Physician Activists and the Development of Rural Health in Postrevolutionary Mexico

Ana Mara Kapelusz-Poppi

In 1930 the governor of Michoacn, General Lzaro Crdenas, dispatched a small

plane to bring ailing Dr. Teodoro Gmez Aguilar back to the state capital in Morelia. Suffering from a severe bout of malaria, Aguilar had to ride a mule for a day in order to reach the landing strip. The day-long mule ride and plane trip was the fastest way out of Apatzingn, the town where the twenty-eight-year-old physician had been working since Crdenas created a hospital there in 1928.1 Teodoro Aguilars journey is an example of the difficulties that academically trained professionals confronted when working in the Mexican hinterland. At the same time, it shows the concern of the Cardenista administration in creating modern medical services in the countryside. Finally, the story illustrates the commitment to ideals of social justice of doctors like Gmez Aguilar and his colleagues from the Colegio de San Nicols de Hidalgo. Inspired by the promises of the 1910 20 revolution and a radical educational background, these doctors were eager to devote their professional skills to social change and economic development. This essay explores the motivations and efforts of the Nicolaitas, a community of medical doctors from the Colegio de San Nicols in Morelia, Michoacn, who strove to spread scientific health services to rural areas during the 1920s and 1930s.2 The professionals from San Nicols were part of the postrevolutionary Mexican left.

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Led by General Francisco I. Mgica, radicals across Mexico believed that the 1910 20 revolution should usher in not only a constitutional republican system but also a dramatic transformation of social and economic relations.3 They succeeded in including their ideas in Mexicos 1917 constitution, which promised the implementation of land reform and workers rights. The constitution also provided for educational reform along the lines of so-called socialist education. This notion embraced a wide variety of meanings, from the secularization of education to the construction of a classless society through educational reform.4 The constitution of 1917 made public health the responsibility of the federal state. The graduates from San Nicols, who despite their federalist sentiments believed that Mexicos progress required a strong central state, agreed with this idea. But they carried the notion of the right to health further. Impressed by the apparent successes of the Soviet Union, and in the midst of the highly mobilized social environment of Michoacn, the Nicolaitas regarded public health programs as a form of wealth redistribution. They were especially concerned with living conditions in the countryside, where more than 60 percent of the Mexicans lived, and argued that poor health and deficient sanitary conditions were examples of social injustice. Their experience as rural doctors enabled the Nicolaitas to develop an agenda for rural health, making the extension of modern health services to rural dwellers part of the radical program for land redistribution, labor reform, and socialist education. During General Crdenass 1928 32 gubernatorial term in Michoacn, the Nicolaitas became his close advisers, following Crdenas to Mexico City when he was elected president of Mexico in 1934. In doing so the graduates from San Nicols, and especially Drs. Jess Daz Barriga and Enrique Arregun Vlez, played a crucial role in drafting and implementing an innovative and socially oriented system of rural health. Their projects, however, also revealed the contradictions that plagued socialist intellectuals in postrevolutionary Mexico. Among the projects that the Nicolaitas inspired were the Servicios Mdicos Ejidales (medical ejidal services). This program aimed at ending social injustice in rural areas by linking the expansion of modern medicine to agrarian reform. It also sought to transform the peasantry into modern citizens. At the same time, the doctors from San Nicols, like other experts working in health matters in Mexico at the time, believed in the superiority of academically trained professionals. This bias led them to regard the peasants, the very same people they were trying to empower, in disparaging ways. Their belief in the superiority of modern science also offered a common ground between the Nicolaitas and the other health experts working at the Federal Health Department the hygienists trained under the influence of their nineteenth-century predecessors, as well as the American officers brought in by the Rockefeller Foundation. By the early 1940s, as the Cardenista administration sought to institutionalize the Nicolaita program for rural health, this understanding also steered the ejidal program away from its early socialist inspiration.

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Public Health in the Aftermath of the Mexican Revolution The idea that an improvement in health standards was a prerequisite for the nations economic growth became increasingly popular among educated men after 1917. Yet the federal state was painstakingly emerging from a decade of civil war and could barely address sanitation problems in urban areas. Scarcity of material resources, as well as political and social upheaval, created further obstacles in urban and rural areas. The federal governments lack of control over most of the regions in the country largely prevented the newly created Departamento de Salubridad Pblica (Federal Health Department) from intervening in the provinces. Furthermore, and despite the fact that postrevolutionary hygienists struggled to increase the intervention of the central state in health matters, they maintained the reluctance for social reform that had characterized their predecessors during Porfirio Dazs dictatorship (1876 1910). Since improving health conditions in rural areas required broad programs of sanitary construction and professional reform, federal health policies largely disregarded the health and sanitary needs of the countryside. In those instances in which rural areas did receive federal health attention after 1917, programs focused on the biological causes of diseases, failing to address the living, dietary, and working conditions that contributed to poor health standards.5 In the early 1920s the Rockefeller Foundation, the most important U.S. philanthropical health organization of the time, started a series of campaigns against yellow fever, malaria, and hookworm. The Rockefeller Foundation, however, was very concerned to appear as a politically neutral organization. This, in turn, led its officers in Mexico to shy away from strategies that could seem to entail any political connotation, including projects for the provision of clean water or sewer construction. In addition, the scientific advisers and officers of the foundation recommended focusing on the diseases they deemed susceptible to rapid diagnosis and treatment. As a result, the Rockefeller Foundation concentrated on controlling yellow fever and organizing antihookworm brigades, training peasants to undergo medical treatment, use modern latrines, and wear shoes, the fundamental strategies for the prevention of hookworm.6 Mexican experts, most notably Miguel E. Bustamante, were aware of the limitations of the existing health programs and fought to expand sanitary and curative activities. A distinguished figure in Mexican health issues since the middle of the 1920s, Bustamante tried to address the more prevalent ailments such as tuberculosis and gastrointestinal and venereal diseases. Bustamante also encouraged the construction of the infrastructure necessary to provide rural villages with clean water and the hygienic disposal of waste. In 1927, when the Rockefeller Foundation and the Health Department began a joint program for the construction of rural sanitary units, Bustamante partially succeeded in implementing his ideas. But these programs were undertaken in sparse and uneven ways and failed to cover the more iso-

