Abstract

This article examines Mexico City's typhus epidemic of 1915–16 and makes three central claims. First, the federal response to the outbreak, while laudable in light of the grim circumstances, was disjointed and excessively bureaucratic. Second, the epidemic drew out long-standing stereotypes of poor indigenous populations, leading people to make misguided linkages between the high incidence of typhus within those populations and their supposed moral or intellectual shortcomings. Third, the typhus epidemic prompted fundamental reforms to the nation's public health system. As a delegate to the constitutional convention of 1917, the nation's chief public health officer, general and doctor José María Rodríguez, successfully promoted his vision of a “sanitary dictatorship” that would operate according to strict authoritarian principles for the sake of efficiency. The epidemic thus shaped not only the human experience in that moment but also the course of revolutionary political reform in the years to come.

Epidemic typhus flourishes in conditions of overcrowding and inadequate sanitation, as it did in Mexico City in 1915–16. This particular bout of epidemic typhus was not the first the capital had suffered, nor would it be the last, but it was the worst in generations—maybe ever.1 As Mauricio Tenorio-Trillo and others have noted, typhus had a long history in the country, where it was known as tabardillo. Nowhere was the presence of typhus more evident than in Mexico City, which seemed almost predestined to host the disease. Mexico's capital, along with cities ranging from Paris to Tunis, formed one of several nodes in the global web of efforts to understand and ultimately eradicate the disease. But that was a longer, more gradual process, carried out in fits and starts punctuated by the personal squabbles that thrive on the egos of great scientists. The 1915–16 epidemic, by contrast, required a more immediate and improvised response.2

Typhus, caused by different varieties of the bacterium Rickettsia, comes in two dominant forms: an endemic variety carried by fleas, specifically those on rodents (it is thus known as murine typhus), and epidemic typhus, with the common body louse as its primary vector. The bacterial strains of typhus are named, curiously, in honor of Howard Taylor Ricketts, a young midwesterner who, after several seminal experiments at Northwestern University concerning Rocky Mountain spotted fever, came to Mexico City in 1910 in pursuit of new research on typhus, only to die there in a matter of days of the very disease he had hoped to conquer. Ricketts was accompanied that year by the great luminaries of the world of typhus research—Charles Nicolle, Ángel Gaviño, and Joseph Girard—on his trip to the National Bacteriological Institute, giving Mexico City a permanent place in the history of human efforts to eradicate the disease.3

For self-evident reasons, epidemic typhus has been called jail fever, camp fever, hunger fever, and war fever at various points in history. In the epidemic form of the disease, the human infection comes not from the bite itself but rather from the feces of the carrier louse being deposited onto a person's skin and then scratched into the bloodstream after the insect leaves an itchy bite mark.4 Common symptoms include weakness, extreme fever, headaches, and muscle aches, accompanied by rashes, spots, and bumps all over the body. The most severe outward symptom—what was known at the time of the 1915 Mexico City outbreak as “typhomania”—is a profound stupor with delirium, signifying the fatal stage of the disease, when the heart and brain swell.5

Mexico City routinely experienced both types of the disease, making the 1915 outbreak seem, at first glance, to be just another periodic flare-up. Yet its arrival in the late part of that year was anything but coincidental. The previous year, counterrevolutionary military dictator Victoriano Huerta had been defeated by revolutionaries, who at that time were still relatively united. Just as quickly, their coalition split apart, leading to a lethal struggle between competing forces loosely bound by the ideologies, class backgrounds, practical goals, and personal ambitions of their leaders and, to a lesser degree, their participants. The conflict eventually turned into an all-out war between two dominant factions: the comparatively radical and agrarian Conventionists, led by the peasant guerrilla Emiliano Zapata and the mercurial commander Pancho Villa, and the more moderate Constitutionalists, led by the deft politician Venustiano Carranza and the brilliant military tactician Álvaro Obregón.6

This chain of events follows a common progression seen in most major revolutionary struggles: the initial coalition, held together by the mutual objective of vanquishing an enemy, flakes apart as its participants turn against one another, their shared sense of purpose giving way to competition and hostility.7 As has been true elsewhere, the effects of this phase of the revolutionary struggle in Mexico were severe for the civilian population. As the capital was cut off from crucial supply routes, famine set in, leading to 1915 being known as the “year of hunger.” Typhus soon followed. Not surprisingly, the populations that were already most vulnerable were hit hardest, as scarcity led to rising prices and as overcrowding and bad infrastructure encouraged the spread of the contagion. The rapid onset of the typhus epidemic prompted an aggressive if uncoordinated response from federal authorities overseen by the revolutionary general and physician José María Rodríguez. Rodríguez, a distinguished surgeon from a prominent Coahuila family, was a close friend and the personal physician of President Venustiano Carranza. After garnering praise for his efforts to fight yellow fever, smallpox, typhus, and influenza in the early years of the revolution, Rodríguez was appointed head of the Superior Council of Public Health in 1914. In that capacity, he organized the antityphus campaign of 1915–16.8

This article examines Mexico City's experience with the typhus epidemic of 1915–16, as well as the subsequent national public health reforms that the crisis prompted during the drafting of the revolutionary constitution of 1917. In doing so, the article makes three central claims. First, the federal response to the outbreak, while laudable in light of the scarce resources and trying circumstances at the time, was disjointed, punitive, excessively bureaucratic, and ultimately inadequate. Second, the epidemic drew out long-standing stereotypes of poor and indigenous populations, leading people to make misguided linkages between the high incidence of typhus within those populations and their supposed moral shortcomings, particularly their susceptibility to the vice of alcoholism. These characterizations were not confined to popular discourse; rather, they found their way into official discussions, first in a landmark study of public health carried out by prominent government minister Alberto J. Pani and then in the debates leading to the 1917 constitution's ratification, in which Rodríguez participated as a delegate. Third, the typhus epidemic prompted fundamental reforms to the nation's public health system. Chief among them was the construction of what Rodríguez called the “sanitary dictatorship.”9 According to his ideal, the federal public health service would operate according to strict authoritarian principles out of necessity, which would give its agents the freedom to respond to epidemics without the burden of labyrinthine bureaucracy. For these reasons, the 1915–16 typhus epidemic, a byproduct of wartime conditions, shaped not only the human experience in that moment but also the course of revolutionary political reform in the years to come.

This study enters an evolving historiographical conversation on public health and medicine across Latin America.10 With regard to Mexico, the last quarter century has seen a proliferation of studies focusing on both official and popular efforts to address health issues, among them hygiene, sanitation, and infectious disease. Scholars have emphasized two areas of particular relevance to this article. First, they have studied the dynamics of public health reform in the late nineteenth-century oligarchic dictatorship of Porfirio Díaz. The years of his regime (1876–1911) overlapped major advances in the rise of germ theory and state-led public medicine, and his ministers, guided by a loosely bound set of social evolutionist ideologies, sought to align Mexico with these emerging global practices.11 Second, historians have looked at the post-1920 period, when revolutionary infighting gave way to a sustained process of state-led development undertaken by an authoritarian political system.12 Once again, public health represented a significant feature of this process. Scholars have increasingly pointed to continuities between these two periods, offset by the decade of armed conflict from 1910 to 1920. For example, health authorities in both the Porfirian and the revolutionary establishments tended to identify public health issues common among the poor as the result of their self-destructive behaviors and inherent vice rather than of the socioeconomic structures within which they lived.13

The major historiographical contribution of this article is to assert that the 1910–20 armed phase of the revolution represented a far more dynamic period in the development of the nation's approach to public health than previously supposed. Whereas most scholars at least implicitly take for granted that chaotic internecine conflict consumed the entire decade, crippling the state and making effective governance nearly impossible, this study demonstrates that the construction of a comprehensive public health system happened at least partially in response to typhus and other epidemics that arose during the conflict.14 In the constitutional convention debates of 1917, Rodríguez drew on his experience organizing the federal response to the 1915–16 epidemic to promote his vision of a sanitary dictatorship, which would be imbued with both an egalitarian spirit and authoritarian characteristics. While Rodríguez's ideal was more extreme than the provisions eventually incorporated into the final document, the 1917 constitution nonetheless guaranteed universal access to health care and established federal responsibility in the areas of sanitation, medical services, and health education. Thus the course and outcomes of the typhus epidemic prove that the decade of revolution was neither a definitive rupture between two distinct periods of national development nor merely a decade of chaos between two periods otherwise defined by continuity. Rather, the period from 1910 to 1920 was a mixture of all of these—a point of divergence between the Porfirian and revolutionary eras, a bridge between the two, and a moment of productive political and social change in its own right.

