In the past decade Marcos Cueto has emerged as one of the leading figures pushing forward the historiography of medicine of Latin America. This new book makes a substantial contribution. Whereas other figures like Anne-Emanuel Birn and Armando Solorzano Rojas have made substantial contributions to the history of Mexican medicine in the first half of the twentieth century, this new work makes a foray into the second. An analysis of the relationship between Cold War politics, campaigns to eradicate malaria, the medical profession and the peasantry is timely and appropriate. It is especially to be welcomed because it approaches decades, which until recently so many historians were reluctant to approach, while many social scientists have increasingly seen them as beyond their remit.

Cueto approaches the topic from international, national and local perspectives. By the 1950s the scientific, political and administrative environments were propitious for international campaigning against malaria. The symptoms, etiology and method of transmission of the disease had been established at the turn of the nineteenth and twentieth centuries. A firm priority was attached to malaria when it afflicted Allied troops in Asia and the Pacific during the Second World War. And the consolidation of international health institutions (with the Pan-American Sanitary Bureau being reshaped as the regional arm of the World Health Organisation) made possible the speedy pooling of experiences and diffusion of methods. The author outlines persuasively how international health programmes, for all their appearance of rationality and neutrality, formed a convenient part of anti-Communist Cold war politics. Like atomic power, medical technology was used by the United States in its competition for hegemony with the Soviet Union. On the death of Stalin in 1953, the United States was especially anxious that the Soviet Union might become a more attractive model to poor countries, and sought new ways of projecting a global image of benevolence. Mexico was a convenient location for experiments with a programme of eradication. Several decades of exposure to US medicine through study by Mexican physicians in the United States and of co-operation with the Rockefeller Foundation in diverse health-care and agricultural projects eased the early stages of the relationship. Mexico, like various Latin American countries, possessed an established public health apparatus (but unlike most of Africa) and gave a strong emphasis on hygiene education, to which malaria eradication could be added. The application to Mexico of the model of yaws eradication in Haiti, of which Dr François Duvalier was the most notorious beneficiary, and the evolution of pumps – that produced a uniform dosage on sprayed surfaces and that required only a minimal technical knowledge to operate – completed the picture. The stage was set for a ‘campaign’ conducted in a military manner against the mosquito. A crusading zeal and the imperative of moral obligation swept aside objections from Nicaragua and El Salvador that eradication was not feasible without a vaccine. Earlier campaigners, like the Rockefeller Foundation, had been reluctant to assume a high profile in Latin America; but no such hesitation inhibited the International Co-operation Agency and the PASB. Eradication, not control or incidence reduction, was a goal so singlemindedly pursued that PASB personnel were forbidden to use the word ‘control’.

The eradication campaign was justified with the argument that the cost of an eradication campaign was less than the cost of the damage caused by one year of malaria, and was complemented by programmes of agrarian reform, peasant resettlement and the ‘march to the seas’. Schoolteachers and public health officials were enlisted in the struggle against peasant opposition. While having some incidental benefits, like reducing the incidence of dengue transmitted by the Aedes aegypti, the campaign aroused much resistance at the local level. Attempts to persuade indigenous Mexicans of the benefits of ‘Western’ medicine were often half-hearted, since translators into indigenous languages and anthropologists were scarce. Furthermore, there was little time for persuasion, given the speed with which a temporary mobile unit appeared in a village, sprayed houses, took blood samples, informed the authorities about feverish cases, and moved on.

The tide slowly turned against the campaign. Physicians pointed to the risks posed to the lives of sprayers, fears of human cancer and problems of miscarriages among farm animals, as well as contamination caused by poor storage conditions. Anthropologists underlined the failure of campaigns to take either lack of health education or indigenous concepts of medicine (mosquitoes were seen as inconveniences to be smoked out, not a menace) into account. Campaign leaders like Fred Soper both assumed that peasants led static lives, when many were migrants who built new homes, and overlooked the damage to diet and income, when DDT killed hens and bees. By 1966 the campaign had stagnated. The Cold War entered a new phase; a loss of impetus from above combined with resistance from below to cause a reappraisal of health policy; and mosquitoes developed a new resistance. National concern at the fragmentation of the public health system was reinforced by the WHO, which stressed the urgency of a transition to national plan for basic health services, in which better mechanisms of assessment and surveillance would take a part. A shift from an emphasis on eradication to one on control seemed successful. No malaria-attributed death was recorded in 1982.

This new work is a model of its kind. It will be welcomed by Mexicanists, historians of medicine and social policy, and of the peasantry and of the professions alike. Some studies of the same period on similar and parallel themes in South American countries, especially Venezuela, would be most welcome.