A Cuban scientist between empires: peripheral vision on race and tropical medicine.

Palmer, Steven

In 1898, as the United States intervened in the Cuban war of independence by declaring war on Spain, an eminent Cuban ophthalmologist, Juan Santos Fernandez, (1) began to tally the results of almost a quarter century of clinical research on the eye diseases of blacks and mulattoes. It is unclear why he decided to sum things up at this point. Perhaps he had already decided to present a paper that required such a tally at the International Medical Conference scheduled for Paris in 1900. Perhaps with the war leaving his ambitions--for the Autonomista cause and for his bacteriological institute--in ruins, he now had the time to turn his attention to a long-overdue task. What is certain is that, as the US easily defeated Spain, occupied Cuba, and took stock of its new acquisition (among other methods, through an elaborate census), Santos Fernandez carried out his own inventory of patient encounters. Each was inscribed in his clinical notebooks, a database amassed over a professional lifetime to prove the hypothesis that optical diseases and conditions differed in type according to race. This was a classic proposition of both inter-tropical pathology and anthropology, disciplines with which Santos Fernandez had been deeply involved since the 1870s.

By the time Santos Fernandez delivered his address in fin-desiecle Paris, however, he had made a surprising volte face: on the basis of his tally of the ample evidence in his clinical registries that left no room for doubt, he now insisted that all people suffered essentially the same diseases of the eye regardless of race, colour, ethnicity, or place of birth. And this was not the only extraordinary reversal made by Santos Fernandez in 1898. A second one occurred during a session of the Cuban Academy of Sciences, an august institution over which he presided. At one of its first post-war assemblies, in November 1898, the recently repatriated academician Carlos Finlay reformulated his old proposition that yellow fever was transmitted by the Culex mosquito. Academy members were quite familiar with Finlay's theory, for he had first presented it to them in 1881 and defended it on the floor of the Academy on a number of occasions over the intervening years. Santos Fernandez had been one of Finlay's most vociferous critics since the very first presentation of this idea, and over the years he had tried to discredit Finlay and even obstruct his research. But when Finlay reiterated his proposition before the Cuban Academy in 1898, Juan Santos Fernandez endorsed the theory of his former rival on the spot.

Two years later, following experiments by the US occupation authorities that established both the accuracy and the public health value of Finlay's research, Santos Fernandez became a zealous advocate of Finlay's priority in discovering the solution to the yellow fever puzzle. He embraced his erstwhile foe in the face of those who claimed that Finlay's theory was more or less a lucky guess that would have remained vague and undeveloped had it not been demonstrated and developed by the true scientific methods of the US military researchers. Curiously, however, even as Santos Fernandez entered this politicized debate at the heart of the revolutionary new discipline of tropical medicine, he simultaneously began refuting the notion that tropical medicine was a valid domain of science. Instead he now insisted that there were no diseases specific to the tropics, and argued that tropical locales were, overall, healthier than temperate ones for human habitation.

This article offers an explanation for the sudden swing in worldview of this patriarch of Cuban medicine. Both as an ophthalmologist and as director of the island's principal research institute during the late Spanish empire, Santos Fernandez had developed the study of the diseases of warm climates as a fulcrum for the acquisition of Cuban scientific and political sovereignty. My hypothesis is that his dramatic reversal of earlier assumptions responded to a tectonic shift in the global political landscape of tropical medicine at the turn of the century, and that it was also the expression of his realization that such a shift was taking place at the expense of science in the tropics. Santos Fernandez came to appreciate that the crystallization of an imperial array of tropical medical institutions and discourses--something he had a close-up view of in the US occupation of Cuba--was a trap. What had been a discourse of medical research among equals and collaborators, one that could promote scientific and political sovereignty, was transformed into a medical discourse generated in Western metropoles as part of an imperial mission, relegating medical science in places like Cuba to the role of peripheral assistant. Like many Cuban "dissident criollos," often elites who had supported Autonomismo as an alternative to the revolutionary independence that, in the end, came wrapped in the neo-colonialism of the USA, Santos Fernandez looked to the ethos and networking potential of Hispanoamericanism as an antidote. In this sense, he engaged in what we might call "scientific Arielismo," (2) one that involved the negation of tropical medicine and a call for a Hispanic medico-scientific renaissance that would be built through alternative networks.

Race in Sight and Pastorian Visions in Late Colonial Havana

From the time he sat down to look into the eyes of his very first patient in the small Spanish town of Bayuela, Juan Santos Fernandez kept a notebook. (3) His first few hundred patients from around the province of Toledo, mostly in need of cataract removal, provided the evidence for the doctoral dissertation he presented at the Universidad Central de Barcelona in 1874 (Ruiz Casabo 1907, 4; Fernandez 1874, 9). The notebooks then register the young practitioner's movements, back to Barcelona, up to Paris again, then seeing patients on the SS Hannover that took him from Le Havre to Havana as the first Cuban war of independence waned and life returned to normal in the capital of a changed colony. Arriving in Cuba, he initially assumed that he would have to repeat the traditional tournee of the untested medical practitioner, touring the interior plantations and treating the slave and indentured workforce to accumulate clinical experience, perhaps publish a few papers, and build a reputation prior to setting himself up in the capital with the substantial sums that such journeys of apprenticeship could deliver. But straight off the ship, a former fellow student at Madrid's San Carlos College of Medicine and Surgery told him there would be no need: Havana could now support even a specialty practice like his (Fernandez 1917-18, vol. I: 304). Santos Fernandez was soon the first doctor in Havana to practice ophthalmology exclusively. Among his only serious rivals was Carlos J. Finlay, who during a mid-career European upgrade had followed in his father's footsteps by acquiring a specialty in diseases of the eye (Lopez 1895). (4)