In making this claim, the article emphasizes the role of the national government, particularly the role of Rodríguez and the Superior Council of Public Health. The article is nonetheless sensitive to the many actors and institutions at all levels that had a role in shaping the national experience of the epidemic. The Public Health Ministry's extensive archives, which include volumes of files on the federal antityphus campaign, allow considerable insight into the perspectives of the numerous stakeholders in the fight against typhus. Beyond Rodríguez and other public health officials, these stakeholders included physicians, volunteers, clergymen, news media representatives, members of the business community, and many others. In examining their diverse perspectives, the study takes a cue from work by Diego Armus (on tuberculosis in Buenos Aires) and Charles Briggs and Clara Mantini-Briggs (on cholera in rural Venezuela) in asserting that typhus became a way of talking about a host of issues, often in discursive terms.15 Typhus, for example, served for some as proof that poor and indigenous Mexicans had failed to modernize by improving their habits and for others as a symbol of the Constitutionalist government's failure to deliver on its lofty promises to bring political stability to the country. For all these reasons, the relatively brief typhus epidemic of 1915–16 clarifies our understanding of the revolutionary period's political and social dynamics.

A War on Typhus, or a War on the Poor?

There probably could not have been a worse year than 1915 to have coordinated a vast effort to combat a lethal epidemic. Political authority at all levels, from the national to the local, buckled under the weight of factional struggle. Inflation skyrocketed as supply lines disintegrated. Federal revenue, normally generated through an already dysfunctional tax collection system, had mostly dried up. Daily life in the capital took on grim, anomic qualities as hunger set in. Theft became an unavoidable threat to some, a means of survival for others. Across the country, a host of epidemics occurred, including bouts of smallpox, measles, bubonic plague, and scarlet fever, while endemic conditions such as yellow fever and malaria flared up.16 None of these proved as lethal as typhus.

As América Molina del Villar notes in her analysis of quantitative assessments of the epidemic—including bulletins issued by the Superior Council of Public Health, hospital registries, and burial records—statistics from the period are unreliable and vary widely. For example, the physician and hygienist Francisco Valenzuela cited approximately 21,600 cases of infection in Mexico City, resulting in about 3,500 deaths, between 1915 and 1917 (out of a total population in the Federal District of approximately 800,000).17 While his numbers are only one example among many, most nonetheless suggest that several thousand died, with many more contracting the disease but surviving.18 One estimate claimed that at its height in 1915, typhus claimed a thousand lives a week in the capital city and countless other lives across the country.19 The only certainty we can glean from the erratic numbers available is that typhus ranked among the predominant causes of death at the midpoint of the revolutionary decade.

In light of these factors, it is remarkable that federal health officials mounted any response at all. Yet they did. José María Rodríguez, recently appointed president of the Superior Council of Public Health by the Constitutionalist authorities nominally controlling national politics, organized a response that was consistent with measures taken across the world. What scientists knew in 1915, thanks largely to the efforts of French scientist Charles Nicolle, was that epidemic typhus was caused by lice. By the end of the decade, Brazilian scientist Henrique da Rocha Lima and his Polish colleague Stanislaus von Prowazek had discovered the pathogen for epidemic typhus, which Rocha Lima would call Rickettsia prowazekii in honor of Ricketts and Prowazek, who had both died of the disease (both Rocha Lima and Prowazek were infected in Germany, but only the latter succumbed).20 Thus the chief strategy in the mid-1910s for confronting a louse-borne condition was delousing, and this is largely what Rodríguez and his subordinates set out to do.

The federal response to the typhus epidemic, led by Rodríguez, unfolded in an improvised manner, with the primary intent being the eradication of lice. Brigades of ad hoc sanitation police and scores of volunteers from every conceivable walk of life were dispatched to do whatever had to be done to rid the city of these microscopic enemies. This included condemnation of commercial zones, closure of businesses, forced eviction and relocation of poor populations, systematic destruction of individual and commercial possessions, and imposition of harsh fines for sanitary infractions that were otherwise rarely enforced. As has been true in countless historical examples, certain people interpreted the correlation between poverty and disease in irrational and often-disturbing ways, in the worst cases adopting a mentality that blamed the victims for their own suffering.

The approach of targeting the poor was not new. Public health authorities in the last quarter of the nineteenth century, during the oligarchic dictatorship of Porfirio Díaz, increasingly came to see the individual failings of the poor as the root cause of epidemic and endemic disease. This proved true in a series of typhus outbreaks, even as scientists and doctors were becoming more aware of the microbiological nature of the disease. The prominent public health official Domingo Orvañanos, the Porfirian era's leading authority on typhus, developed a hybrid understanding of the disease, emphasizing both its microbial nature (he was in line with leading global contemporaries in identifying the louse as its chief carrier) and its supposedly social characteristics.21

By adopting a mentality that blamed disease on the filth and moral degeneracy of destitute populations, Orvañanos and other public health authorities justified draconian measures. These included the forced seizure and destruction of private property, condemnation of housing, separation of families, and quarantine or other forms of isolation (often in specially designated hospital wards).22 Without apologizing for the misdeeds or inhumanity of these policies, it is important to note that health officials undertook them not to punish the poor but rather to combat the disease according to the method they best understood to be effective. Nevertheless, the tendency to locate the problem of typhus (and, indeed, a host of other diseases) in the individual behaviors and supposedly inherent characteristics of the poor, rather than in the socioeconomic structures of poverty and inequality or in the insufficient physical infrastructure of the city, reflected the social evolutionist mind-set of the prerevolutionary Porfirian regime.

Such mentalities, so commonly identified with the Porfirian intellectual set, carried over into the revolutionary era and beyond. Indeed, most of the efforts of the Superior Council of Public Health under Rodríguez, who was also trained in the Porfirian years, were borrowed from the prerevolutionary antityphus campaigns. This is not altogether surprising, given that the leaders of the antityphus campaign had been trained in that milieu. In addition to Rodríguez and Orvañanos, these leaders included the initial head of the Special Antityphus Service, Alfonso Pruneda, as well as his successor, Francisco Valenzuela, who would collect extensive statistics related to the epidemic. These men, among the brightest minds in the field of hygienic medicine to emerge in the rapidly modernizing context of the late nineteenth-century Porfiriato, became the intellectual architects of the 1915–16 effort to eradicate typhus.23

Many of these policies also bore the stamp of miasma theory, which by the 1910s was regarded as an outdated set of assumptions about the connection between disease and the condition of the atmosphere in the immediate vicinity. Miasmatic thinking, which posited that the putrid stench of rotting organic material such as sewage or decomposing trash spread disease through the atmosphere, was mostly discarded in the late nineteenth-century Pasteurian revolution, which inaugurated the turn toward the germ theory of disease that has predominated through the twentieth century and beyond.24 Yet, as América Molina del Villar, Sidney Chalhoub, and others have demonstrated both in Mexico and elsewhere, the shift from one paradigm of biomedical thinking to the other was neither instant nor complete. Rather, the two modes of interpreting disease, though contradictory to one another, often simultaneously informed how health officials in the early twentieth century approached epidemics. Therefore, even as public health authorities and most citizens in everyday life recognized the microbial nature of typhus, the tendency to isolate or even eliminate whole geographic sectors of the city amounted to a kind of scorched-earth campaign, carried out on the assumption that certain environments had to be erased if the disease was also to be eradicated.25

In numerous memoranda sent to the Interior Ministry (which at the time held authority over the Superior Council of Public Health) and other government agencies, Rodríguez drew the contours of what such a response from the federal government would look like. The effort began with assembling sanitation brigades. An initial corps of 400 men, headed by the respected physician Alfonso Pruneda and vested with significant authority, would be dedicated to tasks such as ensuring that streets were cleaned and homes disinfected.26 Most of the corps' members were physicians; the lists of names contained in the public health archives tell us little more than that and that they were awarded modest compensation for their efforts.27 One gains the impression of an all-hands-on-deck approach, in which a majority of the city's doctors and hospitals were called on to aid in responding to an epidemic that reached into all social and geographic sectors of the city.

