Response to Robert Jackson
In my view, historians have long given scant notice to the topics of health care and disease, matters that actually deserve muclh attention. Robert Jackson rightly calls for a fuller understanding of the causes and responses to health conditions and has highlliglted several themes, especially poverty and underdevelopment, for miore discussion. I welcome the opportunity to further open up this topic, first by offering some additional observations on the case of Guayaquil, and second by sketching a few hypotheses for consideration as we take up the study of comparative healtlh conditions in other Latin American cities. As Jackson points out, even before the development of a modern scientific understanding of the origin and spread of disease, some public healtlh care measures were still effective. Quarantining and vaccination, he correctly notes, proved fairly successful in combating illnesses like bubonic plague and smallpox. In Guayaquil, as elsewhere, the prevailing notion that disease stemmed from evil, putrid airs-miasmas-led officials to call for cleanup campaigns to rid the city of the sources of these foul winds. Obviously such measures could be beneficial. Draining pools of water shrank mosquitobreeding areas, thereby reducing the risk of malaria and yellow fever. Hauling away human waste, offal, and garbage reduced the chan-ce that drinking water and food would be contaminated, thereby lowerinig the threat from enteric disorders, cholera, and typhoid fever. Cleaning and disinfecting living quarters reduced the riisk of tuberculosis, and controlling the flea population in dwellings helped lower the threat from bubonic plague and typhus.