Abstract

In the late nineteenth century, Mexico’s Superior Health Council devised a consistent and assertive international strategy around alignment with international scientific standards, the control of disease certification on Mexican soil by Mexican experts, transparent disease reporting, internationally demonstrated competence in campaigns against tropical disease, and participation in multilateral health agreements. The council came to command a central role in the regime of Porfirio Díaz (1877–1911), mainly because this international strategy enabled a successful defense of Mexican sovereignty. In the arena of public health, the council, led by Eduardo Licéaga, came close to realizing the Científicos’ dream of Mexican development “without U.S. investment.” This was largely because the council obtained independent access to European ideas and technologies prior to its engagement with the United States, which began in 1890 when the first Mexican delegation attended the annual meeting of the American Public Health Association (APHA). Through a persistent and creative diplomatic campaign, taking advantage of relationships cultivated through the APHA, Porfirio Díaz’s sanitary advisors persuaded many of their American counterparts that Mexican experts could be trusted partners in defending the health of the western hemisphere. The article describes the Atlantic world of Mexican medicine in the nineteenth century, the significance of public health within a context shaped by rising U.S. imperialism, the key role played by Licéaga, and Mexico’s participation in the APHA.

Between 1887 and 1910, public health experts working within the government of Porfirio Díaz of Mexico joined and fortified international medical networks that tied together Europe, the United States, and Latin America. Led by Dr. Eduardo Licéaga, members of the Mexican medical elite leveraged the knowledge they gained from study in Europe and their interactions with American and Canadian counterparts to both elevate the profile of public health within the Mexican political system and defend Mexico’s sovereignty against perceived imperial designs on the part of the United States. The American Public Health Association brought together the sanitarians of the United States, Canada, and Mexico for the first time. Celebrated as a public health movement for “this side of the Atlantic,” this scientific alliance will be seen here in light of Atlantic medical currents, the development of state institutions in Mexico, and Mexico-U.S. relations.

The American Public Health Association (APHA) was already a key institution of U.S. Progressivism when it issued an invitation for Mexican participation in 1889. The association’s U.S. and Canadian members hoped to create organizational structures that would be able to cope with the sanitary challenges posed by an era of intensified commerce with Latin America. They acquired an assertive new partner when Mexico joined the APHA, for Mexico’s sanitarians saw in the APHA an opportunity to conduct U.S.-Mexican politics on the terrain of science.

By the time members of the Mexican medical elite attended their first annual APHA convention in 1890, the Mexican medical profession was well organized, the fruit of a half-century’s efforts to modernize the profession and its institutional structures. The Superior Health Council (Consejo Superior de Salubridad), board of health for the Federal District and Mexico’s federal territories, was thriving under the leadership of Dr. Eduardo Licéaga. Licéaga typified the virtues of a generation of medical professionals capable of implementing bureaucratic procedures for the state. These men often dealt personally with the caudillo Díaz, advising him on matters related to public health. Under Licéaga’s stewardship, the Superior Health Council was stabilized and strengthened and devised the comprehensive Sanitary Code of the United Mexican States, enacted in 1891 and reformed and revised in 1894, 1902, and 1904. The Mexican Sanitary Code would be admired by leading figures of the U.S. public health movement, such as APHA secretary Dr. Irving Watson, who called it “the most extensive, comprehensive, and the broadest ever adopted by any government in the world, probably.”1

The Atlantic World of Mexican Medicine

The official medical profession in nineteenth-century Mexico was essentially an offshoot of European medicine. Mexico’s independence in 1821 made it possible for medical modernizers to seek non-Spanish European models on which to base new institutions, such as the Establishment of Medical Sciences (Establecimiento de Ciencias Médicas, 1833) and the Superior Health Council (1841). It is not an overstatement to say that Mexican medicine effectively became a satellite of the French medical tradition during these years. For instance, when medical reformers founded a new medical school after independence in 1833, all of the textbooks were French.2 During the cholera pandemics of 1833, 1850, and 1853 – 54, European medical publications (medical manuals, cholera treatises, eyewitness accounts of epidemics, therapeutic programs, and advertisements for miracle cures) traveled across the Atlantic, much like vibrio cholerae itself.3

The French Intervention (the invasion and occupation between 1861 and 1867 of much of Mexico by the France of Napoleon III, which installed the imperial government of the Austrian Hapsburg Maximilian) heightened what one medical historian identified as the paradox of Mexico’s nineteenth-century cultural Francophilia. On the one hand, scientific Francophiles were promoters of national progress, “seeking in French science the elements necessary to elevate national culture and place it on the level of the most advanced countries.” On the other hand, political Francophiles retarded the country’s progress when they collaborated with Napoleon III to import Emperor Maximilian in the 1860s. Today’s National Academy of Medicine (Academia Nacional de Medicina) evolved between these poles. Mexico’s most prestigious medical association was founded in April 1864 as the medical section of the Scientific, Artistic, and Literary Commission of Mexico (an organization sponsored by the invaders, but with significant Mexican participation), but by December 1864, the group separated from the commission, becoming the Medical Society of Mexico (Sociedad Médica de México). From its inception, the society published a medical gazette. Revealingly, many of the articles in the early issues were published in French, authored by the French military doctors who co-founded the group that went on to become Mexico’s foremost medical association. Its current designation — National Academy of Medicine — dates to 1877.4

It is thus not surprising that the Mexican medical elite’s public health initiatives were strongly shaped by Atlantic medical currents. Although none of the Mexican actors seems to have used the phrase “public health movement” to describe Mexican developments, the keywords denoting public health (salubridad, higiene, sanidad, salud pública, policía sanitaria) all implied a collective, indeed civilizational effort toward the reform of public health and the goal of controlling epidemic disease. Founded in 1841 during the centralist republic as a board of health for the Department of Mexico, the Superior Health Council became the institutional home for Mexico’s elite hygienists. When federalism returned, the Superior Health Council’s jurisdiction was the Federal District and federal territories. Constitutional framework aside, the Superior Health Council’s activities rarely had any practical impact beyond the urbanized precincts of Mexico City until the twentieth century.

The institutional record leaves no doubt that over its first quarter-century the council consolidated the scientific repertoire that was known at the time as hygiène publique in France or as sanitarianism or sanitary science in the English-speaking world.5 Mostly, this meant an inglorious struggle, short staffed and underfunded, to regulate medical practice, remediate the urban environment, vaccinate a recalcitrant population against smallpox, and attempt to organize the state’s response to outbreaks of epidemic disease that sometimes claimed thousands of lives. With its active medical profession, Mexico City was the site of the most intense activity of the public health movement in Mexico, but health boards were founded throughout the republic, carrying the ideals of higiene pública to Mexico’s provinces. Like their French role models, Mexico’s sanitarians explained disease as a complex relationship between local environmental conditions (especially miasmas) and individual predisposition.

The history of medical ideas in nineteenth-century Mexico was largely the history of the reception of European theories until the late 1880s, when Mexican medical leaders began to project themselves outwards. This soon included personal attendance at events of the international public health movement and publication in some of Europe’s most prestigious journals.6 In fact, the Atlantic was never really a one-way street. Some Mexican physicians, such as Dr. Manuel Soriano, left Mexico in search of medical training before the 1880s. The most famous Mexican medical returnee was Dr. Gabino Barreda, who came home from Paris imbued with the doctrines of Comte’s positivism.7 However, after 1887, the distance and frequency of these medical pilgrimages increased dramatically. The international efforts of Mexico’s Academy of Medicine operated in parallel to those more directly organized by the state, and scientific talent flowed across the Atlantic in these years as Mexicans went abroad for such purposes as to study European laboratory practices and to display their own accomplishments at universal expositions.8 By the early 1890s, a number of distinguished graduates of the Mexico City Medical School, including Jesús E. Monjarás and Angel Gaviño, were acquiring specialized training in Europe.9 Institutions such as the Superior Health Council, the Academy of Medicine, the Medical School, and the Bacteriological Institute, as well as individuals, sponsored Mexican medical sojourns in Europe.

