Diseased Relations: Epidemics, Public Health, and State-Building in Yucatán, Mexico, 1847-1924 (review)

In this study of the history of public-health campaigns in Yucatan, Mexico, McCrea provides the historical background for an understanding of the limitations that physicians and health-department officials faced while confronting a series of "disease moments" in the nineteenth and twentieth centuries. The focus is on epidemics of smallpox, cholera, and yellow fever from the 1840s to 1924, the year in which the socialist government of the state was overthrown and public-health policies connected to political mobilization were abandoned.

McCrae positions her study within the historiography of Mexico and of public health, comparing and contrasting Yucatan with other well-studied places, such as Hamburg, New York City, and Mexico City. She does not claim to be a historian of science, although she emphasizes that medical science was for a long time confused and contradictory regarding the etiology of disease. The book therefore is not truly interdisciplinary in nature but falls squarely within the regional Mexican historiographical tradition.

The most important theme of the book is that public health was not simply a matter of the government trying to save lives. In Mexico, as elsewhere, modern medicine was seen by elites as a means of advancing civilization and eliminating "barbarism"—in this case, a struggle to impose Western culture on an indigenous people who had every reason to distrust their traditional ruling class, even in matters of health. The elitist public-health campaigns frequently sought to save the upper class first by concentrating resources on Mérida, the state capital. Medical efforts declined with distance from the capital. Failures were often blamed not just on political instability—especially on the effects of the civil war referred to as the Caste War—but also on the ignorance and backwardness of the Maya. McCrae demonstrates that the yellow-fever campaign succeeded because it was implemented by a socialist government willing to mobilize the masses and to collaborate with the Rockefeller Foundation.

Unfortunately, the first half of the book is based on a weak documentary base since the archives apparently did not yield a great deal of information about most of the nineteenth century. McCrea therefore fills out the first several chapters with extended summaries of the Caste War, the Church-state conflict, the henequen boom, and public health in Mexico as a whole. She was better able to study yellow fever, the last disease addressed, because of the extensive archival holdings of both the Rockefeller Foundation and the state government.

The book inadvertently demonstrates that vague statistics are not useful. A table purporting to reveal the discrimination that certain areas faced with respect to the distribution of smallpox vaccine is spurious because the data do not distinguish between cities and the political districts containing those cities (27). An analogy would be the failure to specify whether a certain set of statistics pertained to New York City or New York State. McCrae also makes mistakes about Mexico that are extremely disconcerting: for example, that Coahuila is a state in central Mexico and that Carmen (a town and capital of a political district in Campeche) is in Quintana Roo (24, 78-79). In addition, she betrays a lack of understanding of Hispanic culture by frequently using the maternal rather than the paternal surname of historical personages and authors. The accumulation of errors (such as accidently referring to Salvador Alvarado as Salvador Allende) undermines the overall value of the book (242).