In addition to the people appointed to serve as the officers of this makeshift public health service, others volunteered. The list of volunteers was diverse: physicians offering their expertise pro bono, a businessman trading in horse and mule livestock, working-class neighborhood activists in Santa María la Ribera, and a doctor from Laredo, Texas, specializing in infectious disease, to name a handful.28 The Neutral White Cross—a medical relief organization created during the revolution in response to the void left by the Mexican Red Cross, which appeared both unwilling (due to its Porfirian origins) and unable (due to its scarce resources) to treat wounded or infected insurgents—committed itself to the cause.29

Rodríguez implored doctors employed by the federal government across its various executive departments to lend their services to fighting the epidemic and received statements ranging from enthusiasm to dismissal in response.30 Almost without exception, he consented to giving volunteers, even those who presented no formal credentials and had undergone no systematic vetting or training process, significant authority to do things such as impose fines and condemn squalid homes or businesses. Although Rodríguez and his agency relied heavily on volunteer efforts, some who contributed to the campaign pleaded for petty compensation. A petition sent by various barbers, who noted that they had left their own businesses to help the delousing effort as haircutters, had asked for modest payment, which they were awarded by the Interior Ministry.31

This hastily appointed corps of sanitation officers, along with the volunteers and auxiliary workers, carried out a series of practical measures designed to halt the devastation being caused by typhus. They established large trash receptacles several miles beyond the farthest margins of the capital city in each cardinal direction. To accomplish their trash collection goals, Rodríguez struggled to gain access to an adequate number of cars to transport garbage to be buried in ditches and covered in dirt.32 In certain zones, clothes were burned in giant incinerators, which, one public health official worried, were consuming an enormous quantity of firewood.33 To replace the incinerated clothing worn by poor city residents, the Superior Council of Public Health distributed tens of thousands of articles of clothing made of cheap muslin-type material. Rodríguez used Interior Ministry authority and Finance Ministry funds to contract the purchase of shirts, pants, undergarments, coats, and blankets to be distributed to adults and children alike.34 Lazarettos, or quarantine areas, were set up, such as the one in the Temple of San Sebastián, where public health authorities isolated the infected from the rest of society.35

The Superior Council of Public Health also funded the construction of public baths, designed to allow the city's indigent to bathe as a preventive measure. The baths went defunct quickly, though, and were not reopened, due to a firewood shortage. Documentation from the Public Health Ministry reveals constant wrangling between Rodríguez at the Superior Council of Public Health and officials at various other ministries over the price and supply of firewood.36 Despite some last-ditch efforts, such as convincing the chief of the Constitutionalist Railways to order several train cars full of firewood from Michoacán to the capital, Rodríguez faced such a shortage that his agency abandoned the public baths project.37 Documents also suggest that soap was too expensive given the inadequate supply and high demand, which led to further dysfunction within the public bath initiative.38 By mid-1916, the agent heading the public baths effort had declared it over.39

From the outset, the public health officers were beset by similar kinds of logistical problems. Rodríguez made constant pleas for more cars because shortages of vehicles made swift transport to hospitals impossible, a problem that made those living on the city's outskirts, in places such as Tlalpan and Cuautitlán, especially vulnerable to wait times they did not have the luxury of enduring.40 His pleas met with a mixed response. The postal service, for example, rejected his request, noting that their working fleet of mail trucks was fully occupied delivering mail; others, such as the cigarette company El Buen Tono, contributed.41 Sulfur shortages presented another challenge to the public health service. Fumigation with sulfur dioxide or sulfuric acid was an accepted method of delousing at the time, used in Mexico as well as in campaigns in Europe and the United States.

Rodríguez seemed at times to function as a one-man bureaucracy, dispatching order after terse order to move pharmaceuticals, equipment, and people from one point to the next. In a letter to President Carranza at the conclusion of 1915, Rodríguez noted the response's results up to that point: despite the deaths of 15,000 to 17,000 people so far, a 19 percent mortality rate, the campaign had been radical and effective. Nevertheless, public health efforts were severely hampered by the fact that the sanitation police could only transport between 40 and 50 people to hospitals each day due to the car shortage. It should be noted that Rodríguez's numbers were far higher than many of the already inconsistent estimates found elsewhere, which confirms only that a reliable measure of the death toll was, and remains, nearly impossible to take. Regardless, his message was simple but dire: if the government could not correct the shortage, the epidemic would most likely continue for two or three more months.42

In response, the visible hand of the state, rather than the invisible hand of the market, moved human and material resources. In formulating his directives, Rodríguez certainly did not arrive at his decisions arbitrarily, even if he did so unilaterally and quickly. Rather, he received a daily barrage of letters and telegrams—from state-level health authorities, pharmacists, scientists, entrepreneurs, political leaders at every level, and ordinary citizens. His correspondence and memoranda suggest that he filtered it as efficiently and faithfully as possible.43

This certainly did not insulate him from criticism. Rodríguez spent much of his time trying to appease those making demands on him. In one example, the head of the Superior Council of Public Health in Mexico State, near the Federal District, sent him a long list of the various disinfectants and other material that his state needed to combat the disease: sulphur, liquid creolin, formaldehyde, naphthalene balls, copper sulfate, methyl alcohol, permanganate of potash, hydrochloric acid, manganese peroxide, mercury bichloride, common alcohol, formalin pills, a car or at minimum a few stretchers, and gasoline. The list came with the accusation that the federal Superior Council of Public Health had all these goods but kept them for itself, making states entirely dependent on Rodríguez's office in Mexico City.44 While there is nothing in the documentation to suggest that Rodríguez hoarded goods to increase dependency at the state level—such a move would have been highly counterproductive—the accusation from the state-level public health officer points to the tensions that could arise from such a centralized decision-making system.

Many of the measures taken by the Superior Council of Public Health, though done in good faith to improve the sanitary conditions of Mexico City and its residents, must have come across as punitive to the very populations most vulnerable to a typhus outbreak. Sanitation police, for example, had a tendency to shutter whole commercial zones that served poor populations rather than individual businesses that were in violation of poorly defined and rarely enforced sanitation codes. The places that made urban life bearable for poor denizens, such as the public markets at La Lagunilla or Martínez de la Torre or blocks of food stalls on Calle de la Palma or the Callejón de Tabaqueros, were summarily closed, as were barracks and barbershops, most likely because they had lice-infested hair on their premises.45 Rodríguez mandated that all new construction of houses not “urbanizadas” (presumably meaning appointed with amenities such as indoor plumbing) located outside official city limits be halted immediately.46 Given that housing on the city's fringes often consisted of hastily erected shanties to shelter the very poor, who would have been incapable of paying for such a luxury as indoor plumbing, the demand not only was impractical but potentially could have worsened the situation.

Housing presented an especially burdensome set of issues for the city's poorest residents. Under normal circumstances, some of the measures taken to combat typhus would appear cruel and even unlawful. Rodríguez, for instance, informed the Interior Ministry that homes would be inspected, one by one, and that those in violation of preventive hygienic measures would have their residents evicted. Those unable to find immediate shelter in the city would be assisted in being sent to a location of their choice outside the city, where they would be most likely to find work.47 The implications were severe and obvious: forced relocation and condemnation of private property were extreme measures justified on the grounds that these were unusual times.

