The Return of Epidemics: Health and Society in Peru During the Twentieth Century (review)

Marcos Cueto. The Return of Epidemics: Health and Society in Peru During the Twentieth Century. Aldershot, England, Ashgate Publishing, 2001. x, 176 pp. $79.95.

Few topics in the history of disease have been studied as carefully as the epidemics that devastated New World populations during European colonization in the fifteenth and sixteenth centuries. The epidemics of contemporary Latin America, in contrast, have received much less attention. Marcos Cueto’s The Return of Epidemics fills this void. Thoroughly researched, this interesting and important book applies familiar approaches to history of medicine to original material provided by the epidemics of twentieth-century Peru.

Cueto examines five epidemics: bubonic plague, 1903–1930; yellow fever, 1919–1922; Andean smallpox and typhus, 1930s; malaria, 1940s to 1960s; and cholera, 1991. His analyses, based on extensive use of local and national archives in Peru, cover an impressive range of narrative and analytical material. Burgeoning international trade and urbanization that outpaced sanitary infrastructure created conditions in which plague thrived in the early twentieth century. Resurgent international trade and the decay of once-effective sanitary programs allowed cholera to emerge in the 1990s. The unique features of Peruvian geography (juxtaposition of coast, mountains, and tropical forest) produced locally specific variations on familiar connections between poverty and disease. Health programs as varied as the authoritarian, technological solutions of the Rockefeller Foundation or the community-oriented education campaigns of rural sanitary brigades all had success against Peruvian epidemics. However, disillusionment with the failed campaign to eradicate malaria and growing resentment toward the national government in the late twentieth century led (or forced) the government to withdraw from an activist role in public health.

In addition to describing the broad forces that shaped both the distribution of epidemics, Cueto provides many fascinating examples of local factors that undermined health campaigns. One government program against plague, a bounty offered for dead rats, failed when entrepreneurs began breeding rats solely for the goal of collecting the bounty. When government officials, out of negligence and inadequate funding, failed to chlorinate Peruvian water supplies, they justified this decision with studies from the United States that suggested a link between chlorination and cancer. They also advocated individual hygiene, especially hand washing, as the best method to contain cholera, at a time when 80 percent of water supplies were contaminated with fecal residues.

The most discouraging process documented by Cueto is the rise and fall of government responses to public health crises in Peru. Initial successes in the early twentieth century created both the obligation and the structures for government intervention in public health. The failure of malaria eradication and the increasing economic and political instability in Peru in the 1980s and 1990s reversed this progress. The government neglected the social contexts that created disease, abandoned disease prevention programs, and retreated to treatment programs. Frustrated by the lack of government programs, Peruvians have become increasingly resigned that preventable diseases, such as malaria and cholera, are an inevitable fact of Peruvian life.

Cueto, however, is not completely discouraged. He hopes that the lessons taught by The Return of Epidemics will guide new responses to epidemics in Peru and help break the cycle of poverty and disease that has long afflicted the country. He also succeeds in his goal of showing Latin American historians how a critical social history of epidemics can be a useful window for illuminating social conditions, social movements, and the role of the government. My only regret is that Cueto did not try to do more. His cases show how political and economic instability, of a degree not recently seen in the United States or Europe, fuel epidemics and undermine responses to them. Had he pushed his analysis further and generalized his conclusions beyond Peru, his work could have provided a powerful model for the many developing countries worldwide in...