Disease at the Front Line: Municipal Public Health in São Paulo during the Era of Epidemics, 1875–85

After 1849, townships across Brazil confronted a dramatically changing health environment.  Places long celebrated by foreigners and locals as being particularly salubrious (relative to regions of Europe and the United States) confronted a new set of horrifying infectious diseases, including yellow fever, cholera and bubonic plague.  While the imperial and provincial governments enlarged their budgets and powers over public health provision, the front line in the battle to turn the tide of new diseases was at the municipal level.  Indeed, it was township councilmen, judges, block inspectors and police delegates who bore the greatest responsibility for ensuring that their communities would avoid these new epidemiological threats.  Scholars know very little, however, about how township officials acted.  By comparing efforts taken by 12 diverse muncípios in São Paulo, this paper argues that because responses varied considerably, public health efforts must be locally contextualized.  The immediate response to improving collective health was contingent on geography, environmental propensity to particular disease, agricultural activities, budgets, population densities and proximity to cities.  For the majority of Paulistas – where the provincial capital was far and the imperial capital remote – these responses created the most intimate and potent connection of state and citizen.