Medicine in Mexico: From Aztec Herbs to Betatrons 9781477306352

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MEDICINE IN MEXICO From Aztec Herbs to Betatrons

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THE TEXAS PAN AMERICAN SERIES

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MEDICINE IN MEXICO FROM AZTEC HERBS TO BETATRONS

by GORDON SCHENDEL written with the collaboration of Dr. José Alvarez Amézquita Dr. Miguel E. Bustamante

UNIVERSITY OF TEXAS PRESS, AUSTIN

The Texas Pan American Series is published with the assistance of a revolving publication fund established by the Pan-American Sulphur Company and other friends of Latin America in Texas. Library of Congress Catalog Card No. 68-24663 Copyright © 1968 by Gordon Schendel All Rights Reserved

To Margaret, in appreciation

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NOTES ON SOURCE MATERIAL This book is intended both for members of the medical profession and for the general public. Accordingly, while technical data of special interest to physicians have been incorporated, the overall presentation is journalistic. Intriguing relevant data, little-known historical incidents, and some illustrative anecdotes are included with the basic facts. This broad treatment provides a picture in depth, on many levels, of the medical and public health fields—and simultaneously affords a whole new perspective on Mexico's past and present. ANNOTATION

To achieve maximum readability for both medical doctors and laymen, footnotes have been held to a minimum. For example, some medical terms, but not all, are explained in footnotes. To explain all would be at once time-wasting and irksome to physicians, and tedious and of little real significance to those outside the profession. The less familiar medical terms defined here are chiefly those that either delineate a general subject under discussion or may have some particular interest for laymen. Terminology employed in a (rarely included) technical passage, such as a step-bystep surgical procedure, clearly of importance only to physicians, is not interpreted. Absence of profuse annotation does not mean that supportive data, references, and explanatory notes have been omitted. Much material that might have been presented in footnote form instead has been embodied in the text. SOURCE MATERIAL

Sources of information usually are indicated in the text, or in annotation. If unspecified, as some widely known or long-accepted data, the sources ordinarily He in the relevant books in the Bibliography.

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But it is difficult (in fact, impossible) to enumerate every contributory source. Much miscellaneous and background information was accumulated over a number of years of research for other writing projects. Furthermore, a large part of this book is based on original material, rather than on data gleaned from standard reference works —on the findings of individual doctors, on a long series of interviews with authorities concerned, and on my own investigations and observations in Mexico. The following are the main categories of source material: 1) Reference books, as itemized in the Bibliography. The Bibliography is a representative listing only, and general reference works consulted, such as encyclopedias and medical texts, are not included. 2) Records of Mexico's Department of Public Health and Assistance. This category includes (in addition to several published volumes named in the Bibliography) the Department's voluminous records and reports on its huge body of routine undertakings, special projects, surveys, vital statistics—complete records on achievements throughout the nation during the 1958-1964 administration of Mexico's President Adolfo López Mateos. It includes, also, the Department's records on preceding administrations and its archives of historical source material, plus some original documents now in the National Archives, and archeological and anthropological material now at the National Museum of Anthropology. 3) Medical papers (published and unpublished) by individual doctors and medical teams. This category consists of hundreds of often highly technical papers written by medical doctors from Mexico, the United States, and Latin America, reporting to members of their profession on their findings—in laboratory research, animal experimentation, clinical testing, special studies and surveys, significant case histories, results with new treatments, drugs, and surgical procedures—in their particular specialty or field of activity. Most of these papers were published in medical journals or read before medical congresses. 4) Interviews with government officials and doctors. This is another major category of source material. In years of writing about Mexico, I privately interviewed a number of Mexican government officials and most of the nation's leading doctors. These authorities in the medical and public health areas included, of course, numerous officials in the Department of Public Health and Assistance; officials

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of the Mexican Institute of Social Security; officials of the Institute of Security and Social Services of the Workers of the State; directors and sub-directors at the National Institute of Cardiology, the National Institute of Tropical Diseases, the National Institute of Nutrition, and other national institutions; the rector of the National University; heads of government medical schools; heads of various government hospitals and private hospitals; many doctors in private practice, from specialists in the nation's capital to general practitioners in distant cities and towns. Other officials in different fields that I privately interviewed, discussing matters related in one way or another to medicine or public health, included two former Presidents of Mexico, Lic. Emilio Portes Gil and General Lázaro Cárdenas; several past and present members of presidential Cabinets; senators and deputies. 5) Personal investigations and observations. Some of the material in this book stems from events, incidents, customs, and conditions that I personally investigated, observed at first hand, or experienced in a dozen years of living in Mexico. 6) Published articles. In covering Mexico as a correspondent for U.S. medical publications, I have written and had published over two hundred articles reporting on doctors' activities and findings. Many were based on the doctors' technical papers; others on doctors' speeches and discussions at medical conventions and seminars, or their disclosures to me in private interviews. Some of my articles, originally published in the Medical Tribune (World Wide Medical News Service, Inc., New York City) are incorporated, with minor revisions, in this book. 7) Material provided by Dr. Amézquita and Dr. Bustamante. As Mexico's Secretary of Public Health and Assistance, and Undersecretary of Public Health, respectively, for the 1958-1984 period, Dr. José Alvarez Amézquita and Dr. Miguel E. Bustamante unquestionably are the two top authorities on all aspects of medicine and public health in Mexico throughout their terms of office, and are experts on medical and public health history, as well. They collaborated in this book and contributed much to it. In covering medical developments in Mexico, I became well acquainted with Dr. Amézquita and Dr. Bustamante. One day when I was doing some research at the Department of Public Health and Assistance, Sr. Gerardo d'Isolbi, the Department's director of public relations (and an editor of Siempre, Mexico's leading political publication), suggested that I write this book—an undertaking I already

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had in mind. A series of conferences with the Secretary and the Undersecretary followed. Dr. Amézquita and Dr. Bustamante were interested in collaborating in the book I proposed on medicine and public health in Mexico, presenting a panoramic view of past and present, based on a wide spectrum of governmental and nongovernmental sources—a book designed not only for Mexicans but for persons everywhere interested in Mexico and its achievements; not only for medical doctors and members of allied professions but for the general public. Dr. Amézquita and Dr. Bustamante made available all the material derived from their department's facilities and archives and provided the benefit of their own great experience and knowledge in the field (much of which is included in their four-volume Historia de la Salubridad y de la Asistencia en México). Their personal support and cooperation continued during the writing. For their participation in this book I wish to express my sincere thanks and appreciation. E X T E N T O F COVERAGE

The first part of the book deals with medicine and public health in the Aztec era, ending with the Spanish Conquest in 1521; the second part covers the Spanish Colonial period, that continued until 1821; the third part brings the story of medicine in Mexico up to the present. Records and statistics in government archives are complete through December 1,1964. That date marks the end of the administration of Mexico's President Adolfo López Mateos and the completion of that administration's integrated direction of six years of medical and public health programs. (Mexico's Presidents serve a single, six-year term; hence governmental planning has a sexenio, or sexennial, base.) The administration of President Gustavo Díaz Ordaz is in its initial stage as this account is written and its records are not yet accessible. Only a few of its early statistics could be included. As would be expected, however, most programs conducted by the Department of Public Health and Assistance during the López Mateos administration are being continued and advanced. GORDON SCHENDEL

