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When social service agencies arose in the United States in the late 19th century to address social and health problems , African Americans were often excluded . Azuela ’ s descriptions of the landscape represent the flowery lyrical 19th century style that looked outward to the exotic and describes the jewel-like qualities of nature . Later the kingdoms of Thailand , Laos and Vietnam variously held sway over stretches of the river until the arrival of the French in the 19th century . During the course of the project Dr. Fliess did a preliminary edit of the 19th century material . To be sure , there is your run-of-the-mill bioethicist who in some ways reminds you of 19th century lawyers : anyone who hangs up a shingle qualifies for this ill-defined speciality .