Still, the early years were somewhat sparse for Santos Fernandez, a tale told by the notebooks. Among his early clients were many friends and family from Bolondron, the town where he had grown up the scion of a prosperous family of planters with different branches in charge of a number of semi-mechanized sugar mills. They brought their slaves to be checked as well. It is not clear when Santos Fernandez decided to make his practice the basis for clinical research that would consider racial difference, but it was probably fairly early on, and may have been his intention from the outset. In his Considerations on the diseases of the eye observed in the island of Cuba during the year 1875, a work read before the Academy of Sciences, he announced his project: "Because this land was populated by different races, pathogenic studies encounter here a vast domain of research, since in transplanting themselves some of their natures lose their vitality while others become more robust" (Fernandez 1876, 3). Santos Fernandez had special access to slave bodies during the first 10 or 12 years of his practice because he himself was involved in the operation of sugar mills with slave labour complements, and he also had many medical associates--some of them old friends from Matanzas--who were also slavocrats. In 1879 he recorded details of a "morena [colored woman] operated on in the countryside in the ingenio [sugar mill] of Dr. [Gabriel] Casuso ... one day when he invited me to visit the finca" [LO 1, 7808]. When he wished to put together a sufficiently large subject pool to investigate the prevalence of myopia in Negros in the late 1870s, he simply repaired to the plantation of an acquaintance "with the objective of carrying out our experiments in the most adequate manner on the numerous complement of slaves on the ingenio Recurso" (Fernandez 1876, 17).

By 1881 he had accumulated enough evidence for his first attempt to link tropical ophthalmology and race science. In his "Anthropological essay on eye diseases in the diverse races that inhabit the Island of Cuba" (1881), published in the Boletin de la Sociedad Antropologica (Bulletin of the Anthropological Society), he sought to establish the way that climate and race register themselves in diseases of the eye.

Again he picked up on the French school, launching the central argument of his essay through recourse to the chapter title of a book by Felix Giraud-Teulon: "Myopia is a product of civilization." In testing the hypothesis that the "frequency of myopia in a country revealed the progress of its civilization," Santos Fernandez's clinical findings suggested that Peninsular whites showed the greatest degree of myopia, while only one case of myopia had been observed in an African-born patient (Fernandez 1881, 64).

With a steady stream of patients of African descent--slave and free, mixed race and not--the fastidious ophthalmologist carefully inscribed their place of birth, ethnicity, and race. There was often much hesitation in the annotations concerning race, based as they were on the perceptions of Santos Fernandez or an assistant acting as scribe. Question marks would often follow the racial descriptor for people of colour. The appreciation of race was overlaid with ethnological categories. Those born in Africa were classified according to the categories accepted and shaped by Cuban criollo elites as part of their slavocrat heritage: lucumi, congo, and carabali. Spaniards, too, were registered according to their regional ethnicities: Gallego, Asturiano, Canario, and so on. The number of years any foreign-born patient had spent in Cuba was always noted in an effort to produce data on adaptability to tropical climes, and correlate it to race and ethnicity.

Not all his concerns were racial by any means. Occupational health was another focus, as was the issue of tropical eye diseases believed to result from solar glare or reflection off water, or from the alcoholism believed to exist with particular virulence in the tropics. The ocular manifestations of classic fevers of warm places were also observed very carefully, especially those related to yellow fever and malaria. But race, of course, was privileged, and Santos Fernandez well knew that he had privileged access to subjects of African ancestry, a group who were of great concern in US American medical elites practicing, researching, and pronouncing in a post-slave society, and to European medicos who were deeply invested in the colonization of Africa.

Although Santos Fernandez never ceased to accumulate clinical data, and indeed saw patients and performed surgery at an extraordinarily constant pace over his career, he had wider concerns that included an active participation in societies of clinical studies, in the Royal Academy of Sciences, and in the founding of many other associations, among them the Cuban Anthropological Society in 1877. He also began to publish in 1875 the Cronica Medico-Quirurgica de la Habana, a newspaper that would become the longest lasting medical periodical in Cuban history, and during the 1880s and 1890s was its most important. He was also a leading member of the Partido Autonomista (Autonomist Party) that formed in Cuba in the period between the island's two wars of independence, when for a decade and a half between 1878 and 1895 political space was opened within the Spanish colonial regime and hesitant steps were taken to allow for greater forms of self-government. The Partido Autonomista, taking Britain's white settler colonies (and Canada in particular) as a model, was the party of a liberal Cuban criollo elite that hoped for a gradual acquisition of sovereignty (Garcia Mora and Naranjo Osorio 1997). (5) The nature of this combined scientific and political project changed dramatically between 1885 and 1887 when Santos Fernandez decided to finance and organize the Instituto Histo-bacteriologico y de vacunacion antirrabica de la Cronica Medico-quirurgica de la Habana, one of the first bacteriological laboratories in the Americas. Spurred by Louis Pasteur's dramatic announcement of a vaccine for rabies, one that caused an international sensation, Santos Fernandez mobilized his substantial resources to acquire state-of-the-art bacteriological and serological equipment, and to send a mission to Pasteur's Paris labs to train in the new techniques and methods. Among the many aims of this bold gambit was to raise the scientific stakes in the Autonomista push, establishing a criollo institution that would be alone in exercising sovereignty over these newly discovered material realms--a hitherto unknown, unseen, bacteriological and histological Cuba, one that was out of the grasp of the technically backward Spanish colonial state and only fully knowable by a select criollo elite of scientific savants. Within the space of a year the Instituto had revolutionized Cuban science, engaging a team of some 25 research-oriented medical doctors, chemists, and veterinarians in laboratory and field studies on a wide variety of human, animal, and plant diseases. (6)