PREFACE

Not long ago, during the Second Mexican Congress on Public Health, held at the National Medical Center in Mexico City, visiting public health authorities and doctors from Europe, the United States, and South America paid enthusiastic tribute to the recent achievements of the Mexican Department of Public Health and Assistance. These achievements, unquestionably impressive, included the eradication, by means of intensive nationwide campaigns, of several epidemic and endemic diseases which for centuries had plagued the population. And they included the swift construction of not only the Medical Center complex of auditoriums, research laboratories, and specialized hospitals with the latest and costliest equipment (including betatrons), but a coast-to-coast network of modern clinics, hospitals, and health centers, to bring basic medical care to the country's lowest economic levels in their home environments. However, concurrent with all the reports and evidence of such forward strides at the Public Health Congress, across the city at the internationally known National Institute of Tropical Diseases the director was hearing an all-too-familiar tale of obstructionism: The chief of a mobile medical brigade which had just returned from the jungles of Chiapas, in Southern Mexico, was reporting on the slow progress of the campaign there to stamp out blindness-producing onchocercosis. He was describing the latest sabotaging tactics being employed against the vital work of the brigade by the brujos, or "witch doctors," among the primitive Indians indigenous to the region. Such paradoxical contrasts are commonplace in the operations of

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Mexico's Secretaría de Salubridad y Asistencia, or Department of Public Health and Assistance. They indicate the problems posed by the vast cultural variations—in terms of civilization measurable only by millenia—existing among the millions of recipients of the Department's attention. Mexico had a "Public Health Administration" operating under the Spaniards, almost a century before the Pilgrims first set foot on Plymouth Rock. Furthermore, beginning some two thousand years before the Colonial period, the Olmecs, Totonacs, Mayas, Zapotecs, Toltecs, and eventually the Aztecs—with civilizations in Southern and Central Mexico comparable to those of ancient Egypt, Babylonia, and China—were administering public health programs that, for their times, evidenced some amazing realization of health fundamentals. The pursuit of an optimum level of well-being by the successive dominant inhabitants of Mexico makes an extraordinarily engrossing story. For flamboyance, sweep, and drama it overshadows anything invented by Hollywood's moguls of the wide-screen epic. In addition, the record of medicine and public health administration in Mexico has a special importance in our swiftly evolving world. Having achieved political stability with an enlightened government, under a constitution based on social and economic justice for all, Mexico in a few short years has become a leader, and a model, for all Latin America in the fields of medicine, public health, and welfare, especially in rural areas. Moreover, Mexico's advances in these fields are of world-wide significance today: They demonstrate concretely, to all emerging and developing nations, what can be achieved by a progressive-minded government and its people, in a brief span of time, toward attaining the universal goal of a high level of life and health for all the population. G.S.

CONTENTS

Notes on Source Material Preface List of Illustrations

ix xiii xvii

PART O N E : AZTEC MEDICINE

1. 2. 3. 4. 5. 6.

Introduction Status of the Aztec Civilization The Role of Mythology in Medicine Aztec Public Health and Welfare Aztec G.P.'s and Specialists Aztec Herbs and Therapies Legacies from Aztec Medicine

5 7 16 32 45 62 74

PART T W O : SPANISH COLONIAL MEDICINE

7. 8. 9.

Introduction Medical Progress in New Spain Centuries of Killer Epidemics The Last Years of the Colony

83 85 102 113

PART T H R E E : MODERN MEXICAN MEDICINE

10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Introduction The Problem of Quacks and "Witches" Rural Medicine—With Hazards Fomenting Proper Hygiene Moving In on Malnutrition Improving Poor Environments Combating Tropical Diseases Colorful Mexican Institutions The Status of Medicine in Mexico Medical Research and Discoveries Facing the Future

127 131 148 164 178 193 205 235 250 274 298

Bibliography Index

301 305

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ILLUSTRATIONS (following p. 30) Tenochtitlán Tlazoltéotl Tláloc Tezcatlipoca Mayauel Xipetótec Quetzalcóatl Aztec Medical Practices in Mural at Teotihuacán (following p. 94) A Page from The Badianus Manuscript Hospital de San Hipólito Patio of the Hospital of Jesus Patio of the Hospital of San Juan de Dios Chapel of Hospital de San Lázaro Street Scene of Colonial Mexico City The Convent of San Cosme (following p. 206) Doctor Examining a Sick Child on Village Plaza Doctor Dressing Machete Wound Doctor Examining Pinto Victim Jungle Area Brigade Workers Spraying against Malaria Messenger of Health Number One Messenger of Health in Service Nurses Testing for Brucellosis Doctor Treating a Patient

A Play Demonstrating Sanitation and Hygiene Rural Midwives in Class Searching for Pinto Victims Public Washstands A Scorpion-Proofed Hut Teaching Rural Inhabitants Proper Hygiene Preparing a Patient for Treatment with a Betatron Children at Dinner Mural by Nishizawa Detail of Mural by David Alfaro Siqueiros Auditoriums of the General Hospital, National Medical Center Scale Model of the National Medical Center Hall of Congresses, National Medical Center La Independencia Sanitary Unit Social Security Clinic Rural Health Center Urban Health Center The Doctors' Bullfight Drs. José Alvarez Amézquita and Miguel E. Bustamante

Part One

AZTEC MEDICINE

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Introduction The great Indian civilizations that once flourished in what is now the Republic of Mexico left a tremendously rich heritage. Many of the achievements of Indian Mexico have vanished, but much remains, not only in awesome ruins of architectural wonders, magnificent artifacts,* fragmented records, and surviving folklore, but in subtle influence upon today's socioeconomic structures. All of the ancient Indian civilizations—the Olmec, Totonac, Mayan, Mixtee, Zapotee, Toltec, Aztec, and others—were, of course, equally "Mexican": All were part of, and shaped, the history of Mexico. And all contributed to modern Mexico. Unfortunately, there is space here to consider only the last of the fallen Indian civilizations, that of the Aztecs. But far more is known of the Aztecs than of their predecessors, for they were at their apogee when the first Europeans arrived. And to concentrate upon their civilization is, actually, not to slight the others: The Aztecs were heir to the previous great cultures, and what today is called "Aztec" embodies much of the finest of what was evolved by the earlier nations successively dominant in Middle America. * Collections of the nation's archeological treasures are on display in Mexico City, at the very handsome new National Museum of Anthropology.

