Review of Archiving Medical Violence: Consent and the Carceral State By Christopher Perreira, Minneapolis, MN: University of Minnesota Press. 2023. 170 pp.

Reviewed Book

Archiving Medical Violence: Consent and the Carceral State By Christopher Perreira, Minneapolis, MN: University of Minnesota Press. 2023. 170 pp.

Cover of Archiving Medical Violence (2023)

Aisha Khan

New York University

The human body has long been a site of preservation, experimentation, and imagination, as societies and cultures grapple with disease, death, pleasure, and purpose. All these concerns necessarily reflect the relations of power that structure societies and cultures. Power relations become especially stark when focus is on the quality of life that the body enjoys, or does not. Christopher Perreira’s Archiving Medical Violence: Consent and the Carceral State, is concerned with the connections between bodies, lives, and power that are produced and revealed in the historical relationship between criminalization, racism, and medical knowledge and practice. Perreira looks in detail at four case studies of medical violence: mid-19th century Hawaii, early 20th century Louisiana, mid-20th century Los Angeles, and mid-20th century Guatemala. His central argument, delineated in the Introduction, is that ideas about scientific and national progress are predicated on state-sanctioned forms of medical violence, and that prisoner-patients (incarcerated people, interned patients, and targeted quarantined communities) form the “human soil,” as one scientist put it (24), from which devalued expendables became revalued medical and public health subjects.

Situated between American Studies and the History of Medicine, but joining other disciplines, notably Anthropology, this book seeks new ways to create, collate, and interpret the archival record of what Perreira terms “medical violence,” the enduring consequences of the interdependence between public health and public security. This interdependence, he argues, produces the racialized discourses that define the prisoner-patient as a particular kind of person, and sustain the repository of medical knowledge that preserves, and relies on these discourses. But Perreira also is interested in how the production of medical knowledge holds possibilities for critique, which can fuel resistance, stoke memory, and make imagined alternative futures more palpable. To this end he juxtaposes official documents, scientific writings, novels, memoirs, collective memory, and cultural production as “contested and competing narratives” (26), a move that he pursues in order to disturb the official logics of progress and benevolence and challenge the masking of racism, criminalization, incarceration, and other forms of violence that inform medical knowledge and practice.

Chapter 1 discusses an 1884 criminal case of a Hawaiian man who was incarcerated for murder and sentenced to death. Perreira focuses on the court conviction, its reportage in newspapers and medical journals, and comparable cases that circulated globally in colonial medicine. He contends that it was not the crime that gave this case its prominence but, rather, how it provided the ideological basis for paying social debts through medical experimentation. Perreira recounts a chilling suggestion made by a German microbiologist who was studying leprosy with the Hawaiian Board of Health. After he read about the case he suggested that the convicted man’s death sentence be commuted to life in prison because debts to society could be paid by prisoners’ freely submitting to medical experimentation. Despite the dubiously voluntary nature of this participation and its potentially deadly consequences, this scientist “promised to ‘really advance our knowledge of the obscure disease’” (31). Perreira makes the important point that what ensued was the development of a discourse, promoted by doctors, that medical knowledge could, and should, be learned through racialized criminalization. In other words, devalued lives gain new, pernicious, use-value through medicine.

The second chapter looks at the case of the Carville Leprosarium in Louisiana. After the United States’ annexation of Hawaii in 1898, Congress debated about how to eradicate leprosy and other contagious diseases. One result was to build Louisiana’s leprosarium, which was erected on a slave plantation situated on Indigenous land. Discussions among US Public Health officials and Congress, along with the memories recounted in Carville patients’ writings, puts hegemonic and subaltern points of view into conversation, revealing the importance of memory and race as vital components of what is in fact a medical science and public health story of state-sanctioned medical violence, settler colonialism, and a racial project designed partly on models of prisons.

Memory is also an important consideration in Chapter 3. Here, Perreira inquires into the invention of racialized disease in California’s public health system, drawing on medical journals and news media, among other records, that document forced quarantine and experimental medical procedures at the Los Angeles Olive View Sanitorium. He considers these in conjunction with the role of prisoner-patient memory in Alejandro Morales’ 2008 Chicanx novel, The Captain of All These Men of Death. Juxtaposed as competing narratives, these texts, Perreira argues, together underscore medical scholarship’s need for greater attention to memory and culture as sources of critique and counter-hegemonic ways of knowing. A key point of this chapter is that public health and public safety are mutually constitutive in nation-building projects, forming what Perreira calls “a carceral health imaginary” that has shaped, and that also can reimagine, US history.

Archiving Medical Violence ends with an Epilogue that analyzes the investigation of human subject protections in scientific research conducted in 2010 by the Obama Administration’s Presidential Commission for the Study of Bioethical Issues. One discovery of the study was the United States Public Health Service’s deliberate transmission of syphilis in Guatemala City, Guatemala from 1946–1948, spread among incarcerated people, hospital patients, children in orphanages, and soldiers. Perreira underscores a crucial point: much of mainstream scientific discourse has been conducted for decades “generally behind closed doors and with the authority and resources of the state, universities, hospitals, and laboratories” (107). Thus, medical violence is a building block of the nation-state and its imperatives. Not contained by national boundaries, it is a global language and a global practice.

Perreira draws important conclusions from his analysis of the diverse archives that represent these cases. One is that medical scholarship must approach culture and approach memory (the who, what, where, when, and why of it) as crucial sources of subaltern social critique, steering scholarship and practice away from the medical violence that continues to be committed. Another important message is that medical discourse is an archive that subsumes violence into “narratives of modern reason, progress, and law”; Perreira quotes a prominent scientist’s response to a question about the state’s relationship to medical experiments: “‘it’s against the law to do many things, but the law winks when a reputable man wants to do a scientific experiment’” (112). In examining key factors in what allows for these “winks,” Archiving Medical Violence joins the growing body of scholarship that gives crucial scrutiny to medical violence and the necropolitics of the state.

What readers come away with is that medical violence is no anomaly, nor is it a contained phenomenon. Rather, it remains ubiquitous, present in media, literature, museums, movies, conventional archive storerooms, and, even more broadly, in the “racial geographies of culture” (15). Although this book likely will be most accessible to advanced students and specialists, its subject matter and point of view will be of interest to anyone concerned with the intersections of science and politics, the limitations and potentials of “the archive,” and the consequences of unequal power relations on such seemingly unbiased and humanitarian projects as medical care and public health policy.