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

Abstract

Heather McCrea offers an innovative understanding of public health in Yucatán through her study of smallpox, cholera, and yellow fever epidemics, which “are conceptualized as diseased ‘moments’ ” that provide “insight into the processes of state-building and identity formation” (p. 7). McCrea seeks to “show how the development of public health is really embedded in interventions that collectively changed the dynamic interchange between the indigenous Maya peasantry, mestizos, creole elites, statesmen, foreigners, and medical practitioners in Yucatán” (p. 3). Though the treatment of the nineteenth century is stronger than the twentieth century, Diseased Relations is an admirable success.McCrea sets the stage before examining smallpox as a diseased moment. She traces the vaccination effort, locating the campaign in the context of regional struggles between Campeche, Mérida, and Mexico City. Her research is meticulous on efforts to obtain vaccine from cows in the 1840s, plans to use orphaned children to “carry” the disease from New Orleans to Yucatán, and the deliberate infection of children in order to obtain the pus later in the century. Two chapters examine the cholera outbreaks of 1833 and the 1850s, one focusing on liberal efforts to seize control of burials and cemeteries and the other on how disease control symbolized the elite civilizing mission during and after the Caste War. Yellow fever illuminates the modernizing crusade associated with the henequen boom, as well as the revolutionary objectives of the regimes of Salvador Alvarado and Felipe Carrillo Puerto between 1915 and 1924. McCrea asserts that the Rockefeller Foundation’s anti – yellow fever collaboration with Mexican and Yucatec officials should be seen as a capstone event in the creation of “a popular health ethos” under the management of a “state that presented itself as a product of the popular will” (p. 189). One might question the degree to which the Alvarado and Carrillo Puerto regimes actually changed public health policy, though their rhetoric is clear.McCrea’s discussion of the midcentury cholera epidemic illustrates her intricate analysis of diseased moments. Cholera debilitated the sufferer with horrific attacks of diarrhea, rapid dehydration, and, often, death within 12 hours of the initial symptoms. Entire families and many members of a community could die within weeks. Quickness of onslaught convinced many that public health officials had little control over the disease, even as officials intruded more forcefully in daily lives and rituals. As cholera swept through the peninsula, public health officials dictated burial within two hours of death, just as liberals had ordered the secularization of burial. Prompt burial flew in the face of Maya peasant patterns of all-night vigils with the deceased and graveside assemblies. Peasants preferred burial near the home, or perhaps on church grounds. The quantity of deaths demanded the construction of new cemeteries, often outside the community, and the mobilization of laborers to hack out graves in the rocky soil. “In this diseased moment, the structure of power was stripped of any disguise or ornament in the eyes of the townspeople, and the promise of power — the protection of the villager’s life and limb — was considered to be broken” (p. 61). In the wake of the epidemic, public health and political authority became increasingly intertwined, patterns that were amplified as henequen wealth transformed the state.Diseased Relations is based upon intensive archival research in Mexico and the United States. McCrea probed deeply into church, state, and federal archives. That task was made difficult by episodic rather than sustained patterns of information. Considerable evidence surrounds the cholera epidemic of the 1850s, for example, while the ongoing effort to vaccinate residents of the state against smallpox yielded a less consistent documentary trail. McCrea thus must often speculate from a series of cases and times to the broader scale, usually convincingly, but at times by referencing events in central Mexico and inferring similarities in Yucatán. Documentary evidence becomes more sustained in the late nineteenth century, enabling her arguments to rest upon much firmer foundations.Diseased Relations makes a strong contribution to the rapidly expanding literature on public health in Latin America. McCrea is most helpful in treating the nineteenth century, a period often avoided by scholars more interested in the expansion of the contemporary state. The work demonstrates that study of disease, public health, and state formation should not be relegated to the twentieth century, and that epidemics offer important insights into the history of medicine in nineteenth-century Latin America.