SO( Sci, M,d VollSB, pp 10710 114, 1981Prinled in Great Britain All righls reserved

0160-7987;81;020107-08102.00;0Copyright e 1981 Per8amon Press Ltd

REMEDIOS CASEROS: MEXICAN AMERICAN HOMEREMEDIES AND COMMUNITY HEALTH PROBLEMS

ROBERT T. TROTTER II

Department of Behavioral Sciences, Pan American University, Edinburg, TX 78539, U.S.A

Abstract-A sample of 1235 case examples of remedios caseros (home remedies) was analyzed to deter-mine the morbidity patterns for "home treated" ailments in Mexican American communities in SouthTexas. A group of seventy most commonly encountered ailments was discovered, as described in thepaper. An analysis was made of the variations within the morbidity patterns of these ailments in relationto the age and sex of the informant. Parallels are drawn between the research findings and the results ofconventional morbidity research efforts.

Investigations of the patterns of community healthproblems in the United States are of relatively recentadvent. and are normally pursued within the contextof a demographic analysis of morbidity. While mor-bidity has been defined by Tomlinson [1, p. 138] as"the study of illness", the more commonly accepteddefinition is that of the United States National HealthInterview Survey, which defines morbidity as:

basically a departure from a state of physical or mentalwell-being, resulting from disease or injury, of which theindividual afflicted is aware. Awareness connotes a degreeof measurable impact on the individual or his family interms of the restrictions and disabilities caused by the mor-bidity [2, p. 42].

Most morbidity research divides illness into chro-nic or acute states and attempts to measure either theincidence, t prevalence~ or both of biological and ofpsychological ailments. The protocols for theNational Health Interview Survey state:

A condition is considered to be chronic if (I) it is describedin terms of one of the chronic diseases on the "Checklist ofChronic Conditions" or in terms of one of the impairmentson the "Checklist for Impairments"... or (2) the conditionis described by the respondents as having been first noticedmore than 3 months before the week of the interview.

An acute condition is defined as a condition which haslasted less than 3 months and which has involved eithermedical attention or restricted activity [2, p. 45].

The most common foci of morbidity research areeither household surveys or institutionally basedstudies that attempt to look at morbidity in relationto hospitals, doctors' offices, clinics, etc. Theseresearch efforts normally attempt to measure theoccurrence of disease states that are recognized by themedical system, using instruments developed for that

.As an example, national attention to morbidity datacollection did not occur to any significant extent until theadvent of the National Health Interview Survey (NHS) in1956. Even now, formal demographic texts often pay scantattention to the subject.

t The incidence rate is equal to the number of new casesduring a specified period of time per unit of the midpointpopulation [5, p. 236].

t The prevalence rate is equal to the number of personsdiagnosed as having a condition on any given day per unitof the total population [5, p. 236].

107

purpose [~e 2, 3]. Unfortunately, the weaknesses of.these studies are relatively numerous. Central to theseweaknesses is the condition that morbidity is far moredifficult to identify than the other major demographicmeasure of health, mortality. Death is a reasonablyclear-cut event, and its cause can usually be traced toone or more of the entities listed in the InternationalClassification of Diseases. On the other hand, asPeterson [5] clearly demonstrates, the recognition ofan illness or ailment is an event that is based on thesubjective interpretation of symptoms by patients ortheir families. To overcome this problem, some mor-bidity studies have turned away from clinicalmeasures of health status and have developed anumber of instruments designed to categorize andquantify the informant's life condition, including suchnebulous states of well-being as happiness [see 6-7].Unfortunately, as Mechanic points out, the indirectmeasure of "health status is so involved with subjec-tive perceptions, social expectations, role demands,and value judgments... (that these measurementsoften become)... only poor approximations of theconcepts the investigators wish to study" [9, p. 183].And as Peterson [5, p. 239] indicates, a comparison ofmorbidity patterns across cultural boundariesbecomes particularly perilous. This is partially due tothe condition that the rank ordering of the impor-tance of diseases to a community is normally basedon quantitative evaluations of the reported incidence,or prevalence, of previously defined illnesses. This is apractice which is generally acceptable for a dominantcultural group, such as Anglo Americans in theUnited States, since the categories of illnesses beingmeasured are relatively well agreed upon by both theinformants and the evaluators. However, this agree-ment is not necessarily pertinent for ethnic groups ormembers of other cultures who recognize and beha-viorally react to disease entities not recognized by thedominant group, and who may fail to recognize dis-eases that are a part of the medical model [5, pp.235-244].