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lated areas. Difficulties also arose from a complex financial arrangement that attempted to make local municipalities, provincial authorities, and the federal state share the program expenses.7 It was not until 1934, when General Crdenas became president, that federal authorities committed themselves to managing and supporting rural health programs in systematic ways. Seeing the potential of modern medical services for economic development, social justice, and political support, General Crdenas tripled the Health Departments budget and created a new system that included scientific medical services into his agenda for agrarian reform.8 The doctors from San Nicols, in Morelia, played a crucial role in drafting and implementing this program.
The Nicolaita Community and Rural Health in Michoacn Don Vasco de Quiroga, the enlightened first bishop of Michoacn, founded the Colegio de San Nicols in the sixteenth century. Despite political and economic difficulties, the institution managed to survive until the end of colonial times, when it became a center of liberal thought. By the mid-nineteenth century the school was associated with radical anticlericalism, socially modern ideas, and relentless nationalism. During the dictatorship of Porfirio Daz (18761910), the Nicolaitas replaced much of their political militancy with a concern for scientific achievement and rational thinking. This trend, in tune with the influence of the positivist philosopher Auguste Comte in Mexico City at the time, remained an important element of Nicolaismo long after the end of Dazs regime.9 Despite their acceptance of these philosophical trends, the Nicolaitas participated in the 1910 movement that ended the Porfirian regime in Michoacn. As they became part of the new middle classes that the revolution brought to the political forefront, they merged the positivism of Porfirian times with the universitys anticlerical and nationalistic traditions.10 By 1920, when General Francisco I. Mgica was elected governor of Michoacn, many Nicolaitas came to endorse his program for social and economic reform.11 During his seventeen months in office, Mgica sought to implement the transformations promised by the 1917 constitution. He and his allies focused on land redistribution and educational reform. Their goal was to end social injustice and modernize what they regarded as the backward practices of the peasantry.12 The radical doctors from San Nicols tried to reorganize health services in their state in accordance with these ideas. These efforts were led by Dr. Jess Daz Barriga, who served as the head of the states health department in 1921, the head of the public education department in 1924 and 1925, and the rector of the Universidad Michoacana from 192632.13 Like his colleagues in the capital city, Daz Barriga regarded rural dwellers as ignorant and backward. Based on this belief, experts claimed the right to reeducate the peasants into changing their living, dietary, and hygienic habits.14 Daz Barriga

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believed that one of the main problems in Mexico was the low nutritional value of the peasants diets. To address this situation, he encouraged the consumption of foods rich in proteins. He had his wife create new recipes to show peasant housewives how to prepare meals with fish, eggs, and vegetables. Since these products were not easily available, he studied ways in which the state could help to diversify agrarian production in Michoacn. With the modernization of mass communication during Plutarco Elas Calless presidency (192428), he broadcast his ideas via radio programs.15 Daz Barrigas work with rural populations soon brought him to the conclusion that improving their living conditions required broader changes. Regarding the lack of modern medical services in isolated areas as a consequence of the dramatic class differences in Mexico, he argued that the modernization of health services in rural areas was part of the revolutionary redistribution of material and intellectual wealth.16 The constitution of 1917 had made health care the responsibility of the federal state, yet Barriga also viewed the extension of these services to the countryside as the duty of health professionals. Instead of blaming the peasants for their poor health, the way modernizing hygienists at the federal health department usually did, he emphasized the professional and social responsibility of rural doctors. He claimed that an improvement in health standards throughout the nation required the reorganization of medical practice.17 After he was appointed the rector of the Universidad Michoacana de San Nicols de Hidalgo, Barriga applied his ideas of social medicine and committed professional service to medical training by creating the Brigadas de la Juventud (Youth Brigades). These were groups of medical students from San Nicols who volunteered their services in isolated areas.18 The Nicolaita brigades enjoyed only a limited budget, and since they were not part of any state agency, they depended on the goodwill of the Morelian authorities to carry on their work. Despite the challenges, they were able to conduct inoculation campaigns when epidemics broke out. They also made antirabies procedures available to rural dwellers and helped prevent the spread of contagious diseases by isolating infected individuals. Although the brigades efforts focused on the areas around the city of Morelia, these were often just as isolated and poor as villages in the midst of the countryside. Thus the Nicolaita students efforts revealed the administrative and financial difficulties that any program for rural health would encounter.19 By the end of the decade Barrigas closest disciple, a recently graduated physician named Enrique Arregun, extended Barrigas ideas by claiming that capitalist relations of production were to blame for poor health in the countryside. Arregun was part of a younger generation of Mexican intellectuals who, following their own interpretation of Marxism, hoped to construct a socialist regime through gradual reform. He believed that a state-managed health system was a step toward the construction of a classless society. In his view, this system would create a new

