Reviewed by:

• Enlightened Immunity: Mexico’s Experiments with Disease Prevention in the Age of Reason by Paul Ramírez
• Travis Chi Wing Lau (bio)

Too often the history of disease prevention gets told as the enlightenment of medicine: through a series of theoretical, practical, and professional innovations, technologies like vaccination mitigated major health threats such as smallpox and culminated in increasingly efficient forms of public health management. In an eighteenth-century context, such paradigm shifts toward preventative health typically get attributed to the contributions of key figures like Mary Wortley Montagu and Edward Jenner, who both popularized inoculation methods in the British nation and beyond. As Paul Ramírez explores in a rich archive of eighteenth-and early nineteenth-century political, religious, medical, and cultural sources in New Spain, such developments in epidemic responses and disease control were actually a product of complex negotiations between lay communities and state officials. In Enlightened Immunity, Ramírez models what Roy Porter has called “doing medical history from below” (Porter, “The Patient’s View: Doing Medical History from Below,” Theory and Society 14, no. 2 (1985): 175–98). Ramírez focuses his analysis on popular responses to imperial medical reform in Bourbon-era colonial Mexico (ca. 1713–ca. 1870), especially those of Indigenous healers, village priests, and barbers who mediated the work of translating public health into accessible forms tailored to community values and needs. Instead of presuming that “medical knowledge and expertise flow outward, or downward, from the social elite or institutional centers of medical authority to the masses” (61), Ramírez turns to vernacular forms like Mexico City’s journals that synthesized Indigenous and African community knowledges with developing therapies and technologies.

Drawing together methods in the history of medicine, the history of religion, and the history of colonialism, Ramírez contributes to a historiography of global Enlightenment by decentring Europe, Britain, and the United States. His rigorous engagement with the “decades-long struggle to graft vaccination into the routines of everyday life” in colonial-era Mexico reveals the vast extent to which such enlightened shifts in medical thinking required “domestication” in the form of public rituals like processions and sermons, and spaces for dissent and debate like the free periodical press (136–37). Ramírez compellingly argues how the archival record (and its many gaps), which later nineteenth-century thinkers and more recent historians have taken for granted as the ignorance of laypeople, helps to justify why ongoing debates [End Page 451] over vaccination cannot be resolved with the reiteration of medical fact. Rather, personal, affective responses to vaccination like rumour and gossip, and the various ways physicians and state officials made sense of them, were foundational to the procedure’s normalization upon its arrival via the Royal Vaccination Expedition of 1804 led by Francisco Xavier de Balmis. For example, Ramírez recovers how Mexican devotional culture incorporated quarantine and treatment strategies into the cultural practices of veneration and the highly circulated iconography of saints like the Virgin of Guadalupe and the Virgin of Loreto. The Catholic Church would be crucial in the circulation of the Jennerian vaccination precisely because of its persistent public presence in the daily lives of Mexican people. This, Ramírez points out, became a “mode of governance that revived religion’s special role in advancing a variety of colonial projects” like the repackaging of public health in personalized ways (164). The convenient trajectory from spiritual to scientific frameworks for health and the body is simply ahistorical.

What makes Ramírez’s account of preventative medicine and public health in colonial-era Mexico so incisive is its deliberate problematizing of any clear distinctions between urban and rural, secular and religious, and elite and vernacular toward a thick history of how “heterogeneous voices shaped debate” (131). The portrait of colonial power in New Spain is hardly monolithic and centralized but in reality, far more diffuse and contingent, which Ramírez beautifully likens to the procedure of vaccination itself: “Like the crushed scabs used in vaccinating campaigns, medical authority, skill, and knowledge...

审核人：

• 开明的免疫力：保罗·拉米雷斯（PaulRamírez）在理性时代墨西哥的疾病预防实验
• 特拉维斯志荣楼（生物）

随着医学的启迪，疾病预防的历史常常被告知：通过一系列理论，实践和专业创新，疫苗接种等技术减轻了天花等主要健康威胁，并最终以日益有效的公共卫生管理形式达到顶峰。在18世纪的背景下，这种向预防健康的范式转变通常归​​因于玛丽·沃特利·蒙塔古（Mary Wortley Montagu）和爱德华·詹纳（Edward Jenner）等关键人物的贡献，他们在英美乃至其他国家都普及了接种方法。保罗·拉米雷斯（PaulRamírez）在新西班牙的18世纪和19世纪初的政治，宗教，医学和文化资源的丰富档案中进行探索时，这种流行病应对和疾病控制的发展实际上是非专业社区与州官员之间进行复杂谈判的产物。在开悟的免疫中，拉米雷斯（Ramírez）模仿了罗伊·波特（Roy Porter）所谓的“从下面做病史”（波特，“患者的观点：从下面做病史”，理论与社会14号 2（1985）：175–98）。拉米雷斯将他的分析重点放在波旁时代殖民地墨西哥（大约1713年至1870年）对帝国医疗改革的普遍反应上，尤其是调解工作的土著医治者，乡村牧师和理发师，他们将公共卫生转化为量身定制的形式社区的价值观和需求。拉米雷斯没有假定“医学知识和专业知识是从社会精英或医学权威的机构中心向外或向下流动到大众”（61），而是转向像墨西哥城期刊这样的本土形式，将土著和非洲社区知识与开发疗法和技术。

拉米雷斯汇集了医学史，宗教史和殖民主义史上的各种方法，通过分散欧洲，英国和美国的参与，为全球启蒙史学做出了贡献。他在殖民时代墨西哥对“数十年的将疫苗移植到日常生活中的长期斗争”的严格参与揭示了医学思想的这种开明的转变在很大程度上需要以“游行”和“游行”等公共仪式的形式进行“驯化”。讲道，异议和辩论的空间，例如免费期刊（136-37）。拉米雷斯令人信服地争论说，档案记录（及其许多空白）是如何证明正在进行的辩论的理由，档案记录（及其许多空白）后来被十九世纪的思想家和较新的历史学家认为是外行人的无知。[结束页451]重申医学事实不能解决过度疫苗接种的问题。相反，对于谣言和八卦等疫苗接种的个人情感反应以及医生和州官员对它们的各种理解方式，是该程序通过弗朗西斯科·泽维尔·德·巴尔米斯（Francisco Xavier de Balmis）领导的1804年皇家疫苗接种探险队到达该程序时正常化的基础。例如，拉米雷斯（Ramírez）恢复了墨西哥虔诚的文化如何将检疫和治疗策略纳入尊崇的文化习俗以及圣像瓜达卢佩圣母和洛雷托圣母的流传甚广的肖像画中。天主教教会对詹纳里亚疫苗的流通至关重要，这恰恰是因为它在墨西哥人民的日常生活中持续存在。拉米雷斯指出，成为一种“治理模式，复兴了宗教在推进各种殖民计划中的特殊作用”，例如以个性化方式重新包装公共卫生（164）。从精神到科学的健康和身体框架的便利轨迹简直是历史性的。

拉米雷斯在殖民地时代的墨西哥对预防医学和公共卫生的描述之所以如此敏锐，是因为它故意质疑城市与乡村，世俗和宗教之间，精英与乡土之间的任何明显区别，以解决“异质声音如何塑造辩论”的悠久历史。 （131）。在新西班牙，殖民权力的画像几乎不是一成不变的，而是集中的，但实际上，它却更加分散和偶然，拉米雷斯将其漂亮地比喻为疫苗接种过程本身：“就像在疫苗接种运动中使用的碎sc，医务人员，技能和知识...