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SUMMARY: Circa 1900 Uruguayan medical authorities prided themselves on their country's health achievement: the lowest recorded infant mortality rate in Latin America and one of the lowest rates in the world. Over the next three decades, however, these doctors' pride suffered blow after blow as Uruguay's infant mortality stagnated at roughly the same 1900 rate, while other countries experienced sustained mortality declines. Even more frustrating was the apparent inadequacy of the measures that physicians themselves had advocated and implemented. This paper explores Uruguay's infant mortality dynamics during the first half of the twentieth century through the observations, acerbic debates, analyses, policymaking, and administrative perspectives of the country's pediatricians and public health experts. Only after infant health began to be addressed as an integral part of Uruguay's burgeoning welfare state in the 1930s did infant mortality rates start to decline once again.
KEYWORDS: infant mortality, Uruguay, public health, Luis Morquio, welfare state, Julio Bauzá, wet nurses, milk depots (gotas de leche)
In 1896 Montevideo's public health officer, Dr. Joaquín de Salterain, boasted that Uruguay's mortality rate was dropping steadily and that capital city's rate was lower than those of Paris, London, and Buenos Aires. "What other explanation could there be for such pleasing results," Salterain asked, "than the progress of our public welfare institutions, health administration, and hygiene education?"1 More than a decade later, Julio Bauzá, a newly minted medical graduate and head of Montevideo's milk depots, noted that Uruguay's infant mortality rate was well below those of Chile, France, Russia, and Germany. Although he felt that political authorities paid insufficient attention to child health, Uruguay occupied "a still enviable position for a myriad of European and American countries."2 Even famed pediatrician Dr. Luis Morquio, perennially with Uruguay's infant mortality efforts, admitted that its record merited "appreciation."3
Just a few years later, the same cast of public health experts was decrying the country's inability to lower its infant mortality rate, which had remained stuck at turn-of-the-century levels of approximately 100 deaths per 1,000 live births. Boaster Salterain now noted that drops in smallpox, diphtheria, and measles mortality had not been accompanied by improvements in seasonal diarrheal and respiratory death rates, both of which were rising despite the country's "mild and delicious" climate.4 By 1920...