This book provides a wide-ranging account of public health in Yucatán, focusing on the changing power of state and federal authorities. From the late nineteenth century to the 1920s, Yucatec elites and doctors in Mérida largely controlled the development of new hospitals, medical education, professional associations, laboratories, and campaigns against disease. During the 1930s, the balance began to shift towards greater federal involvement. At the same time, modern biomedicine gradually reached further into the countryside and down the social hierarchy. International innovations in medicine and public health shaped developments in the Yucatán throughout the period in a host of ways. However, the cause of the shift from state to federal power lay elsewhere: Yucatán's political economy. The henequen boom first allowed regional elites to significantly expand public health and keep the federal government at arm's length; the post-war collapse of henequen prices decisively sapped Yucatec authority over public health.

Historians of medicine will find the book a very valuable source of information on different institutions and campaigns. Some of these are quite well known – the 1920s Rockefeller-supported campaigns against yellow fever and hookworm – but the book discusses them alongside many others, providing a sense of overall development. At times, the book struggles to combine this breadth with a deep treatment of the reception and impact of particular policies. However, the approach allows for some revealing comparisons across time and space, and points to areas for future research. For example, in the late 1920s the little-studied anti-rabies campaign ‘became one of the most consistent public health activities in the state’ (p. 104). By comparing the 1950s project for ‘rural wellbeing’ with nineteenth-century antecedents we see the profound change in the government's definition and pursuit of public health. At times, more national comparisons would have been welcome and helped to clarify how atypical were developments in the peninsula.

Scholars interested in state formation and social history will also find much of interest, particularly the chapter on the ‘revolutionary state’. Sowell convincingly argues that health was an important part of the pact that emerged between the reforming President Cárdenas and Yucatán's henequen elite in the late 1930s. Cárdenas expropriated henequen estates, but allowed the old elite to maintain power through control over marketing and credit. However, Cardenismo successfully prompted elites to build one of the most extensive systems of local medical services in the country, if only to shore up their own authority and modernising credentials. Another chapter describes doctors’ efforts to define themselves as a profession. Predictably this involved repeated efforts to discredit curanderos and folk medicine; more surprisingly, it also led to conflict between doctors and other self-consciously modern pretenders – homeopaths and spiritists – some of whom enjoyed support among political leaders.

Well-researched and interesting, the book could be more tightly organised. Thematic chapters suffer from an unusual degree of overlap, and the discussion of key topics – the colonial background, revolutionary state, infectious disease – are spread across different parts of the book, making it harder to navigate than it need be. At times the international dimension of the argument could also be more developed. Sowell argues that Yucatán became more peripheral in global terms too, although he admits the process was not as ‘visible’ as the subordination of state to federal republic (p. 167). The main evidence provided for Yucatán's loss of medical power relative to the wider world is the rise of capital-intensive, industrially-made drugs and medicines, which gradually displaced late-nineteenth-century remedies produced in Yucatán. This is certainly an important change, but only one aspect of the relationship with foreign biomedical ideas and institutions. For example, Sowell also provides some hints of continuing intellectual autonomy and innovation in Mexico in the form of an early embrace of medical anthropology.

All in all, Sowell successfully uses this story to challenge overly static notions of centre and periphery, allying himself with the new literature on medicine and science in Latin America. He shows how the slow advance of biomedicine in Yucatán is necessarily a story of ‘shifting centers, peripheries, and nodes of power/authority’ (p. xiv). This book represents a valuable contribution to this dynamic subfield, and will also be read with profit by Mexicanists for its original and revealing perspective on the dynamics of regionalism.