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generation of socially committed professionals who would not only care for the physical and intellectual soundness of their patients, but would also contribute to the improvement of the social and economic conditions of the entire community.20 Inspired by the Nicolaitas nationalistic zeal and concern for social justice, Arregun also tried to curb the intellectual influence of the United States in Mexico. He preferred other Latin American countries and Europe as alternative sources of academic inspiration. Impressed by the economic achievements of Soviet Russia, he sought to adapt their political and cultural strategies to the needs of Mexican health programs.21 Both Barriga and Arregun viewed their interest in worldwide professional activities and political developments as an integral part of what they called humanism. They saw this humanism as synonymous with the social and political commitment inherited from the revolutionary years.22 As a forum for their humanist goals, Barriga and Arregun organized the cafs Nicolaitas. At these meetings, the Nicolaita graduates and students discussed everything from national and international politics to literary and philosophical works. But the weekly meetings also had practical benefits, enabling the Nicolaitas to operate as a well-informed and dynamic network, ready to protect their political ideals as well as their professional interests whenever necessary.23 By 1928, when General Crdenas was elected governor of Michoacn, the Nicolaita community had become a group of well-trained and socially committed professionals. As a longtime friend of General Mgica, Crdenas was also close to the Nicolaitas, in particular to Jess Daz Barriga and Enrique Arregun, and he frequently attended their cafs.24 Moreover, by the end of the 1920s changes in the Mexican political arena also made the Nicolaitas ideas popular while transforming its members into helpful political advisers. The Nicolaitas concern for the countryside and their radical views fit the rhetoric for social reform that revived in the late 1920s, triggered by a variety of political processes. In the first place, the 192629 Cristero Warthe armed resistance of Catholic peasant guerrillas against the secularizing policies of the central state was a clear indication of deep discontent in the countryside. At the same time, the assassination of president-elect Alvaro Obregn in late 1928 created a very delicate political situation. Finally, the effects of the international depression heightened social demands by peasants and rural workers. In addition, General Crdenas distrusted the graduates from the Universidad Nacional in Mexico City, most of whom vigorously opposed the program of socialist education.25 It was only natural, then, for General Crdenas to appeal to the Nicolaitas as one of his main sources for political advice. He also turned to them as administrators of federal public offices. In this way, the political preeminence that Barriga and Arregun gained during the Cardenista years in Michoacn gave Nicolaita doctors the chance to implement their ideas, while also guaranteeing a steady supply of jobs for their colleagues from San Nicols. The hospital that Crdenas created in 1928 in Apatzingn was the first vis-

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ible result of this collaboration. This town was an important center of the Cristero opposition and of political interest to General Crdenas; the hospital is an early example of the way in which the Cardenista regime merged medical goals, social concerns, and political needs.26 Barriga recommended two young doctors to run the hospital, Teodoro Gmez Aguilar and Antonio Alcantar. Like their close friend Enrique Arregun they were recent graduates from San Nicols and former members of the Brigadas de la Juventud. Barriga was particularly impressed by Aguilars commitment to social reform and suggested he become the first director of the hospital in Apatzingn.27 The governor hoped that the local population would regard the creation of this small hospital as a gesture of his concern for their well-being. As he made it clear at his annual address to the state legislature, Crdenas expected that bringing modern medicine to the area would gain him political support and thus contribute to the pacification of the region.28 But it was the small clinic that the Nicolaita doctors founded in 1932 in Zacapu another area plagued by the confrontations between revolutionary and Catholic peasantsthat marked the beginning of a new system for rural health. Dr. Gmez Aguilar, who by then had recovered from his bout with malaria, was again in charge of the experiment. The hospital included a few beds and a pharmacy, the latter managed by Gmez Aguilars wife. Despite its initial experimental character, this clinic became the model for the servicios mdicos ejidales. After 1934, the Cardenista efforts to bring modern health to the countryside concentrated heavily on these services.29
The Ejidal Clinic in Zacapu The clinic in Zacapu, a region where General Crdenas had recently started a broader program of land redistribution, foreshadowed a program linking the introduction of modern medicine in rural areas to the wider agenda of agrarian reform. The Cardenista administration aimed at providing rural dwellers with better living conditions and educational opportunities while also increasing agrarian production. Therefore it complemented massive land redistribution programs guaranteeing the economic and social development of the Mexican hinterland. In order to meet this goal, much of the land was not assigned to individual holders but rather distributed to the collective ejidos, that is to the traditional communal villages. The land of the collective ejidos, which could not be sold to private individuals, was assigned to the whole community, and each head of a household in it, the ejidatario, was assigned a parcel to till. This system protected peasants from wealthier landowners who were eager to buy them off. It expected to bring about rural development because the communal ejido could invest in the large-scale production techniques not affordable to individual peasants. It also supported infrastructural improvements like rebuilding or constructing schools and health units.30