Still, Rodríguez expressed personal concern for those who stood to be affected by his agency's measures. In early 1916 he asked the Interior Ministry to secure free passage to Xalapa, Veracruz, for a woman named María Sarabia, who could not go back to her home, which had been ordered closed due to sanitary concerns. His letter did not specify why Xalapa was her preferred destination—most likely she had family there to provide her shelter—but the correspondence revealed a surprising degree of concern on Rodríguez's part for the plight of one individual.48 He would write similar letters over the duration of the epidemic. In one instance, for example, he sent a letter to the oficial mayor of the Interior Ministry (third in command) asking for the tiny sum of eight pesos in order to reimburse a citizen named Alberto Sánchez, citing an agreement between the ministry and the Superior Council of Public Health stipulating that poor people whose possessions were destroyed by agents of the special sanitation police as threats to public health be compensated.49 At another point, he made a more general plea for the Interior Ministry to provide tickets on the Constitutionalist Railways for those who had to be relocated.50

These small interventions suggest that Rodríguez understood and regretted the harsh effects that his agency's actions had on the lives of individuals. They also demonstrate the unappealing choice he faced, again and again, between protecting the nation against an epidemic at the expense of certain people's livelihoods and protecting those certain individuals even if it slowed the progress of the fight against typhus. These cases demonstrate that the exigencies of the time forced public health officials to grapple with philosophical and moral questions rather than strictly pragmatic ones. Should health authorities impose financial burdens on people already facing economic distress in order to combat disease? Could such an action worsen, rather than improve, the situation? More abstractly, to what degree should public health officers, as agents of state power, be willing to trample basic rights—individual sovereign rights over property or the right to privacy, for example—in order to ensure the safety and health of the population?

Jail Fever

The condition of prisons and prisoners weighed heavily on Rodríguez and presented others, including hospital administrators and government officials, with a moral quandary over whether incarcerated people were worthy of scarce resources such as hospital beds. Like the expanded public health service in Mexico, the nation's prison system and overall approach to criminal justice at the time of the typhus outbreak reflected the Porfiriato's modernization drive. Indeed, as Pablo Piccato argues, the Porfirian effort to promote the twin ideals of order and progress led to increased criminalization of the economically marginal population's everyday lives, which in turn led to an expansion of prisons, most having deplorable conditions. While the revolutionary establishment in the 1920s and 1930s sought to address these issues, prison conditions, and consequently the condition of prisoners, were predictably bad during the revolution's armed phase.51 Thus jails, those crowded, filthy quarters so prone to official and popular neglect alike, were especially prone to typhus.

Rodríguez pleaded with the Interior Ministry to intervene on behalf of afflicted inmates of the Tlalpan Correctional School, who had been turned away by the city's General Hospital. Given the shortage of transport vehicles, Rodríguez was as concerned with efficiency as with the health of the prisoners. Nonetheless, he deviated from his typically terse and bureaucratic communication style to plead that the ministry direct the Federal Directorate of Public Charity to force the hospital to admit all typhus victims, including the incarcerated.52

Rodríguez expressed particular concern for the plight of juvenile detainees. He complained to the Interior Ministry's oficial mayor that the Constitutionalist Asylums, which had been established for orphans by the Carranza administration, should be condemned due to their generally unsanitary state.53 The ministry wrote back that the facility should be shuttered and its inmates relocated. Due to some redundant correspondence (suggesting that an original message was lost in the post and thus needed to be re-sent), the process took over a month.54 While we cannot know the outcomes of these particular patients, a month in the midst of a typhus epidemic is an eternity, more than enough time to end numerous lives.

In another case, Rodríguez reported to the Federal District's governor that the adult male inmates had been denied admission to all the capital city's hospitals, which did not want to be responsible for sick prisoners. The Superior Council of Public Health was left with no choice but to take them back to jail. He noted that while sanitation officers had tried to disinfect the cells, their efforts would be futile so long as the sick prisoners remained there.55 Perhaps to assuage hospital administrators' fears about admitting prisoners and correctional school students as patients, Rodríguez promised General Ignacio L. Pesqueira, subsecretary of the army and navy, that guards would be installed at the San Joaquín Hospital.56

Interior Ministry officials shared Rodríguez's concerns. The official correspondence between Rodríguez and the ministry suggests general agreement between him and his superiors in the federal bureaucracy. In one letter, the interior minister shared with Rodríguez news from the Federal District's attorney general that three prisoners, who were being held in the district of Azcapotzalco, had arrived at Mexico City's General Hospital. The hospital's director turned them away, supposedly because there were no beds for typhus patients. The minister further noted that he suspected that the real reason that the prisoners were denied admission was that hospital administrators did not have the means to cure them and thought they would infect other patients.57

The back-and-forth persisted through the later months of 1915, suggesting that the capital's major hospitals were improvising their admission policies and that officials were perhaps just as uncertain about the extent of their authority. In mid-December 1915, the Interior Ministry's oficial mayor wrote to Rodríguez that he had been assured by the General Hospital's director that the hospital's policy was to admit anyone who presented with typhus and that any prior irregularities would not be repeated.58 Around the same time, the chief of the disinfection service had complained to Rodríguez that he had received a note from the General Hospital saying that they would not admit typhus patients after 6:00 p.m. An unsigned handwritten response, most likely from Rodríguez, ordered that the hospital take patients in need of care at any hour.59

Reading between the lines of the typically staid bureaucratic correspondence, one gains an appreciation of Rodríguez as a crusader for the basic dignity of those on the society's margins. Of course, legitimate concerns over public safety are always present in situations involving the transport of inmates, and doubly so when those inmates are infected with something as deadly as typhus. There is an obvious temptation to vilify the hospital administrators who allegedly turned them away, but we might also assume that these administrators were simply guarding the interests of their patients and staffers the best way they knew how. The other side of the argument—undeniable in light of the number of cases involving prisoners—is that some considered them unworthy of treatment, at least in the same facilities as nonincarcerated civilians. The issue was also partly economic: the scarcer a resource became, the higher its value climbed, and hospital beds were certainly in high demand. But under these pragmatic considerations lay a moral question for all involved parties and the society at large: Did the lives of all citizens matter the same? And if not, who would decide who got access to resources like hospital beds, and how?

As we have seen, the federal response to typhus, while carried out with sincerity of conviction, was more an improvised collection of stopgap measures than a coordinated strategy. Regardless, there was the matter of paying for it. After the epidemic subsided, and once Rodríguez had succeeded in establishing and then taking charge of a fortified national public health service in the constitutional processes of 1917, he had an equally robust federal budget at his command. In 1915, however, he was working with more limited resources. To confront that challenge, he proposed that the Interior Ministry force owners of theaters and cinemas, as well as chaplains, to defray the high cost of sending sanitation police to their work spaces.60 This type of pass-the-hat approach was discarded in later efforts to appoint sanitation police and medical brigades spearheaded by the Superior Council of Public Health, most notably in its response to the 1918 influenza epidemic, after the 1917 constitutional reforms.

Rodríguez's slender budget was bad enough, but the economic realities of the time would have made his task nearly impossible even if he had started with more money to spend. After all, epidemic typhus almost always strikes in situations of duress. This reality gave the antityphus campaign a narrow scope, one consisting primarily of reactive measures such as delousing people or condemning their homes. Without lasting peace and a sustained effort to address the underlying socioeconomic conditions of endemic poverty, overcrowded housing, and poor infrastructure and sanitation—factors that could only be addressed through a long-term political effort to reconfigure the nation's economic and social structures—typhus was bound to persist. These challenges did not stop Rodríguez and his subordinates from launching a herculean crusade against the disease but did place significant limitations on what they could accomplish.