Complementing the intensified schedule of foreign travel by Mexican doctors, the official medical establishment also began to host international medical congresses in Mexico City. The first of these events, the APHA convention of 1892, was the culmination of nearly two decades of hygiene congresses convened in the Mexican capital. These events consolidated the scientific prowess and group identity of Mexico’s public health experts prior to their encounter with the APHA. For instance, the Congreso Nacional de Higiene, which met from September 1883 to April 1884, provided an important forum for elaborating the details of Mexico’s Sanitary Code, ultimately promulgated in 1891.10

No individual illustrates the new international scope of Mexican medicine better than Eduardo Licéaga. Most of Licéaga’s trips were related to his official role as president of the Superior Health Council, which he assumed in 1885. In 1890, he attended the Tenth International Medical Congress (X. Internationaler Medizinischer Congress) in Berlin with five fellow members of the Mexican Academy of Medicine, a useful reminder that Mexico’s foremost medical association was also supporting physicians’ attendance at international medical events, which had become highly desirable additions to a medical résumé.11

Mexican physicians’ increasingly international outlook coincided exactly with the Porfiriato, the period of Mexican history that takes its name from the long presidency of the dictator Porfirio Díaz (1877 – 1911, including the four-year term of Díaz’s ally Manuel González). In terms of public health, the Porfiriato was marked by the consolidation of higiene as a formal medical specialty and the development of a strong alliance between medical experts and the state. The state’s commitment to hygiene before the Porfiriato had never been particularly strong. The Superior Health Council had no function outside Mexico City, was confined to an advisory role, and lacked the personnel or funding to consistently implement its agenda.12 The Porfirian state-building project made possible a new relationship between medical power and the power of the state, facilitated at the highest levels by the personal relationship between Díaz and Licéaga.

Licéaga’s first journey abroad was in the company of Porfirio Díaz himself, who traveled to the United States between his first and second presidential terms for meetings with a U.S. investment cartel whose spokesman was former U.S. president Ulysses S. Grant. Licéaga’s presence in the Díaz entourage in 1883 might be little more than a minor footnote to the bigger story of Mexico’s entry into the orbit of U.S. capitalism, but during their trip, Díaz and Licéaga cemented the clientelistic relationship upon which they would build a formidable public health apparatus. The tie between Porfirio Díaz and Licéaga was at the center of the Porfirian nexus among caudillismo, the growth of the bureaucratic state, science, and rapid economic modernization. Their 1883 journey to the United States was important enough to Licéaga to merit a full chapter in his memoirs. In addition to the courtesies paid to him by Mexico’s most influential families, the Díazes and Romero Rubios, Licéaga recalled a number of illuminating excursions to sites of sociological and scientific interest. These side trips to places such as the model company town of Pullman, Illinois, and the sanitary institutions of several U.S. cities reveal the scientific interests shared by the leaders of the American Public Health Association and Licéaga, who would deal with them later in the decade.13

A few years later, the Superior Health Council sent Licéaga (by then, president of the council) on a mission to Europe “to study diverse matters of public hygiene.” He departed Veracruz on July 12, 1887, with a mandate to investigate European techniques for preventing epidemic disease, particularly disinfection practices in hospitals and pesthouses; to study special stoves employed for disinfection; to learn about the best sewage systems used in European cities; to study the procedures followed by the municipal laboratories of Paris for detecting the adulteration and falsification of food and drink; and finally, to “seek to establish relations between this Council and analogous institutions existent in the places that are to be visited.”14

At “the laboratory of Mr. Pasteur” in Paris, Licéaga was given a demonstration of the workings of a modern disinfection stove. In his correspondence with the council he noted that samples from the objects subject to disinfection were first examined in the Pasteur Laboratory. “If the toxic germs [germenes morbosos] that were found in the first place have disappeared after the effects have passed through the stove,” Licéaga wrote, “then they consider the demonstration complete.”15 He noted that the use of similar disinfection stoves was already accepted in many European cities, but that he had decided not to make a purchase until he could learn more at the upcoming 1887 Congress of Hygiene and Demography in Vienna. “I hadn’t thought to visit this city [Vienna], in which we have no official representative and in which I have no private ties,” he reported to his colleagues in Mexico City, but the main scientific centers of Paris, London, and Berlin had shut down for the long European summer vacation. The Vienna Congress offered an excellent way to become acquainted with “the sum of opinions that are being professed at the moment about diverse issues of public hygiene.”16

With the blessing of Dr. Emile Roux, head of the Pasteur Institute and a distinguished collaborator of Louis Pasteur, Licéaga was able to attend sessions in which antirabies serum was cultured. He followed the process step by step, starting with the extraction of spinal fluid from rabbits that had perished after being inoculated with rabies. Shortly before his return to Mexico, Licéaga requested one of the institute’s inoculated rabbit brains, which he carried in his baggage in a sterile jar filled with glycerin. When he returned to Mexico City, Licéaga immediately duplicated the process, and after gathering sufficient serum, he began human inoculations on April 18, 1888.17 The Mexico City Antirabies Institute was soon up and running, the first fruit of the Atlantic crossings instigated by the Superior Health Council. His Pasteurian laboratory experience placed Dr. Licéaga in the vanguard of international science, much as it did for his Brazilian contemporary Osvaldo Cruz, and probably helped him later in his dealings with the Americans.18

Licéaga’s letters illustrate the period’s “hygienic tourism.” Of the Paris sewer, he would write, “It is a most beautiful edifice, constructed in conformity with the precepts of modern science. The part which I will describe here is that which is relative to the circulation and evacuation of household water, urine, excrement, and rain water.”19 He noted the similarity of the Paris sewer’s reservoirs to ones that had recently been recommended by the Superior Health Council and which some (well-heeled) private individuals had already installed in their Mexico City homes, reflecting the existing demand for “the delicacies of hygiene” among Mexico City’s wealthy residents.20

To my knowledge, the 1887 Congress of Hygiene and Demography was the first large event of the European public health movement attended by a member of Mexico’s Superior Health Council. Over two thousand people converged on Vienna, mostly Europeans, but also Americans and representatives from New South Wales, Egypt, and South America. Papers discussed topics ranging from recent European experiences with cholera to smallpox vaccination in the Ottoman Empire.21 Licéaga would later use ideas that he encountered in Vienna in 1887 to enunciate the objectives of Porfirian public health legislation. Thus, the preamble of the 1891 Mexican Sanitary Code incorporated almost verbatim a fragment of the Austrian crown prince’s speech to the congress’s inaugural assembly in which the prince declared that “the life of every man represents a value, and to preserve that value intact is a requirement of humanity and moreover a duty in the interest of states.”22 In Licéaga’s rendering this turned into the statement, “But let us forget for a moment that man is our brother and fellow citizen and consider him instead from an economic point of view, as a value in the state, and as such we are obligated to preserve health, prolong life and improve his physical condition.”23

Licéaga’s attendance at the 1887 Congress of Hygiene and Demography probably helped him to complete his personal scientific evolution from the miasmatic sanitarianism of his youth to the international bacteriology of the 1890s.24 By 1892 he was preaching the gospel of germs: “Bacteriology is the hope of hygiene, both now and for the future. It will discover germs as yet unknown, will continue to study the natural history of those that are known, and when it has found out their mode of generation, their habitat, their nourishment, the conditions under which they thrive, and, above all, those under which they die off, then it will be in a position to place more effective weapons in the hands of hygiene.”25

Licéaga’s 1887 mission to Europe ensured that when the Superior Health Council joined the American Public Health Association, Mexico possessed independent access to the latest European hygienic technologies. Licéaga had become a practitioner of Pasteurian science. Unlike the Mexican economy, Mexican medicine was not in danger of becoming a satellite of the United States during the Porfiriato. As Mauricio Tenorio points out, “in certain areas Mexican scientists were as close as they had ever been — or would ever be — to the mainstream development of their respective disciplines. The scientific gap, albeit still wide, had never been as narrow for Mexico as it was in the late nineteenth century.”26 The technologies and procedures implemented by the Superior Health Council in the late 1880s placed Mexico on the leading edge of international sanitary reform. Mexican public health’s modernized face received legal force in the Sanitary Code of the United Mexican States (1891), which authorized an unprecedented degree of state intervention in society in the name of public health. The code would also serve as the foundation for a highly effective public relations campaign waged by Mexican public health technocrats within the APHA.