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An elected committee of six members, including an executive secretary, administered the larger ejidos, and all the ejidatarios were required to participate in monthly assemblies.31 The medical clinic in Zacapu, organized as a cooperative health unit financially supported by the peasants themselves, showed this collective inspiration. It also reflected the Nicolaitas idea that the development of socially oriented medical units in the countryside could contribute to the organization of a classless society. At first the ejidatarios compensated Gmez Aguilars services with their own crops. However, soon after General Crdenas took office as Mexicos president in 1934, his administration reorganized the Banco de Crdito Agrcola y Ejidal (Bank for Agrarian and Ejidal Credit) as an institution geared to provide ejidatarios with the credit necessary to afford seed, fertilizer, and machinery. The medical expenses of the clinic were also channeled through the bank.32 The Cardenista idea for agrarian reform considered an increase in agricultural output a key element in the development of Mexico as a modern and powerful nation. This required the expansion of modern medical services to rural areas. But the experts drafting the project considered that the modernization of the nation also entailed the transformation of the peasants into hardworking, self-assured, and nationally committed producers. Making the ejidatarios financially responsible for their own health was, therefore, another piece in an agenda that sought to transform social relations and everyday practices in the countryside. The Nicolaitas believed that their programs would contribute to the material and intellectual empowerment of the peasants. But in believing in the superiority of scientific medicine, they also saw the creation of ejidal clinics as an opportunity to replace the curanderos (traditional healers), whom they blamed for maintaining backward health practices in the countryside. The Nicolaitas believed that replacing curanderos with university graduates, preferably from San Nicols, would contribute to the modernizing project.33 But undoubtedly the plan also served the professional interests of academically trained physicians who struggled to make a living in the countryside.34 The Nicolaitas shared their disparaging views of popular practices and their concerns for control of the professional field with the experts working at the Health Department in Mexico City. These coinciding views facilitated the understanding between Nicolaitas and other experts working to bring scientific medicine to the countryside. This became evident in 1934, when a second ejidal health service was created in Ciudad Anahuac, Nuevo Lon. While the clinic at Zacapu was organized without any federal support, the ejidal service in Anahuac was the result of the efforts of Dr. Miguel E. Bustamante.35 This suggests that, in an effort to reconcile existing systems, President Crdenas tried to incorporate the experience developed by the Nicolaitas in Michoacn to the existing administrative structure at the Health Department.

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Peasants, the Health Department, the Comisin Nacional de Irrigacin (National Irrigation Commission), and the state of Nuevo Lon shared the health expenses of the Ciudad Anahuac clinic. The organizers of this clinic also invited local industrialists to join the program. According to the agreement each ejidatario (most of them owned an average of twenty-five hectares) was to pay three pesos per hectare for medical expenses, averaging a total of seventy-five pesos per year. This fixed fee covered medical, surgical, and maternity services as well as the cost of medicines for each ejidatarian family, plus one rural worker (pen) for every ten hectares. Advocates of the system considered it to be highly advantageous, especially when taking into account that a visit to a private physician cost between five and twentyfive pesos, medical help during childbirth between twenty and fifty pesos, and because it was impossible to know in advance how much a surgical procedure would cost.36 Yet advocates of the system forgot to mention that curanderos, midwives, and homeopaths, whom the peasants trusted, charged far less than university graduates.37
The Ejidal Health System Reaches National Scope The First Rural Hygiene Conference, held in Morelia in November of 1935, officially launched the project for a national system of ejidal health services. Barriga, as the director general of the Health Department (Dr. Jos Siurob, a military physician and a former member of the Socialist Party, was the chief of the department), and Arregun, at the time the rector of the Universidad Michoacana, hosted the conference. Following the conferences recommendations, President Crdenas founded the office of Servicios Mdicos-Sanitarios Ejidales Colectivos (Collective Ejidal Medical and Sanitary Services) early in 1936.38 By linking modern medical services to land reform, these services aimed at bringing academically trained physicians to rural areas. The ejidal services were original not only in making modern health an integral part of the project for agrarian reform but also in emphasizing the need to provide peasants with curative services. According to the 1936 statute that created the ejidal services as a nationwide enterprise, the attention given to curative and preventive strategies depended on the mortality rates affecting specific areas in the previous five years. So in those areas where mortality rates averaged more than 25 deaths per 1,000 inhabitants, 70 percent of the resources were to be devoted to curative efforts. In regions where the mortality rate averaged 20 to 25 deaths per 1,000 inhabitants during the same period, expenses should be divided equally between curative and preventive care. Finally, 30 percent of the expenses were to go to curative procedures in those areas where, for the previous five years, the mortality rate averaged less than 20 deaths per 1,000.39

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As a result of the impetus given to the project of ejidal medicine, by the end of 1936 there were thirty-six ejidal units, which absorbed 5 percent of the budgetary resources of the Federal Health Department. Consistent with Crdenass efforts to merge the experience developed in San Nicols with the programs already underway in the Health Department, the ejidal services were first put under the wing of the Direccin de Higiene Rural (Rural Hygiene Division), the office founded in 1927 as the administrative locus for the sanitary units that the Rockefeller Foundation promoted. The program was a resounding success. Peasants overwhelmed the Health Department with demands for ejidal clinics, medical services, and medicines. They also requested ejidal clinics to offer more than the basic services, including specialized medical experts. Ejidal doctors, in turn, complained that their new clients often overworked them.40 These demands suggest that peasants rapidly accepted the constitutional notion of the right to modern health services. But they also made evident that rural ejidal services required broad financial and administrative resources. In January 1937 the services were reorganized under the newly created Oficina Central de Medicina Social de Higiene Ejidal (Central Office for Social Medicine and Ejidal Hygiene).41 By 1941, when the office administering these services was elevated to a higher administrative category, that of a direccin (division), it managed 120 rural medical units and served around 300,000 people.42 Important differences existed, however, among the various ejidos. While some of them were affluent and enjoyed clinics with full medical services, others could offer only limited services, usually restricted to a dispensary and a stock of basic medicines. According to their statute, federal, state, and local authorities supported and managed the ejidal clinics. However, the units were largely dependent on the federal budget, thus bypassing the provincial authorities.43 As a result, this health system contributed to strengthening the influence of the central state in matters of health. In addition, and despite the institutionalization of the system, many of the health projects relied on the financial support that President Crdenas provided on an ad hoc and individual basis.44 In the long run this situation would threaten the very existence of the ejidal units, especially the weakest among them. Optimistic policymakers believed that the cooperative system could support the expansion of modern medical services in the countryside. In the heightened revolutionary language of the times, they regarded ejidal medical services as part of the attack against the oligarchic elite that, they argued, had controlled health in Mexico since Porfirian times.45 Yet other technocrats complained about the excessive proportion of funding that the ejidal health units consumed. They tried to increase the contributions of the ejidatarios to the system and enforce the collection of their mandatory contributions.46 But frequently this was a burden peasants either could not shoulder or were simply not willing to share. Peasants did not always see the need to pay for medical services while they were healthy, especially since they could