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CHAPTER ONE

Status of the Aztec Civilization

The Aztec Empire of pre-Cortesian Mexico. . . . The first scene these words evoke in the popular mind is horrendously barbaric: Priests with hip-long, blood-matted hair waiting atop a lofty truncated pyramid, as a line of doomed prisoners files upward. The first victim seized, head, hand, and foot, by five black-robed priests and flung, spread-eagled, on the convex sacrificial stone—his bare chest conveniently arched, ribs expanded. The red-mantled executionerpriest slashing swiftly with a black obsidian knife. His practiced hand wrenching out the still-wildly-beating heart. A fountain-spurt of hot blood drenching victim, priests, and reeking altar. And another human heart held high toward the sun, then placed before a forever insatiable stone god. . . . Mass human sacrifices to "bloodthirsty" pagan idols, however, formed only one facet of an impressive civilization that in other ways equaled that of ancient Egypt—which it resembled in several particulars, most patently in the construction of enormous pyramids. Furthermore, the Aztec sacrifices—unlike the circuses of death staged in the Roman Coliseum—were no mere spectacles to entertain a jaded populace. From the Indians' viewpoint, there were important reasons for the excision from living bodies of so many human hearts. What was the status of medicine and public health in the Aztec world? The fields of medicine and public health quite naturally were influenced by the general cultural development. Hence, before nar-

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rowing focus on these fields, it is relevant to review the overall status of the Aztec civilization. From the Lake Mud, Caesars The Tenochcas, or Nahuas, later called the Aztecs—probably one of the last of the Indian (or more accurately, Mongolian) tribes which had migrated from Asia by way of the Bering Strait—arrived in the mile-and-a-half-high, mountain-rimmed Valley of Mexico in 1168 A.D. and settled on marshy islands in the large shallow lake that covered much of what is now Mexico City. According to legend, the wandering tribe, previously foot-loose (and footsore; it had no riding animals), had chosen this site upon seeing an eagle, perched on a nopal cactus on a rock, with a rattlesnake in its beak. The Tenochcas' priests long before had foretold that just such an omen would indicate where they should halt and eventually build their city, Tenochtitlán. (The flag of the modern Mexican Republic immortalizes the Eagle and the Serpent and that symbolic founding of the nation's capital.) The Indian races which had preceded the Aztecs into sunny, fertile Middle America—the Western Hemisphere's "cradle of civilization," comparable to the once-lush area bracketed by the Tigris and the Euphrates—long before had evolved impressive city-states. The greatest of these—such as the nearby Toltec 1 Teotihuacán, containing the enormous Pyramids of the Sun and Moon, and, in the lowlands, Uxmal, Palenque, Chichén Itzá, and almost numberless others jungle-buried Mayan cities—all already had been mysteriously abandoned and lay in majestic ruins. As newly rooted nomads, the Aztec islanders lived humbly on whatever swimming and crawling creatures they could get from the lake, and hired themselves out as mercenaries to various of their longestablished and much more prosperous neighbors in the Valley, who carried on intermittent warfare with each other. By 1325, constant practice as mercenaries had enabled the Aztecs to develop into such a formidable military force that they were in1 The vanished builders of Teotihuacán, here called Toltecs, have been variously identified as Toltecs, as Totonacs, as Otomies (!) and, most safely of all, simply as Teotihuacáns (teotihuacanos). The Toltecs themselves, although evidently of the early-arrived Nahuatlán tribes, have been linked by some to the Olmecs, and, culturally at least, to the Mayas, with whom certain Toltec tribes eventually merged.

STATUS OF THE AZTEC CIVILIZATION

9

spired to turn on, conquer, and annex one after another of the nearby nations that so helpfully had been employing and perfecting their war-making talents. By the time the Spanish adventurer Hernán Cortés and his band of 553 soldiers landed at what is now Veracruz, the Aztecs ruled a mighty empire that stretched from the Gulf Coast to the Pacific Ocean, south to Honduras and Nicaragua, and as far as they wished to dispatch their armies into the arid, sparsely inhabited north. In building their empire, the Aztecs not only had annexed the domains of their neighbors but shrewdly had taken over their far more advanced cultures—either in toto or with a few modifications. Relatively little in the subsequent Aztec culture was purely Aztec. But the fact that these people were heir to older Indian civilizations in no way detracts from their achievements. (All civilizations build upon preceding ones. Not to do so would require each developing nation to re-invent the lever and the wheel. 2 The ancient Greeks derived much from Egypt; subsequently the ancient Romans carried off and held captive in Rome the leading Greek philosophers and teachers, to acquire the magnificent Greek culture directly. And, after World War II, both the U.S. and the U.S.S.R. obtained much of their technical knowledge on rocketry and satellites from German experts who worked with their own scientists.) In short, thanks to their warriors' vigor and their leaders' ability to recognize and adopt a superior culture, the Aztecs effected one of history's speediest evolutions from primitive nomadic level to advanced, urban-centered civilization and dominance over their world. In their swift upsurge, drive, efficiency, and imitative-inventive capacity to absorb and expand upon other peoples' highest achievements, the Aztecs might be dubbed "the Japanese of Indigenous America"—quite as the Japanese today, due to similar qualities, often are nicknamed, by other Orientals, "the Americans of Asia." 2 The inhabitants of Middle America did not employ the wheel, although discoveries of tiny wheeled toys at archeological sites indicate that the principle was known. Actually, the wheel would have been of little practical use in ancient Mexico: The Aztec capital was a city of canals. Most commerce moved over high mountains and across terrain gashed by deep ravines or choked with jungle undergrowth—on narrow footpaths along which no wheeled vehicle could have passed. Moreover, there were no available dray animals (or beasts of burden). All goods were transported by boat or on the backs of human porters (there were slaves unlimited).

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What the Spaniards Found When the Spanish conquistadores penetrated Mexico, in 1519, they were frankly awestruck by the Aztec civilization. The bustling capital, Tenochtitlán, in the center of the lake—a huge city, threaded by canals and reached by miles-long, broad stone causeways; with hundreds of pyramidal temples and many white or flamboyantly colored palaces, all gleaming in the brilliant sunlight— reminded Cortés of Venice. One of his soldiers, Bernal Díaz del Castillo, in his classic chronicle, The Discovery and Conquest of Mexico, written over a half century later, remembered it as a veritable enchanted city. The magnificent palaces, with their acres of rooms, sumptuous courts and roof gardens, fountains and pools, and the equally luxurious country villas and outlying elegantly landscaped estates of the rulers and the nobility; the high level of agriculture and horticulture; the Empire-wide commerce which resulted in the capital's fabulously stocked central market; the beautifully executed murals and sculptures; the extensive archives and libraries of codices; the clearly demonstrated scientific progress; the privileged status of poets, painters, sculptors, and fine artisans in featherwork, gold, silver, and precious stones—all these were immediate overwhelming evidence of an advanced state of civilization. The Aztec Emperor Moctezuma II lived in his vast jasper-pillared palaces in Oriental splendor. He had a harem of hundreds of beauties selected for him from all his subject city-states. He was attended by thousands of courtiers, officials, aides, servants, entertainers, and palace artisans. He permitted only the nobility to wait on his personal wants; even they were required to avert their eyes from his face. He drank spiced chocolate from gold vessels and dined on his choice of over one hundred prepared dishes at each meal—including fresh ocean fish, exotic game, and fruits rushed daily from the Gulf Coast and tropical forests by fleet-footed relay runners. He had a virtual wirephoto news service, with messages and on-the-spot news drawings sped to him by the same means from all parts of his empire. He dressed in a feather mantle, a richly embroidered girdle, and gold sandals, all sprinkled with pearls and gems, and a headdress of the royal green quetzal plumes. He reportedly bathed and changed his apparel four times daily, discarding every item after wearing it once. (The doomed Emperor's obvious great wealth, his far-flung, over-

STATUS OF THE AZTEC CIVILIZATION

11

extended empire, the voluptuously sybaritic manner in which he lived, and even his excessive bathing combined to form a close parallel with the way of life of the luxury-steeped rulers of the Roman Empire just before Rome fell to the unwashed barbarian hordes. Completing the parallel is the fact that in the Europe from which the Spanish conquerors came baths were almost as rare as among the sackers of Rome. (From which repeating pattern a cynical observer might deduce that overmuch bathing is a fateful symptom of national decadence and imminent downfall. And that therefore those who today fancy gold-plated, push-button bathrooms as "status symbols" might be wise to ponder the handwriting on the marble walls.) Aztec