The New Era of American Influence

The economic and political context for the Superior Health Council’s international activities was what John Hart calls “a new era of American influence,” which began during Porfirio Díaz’s first presidential term (1876 – 80). According to Hart, “Díaz and his followers were determined to modernize what they believed was a poor and backward country, but the Mexican government was deeply in debt and had few cash reserves.” As a result, “[Díaz] believed that only American involvement in all aspects of the Mexican economy could transform the country.”27 To protect Mexico’s economic sovereignty, the Científicos (Díaz’s technocratic advisors, so called because of their devotion to the Comtian principles of “scientific politics”) also “looked to Europe to offset American influence and they anticipated the day when . . . domestic capital, already dominant in some sectors, would assume a greater, determining role within the economy.”28

Licéaga, who was present at the 1883 New York meetings at which Díaz and his aides negotiated a program of “free trade, foreign investment, and privatization of the Mexican countryside,” surely gained an appreciation of the economic and political stakes in the Mexico-U.S. relationship.29 Later, these political and economic considerations were among the important motivations for Mexico to join the American Public Health Association. Tropical disease (especially yellow fever) led to the regular imposition of quarantines, which interrupted exports important to Mexico’s economic growth. Over time, the Superior Health Council became an informal branch of Mexican diplomacy, participating in the negotiation of many international sanitary agreements. Its members consistently sought scientific standards and a clear, multilateral framework to limit the frequency of quarantine. In the process, they came to see themselves as defenders of Mexico’s “sanitary independence.”30

This story of the new form of economic integration between Mexico and the United States is familiar to historians of Latin America. Somewhat less familiar is the history of how public health emerged as a highly politicized terrain in the western hemisphere in the late nineteenth century. The quickened pace of economic exchange raised justifiable fears about the spread of disease, and it was not long before the United States began to use public health as a pretext for intervention in other countries’ affairs. In 1889, the year before Mexico entered the APHA, Dr. Benjamin Lee, a Philadelphia physician who was a leading figure in the U.S. medical profession, delivered a paper with the ominous title, “Do the Sanitary Interests of the United States Demand the Annexation of Cuba?”31 After depicting Havana’s unsanitary conditions in particularly lurid terms, Lee suggested that with a proper system for sewerage, “yellow fever in Havana would soon be a thing of the past, and the island would become a noted health resort rather than a plague spot.” Forming his plan before mosquitoes were identified as agents in the spread of disease, Lee believed that “the only means by which the germs of this disease can be eradicated are a proper system of sewerage and drainage, which shall deliver the filth of the city at a distant point into the waters of the ocean, and the removal of the feculent soil.” Lee concluded that only the United States had the capacity to carry out a project of this magnitude, which was in the U.S. national interest because “a single widespread epidemic of yellow-fever would cost the United States more in money, to say nothing of grief and misery which it would entail, than the purchase-money of Cuba.”32 With such opinions present among the APHA’s leadership, it is not surprising that the Mexicans approached the relationships they made in the APHA in terms of sovereignty.

When U.S. forces occupied Cuba in 1898, the sanitary justification for U.S. intervention in Latin America surfaced again and was incorporated in the infamous Platt Amendment. Drafted by Secretary of War Elihu Root, the Platt Amendment passed the U.S. Congress in 1901 and was added (despite serious opposition) to the Cuban Constitution in 1902. Fulfilling Lee’s vision, the Platt Amendment’s fourth article stipulated: “The Government of Cuba will execute, and, as far as necessary, extend the plans already devised, or other plans to be mutually agreed upon, for the sanitation of the cities of the island, to the end that a recurrence of epidemic and infectious diseases may be prevented, thereby assuring protection to the people and commerce of Cuba, as well as to the commerce of the Southern ports of the United States and the people residing therein.”33

By 1902, U.S. government reports celebrated the improvements in Cuban sanitary conditions brought about by the work of the occupation government’s Sanitary Department, directed by Dr. William Gorgas.34 Havana served as the laboratory for testing the practical aspects of using mosquito control to eliminate yellow fever, practices that were later applied not only in the U.S. effort to construct the Panama Canal, but also in Mexican efforts to rid the Gulf of Mexico region of yellow fever, at least near major urban centers. Ultimately, the control of urban yellow fever was one of the major practical accomplishments of Porfirian public health.35

In addition to its direct sanitary intervention in Cuba, the United States developed a system for the sanitary surveillance of Central America and the Caribbean. In 1899, the surgeon general of the U.S. Marine-Hospital Service appointed seven inspectors for the fruit ports of Central America, the origin of most shipments of bananas to the United States. The inspectors were responsible for reporting any suspicion of yellow fever, because if fruit ships had to be detained after reaching ports in the United States, the valuable but perishable cargo of bananas could easily be lost. The inspectors’ work had potentially serious economic consequences for the countries in question, because if “well-defined yellow fever” were discovered in one of the ports, no vessel from that country would be permitted to land in the United States.36

In short, by 1900 public health had become an integral part of the United States’ imperial repertoire in the Caribbean basin. Within the new ideology of empire, public health and hygiene were imagined as essential to the United States’ civilizing mission. Hygiene was easily incorporated as a pillar of the imperialist imaginary because it appeared to be above politics, a universal value of modernity. This view offered significant rhetorical possibilities for Mexican public health officials. Through the establishment of hygienic credentials, the Mexican government acquired a strong position from which to talk back against the United States. The possibility of such a reversal was explicit in some statements by U.S. politicians. Theodore Roosevelt addressed the delegates to the Second International Sanitary Convention, held in Washington, D.C., in 1905:

The outside world is only beginning to understand the astonishing progress made, not only socially and industrially, but in science, literature, and art, by the Central and South American Republics. In medical matters, in industrial, scientific, social, artistic matters, each of our countries has something to learn from the others, and I welcome you as colleagues and as teachers. Of course I could not overstate the all importance of the medical profession in modern life, and as it is now becoming in modern international life. In the old days a plague that happened in one country was regarded as only concerning that country, until it spread over into some other, helpless to defend itself against it. Now we recognize that the stamping out of disease, the warfare against unhygienic conditions, must be done by the organized effort of the medical profession of all the countries joined together.37

Mexican physicians addressed the APHA in exactly the way Roosevelt had suggested, as colleagues and (sometimes) as teachers. In doing so, they exploited terms of an imperial discourse defined by the United States. An excellent example is a statement made in 1906 by Dr. José Mesa y Gutierrez:

I may presume that this is also the occasion for telling you that you maybe have something to learn from us. You have not a sanitary institution capable of putting into action the measures to which I have referred; with sufficient authority and responsibility and broad-minded enough toward your own country and neighboring nations. Had you such a powerful institution, the bubonic plague would not have reached the port of Mazatlán from its focus at San Francisco, concealed as it was, by the local authorities, nor would our board have had to fight the empirical quarantine measures taken not long ago in Texas, without being able to meet at the northern side of the Rio Grande a competent authority to deal with.38

To sum up, Mexican doctors responded assertively to what they perceived as the imperialist connotations of many U.S. public health proposals. They dealt with leaders of the U.S. public health movement like Lee, who had openly argued for annexation as a strategy to defend the health of the southern United States and personally knew Gorgas and Dr. Juan Guiteras, supervisor of the U.S. Army’s sanitation efforts in Cuba and Panama. For Licéaga and his associates, those experiments seem to have evoked a mixture of technical curiosity (Mexico soon applied the U.S. Army’s antimosquito techniques in Mexico) and nationalist misgivings about the aims and justifications of U.S. policies. Many statements made by U.S. politicians could sound like threats in Latin American ears, even when they dealt with humanitarian objectives such as the eradication of yellow fever.

“Our Health Organization Judged the Best”

Despite Atlantic ambitions that were first aimed at Europe, the strongest connection that the Mexican wizards of sanitary progress forged with other members of the international public health movement was with their American and Canadian peers in the American Public Health Association. The 1872 organization of the APHA defined the efforts by American sanitarians to professionalize public health in the United States after the Civil War. By the late 1880s, public health reform symbolized important aspects of emerging Progressivism. As John Duffy explains,

Professionalization and efficiency were the key methods by which the Progressive Movement, in full swing by 1900, hoped to create a new society. Health departments helped lead the way toward professionalization, and their successes undoubtedly reinforced the optimism of Progressive reformers . . . . Recognizing that disease knew no boundaries and that public health problems were universal, in 1884 Canada was invited to become a constituent member of the association. Five years later approaches were made to Mexico, Cuba, and the Central American countries.39

As Duffy’s account implies, the decision to seek Latin American participation in the APHA was governed by both U.S. sanitarians’ self-image as progressive reformers and their increasingly international view of disease. Large-scale immigration and fears about epidemics (especially the threat posed to the southern United States by yellow fever) “contributed to doubts about traditional maritime health, which began to be perceived as a set of arbitrary, disordered, authoritarian measures, and as the source of mutual recrimination and rancor among states and nations,” writes Marcos Cueto.40 Discussions within the APHA led to a resolution passed at the association’s 1889 meeting in Brooklyn, New York:

Resolved, in view of the rapidly increasing travel and commercial intercourse between this country and Mexico and Cuba, and the United States of Colombia, and the consequent growing importance of establishing and cultivating the most friendly relations between the health authorities of our own and those of the countries above named, that a cordial invitation be extended to the sanitary authorities of Mexico and Cuba to send representatives to the future meetings of this Association, and that the secretary be instructed to open correspondence with these authorities, looking to this end.41

The Superior Health Council sent two of its members to attend the APHA’s 1890 meeting at Charleston, South Carolina: Dr. Domingo Orvañanos and the veterinarian Dr. José de la Luz Gómez. According to the proceedings, “great applause” followed the reading of the correspondence between the APHA’s secretary, Dr. Irving A. Watson, and Dr. Nicolás Ramírez de Arellano, secretary of the Superior Health Council. Then Dr. Albert L. Gihon, medical director of the U.S. Navy, offered the following motion, which was unanimously adopted: “Resolved, That the American Public Health Association expresses its high appreciation of the action of the Mexican government and of the Superior Board of Health of the Republic in sending delegates to this Association, and cordially welcomes them to the fraternity of American sanitarians who are laboring in the common cause of Public Health.”42 Taking advantage of the assembly’s enthusiasm, Orvañanos and Gómez immediately invited the APHA to hold its 1892 convention in Mexico City.43

Mexican participation in the APHA signified the creation of a continental public health movement whose expanded scope was felt to be necessary in an era when economic forces were bringing the United States and Mexico closer together. As Watson put it in an 1891 letter to the Superior Health Council: “It is the desire of the Association that your own progressive Republic, as well as the countries still further south, including the West Indies islands, shall become so closely identified with our work as to reap the unlimited benefits that would follow from such an alliance.”44 The reference to “your own progressive Republic” shows the positive and somewhat naive view that U.S. progressive reformers held of Díaz’s Mexico.