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always resort to the more inexpensive, and perhaps more approachable, curanderos and midwives. Neither did the rural population agree with the stringent manner in which university-trained physicians defined curative techniques, and peasants vocally defended homeopathic doctors against the allopaths who tried to forbid their practice.47 After the 1940 presidential elections, an overall change in the national political and economic orientation also affected the programs for rural health. The Second World War meant de facto protection for industrial development, leading investment away from the countryside and into industrial ventures. In addition, President Crdenas had already succeeded in bringing peasants and workers organizations under the wing of the official party and no longer needed to court these groups. As social mobilization lost much of the effervescence of the 1930s, politicians began to soften the revolutionary tone of official rhetoric. Simultaneously, sectors favoring more stringent economic policies insisted on the need to control social expenses. During Miguel Alemns presidential term (1940 46), the federal administration began to press the ejidos to support an increasing portion of their health costs while reducing government participation. The proportion of expenses paid by the federal government to the ejidal clinics decreased from 92 percent in 1936 to approximately 42 percent in 1943, while the services catered to less than a third of the population that they had served under Crdenas. After 1940 the servicios mdicos ejidales concentrated in the areas where the peasants could afford to support most of the health expenses.48 These changes seem to indicate that federal administrations after 1940 abandoned the idea of addressing curative and sanitary needs in the poorer rural areas of the country. Still, during the 1940s and 1950s, the Health Department undertook a broad program for the construction of hospitals in isolated areas, showing that the idea of the right to health was becoming part of the postrevolutionary notion of citizenship.49
Conclusion The Nicolaita physicians who were behind the program of the ejidal services saw bringing modern health care to the countryside as one step toward the construction of a classless society in postrevolutionary Mexico. As they became high officers of the Cardenista administration, the Nicolaitas also believed that, in the long run, their project would contribute to the transformation of the peasantry into the modern citizens of a socialist system. Between 1936 and 1940, the program for rural health was included in the national agenda for social justice and revolutionary change. Yet as the Nicolaitas sought to institutionalize the ejidal health system, they also confronted a dilemma. In its quest to strengthen the federal state, the Cardenista administration tried to adapt the servicios mdicos ejidales to the administrative structures and ideological tendencies existing in the health department in Mexico City. Here more conservative

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sectors strove to replace the original ideas of social justice with a plan concentrating on social modernization and economic progress. As loyal supporters of the regime, the Nicolaitas adopted a conciliatory attitude and softened the radical edges of their agenda. In addition, their own prejudices and professional interests pushed the graduates from San Nicols to regard campesino practices in disparaging ways. This bias, in turn, divorced the Nicolaita program from the revolutionary forces that had contributed to its enactment during the 1920s. As a result, much of the earlier emphasis on health reform as part of the agenda for social transformation was lost. This tendency became particularly visible after international and national political pressures moved the focus away from rural areas into industrial development. Nonetheless, the rapid increase in the number and expenses of the ejidal clinics between 1936 and 1940 and the peasants demands for modern medical services suggest that the system did meet the needs of the ejidatarios at least for a short period of time. Although the dilemmas of state-building in Mexico resulted in a taming of the radical rhetoric that inspired the original Nicolaita program for rural health, the Nicolaitas nonetheless contributed to making the right to modern health care part of the notion of citizenship in postrevolutionary Mexico.
Notes
I would like to thank Anne-Emanuelle Birn and George Huppert for their helpful suggestions. I also thank the anonymous reviewers of this article for their comments. 1. Dr. Laura Gmez Trillo, personal communication with author, Morelia, Mexico, February 1999. 2. Graduates from the Colegio de San Nicols pronounce the word Nicolaita without the emphasis that Spanish usage would normally put in the second i. They do not use a written accent when spelling the word Nicolaita. 3. This essay focuses exclusively on the physicians from San Nicols. However, the Nicolaita community included graduates from other professional fields. 4. For a thorough analysis of the notion of socialist education in postrevolutionary Mexico, see Victoria Lerner, La educacin socialista (Mexico City: El Colegio de Mxico, 1982). 5. Anne-Emanuelle Birn, A Revolution in Rural Health? The Struggle over Local Health Units in Mexico, 19281940, Journal of the History of Medicine 35 (January 1998): 4376; Anne-Emanuelle Birn, Las unidades sanitarias: La fundacin Rockefeller versus el modelo Crdenas en Mxico, in Marcos Cueto, ed., Salud, cultura, y sociedad en Amrica Latina (Lima, Peru: Instituto de Estudios Peruanos y Organizacin Panamericana de la Salud, 1997); Anne-Emanuelle Birn, Local Health and Foreign Wealth: The Rockefeller Foundations Public Health Program in Mexico, 19241951, (Ph. D. diss., Johns Hopkins University, 1993); Marcos Cueto, Introduction and Visions of Science and Development: The Rockefeller Foundations Latin American Surveys of the 1920s, and Armando Solorzano, The Rockefeller Foundation in Revolutionary Mexico: Yellow Fever in Yucatn and Veracruz, all in Missionaries of Science, ed. Marcos Cueto (Bloomington: Indiana University Press, 1994). 6. Birn, A Revolution in Rural Health?, Las unidades sanitarias, and Local Health and Foreign Wealth.