Government

Despite the opulent way of life of ruler and nobility, the Aztec government was more democratic than any of Europe's absolute, hereditary monarchies. In the first place, the Aztecs had—as the nineteenth-century historian, William H. Prescott, termed it—an "elective monarchy": Upon the death of an emperor, his successor was elected by a council of tribal leaders and regal advisors. The new emperor was chosen from among the defunct ruler's eligible male relatives, on the basis of merit. Experience as a military leader or as a priest was requisite; Moctezuma II had been both. In the second place, although the Aztec emperor ruled as head of state, high priest, and commander-inchief of the army, his power was not absolute. Both his advisory council and the priesthood made their influence felt. The Aztecs also had a well-developed judicial system which protected the rights of the lowly as well as of the highborn. In every city and town one or more magistrates presided over a "federal" court and dispensed justice according to the nation's carefully elaborated, rigid code of laws. Murder, theft, adultery, desecration, even drunkenness, ordinarily were punishable by death. Archives were filled from floor to ceiling with scrolls and books of ámatl paper, in which were inscribed all trial records, land deeds, genealogical records, tax and tribute lists, and other statistical information. Moctezuma II had improved the courts of justice during his reign and had personally exerted himself to see that the laws were strictly

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and impartially enforced. Although majestically aloof when with his imperial court, he often walked the streets of Tenochtitlán at night in disguise, to mingle with the common people and learn of any abuses or corruption of his courts and public officials. Thus, an Aztec plebe who had idly griped one night, to a chance acquaintance he had met along the main canal, about his inability to obtain relief from the barrio (district) judge against a wealthy neighbor's progressive encroachments on his humble homestead—might be astounded early next morning by a summons to a superior court. There, after repeating his complaint, and after the interrogation of all parties concerned, he might see his overbearing neighbor and the local magistrate brusquely turned over to the priests of the Great Temple for sacrifice, in a typical, speedy Aztec judgment. Under Aztec law, the women of Mexico enjoyed a status far superior to that of the women of Europe, who then legally were mere chattels of their husbands, with no rights as individuals. Aztec women approached equal rights with men: They could own property in their own name, go to court for justice, and even obtain a divorce if mistreated. The Conquest thus dealt a shattering setback to women's rights in Mexico—a situation that was not remedied until recent times. The Aztec government was administered by a sizable bureaucracy of public officials, drawn from the nobility and the male offspring of the Emperor's hundreds of concubines. Royal and noble youngsters destined for public office were specially educated. Pains were taken to insure that public officials remained physically and psychologically in the pink of condition to carry out their duties with bright-eyed efficiency. At the first yawn, they received special attention to ward off boredom and lassitude, which the Aztecs astutely recognized as two great enemies of effective public service. In fact, Aztec physicians treated fatigue as a disease—especially "the fatigue of those administering government and holding public office." (Government bureaucrats in all the world's capitals who today are ceaselessly shuflBing papers from "in" to "out" baskets, after boredly checking off their names on the route slip of each thick bundle, may agree that Aztec physicians had something here.)

13 The doctors prescribed rest, flowers, scented beverages, and other drinks whose ingredients included pep-producing herbs and "a pearl, wolf liver, and wine," cheerful singing, instrumental music, and the application of a fragrant, stimulating lotion to the bored bureaucrat's body—while psychologically potent charms and incantations were recited. All this was to be administered to drooping officials by eyepleasing feminine therapists. The Aztecs conceded the physician a key role in maintaining governmental excellence. STATUS OF THE AZTEC CIVILIZATION

Finally, it should be noted that the Aztec government—as was almost undreamed of elsewhere in that era—functioned as a veritable welfare state, for the benefit of its poorest citizens and its incapacitated war veterans. The Role of the Priesthood Education, the arts, sciences, and professions all were supervised by the Aztec priesthood—an arrangement to be expected in this basically theocratic state. Vast numbers of priests naturally were fully occupied with sacerdotal functions, such as attending the thousands of temples and presiding at sacrificial rites and religious festivals. But other priests (and priestesses) were assigned to serve as educators of the sons and daughters of the nobility in temple seminaries where children received stern instruction in religion, Aztec history, the laws and ethics, glyph writing, oral and written literature, and other subjects. Priests also served as historians, scribes, mathematicians, astronomers, and astrologers in the service of the state; and as research workers, instructors, and practitioners in the various Aztec sciences. Hundreds of priests functioned in these capacities in the medical field. Aztec Scientific Progress Thanks to the earlier civilizations to which they had fallen heir, the Aztecs were very advanced not only in the arts but, for their time, in the sciences. In mathematics, they had inherited the knowledge of the Mayans. And the Mayans had discovered the concept of zero and made some

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use of it as early as B.C. 2000—long before it was independently discovered in India and eventually introduced, via the Arabs, into Europe. In astronomy, the Aztecs had reached a fantastic level. Again probably largely through inherited (Mayan and Toltec) knowledge, the priestly astronomers—with only their naked eyes—had so well learned and mapped the movements of the stars that they could predict eclipses of the sun and moon with complete accuracy, centuries in advance. They expressed the mathematics of planetary cycles in geometric symbols and thus recorded their knowledge and made further calculations—according to the present-day Mexican astronomer Dr. Raúl Noriega, "with a perfection unmatched by any culture, ancient or modern." The ancient Mexicans, for example, knew the elapsed time from one transit of Venus to another. This was unknown in Europe until the seventeenth century, when Johann Kepler noted that a planet traversing its ellipse varies in a regular pattern, accelerating in approaching the sun and decelerating in departing from it. These Indians may have been more advanced than even twentieth-century astronomers in their knowledge of solar, lunar, and planetary chronological intercycles. Modern astronomy knows only twelve, but the Aztecs recorded at least forty minor and major intercycles and calculated these in their small and great magnitudes. Much of the Aztecs' astronomical knowledge is recorded in basrelief on the huge, twenty-four-ton Aztec Calendar Stone (known in Spanish as La Piedra del Sol, the Stone of the Sun) with 1,878 symbols inscribed in concentric rings about a mask of Tonatiuh, the sun god. It was completed in 1479, during the reign of the father of Moctezuma II. (Still only partially decoded, this archeological treasure is on display in the National Anthropological Museum in Mexico City. 3 ) The calendar the Aztecs employed actually was more uniform and more convenient than, and at least as accurate as, the one the world uses today. The Aztec year had eighteen months of twenty days each; the remaining five days were deemed "days of ill omen," on which no ceremonies could be held. Instead of our "leap-year" adjustment, the Aztecs interposed thirteen extra days every fifty-two years—which brought their calculations to within eleven minutes of absolute astronomical exactitude. 3 Its image is familiar to millions all over the world, as reproduced on countless Mexican tourist items, from leather handbags to silver jewelry.