The APHA hoped that the Superior Health Council would “take such action as you may deem necessary to secure a large delegation from your country to attend the forthcoming meeting of this Association.”45 Indeed, the council did not delay in mobilizing the Mexican state and the medical profession to foster their emerging ties to the APHA. In fact, the APHA’s attention provided the Superior Health Council with an additional tool to seek support from Porfirio Díaz’s government. On August 25, 1891, the council forwarded Watson’s correspondence to the Interior Ministry. The council stressed “the honor that will result for Mexico from taking part in the deliberations and resolutions of the American [Public Health] Association, [and] the advantages that would be obtained for international hygiene.” These advantages included uniform sanitary legislation in the Americas, which would simplify Mexico’s treaties with other countries, and international support in case an “exotic” (that is, foreign) epidemic struck Mexico.46

The success of Mexican sanitary experts in the APHA fortified their standing at home and lent an international glamour to the bureaucratic routines of public health work in Mexico. At Licéaga’s request, the minister of the interior wrote to the state governors, asking them to name delegates to the APHA’s 1891 meeting. The APHA meeting thus served as an occasion for the leaders of Mexican public health institutions to recruit the power of the federal executive to organize and mobilize the medical profession in Mexico. Prior to this time, medical civil society in Mexico had been largely self-organized, but now the state began to play an important auxiliary role.47

The 1891 APHA meeting, held in Kansas City, was a triumph for the Mexican physicians. The assembled delegates elected Orvañanos as first vice-president of the association. (U.S. surgeon general Walter Wyman, who would lead the transformation of the U.S. Marine Hospital Service into the U.S. Public Health Service in 1902, was elected second vice-president.) Orvañanos presented a paper summarizing the Mexican Sanitary Code for the American and Canadian conventioneers. After the paper was read, Dr. Henry B. Baker, who had organized the Michigan State Board of Health and was a past president of the APHA, rose and offered a challenge to those present. Baker said, “I wish someone could get up and truthfully describe such a system for the United States of America. I hope that someday we shall be able to go to Mexico and describe to them truthfully as good a system for our country.”48 Baker’s public compliment to Mexican sanitary laws was followed by a lively discussion about establishing a national health bureau in the United States. A certain Professor Daniells responded to Baker, saying, “I call the attention of Dr. Baker to the constitution of the United States, that each state has its own laws: we cannot establish laws for the state of Missouri or any other state.” In any case, there was a note of victory in the message that Orvañanos cabled home: Mexico City had been designated to host the APHA’s 1892 meeting. And with all the brevity of the telegraphic age, Orvañanos added “our health organization judged the best.”49

As a result of the 1890 and 1891 APHA meetings, Mexico entered into direct sanitary cooperation with the United States and Canada almost immediately. On December 12, 1891, Watson wrote to the state and local boards of health of the United States and Canada, informing them that henceforth, Mexico would be participating in the interstate and interprovincial warning system of disease notification. In a significant slip, Watson referred to the Superior Health Council as the “National Board of Health of Mexico.”50 He may have chosen the title “National Board of Health” in this instance because it sounded more impressive, or to stress to the recipients of his letter that Mexico already had something that many American sanitarians desperately wanted, namely a health agency with de facto national power.

The rapid courtship with the APHA had already brought several tangible benefits to the Superior Health Council by the end of 1891. The council had been recognized by one of the most important associations of the international public health movement and as a desirable partner for international sanitary cooperation. American recognition, combined with the election of Orvañanos to the APHA’s vice presidency, enhanced hygienists’ standing within the Mexican state, strengthened the council’s bid for budgetary resources, and deepened the commitment of the executive branch of Mexico’s government not only to the project of public health but also to the general professionalization of medicine. The Superior Health Council’s first opportunity to display Mexico’s sanitary modernity to their new North American partners came in 1892, when American and Canadian doctors converged on Mexico’s capital for the APHA convention.

The American Public Health Association Meets in Mexico City, 1892

Porfirio Díaz’s corps of hygienic experts put Mexico City’s most modern, sanitary face on display for the APHA in 1892. This required a certain amount of sleight of hand, since both the capital and the country as a whole had serious problems with health and sanitation.51 Licéaga expressed a deliberate and perhaps disingenuous modesty when he welcomed the American and Canadian delegates to Mexico City, declaring,

Little has been done as yet towards the sanitation of our cities, but this is a truth which we need not to be ashamed to confess, for we are a young people, desirous of understanding thoroughly the evils under which we labor before seeking a remedy. Our governments have given us good sanitary laws, and it remains for us to devote our intelligence, our energy, and our zeal to the service of our countrymen and the fulfillment of those laws.52

Since they knew that at least some of their guests might be critical of Mexican hygienic circumstances, Licéaga and his associates consistently sought to define discussions of Mexican public health in ways that emphasized their own technical expertise and legislative successes and skirted over the country’s hygienic deficiencies. They hoped to control the international representation of Mexico’s stark sociohygienic divide, and for the most part they succeeded. Thus it must have stung when the Texas delegate observed that “to-day, while the advanced sanitarians of Mexico are in the forefront of sanitary progress and enlightenment, the peasantry of that country are as benighted as though Jenner had never lived, nor Pasteur made a discovery.”53 Luckily for the Superior Health Council, such statements proved to be the exception rather than the rule.

Practically the entire Mexican medical profession attended the meeting, which was carefully planned and coordinated by the Superior Health Council. Licéaga recruited physicians and politicians to speak, planned banquets, and organized excursions to sites of interest such as Teotihuacán and the new drainage works of the Valley of Mexico. Employing the clout of the Interior Ministry and his personal relationships with many physicians as a medical school professor, Licéaga mobilized hundreds of Mexican doctors to attend.54

Once in Mexico City, members of the APHA toured the physical infrastructure of Mexico’s health system, ranging from the capital’s hospitals and asylums to the laboratory of the Superior Health Council. The American and Canadian delegates were plied with propaganda about the legal infrastructure of Mexican public health reform, particularly the recently implemented Sanitary Code. Three mutually reinforcing processes — urban modernization, the creation of a modern bureaucracy, and the redefinition of Mexico’s national image — converged in the early 1890s, just in time for the APHA convention. A renovated Mexico City offered new suburban colonias with Victorian-style villas and a refurbished colonial business district, a modern capital in line with the tastes of Mexico’s positivist elite.55

Since Licéaga and several other leading hygienists were also members of the team who designed Mexico’s entries for the universal expositions of the era (Mauricio Tenorio’s “wizards of progress”), we can assume a high level of self-consciousness in the way that they went about presenting a modern Mexico to foreign medical guests.56 Porfirio Díaz’s wizards of sanitary progress assumed a central role in redefining Mexico’s image in accordance with “the international field of ideas and models of civilization, science and development, that forms part of what could be called the civilizing horizon of nation-states.”57 This process continued throughout the Porfiriato at subsequent international medical events held in Mexico City.58

Not all Mexicans wished the nation to be defined by science. The 1892 APHA meeting was contested on antimodernist grounds by leaders of the Catholic Church. Under the headline “The Medical Congress and the Provincial Council of Oaxaca,” the liberal-positivist newspaper El Siglo Diez y Nueve quoted the Catholic press in its November 21, 1892, edition, presumably to shock its liberal readership with the troglodyte opinions of the conservative clergy. Calling for a congress of moral hygienists in lieu of the upcoming APHA convention, a Catholic publicist had written,

That congress of hygienists has no interest for anyone other than the initiates of the most disgusting aspects of human materiality [grandes porquerías de la materia humana] and what interest could one possibly glean from this kind of medical parliament when one starts not even knowing the names of the things they deal with? . . . What we need more is a congress of moral hygienists. The day when that congress can speak freely and propose to our country to relieve the moral afflictions that trouble it, on that day, farewell to this most false freedom and farewell to that hollow progress which covers all the gangrenes and moral ulcers that have been dragging us along since we were constituted as a nation!59

There is no evidence to suggest that the American and Canadian delegates were aware that hygiene possessed the power to arouse this kind of controversy in Mexican society. They may have been conscious of the fact that they were helping to refashion Mexican culture in relation to the international discourse of science, for that was the purpose of the hygiene movement in all countries. Indeed, the presence of the APHA in Mexico City ratified the goals of the hygienists before both the Mexican state and the public. By tapping science as a cosmopolitan and international source of legitimacy, the higienistas were beginning to define a new form of population-oriented governmentality in Mexico. They devised structures of the state for monitoring and protecting the people’s health, and by promoting the bodily practices of hygiene in Mexican society began to create the sanitary citizens who were the ideal subjects for this bio-political form of rule.60 The dictator Díaz could provide political and material support for this project, but he could not legitimate it. In fact, it seems to have been the other way around: public health helped to legitimate Porfirian development. Indeed, the Porfirian hygienists’ biopolitics would survive the fall of their master and continue to influence the shape of the Mexican state after the Mexican Revolution of 1910.