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7.

8. 9.

10.

11. 12.

13.

14.

Ibid. For a firsthand idea of Bustamantes views, see Miguel E. Bustamante, La coordinacin de los servicios sanitarios federales y locales como factor de progreso higinico en Mxico, in La salud rural en Mxico, ed. H. Hernndez Llamas (Mexico City: IMSS, 1984), 3590. Birn, A Revolution in Rural Health?, Las unidades sanitarias, and Local Health and Foreign Wealth. Enrique Arregun Vlez, Del Colegio Primitivo de San Nicols de Hidalgo: Sntesis histrica (Morelia, Mexico: n.p., 1940), in Enrique Arregun Vlez personal archive, Colegio de Michoacn, Zamora, Mexico); Pablo G. Macas, Aula nobilis (Mexico City: Editorial Vanguardia nicolaita; reprint, Morelia, Mexico: Universidad Michoacana de San Nicols de Hidalgo, 1985); Pascual Ortz Rubio, Memorias (Morelia, Mexico: Universidad Michoacana de San Nicols de Hidalgo, 1989); Manuel Martnez Bez, Ignacio Chvez, Nicolaita, in Centro de Estudios sobre la cultura nicolaita, Ignacio Chvez (Morelia, Mexico: Universidad Michoacana de San Nicols de Hidalgo, 1993); Manuel Martnez Bez, Memorias de un Nicolaita, in Manuel Martnez Bez, cientfico, y humanista, ed. Raul Arreola Corts (Morelia, Mexico: Universidad Michoacana de San Nicols de Hidalgo, 1994). The Universidad Michoacana de San Nicols de Hidalgo was created in 1917. Since then the Colegio de San Nicols and the medical school, founded in 1830, became part of the university. Macas, Aula nobilis; Jos Valdovinos Garza, Tres captulos de la poltica mexicana (Mexico City: Ediciones Casa de Michoacn, 1960). Christopher Boyer, The Cultural Politics of Agrarismo: Agrarian Revolt, Village Revolutionaries, and State-Formation in Michoacn, Mexico, (Ph.D. diss., University of Chicago, 1997), esp. 4958. See also Christopher Boyer, Old Loves, New Loyalties: Agrarismo in Michoacn, 19201928, Hispanic American Historical Review 78 (August 1998): 41955; Gerardo Snchez Daz, El movimiento socialista y la lucha agraria en Michoacn, in La cuestin agraria: Revolucin y contrarrevolucion en Michoacn, ed. Angel Gutirrez, Jos Napolen Guzmn, and Gerardo Snchez (Morelia, Mexico: Universidad Michoacana de San Nicols de Hidalgo, 1984), 4171; Gerardo Snchez Daz, Los pasos al socialismo en la lucha agraria y sindical en Michoacn, 19171938, Tzin Tzun 6 (June 1986): 3552; Martn Snchez Daz, Grupos de poder y centralizacin poltica: El caso Michoacn, 19201924, (Mexico City: Instituto Nacional de Estudios de la Revolucin Mexicana, 1994). On the Universidad Michoacana de San Nicols de Hidalgo, see Macas, Aula nobilis, and Manuel Martnez Bez, Ignacio Chvez Nicolaita. On the ideology of the school during these years, see Acta del Consejo Universitario de la Universidad Michoacana, January 5, 1921 (Archivo de la Universidad Michoacana de San Nicols de Hidalgo, Morelia, Mexico). On Jess Daz Barriga, see Enrique Arregun Vlez, Mis recuerdos del Maestro Don Chucho Daz Barriga, and Brgido Ayala, Semblanza del doctor Jess Daz Barriga, both in Centro de Estudios sobre la Cultura Nicolaita, Jess Daz Barriga: Su pensamiento sobre la educacin socalista y la nutricin popular (Morelia, Mexico: Universidad Michoacana de San Nicols de Hidalgo, 1981), 1521 and 915. See Jess Daz Barriga and Enrique Arregun, Misin de las universidades e instituciones de cultura superior ante los problemas del campo (presentation at the Congreso Nacional de Educacin Rural, Universidad Michoacana de San Nicols de Hidalgo. Morelia, Mexico, June 28, 1948), in Enrique Arregun Vlez personal archive.