Fighting Enemies Real and Perceived

Moments of crisis, whether caused by human-induced or natural disasters, tend to crystallize our view of the socioeconomic structure of a society, allowing us to see its points of division and unity. In this case, the typhus outbreak was framed in both elite and popular discourse as a product not only of the stresses caused by revolutionary upheaval but also of the moral and behavioral predispositions of the populations most severely affected. Thus, perhaps not surprisingly, the typhus epidemic of 1915–16 drew out familiar assumptions shared among those with relative social privilege about poor and indigenous populations—that they were ignorant, intellectually primitive, religiously fanatical, superstitious, and prone to alcoholism and other forms of substance abuse. Such stereotypes, while not unique to this context, had the effect of confusing people's understanding of the epidemic's cause.

There was obvious logic in pointing out the correlation between poverty and disease; the poor tended to suffer the brunt of the epidemic, and a larger percentage of the poor were indigenous (and vice versa). The problem came when people mistook correlation for cause. As noted earlier, the leading hygienists and public health authorities of the era, including Orvañanos, Valenzuela, and Pruneda, tended to see the cause of disease in either cultural or individual, but never structural, terms. Their view, expressed by one of their contemporaries, Porfirio Parra, was that typhus was caused by a lack of a hygienic “instinct” among the common people.61

Arguably the most prominent figure to identify moral deficiency as a cause of the epidemic was Alberto J. Pani, an engineer and Carranza ally who would go on to become one of the architects of the nation's modern financial system. In a landmark 1916 study of public health in Mexico, an effort commissioned by the Carranza government partly in response to the prior year's typhus outbreak, Pani pointed to the deficient “moral education” among the society's poorest as ranking among the causes of the epidemic. While Pani did not overtly point to the woes of the poor in any racially determined manner, his views exhibited the Porfirian tendency, one that was fundamentally racist at its core, to identify their problems in a combination of moral shortcomings and a lack of education. As he saw it, education without material improvement would do little to correct the problem and could in fact make things worse by giving disgruntled masses of people the intellectual apparatus to combat the socioeconomic structures within which they lived. He used the latter point to lash out at Zapatista and other agrarian radicals, whom he saw as little more than bandits masquerading as political activists.62

Pani's prescription for his country was threefold. First, immense political reform would be necessary if Mexico hoped to emerge from its backward position in hygiene, sanitation, and public health. His advocacy for a “unipersonal” approach to state public health, which would allow health authorities to evade lengthy discussions over legal minutiae that could cost lives, closely mirrored Rodríguez's “sanitary dictatorship” ideal. Second, cities below a minimum sanitation standard should be subjected to compulsory federal oversight. His recommendation was universal, but he clearly had the capital, which he identified as the least healthy and most disease-prone city in the world, in mind. Third, he saw elevating the economic, intellectual, and moral levels of the lower classes as a priority. To that end, he argued that the rudimentary schools set up during the Porfirian regime, which were rigidly focused on increasing literacy and the abstract goal of teaching the Spanish language to indigenous villagers, instead should focus more on helping these villagers to develop a civic consciousness that would include, in addition to love of country, the practical tools and personal values of hygiene. As he understood it, the root of the problem was “the loathsome corruption of the upper classes and the inconscience [sic] and wretchedness of the lower.”63

In the throes of a typhus outbreak, Rodríguez had very little time to ponder such lofty concepts, although he would promote many of the same ideas as a delegate to the constitutional convention once the contagion was relatively contained. But for the time being, his work consisted primarily of reactive measures designed to eradicate lice. Inevitably his campaign would have limitations, since it attacked lice rather than the underlying causes of the lice. A fuller remedy to typhus, whether the epidemic sort brought on by the deprivations of revolution or the more persistent endemic form, would require more substantive alterations to both the built environment of the city and its socioeconomic structures. The alleviation of crowded housing and the effective management of garbage and sewage, for instance, would have had a far greater effect than proscriptive measures targeting the cleanliness of the poor and their environs. Ultimately a more equitable distribution of wealth and social benefits, beginning with proper investment in infrastructure, would provide the surest means of eradicating the scourge of typhus.

With few exceptions, the sanitation officers working under Rodríguez selflessly carried out their tasks with pragmatic sensibility. Nevertheless, the chaos of the epidemic offered an opportunity for some to express common prejudices. In one letter to Rodríguez, Venencio Caseres, who identified himself as the chief of staff of the special police of Division General Pablo González, registered his disgust at Mexico City's filthiest places—among them milk stands, cafés, produce stands full of rotting fruit, and “second-rate cheap restaurants”—adding that the majority seemed to be owned by Spanish merchants. He offered his services as a sanitation inspector. Rodríguez surprisingly, given the petitioner's lack of professional qualifications and antigachupin sentiment, allowed him to serve as an inspector ad honorem.64 Thus, while the honorary title most likely prevented Caseres from earning a paycheck, Rodríguez did allow him to regulate the stands and collect fines for infractions. The fact that there was no set of hiring protocols or any effort to vet credentials suggests that Rodríguez was desperate to take whatever help came his way.

Clergymen entered the fray as well. A group of priests wrote to the Archbishopric of Mexico that they were ramping up the church's effort to combat typhus. They noted that many priests had already died heroically trying to help parishioners suffering from the disease. The authors of the letter claimed that in light of their colleagues' ultimate sacrifice, they intended to begin coordinating their efforts by forming a sanitary brigade made up of parochial clergy, such that each parish priest or chaplain would lead a campaign within his own parish. Their rationale went beyond well-intended volunteerism. In their view, secular messengers of public health would have little effect on the parishioners, since they were not accustomed to the kind of speech proffered by government bureaucrats, whom they called “científicos.”65 The term, meaning men inclined toward science, had layers of meaning in Mexico during this period. In the Porfirian era, government ministers proudly called themselves científicos to flaunt their positivistic philosophical orientation, while clergy were more likely to use the term derisively to criticize what they saw as the godless anticlericalism of the revolutionary political classes.

As the priests authoring the letter put it, the majority of church congregants would not be receptive to government mandates, whereas priests could open the “doors to the conscience.” Their letter contained more than its share of condescension aimed at their own followers; the priests openly stated that they alone had the power to get through to the society's most backward people.66 Given the Roman Catholic Church's long-standing presence in education, ecclesiastical groups sought to target not only the biological or structural elements of the disease but also the perceived ignorance that supposedly fed it. To that end, the Christian Youth Association confirmed that it would organize a conference on the topics of personal hygiene and physical culture as preventive measures against typhus.67

Rodríguez tended to avoid engaging such discourses regarding poor indigenous people, with one exception: the topic of alcohol. He developed an attitude bordering on obsession with the effect that alcohol had taken on the body politic. In this regard, he certainly was not alone; the familiar stereotype of indigenous peoples as being particularly prone to alcoholism was specific to neither Mexico nor the early twentieth century. Moreover, alcoholism became a preoccupation of indigenistas—reformers seeking to address the plight of indigenous populations—across Latin America in the late nineteenth and twentieth centuries.68 Therefore Rodríguez, while not typically identified as part of the indigenismo movement, was touting commonly held beliefs within official circles.

