Chapter 2 summary and answers to questions

International Development Studies
Course Code
Anne- Emanuelle Birn

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Chapter 2
The Historical Origins of Modern International Health
Plague and the Beginnings of Health Regulation
- Until the middle ages, health concerns and disease outbreaks rarely extended beyond limited
regions, except in the case of military incursions and the occasional ailing trader
- The congested towns of late medieval Europe had far lower standards of water supply,
sanitation, and hygiene than ancient civilizations (because people started to travel here)
- The middle ages had two great outbreaks of plague: Plague of Justinian & the Great Black
Death of the 14th century (most destructive pandemic ever)
- In the belief that plague was introduced by ships, the city-state of Venice in 1348 adopted a 40-
day detention period for entering vessels after which the disease was believed to remit. This
quarantine was minimally effective in stopping plague
- The stricter “cordon sanitaire a protective belt barring entry of people or goods to cities or
entire regions was also used frequently in succeeding centuries
- Lazaretto: a quarantine station to hold and disinfect humans and cargo, est. 1403
- Because the Black Deaths first appearance preceded the formation of nation-states, sanitary
efforts were adopted and implemented by municipal authorities, one at a time, rather than by
(non-existent) national governments
- Dealt with locally, in terms of measures to dispose of and fumigate the bodies and belongings
of the dead, as well as quarantine
- No official system of notification or cooperation between city-states
- Many cities has “plague boards” or permanent public health boards, that imposed the necessary
measures at times of outbreak
- Plague boards disbanded in the 17th century but many towns took over control of street
cleaning, disposal of dead bodies and carcasses, public baths, and water maintenance
The Rise of European Imperialism
- The Spanish invasion and colonization of what is now Latin America and the Caribbean had a
devastating demographic impact on indigenous populations
- Smallpox is believed to have been spread throughout Mesoamerica through distribution of
infested blankets by the forces of Spanish conquistador Hernan Cortes, though mortality from
forces labour was likely higher
- Between one-third and one-half of indigenous inhabitants were killed in the late 15th and early
16th centuries by the military, economic, and social aspects of the conquest
- Codex Badianus: an illustrated collection of hundreds of medicinal herbs, published in 1552,
produced for the Spanish emperor
- The colonial Spanish and Portuguese administrations supported the founding of medical
faculties in leading colonial cities, such as Lima (Peru) and Salvador da Bahia (Brazil), greatly
abetted by the Catholic Church, and built hundreds of hospitals across the continent, segregating
care for colonists and native populations
- Inoculation: prepared by grinding up smallpox pustules and administering the powdered
material in a wad of cotton fibres placed inside the nosewas effective but caused substantial

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Chapter 2
- The hope of obtaining riches outweighed the fear of sickness and death in the minds of many
Europeans, especially those who profited from these exploits without leaving Europe
The Slave Trade
- Europeans selected Africans to be slaves due to a combination of factors: a visible
physiological characteristic dark skin colourenabling control and vigilance over escapees;
perception of Africans’ easy physical adaptation to tropical climates where most agricultural
labour was needed; and dispersion of social groups and limited weaponry in much of Africa,
which facilitated capture
- The Atlantic route between Africa and the Americas accounted for most of the slave trade
- Slave trade continued for over three centuries
Health, The Tropics, and The Imperial System
- As long as profits were being made, imperial authorities paid little attention to the health of
- Calling a part of the globe “the tropics” became a way for imperial powers to define something
culturally alien to, as well as environmentally distinct from, Europe and the other parts of the
temperate world
- Thisinvention” of the tropics and of tropical medicine also shaped a series of racialized
explanations regarding susceptibility to disease, suitability for work, and underdevelopment
- European demands for cultivated plants (rice, bananas, peanuts, tomatoes) stimulated
development of estates or plantations, with labour needs met either by the importation of slaves
or, after the slave trade was abolished, large-scale hiring of contract workers, resulting in further
untoward health consequences
- In the early 1600’s, Jesuits in South America learned of an indigenous cure for malaria. It
consisted of an alkaloid that occurs in the bark of Cinchona officinalis, a tree native to Peru
- The great demand for cinchona bark almost led to the disappearance of the trees in Peru,
Bolivia, and Equador
- The spread of chloroquine-resistant malaria in recent years has renewed demand for quinine
and the Chinese remedy artemisinin
Tropical Medicine
- Despite numerous advances in the scientific understanding of malaria and methods for its
control (e.g. insecticides, drug prophylaxis), today it continues to plague sub-Saharan Africa and
other developing regions, with almost 1 million annual deaths
- The parasite, transmitted by biting tsetse flies, has prevented introduction of large domesticated
animals for food protein, labour, or transportation in many areas of the continent
Motives for Imperial Health (Box 2-1, pg. 30)
- Protecting soldiers and settlers
- Safeguarding commerce
- Ensuring productivity of workers
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