- Carving a Niche: The Medical Profession in Mexico, 1800–1870 by Luz María Hernández Sáenz
medical profession, education, continuity, licensed and non licensed practitioners, Mexico
This welcome contribution to the history of medicine offers a detailed examination of the trajectories of licensed medical practitioners and their efforts to acquire professional, social, and scientific recognition between the 1800s and the 1870s. During those [End Page 223] decades, New Spain obtained its independence from Spain (1821), and up to at least the 1870s, regional conflicts, political divisions, foreign interventions, internal civil wars, and a devastated economy prevailed. It is precisely against that backdrop of political, economic, social, and administrative instability, and when diverse epidemic diseases claimed numerous lives, that Hernández Saenz’s analysis takes place. The book offers the striking conclusion that the ‘carving of a niche’ of the medical profession during the period under consideration was possible due to continuity in the development of medical education, legislation and institutions, and because of the continuous struggles and competition among licensed and unlicensed healers, between different political actors, between church and state, and also, among the capital and the provinces.
Drawing upon numerous historical works that have examined the processes of medical professionalization in France, Great Britain, and the United States, on diverse accounts written by late-nineteenth century Mexican physicians, and upon recent Latin American historical contributions, including her previously published monograph, Learning to Heal. The Medical Profession in Colonial Mexico, 1767-1831 (New York, Peter Lang, 1997), Hernández Sáenz contends four central arguments that intertwine throughout this book. The first is that there was continuity in the transformations that medical education and legislation underwent throughout the course of the nineteenth century. She maintains that contrary to “the traditional literature, which portrays sudden change, individual action, and clashes between factions and institutions as triggers of change” (p. 24), continuity characterized the collaboration among diverse institutions and individuals throughout most of the nineteenth century. The second claim is that the Paris School and French notions of public health influenced both national and foreign medical practitioners in independent Mexico. The third contention is that competition among licenced and unlicensed medical practitioners, among different teaching institutions, and between church and state were central organizing forces in Mexico. The fourth argument is that the Mexican government played an ambiguous and often hindering role in the modernization and reorganization of the medical profession.
The book is sustained in a detailed analysis of numerous primary and secondary sources, and delves into various topics throughout its five chapters. The first scrutinizes the conflictive decline of the prestige and authority of the Royal Protomedicato Tribunal during the late colonial period up to its abolishment in 1831. In doing so, it examines the rivalry and competition among the members of the Protomedicato and the select group of medical practitioners who served in the health boards or juntas de sanidad established between 1812 and 1831, and the initial reorganization of medical education and practice when medicine and surgery merged into one profession (also in 1831), as well as the creation of the Medical Faculty of the Federal District and Territories that among other issues, transformed the health boards into charity boards in 1836. Hernández Sáenz situates those transformations not only within the conflicts between traditional and modern medicine, but also within the social and political context of the period.
The second chapter surveys the reorganization of the medical profession between the 1800s and the 1860s, and underlines the importance of merging of medicine and surgery. That unification, Hernández Sáenz demonstrates, was prompted by the [End Page 224] influence of French medicine, due to the desire of physicians and surgeons to defend their interests from the health boards or juntas de sanidad, and to secure their position, recognition and control over the practice of medicine in face of the numerous non-licensed practitioners: phlebotomists...