Diego Tamayo, a charismatic young doctor and member of the Cronica circle, had been sent to Paris to study bacteriology and to oversee the successful transfer to Cuba of the Pastorian method for producing rabies vaccine. He became the head of the bacteriology division of the Instituto as soon as he returned, and he focused his research on finding the germ responsible for yellow fever. This was the elusive motherlode of the golden age of microbe hunting, chased by talented and ambitious research scientists from Paris to Buenos Aires. Havana's Instituto Histo-bacteriologico had an important and respected profile in this Atlantic field of research. Hardly a peripheral lab, it was a state-of-the-art facility with considerable resources. Its scientific director was a graduate of the cutting-edge bacteriology master classes taught by a Pastorian, Andre Chantemesse, after a residency at the Berlin laboratories of Robert Koch where the principles and technical standards of modern bacteriology were being laid down. Moreover, the Havana Instituto team had a considerable advantage in that yellow fever was endemic to the city, and they had ample research material to work with--something not enjoyed by "metropolitan" scientists, many of whom decamped to Havana to do their research. When they did, they sought to use the facilities of the Instituto: the very appreciative Pastorian, Paul Gibier, for example, and the equally impressed US envoy, George Sternberg (Tamayo 1888). (7)

Carlos Finlay was not, however, welcome at the Instituto--at least not at the outset. Without abandoning the mosquito theory of transmission, Carlos Finlay and his Spanish research partner, Claudio Delgado, eagerly plunged into bacteriological efforts to identify the germ transmitted. Simultaneous to Santos Fernandez's private initiative, in 1887 they unsuccessfully petitioned the Spanish governor of Cuba to finance a public bacteriological facility where all researchers could work. Finlay, his bacteriological research, and his announcement that he had discovered the germ responsible were attacked ferociously in print by Tamayo for technical and theoretical shortcomings, and ended up being thoroughly discredited in the yellow fever debates that raged in the international medical press of the day. Like many of Finlay's contemporary and future critics, both Santos Fernandez and Tamayo saw him at this time as more of an artisan and confabulator than a scientific researcher or visionary. That he was one of Santos Fernandez's professional rivals did not help, nor did the generational, ethnic, and class divisions: Finlay, a decade older than Santos Fernandez, was the son of an immigrant of Scottish origin who was never granted full stature as an eminent criollo. The upshot was that during a five-year period (1887-92) that was critical for international medical research on yellow fever, Finlay was deprived of a world-class medical research team and facility, while the Instituto was deprived of hosting the medical researcher who had the key to unlocking the mystery of yellow fever. (8)

This is not to say that together they would have been able to use Finlay's theory and considerable knowledge of the Culex mosquito to prove yellow fever transmission by mosquitoes, as Walter Reed's US Army medical team was able to do on the basis of Finlay's theory and knowledge in Cuban in 1900. Indeed, a more likely scenario would have seen such an effort in the years 1895-98, when Theobald Smith's studies of the tick's role in transmitting Texas Cattle Fever and Ronald Ross's work on the role of the mosquito in malaria transmission reoriented thinking on parasites and pathogenesis. And the chance for such a breakthrough was in the cards. The beginnings of a rapprochement between Finlay and the Instituto came after the 1892 resignation of Diego Tamayo following a serious falling out with Santos Fernandez that may have flared up in part due to the fact that Tamayo's own research agenda on yellow fever had not borne much fruit. (9) Between 1893 and 1895 Finlay and Delgado collaborated sporadically with Instituto researchers such as Juan Davalos, in close contact with Smith at the US Bureau of Animal Husbandry, and Alphonse Laveran, the discoverer of the malaria parasite. But the years 1895-98 were not propitious ones for Cuban science, for they coincided exactly with the second Cuban war of independence.

Breaking out in February 1895, the war came at an awful time for the Instituto. Collaboration with Finlay was finally underway. The Instituto's triumphant production and successful use of an autochthonous diphtheria antitoxin had earned the praise of Emile Roux, the Pastorian who in the early 1890s had played the central role in making such an antitoxin. This brought a good deal of favourable publicity at home and abroad to the laboratory and its scientists. But with the war, scientific life inside Cuba collapsed slowly but surely. Medical periodicals ceased publication, while many criollo doctors reduced public activity to a minimum. Some were arrested, others quietly took leave of the island to ride out the war, among them men like Finlay and Tamayo who, once the die was cast, joined the moderate ranks of the revolutionary movement in exile or enlisted in the US Army medi cal corps. Some of the most important members of the Instituto group joined the exodus of Cuban doctors to the United States. Among those who stayed, medical priorities changed to dealing with the suffering brought on by the harsh wartime conditions and the Spanish reconcentracion policy, which was blamed by many Instituto collaborators for the death, from dysentery, of the brilliant young doctor and leading Instituto researcher, Domingo Madan (Anonymous 1898, 26).

The New Landscape of Tropical Medicine

In 1898 and 1899 a number of historical forces, episodes, coincidences, and realizations crossed to create a new balance of forces in medical research on diseases or conditions in countries located in the tropics (Arnold 1996; Worboys 1996; Farley 1991). The key manifestations of this shift included the creation of a Colonial Medical Service by the British Colonial Office (1898); the publication of the "bible" of tropical medicine, Patrick Manson's Tropical Diseases: A Manual of the Diseases of Warm Climates (1898); the announcement of the work of Ronald Ross on the role of mosquitoes in the transmission of malaria (1898); and the creation of the London and the Liverpool Schools of Tropical Medicine (1899). Amplifying this British nexus was the tropical medicine that came of the so-called "Spanish-American War"--that is, the US occupation of Puerto Rico, the Philippines, and Cuba. The US involvement in Cuba was peculiarly "medical" in nature, with Surgeon General George Sternberg and General Leonard Wood, a physician, playing key governing roles in the occupation authority, and the hygienization of the island occupying a high priority (Espinosa 2009).