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15. Ayala, Semblanza del doctor Jess Daz Barriga; Jess Daz Barriga, La nutricin popular, in Centro de Estudios sobre la Cultura Nicolaita, Jess Daz Barriga, 97151. See also, in the same volume, Jos Aguilar Guzmn, El rector Jess Daz Barriga, el santo laico de la Universidad Michoacana, 2140. See the Enrique Arregun Vlez personal archive scripts for radio broadcasts. 16. See Jess Daz Barriga, La asistencia social en Mxico, in Gobierno del Estado de Michoacn, Aspectos del pensamiento michoacano (Mexico City: Feria del Libro y Exposicin Nacional de Periodismo, 1943), 13548. 17. Daz Barriga and Arregun, Misin de las universidades. 18. Enrique Arregun Vlez, Mis recuerdos del Maestro Don Chucho Daz Barriga, 1519. 19. Ayala, Semblanza del doctor Jess Daz Barriga; Aguilar Guzmn, El rector. See also a handwritten biography on Juan Jos Alcocer by Enrique Arregun Vlez (Enrique Arregun Vlez personal archive); Jess Daz Barriga to Donato Guevara, September 26, 1933, Archivo Histrico de la Ciudad de Morelia, box 79, folder 38; Salvador Molina, Enrique Arregun Vlez: Pionero del humanismo mdico y del servicio social michoacano, La Voz de Michoacn, (January 29, 1989); and Andrs Resillas Meja, Los profesionistas, La Voz de Michoacn, (January 31, 1989). All these documents are in Enrique Arregun Vlezs personal archive, Colegio de Michoacn, Zamora, Mexico. 20. Enrique Arregun Vlez, Ponencia ante el Primer Congreso Nacional de Universidades organizado por el Consejo Estudiantil Nicolaita y la Unin Socialista Universitaria de Michoacn de la UMSNH. (Morelia, Mexico, 1933). See also Enrique Arregun Vlez, El charlatanismo en la profesin mdica, (paper presented to the Sociedad de Mdicos y Estudiantes de Medicina de Michoacn, November 1933); Enrique Arregun (Secretary of the Bloque de Jvenes Revolucionarios Michoacanos), From the Bloque de Jvenes Revolucionarios Michoacanos to the Rector and the Directive Board of the Universidad Michoacana (Morelia, Mexico, September 14, 1934); and Enrique Arregun Vlez, Algunas consideraciones sobre el problema del ejercicio de la medicina (paper written for the Revista de la Unin de Estudiantes Universitarios Michoacanos, February 1936). All these papers are in Enrique Arregun Vlez personal archive. For an overview of this Marxist generation, see Sebastin Mayo, La educacin socialista en Mxico (Buenos Aires: Editorial Bear, 1966), 18993. For an interpretation of Barrigas activities as part of the mobilization of the state in favor of socialist education, see Eitan Ginzberg, Abriendo nuevos surcos: Ideologa, poltica, y labor social de Lzaro Crdenas en Michoacn, 19281932, Historia Mexicana 48 (JanuaryMarch 1999): 567633. 21. Mara de los Angeles Rodrguez, personal communication with author, Mexico City, March 2000. See also Enrique Arregun and Natalio Vzquez Pallares, Proyecto de la Universidad de Primavera Vasco de Quiroga (Mexico City, December 1939), in Enrique Arregun Vlez personal archive. 22. See Manuel Martnez Bez, Memorias de un Nicolaita, in Corts, Manuel Martnez Bez. See also Macas, Aula nobilis. 23. Ayala, Semblanza del doctor Jess Daz Barriga; Aguilar Guzmn, El rector; Martnez Bez, Ignacio Chvez, Nicolaita; and Martnez Bez, Memorias de un Nicolaita. 24. Crispn Rico Cano, personal communication with author, Morelia, Mexico, February 1999. For an illustration of the relations between the Nicolaita doctors and General Crdenas, see a handwritten note to President Crdenas signed by Barriga and Arregun, November 4, 1936, Archivo General de la Nacin, Seccin Presidentes, Lzaro Crdenas, 534/100. For a

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25.

26.

27.

28.

29.

30.

31. 32.

33. 34.

sense of the way in which the Nicolaita community worked as a professional and political network, see letters of June 1936 between Antonio Alcntar and Enrique Arregun, in Enrique Arregun Vlez personal archive. Sebastin Mayo describes this process while also suggesting the hostility that the Nicolaitas received from outsiders and political opponents. Alan Knight, The Rise and Fall of Cardenismo, c. 19301946, in Mexico since Independence, ed. Leslie Bethell (Cambridge: Cambridge University Press, 1991), 241320. On the matter of the relations between General Crdenas and the Universidad Nacional, see Donald Mabry, The Mexican University and the State: Student Conflicts, 19101971 (College Station: Texas A&M University Press, 1982), chaps. 5 and 6. For an analysis of the General Crdenas gubernatorial administration in Michoacn, see Eitan Ginzberg, Abriendo nuevos surcos: Ideologa, poltica, y labor social de Lzaro Crdenas en Michoacn, 19281932, Historia Mexicana 48 (JanuaryMarch 1999): 567633. For a thorough analysis of the Cristero War in Michoacn, see Jennie Purnell, Popular Movements and State Formation in Revolutionary Mexico: The Agraristas and Cristeros in Michoacn (Durham, NC: Duke University Press, 1999). Dr. Laura Gmez Trillo, personal communication with author, February 1999. Enrique Arregun, Falleci el Dr. Teodoro Gmez Aguilar, draft for a newspaper article (March 30, 1951). Informe de Gobierno de 19281929 que rinde el General Lzaro Crdenas al Honorable Congreso de Michoacn, XLII legislative period, Biblioteca y Archivo del Congreso de Michoacn, box 1, folder 19. See also Informe que rinde el Sr. Dr. Leopoldo Escobar, Secretario General Tesorero de la Asociacin Mdica Mexicana a la Asamblea General Extraordinaria el 1651932, in Enrique Arregun Vlez personal archive. Juan Jos Alcocer Campero, La salud pblica en Michoacn (Morelia, Mexico: Universidad Michoacana de San Nicols de Hidalgo, 1983); J. Alvrez Amzquita, Servicios mdicos rurales cooperativos, in La salud rural en Mxico, ed. H. Hernndez Llamas (Mexico City: IMSS, 1984), 93108; and Miguel Angel Gonzlez-Block, Gensis y articulacin de los principios rectores de la salud pblica de Mxico, Salud Publica de Mxico 32 (1990): 33751. H. Hernndez Llamas, Introduccin, in La salud rural, 1120; Alan Knight, The Rise and Fall of Cardenismo; Guillermo Ramos Arizpe and Salvador Rueda Smithers, Jiquilpn, 19201940 (Mexico City: Centro de Estudios de la Revolucin Mexicana, 1994); Raquel Sosa Elzaga, Los cdigos ocultos del Cardenismo (Mexico City: Plaza y Valds Editores, 1996). For the history of the agrarista movement in Zacapu, see Paul Friederich, Agrarian Revolt in a Mexican Village (Chicago: University of Chicago Press, 1977). See also Gerardo Snchez, Los pasos al socialismo en la lucha agraria y sindical en Michoacn, 19171938. Clarence Senior, La revolucin llega a La Laguna (La democracia en el reino del algodn), in Llamas, La salud rural, 11025. Gmez Trillo, personal communication with author, February 1999. The fact that Nicolaita Eduardo Villaseor was the director of the Banco de Crdito Ejidal between 1936 and 1946 further hints at the influence that the graduates from San Nicols played on the program for agrarian reform. Enrique Arregun to Enrique Villagmez, April 24, 1936, in Enrique Arregun Vlez personal archive. Vlez, El charlatanismo en la profesin mdica; Arregun From the Bloque de Jvenes Revolucionarios Michoacanos; Vlez, Algunas consideraciones..

