H-Net Review [H-LatAm]: Ortiz Díaz on Birn and Necochea López, 'Peripheral Nerve: Health and Medicine in Cold War Latin America'

Andrew Stewart

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Anne-Emanuelle Birn, Raúl Necochea López, eds.  Peripheral Nerve:
Health and Medicine in Cold War Latin America.  Durham  Duke
University Press, 2020.  384 pp.  $29.95 (paper), ISBN

Reviewed by Alberto Ortiz Díaz (University of Texas at Arlington)
Published on H-LatAm (August, 2021)
Commissioned by Casey M. Lurtz

For several decades now, historians of medicine have gradually
shifted their attention away from the biological and epidemiological
imperatives that long characterized the field. New histories of
medicine not only underscore how social, cultural, political, and
economic factors have shaped medical logics and practices, but also
stretch who has qualified to produce and exercise medical knowledge
and power. An emphasis on variable health and medical actors is a
defining feature of Anne-Emanuelle Birn and Raúl Necochea López's
_Peripheral Nerve_, an ambitious volume that traces the footsteps of
Latin American medical professionals, scientists, and political
intermediaries during the Cold War. Geographically expansive and
compelling, the text challenges binaries in, and the traditional
periodization associated with, the history of Cold War Latin
America--namely that the region was inextricably caught between the
rigid prerogatives of the United States and the Soviet Union (pp. 4,

_Peripheral Nerve _adds to the burgeoning scholarship on the Cold War
in Latin America.[1] What distinguishes it from recent predecessors,
however, is its focus on health and medicine as fields of
multifaceted, multidirectional encounter and action that defied being
ensnared by unidimensional influence (p. 22). Birn, Necochea López,
et al. instead spotlight the many applications, interpretations, and
meanings of health and medicine emanating from Cold War Latin America
and their imbrication with politics. Contributing authors lay bare
that health, medicine, and science were fused to "high" and
subjective politics--ideological, national, international, and so
on--as well as the convoluted search for solidarities within and
beyond the region.

Part 1 features essays on a transnational nurse with
humanist-idealist sensibilities surveilled by intelligence agencies
across the United States-Mexico border (Katherine Bliss), a
forthright Bolivian university rector perceived as out of step with a
brand of Rockefeller philanthropy sensitive to United States
anticommunism (Nicole Pacino), and US policymakers and Mexican
embassy staff on the front lines of major shifts in what was once
Mexico's steroid production monopoly (Gabriela Soto Laveaga). Part 2
dives into health experts, the knowledge they produced, and the
ideologies they contested. In this section, Necochea López examines
Puerto Rico's Center for Social Research fertility surveys, which
were engineered by US scholars eager to produce a showcase of
democracy at the crossroads of the Americas, critiqued by Puerto
Rican nationalists, and compiled by local research assistants.
Gilberto Hochman and Carlos Henrique Assunção Paiva then delve into
the junction of scientific, medical, and communist ideas in the
career of a Brazilian parasitologist who started out as a golden
child of Rockefeller philanthropy but whose political trajectory
diminished his clout. Finally, Jennifer Lambe probes Cuban
psychiatric debates anchored in the functional-organic (Freud-Pavlov)
dyad that provided mental health professionals the tools with which
to wage revolutionary politics. Part 3 considers health politics and
publics first in Chile, where Jadwiga Pieper Mooney looks at how
health policymakers negotiated social and socialized medicine to
circumvent certain global political paradigms while borrowing from
others to enact public health initiatives. Marco Ramos then turns to
Argentina, where militant psychiatrists and their European
interlocutors espoused conflicting global visions of anti-imperialism
and the Third World, resulting in a nationalist model for engagement
with oppressed peoples. Lastly, Cheasty Anderson takes us to
Nicaragua, where Cuban medical brigades cooperated with Sandinistas
to introduce a socialist health care system but had limited ability
to promote communism and become part of the host society. In each of
these chapters, authors go to great lengths to account for the
political factors, forces, and contingencies informing health and
medical enterprise, which in many cases also included the human or
social sciences.