Within a very short period of time, then, two great empires--one in mid life, the other declaring itself dramatically for the first time--created institutional circuitries of medicine and sanitation for their imperial spheres of influence and electrified them with a scientific discourse coterminous with imperial dominion. Obviously, the moment did not emerge from nothing. Medical researchers who we might see as engaged in "tropical medicine" had been active throughout Britain's colonies since the 17th century, and if the US was a new player in this game, French, German, and Spanish scientists had been at it for a very long time. But something fundamental had changed.

What had been a multipolar endeavour, with heterogeneous and individual actors, shifted very suddenly toward an Anglo-American apparatus of network-based and institutionalized research, codification, classification, agenda setting, and application. The work of the Reed Commission and Gorgas's sanitary regime in Havana would be a confirmation of this shift, and the US ability to successfully tackle the disease obstacles of the Panamanian isthmus through sanitary engineering a spectacular demonstration of the practical power of Anglo-Saxon tropical medicine (Stern 2006).

This was the context in which Juan Santos Fernandez came to realize that his old nemesis had been right all along. Sitting in his presidential chair at the Academy, surrounded by the catastrophe of war and the ruins of his scientific and political ambitions, knowing that the US occupation authorities were on the doorstep, he listened as Carlos Finlay (just returned from service as a doctor in the US Army, no less, and a stint treating yellow fever cases in Santiago) expounded for the umpteenth time his theory of the transmission of yellow fever by the Culex mosquito. After two decades of international ridicule, Finlay can finally put something really new on the table: he makes reference to Ross's recent demonstration that the mosquito plays the crucial role in transmitting the malaria parasite, and to Smith's work on the role of the tick in incubating the parasite that causes Texas Cattle Fever (Finlay 1965). (10)

Santos Fernandez was quite familiar with the work Finlay cited. On an 1891 scientific tour in Paris, Santos Fernandez had paid a visit to Alphonse Laveran at the Val-de-Grace military hospital and found him studying a preparation of avian blood. Invited to look down the barrel of the microscope, he saw Laveran's hematozoas. An immediate convert to Laveran's thesis that these were the parasites that caused malaria, at the time he remarked on "los cuerpos granulosos que presentan, los cuales pueden en su dia dar alguna luz acerca de la biologia de los hematozoarios del paludismo por el descubiertos y hoy admitidos y reconocidos por todos los investigadores competentes" (Fernandez 1891, 32).11

Whether the penny dropped for Santos Fernandez during Finlay's Academy presentation, or whether it had happened earlier, the realization that Finlay had been right about the mosquito must have been a kind of "negative Eureka" moment for him--a painful recognition

of how agonizingly close the Instituto Histo-Bacteriologico had been to discovering the mode of transmission of yellow fever. Though he never expressed it publicly in such terms, he may well have begun to regret his irrational dislike of this irritating rival ophthalmologist and his choice of the tempestuous Tamayo to direct yellow fever research. In later years he would publicly lament the way the war had interrupted the research and scientific travels of his younger generation of Instituto doctors who had been collaborating with Finlay on a series of experiments, and who had been visiting Laveran in Paris and the Bureau of Animal Husbandry in Washington where Smith worked.

In any event, he did choose that moment to endorse for the first time both Finlay's theory and his worth as a scientist. The official record of the extraordinary event is understated. The minutes published in the Anales de la Academia de Ciencias Medicas register that, following Finlay's presentation to the Academy of his new formulation of the theory of yellow fever transmission by mosquitoes, Santos Fernandez, as President of the Academy, made the following remark: "It calls one's attention how sometimes the work of our scientists goes unnoticed and later others come from outside to pick this up and come here expounding what amongst us was already known" (Sesion publica ordinaria del 13 de noviembre de 1898, 32). (12) Despite this endorsement, and the rapprochement that had been underway prior to the war, it seems that no effort was made by either party to pursue new research on yellow fever at the Instituto. The laboratory may not have been in any condition to sponsor such work at this juncture, or it may be that Santos Fernandez's ability to muster the political resources necessary to conduct such work was a thing of the past. Santos Fernandez had held considerable sway with the Spanish colonial regime, but such influence was not likely with the US occupation authorities, and would perhaps have been unpalatable to him.

Finlay was already working with the Americans anyway, on a panel appointed by the US occupation authorities to study the problem of yellow fever--along with Diego Tamayo, of all people, and Henry Carter, a great student of yellow fever whose epidemiological work would lead to the crucial understanding of the temporal thresholds involved in the transmission from infected patients to mosquitoes, and then on to new victims. There is very little reliable material on the exact path by which the US team arrived at its decision to give

Finlay's hypothesis and methods a systematic trial. (13) If I had to guess, however, I would say that after the dissemination of Ross's finding on the mosquito and malaria, and after working with Carter in Santiago, Finlay knew for sure that he was right about the Culex mosquito's role in yellow fever when he made his presentation to the Academy in 1898, and he knew that all he had to do was wait at home for the moment when Walter Reed and company would run out of options, finally listen to Carter tell them that Finlay's mosquito theory should be revisited, and come calling.