It was almost inevitable that the issue of U.S.-Mexican relations would surface during the 1892 APHA meeting. The way that the issue was managed demonstrated the Mexicans’ finesse at handling their American partners. In his paper on “The Sanitary Relations of Texas and Mexico,” Dr. R. M. Swearingen, chief health officer of Texas, argued that the Mexican peasantry was a reservoir of disease for Texas, which “with a border-line of hundreds of miles confronting the republic of Mexico, is, of course, more exposed to invasions of this kind than are all the other states combined.” In 1891 Swearingen had imposed quarantine against ships arriving from Veracruz, Tampico, and Tuxpan “on account of yellow fever.”61 His paper also presented the correspondence between officials in Austin and Washington and Matías Romero, Mexican minister to the United States. Two communications came from U.S. Surgeon General Walter Wyman, who proposed calling a U.S.-Mexico conference to negotiate the issue in Mexico City concurrently with the APHA’s meeting.

Licéaga seems to have been caught off guard by Swearingen’s aggressive posture and moved to postpone the discussion, saying, “As the paper which has just been read treats of a question whose discussion is of the greatest interest to ourselves, I move that the paper, which unfortunately has not been translated for want of time, be held for discussion until the Mexicans have been able to read it, so that we may be able to take a part in its discussion.”62 The next day, Licéaga was prepared, agreeing that commissions from Mexico and Texas meet to study the question of quarantine and devise “a plan which should be least prejudicial to the interests of commerce.” Moreover, Licéaga contended that Swearingen’s quarantine was already unnecessary due to the modernization of public health bureaucracy and technology in Mexico’s ports, carried out in accordance with Mexico’s Sanitary Code. He even asserted that Mexico’s new sanitary infrastructure would defend the United States from disease. The technology in question was none other than the disinfection stoves that he had purchased in Europe in 1887 – 88 and which had already been installed in sanitary stations on the Gulf of Mexico.63

None of the other American delegates brought up Mexican hygienic deficiencies during the association’s 1892 meeting, at least during the public sessions for which we have a transcript. At present, no diaries or private correspondence are available that might offer a window into the private thoughts of the APHA members (of any nationality) who met in Mexico City that year. The public statements stressed the idea that the Mexico City meeting was a milestone for the North American public health movement’s international aims. In the words of Dr. Felix Formento of New Orleans, the APHA’s outgoing president, it was “the first real International Health Congress held on this side of the Atlantic.”

The ideological conviction that science could (and should) overcome nationality made the APHA a favorable forum for Licéaga and his associates. “We recognize that in science, in public hygiene, the different nations of a whole continent are as much our fellow-citizens as those living under our flag and institutions,” Formento declared.64 In other words, science possessed the ideological power to transform its practitioners into equals — cosmopolitan bourgeois subjects. The APHA was a bourgeois public sphere, in Habermas’s original sense, where rational discussion among equals prevailed.65 Needless to say, in both Mexico and the United States, the public health movement embraced the hygienic upper layers of society and directed repressive and exclusionary measures toward the “unwashed masses.”

Several presentations at the 1892 convention took the 1891 Sanitary Code as a subject. We have seen that leaders of the U.S. public health movement admired Mexico’s Sanitary Code, as when Baker declared the Mexican code superior to contemporary U.S. examples. They praised Mexico’s sanitary legislation not only in the context of the convention (where such remarks could be dismissed as flattery) but even at home.66 The Mexican Sanitary Code was the fruit of a detailed study of many nations’ sanitary legislation, and portions probably seemed familiar to the American delegates, because the Superior Health Council had incorporated elements from the health codes of several U.S. states.67 In the end, the perceived superiority of Mexican sanitary legislation had less to do with specific details than with its national scope. Many of the American members of the APHA were still licking their wounds after the rapid decline into irrelevance of the United States’ first federal health agency (the National Board of Health) between 1879 and 1882.

Mexico’s authoritarian political structures made it relatively easy for Porfirio Díaz to grant powers to the federal government that probably still belonged to Mexico’s states. After all, Díaz controlled the Mexican Congress and the Supreme Court.68 The Mexican Constitution of 1857 made no specific mention of public health, but it clearly established a federal system in which the sovereignty of the states was very strong. Díaz’s willingness to undermine states’ sovereignty in matters related to public health went back at least to 1883. That year, advised by Licéaga, he federalized the country’s ports to defend against a potential cholera epidemic. Díaz and his sanitary advisor ignored the complaints of the municipality of Veracruz, which protested that the federal government could not intervene without injuring the sovereignty of the state of Veracruz.69

According to the Superior Health Council’s lawyer, José Gamboa, the Superior Health Council could intervene in the states at practically any time, as long as the federal executive acquiesced (and he usually did). A detailed explanation of the Sanitary Code (and its amended versions, enacted in 1894 and 1903) is beyond the scope of this paper. Suffice it to say that it arranged local, state, and federal health authorities in one structure, with the Superior Health Council at the apex, but it was promulgated without any alteration to Mexico’s constitution. Gamboa, who was a primary author of the code, made a presentation to the APHA with the suggestive title, “In Countries under a Federal Regimen, Can and Should the Union Exercise Any Intervention on Sanitary Matters?” The Superior Health Council’s answer was a strident yes, and Gamboa goaded the American delegates, implying that the United States should follow Mexico’s lead in erecting a health agency with sweeping national power. According to Gamboa, Mexico’s federal government enjoyed jurisdiction not only in ports, frontier towns, and in all dealings with foreign countries, but “on all those subjects that bear on general interests,” and “in all cases of conflict on these matters the federal authorities shall always have the preponderance over state authorities.”70

Mexico’s Sanitary Code proved to be an apple of discord for the American delegates to the APHA, divided between advocates of a strong federal health agency and supporters of states’ rights. Perhaps sensing these divisions, Licéaga presented a paper detailing the plan devised by the Superior Health Council to defend Mexico against cholera in 1892.71 After hearing Licéaga’s paper, Albert L. Gihon of the U.S. Navy sponsored a resolution that stated, “in view of the impending danger from cholera in 1893, it is the opinion of the American Public Health Association that a National Health Service should be established in the United States of America, as has been done in the Republic of Mexico, to procure uniformity of action in protecting the sea-coast from invasion by epidemic disease.”72

Public Health and the Defense of Sovereignty

In its scientific ambit, the Superior Health Council came close to realizing the Científicos’ dream of Mexican development “without U.S. investment,” in large part because the council obtained independent access to European ideas and technologies prior to its engagement with the Americans. Efforts by Mexican hygienists to modernize public health in Mexico bore fruit twice. The hygienists created public health institutions through which medical doctors became essential actors in making modern Mexico, and they persuaded their American counterparts that Mexican experts could be trusted partners in defending the health of the western hemisphere. These two processes supported each other: the Mexican hygienists were surprisingly successful in their role as medical diplomats, and as they developed more influence with their U.S. counterparts, it became more important for the government of Porfirio Díaz to implement their initiatives for creating more forceful public health institutions.

When the invitation for Mexico to join the APHA came in 1889, the Superior Health Council’s members realized immediately that participation in the APHA would allow them to address the international ramifications of public health questions, which would bear directly on Mexico’s commerce and economic development. A little more than a decade later, Porfirio Díaz’s sanitary advisors had devised a consistent and assertive international strategy around the following positions: (1) alignment with international scientific standards; (2) principled defense of sovereignty, with Mexican officials controlling the certification of transmissible disease on Mexican soil; (3) transparency in disease reporting; (4) internationally publicized demonstrations of Mexican competence in campaigns against tropical disease that might threaten the United States; and (5) negotiation of multilateral institutional structures to counter the influence of the United States.