After the typhus epidemic had subsided, Rodríguez used the 1917 constitutional debates to launch a crusade for temperance. In the case of the 1915–16 typhus epidemic, the Superior Council of Public Health banned the sale and consumption of alcohol on two occasions—once for two months and later for six. Before the constitutional assembly, he asserted that over those eight months the moratoria on alcohol alleviated a variety of social and physiological ills. As he claimed, doctors and nurses were freed from having to treat patient after patient for alcohol-related problems. Wives were not being abused, tradesmen were not drunk at work, and the population witnessed a measurable decline in pneumonia, rheumatism, and dysentery, since stomach parasites decreased. For him, the crowning achievement of the moratoria was the decline of typhus cases. While he was unable to provide concrete statistics, Rodríguez clearly considered alcohol one of the great moral challenges of the time and a fundamental threat to the integrity of the population.69

Members of the public also drew some linkage between the typhus outbreak and their beliefs regarding morality and poverty. In a letter to Rodríguez, Dr. Marcos E. Juárez, a surgeon in the capital, claimed to understand the reason behind the proliferation of typhus: the Superior Council of Public Health's closure of the pulquerias (working-class taverns selling the fermented maguey-based alcoholic drink pulque) surrounding the Plaza de la Merced had driven their patrons to drink on the street, creating “truly immoral spectacles” on the sidewalk. Added to that was the fact that the various antojitos—humble foods often sold by street vendors, such as tacos, enchiladas, carnitas, and tripe, among others—caused intestinal infections that later degenerated into typhus. Juárez urged either tougher regulations on alcohol or, ideally, total prohibition of it.70

The flaws in Juárez's reasoning are clear, and his prejudices evident: typhus had nothing to do with the gastrointestinal infections supposedly being caused by street food. With that factual thread pulled out, the rest of his logic unraveled along with it: infections due to bad food eaten by the poor segments of the society, who were apparently more given to drink due to their deficient moral state, did not cause typhus. Of course, Juárez did not speak for anyone but himself, and we can extrapolate only so much from his letter, but his comments illustrate the commonsensical and seemingly causal linkage between poverty, immorality, vice, and disease that some made as they sought to understand the epidemic.

A series of oral interviews in 1972 with Pedro Pérez Grovas reveals similar sentiments. Pérez Grovas, a soldier-doctor during the revolution, a researcher with the National Bacteriological Institute during the Carranza era, and later the director of the National Public Health Laboratory, helped to run a small hospital operated by nuns in 1916–17. He recounted those years as a grave time. In famine conditions numerous diseases proliferated, among them hemorrhagic smallpox (sometimes called black smallpox) and rabies, but the major epidemic of the era was typhus, the scourge of the “undisciplined rabble,” of those with “primitive psychology,” to cite two of the ways he described campesinos (the rural poor). As he put it, typhus was bad across the country, striking soldiers kept in close quarters, but those worst affected were the masses of poor, indigenous people living in filth. While acknowledging that bathing was hard in the hottest regions given the lack of water, he placed most blame on the indigenous poor's ignorance and predilection toward pulque. Their lack of understanding of basic nutrition, their preference for curanderos (folk or witch healers) over conventional medicine, their superstitions, and their state of squalor all left them vulnerable in his eyes.71

Conclusion: Typhus, the Revolutionary Process, and the Sanitary Dictatorship

What did the typhus epidemic mean in the grand scheme of the Mexican Revolution? Cataclysmic societal upheavals are frequently accompanied by disease epidemics, among which typhus ranks as one of the most common, but do these epidemics register as anything other than byproducts of social and political processes? In the short run, the typhus epidemic stimulated not only cultural discussions but also political movement. Carranza certainly attempted to use it to his advantage in a number of ways. As chronicled in the New York Times, he expelled the American Red Cross in 1915 and barred its future entry into the country, simultaneously denying the existence of a national famine and asserting that the Constitutionalist government, once firmly in control in Mexico City, would be able to provide for the citizenry. The New York Times published a succession of articles saying that the Red Cross was eager to provide sustained relief to Mexico should the Carranza government authorize it and that the Rockefeller Foundation was most likely prepared to do the same. Meanwhile, the US State Department complied with the wishes of the Constitutionalist authorities to have international relief efforts withdrawn.72

Carranza's positions at first glance appear self-destructive, given that the Red Cross and Rockefeller Foundation could have provided much-needed support. Nonetheless, his actions were consistent with the nationalist orientation of the Constitutionalists, the putative national authorities at the time. By denying the existence of famine conditions he undermined the premise of foreign concern, and by asserting that his government could handle the epidemic he made a confident claim to national sovereignty. To bolster his effort to establish political legitimacy, he shifted blame to the Conventionists, who according to him had sparked the problems with the food supply and epidemic disease in the capital during their occupation of the city in the previous year.73

Not everyone bought this explanation. On the contrary, Carranza suffered attacks on his legitimacy as the revolution's First Chief. The opposition newspaper Revista Mexicana exemplified the trend of linking typhus and the Constitutionalists' political activity. In a series of articles, the publication said that Carranza may have worn the clothing of constitutionalism and even posited himself as a Pan-American leader but in reality had done more than anyone to damage the ideal of constitutionalism. As the article put it, Carranza's propaganda said that happiness prevailed in Mexico when in fact typhus reigned. Similarly, the article claimed that, contrary to Constitutionalist assertions, typhus rather than liberty now blanketed Mexico.74 In another piece, the paper responded to the claim by Carranza supporters that wherever he went, public investment increased. In the Revista Mexicana's view, he brought only strikes, typhus, and a release of microbes.75 In a third piece, the paper unleashed a torrent of mockery and sarcasm aimed at the president, accusing him of running away from typhus. They excoriated Carranza's self-professed antimonarchical behavior: while King Albert I of Belgium accompanied his troops on the front lines, putting himself in the line of fire and in danger of typhus, Carranza retreated to safety. While Queen Elena of Italy sought out the sites of danger to offer loving care to her subjects, Carranza escaped to places scrubbed of typhus. Carranza was, according to the sardonic editors, the antithesis of the European monarchs he sought to condemn as a self-professed liberal.76 All these articles aimed to make a statement against Carranza, usually by mocking him, and typhus provided a means to do that.

If typhus gave Carranza a chance to smear his opponents and establish his early legitimacy as First Chief, and if the disease gave his opponents evidence of his personal and political limitations, it gave Rodríguez a mission. His leadership in the campaign against the epidemic allowed him the recognition and stature to be named a delegate to the constituent congress that would craft Mexico's new revolutionary constitution. More than that, the antityphus campaign gave him a clearer vision of what needed to be done for public health.

The genesis of Rodríguez's “sanitary dictatorship” ideal can be found in the late nineteenth-century modernizing authoritarian regime of Díaz. The unapologetically Eurocentric ministers of his government, nicknamed científicos for their predilection toward applying scientific precepts to public administration, incorporated public health into the institutional framework of national governance by creating the National Bacteriological Institute and expanding the scope of the Superior Council of Public Health. The latter's first leader, the celebrated Dr. Eduardo Liceaga, was Rodríguez's predecessor. At the same time, the Porfirian government initiated massive public works projects, such as the Mexico City drainage system and the Veracruz municipal port, with the intent of creating a more hygienic physical environment.77 The national government also imposed a series of sanitary codes, first in 1891 and then again in 1894 and 1903, mandating sanitary practices in both residential and commercial zones and establishing punishments for failure to comply. Finally, the regime launched educational campaigns aimed at correcting problems such as prostitution, insufficient bathing, and excessive alcohol use.

These educational campaigns in particular showcased a tendency—particularly acute within the Porfirian mind-set—to associate public health problems with the supposedly degenerate behaviors of the poor.78 This tendency, aside from its discriminatory nature, failed to identify deficiencies in certain populations' collective health as being rooted in material reality, blaming vice, rather than poverty, for bringing conditions such as infectious disease epidemics to the nation's most vulnerable. Rodríguez, a self-avowed revolutionary, took a similar view in implementing his sanitary dictatorship. Thus his pursuit of a sanitary dictatorship, though cast in revolutionary language and undertaken in the spirit of revolutionary reform, in fact represented a continuation of the Porfirian establishment's civilizing mission, a multifront effort to save the most vulnerable from themselves.

