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This essay offers a comparative analysis of the uneven development of scientific, modern medicine in the northern Mexican states of Nuevo León and Sonora during the late nineteenth and early twentieth centuries. Formally-trained medical doctors and their state allies did not dominate medical treatment as residents of northern Mexico navigated a hybridized folk/science pharmacopeia. Even doctors who aligned themselves with scientific professionalism sometimes adopted medical practices that drew on local and popular healing. Medical schools, municipal governments, and courtrooms were among the most important spaces within which doctors attempted to assert a new role for themselves and legitimate their vision of medicine. Due to the presence of a medical school in Monterrey since in the late 1850s, doctors in Nuevo León such as Dr. José Eleuterio González were particularly successful at promoting a modernizing medical model, even as they drew on indigenous knowledge and plants to make a nationalist case for Mexico's unique contributions to a universal pharmacopeia. Of the two states, Nuevo León created a more influential and structured medical profession, especially when compared to Sonora, yet their position on the Mexican periphery meant that licensed physicians were relatively scarce in both states. Thus, medical pluralism continued to shape the profession, as patients consistently looked to lay healers for care.