After reading _Peripheral Nerve_, however, one is left wondering how
health and medicine circulated on the ground among nonprofessionals
and ordinary people. Like many histories of science and medicine,
_Peripheral Nerve_, too, leans toward underscoring credentialed
health and medical actors on their own terms. The volume does not
orbit the United States, but medical professionals, scientists, and
politicians are certainly at its core. This restrains our
understanding of what can be taken as scientifically legitimate and
medically knowable. The approach results in fascinating local and
transnational snapshots of primarily privileged actors and the
overlapping contexts they navigated. A consequence of such framing is
that we miss out, for the most part, on the vernacular experiences
and narratives of everyday Latin Americans--patients and otherwise.
Several essays in _Peripheral Nerve _achieve some of this, but in
fleeting fashion (pp. 42, 67, 98-99, 195, 232-33, 254). Overall, the
volume by and large concerns a class of aspiring, resourced health
and medical globalists either able to travel or somehow plugged into
advantaged networks on multiple scales. Despite gesturing toward
marginalized views, the "subaltern" are, generally speaking,
discussed, acted upon, and helped further but did not dominate
knowledge production processes in _Peripheral Nerve_.

More broadly, in the text's forward, Gilbert Joseph signals the
double meaning of "peripheral nerve" (pp. ix-x). The book's title
identifies Latin America as a periphery of the broader Western world,
and more specifically, the United States. This world-systems
perspective is shackling, though, for it turns out the periphery
itself was multipolar and showed a great deal of audacity in the face
of ironclad US and Soviet Cold War command. Birn appends a third
meaning, a physiological metaphor indicating that "peripheral nerves
often cause the most insistent shock (pain) that makes the body take
note, evoking the ways in which health and medicine actors and
activities in Cold War Latin America, though often overlooked,
created enormous shockwaves that affected both peripheral and core
places and players" (p. 19). I believe _Peripheral Nerve_ pushes us
to go even further in the sense that Birn and Necochea López invite
us to assume the equality of Latin America and Latin Americans during
the Cold War. [2] Rather than rehash a superpower binary that
requires troubling, we are now faced with the empirical reality that
Latin America could set the terms and dictate the pace of health and
medical interactions with the global North, as well as pursue
South-South exchanges. Nuanced competing supremacies, then--instead
of reductive center-periphery or (neo)colonial-imperial
relations--afford a more fruitful framework with which to understand
this history.

The range of these competing supremacies is not restricted to the
mainly professional actors documented in _Peripheral Nerve_. As Birn
and Necochea López acknowledge in their conclusion, more can be done
to unpack how blackness, indigeneity, gender, and the internal
diversity of these and other categories of analysis shaped the
histories contained in their volume. Several essays in _Peripheral
Nerve _start to go down this road, but not as comprehensively as they
could have. This reflects a broader pattern in modern histories of
health and medicine, which still tend to revolve around scientists'
and medical professionals' adherence to specialized training,
protocols, institutional circumstances, vested interests, and their
own idiosyncratic takes on what ought to be said and remembered.
Leaving the task of more thoroughly exploring race, ethnicity, and
gender beyond how they are usually cast in existing scholarship to a
future generation of scholars is one of the most glaring missed
opportunities of _Peripheral Nerve_, particularly in light of the
concurrent circulation of assumptions about these very demographics
and dimensions in many of the locations represented in the volume
(pp. 75, 122, 139, 169, 176, 199, 227, 259).

_Peripheral Nerve_'s brilliance, on the other hand, is on full
display when it creatively reimagines the role of the United States
in Cold War Latin American historiography. The point here is not that
the United States was passive or irrelevant--clearly, that was not
the case--but rather that (in)formal US hegemony, policies, and
interests can be presented in a way that checks and balances the
extent to which it is used as an analytical straw man. Webs of
interaction that find resonance with those illuminated by Cold War
scholars like Heidi Tinsman in her _Buying into the Regime_[3] are
evident throughout much of _Peripheral Nerve_, for instance in how
the volume sheds light on Latin American synergies with the Soviet
Union and Eastern bloc (pp. 1-3, 7, 10, 12-16), on Latin American
universities and how they served as a collective nexus of Cold War
conflicts (most chapters), and on the roles of US companies and
foundations that have escaped deep historical scrutiny to date (pp.
93, 95, 219, 224-25). In other words, regionalizing US power, or
tracing how developments in the periphery influenced organization and
policies on the mainland, allows us to rediscover the utility of
researching Cold War Latin America from the vantage point of the
United States.[4]

In the end, _Peripheral Nerve _proposes several pathways forward.
Whether recognizing that hemispheric and international organizations
merit study, advocating for deeper graduate training in Asian
languages so that future historians can access Russian and Chinese
sources, planting the seed that oral histories can unsettle what we
think we know about health and medicine in Cold War Latin America,
pointing toward revisiting the health-conflict nexus across the
region, or reflecting on the post-Cold War period, Birn and Necochea
López know that _Peripheral Nerve _only begins to scratch the
surface of histories of the Cold War that zoom in and out of
individual nation-states and world regions. Realizing a project of
this magnitude is no easy feat for a single tome. _Peripheral Nerve
_is a welcome addition to the scholarly literature precisely because
it articulates the urgency of doing so and demonstrates how we might
go about it. The volume encourages readers to humanize health and
medical practitioners on biographical and collective levels, and to
see Latin America not just as audacious but as self-assured and an
activist on the world stage.