This paper presents an alternative method forexploring community morbidity patterns for groupswhere more conventional approaches either have notbeen undertaken, or cannot be conducted at present.The method utilizes an anthropological approach forthe derivation of a typology of ailments, combinedwith quantification to allow the rank ordering of ail-

108 ROBERT T. TROTTER II

ments in relation to their "prominence". in the com-munity. Developing a community based classificationof ailments avoids the cultural bias of the methodspreviously mentioned, however, it produces its ownweakness in that it does not generate incidence andprevalence rates comparable to other studies. Thisweakness can be considered minor, in light of the factthat the illness typology produced by this method cansubsequently be used to generate surveys of mor-bidity, using more conventional methodologies, whentime and financial resources (or interest) permit.

RESEARCH AREA AND POPULATION

The data for this paper were collected in the LowerRio Grande Valley of Texas, commonly called theValley by local residents. The Valley is composed offour Texas counties (Starr, Hidalgo, Willacy andCameron) adjacent to the United States-Mexicoborder at the mouth of the Rio Grande River. It con-tains numerous small and medium-sized towns, thelargest of which are Brownsville, Harlingen, andMcAllen. The estimated half-million people in theValley live in a nearly continuous "population strip"following the river and the railroad up and down theValley in an approximately east-west direction.

Agriculture is the primary Valley industry,although assembly plants, maquiladoras, and U.S.-Mexico "sister" plants are being introduced into thelocal economy. This condition, along with the demo-graphic spread of the population, has produced anarea that is neither rural nor urban, but some inex-tricable combination of the two.

With the exception of the immediately adjacentborder towns of Reynosa and Matamoros (Tamau-lipas) Mexico, the Valley is somewhat isolated. Thenearest towns of any significant size are CorpusChristi and San Antonio, 130 and 250 miles awayrespectively. This relative isolation, along with theextreme ease of movement between the United Statesand Mexico causes the Mexican border towns to haveboth a strong cultural, as well as economic impact onthe Valley. Part of the impact comes from the nearlyone million people on the Mexican side of the riverwho account for between 40 and 60"10 of the retailtrade in the Valley, while they also provide a largelabor pool that reduces upward wage pressures andmakes both seasonal and permanent underemploy-ment a chronic problem for Valley residents. Theresult is that the Valley contains the two poorestStandard Metropolitan Statistical Areas surveyed inthe 1970 Census of Population. At that time the percapita income in Hidalgo County was 11777 perannum, with over half of the population falling belowfederal poverty guidelines. There is no indication thatthe 1980 Census will significantly revise the economicprofile of the area.

The demographic chara<;teristics of the Valley are

.Prominence is defined a~ the likelihood that a particu-lar illness will be presented in a case example of the hometreatment of health problems, within the context of a non-directive interview that seeks to collect such treatments.

t The form was developed by Dr Mark Glazer, Depart-ment of Behavioral Sciences, Pan American University.The author would like to thank Dr Glazer for allowinghim the use of the form for data collection purposes.

as interesting as its economic characteristics are grim.The population is young, over half being under 25years of age, by current estimates. Approximately 80"10of the residents are Spanish surnamed and/or of Mex-ican descent, another approximately 20"10 of the resi-dents are Anglo American, and less than one half of1% are Black. The area is distinctly bilingual and bi-cultural. The population dynamics of the Valley arefurther complicated by the presence of approximately130-150 thousand migrant farmworkers who makethe Valley their home, but who spend from 3-6months out of the area participating in the migrantstream northward. Finally, an estimated 200 thousandwinter residents, most of whom are retired, make theValley their home between October and March. All ofthese characteristics combine to make the Valley anarea of key interest for social research in the UnitedStates.

METHODOLOGY

The methodology utilized in collecting the data forthis report combines the strength of an open endedcase study approach for generating a communitybased typology of ailments (as opposed to testing forthe presence of a priori categories thought to be im-portant by the researcher) with the potential forquantification. Each case that was collected within acommon format by being recorded on a data collec-tion form. t The data recorded on the form includesthe common name (either English, Spanish, or otherlanguages) of the remedio casero (home remedy) andits English translation, if available; the scientific nameof the remedy, if available; the type of illness or ill-nesses treated by the remedy; a description of themethod of preparation of the remedio; a case descrip-tion of a known use of the remedy; basic socio-cultural data about the informant (name, age, sex,address, where born, languages spoken); and identify-ing information about the interviewer/collector(name, address, etc.).

A sample of case examples was drawn from theover 2000 cases currently available in the ethnophar-macological archive at Pan American University. Thearchive cases were collected from members of threedifferent U.S. ethnic groups and a large number offoreign nationals, however, only those cases coded asbeing presented by a Mexican American informantwere retained for analysis for this paper.