His efforts had two aims. The first was to restructure the national public health service by extricating it from the Interior Ministry and placing it under the president's direct control. The intent behind this seemingly benign transfer of authority was, in fact, to give the Superior Council of Public Health more ability to act immediately and independently, without getting stifled by excessive bureaucracy, regulation, or political wrangling. In advocating for this arrangement, Rodríguez was blunt in asserting that the public health service should have an authoritarian character, an exception to his otherwise liberal political convictions.79

The second aim of his efforts was to combat what he saw as the most direct cause of what he called the “degeneration of the race”—the pernicious effects of alcohol consumption.80 Like Alberto J. Pani, who conducted the most comprehensive study of national public health in the era, he drew questionable causal linkages between alcohol use, public health outcomes (especially epidemic outbreaks), and morality. Indeed, whereas most epidemiologists and public health experts today identify sociological structures as the chief factor in need of remediation, for Rodríguez, Pani, and others in the early twentieth century the answer to disease was a combination of more centralized political authority and the renovation of the society's collective morality. Whether the antityphus campaign organized by Rodríguez helped, hurt, or had no effect whatsoever, by mid-1916 the worst of the disease had passed. With the epidemic over, Rodríguez focused his efforts on realizing his vision of a sanitary dictatorship.

He did not get exactly what he wanted. Certainly, as Claudia Agostoni has noted, he fell short of accomplishing his goal of creating a single public health bureaucracy with hardly any checks on its authority.81 Nevertheless, his vision was at least partially realized, as public health figured prominently in the process of state-led development in the decades to come. Numerous initiatives, including Rockefeller Foundation–funded antihookworm programs, state efforts to regulate prostitution, hygienic education curricula aimed at rural children, antialcoholism crusades, and campaigns to end tuberculosis and malaria in rural areas, all represented this vision.82 The 1915–16 typhus epidemic thus became a kind of stepping-stone, small yet crucial, on a path that extended from the modernizing regime of Porfirio Díaz to the revolution's reconstructive phase in the decades after 1920.

Notes

1.

Knight, Mexican Revolution, 2:419.

2.

Tenorio-Trillo, I Speak of the City, 311–25, 328–29, 338.

3.

Molina del Villar, “El tifo,” 1209.

4.

Tenorio-Trillo, I Speak of the City, 312.

5.

Eugenia-Rodríguez, “Typhus in Mexico City,” 227.

6.

Debates over the social and political dynamics of the revolution have dominated historiographical discussion for over a century. Alan Knight's two-volume work, part survey and part historiographical rejoinder, has become a totem in the English language, but in an earlier essay he clears the way for his own work by discarding a number of other approaches. To summarize his argument in brief: the Mexican Revolution, despite the conviction of some authors, was not a bourgeois struggle for narrow political reform, an aimless set of agrarian revolts adding up to a simple rebellion, an assertion of nationalist or anti-imperialist ideology (and even less of Marxist ideology), or a period of chaos bridging the otherwise-capitalist development frameworks of the Porfirian and postrevolutionary eras. Rather, it was an authentic, multiclass, popular social revolution. See Knight, “Mexican Revolution”; Knight, Mexican Revolution.

7.

This tendency in the course of social revolution, in which different sections of the revolutionary coalition (one primarily representing the bourgeoisie and oriented toward political reform, the other peasant-based and more focused on bread-and-butter material issues) splinter into competing power-seeking groups, is explored in Markoff, Abolition of Feudalism.

8.

Gudiño Cejudo, “José María Rodríguez.”

9.

Speech of José María Rodríguez, 50th ordinary session, in Diario de los debates, 3:136.

10.

This is too large a field of study to summarize here, but the best historiographical survey of the field is Armus, “Disease.”

11.

Agostoni, Monuments of Progress; Soto Laveaga and Agostoni, “Science and Public Health.” For a general discussion of global shifts in medical thinking and practice at the time, see Porter, Greatest Benefit to Mankind, 304–427.

12.

Agostoni, “Popular Health Education.”

13.

For analysis of the Porfirian establishment's views of the linkage between disease and poverty, see Carrillo, “Del miedo a la enfermedad.” For a discussion of the continuities between the Porfirian and revolutionary mind-sets on the topic, see Aréchiga Córdoba, “Educación.” The anthropologist and physician Paul Farmer makes a forceful case for identifying the root cause of infectious disease in social inequality. See Farmer, Infections and Inequalities. For a similar framework applied to Latin America, see Cueto, Return of Epidemics.

14.

The existing studies of the 1915–16 typhus epidemic, for the most part, do not situate it in a longer consolidation of a state-led public health system whose institutions were informed by enduring elite assumptions about indigenous and poor populations. For example, América Molina del Villar's excellent and comprehensive work on the epidemic surveys it in great depth without extrapolating much meaning from it beyond 1917. My work does not challenge her findings and relies on her analysis and statistics. I nonetheless seek to historicize the epidemic to a greater degree. See Molina del Villar, Guerra; Molina del Villar, “El tifo.”

15.

Armus, Ailing City, 2–12; Briggs, Stories in the Time of Cholera.

16.

Eugenia-Rodríguez, “Typhus in Mexico City,” 226.

17.

Molina del Villar, Guerra, 231. Molina del Villar derives the total population statistic from the Instituto Nacional de Estadística y Geografía (INEGI). The federal agency estimates that the population of the Federal District in 1910 was about 720,000, while in 1921 it was approximately 906,000; hence the estimate of 800,000 at the midway point. Molina del Villar, 252.

18.

Molina del Villar, “El tifo,” 1204–5.

19.

Knight, Mexican Revolution, 2:315, 402, 419–22.

20.

Tenorio-Trillo, I Speak of the City, 312–25; Eugenia-Rodríguez, “Typhus in Mexico City,” 227–28.

21.

Carrillo, “Del miedo a la enfermedad,” 131; Molina del Villar, Guerra, 153, 156–58.

22.

Carrillo, “Del miedo a la enfermedad,” 114, 117–18, 122–29, 140–41.

23.

Molina del Villar, Guerra, 322–23, 442.

24.

Porter, Greatest Benefit to Mankind, 304–427.

25.

Sidney Chalhoub argues that public health officials blended miasmic and germ-based theory in their response to yellow fever outbreaks in Rio de Janeiro, which resulted in the destruction of the poor's housing establishments. See Chalhoub, “Politics of Disease Control,” 443–47, 456. For a similar discussion involving typhus in Mexico City, see Molina del Villar, “El tifo,” 1210–11.

26.

José María Rodríguez to Interior Ministry, 13 Dec. 1915, Archivo Histórico de la Secretaría de Salud, Mexico City, Fondo Salubridad Pública, Sección Epidemiología (hereafter cited as AHSSA, F-SP, S-Epid), caja 10, exp. 3; Molina del Villar, “El tifo,” 1191.

27.

Reams of physician names are interspersed in this file: AHSSA, F-SP, S-Epid, caja 10, exp. 7; AHSSA, F-SP, S-Epid, caja 11, exp. 3.

28.

For the pro bono physicians, see assistant chief of section of Interior Ministry to Ignacio L. Pesqueira, 31 Dec. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5; municipal president of Mexico City to José María Rodríguez, 21 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5. For the other examples listed, see, respectively, Rivero Vidal to José María Rodríguez, 26 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5; José María Rodríguez to Luis F. Correa, 11 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5; Guellero E. Hale to José María Rodríguez, 29 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

29.

V. Escársega (secretary-general of Neutral White Cross) to José María Rodríguez, 17 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5; secretary-general of Superior Council of Public Health to V. Escársega, 31 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5; Cano, “La Cruz Blanca Neutral”; Pedro Pérez Grovas, interview by Eugenia Meyer, 13, 19, 26 Sept., 3 Oct. 1972, Instituto de Investigaciones Dr. José María Luis Mora, Mexico City, Proyecto de Historia Oral (hereafter cited as Instituto Mora, PHO), 1/8.

30.

José María Rodríguez to interior minister, 27 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5; oficial mayor of Interior Ministry to José María Rodríguez, 28 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5; subsecretary of oficial mayor of Interior Ministry to José María Rodríguez, 4 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5; subsecretary of communications and public works to José María Rodríguez, 5 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5; subsecretary of state and of Office of Development, Colonization, and Industry to José María Rodríguez, 7 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

31.