Still, this reviewer would add, more needs to be done to temper
romanticizing Latin America in this regard. Interrogating the
biomedical, sociocultural, and political harm unleashed not only by
authoritarian regimes but by self-styled social justice-oriented
Latin Americans and their partners is one way to curb such
idealization. Since science and medicine always exist in context,
another area ripe for examination is not just the politicization of
knowledge production but its culturally motivated manipulation, an
insight gifted by Stephen Jay Gould many moons ago.[5] Though perhaps
harder to accomplish, scholars also still need to transcend the cast
of characters that often stand in for the periphery or Third World
(i.e., Frantz Fanon, Che Guevara, etc.). While _Peripheral Nerve
_admirably does so from the middle up, few of the volume's numerous
protagonists were themselves "wretched of the earth." This creates an
opportunity to explicitly reconsider how class dynamics and
identities function as levees that delimit and guide the substance
and flow of radical political desires like those chronicled in
_Peripheral Nerve_.

Finally, there are many poignant lessons to be drawn from _Peripheral
Nerve _in our current COVID-19 moment as governments, industries,
mass and social media companies, and populations, particularly in the
global North, blur the boundaries between humanitarianism and
biosecurity while at the same time inching toward contemporary
manifestations of health-based exclusion and medical coercion and
tyranny. As _Peripheral Nerve _makes clear, there is great value in
historically corroborating the heterogeneity of medicine and the
medical class. It is a stark reminder that health issues and medical
knowledge, treatments, and technologies can and should be debated in
the public square. Meaningful, effective solutions to health and
medical problems must take seriously varied perspectives and fuse the
positions of incompatible stakeholders. Academics, students,
scientists, policymakers, and many others who should and will pick up
_Peripheral Nerve _would be wise to "sit with" these insights, as
well as the fact that health and medical activism still cuts in
multiple ideological directions, as we endeavor to problem-solve in a
polemical present.


[1]. Thomas C. Field Jr., Stella Krepp, and Vanni Pettinà, eds.,
_Latin America and the Global Cold War _(Chapel Hill: University of
North Carolina Press, 2020); Tanya Harmer, _Beatriz Allende: A
Revolutionary Life in Cold War Latin America _(Chapel Hill:
University of North Carolina Press, 2020); Eyal Weinberg, "'With
Colleagues Like That, Who Needs Enemies?': Doctors and Repression
under Military and Post-Authoritarian Brazil," _The Americas_ 76, no.
3 (July 2019): 467-505; Stephen G. Rabe, _The Killing Zone: The
United States Wages Cold War in Latin America _(New York: Oxford
University Press, 2012); Gilbert M. Joseph and Greg Grandin, eds., _A
Century of Revolution: Insurgent and Counterinsurgent Violence during
Latin America's Long Cold War _(Durham, NC: Duke University Press,
2010); Gilbert M. Joseph and Daniela Spenser, eds., _In from the
Cold: Latin America's New Encounter with the Cold War _(Durham, NC:
Duke University Press, 2008).

[2]. Mariola Espinosa, "Globalizing the History of Disease, Medicine,
and Public Health in Latin America," _Isis _104, no. 4 (December
2013): 798-806.

[3]. Heidi Tinsman, _Buying into the Regime: Grapes and Consumption
in Cold War Chile and the United States_ (Durham, NC: Duke University
Press, 2014).

[4]. Alfred W. McCoy and Francisco A. Scarano, eds., _Colonial
Crucible: Empire in the Making of the Modern American State
_(Madison: University of Wisconsin Press, 2009).

[5]. Stephen Jay Gould, _The Mismeasure of Man _(New York: W. W.
Norton &amp; Company, 1996 [1981]).

Citation: Alberto Ortiz Díaz. Review of Birn, Anne-Emanuelle;
Necochea López, Raúl, eds., _Peripheral Nerve: Health and
Medicine in Cold War Latin America_. H-LatAm, H-Net Reviews. August,
URL: https://www.h-net.org/reviews/showrev.php?id=55924

This work is licensed under a Creative Commons
Attribution-Noncommercial-No Derivative Works 3.0 United States

Best regards,

Andrew Stewart