Two weeks later, in one of Santos Fernandez's final official acts as president of the Academy, he returned the institution's Spanish flag and crest and the portrait of Alfonso XII to the last Spanish governor of the island (Pruna Goodgall 2002, 325-326). He chose to do so on 27 November, the anniversary of the Spanish execution of eight criollo medical students in 1871. After the grim holidays of 1898, after watching the occupation authorities move into the Captain General's palace in the Plaza de Armas, he delivered the terminal address, bringing the life of the Royal Academy of Sciences to a close and ending his presidency. The Academy was rechristened a republican institution in waiting, and he was replaced as president by Diego Tamayo, Santos Fernandez's once protege and the purveyor of Pastorian method to Cuba, who had left the Instituto after a dispute in 1892 and now returned triumphant to Havana as the highest Cuban functionary in the US occupation government. Then, presumably, Santos Fernandez continued reckoning with his clinical notebooks. (14)

Negating Medical Concepts of Race and the Tropics

As Louis Perez (1983) has pointed out, Cuba remained "between empires" during this era, and the transitional years of the US occupation, from 1898 to 1902, were particularly intense times of negotiating the restructuring of an old Spanish colony into a US neo-colony. Marial Iglesias (2006) has explored the way these changes were captured and worked out in the metaphorical and symbolic registers of everyday life among the population at large. Each sector of Cuban society lived a different transformation of everyday practices and meaning, and the scientific sector was not outside the process. If Santos Fernandez had misgivings about the entry of US political and scientific power into Cuba, he did not have to wait long to see them take their toll on his own position and project. The early period of the US occupation made scientific research at the Instituto extremely difficult in a variety of ways. Not only did the laboratory lose its government subsidy, but for reasons that are still not clear but almost certainly had to do with Santos Fernandez having been a Hispanophile and an Autonomist to the end, he was never favoured by the US occupation government or the Cuban physicians whose stature and political fortune rose through their association with the US authorities (Diego Tamayo and Carlos Finlay among them), in some cases through a long residency in the United States (for example, John/Juan Guiteras and Aristides Agramonte).

Diego Tamayo became the most powerful physician in the country under the US occupation, was appointed Minister of the Interior by Leonard Wood in 1899, and was charged among other things with overseeing the civilian side of health and sanitary matters (Espinosa 2009). Rather than directing resources toward the Instituto, Tamayo and Wood promoted the creation of a new facility, the Laboratorio de la Isla de Cuba (after 1902, the Laboratorio Nacional de la Isla) under the direction of an alumnus of the Instituto Histo-bacteriologico, Juan Davalos. It was fully public in nature but its research mission was not stressed. Instead the lab was to provide public health and legal medical analyses, while producing vaccines, and to play its role in the general hygienization of Cuba that was the United States' first priority, as well as that of the Cuban physicians charged with keeping the young republic "clean" enough to preclude a new US intervention (a right the US had arrogated for itself in Article V of the Platt Amendment). The Instituto Histo-bacteriologico lost important sources of income in the process, and saw its own infrastructure relegated to second rank and many of the best young doctors in the island ally themselves with the US-backed sanitary project (Ruiz Casabo 1912).

The eradication of yellow fever in Havana by US sanitary authorities within a year of the Reed team's demonstration, and refinement, of Finlay's mosquito hypothesis, was a milestone in the history of medicine. It consolidated tropical medicine as a domain where concrete applications could achieve spectacular results, even without discovering the pathogenic "germ" (the yellow fever virus was too small to be seen by microscope technologies at this time, and its discovery would have to wait two decades). The prevention of the deaths of non-immunes--that is, those not born and raised in the tropics who acquired immunity through childhood bites from infected mosquitoes--would allow for colonization and development of formerly untameable space, something whose ultimate demonstration would be the successful building of the Panama Canal. Medical researchers the world over climbed aboard the tropical medicine express, including the heroes of the bacteriological age: Pastorians invited Alphonse Laveran to join the Pasteur Institute and established branches throughout the French tropical colonies; Koch embarked on sustained research in tropical Africa (Moulin 1996).

It is extraordinary, then, that Santos Fernandez abandoned tropical medicine at this time--not only in terms of a way of framing his research agenda, but as a concept tout court--even as those around him took their seats on the train. Others, even Finlay, did very well by claiming a place for themselves within the new discipline, and by creating institutions inside Cuba and cultivating connections internationally on the basis of a comparative advantage in conducting research into tropical medicine (Aristides Agramonte and Juan Guiteras being the most obvious). Already in July 1900, before the Reed team had completed its experiments that would confirm Finlay's hypothesis, Juan Guiteras, a former associate of Reed's and the new Professor of Tropical Medicine at the University of Havana, launched his Revista de Medicina Tropical. His collaborator in the journal was Emilio Martinez, director of the Laboratorio Clinico, a rival to Santos Fernandez's Instituto Histo-bacteriologico. Carlos Finlay figured as a writer on the masthead, and listed collaborators included Enrique Lopez (Santos Fernandez's principal commercial-professional rival as a cutting-edge ophthalmologist in Havana) and Aristides Agramonte (the other Cuban-born naturalized US citizen who was working with the Reed team, and who would now repatriate to Cuba with the intention of ploughing its fertile fields for tropical medical harvests). Most indicative of the way the new winds were changing Santos Fernandez's fortunes, the list of collaborators included three men who had been central to the scientific project of his Instituto Histobacteriologico: Juan Davalos, Eduardo Laine, and Tomas Coronado. (15)