Various barbers to José María Rodríguez, 31 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 6; secretary-general of Superior Council of Public Health to Interior Ministry, 31 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 6; oficial mayor of Interior Ministry to José María Rodríguez, 5 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

32.

José María Rodríguez to Interior Ministry, 2 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

33.

Chief of Clerk's Office of Superior Council of Public Health to José María Rodríguez, 19 Oct. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 2.

34.

José María Rodríguez to interior minister, 13 Dec. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6; oficial mayor of Interior Ministry to José María Rodríguez, 23 Dec. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

35.

Oficial mayor of Finance Ministry to interior minister, 21 Oct. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 6; José María Rodríguez to interior minister, 3 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

36.

Chief of Department of Confiscated Goods to José María Rodríguez, 15 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6; José María Rodríguez to chief of Department of Confiscated Goods, 28 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

37.

José María Rodríguez to subsecretary of development, 28 Mar. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6; Felipe Pescador to subsecretary of interior, 11 Dec. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6; subsecretary of interior to chief of Constitutionalist Railways station, 4 Dec. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6; director of Constitutionalist Railways to [Interior Ministry?], n.d., AHSSA, F-SP, S-Epid, caja 10, exp. 6; subsecretary of interior to station agent, 8 Dec. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

38.

José María Rodríguez to interior minister, 27 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

39.

President of Public Baths Commission of Campaign against Typhus to Benjamin Hill (general), 7 June 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

40.

José María Rodríguez to Pablo González, 25 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; secretary-general of government of Federal District to José María Rodríguez, 11 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; assistant chief of section of Interior Ministry to José María Rodríguez, 5 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to interior minister, 13 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to minister of communications and public works, 11 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to governor of Tacubaya district, 18 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to J. Morales Hesse (colonel), 20 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to interior minister, 20 Oct. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; oficial mayor of Interior Ministry to José María Rodríguez, 7 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to oficial mayor of Interior Ministry, n.d., AHSSA, F-SP, S-Epid, caja 10, exp. 4; assistant chief of interior to José María Rodríguez, 26 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; chief of disinfection service to José María Rodríguez, 19 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to director of General Hospital of Mexico, 23 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

41.

Subsecretary of General Directorate of Mail to José María Rodríguez, 14 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4. El Buen Tono's contribution was also confirmed in chief of disinfection service to José María Rodríguez, 7 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

42.

José María Rodríguez to Venustiano Carranza, 19 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

43.

Although personal correspondence mentioning his quick decisions persists through the public health documentation, one can glimpse the pleas to Rodríguez, and his responses, in documents concerning sulphur distribution contained in AHSSA, F-SP, S-Epid, caja 10, exp. 2, esp. José María Rodríguez to Pablo González, 21 Dec. 1915; José María Rodríguez to administrator of maritime customs in Veracruz, 6 Dec. 1915; Droguería Grisi to José María Rodríguez, 13 Dec. 1915; José María Rodríguez to interior minister, 6 Jan. 1915.

44.

Mexico State Superior Council of Public Health to José María Rodríguez, 15 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 2.

45.

The efforts to shut down such establishments are detailed in various reports: José María Rodríguez to Interior Ministry, 2 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3; Interior Ministry to José María Rodríguez, 9 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3; José María Rodríguez to governor of Federal District, 27 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3; special sanitation inspector of Special Antityphus Service to Superior Council of Public Health, 18 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3; secretary-general of Superior Council of Public Health to interior secretary of Federal District, 24 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3; José María Rodríguez to Interior Ministry, 13 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3; José María Rodríguez to interior minister, 13 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 6.

46.

José María Rodríguez to interior minister, 26 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

47.

José María Rodríguez to Interior Ministry, 13 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

48.

José María Rodríguez to Interior Ministry, 27 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

49.

José María Rodríguez to oficial mayor of Interior Ministry, 2 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

50.

José María Rodríguez to Interior Ministry, 13 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

51.

Piccato, City of Suspects, 5, 192–93, 212.

52.

José María Rodríguez to Interior Ministry, 23 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

53.

Molina del Villar, “Vivir en la orfandad.”

54.

José María Rodríguez to oficial mayor of Interior Ministry, 17 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 3; oficial mayor of Interior Ministry to José María Rodríguez, 19 Jan. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 3; José María Rodríguez to oficial mayor of Interior Ministry, 10 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 3; oficial mayor of Interior Ministry to José María Rodríguez, 15 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

55.

José María Rodríguez to governor of Federal District, 16 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

56.

José María Rodríguez to Ignacio L. Pesqueira, 22 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

57.

Interior Ministry to José María Rodríguez, 28 Nov. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

58.

Oficial mayor of Interior Ministry to José María Rodríguez, 7 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

59.

Chief of disinfection service to José María Rodríguez, 14 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4; José María Rodríguez to chief of disinfection service, 14 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 4.

60.

José María Rodríguez to Interior Ministry, 10 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5; Interior Ministry to José María Rodríguez, 16 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

61.

Porfirio Parra, quoted in Agostoni, “Popular Health Education,” 55.

62.

Pani, Hygiene in Mexico, 134–45.

63.

Pani, 120–27, 133. Italics in original.

64.

Venencio Caseres to José María Rodríguez, 26 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5; José María Rodríguez to Venencio Caseres, 27 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

65.

Various priests and chaplains to vicar-general of Archbishopric of Mexico, 29 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

66.

Various priests and chaplains to vicar-general of Archbishopric of Mexico, 29 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

67.

Secretary-general of Superior Council of Public Health to Francisco Valenzuela, 18 Feb. 1916, AHSSA, F-SP, S-Epid, caja 10, exp. 5.

68.

Garrard-Burnett, “Indians Are Drunks.” For a more general introduction to the topic of indigenismo, see Tarica, “Indigenismo.”

69.

Speech of José María Rodríguez, 49th ordinary session, in Diario de los debates, 3:110.

70.

Marcos E. Juárez to José María Rodríguez, 23 Dec. 1915, AHSSA, F-SP, S-Epid, caja 10, exp. 3.

71.

Pérez Grovas, interview by Meyer, 13, 19, 26 Sept., 3 Oct. 1972, Instituto Mora, PHO 1/8.

72.

“Red Cross Anxious to Fight Typhus,” New York Times (New York), 25 Dec. 1915, p. 3; “Typhus Leaps Line; Laredo Is Stricken,” New York Times (New York), 24 Dec. 1915, p. 4; “To Fight Typhus in Mexico City,” New York Times (New York), 23 Dec. 1915, p. 1; “Expedition to Fight Epidemic of Typhus,” New York Times (New York), 18 Jan. 1916, p. 4.

73.

“Mexicans Starving, Red Cross Shows,” New York Times (New York), 31 May 1915, p. 4.

74.

“Tópicos del día,” Revista Mexicana (San Antonio), 9 Jan. 1916, p. 9.

75.

“Tópicos del día,” Revista Mexicana (San Antonio), 28 May 1916, p. 10.

76.

“Tópicos del día,” Revista Mexicana (San Antonio), 30 Jan. 1916, p. 15.

77.

Agostoni, Monuments of Progress, xii–xvii.

78.

Aréchiga Córdoba, “Educación,” 59; Soto Laveaga and Agostoni, “Science and Public Health,” 564–65; Carrillo, “Del miedo a la enfermedad,” 113–47.

79.

Speech of Rodríguez, 50th ordinary session, in Diario de los debates, 3:136–40.

80.

Speech of Rodríguez, 49th ordinary session, in Diario de los debates, 3:106–10.

81.

Agostoni, “Popular Health Education,” 58.

82.

For antihookworm programs, see Birn, “Revolution, the Scatological Way.” For prostitution reform, see Bliss, Compromised Positions. For education campaigns, see Agostoni, “Popular Health Education.” For antialcoholism campaigns, see Pierce, “Sobering the Revolution.” For rural programs targeting infectious disease, see Opperman, “Bienestar Social Rural.”

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