The analysis focuses on an unsuccessful case of public health reform during Brazil’s first republican period. Why did Bahia, a state boasting a century-old tradition in medical education, medical societies, and scientific journals, fail to develop a statewide system of public health research and "medical police" during the early twentieth century? Bahia had no strong political machine, it lacked a favorable intellectual climate among medical and public health professionals, the state’s economic basis was fragile, and therefore sanitary programs developed at a slow pace. The first signs of sanitary reform came during the 1920s and were triggered by the national government apparatus, which was absolutely essential to the formulation and implementation of plans to "rescue the backlands" in Bahia.
public health reform; State building; modernization "from above"