The first three parts of this strategy were in place by 1892. The last two had evolved by 1905 and can be addressed here in brief. The Superior Health Council had shown that it had mastered the newest methods for disease control in successful campaigns against bubonic plague in Sinaloa and Baja California (1902–3) and against yellow fever from 1903 on. In 1910, Licéaga would declare to the APHA that “Yellow Fever Has Disappeared from the Mexican Republic.”73 In addition to the publication of special bulletins that highlighted Mexican successes in using tropical medicine, vector theory, and bacteriological methods against disease, Mexican officials made many presentations on these subjects to the APHA, constantly reinforcing the idea that Mexican officials could be trusted to deal with health emergencies on their own.

Perhaps the most important political achievement of the Mexican hygienists in the APHA was to construct a potent image of their technical competence, which was symbolically ratified by the election of two Mexican physicians to the presidency of the association (Licéaga in 1895 and Orvañanos in 1906). The Mexican sanitary authorities used this image of competence and their close personal relationships with U.S. officials to great effect in the negotiation of multilateral sanitary agreements in the years after 1901. U.S.-Mexican relations over public health questions shifted away from the professional forum of the APHA to diplomatic negotiations between the two countries. Between 1901 and 1907, three International Sanitary Conventions produced inter-American agreements on public health questions related to the intercourse between the countries of the western hemisphere, especially maritime sanitation, quarantine, and the control of yellow fever and other transmissible diseases.74 These agreements could be seen as the culmination of the APHA’s project to create a continental public health movement. In this way, Mexican public health leaders made a distinctive contribution to the development of international health, efforts that are still honored by the Pan American Health Organization, whose parent organization, the International Sanitary Bureau, Licéaga helped to found in 1902.75

In the final analysis, Porfirian public health developed an imperative to defend Mexican sovereignty because it could not avoid the field of power created by rising U.S. imperialism in the Caribbean region. The efforts of the Superior Health Council in the APHA and other forums were intended to keep public health from being a pretext for the United States to meddle in Mexican affairs. In this respect, the efforts of the Mexican hygienists may be deemed to have been largely successful, even though sanitary relations between the two countries were sometimes strained as economic integration proceeded. In 1904, the state of Texas, acting on its own, imposed quarantine on Mexican passengers and goods, motivated by its traditional policy of banning commerce with areas that had been infected with yellow fever the previous year. The entire machinery of Mexican and U.S. diplomacy swung into gear as Texas requested the right to place sanitary inspectors in Mexico as a precondition for lowering its quarantine restrictions. The Texans also sought to pressure the Mexican government through the railroad companies, which stood to incur major economic losses from the interruption of train traffic.

Licéaga protested the Texas quarantine energetically. He argued that it violated international scientific standards to impose quarantine in the absence of an actual yellow fever epidemic. (Licéaga admitted that isolated cases of yellow fever existed in Mexico, but insisted that there was no epidemic.) Furthermore, the Mexican government was already carrying out systematic campaigns against mosquitoes based on the U.S. Army’s methods tested in Cuba, which they had demonstrated to officials from Texas and the U.S. Public Health and Marine Hospital Service. Licéaga felt that there were no circumstances under which Mexico could acquiesce to Texan sanitary inspectors issuing official health certificates from Mexican territory and insisted that Texas accept the value of certification by Mexican officials. If they were given the right to rule on sanitary conditions in Mexico, Licéaga feared that Texas officials would acquire an unwarranted degree of control over Mexico’s internal affairs. In light of these considerations, Licéaga wrote candidly to George Tabor, health officer of the State of Texas:

I am going to explain with utter clarity why we cannot accept for you to send us sanitary agents. If the Mexican government, in the exercise of its sovereignty, is putting into practice sanitary measures that don’t only protect its own territory against transmissible diseases, but is at this very moment implementing measures so that those diseases cannot be transmitted to a neighboring country, this government cannot, for its own dignity, accept that agents of another State come and impose upon it as an obligation that which it is already doing voluntarily.76

In short, the Superior Health Council’s decade-long campaign in the APHA did not mean that all American officials trusted their Mexican partners. The case shows the limits of the Superior Health Council’s strategy for defending Mexican sanitary sovereignty, because Licéaga finally acquiesced to Texas dispatching sanitary agents in an unofficial (“private”) capacity to Mexican cities. In the final analysis, even though Licéaga defended a very clear definition of sovereignty, he was willing to make “private” concessions in order to resolve a situation that threatened commerce with the United States.77

The longtime leader of Mexico’s sanitarians finally retired in 1914 at the age of 74. In his memoirs, he stressed the positive ramifications of the encounter between the Superior Health Council and the APHA. “The benefit that Mexico has obtained from the [APHA],” Licéaga wrote, “is the enhanced knowledge that the physicians who attended the Association’s meetings have acquired; the propagation of that knowledge in their respective localities, and the benefit of the cultivation of relations between the sanitary authorities of [Mexico] and the United States, relations which became very cordial and very beneficial for the conservation of our independence from the United States in sanitary matters, against the tendency of that country to impose itself upon the Latin American republics.”78 The evidence presented here largely supports Licéaga’s appraisal, while also showing that a degree of unofficial U.S. influence in Mexican sanitary affairs could not be avoided. It is clear that foreign policy objectives decisively shaped Porfirian health policy by obligating the Superior Health Council to devote major resources for the control of the tropical diseases (such as yellow fever) that most concerned the United States. Under Licéaga’s leadership, the Superior Health Council’s diplomatic function became an integral aspect of its operations, and it was this function that largely accounts for the importance of the council to the Porfirian regime, an importance which alternative explanations (positivist devotion to modern hygiene, or effectiveness in disease control) do not adequately capture.

1

Irving A. Watson, “The Republic of Mexico — Medicine Curative and Preventive,” The Sanitarian, a Monthly Magazine Devoted to the Preservation of Health, Mental and Physical Culture 29 (July – Dec. 1892): 122. Dr. Watson made this statement in a speech to the New Hampshire Medical Society.

2

Francisco Flores, Historia de la medicina en México desde la época de los indios hasta la presente, vol. 3 (Mexico City: Oficina Tip. de la Secretaría de Fomento, 1886 – 88), 135.

3

Examples are numerous. See for instance, Mejía, undated letter to Ayuntamiento (bound between documents from early September 1832) introducing translation of F. J. V. Broussais’s treatise on cholera morbus, Archivo Histórico del Distrito Federal, Mexico City, Policía Salubridad, Cólera morbus, vol. 3676, exp. 2, pp. 6 – 7; and Dr. Ignacio Erazo, “Report on Cholera” (based on Broussais’s work), 4 Oct. 1832, Archivo Histórico del Distrito Federal, Ramos Municipales, Policía Salubridad, Cólera morbus, exp. 12, p. 4.

4

Germán Somolinos d’Ardois, Historia de la fundación de la Academia Nacional de Medicina y su tiempo (Mexico City: Academia Nacional de Medicina, 1964), 11 – 12, 17 – 23.

5

Dr. José María Reyes’s annual memorandum of the council’s activities, written in 1866, is the most complete report written before the book-length Memorias of the Porfiriato. See Reyes, Memoria de los trabajos del Consejo de Salubridad en el año de 1866 (Mexico City: Imprenta Imperial, 1867). For the foundation and early years of the Superior Health Council, see Fernando Martínez Cortés, De los miasmas y efluvios al descubrimiento de las bacterias patógenas: Los primeros cincuenta años del Consejo Superior de Salubridad (Mexico City: Consejo de Salubridad General, 1998). A very clear and concise account of the French hygienists who were the principal role models for their Mexican brethren may be found in Catherine J. Kudlick, Cholera in Post-Revolutionary Paris: A Cultural History (Berkeley: Univ. of California Press, 1996), 71 – 81.

6

Verhandlungen der Berliner medicinischen Gesellschaft aus dem Gesellschaftsjahre 1886/86. (Berlin: L. Schumacher, 1887), 142. “Für die Bibliothek sind eingegangen: . . . 2) D. Eduardo Licéaga, Leçons sur l’etiologie et la prophylaxe de la fièvre jaune, Mexico 1885.” Appropriately, given Mexican medical Francophilia, Dr. Licéaga’s reflections on yellow fever found their way into the library of the Berlin Medical Society in French.

7

Manuel Soriano, Memoria sobre la canalización quirúrgica, llamada en francés drainage (Mexico City: Imprenta de J. M. Aguilar y Ortiz, 1865), Yale Latin American Pamphlet Collection #8001952. On Dr. Gabino Barreda, see Charles A. Hale, “Political Ideas and Ideologies in Latin America, 1870 – 1930,” in Ideas and Ideologies in Twentieth Century Latin America, ed. Leslie Bethell (New York: Cambridge Univ. Press, 1996), 148 – 52.