In his presentation in the first issue, Guiteras underlined that in the age of medical specialization, with the growth of subdivisions in medical science, tropical medicine should become the specialty of "nuestro pais, por su clima, sus condiciones topograficas y etnicas" (Guiteras 1900b, 1). He specifically inserted this project into the Anglo-American ascendancy (emerging "in the last five years") over a French-based anatomo-clinical and bacteriological tradition, and linked the project to the emergence of parasitology as a discipline. In other words, there was a tremendous awareness among protagonists that they were living a world-historical moment. Guiteras also explicitly endorsed the reaping of Cuba's comparative advantage in relation to the interest of the new colonial powers in solving problems associated with the colonization of the tropics, proposed a move to parasitology over bacteriology (a discipline that had not provided the applications that it promised), and proposed applying to Cuba the lessons learned on recent trips to Africa by researchers from the Liverpool School of Tropical Medicine and from the work of Koch showing that the population of "negros" were actually carriers of malaria (Guiteras 1900a, 3-4).

Moreover, this tropical medical turn to a concentration on the pathological specificities of certain racial groups as "carriers" or as eugenically degenerate was complemented in the domain of anthropology in Cuba at this time. Especially in the early work of Fernando Ortiz, the proposition that the African-descended population of Cuba had behavioural and physiological proclivities to disease and degeneration was widely spread. In his classic work of 1906, Ortiz used metaphors drawn from tropical medicine to propose a program for isolating the source of criminal behaviour--the negro brujo (16) (Amador 2008, 80-82). These were the heirs to an anthropological project that Santos Fernandez had played a central role in establishing. They eagerly seized the discourse of tropical medicine, blended it with eugenics, and turned it into a key theme in Cuban immigration policy and in the police surveillance and repression of Afro-Cuban political movements and cultural organizations (Bronfman 2004).

But Juan Santos Fernandez's grand tally of 1898-99 did not lead in the same direction. Over two decades of practice, he had accumulated clinical data on some 5,531 subjects deemed to be of African descent (3,003 "negros" and 2,528 "mulatos"). His "final" findings, Enfermedades de los Ojos en los Negros y Mulatos (1901), presented to the 1900 International Medical Congress in Paris at exactly the moment that Guiteras was launching his Revista de Medicina Tropical in Havana, showed that there were no new or special diseases in determinate races. In fact, Santos Fernandez's immense database demonstrated the opposite. He informed the delegates that the studies undertaken in the United States on this subject have a certain limitation because they have not always been formulated on the basis of statistics and when they have been, the statistics do not take in a period anywhere near as long as ours do, and so offer quite imprecise deductions. ... We think that our work will reveal in a sense the proportion in which specific diseases of the eye attack the black race, and we can propose that, with rare exceptions, blacks and mulattos are affected by diseases of the eye in Cuba in an analogous manner to people of other races, due to the development of causes and individual predispositions which no men are exempt from, no matter what their ethnic origin. (Fernandez 1901, 4)

Santos Fernandez's statistics suggested that certain eye conditions were less prevalent among blacks and mulattos than among whites, but little else: they are "in a sense, of scarce interest, if you consider that we are not referring to new illnesses nor special ones specific to determinate races; on the contrary we are obliged to deny the existence of such illnesses because of our long observation and the support that the numbers give us" (Fernandez 1901, 7).

Not only did he deny any essential pathological differences according to race, his tally marked a major shift in his conceptualization of race itself. His Indice was arranged according to the categories moreno, negro, mulato, and pardo. Occasionally there is a hybrid notation (for example, pardo-chino) 11 But the individualizing marks of the clinical encounter, once inscribed with great care in the notebooks, are gone from the index, as are all but the most vestigial ambiguities and doubts. Also dropped from the 1898 Indice were the ethno-regional markers that were carefully preserved in the clinical record--for patients from both Africa and Spain. Particularly interesting here was that, while his earlier paper of 1879 had distinguished between peninsulares (from Spain), insulares (from Cuba), people from the Canary Islands, negros africanos, negros nacidos en Cuba, and mulatos, as well as to a significant number of Chinese indentured labourers listed as of "yellow or mongolic race," his new tally differentiated only between whites, mulatos, and negros (Fernandez 1901, 4-5).

Moreover, in Paris he introduced a second new theme: that his work on eye diseases in blacks and mulattos, despite its exhaustiveness, was not particularly notable because, alongside the fact that it refuted the notion of new or specific illnesses in different races, it proved that "diseases of the eye suffered in the Island of Cuba, despite its warm climate, do not differ from those suffered in other countries" (Fernandez 1901, 6-7). He would repeat this message frequently over the next two decades, most emphatically in an address he was invited to give at the 1909 annual meeting of the American Academy of Ophthalmology and Oto-Laryngology in Chicago. In it he systematically refuted all of the theories of tropical ophthalmology, many that he himself had once proposed. Purulent conjunctivitis was actually less prevalent in Cuba than elsewhere, and the germs that cause it likely "less virulent in Cuba than in Europe." The effects of the sun and wind of the Cuban tropics are actually, overall, salutary for the eyes. The average temperature leads to a lesser inclination to imbibe alcohol, and so ocular diseases resulting from alcoholism were less prevalent there. Blacks do not have a greater disposition toward tetanus; it was simply that in the days of slavery they worked with bare feet. In sum, he concluded, "intertropical countries are unhealthy while civilized man does not exert himself. Once this influence is felt, they may be unpleasant if inhabited all the year round, but are of more easy hygienization than cold countries" (Fernandez 1909, 1, 9).