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35. Alcocer Campero, La salud pblica en Michoacn; Manuel Crcamo Mendizbal, El Departamento de Salubridad Pblica como institucin revolucionaria, July 10, 1935, Archivo Histrico de la Secretara de Salud y Asistencia, RG Public Health, juridical section, box 42, folder 19; Los servicios de higiene rural y medicina social dentro del Departamento de Salubridad Pblica (Mexico City, 1941), Archivo Histrico de la Secretara de Salud y Asistencia. RG Public Health, section salubridad pblica y asistencia, box 15, folder 1. See also Secretara de Salubridad y Asistencia: Direccin de servicios mdicos rurales cooperativos: Resea histrica, Boletn informativo: Organo de la Direccin de Servicios Mdicos Rurales Cooperativos 1 (January 1961). 36. Crcamo Mendizbal, El Departamento de Salubridad Pblica; Secretara de Salubridad y Asistencia. 37. Confederacin Campesina Emiliano Zapata del Estado de Puebla al General de Divisin, Lzaro Crdenas, December 18, 1935, in Archivo Histrico del Departamento de Salud Pblica, fondo salubridad publica, seccin jurdica, box 31, folder 14. 38. Diario del Primer Congreso Nacional de Higiene Rural, Morelia, Mexico, November 4, 1935. In Arregun Vlez personal archive, Colegio de Michocn, Zamora, Mexico. 39. Crcamo Mendizabal, Los servicios de higiene rural. 40. Los Servicios Coordinados Ejidales (paper presented at the Primer Congreso Nacional de Salubridad y Asistencia, in Archivo Histrico de la Secretara de Salud y Asistencia. RG Secretara de Salubridad y Asistencia, box 1, folder 7. 41. In 1938 the office reverted its title to Servicios de Higiene Rural y Medicina Social. 42. Alcocer Campero, La salud pblica en Michoacn; Crcamo Mendizbal, El Departamento de Salubridad Pblica, Los Servicios de Higine Rural, and Secretara de Saludbridad y Asistencia. Also see Whetten, Salud y mortalidad en el Mxico rural, in Llamas, La salud rural en Mxico, 14780. 43. Anonymous draft on the organization of a system of a compulsory social service for rural doctors (paper presented at the Congreso de Higiene Rural, Morelia, Mexico, 1935); in Enrique Arregun Vlez personal archive; Proyecto de ley creando Unidades Sanitarias Ejidales, Archivo Histrico de la Secretara de Salud y Asistencia, RG Public Health, Section Servicios Jurdicos, box 47, folder 9; 19. See also Whetten, Salud y mortalidad en el Mxico rural, 14780. 44. See Informe de las obras ordenadas directamente por el Presidente de la Republica que corresponden a este departamento, October 1938, in Archivo Histrico de la Secretara de Salud y Asistencia. RG Public Health, section servicios jurdicos, box 50, folder 15, 13. See also Relacin de las peticiones hechas al seor Presidente de la Repblica en su ltma jira al estado de Guerrero que corresponden al Departamento de Salubridad, in Archivo Histrico de la Secretara de Salud y Asistencia. RG Public Health, Section Servicios Jurdicos, box 46, folder 2. 45. Crcamo Mendizbal, El Departamento de Salubridad Pblica. 46. Memorandum #70, in Archivo Histrico de la Secretara de Salud y Asistencia. RG Public Health, Section Servicios Jurdicos, box 514, folder 22. 47. Gmez Trillo, personal communication with author, Morelia, February 1999. See also Confederacin Campesina Emiliano Zapata del Estado de Puebla al General de Divisin, Lzaro Crdenas, December 18, 1935, in Archivo Histrico del Departamento de Salud Pblica, RG Salubridad Pblica, Section Servicios Jurdicos box 31, folder 14. 48. Whetten, Salud y mortalidad en el Mxico rural. See also Los Servicios Coordinados Ejidales. 49. Whetten, Salud y montalidad en el Mxico rural.