8

Mauricio Tenorio-Trillo, Mexico at the World’s Fairs: Crafting a Modern Nation (Berkeley: Univ. of California Press, 1996), 143 – 44, 147 – 49.

9

Ana María Carrillo, “Los comienzos de la bacteriología en México,” Elementos 42 (2001): 24.

10

The first Congreso Médico met in the famous Casa de los Azulejos to discuss a great fecal stink that had settled on Mexico City, which hygienists feared might herald a typhus epidemic (1876, reconvened 1878). A Congreso Higiénico Pedagógico (1883) and Congreso Nacional de Higiene (1883 – 84) followed.

11

The Transactions of the 1890 Berlin Medical Congress noted that “even Mexico” was named as a possible site of the next International Medical Congress. Other cities nominated were St. Petersburg, Madrid, Paris, and Rome. Licéaga’s colleague Dr. Rafael Lavista chaired one of the congress’s meetings. Verhandlungen des X. Internationalen Medicinischen Congresses. Berlin, 4.–9. August 1890. Band 1: Allgemeiner Theil (Berlin: August Hirschwald, 1891), 173. See Daniel T. Rodgers, Atlantic Crossings: Social Politics in a Progressive Age (Cambridge: Harvard Univ. Press, 2000), for the parallel history of U.S. figures seeking models for “Progressive” governance in Europe.

12

Martínez Cortés, De los miasmas y efluvios.

13

Eduardo Licéaga, Mis recuerdos de otros tiempos (Mexico City: Talleres Gráficos de la Nación, 1949), 63 – 78. Liceaga’s interests closely paralleled those of the U.S. “cosmopolitan progressives” studied by Daniel Rodgers, who undertook similar social-scientific tours of Europe in this era. See Rodgers, Atlantic Crossings, 209.

14

Archivo Histórico de Salubridad y Asistencia (hereafter cited as AHSSA), Mexico City, Salubridad Pública (hereafter cited as SP), Presidencia, Secretaria, caja 6, exp. 6.

15

Dr. Eduardo Licéaga to Superior Health Council, Vienna, 28 Sept. 1887. AHSSA, SP, Presidencia, Secretaria, caja 6, exp. 6. All translations are mine, unless otherwise noted.

16

Ibid.

17

Licéaga, Mis recuerdos de otros tiempos, 88 – 89.

18

Nancy Stepan, Beginnings of Brazilian Science: Oswaldo Cruz, Medical Research and Policy, 1890 – 1920 (New York: Science History Publications, 1976). Other Latin American medical leaders of the period also entered transatlantic scientific networks and discussions during this period. For a South Atlantic view, consult the memoirs of Dr. Emilio R. Coni, Argentina’s foremost hygienist of this era. Emilio Coni, Memorias de un médico higienista: Contribución a la historia de la higiene pública y social Argentina (1867 – 1917) (Buenos Aires: Talleres Gráficos A. Flaiban, 1918), 649 – 53.

19

AHSSA, SP, Presidencia, Secretaria, caja 6, exp. 6. Donald Reid describes tours in the Paris sewer system in Paris Sewers and Sewermen: Realities and Representations (Cambridge: Harvard Univ. Press, 1991), chap. 4.

20

See Claudia Agostoni, “Las delicias de la limpieza: La higiene en la ciudad de México,” in Historia de la vida cotidiana en México, vol. 4, ed. Ann Staples (Mexico City: Fondo de Cultura Económica, 2004).

21

AHSSA, SP, Presidencia, Secretaria, caja 6, exp. 6.

22

Eduardo Licéaga to Superior Health Council, Vienna, 6 Oct. 1887. AHSSA, SP, Presidencia, Secretaria, caja 6, exp. 6.

23

Eduardo Licéaga, “Preamble to the Mexican Sanitary Code,” in José Alvarez Amézquita et al., Historia de la Salubridad y de la Asistencia en México (Mexico City: Secretaría de Salubridad y Asistencia, 1960), vol. 1, p. 327.

24

Documentation generated around the 1876 Medical Congress, which Dr. Licéaga organized, shows that he was a dedicated sanitarian who related the threat of epidemic typhus to the decomposition of organic wastes and poor circulation in Mexico City’s drainage system. He may have been agnostic on the question of miasma, since he never used the term in those writings. See Trabajos emprendidos para mejorar la salubridad del valle y de la ciudad de México por una asociación de médicos — promovida por el Sr. Lic. Martínez de la Torre — 1876 y 1877 (Mexico City, 1877), Yale Latin American Pamphlet Collection #8004642.

25

Eduardo Licéaga, “Address,” Public Health Papers and Reports 18 (1892): 18.

26

Tenorio-Trillo, Mexico at the World’s Fairs, 157. Tenorio-Trillo observes that “in certain fields, Mexican scientists, though often few, were working modestly but efficiently.” For a less sanguine view of early Mexican bacteriology, see Manuel Servín Massieu, Microbiología, vacunas y el rezago científico de México a partir del siglo XIX (Mexico City: Plaza y Valdés, 2000). American medicine was itself relatively underdeveloped in the 30 years before World War I, leading approximately 15,000 Americans to go to Germany and Austria to study medicine between 1870 and 1914. The first American medical school to require a college degree for admission was Johns Hopkins, opened in 1893. The United States did not become the world leader in biomedical research until after World War I. On the backwardness of U.S. medicine in the late nineteenth and early twentieth century see John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Penguin, 2004), especially 42 and 65. See also Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 115 – 16.

27

John M. Hart, Empire and Revolution: The Americans in Mexico since the Civil War (Berkeley: Univ. of California Press, 2002), 73.

28

Alan Knight, The Mexican Revolution, vol. 1, Porfirians, Liberals, and Peasants (Lincoln: Univ. of Nebraska Press, 1990), 22 – 23.

29

Hart, Empire and Revolution, 73.

30

Licéaga, Mis recuerdos de otros tiempos, 225.

31

Benjamin Lee, “Do the Sanitary Interests of the United States Demand the Annexation of Cuba?” Public Health Papers and Reports 15 (1889): 47 – 52.

32

Lee, “Do the Sanitary Interests of the United States Demand the Annexation of Cuba?” 48.

33

Internet Modern History Sourcebook, “Modern History Sourcebook: The Platt Amendment, 1901,” http://www.fordham.edu/halsall/mod/1901platt.html (accessed 26 May 2008).

34

A report from 1902 summarizes the decline in yellow fever mortality as a result of U.S. efforts in Cuba. Monthly Bulletin of the International Bureau of the American Republics, International Union of American Republics (May 1902): 1179 – 81.

35

See Anne-Emanuelle Birn, Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico (Rochester, NY: Univ. of Rochester Press, 2006), 45.

36

Monthly Bulletin of the International Bureau of the American Republics (Jan. – June 1899): 1799 – 1800.

37

Theodore Roosevelt, “Remarks of President Roosevelt to the Members of the Second International Sanitary Convention,” in Transactions of the First General International Sanitary Convention of the American Republics (Washington, D.C.: Government Printing Office, 1903), 223. Emphasis added.

38

José Mesa y Gutierrez, “Contribution to the Study of Problems of National and International Sanitary Legislation” (Mexico City: Imprenta de Hull, 1906), 4. Emphasis added.

39

John Duffy, The Sanitarians: A History of American Public Health (Urbana: Univ. of Illinois Press, 1990), 131. Duffy’s excellent Sanitarians is the standard history of U.S. public health.

40

Marcos Cueto, The Value of Health: A History of the Pan American Health Organization (Rochester, NY: Univ. of Rochester Press, 2007), 16.

41

“Proceedings and Discussions of the Seventeenth Annual Meeting,” Public Health Papers and Reports 15 (1889): 297. Italics in original.

42

J. J. R. de Arellano to Irving Watson, 7 Aug. 1890, Public Health Papers and Reports 16 (1890): 310.

43

AHSSA, SP, Presidencia, Actas de Sesión, caja 4, exp. 4.

44

Dr. Irving A. Watson, Secretary of the APHA, to Dr. Juan J. R. de Arellano, Secretary of the Superior Health Council, 6 July 1891. AHSSA, SP, Presidencia, Congresos y Convenciones, caja 1, exp. 9. Emphasis added.

45

Ibid.

46

Memorandum, Superior Health Council to Secretary of the Interior, 25 Aug. 1891. AHSSA, SP, Presidencia, Congresos y Convenciones, caja 1, exp. 9.

47

For aspects of medical civil society, see Ana María Carrillo, “Profesiones sanitarias y lucha de poderes en el México del siglo XIX,” Asclepio 50, no. 2 (1998): 149 – 68.

