This study examines processes of reform in disease management in the Viceroyalty of New Spain in the eighteenth and early-nineteenth centuries. Especially under the enlightened rule of Charles III (1759-1788), onerous programs of epidemic management were introduced into communities accustomed to resolving disease in municipalities, villages, barrios, parishes, and homes. The objections of these communities to the interventions of the state led to an early and rapid adjustment in the official policy. In place of disruptive cordons sanitaires and isolation of patients in makeshift infirmaries, the viceregal government turned to immunization, where religious symbols, personnel, rituals, charity, and institutions helped frame modern medicine for lay communities. Bourbon reforms in the realm of public health ultimately became a reality through a modified "paternalistic" program of medical provision.
This program was a natural outcome of centuries of Habsburg rule, in which indigenous villages had been accorded certain legal and fiduciary considerations and deemed especially vulnerable to disease, intemperate reform, and intervention from outsiders. Bourbon innovations in public health of necessity respected these longstanding arrangements or risked failure. The injunction to provide and receive charity in crisis, and the belief that ceremonial performance was the best way to effect conversions to novel practices such as vaccine, led to a sustained effort to transfer sacred status to the new components of public health policy. As one crown attorney observed, administrators had been reminded by subjects of the obligation to make use of the "sacred ties of civil society" whenever possible.
Historical studies of public health have tended to stress innovations in hygiene and urban sanitation in the nineteenth century. This study shows that significant change occurred earlier and actively involved non-state actors in adapting and popularizing medicine at the local level. By considering the numerous sites where medical science, ideology, and techniques were tested and critiqued, it seeks a more adequate view of scientific culture and enlightened medical programs as the product of diverse laypeople, multiple epistemologies, and longstanding colonial practice.