Epidemiología americana y filipina, 1492-1898 (review)

Francisco Guerra. Epidemiología americana y filipina, 1492-1898. Madrid: Ministerio de Sanidad y Consumo, 1999. 878 pp. Ill. $25.00; Ptas. 4,000.00.

Francisco Guerra's gift to readers, on his fiftieth anniversary of writing comprehensive medical histories and bibliographies, is a work that bespeaks his last name ("war"). Epidemiología americana y filipina is a frontal assault against the "Black Legend" that blames Spanish cruelty for the disappearance of the natives of the American continent. From the first page Guerra indicates that demographic "abysses" cannot be explained by murder or battle, for the number of the fallen was very small in proportion to the population, and high mortality occurred mostly while Spaniards and natives coexisted peacefully in colonial times. He points to similar demographic catastrophes in English and French America, and compares these to the population of the Philippines, with its evolutionary and epidemic history related to Asia, which did not show a decline during the Spanish colonial period. Epidemiología is a monumental achievement, bursting with rare and unexpected information, such as differential mortality rates by race; the geographic transmission routes of diseases; early uses of prevention methods (quarantine, inoculation, cohorting); sixteenth-century Mexico's "hospital republics" (towns of native Americans established with a hospital as their center); diseases introduced into Haiti by African-American immigrants from the United States (1824-26); and the Latin American humor in giving names to epidemics.

The book opens with a disclosure of the author's personal research on the diseases to be discussed, particularly typhus and influenza (his career has included the roles of military physician, research pharmacologist, and historian). The most important sources of demographic and medical information for the period 1492-1898 in the Americas and the Philippines are then discussed. Four succeeding chapters (Iberian man, American man, Iberian diseases, American diseases) show the hallmarks of Guerra's writing: panoramic range and terse exposition. To describe the evolution of the human groups that met in colonial times, special emphasis is placed on migrations, environments, domestic animals, and microbial pathogens. Guerra stresses that "the most important epidemiologic fact in pre-Columbian nosology is the absence of viral diseases" (p. 88) and therefore the lack of immunity to them. "Epidemic chronology" presents a 432-page annotated list of 1,631 epidemics in humans and animals in a 406-year period, from Alaska to Patagonia and from Barbados to the Philippines, often providing the number of the dead and the size of populations, to document the astonishing mortality rates of infections. Three short chapters summarize the impact of these events and the societal response (religious interpretation, foundation of hospitals, treatment and prevention methods), and correlate epidemics and population estimates to show the devastating effect of the first century of contact between natives and Europeans. This contact occurred in the sixteenth century from Mexico to Chile and in the seventeenth century or later in present-day Canada and the United States. The microbial pathogens that most affected demography in the Americas from 1492 to 1898 are judged to be smallpox, typhus, measles, influenza, yellow fever, and dysentery.

The remaining 210 pages provide summary listings of the epidemics by disease, and annual population censuses for cities from Boston to Manila, including, where available, natality and mortality, with especially abundant data for Mexico City and Havana. A 63-page bibliography in nine languages shows the book's deep foundations, citing authors from Christopher Columbus to Marcos Cueto and Howard Markel, and sources from pre-Cortesian codices to the National Geographic.

The immenseness of this database produces accessibility problems. Guerra's punctiliousness in citing all possible epidemic diagnoses, while respectful of alternative hypotheses, requires the reader to contrast different entries for the same disease or epidemic, a task made difficult by the absence of a subject index. For that reason, the book is begging for an edition in CD-ROM format. Epidemiología is timely...