The sample was drawn in a way that not onlyretained cases presented by Mexican American infor-mants, but also assured that all of the cases presentedby each informant would be contained in the sample.This was done to assure that the data could provide apreliminary estimate of the breadth of knowledge ofvarious informants. The number of case examplespresented by informants ranged from 1 to 29. How-ever, this number should not be taken as the upperlimit of knowledge of remedios caseros in the com-munity. An upper limit of 25 cases was imposed oncollectors as being the maximum number of cases thatcould be collected from a single informant withoutunduly taxing the informant's patients and goodwill.Thus, even though most of the informants presentedfar less than 25 cases (mean = 3.3; median = 2;mode = I), there are individuals in the Valley com-munities who specialize in herbal knowledge called

Remedios caseros: home remedies in Mexican America 109

unduly clustering in anyone area, age group, or socialgroup. Therefore, the results are reasonably represen-tative of the ethnopharmacological knowledge andpractices of the region.

yerberos, who know literally hundreds of remedies[see 10].

The sample contains 1235 cases collected from 378informants ranging in age from 15 to 86(mean = 50.5; median = 50; mode = 50). All of theinformants in the sample identified themselves asMexican American; 58.6% of the cases were providedby individuals born.in the United States, while 41.4%of the cases were provided by individuals born inMexico. A later report will measure whether or notthere are significant differences in the remedios andailments reported by these two groups. Women pre-dominate in the sample; 85.4% of the cases (1050),where sex is identified, were collected from women,while 14.6% (179) were collected from males (6 had nosex identifier). This is generally representative of thestudy population, in that ethnographic data collectedin the Valley indicates that women are normally theprimary informants about remedios caseros. There-fore, the sample can be considered representative ofthe general knowledge about remedios caseros in thearea.

The sample should probably be considered a con-venience sample, since no effort was made to assurethat the data collected for the ethnopharmacologicalarchive would be amassed in a way that made it rep-resentative of any specific geographical or sociocul-tural characteristics of the Valley. Nevertheless, aninspection of the data indicates that it is consistentwith the results of ethnographic research conductedby the author and others, and that the informantscover the demographics of the Valley area without

THE DATA

One assumption was made about the case data thatis central to the results of this paper. It was assumedthat when people were asked in a nondirective man-ner to recall remedios caseros, the ones they recountedwould be either the ones they most commonly used orthe ones that treated ailments that had been signifi-cant events in either their own lives or the life ofsomeone important to them. In either situation, themost frequently repeated case examples are assumedto be the ones that represent a combination of com-mon and key ailments in the community. Those lessfrequently presented are assumed to represent un-usual or less frequently encountered community ail-ments. A total of 510 remedios caseros (both botanicaland non-botanical items) treating 198 discrete ill-nesses were discovered in the sample. Within thisfield, there was clearly a core group of remedios thatconstituted the bulk of those presented in the samplecases. The 25 most frequently encountered remedios(4.9% of all remedios discovered) constitute 40.9% ofthe total cases in the sample.. Since each remedio islinked to one or more ailments it is obvious that thereis also a core group of ailments which informants feelare amenable to home treatment. Although, it mightbe more accurate to state that each ailment is linkedto one or more remedio, since new remedios wereencountered and coded throughout the coding pro-cess at approximately the same frequency, while theailments began to repeat very rapidly and almost nonew ailments were added to the informant's ailmenttypology from the point when about half of the totalsample was coded. The core group of ailments ispresented in Table 1.

The sample produced a core group of 70 most fre-quently encountered ailments that are treated byremedios caseros. These remedies (representing 35.9%of the tota1198 ailments) constitute 84.0% of all of thecases. t

This group of ailments is assumed to be an ethno-typology of health problems within MexicanAmerican communities, especially those ailments thatinformants feel can or should be given home treat-ment as opposed to medical attention. The labels ofthe ailments (or conditions) were taken directly fromthe collection form, without modification. Those ail-ments that could be translated (or had been by theinformants) are rendered in the table in English. Carewas taken to assure that the exact English equivalentof a Spanish term was used and where there is noEnglish equivalent, the Spanish was retained. In mostcases, the informants provided the translation, butwhere they did not do so, matches were sought withsimilar cases, or other informants in the communitywere utilized to provide the translations. Some of theoriginal list of ailments produced by this method werecombined in the table (e.g. IJpset stomach and indiges-tion; or body aches and aches and pains) into a singleailment category, since informants tended to fail to beable to differentiate amongst the labels and used them

