Enlightened Immunity: Mexico’s Experiments with Disease Prevention in the Age of Reason by Paul Ramírez (review)

Too often the history of disease prevention gets told as the enlightenment of medicine: through a series of theoretical, practical, and professional innovations, technologies like vaccination mitigated major health threats such as smallpox and culminated in increasingly efficient forms of public health management. In an eighteenth-century context, such paradigm shifts toward preventative health typically get attributed to the contributions of key figures like Mary Wortley Montagu and Edward Jenner, who both popularized inoculation methods in the British nation and beyond. As Paul Ramírez explores in a rich archive of eighteenth-and early nineteenth-century political, religious, medical, and cultural sources in New Spain, such developments in epidemic responses and disease control were actually a product of complex negotiations between lay communities and state officials. In Enlightened Immunity, Ramírez models what Roy Porter has called “doing medical history from below” (Porter, “The Patient’s View: Doing Medical History from Below,” Theory and Society 14, no. 2 (1985): 175–98). Ramírez focuses his analysis on popular responses to imperial medical reform in Bourbon-era colonial Mexico (ca. 1713–ca. 1870), especially those of Indigenous healers, village priests, and barbers who mediated the work of translating public health into accessible forms tailored to community values and needs. Instead of presuming that “medical knowledge and expertise flow outward, or downward, from the social elite or institutional centers of medical authority to the masses” (61), Ramírez turns to vernacular forms like Mexico City’s journals that synthesized Indigenous and African community knowledges with developing therapies and technologies.

Drawing together methods in the history of medicine, the history of religion, and the history of colonialism, Ramírez contributes to a historiography of global Enlightenment by decentring Europe, Britain, and the United States. His rigorous engagement with the “decades-long struggle to graft vaccination into the routines of everyday life” in colonial-era Mexico reveals the vast extent to which such enlightened shifts in medical thinking required “domestication” in the form of public rituals like processions and sermons, and spaces for dissent and debate like the free periodical press (136–37). Ramírez compellingly argues how the archival record (and its many gaps), which later nineteenth-century thinkers and more recent historians have taken for granted as the ignorance of laypeople, helps to justify why ongoing debates over vaccination cannot be resolved with the reiteration of medical fact. Rather, personal, affective responses to vaccination like rumour and gossip, and the various ways physicians and state officials made sense of them, were foundational to the procedure’s normalization upon its arrival via the Royal Vaccination Expedition of 1804 led by Francisco Xavier de Balmis. For example, Ramírez recovers how Mexican devotional culture incorporated quarantine and treatment strategies into the cultural practices of veneration and the highly circulated iconography of saints like the Virgin of Guadalupe and the Virgin of Loreto. The Catholic Church would be crucial in the circulation of the Jennerian vaccination precisely because of its persistent public presence in the daily lives of Mexican people. This, Ramírez points out, became a “mode of governance that revived religion’s special role in advancing a variety of colonial projects” like the repackaging of public health in personalized ways (164). The convenient trajectory from spiritual to scientific frameworks for health and the body is simply ahistorical.

What makes Ramírez’s account of preventative medicine and public health in colonial-era Mexico so incisive is its deliberate problematizing of any clear distinctions between urban and rural, secular and religious, and elite and vernacular toward a thick history of how “heterogeneous voices shaped debate” (131). The portrait of colonial power in New Spain is hardly monolithic and centralized but in reality, far more diffuse and contingent, which Ramírez beautifully likens to the procedure of vaccination itself: “Like the crushed scabs used in vaccinating campaigns, medical authority, skill, and knowledge...