STATUS OF THE AZTEC CIVILIZATION

Aztec

15

Medicine

In such a generally advanced civilization as that of the Aztecs, particularly one that showed striking progress in mathematics and astronomy, it was only natural that the science of medicine was developed to a remarkable degree. The Aztec practitioners were almost all specialists. And their wide employment of medicinal herbs amazed the Spaniards, who readily acknowledged Indian superiority in this field. In the raging battle for Tenochtitlán, Cortés and his soldiers demolished the city, stone by stone. Spanish priests who followed on the heels of the conquistadores located whatever Aztec books and codices had escaped the holocaust and consigned them to bonfires. But, soon afterward, certain other priests, together with a few educated Aztecs, painstakingly recompiled as much as possible of the old Indian medical lore. The Aztecs' many sound medical practices and extensive knowledge and use of medicinal herbs will be detailed in later chapters. Principal Sources William H. Prescott, History of the Conquest of Mexico; Bernal Díaz del Castillo, The Discovery and Conquest of Mexico, 1517-1521; and other histories and historic source material listed in the Selected Bibliography.

CHAPTER TWO

The Role of Mythology in Medicine

Mythology in any pagan culture plays an important and direct role in the concept of health and disease. The city-states of Middle America, which successively rose and fell over a period of 2,500 years, shared the same basic racial origin, cultural elements, and religious concepts. Even that keystone of the Aztecs' mythology—the Quetzalcóatl legend which was to bring their civilization crashing—had not originated with the Aztecs. They had adopted both the fatal legend and Quetzaloóatl's symbol, the Plumed Serpent, from the Toltecs, the once-dominant nation that had constructed the magnificent temple cities of Teotihuacán and Tula and then mysteriously vanished several centuries before the Aztecs founded their capital, Tenochtitlán. (The facts that the Aztecs nonetheless acquired the Number One Toltec god, that they reverently referred to abandoned Teotihuacán as the "City of the Gods," and that they even spoke the same language as the Toltecs, Náhuatl, suggest the possibility that they themselves originally had been a splinter tribe of Toltecs, or once had been slaves of the Toltecs, thereby acquiring their language and religion. ) All of Middle America's Neolithic peoples were in some fashion sun-worshipers and venerated a galaxy of gods and goddesses, whom they periodically propitiated in the hope of persuading them to maintain the beneficence of the sun and the forces of nature. The gods and goddesses, as will be shown, figured prominently in the medical lore of the ancient Mexicans, since it was believed that they possessed the power both to inflict and to cure diseases.

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Of Human Sacrifice Virtually all the Indian civilizations at one period or another employed human sacrifice, at least occasionally, to placate their gods and obtain desired favors. For that matter, most peoples of the world practiced it, to some degree, in an early stage of their cultural development. No other Middle American group, however, ever sacrificed such enormous numbers of victims, or placed such unending emphasis on the rite, as did the Aztecs. It is this factor of mass human sacrifice which has so detracted from the constructive achievements of the Aztecs and besmirched their name on the pages of history. And thus it warrants being placed in proper perspective here, before we get into the medical aspects of Aztec mythology. The apogee of the Aztecs' human sacrifices had been reached in 1486, when, to dedicate the newly completed Great Temple, or Teocalli (literally "god-house" in Náhuatl)—a huge truncated pyramid topped with two temples, one consecrated to Huitzilopochtli, the god of war, the other to Tezcatlipoca, the god of creation—Emperor Ahuítzotl caused seventy thousand war prisoners to be sacrificed.1 The bloody ceremonies lasted nearly a week, while captives (accumulated and hoarded for years for the purpose) waited meekly in ranks stretching two miles to mount the two-hundred-foot-high pyramid and be relieved of their hearts. No mass sacrifices remotely approached that scale after Moctezuma II ascended the throne. But thousands of human beings still were immolated each year. It should be noted that the Aztec priests effected their sacrifices in what might be termed a relatively humane manner. The act of immolation, though dreadful in form—the thoracic incision made with a surgeon's skill; the manual removal of the stillbeating heart—was mercifully swift. More important: For practical if not compassionate reasons (i.e., to dignify the rites and prevent disruptive final struggles or unseemly displays of fear), the priests dulled the senses of their victims, in advance, with narcotics. A first potent narcotic was given a prospective 1 According to Prescott, 70,000; to Torquemada, 72,344; to Ixtlilxóchitl, 80,400.

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sacrificial victim at dawn of the day he was to die. Later, before he was flung onto the sacrificial stone, a second narcotic—in the form of a powder—was blown into his face. Which explains why even huge groups of prisoners submitted passively, patiently waiting their turn to ascend the pyramid to certain death. In this sense, the ritual of sacrifice to the Aztec gods compared rather well with modern "humanitarian" methods of executing condemned criminals—and was far more mercifully accomplished than most executions in sixteenth-century Europe, where trivial offenses often drew the death penalty, and the occasional swift chop of the headman's axe was far outweighed by horrible slow death via garroting, hanging, burning at the stake, drawing and quartering, and/or assorted hellish devices for excruciating torture. How frequently the Aztecs practiced cannibalism has been hotly debated. Whether often or seldom, it is a fact that at times sacrifice was followed by cannibalism—in the form of an epicurean banquet privately staged by the warrior who had taken prisoner the pièce de r-sistance. (In such a case, after ceremoniously removing the heart for the gods and the skull for deposit on the temple's "trophy" racks, the priests returned the prisoner's body to his captor.) The Aztecs' cannibalism was nothing like that of primitive savages squatting about a campfire and gluttonously wolfing half-cooked human flesh and viscera. Rather it was a cultivated people's formal banquet (held in a stately, flower-and-incense-perfumed chamber) with a great number of foods elegantly served in gold and silver vessels— and the featured roast-haunch-of-warrior exquisitely prepared and seasoned according to one of several extant gourmet recipes. But such trappings of civilization only make the barbaric practice seem the more shocking and grotesque. Much has been made, correctly, of the debasing influence upon the human spirit, and upon an entire people, of the practice of cannibalism. Nevertheless, looking at it from a purely objective viewpoint, hardheaded realists might concede that once a man had had his heart and skull removed he could not be further harmed by being eaten. That, indeed, he thereby served a constructive community function in providing meat for a people who had no source of beef; whose only animal food was wild deer, peccary, the hairless dog, and small game.

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Some might even argue that the Aztecs' constant warfare—whose main objective was not to slay as many of the enemy as possible but simply to capture hordes of prisoners to herd back to Tenochtitlán for sacrifice (that, requiring removal only of their hearts, obviously left all the bodies to be disposed of some way)—might have been, in a secondary sense, foraging expeditions whereby the Aztecs hunted man for meat, as the North American Indian tribes hunted the vast herds of bison a bountiful Nature provided them. If so, among the Aztecs' elite Jaguar and Eagle Imperial Guards, the Number One topic of barracks-room conversation well may have been not the "comparative anatomy" of Tehuana and Tarascan maidens but, instead, the relative succulence of, say, a seafood-fed Totonac warrior from coastal Cempoalla and a corn-and-yam-fattened Zapotec from the Oaxaca highlands... . However, negating any such fanciful hypothesis, it is generally conceded that the Aztecs practiced cannibalism not primarily for nourishment but as a religious ritual. The flesh of an immolated person was deemed sanctified by the act of sacrifice to a deity. It was partaken of ceremoniously, in the belief that the eater thereby acquired special physical or spiritual benefits. The Aztec concept of cannibalism as a religious rite is not so unique, nor so purely pagan, as it may seem. There is a parallel in the Christian sacrament of Holy Communion—in which the devout, by swallowing consecrated bread and wine, symbolically partake of the body and blood of Christ. Christ himself instituted this sacrament at the Last Supper: And as they were eating, Jesus took bread, and blessed it, and brake it, and gave it to the disciples, and said, Take, eat; this is my body. And he took the cup, and gave thanks, and gave it to them, saying, Drink ye all of it; For this is my blood . . . (Matthew XXVI:26-28) The very term "host" for the consecrated Eucharistic wafer comes from the Latin hostia, which means "sacrifice" or "victim." (For what was the crucifixion itself but a human—or divine—sacrifice? Does not the Bible teach that Christ offered himself as a sacrifice—voluntarily gave up his life—to save mankind from the consequences of sin; in other words, precisely to provide spiritual salvation? This to be imparted thereafter through the symbolic act of Holy Communion?) Thus it seems undebatable that the Christian sacrament is a benign adaptation of a banned heathen practice—symbolizing the acquire-