* The 25 most common remedios caseros are: manzanilla(cammomile) Matricaria chamomilla L.; savile (aloe vera)Aloe barbadensis Mill.; ruda (rue) Ruta graveolens L.; yerbaaniz (anise) Pimpinella anisum L.; yerba buena (mint) Men-tha spicata L., estafiate (worm wood) Artemisia mexicanaWilld.; hojas de naranjo (orange leaves) Citrus aurantium L.,albacar (sweet basil) Ocimum basilicum L.; oregano (ore-gano) Monarda methaefolia Graham; ajo (garlic) Alliumsativum L.; pelos de elote (corn silks) Zea mays L.; canela(cinnamon) Pulchea orodata (L) Cass; romero (rosemary)Rosmarinus officinalis L.; borraja (borrage) Borajo offici-nalis L.;cenizo (purple sage) Leucophyllum texanum Benth.;nopal (prickly pear cactus) Opuntia sp.; Rosa de Castillo(rose) Rosa centifolia sp.; salvia (sage) Salvia leucanthaCav.; hojas de mesquite (mesquite leaves) Prosopis glandu-losa Torr.; marijuana (marijuana) Cannabis sativa L.; nogal(pecan) Carya illonoensis Koch; comino (cumin) Arracaciaatropurpurea Benth. et. Hook; golondrina (swallow-wort)Euphorbia prost rata Ait.; sacate de limon (lemon grass) un-identified local plant; el azajar (orange blossoms) Citrusaurantium L.

t Table 1 was limited to those ailments which wererepeated in the sample at least four times. Including ail-ments that represented approximately 0.2% of the cases(the other multiple example cases) would have increasedthe core group by the addition of 35 ailments, but wouldonly have increased the cumulative percentage of cases by7.0";';, too large an increase for too small an addition towarrant their inclusion. The final 93 ailments were singleexample cases from the sample. Since they were notrepeated, they were considered to be inappropriate for in-clusion in the core group. In fact, the core group couldeasily be restricted to the top forty or fifty most commonlyencountered ailments and still represent the bulk of the keymorbidity problems found within the Mexican Americancommunities of South Texas.

110 ROBERT T. TROTTER II

Table I. Most common ailments treated by remedios caseros

No. ofcases

No. of Cumulativecases % %

Cumulative% %Ailment Ailment

765546454338363636292727

6.24.53.73.73.53.12.92.92.92.72.22.2

6.210.714.418.121.624.727.630.533.436.138.340.5

0.70.70.70.60.60.60.60.60.60.50.50.50.50.50.50.40.40.40.40.40.40.40.4

69.370.070.771.371.9n.573.173.774.374.875.375.876.376.877.377.778.178.578.979.379.780.180.5

I. Stomach ache2. Cough3. Nervios4. Colic5. Fever6. Earache7. Diarrhea8. Susto9. Upset stomach

10. Constipation11. Eye irritation12. Painful joints.

arthritis13. Insomnia 2314. Sores (granos) 2315. Bladder infection 2016. Burns 2017. Kidney infection 2018. Diabetes 1919. Intestinal parasites 1720. Sore throats 1721. Colds 1622. Boils (tacotes) 1523. Bleeding 1424. Heart problems 1425. Insect bites 1426. Headaches 1327. Menstrual cramps 1328. Congestion 1129.

Empacho 1130. Gases 1131. Acre 1032. Anemia 1033. Balding 1034. Cuts 1035. Late menstruation 1036. Bronchitis 9

Total cases = 1235

1.91.91.61.61.61.51.41.41.31.21.11.11.11.01.00.90.90.90.80.80.80.80.80.7

42.444.345.947.549.150.652.053.454.755.957.058.159.260.261.262.163.063.964.765.566.367.167.968.6

0.40.40.30.30.3

80.981.381.681.982.2

0.30.30.30.30.3

82.582.883.183.483.7

37. Stomach cramps 938. Toothache 939. Ulcers 940. Asthma 841. Body aches and pains 842. Infected wounds 843. Feeling rundown 744. High blood pressure 745. Tired blood 746. Mental disorders 647. Mild rashes 648. Mouth infections 649. Obesity 650. Pneumonia 651. Tuberculosis 652. Hemorrhage 553. Hemorrhoids 554. Hiccups 555. Liver 556. Mal de ojo 557. Mumps 558. Pain 559. To keep away evil 5

spirits60. To sterilize wounds 561. Warts 562. Cancer 463. Infertile womb 464. Insufficient milk 4

for nursing65. Stomach infection 466. Sun stroke fevers 467. To induce labor 468. Tonic for blood 469. Urinary tract 4

infection70. Whooping cough 4

Total ailments = 1980.3 84.0

interchangeably. The resulting list is assumed to con-tain only conditions that are considered by the infor-mants to be mutually exclusive categories. If there isany error in the categories, it is probably in the direc-tion of lumping together categories that should haveremained separate rather than from retaining cate-gories that duplicated or overlapped one another.

