professionalize, the dissertation examines the twentieth-century anemia campaign. This campaign promoted the widespread adoption of a new perspective on anemia that depoliticized disease, rather than treating it as a consequence of poverty, malnutrition or climate. On the one hand, developing Puerto Rican medicine around the anemia campaign meant expanding Puerto Rico's access to public health services, clinical medicine and laboratories, and medical training and research. On the other, the anemia campaign assumed that Puerto Rican rural peasants did not know how to take care of themselves. This assumption is still very much present in current public health approaches.