This important and complicated work investigates the relationship between medicine and illness, political and medical borders, and race. As Mckiernan-González states at the outset of his notes for the reader, “Public health campaigns and interventions were not simply a way to prevent illness. The act of deciding who to protect became key to establishing what it meant to be Mexican or American” (p. xi). In the substantive chapters that follow, however, he shows how difficult it is to divide ill people by race or nationality, and how messy any actions based on those criteria were. Although he asserts at some points a clear-cut understanding of race in the Mexico-Texas borderlands, and finds it reflected in medical policy during the period he studies, over and over again the categories become blurred.

What is clear is that a number of diseases associated with hot, humid places—yellow fever, smallpox, cholera, typhoid and typhus, and malaria—all lethal and sometimes difficult to diagnose or distinguish—arrived at the Texas border with Mexicans or travelers from Mexico. These diseases then became associated with Mexicans who came from those hot, humid areas, and with Mexican and Mexican-American residents of the border region. However, in the cases Mckiernan-González cites, the quarantines that were designed to contain these diseases, characterized by a medical border moving north of the political dividing line, involved not only persons of Mexican descent but also Anglos and African Americans. The quarantines, apart from the illnesses themselves, caused suffering and difficulty for all residents of the affected border areas. One is struck by the possibility that Mckiernan-González, seeking to confirm a division, came across more complexity than his prior assumptions could account for.

Certainly, Mexico was associated with disease and had been since the time of the United States-Mexico War (1846–1848). In one of his many vivid examples, he tells us that agreements with the Mexican government at the end of the struggle provided that U.S. forces remain in the highlands of that country “until the return of the healthy season,” that is, when cooler weather would reduce the threat of devastating illness in the lower altitudes and humid climates from which they would disembark. During the war, U.S. soldiers suffered profoundly and enormous numbers died from various kinds of fevers. Later, just after the Civil War, there was an outbreak of disease along the border just as it was returned to U.S. control from the hands of the Confederates. The outbreak reinforced the association of the border with disease. In a peculiar development, African-Americans troops, believed to be both comfortable in the area and perhaps less susceptible to these illnesses (or more dispensable), came to be stationed in the region, and it was these soldiers who not infrequently enforced quarantines on the local population.

In 1878, a ghastly epidemic of yellow fever swept up the Mississippi River from near New Orleans, eventually affecting 100,000 people and leading to 20,000 deaths. This event in particular led to government and medical concern about the ways in which South Texas might be like the Gulf Coast where the yellow fever epidemic had begun, and brought about the founding of the rather short-lived National Board of Health. The new institution sent a representative to the Texas-Mexico border, physician John Hunter Pope, and he met primarily with Anglo elites during his tour of the region. His evaluation of the propensity to disease of the population he called “Mexican” was exceptionally negative, associated with adjectives such as “filth” (p. 35). Yet, significantly and in spite of his clear racial bias, Pope recommended that all residents of South Texas be provided with adequate health services and housing.

The racialized interpretation that the author brings to the tragedy of disease epidemics persists throughout the book, and no doubt the strains between Anglos and the Mexican-descent population in the region were always problematic. Quarantines threatened everyone economically—the medical border that cordoned off South Texas caused hardship for everyone. During epidemics, the urgency to inspect homes, to invade bodies of the ill with tests and supposed remedies, and to remove the diseased to locations where their families were no longer permitted to care for them led to hardships and heartache for Mexicans and Mexican-Americans, but also for others. Often physicians and enforcement personnel of Mexican descent were involved in these removals, and some of all races and ethnic backgrounds died.

The reader is reminded of the current Ebola epidemic in Africa, and also reminded that the treatment of epidemic disease without a known cure frequently tramples on what we think of as human rights. It leads to fear and hatred and the stigmatizing of those associated with the disaster, both the afflicted and those trying to aid the afflicted. In a 1917 case that Mckiernan-González studies, the fear of typhus led to the forced bathing in kerosene and vinegar of cleaning women coming across the border into El Paso from Mexico and the chemical disinfection of their belongings, degrading and dangerous practices that led the women to push back in what became known as the “Typhus Bath Riots.” The author does not miss the irony: public authorities on the border were cleaning the women who were cleaning U.S. homes.

Yet the humane containment of devastating diseases without known cures and the prevention of its spread are difficult to reconcile, and the story that Mckiernan-González tells makes clear that Mexicans were stigmatized racially and suffered doubly in these disasters. These notions were reinforced by their association of disease-prone locales with hot and humid environments. This reader, at least, could hope that the author's experience with epidemic disease might have led to a more thorough discussion of just what these epidemics entailed scientifically and medically, thus making more intelligible the racially repressive details that he privileges. But the questions he asks and the ways he answers them sensitize us to the scapegoating and medical victimization of a population associated with the eruption of devastating illness.