MORBIDITY PAlTERNS

The core ailments can be assembled into groups ofrelated illnesses which are useful for an analysis ofsome of the trends in morbidity derived from thedata. Although these groupings do not represent afolk taxonomy of ailments, several interesting attri-butes of the morbidity patterns in Mexican Americancommunities are apparent from an inspection ofTable 1. The first is the inclusion of ailments thathave no English equivalents and are basically of amagical or supernatural nature. These ailments aresusto, empacho, keeping evil spirits away, mal de ojo,and caida de mol/era (one case, not listed in the coregroup). They are the so-called Mexican American folkillnesses that have received such prominent attentionin the anthropological literature, since the folk medi-cal system makes this basic distinction between

natural and magical ailments [see 11-16]. The pres-ence of these ailments, in and of themselves, guaran-tees that the morbidity patterns of MexicanAmericans are different from those of AngloAmericans. However, caution should be maintainedto avoid overemphasizing the prominence and impor-tance of these ailments within the ethnomedicine ofMexican Americans. To ignore them because they donot fit the medical model would be a serious mistake,one which would distort the actual morbidity patternsin Mexican American communities, since these ill-nesses are "a departure from a state of. ..well-beingof which the individual afflicted is aware" [2]. At thesame time, these ailments represent only 2.5% of thetotal group of ailments in the sample and constituteonly 4.7% of the total sample of cases. So the under-emphasis of the treatment of other ailments, as hasbeen done in the past, is equally inappropriate andproduces an even more serious distortion of com-munity health patterns in places such as the LowerRio Grande Valley.

In addition to the folk illnesses, there are severalother groups of ailments that provide insight into thehome treatment of health care problems in MexicanAmerican communities. These include digestive sys-

Remedio.~ caseros: home remedies in Mexican America III

equal to 22.3% of the total sample of cases. The ail-ments in this group are very similar to the group of"other acute ailments" reported for the United Statesas a whole. Cole states the following:

Among the category of "other acute ailments" for females,about one-fifth were reported as genitourinary problemsand one-eighth as deliveries and disorders of pregnancyand puerperium. Among males, over one-fourth of thisresidual category was reported as diseases of the ear, one-sixth as diseases of the skin, and about one-tenth as head-aches. These conditions were also prominent amongfemales [17, p. 35].

tem problems, upper respiratory ailments, infectiousand parasitic diseases, injuries and environmentallyproduced ailments, other acute conditions, mentalproblems, and chronic ailments. These categories cor-respond, at least partially, with the groupings of ill-ness most frequently presented in morbidity tablesand articles. Since some of the ailments listed in TableI could potentially be placed in more than one ofthese categories, the list of ailments assigned to eachis presented within the context of the discussion ofthat grouping.

The digestive system problems listed in the coreailment group include stomach aches, colic, diarrhea,upset stomach, constipation, gases, stomach crampsand ulcers. These ailments account for 20.7% of thetotal cases in the sample, which makes them the singlemost prominent group of closely related ailments inthe community. This finding is consistent with othermorbidity studies, since, as Cole [17, p. 36] indicates,problems with the digestive system are reported muchmore frequently amongst low income families thanamongst families of moderate or high income.

The core group of upper respiratory infections in-cludes coughs, sore throats, colds, congestion, bron-chitis, pneumonia, and whooping cough. These ail-ments account for a total of 9.6% of the total cases inthe sample. In most morbidity studies, upper respirat-ory infections constitute the largest single group ofailments [17, p. 34] with the common cold being theprinciple contributor to incidence rates. Colds rank21st on the core group list, however, when the cate-gory "colds" is combined with two cold symptoms(coughs and congestion) the group cases equal 6.7% ofthe total sample and would rank first on the core list.

Infectious and parasitic diseases listed in the coreailment group include intestinal parasites, tubercu-losis, and mumps, which account for 2.3% of thesample of cases. Public heath morbidity reports fromthe Lower Rio Grande Valley all indicate that therates for nearly all infectious diseases are significantlyhigher than elsewhere in the United States. Twofactors, the poverty of the area and the proximity andease of access to Mexico, are blamed for this con-dition. Yet, this condition does not appear to be re-flected in the core ailment group. One explanation forthis is that the majority of infectious diseases are nowviewed as being best treated by medical intervention,and they are, therefore, no longer a part of the hometreatment or ethnopharmacological system.

The category injuries and environmentally pro-duced ailments includes eye irritation, sores, burns,bleeding, insect bites, cuts, wounds (2 categories), mildrashes, and sun stroke. These ailments represent 8.5%of the cases analyzed for this paper. These ailmentsare primarily first aid problems and are not easilycomparable to the accident category that is presentedin most morbidity studies [17, p. 35].

The final grouping of acute illnesses, "other acuteillnesses", includes fevers, earaches, bladder infections,kidney infections, boils, headaches, menstrual cramps,acne, anemia, late menstruation, toothaches, achesand pains, feeling rundown, tired blood, mouth infec-tions, hemorrhage, hemorrhoids, hiccups, liver prob-lems, pain, warts, infertile womb, insufficient milk,stomach infection, inducing labor and urinary tractinfection. The sum of all the cases in this group is

An inspection of the list of ailments in this categoryshows that these are also prominent ailments treatedby home remedies. The comparison of ailments by sexis presented below.

