Medicine on the Periphery: Public Health in Yucatan, Mexico, 1870–1960 by David Sowell (review)

During the past few years, panoramic historical accounts of medicine in some Latin American countries have appeared. However, only a few studies have provided sophisticated and holistic perspectives of medicine and public health in subnational regions. This book is a good example of the latter for a Mexican state that had a virtually autocratic dynamic thanks to the exportation of henequen (a native plant used in textiles). In addition, the Mexican Revolution of 1910 did not have an immediate impact in the region.

In 1833, a school of medicine was founded in Merida, the main city of the state, which in the following decades trained a few hundred professionals who mainly worked in urban centers. Toward the turn of the twentieth century, European-style laboratory work was part of the training of physicians, medical professional associations and specialized journals appeared, hospitals were created, campaigns against some endemic diseases such as yellow fever and smallpox were launched, and a permanent local public health agency operated mainly in cities, big towns, and ports. The author demonstrates that epidemiological surveillance and sanitary inspections were of the outmost importance during the early twentieth century. Different sections of the book examine the temporary agreements and difficult coexistence among indigenous healers, quacks, herbalists, and university-trained physicians. According to Sowell, about five generations of local physicians were able to find a niche in an active national and international medical network that existed in the circum-Caribbean.

The book has two organizing principles. First, federal authorities had, initially, little legitimacy in the state. Yucatan physicians were more proactive in their relationships with medical doctors from Mexico City and other countries. Toward the mid-twentieth century the autonomy of medical and political authorities began to diminish. Over the course of the second half of the century, an emphasis on cosmopolitan medical specialization substituted independent medical professionalization. The second organizing principle is that local elites embraced biomedicalization to validate their status and modernize the state. They hoped to “civilize” rural areas of the state, make Western medicine hegemonic, and severely restrict the activities of other healers. Biomedicine was a tool to make Maya people part of the Spanish-speaking, commercial, and dominant urban society.

The author has an impressive command of sources in diverse archives and libraries located in Mexico and the United States. The book discusses events before and after the years announced in the subtitle. For example, a section provides insightful information on the medical legacies of the Maya, and on Yucatan’s place within the Spanish Viceroyalty of New Spain. A section of the final chapter provides data to demonstrate the improvement of health indicators in Yucatan during the early 1970s thanks to public health interventions.

Missing in this book is a map of Yucatan and the locations that appear in the study. Another problem is the minimal discussion and problematization of the term “periphery” that appears in the title (I must confess that I have used it myself in the past). For the past few years, most historians of Latin American medicine—including Sowell, who is the author of outstanding works on South American medical pluralism—have demonstrated that not all medical developments in the so-called periphery were peripheral to the metropolitan centers of power. The author uses the term “peripheralization” in the text to convey the transition in Yucatan’s medicine from an almost sovereign center to a subordinate periphery (p. xviii). The question remains if “center” and “periphery” are still valid terms to identify medical realities in developing countries. This question is part of a never-ending debate, enriched recently by the challenging “global health,” that makes compelling the study of the history of medicine in developing countries. Frankly, I hope that historians of Latin American medicine will never answer this question and continue to use “periphery” ambiguously.

In any case, Sowell’s book is a sound contribution to the history of...