Santos Fernandez's Paris paper was an early announcement of the kind of reformulation of categories that would characterize post-colonial Cuban racism--a shift that has been part of a major recent historiographical discussion (Bronfman 2004; Helg 1995; de la Fuente 2001; Palmie 2002). In one way or another, all of the works on this subject emphasize the way that Cubans of African ancestry were denied citizenship and scripted into a US and Western European-influenced eugenic narrative that focused on atavism. Yet Santos Fernandez is precisely moving away from this eugenic notion of pathologies native to different races. Instead, his vision of race was more in keeping with the growing mestizaje currents in Latin America--that is, the conjuring of a cubanidad that would come from the gradual absorption of those of African ancestry into the general population pool. His proj ect reminds us that the intellectual process of this reformulation long pre-dated independence, and was the product of the internal development of Cuban science (including its anthropological vector) using Cuban data--not simply, as Stephane Palmie in particular has proposed, only made possible by intellectuals like Ortiz after independence when they were supposedly mature enough to copy European intellectual stylings.18 Santos Fernandez certainly remained a leading criollo voice in favour of immigration from Spain (Naranjo and Garcia 1996, 12). His predilection, however, was based more on the logic of a "whitening" mestizaje and a belief that Spaniards were more suited to improving Cuba, having acquired greater "civilization." This was a very different current of racism than the more genetically- and tropical medicine-based racist essentialism expressed at this time by Cuban intellectuals such as Ortiz and Guiteras.

Conclusion: Scientific Arielismo

Given the national and international medical landscape, the position developed by Santos Fernandez on the cusp of the 20th century was unexpected and, indeed, original. But this should not lead to the conclusion that Santos Fernandez was a figure of redemption or a reborn hero of anti-imperialist, anti-racist progressivism. He did not become a radical critic of biomedicine, nor did he repudiate racism. He himself remained firmly convinced that white European civilization was superior, and was a leading voice among elites who argued that Cuban immigration should be restricted to whites. Nor was he dislodged from his elite position in Havana's medical community. His leadership was championed by an influential coterie, and he was re-elected to the presidency of the (increasingly moribund, it is true) Cuban Academy of Sciences in 1902, remaining at the helm until his death in 1922. He maintained relatively good relations with the US occupation authorities, despite exchanging some letters with Leonard Wood in which he suggested that the occupiers should spend more effort on health problems that were afflicting Cubans (like tuberculosis) than concentrating all their efforts on yellow fever control (which threatened US troops and the non-immune populations of the US Gulf coast) (Espinosa 2009, 69-70). He continued his professional relationships with colleagues and societies in the United States, and was by and large an admirer of US American civilization.

After 1902 the Instituto slipped slowly into scientific insignificance, and the Cronica gradually lost its role as a vanguard journal of laboratory science and became a slim journal of ophthalmological tidbits, advertisements, and obituaries. The final 20 years of Santos Fernandez's life were devoted to three projects. One was the rehabilitation of Carlos Finlay's scientific reputation and the insistence on Finlay's priority in the discovery of the mode of yellow fever transmission. A second was the flat and systematic denial that there was any pathological character or inherent hygienic deficiency peculiar to Cuba or any other country in the tropics, or to the races that live there. Third was a program of building up research and professional networks of a Hispanoamerican character. After the US occupation ended, he kept his clear preference for maintaining Hispanic connections despite a growing reputation within US opthalmology. He travelled frequently to Mexico and Spain, and remained Cuba's leading organizer of the national and international medical gatherings that made the young country a showcase for medicine and hygiene in the Americas (Funes Monzote 2004). He was a driving force behind the creation of the Union Medica Hispanoamericana, initially proposed during the 1900 medical congress in Paris (ACTAS 1904). The organization held a high-level constituent meeting in Madrid in 1903, though the only cohesive group to come of it was an ophthalmological one created by Santos Fernandez along with Manuel Menacho Peiron of Barcelona, Demicheri of Montevideo, Sagleyce of Buenos Aires, and Marquez of Madrid. Their journal, Archivos de Oftalmologia Hispanoamericanos, was soon paired with a Sociedad de Oftalmologia Hispanoamericana, founded in 1904 (Garcia del Real 1921, 1037-1038; Vila-Coro 1970, 11-13; Menacho n.d.; Menacho 1927). The former Autonomista also wrote extensively on the development of ophthalmology in Spain and Latin America in order to promote its importance, and proposed a project to translate Spanish scientific works into English--an idea launched at the 1903 meeting in Madrid where a project was hatched to produce a dictionary that could sustain a proper Hispanic project in science and medicine to rival the Northern giants (Olague de Ros 2007). (19) The European war of 1914-18 left Santos Fernandez wondering if the degeneracy of the European powers might be the opportunity for a rebirth of the Hispanoamerican world (Fernandez 1916).

On one level, I think we do have to read this agenda as counterhegemonic--or perhaps "extra-hegemonic"--in the way that Rodo's Ariel promoted the need to look within Hispanoamerican cultural and intellectual traditions, and to cultivate such networks and modes of intellectual practice, in order to encounter modernity on terms that were not simply dictated by the new imperial United States. Santos Fernandez was creating what we might consider a dominant culture in waiting that, while it never returned to power, must be considered one source and reference point for the development of future challenges to the dominant order. The defence of Finlay's scientific integrity and priority (a battle that continues today, it should be noted, and that remains a banner of the Cuban regime and a rallying point for historians of Latin America) fits nicely into this project. In retrospect, Santos Fernandez could read the attributes he once dismissed as "artisanal" and "speculative" as having been part of an original Hispanic mode of scientific thinking that could arrive at essential truths ahead of the Anglo-Saxon mode of science. This form of conservative Hispanism tinged with anti-imperialism, while very much in keeping with the elitist criollo tendencies evident in Rodo's text, do have an intriguing overlap with the radical left that would develop in Latin America over the following half century. Both projects are animated by concerns with developing alternate networks--spaces of sovereign science--outside of Anglo-American domination.