Chronic ailments are normally separated out fromacute ones for special emphasis in morbidity studies,and have even formed the topic of interest for specificstudies. The chronic ailments found in the core groupare arthritis, diabetes, heart problems, balding,asthma, high blood pressure, obesity, and cancer,which constitute 5.4% of all of the cases analyzed.Approximately one-half of the civilian non-insti-tutional population of the United States commonlyreports having more chronic conditions [17, p. 38],however, only 1.2% of the females and 3.0010 of themales were considered disabled to the extent theycould not work or do whatever they were doing priorto the disability [17, p. 40]. Listed in the conditionsreported nationwide as most commonly restricting ac-tivity were arthritis, visual impairments, hearing im-pairments, high blood pressure, heart conditions,digestive conditions, and orthopedic impairments [17,pp. 40-42]. Obesity is generally not labeled as anillness in medically based surveys, while asthma anddiabetes are not amongst the prominent problemslisted by Cole for the United States as a whole. Thismakes a comparison of the ethnographic and demo-graphic data difficult, however, it is interesting to notethat both studies listed four ailments as prominentproblems: arthritis, digestive conditions, heart prob-lems, and high blood pressure. Equally germane is thegrowing concern in the Valley over the evidence thatthere is a higher incidence of diabetes amongst Mexi-can Americans than the country as a whole [18, p.44]. Cancer was placed in the chronic illness categoryby the author, since its duration is often more thanthree months, but a similar treatment was not foundin Cole [17], Peterson [5], Tomlinson [19] or Mech-anic [9]. The other illness in this category, balding,represents a community health concern that wouldnot be considered a high priority condition by themedical establishment, but is of concern within thecommunity. It is discussed in more detail below.

The final category of illnesses derived from group-ing the core ailments is the category of "mental prob-lems". These include the categories nervios, insomnia,and mental disorders. N ervios is a broad conditionthat includes anxiety, irritability, and insomnia buthas no exact English equivalent, either as a folk illnessor as a medical condition. The category "mental dis-orders" includes depression, sadness, the relief of gen-eral mental disorders, and the restoration of sanity.The broadness and inexactness of definition of these

ROBERT T. TROTTER II112

Table 2. Sex specific comparisons of frequencies of ailment case examples

Females Males

Cumulative%

No. ofcases

Cumulative% %Ailment Ailment

No. ofcases

I. Arthritis 9 5.02. Fever 9 5.03. Stomach ache 9 5.04. Upset stomach 9 5.05. Constipation 8 4.56. Diarrhea 7 3.97. Sore throats 6 3.48. Intestinal parasites 5 2.89. Nervios 5 2.8

10. Boils 4 2.2II. Cough 4 2.212. Eye irritation 4 2.213. Insect bites 4 2.214. Kidney infection 4 2.2IS. Backache 3 1.716. Bladder infection 3 1.717. Feeling rundown 3 1.718. High blood pressure 3 1.719. Heart problems 3 1.720. Insomnia 3 1.721. Sores 3 1.7

Total cases, male informants = 179

5.010.015.020.024.528.431.834.637.439.641.844.046.248.450.151.853.555.256.958.660.3

6.411.215.419.322.826.129.332.134.336.538.540.342.344.045.747.348.950.451.752.954.0

1. Stomach ache 67 6.42. Cough 50 4.83. Colic 44 4.24. Nervios 41 3.95. Earache 37 3.56. Susto 35 3.37. Fever 34 3.28. Diarrhea 29 2.89. Eye irritation 23 2.210. Upset stomach 23 2.2II. Constipation 21 2.012. Insomnia 20 1.913. Sores 20 1.914. Arthritis 18 1.715. Burns 18 1.716. Bladder infection 17 1.617. Diabetes 17 1.618. Kidney infection 16 1.519. Colds 14 1.320. Headaches 13 1.221. Intestinal parasites 12 1.1

Total cases, female informants = 1050

ailments makes a comparison of these problems withclinical mental health categories impossible untilenough further research has been done to more pre-cisely define them and their treatment within an eth-nographic context. This category represents 6.1% ofthe total sample of cases.

AGE AND SEX COMPARISONS

Most morbidity studies include a comparativeanalysis of morbidity patterns by sex and by ageranked groups within the gender categories. The datacollected for this paper were sufficient to allow a par-tial analysis of the sex and age related differences inhome treated morbidity problems in the Valley. How-ever, a certain amount of caution should be main-tained in applying this data elsewhere, due to the rela-tively small number of case examples collected frommale informants. Thus, this must be considered anexploratory, rather than a final analysis of sex and agespecific morbidity problems.

Table 2 presents the 21 most commonly recordedailments for all males and for all females, along withthe frequency of reporting of each ailment within therespective group, but not for the total sample of cases.