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ment of sanctification, in the most direct way possible, through a physical act readily comprehended by even the most primitive people: the process of ingestion. Nor can we entirely shrug off primitive peoples' "naive" belief that desired attributes of an ingested subject (be these courage, strength, sexual potency, intelligence, virtue, or the ability to fly) automatically are acquired by the diner. Consider the provocative recent experiments by the Planaria Research Group of the Mental Health Research Institute at the University of Michigan, upon planaria, or ordinary flatworms (most notably, Dugesia dorotocephela): Worms which were fed chopped-up other worms that first had been conditioned to react to lights and electric shocks and to travel elaborate mazes subsequently learned the same reaction patterns themselves in 50 percent less time than required by worms that had dined only upon uneducated worms. In short, it was demonstrated that untrained worms can acquire much of the wisdom of their erudite fellows simply by eating them! This discovery—and the inference that memory may be retained not merely in the brain but throughout the body, perhaps via RNA (ribonucleic acid)—opens long-range educational vistas that stagger the imagination. Needless to say, the author intends none of the foregoing as a brief for cannibalism. Musings on Relative Morality Unquestionably, human sacrifice, and the religious-ritual cannibalism which sometimes followed, were revolting and barbaric acts— the two great flaws which marred the Aztec civilization. They seem in impossible conflict with an otherwise surprisingly refined and progressive culture. But the key to the paradox is that the great culture of Aztec Mexico had been evolved almost entirely by the Aztecs' predecessors—the Mayas, Toltecs, and others—who seldom had practiced human sacrifice. Large-scale immolation of human beings had been superimposed on the earlier Mexican cultures by the Aztecs—who, it should be remembered, had risen overrapidly from a primitive nomadic state. Hernán Cortés, though not unmotivated by the lure of Aztec gold, was convinced that in conquering Mexico he was conducting a Holy Crusade, to convert the heathen and stamp out human sacrifice. Accordingly, after every battle he dutifully sent pagan idols hurtling

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from their lofty temples, had the reeking blood-blackened altars whitewashed and the shattered old gods supplanted with a cross or an image of the Virgin Mary—while his chaplains hastily baptized large numbers of bemused Indian "converts." The Roman Catholic clergy who subsequently poured into New Spain, razing thousands of Aztec temples and burning tons of potentially priceless Indian manuscripts and records, similarly were convinced they were simply obliterating a demonic faith, to the greater glory of God. 2 Nevertheless, in this connection it must be recalled that the sixteenth-century Christians themselves were guilty of wanton bloodspilling—often also in the name of their religion. After the Conquest, the Spaniards committed many atrocities upon their remarkably submissive Indian subjects. Cortés, on a flimsy excuse, personally was responsible for the torture-murder of Cuauht-moc, the last Aztec ruler. 3 And the priestly agents of the Inquisition later burned several hundred "heretics" alive at the stake, in the Alameda—Mexico City's principal downtown p a r k . . . . In addition, it should be remembered that the Aztecs' human sacrifices during the whole of their relatively brief ascendancy—and their victims were chiefly adult male prisoners taken in war, convicted lawbreakers, and rebellious slaves—unquestionably totaled but a fraction of the number of innocent civilians, men, women, and children, who were incinerated alive in German and Japanese cities by the block-buster and atomic bombs deliberately dropped upon nonmilitary targets in World War II, merely "to undermine morale"—which indiscriminate mass murdering the "enlightened" Western victors then and ever afterward shrugged off as "necessary" and "therefore legitimate." The Aztecs, moreover, had fully as "necessary" and as "legitimate" reasons as the above for their mass killings. A primitive utilitarian purpose of the Aztec religion, like that of state religions since time immemorial, was to keep the people in line —subservient to the dictates of the ruling caste. And, as the Aztecs extended the boundaries of their nation to build a mighty empire, 2

The nineteenth-century American historian, Prescott, himself a Protestant, agreed that ending human sacrifice alone justified the Spaniards' conquest of Mexico and destruction of the Aztec culture. 3 Otherwise, Cortés was more of a humanitarian than many of his Spanish contemporaries: All his life, he opposed the Spaniards' outright enslavement of the Indians.

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they found their religion an effective tool to keep vassal nations submissive. In contrast to the "Christian" nations in the Old World, these Indians had little use for such diabolic torture techniques as the rack, the screw, and the practice of tearing a man apart with the aid of four horses; nor did they need dungeons for long-term incarceration. Their high priests always had immediate use for sacrificial raw material. Rebellions of conquered nations understandably became much less frequent when dissidents realized resistance to the Aztec overlordship inevitably would result in their ending up arched on a sacrificial stone in the Aztec capital. Dilatoriness in payment of taxes imposed upon a subject city-state seldom recurred once it was demonstrated that the penalty (like that the Athenians had been forced to pay the voracious Cretan Minotaur) was a forced levy upon its maidens and youths. A like admonitory effect was obtained in domestic affairs by the Aztec laws directing that criminals and recalcitrant slaves also be sacrificed. As will be referred to again shortly, the practice at times even was utilized as a public health measure: Potential epidemics usually were nipped in the bud by the orders to Aztec physicians to dispatch to the priests, for sacrifice, any patient with a "loathsome" or highly contagious disease. In addition, human sacrifice—perpetually called for, and consummated by, the priests—served the very realistic purpose for the priesthood of cementing theocratic control over the nation. Mythology The Aztecs' "moral" justification for human sacrifice was embedded in their mythology and religious beliefs—which also provided further compelling "reasons" for it. As an agricultural people, the Aztecs realized the sun was allimportant to their well-being. They were taught by their priesthood that, to maintain the energy that enabled it to continue shining, the sun required a diet of hearts and blood—and that the gods interceded for the people with the sun, daily offering themselves to it as divine sacrifices. (The sun god, Tonatiuh, was depicted in the center of the Aztec Calendar Stone hungrily waiting, with jaws wide and tongue lolling.) It followed, reasonably enough, that in return men