Acknowledgements

The author thanks Reinaldo Funes Monzote and Ricardo Gonzalez Leandri, as well as participants in the UNAM colloquium, for their insightful comments on this article. Special gratitude goes to Magalys Reyes Silva, Paula Regla Hernandez Pino, and Graciela Guevara Benitez of the Museo de la Ciencia "Carlos J. Finlay" for assistance with archival and periodical information. The research and writing of this article were supported by grants from the Social Sciences and Humanities Research Council of Canada, and the Canada Research Chair in History of International Health at the University of Windsor.

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Notes

(1) Although Juan Santos were his given names, and his full last name was Fernandez y Hernandez, it became customary to refer to him during his lifetime and subsequently simply as "Santos Fernandez," even for formal purposes, to the point that his works were often indexed under "S" as though Santos was his patronym (or first last name, according to the Hispanic protocol); indeed, his daughter followed this by adopting Santos Fernandez as her own last names. I have chosen to follow this customary form in the text, but to maintain the standard form in the alphabetization of his cited works.

(2) Jose Enrique Rodo's essay Ariel (1900) was a powerful and influential expression of Latin American concern about the rapid and over-whelming rise of a highly materialist US politics and culture in the Americas. Arielismo, the label given to the expression of such concerns in Latin American literature between 1900 and 1920, was critical of positivism and materialism and proposed as an alternative the recuperation of spiritual, philosophical, and aesthetic elements in the Hispanic cultural repertoire.

(3) Juan Santos Fernandez y Hernandez, Libros Clinicos, Archivo del Museo Historico-Nacional de las Ciencias "Carlos J. Finlay," La Habana, Cuba, LC 1. The collection of Santos Fernandez's registers consists of 128 clinical notebooks (hereafter LC [Libros Clinicos]) covering the period 10 March 1874 to 24 July 1922, and containing 63,510 patient records. There are also 14 surgical notebooks (hereafter LO [Libros de Operaciones]) covering the period 25 March 1875 to January 1916, documenting some 19,000 operations. There is a complete Index for the clinical notebooks by name, and also an "Indice de Negros y Pardos" that cross-lists all those registered as of African ancestry through 1897.

(4) The great biography of Finlay is Lopez Sanchez (1999).

(5) On the overlap of scientific and medical research with this political process, see Pruna Goodgall (2002) and Pruna (1994).

(6) The only major work on the laboratory is Diaz-Arguelles (1988). The numerical data and list of collaborators has been collected from publications with the Instituto imprimatur between 1887 and 1895, especially Pla (1888, 294).

(7) On this context, as well as the work of Lopez Sanchez (1999) and Delaporte (1991), see Stepan (1978, 412).

(8) The destructive rivalry between Finlay and the Santos Fernandez group of the Instituto is covered in detail by Lopez Sanchez (1999, 298-326) in his scientific biography of Finlay.

(9) For Tamayo's resignation letter, 22 March 1891. 10362-DTF-CO 3-Archivo de la Academia de Ciencias, Museo Carlos J. Finlay, Havana, ff. 2-3.

(10) For a detailed account of Finlay's November intervention and Santos Fernandez's "surprise" endorsement, as well as the importance of the discoveries by Smith and Ross to contemporary thinking about tropical medicine, see Lopez Sanchez (1999, 352-353). An account of yellow fever research that portrays Finlay in a negative light is Delaporte (1991).

(11) "[T]he granulous bodies present, which one day might shed some light on the biology of the malaria hematozoas discovered by him and today understood and recognized by all competent researchers" (my translation).

(12) The original transcript reads, "Llama la atencion de como pasan a veces inadvertidos los trabajos de nuestros clinicos y luego se acogen los que nos viene de afuera exponiendo lo que ya entre nosotros era conocido."

(13) Those who wish to decide for themselves can look at the rich repository of primary sources on the Reed Commission's activities, http://yellowfever. lib.virginia.edu/reed/

(14) "Indice de Negros y Pardos," collection of Libros Clinicos at the Museo Finlay. The "Indice de Negros y Pardos" must have been compiled during 1898-99, because it includes all those registered as having African ancestry through 1897, and it was used as the basis for tables presented to the Paris congress in 1900.

(15) Revista de Medicina Tropical, I (1) 1900: frontispiece.

(16) Published in 1906, Fernando Ortiz's Los negros brujos (Black Wizards) was an influential study of Afro-Cuban religion that linked some spiritual practices to violent criminal behaviour and helped to fuel a series of moral panics in the early republican period over the alleged kidnapping and murder of white Cuban children to satisfy Afro-Cuban religious practices.

(17) "Indice de negros y pardos," no pages.

(18) Palmie's take on this actually reproduces one imperial trope concerning intellectual transmission, by proposing that scientific racist ideas originated in US and European metropoles and later were taken to the periphery, and another related one, by suggesting that technical and intellectual expressions of the native colonial elite are simply mimicry and lack authenticity or originality.

(19) The original dictionary project foundered, was attempted again by the Union Internacional Hispano-americana de Bibliografia y Tecnologia Cientifica (f. 1910), "with better backing from the authorities," that managed to publish a few issues in the 1920s, but the Diccionario Tecnologico Hispano-Americano would not see a complete first edition until 1983, with a second expanded edition in 1990 (Olague de Ros 2007, 509). See also Ramos (2001, 237-251).

STEVEN PALMER

University of Windsor