Even a casual inspection of the rankings for the twosexes indicates a considerable divergence between thetwo groups, which is confirmed by computing a chi-squared statistic for the table that indicates that thereis less than one chance in a thousand that the differ-ences between the group was produced by chancealone (x2 = 621.3, 27 df, P < 0.001). Thus, there areage specific differences in the reporting of remedioscaseros by males and females which are probablylinked to differences in their morbidity patterns (seeTomlinson [19], Cole [17], Mechanic [9] and Peter-son [5] for discussions of the causes for these differ-ences).

There were 10 ailments from Table I, the core ail-ment group, that were collected only from femaleinformants. These included colic (44 cases), headaches(13 cases), balding (10 cases), tired blood (6 cases),hemorrhoids (5 cases), keeping away evil spirits (5cases), mumps (5 cases), infertile womb (4 cases), uri-nary tract infection (4 cases), and whooping cough (4cases). Other multiple example ailments presented byfemales, but not by males, include dolor del aire, chills,babies' diarrhea, bad luck, deformaties, bed wetting,nose bleeds, sprained joints, ringworms, dandruff,pano (dark spots on the skin), dry irritated skin,measles, loss of appetite, to gain weight, anxiety, faceproblems (spots, rough skin), help close navel on new-borns, and to clean the uterus. There were ~even con-ditions presented by males alone (restoring eyesight,clean out stomach, poison oak, keep teeth and gumshealthy, stay awake, abscesses, and intestinal flu), butsince they are all single example cases, it is impossibleto assess their importance until the sample of casesfrom male informants is increased significantly.

Some patterns are suggested by the above data. Anumber of the ailments collected solely from womenare childhood diseases, such as colic, mumps, andwhooping cough, which suggests a much greater roleof females in the treatment of these illnesses than formales. Others are "female problems," such as infertilewomb (along with morning sickness, vaginal douches,yeast infections, which were not in the core group).The fact that no males reported keeping away evilspirits as a problem may be due to the greater rolewomen in the community play in participating in re-ligious activities. However, as yet there is no explana-tion, and not even a decent speculation, as to whyonly women reported balding as a community healthproblem, especially given that balding is in the tophalf of the core ailment group.

Remedios caseros: home remedies in Mexican America 113

Table 3. Age and sex specific comparisons of frequencies of ailment case examples, ages: 17-44

Females Males

No. ofcases

Cumulative%

No. of Cumulativecases % %Ailment%Ailment

2115121212II101088777

Total=311

6.84.83.93.93.93.53.23.22.62.62.32.32.3

6.811.615.519.423.326.830.033.235.838.440.743.045.3

655433332222

8.57.17.15.74.34.34.34.32.92.92.92.9

8.515.622.728.432.737.041.345.648.551.454.357.2

I. Upset stomache2. Constipation3. Intestinal parasites4. Painful joints5. Diarrhea6. Fever7. Sore throats8. Stomach ache9. Boils (tacotes)10. ColdsII. Gas12. Nervios

I. Stomach ache2. N ervios3. Colic4. Cough5. Diarrhea6. Earache7. Constipation8. Susto9. Fever10. Upset stomachII. Eye irritation12. Kidney infection13. Sores (granos)

Total = 70

The comparisons presented in Table 2 are furtherrefined in Tables 3 and 4, which present the agespecific comparisons of the most commonly reportedailments of males and females from the sample cases.

Age specific comparisons are commonly reportedfor the age ranks of 0-6, 7-16, 17-44 and 45 and over[17, p. 34]. However, there were only eight cases inthe sample that were collected from males under theage of seventeen years old, so only the two compari-sons of age ranks in Table 3 and Table 4 arepresented. The reason for the difference in the size ofthe lists of ailments is that the lists were restricted tomultiple example ailments reported for the males, and

the length of the female rankings was conformed tothat of the male list of multiple examples.

Dividing the data into these groupings allows athree-way comparison of the listing of the ailments:between males and females in each of the two ageranks, and between the same sex informants in thetwo different age ranks. The differences between theailments presented by the males and females withineach rank is far greater than it would have been ifproduced by chance alone <xl = 181.2, 18df,P<O.OOI for ages 17-44; and 1=254.7, 33df,P < 0.001 for ages 45+). This indicates that sex roles,occupation, cultural values and other socio-cultural

Table 4. Age and sex specific comparisons of frequencies of ailment case examples, age: 45 +

Females Males

No. of Cumulativecases % %

No. ofcasesAilment

Cumulative% % Ailment

41363226252521201614141413121111101010999877

Total = 678

6.05.34.73.83.73.73.92.92.42.92.92.11.91.81.61.61.51.51.51.31.31.31.21.11.1

6.011.316.019.823.527.230.333.235.637.739.841.943.845.647.248.850.351.853.354.655.957.258.459.560.6