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must be offered up to the gods—so the deities could replenish themselves, after their daily self-sacrifice. The priests' principal effort therefore was directed at persuading the gods to continue to keep the sun shining. According to Aztec mythology, at the birth of the world the sun gave out no light. Furthermore, within the Aztecs' racial memory the sun reportedly had vanished for a considerable period, no less than four times. (This belief, the author suggests, may have had a factual physical basis—the long, sunless Arctic winters the ancestors of the Aztecs had endured in northern Siberia and Alaska during their slow migration from Asia. Possibly they literally had spent four years in the Far North.) Keeping this racial history vividly alive in the minds of the people, the priesthood constantly fanned superstitious fears that the sun might vanish a fifth time, perhaps permanently. To retain their dominance, they emphasized that they alone, by adequately propitiating the gods, might forestall such a dreaded calamity. It was believed the catastrophe was most likely to occur during the thirteen interposed "extra" days at the end of one of the fifty-two-year cycles into which the Aztecs divided time. Consequently, at such ominous periods there always was a national crisis: The nation went into mourning, all fires were quenched, household articles were broken, all normal activities, including sexual intercourse, were halted—and everyone waited with bated breath for the feared end of the world. Always, however, by means of prayers, incantations, and more human sacrifice, the high priests would manage to "save" the nation. During the most critical night, on a mountain peak overlooking the capital they ignited fagots thrust into the chest cavity of a sacrificial victim—and from the blazing new bonfire relay runners with torches relighted the fires of the nation's temples. This signaled that the sun would rise and shine that morning and every morning during the next fifty-two-year cycle. Note that the marvelously precise Aztec calendar itself seemed, to the devout Aztec, to confirm the need for human sacrifice. Finally, the priesthood credited the rites of sacrifice, instituted in primitive days, with the Aztecs' amazingly swift rise to become the unchallenged dominant power of Middle America, consistently victorious over nations with a long background of civilization. The nat-

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ural result was a compulsion to continue and even to increase the number of human sacrifices, on the theory that failure to daily satisfy the gods' appetite for fresh human hearts would offend them and cause them to stop looking upon the Aztecs with such favor. Mythology in Medicine The practice of medicine and surgery, and the conducting of medical research, were regarded as so important by the successive emperors of the Aztecs and by the powerful Aztec priesthood that it is not surprising there were not one but a large number of gods and goddesses who were identified with these fields. Individual gods and goddesses were believed to have the dual power to both cause and cure certain diseases, at will—and often were linked to specific herbs and other remedies. Thus the Aztec physician's treatment of illness frequently had to take into account the role of the relevant deity. Quetzalcóatl The overall most important god in the Aztec hierarchy of deities, Quetzalcóatl—the great god-teacher who was responsible both for much of the Aztecs' superior knowledge and for their eventual downfall—probably had a considerable, early influence on Aztec medicine. The Aztecs' version of the Quetzalcóatl legend, which they had adopted from the Toltecs, was as follows: Quetzalcóatl, who was described as tall, white-skinned, and with light hair and beard, mysteriously had arrived in a large ship, from the Gulf of Mexico, and had remained as a well-loved ruler for many years—during which he taught the ancient Mexicans much about agriculture, including the use of some medicinal plants, and the arts, crafts, and ethics. However, he aroused the anger of the Indian priesthood when he opposed, and attempted to end, human sacrifice. And after a losing power struggle with the priests on this issue, he left Mexico—sailing eastward into the Gulf as mysteriously as he had come. But not before predicting he would return in the distant future —"to re-establish his rule." Thereafter, he was worshiped as a god who had come to earth in mortal form. This legend is one of history's most provocative. Historians have differed widely as to whether Quetzalcóatl was purely legendary or had been a real person—and, in the latter case, whether he had been an Indian or a visitor from some remote land,

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possibly the lone survivor of a ship blown far off its course along the coastline of Europe or Africa. The author of this book herewith advances his opinion that Quetzalcóatl once did exist and most probably was a stranded Viking. In physical appearance Quetzalcóatl certainly resembled a Norseman. And he had come by ship, from the sea to the east. He allegedly had ruled the Toltecs in Tula, which was a "living" city between 900 and 1100 A.D. That happened to be the time also when the Vikings were roving farthest afield into the Atlantic—when these bold seafarers landed and built forts in Newfoundland, Rhode Island, and Delaware and, many believe, even went inland by way of the St. Lawrence River and the Great Lakes as far as Minnesota. Furthermore, it is particularly striking that Quetzalcóatl, "the Plumed Serpent," should have been so named (in Náhautl, quetzalli is the tail feather of the quetzal bird; cóatl is "serpent")—and symbolized, by both Aztecs and Toltecs, with a stylized feathered serpent. For the prows of Viking ships invariably were carved into the form of a stylized serpent's head, sometimes that of a winged serpent —and consequently were known throughout the Medieval Europe they pillaged as "dragon ships." And ancient paintings of Norsemen in battle dress depicted some wearing not only winged helmets but coiled-serpent armbands—in another Norse welding of the two symbols that, combined, attained such enduring significance in Mexico's great Indian cultures. Regardless of who or what Quetzalcóatl really was, the important point is that the Aztec Emperor Moctezuma II implicitly believed the legend of the bearded, white-skinned ruler-god and his pledged return. By one of the most fantastic coincidences in history, the Aztecs' priest-astrologers had predicted the year Quetzalcóatl would reappear from the east to reinstate his rule would be 1519. And this was the year the bearded, white-skinned Hernán Cortés, with his band of bearded and white-skinned conquistadores, arrived in ships from the Gulf of Mexico, landed at Veracruz, and marched resolutely inland to Tenochtitlán. It is thus completely understandable that Moctezuma reacted as he did—becoming increasingly worried and irresolute, uncertain whether to regard Cortés as friend or foe, as vulnerable man or invincible god to whom he was predestined to relinquish his throne.

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His indecision speedily cost him his empire. Quetzalcóatl, the author suspects, still may be watching over the destiny of Mexico—from the Mexican flag. The flag memorializes the legendary founding of Mexico City on the site where the wandering Aztecs saw an omen foretold by their priests: an eagle, with its wings outspread and a rattlesnake in its beak, perched on a nopal cactus on a rock in the lake. This entire scene is superimposed on the nation's green-white-and-red tricolor. But there may be an additional significance: It is very possible that the Aztec priests had selected the eagle-cum-snake omen because it was an obvious "natural" representation of the anciently revered Plumed Serpent—Quetzalcóatl. Quetzalcóatl was a fitting symbol to represent not only the past but the future greatness of the Mexican people. Huitzilopochtli Huitzilopochtli, the Mexican god of war, who had led the Aztecs to victory after victory as they forged their empire, not surprisingly was worshiped as the national patron. It was to the war god that the most human sacrifices were made; Prescott noted "his altars reeked with the blood of human hecatombs in every city of the empire." But Huitzilopochtli's name incongruously translates as "hummingbird-left" (his idol wore hummingbird feathers on its left foot), presumably because tradition had it that this god was of virgin birth, conceived when his mother tucked into her bosom a ball of brilliant feathers she had found floating in the air beside a temple. In due time he was brought forth (rather painfully, one presumes) as a fully accoutered warrior, complete with spear, shield, and towering feather headdress. Tláloc Tláloc was the rain god and, logically, also the god of respiratory diseases—pneumonia, tuberculosis, asthma, the common cold; all those ailments popularly associated with cold, wet, and stormy weather. Tláloc was supposed to dwell in a supernatural region in the eastern mountains—from whence came the rain clouds. And, as is understandable among an agricultural people, he was one of the most important deities in the Aztec pantheon. In fact, even today his name and awesome image carry weight in