48

“Proceedings and Discussions at the Nineteenth Annual Meeting,” Public Health Papers and Reports 17 (1891): 247 – 49. In his memoirs, Eduardo Licéaga (who was not present) remembered Dr. Baker saying, “Si hay algun representante de las autoridades sanitarias que tenga conocimiento de que en alguno de los estados de la Unión Americana haya una colección de preceptos sanitarios tan completa como el Código Sanitario de México, que se levante y lo diga.” Licéaga, Mis recuerdos de otros tiempos, 222.

49

AHSSA, SP, Presidencia, Congresos y Convenciones, caja 1, exp. 9. Orvañanos’s telegram was sent in English via Galveston.

50

Dr. Irving Watson to State Boards of Health, 12 Dec. 1891. AHSSA, SP, Presidencia, Congresos y Convenciones, caja 1, exp. 9. “I recently had the honor of presenting the subject to the National Board of Health of the Republic of Mexico, and this most active, efficient and accomplished board . . . will hereafter promptly notify your board of the outbreak or existence of such diseases in the Federal District of Mexico, at all the Mexican Ports, and along the frontier between Mexico and the United States. Beyond this the State authorities have control in these matters, and in order to extend this system of notification to these States, the National Board of Health will ask the governors of the several States to request that such notification be promptly made. I have assurance that in a short time the system will embrace every State in Mexico.”

51

The reader should note that health of the country’s rural majority was not part of the Porfirian public health agenda, but in this regard Mexico was not different from other Latin American countries. The Porfiriato’s most successful later campaigns against disease focused their efforts on the urban cores of provincial locales. For dimensions of the Porfirian public health project in Mexico City during the Porfiriato, see Claudia Agostoni, Monuments of Progress: Modernization and Public Health in Mexico City, 1876 – 1910 (Calgary: Univ. of Calgary Press / Boulder: Univ. Press of Colorado / Mexico City: UNAM, 2003). For an account of the bubonic plague epidemic that broke out at Mazatlán in 1902 and which featured the first Mexican campaign against infectious disease based entirely on bacteriology, vector theory, and tropical medicine, see Ana María Carrillo, “¿Estado de peste o estado de sitio? Sinaloa y Baja California, 1902–1903,” Historia Mexicana 54, no. 4 (2005): 1049 – 1103.

52

Licéaga, “Address,” 24.

53

R. M. Swearingen, “The Sanitary Relations of Texas and Mexico, and the Official Correspondence Relating Thereto,” Public Health Papers and Reports 18 (1892): 323; and “Proceedings and Discussion of the Twentieth Annual Meeting,” Public Health Papers and Reports 18 (1892): 424 – 25.

54

Licéaga issued a personal appeal to virtually every doctor in Mexico to write scientific papers and travel to Mexico City to attend the conference. The secretary of the interior wrote to the state governors urging them to send state delegations consisting of local sanitary authorities, and President Díaz approached the Chamber of Deputies to ask for a credit to cover the costs associated with holding the event in the capital (which was granted). In subsequent years, Licéaga worked out a deal whereby Mexico’s federal government and the state governors shared the cost of sending delegations to the APHA’s annual meetings. See Licéaga, Mis recuerdos de otros tiempos, 222.

55

For the apotheosis of Porfirian efforts to create the image of a modern capital, which he calls “the ideal city,” see Mauricio Tenorio-Trillo, “1910 Mexico City: Space and Nation in the City of the Centenario,” Journal of Latin American Studies 28, no. 1 (Feb. 1996): 75 – 104. See also Claudia Agostoni and Elisa Speckman, eds., Modernidad, tradición y alteridad: La Ciudad de México en el cambio de siglo (XIX – XX) (Mexico City: UNAM, 2001); and Pablo Piccato, City of Suspects: Crime in Mexico City, 1900 – 1931 (Durham, NC: Duke Univ. Press, 2001), 18 – 33.

56

See Tenorio-Trillo, Mexico at the World’s Fairs, especially chap. 9.

57

Claudio Lomnitz, “ ‘Contact Zones’ and the Topography of National Identity,” in Deep Mexico, Silent Mexico: An Anthropology of Nationalism (Minneapolis: Univ. of Minnesota Press, 2001), 130. The role of the Superior Health Council in organizing the international medical events held in Mexico City during the Porfiriato is abundantly documented in thousands of pages held in AHSSA, SP, Presidencia, Secretaria, Congresos y Convenciones.

58

Subsequent international medical events held in Mexico City included a Pan-American Medical Congress (1896); International Sanitary Conference (1902); and another APHA meeting (1906).

59

“El Congreso Médico de esta Capital y el Concilio Provincial de Oaxaca,” El Siglo Diez y Nueve, 21 Nov. 1892.

60

See Michel Foucault, The Birth of Biopolitics: Lectures at the College de France, 1978 – 1979 (New York: Palgrave Macmillan, 1978). Luis E. Ruiz, a disciple of both Licéaga and Gabino Barreda, authored two hygiene treatises that may be considered exemplary of Porfirian biopolitics, one for children, and the other for medical students. Luis E. Ruiz, Cartilla de higiene (profilaxis de las enfermedades transmisibles) escrita para la enseñanza primaria (Mexico City and Paris: Bouret, 1903) and Tratado elemental de higiene (Mexico City: Secretaría de Fomento, 1904).

61

Swearingen, “The Sanitary Relations of Texas and Mexico,” 324.

62

“Proceedings and Discussions of the Twentieth Annual Meeting,” 424 – 25.

63

Ibid., 432 – 33.

64

Felix Formento, “Anniversary Address,” Sanitarian 21 (Jan. 1893): 8.

65

Issues of class origin were irrelevant, for all the participants were members of the bourgeoisie, and the issue of national origin was bracketed by decorum. Leaving aside lengthy debates about the utility of Jürgen Habermas’s notion of the public sphere for historical analysis, I have intentionally used his original term bourgeois public sphere here because Habermas’s original formulation captures resonances that are so close to the historical practice preserved in the archive that I have studied. All participants in the APHA belonged to a social formation recognizable as bourgeois, despite the obvious differences between the social stratification of Mexico, the United States, and Canada. See Jürgen Habermas, The Structural Transformation of the Public Sphere (Cambridge: MIT Press, 1989).

66

Watson, “The Republic of Mexico — Medicine Curative and Preventive,” 122 (see note 1).

67

In 1886 – 87, the Superior Health Council had an agent in New York City who remitted copies of U.S. sanitary legislation to the council, including the public health laws of Maine, Pennsylvania, and New York. See AHSSA, SP, Presidencia, Congresos y Convenciones, exp. 7.

68

See Knight, Mexican Revolution, 20 – 21.

69

Liceaga, Mis recuerdos de otros tiempos, 80 – 82.

70

José M. Gamboa, “In Countries under a Federal Regimen, Can and Should the Union Exercise Any Intervention on Sanitary Matters?” Public Health Papers and Reports 18 (1892): 127 – 29, 128.

71

Eduardo Licéaga, “Defence of the Ports and Frontier Cities of Mexico against the Epidemic of Cholera that Invaded Europe and Was on the Point of Invading the United States in 1892,” Public Health Papers and Reports 18 (1892): 240 – 58.

72

“Proceedings and Discussions of the Twentieth Annual Meeting,” 438.

73

Eduardo Licéaga, “Yellow Fever Has Disappeared from the Mexican Republic,” Journal of the American Public Health Association 1, no. 10 (Oct. 1911): 735 (paper read at the annual meeting of the APHA in Milwaukee, September 1910). For the fight against the bubonic plague see Carrillo, “¿Estado de peste o estado de sitio?”

74

See Cueto, The Value of Health, 39 – 52.

75

See “A Century of Public Health: PAHO Family Album,” Perspectives in Health: The Magazine of the Pan American Health Organization 7, no. 1 (2002); http://www.paho.org/english/dpi/Number13_article3_9.htm (accessed 25 May 2008). Marcos Cueto has traced the history of the early twentieth-century sanitary meetings in The Value of Health. He underlines the point that Mexico’s “role in helping to organize and prepare the resolutions of the International Conference of American States of 1902 and the Washington Convention of 1905 was considered a major triumph of Mexican foreign policy” (45).

76

Dr. Eduardo Licéaga to Dr. George R. Tabor, 25 Apr. 1904, in “Expediente formado con motivo que las autoridades sanitarias del Estado de Texas, E. U., han impuesto contra las procedencias de México,” Diario Oficial del supremo gobierno de los Estados Unidos Mexicanos, 18 May 1904, p. 255.

77

Telegram, Dr. Eduardo Licéaga to Dr. George R. Tabor, 8 May 1904, in Diario Oficial del supremo gobierno de los Estados Unidos Mexicanos, 18 May 1904, p. 258.

78

Eduardo Licéaga, Mis recuerdos de otros tiempos, 225. Dr. Licéaga appears to have composed this assessment in 1915.