I. Fever 62. Stomach ache 53. Diarrhea 44. Kidney infection 45. Painful joints 46. Backache 37. Bladder infection 38. Constipation 39. Cough 310. Eye irritation 3II. Feeling rundown 312. Insect bites 313. Sores (granos) 314. Upset stomach 315. Asthma 216. Bleeding 217. Body aches 218. Boils (tacotes) 219. Heart problems 220. High blood pressure 221. Infected wounds 222. Nervios 223. Pneumonia 224. Sore throats I25. Stomach cramps 2

Total = 101

5.9

5.04.04.0

4.0

3.0

3.0

3.03.0

3.0

3.03.0

3.0

3.02.0

2.0

2.0

2.0

2.0

2.02.0

2.0

2.0

20

1.0

5.910.914.918.9

22.925.9

28.931.9

34.9

37.940.9

43.9

46.949.9

51.953.9

55.9

57.9

59.9

61.963.9

65.9

67.9

69.9

71.9

I. Stomach ache2. Cough3. Colic4. Upset stomach5. Nervios6. Susto7. Earache8. Fever9. Diarrhea

10. Eye irritationII. Insomnia12. Painful joints13. Burns14. Sores (granos)15. Colds16. Diabetes17. Bladder infection18. Constipation19. Headaches20. Bleeding21. Congestion22. Kidney infection23. Heart problems24. Sore throats25. Stomach cramps

114 ROBERT T. TROTTER II

will decide to use both systems either simultaneouslyor sequentially, as discussed in Trotter and Chavira[10].

Future research, both in Mexican American com-munities and within other cultural groups, which fol-lows or extends the format set out in this papershould produce valuable results in at least two areas.One is a delineation of the parameters of the systemof choice that is operating; the factors which deter-mine the course of treatment of an ailment pursuedby a patient, both at given points in time and througha course of treatment. The second is in determiningthe nature and scope of the whole field of homehealth care and self help patterns, since these are notnormally known nor are they commonly capable ofbeing established by other methodologies, yeat theyappear to have a major impact on the health status ofcommunities or regions where they are found.

variables playa part in differentially shaping the mor-bidity patterns of home treated ailments in ways thatare probably similar to those reported by Cole [17]and others for national and regional morbiditystudies. Similarly, the differences between the two ageranks for informants of the same sex were significant.for females, the probability that the differences withinthe two lists of the top ten ailments for the 17-44group and the 45 + group were due to chance alonewere less than one in a thousand (xl = 95.5, 12 df,P < 0.001), and the probability that the differences inthe top 10 ailments in each of the two male lists werealso less than one in a thousand (xl = 44.16, 15 df,P < 0.001). These findings are consistent with othertypes of morbidity studies, which have shown thatsuch differentials are due, at least in part, to thechanging social environment for the individual atvarious ages and, in part, to the changing physiologi-cal characteristics of individuals of varying ages.Thus, all three comparisons produce results that arecomparable with conventional morbidity studies.

SUMMARY AND CONCLUSIONS

The data presented within this paper indicate thatan analysis of appropriate samples of remedios caseroscan provide a considerable amount of insight into thecommon ailments treated in the home with ethno-pharmacological resources. Further, the morbiditypatterns discovered by the analysis of this type of dataparallel those from more conventional mortalityresearch efforts, especially in that the patterns of thehealth problems collected from informants vary sig-nificantly in relation to the age and sex of the individ-ual providing the information.

The ailments and groupings of ailments describedin this paper are interesting not only for the patternswithin the ailments that are included in the sample,but also for the patterns of ailments and groups thatare not found in the sample. Since the majority ofMexican Americans in the Valley now have access tomedical treatment, it can be assumed that remedioscaseros are currently being utilized within the contextof a total field of health resources that necessitatesomeone choosing between home treatment andmedical treatment. Some ailments appear to betreated only in the home and others treated only bythe medical establishment. Thus, the core ailmentgroup was inspected for regularities that might sug-gest a rationale behind the choices that are made. Theresult is that the core ailments were subdivided intothree groups: ailments having no medical treatment(e.g. susto, mal de ojo, etc.); ailments that do not nor-mally require medical treatment (e.g. cuts, minorrashes, burns, stomachaches, diarrhea); and ailmentsthat the patient perceives the medical system hasfailed to cure or eliminate (e.g. terminal cancer, dia-betes, balding, or arthritis). The rationale for choosingfolk remedies, then, may be a process of evaluatingthe symptoms an ailment presents, classifying it as aparticular ailment, and pursuing treatment. If it isfurther assessed or categorized as being outside thescope of medical treatment, or if medical treatmenthas "failed", then, obviously, many people will opt forself help forms of treatment, rather than giving uphope. Naturally, some health problems are extremelyambiguous in their presenting symptoms, and patients

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