In The Ailing City: Health, Tuberculosis, and Culture in Buenos Aires, 1870–1950, Diego Armus provides a sweeping analysis of how tuberculosis shaped modernity and urban life in Argentina's largest city during the period between the discovery of the disease's cause and the development of effective treatments through antibiotics. This period, in which tuberculosis was widespread, easily transmitted, and difficult to treat, was characterized by uncertainty and fear for both the sick and the well. Armus shows how concerns about tuberculosis permeated urban life and intersected with broader sets of political, social, and cultural issues linked to rapid change and modernization. He argues that Buenos Aires became home to a kind of subculture surrounding tuberculosis, which influenced the emergence of the social hygiene movement and the eventual development of the public health system.Armus's analysis is organized thematically rather than chronologically, with chapters covering topics that span the time period. As a result, there is some overlap between chapters, but this potential drawback is far outweighed by what each chapter accomplishes. The first three chapters explore what it was like for ordinary people to be sick with the disease, what treatment options existed for them, and how they navigated, negotiated, and contested the choices available to them both within and outside institutional settings. These chapters also introduce readers to the moralizing discourses that were employed to judge whether the sick protected or threatened society through their behavior and self-care. Chapter 4 then shifts the focus away from patients to examine the emergence of tuberculosis as an issue of widespread public concern, tracing the disease's relationship to an expanding discourse on hygiene that cut across various political divisions and brought together medical professionals, civil society, and the state. Chapters 5 and 6 examine efforts to reduce tuberculosis transmission through the adoption of modern hygienic habits organized around values that included individual responsibility and through efforts to reduce behaviors and living practices associated with the disease. Included in chapter 6 is a nuanced discussion of the circumstances, factors, and forms of excess thought to predispose one to contagion. Chapters 7, 8, and 9 respectively analyze how concerns about tuberculosis shaped policies on the selection of immigrant groups to enter Argentina, ideas about health and proper behavior among women, and measures for promoting child health. A key feature of these chapters is a focus on the production of stereotypes linking tuberculosis to shifting ideas of race, gender, morality, overwork, poverty, and fitness. A brilliant final chapter then surveys how residents of Buenos Aires imagined individual and collective regeneration and liberation from tuberculosis in the future.Armus's study excels not just as a history of tuberculosis but also as an urban history, a history of medicalization, and a history of hygiene. This last focus is a particular strength of the book, as Armus masterfully reconstructs the multiple and shifting understandings of hygiene present in Buenos Aires during this period. More generally, tuberculosis serves as a means to examine processes critical to grasping the development of modern Buenos Aires and the ways that its residents experienced urban life. The disease itself does not always take center stage, and the different chapter subsections vary in their level of focus on tuberculosis. Armus, however, draws from a vast range of sources on the disease to document the complex politics and social relations that defined the city, as well as the shifting practices that sought to discipline modern urban subjects, order their daily lives, and transform them into what he calls “hygienic citizens.” In the process, his research demonstrates the increasing prominence of medical authorities, even as they grappled unsuccessfully with biomedical uncertainties around tuberculosis. It also illustrates the growing role of the labor movement, civic organizations, and the state in matters related to health.Armus insists in his introduction to The Ailing City that he intended it to be a local study and that he has no pretensions of making it speak to the larger agendas of historians of international and global health. The reasons behind this decision are certainly sensible and even admirable, and it is true that the value of Latin American case studies should not be judged on the sole criterion of their relevance for understanding larger international and transnational processes. At the same time, one might ask whether something is also lost in adhering rigidly to such a position and in not at least situating tuberculosis in Buenos Aires more solidly within a literature on the history of the disease in Latin America and elsewhere. At times, the story seems insular, even though there are occasional references to ideas, practices, and technologies brought to Buenos Aires from abroad. This narrow focus in an otherwise outstanding work may leave some readers wishing that they could more easily connect it to a larger historical narrative of health.
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