This monograph is a valuable addition to the still small body of literature on Latin American epidemiology. It focuses on sociological and ecological factors in four villages of Peru (each located in a different geographical and climatic region) and provides clues to the distribution and significance of disease phenomena. The multidisciplinary team sent to Peru by the Geographic Epidemiology Unit of the Johns Hopkins School of Hygiene and Public Health included specialists in epidemiology, parasitology, entymology, sanitary engineering, and anthropology.
Among the specific subjects discussed are the following: the distribution of infections and diseases in the four villages; the sources and sanitary quality of their water supply; waste disposal and housing; nutrition and its influence on certain aspects of disease; and the health significance of coca chewing. The technical nature of the material discussed may restrict interest in the volume largely to specialists in public health. Social anthropologists, however, would likely be interested in the detailed discussion on methodology (pp. 119-130). There is very little in the volume of specific interest to historians.
One of the most interesting sections is the one on coca chewing. It was found that the average daily consumption of coca leaves by a regular ehewer was about thirty-five to fifty grams. Practiced on such a scale, coca chewing was found to be “an important disease determinant in the vicious cycle of hookworm infection and malnutrition” (p. 103), because “in all categories coca chewers had lower hemoglobin and hematocrit levels than the control subjects” (p. 102). Other points raised that might be of general interest include the fact that Peru has achieved an excellent level of smallpox vaccination, and that malaria eradication there has reached an “advanced state.” This latter important achievement is threatened, however, by “the lack of an efficient malaria eradication program in the Brazilian part of the Amazon Basin, [which] is responsible for a more or less permanent reintroduction of infected cases via the Amazon River” (p. 58).
There is one puzzling statement in the book which appears to be in need of clarification—that arbo-virus infections are “new to Peru” (p. 39). But historical sources leave no doubt that one such disease, yellow fever, occurred epidemically in Lima and Callao as early as 1852. What the authors may have intended was the more specific statement (p. 83) that “no previous serologic surveys of arbo-virus infections were carried out in Peru prior to the conduct of this study.”
The style and editing are excellent. Despite the highly technical vocabulary, the reviewer found only two slips by the proofreader—misspellings of “toucan” (p. 31) and “gringos” (p. 129). Several maps and dozens of charts and tables summarize and clarify the textual material.