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Mexico. Many country people still propitiate him—with food offerings or little rain dances—when their milpas, or corn patches, are threatened by drouth. Mexico City newspapers frequently dress up their weather stories with a humorous sketch of the ugly god. Capital sophisticates, perhaps not entirely flippantly, sometimes can be overheard muttering a hurried plea to Tláloc to withhold his rainy-season daily downpour—at least until after the first race has been run at the Hipódromo. And, early in 1964, when the National Museum of Anthropology sought to uproot and transport to Mexico City a two-hundred-ton stone statue of Tláloc, erected many centuries ago in Cuautlinchán, near Texcoco, hundreds of local farmers, declaring that loss of the god would bring drouth and perhaps illness to the area, mobbed the museum workers, angrily tore down the scaffolding and winches and cut the steel cables with which the ancient god was to be hoisted onto a specially built huge trailer platform. The government had to rush out soldiers to protect museum workers and equipment. And finally, avoiding bloodshed, a deal was negotiated with the inhabitants of the affected region, whereby—in return for the government's pledge to drill artesian wells to "replace" Tláloc—the farmers reluctantly relinquished their hoary old rain god. On the day Tláloc, chained to his enormous trailer powered by two diesel trucks, finally rumbled into the capital, the city was deluged with a terrific cloudburst: Storm sewers were flooded, traffic was tied up, and a retaining wall in the rear of a parking lot collapsed, burying thirteen cars! When the nation's newspapers front-paged this evidence of Tláloc's undiminished vigor, the governor of the drouthstricken northwestern state of Jalisco immediately wired a plea that he be permitted to borrow the great stone monolith. Tzapotlatena Tzapotlatena, venerated as the goddess of pharmacy, allegedly had "tipped" Aztec physicians to uxtli, a. wood-tar preparation which they employed extensively and effectively in treating various dermatological conditions. Tzapotlatena, incidentally, has been accorded recognition by the medical profession of modern Mexico: She was chosen as the symbol of Mexico's National Public Health Congresses.

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And a bas-relief of her decorates the base of the heroic statue of Hippocrates before the main entrance of the auditorium in Mexico City's handsome National Medical Center. Tonantzin The earth goddess, Tonantzin, was revered also as the goddess of medicine, especially of medicines derived from herbs, since she had under her care the welfare of all things that grow in the earth. Xipe Xipe, or Xipetótec, was the special god, or patron, of doctors, and in addition was deemed the god of skin diseases. He always was depicted (with what might be termed all-too-literal appropriateness) wearing the skin of a flayed human sacrificial victim. The most common dermatoses among the Aztecs prior to the Conquest apparently were scabies and abscesses; after the Spaniards introduced smallpox, this, too, was placed in Xipe's province (by incompletely converted Indians). Xipe furthermore was the special god, or patron, of goldsmiths, silversmiths, and gem-workers, and was believed to look after their welfare. However, when an Aztec god was a patron of a profession or craft, he was more an admonitory than a sympathetic influence. If any goldsmith or silversmith became afflicted with a skin disease, it was logically deduced he had failed in due veneration of Xipe and the god had punished him with one of the diseases in his quiver. And, worse, if one of these craftsmen became a jewel thief—with equal logic, he was summarily sacrificed on an altar dedicated to his "patron saint." Nanáhuatl An extremely repulsive-looking god, Nanáhuatl, had as his special province the causing and/or curing of what were categorized as "loathsome diseases"—which included what the Spaniards took to be leprosy, buboes, and elephantiasis. Amimitl Amímitl was a minor Aztec god principally remembered for his association with dysentery, which apparently was endemic in Mexico in the pre-Cortesian era.

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Xoaltecuhtli The god who presided over sleep and dreams, Xoaltecuhtli, was the patron of those members of the Aztec medical profession who might be regarded as counterparts of our modern psychiatrists. Mictlantecuhtli Mictlantecuhtli was the grim-visaged deity who presided over Mictlán, world of the Aztec dead—a dark, cold and subterranean hell. But not all the dead ended up at this dismal destination. Like most of the world's peoples, the Aztecs hopefully visualized an afterlife in which special rewards were handed out to the deserving. And, appropriately in a theocratic welfare state, such rewards were stipulated by the priesthood as accruing to those who had defended the state on the battlefield or who, through some other act beneficial to the state, had been deprived of the opportunity of enjoying to the fullest the good Aztec life. Specifically, Aztec warriors, sacrificed captives, and women who died giving birth to their first child were destined for the pleasant, sunny Aztec heaven. (Women who so died were regarded as minor deities and their fingers and hair were kept as charms. Interestingly, this belief in the deification of women who die in a first childbirth survives today among Mexico's Huastec Indians, on the Gulf Coast.) The Aztec dead were ceremoniously cremated and their ashes were kept in an urn in the home of relatives, who annually observed special periods of mourning for them. Coatlicue Coatlicue, who was depicted with a skirt of writhing serpents, was variously known as "Mother Earth," "Our Grandmother," and "Mother of the Gods." However, her most important role in the life of the Aztecs was as the goddess of death. Tlazoltéotl Tlazoltéotl, the Mexican Venus and goddess of carnal pleasure, was important to the Aztec medical profession because she was also the goddess of gynecology and obstetrics, pediatrics, and venereal diseases.

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And in line with her pediatric capacity, her priests were the sources of the horoscopes deemed vital for newborn infants. A plant dedicated to this love goddess (with fleshlike red petals and deep cup) was used to treat "an injured and roughly-handled body." Tlazoltéotl usually was depicted, like Xipe, in the flayed skin of a sacrificial victim. But, in her case, the flayed-skin costume was held to represent the annual rejuvenation of the earth with new vegetation. And she was extravagantly decorated with crescent moons, the universal symbol of the female and, hence, of fertility. Furthermore, she was almost invariably shown in the act of giving birth. Tlazoltéotl was also slangily known as "the Goddess of Filthiness" and "Devourer of Dirty Things," appellations that require a word of explanation. Revolting as her image appears at first inspection—clad in the stripped-off skin of a human sacrificial victim and sometimes with maggots at her lips—she was actually not a goddess of filth wallowing in corruption but quite the opposite: She was one of the Aztecs' earth deities. And it was believed that, just as the earth itself receives and absorbs garbage, corpses, and other putrefying matter until they are consumed, the goddess Tlazoltéotl had the power to consume the filth in the souls of men. Thus, she was actually a goddess of purification. And as such she rode herd on Aztec morals. The Aztec moral code over which Tlazoltéotl presided reflected a militaristic state's need for stability of the home and a sustained high birth rate. Chastity was sometimes enforced under a law whereby adulterers could be dispatched to the sacrificial altars. However, one "mistake" was allowed. If a sinner, inspired perhaps by the desire to avoid venereal disease or similar unwanted consequences, confessed his transgression to a different Aztec deity, Tezcatlipoca, he would be pardoned—a first mistake. In view of this puritanical moral code, the marriage customs of the Aztecs seem shocking: After the wedding of a presumably chaste young Aztec couple, the groom was not allowed to touch his bride for several nights. Her male relatives generously spared him the "contamination of newness" in his marital relationship.

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

Tenochtitlán, capital of the Aztec Empire. Drawing by The Anonymous Conqueror.

Medical Tribune drawing by Margaret Waltz Schendel

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

Aztec deities, sovereigns of health and disease. dess of medicine and maternity, from an Aztec Tláloc (top, right), the rain god; Tezcatlipoca health or illness, riches or poverty; and Mayauel,

Tlazoltéotl (top, left) goddrawing. Aztec drawings of (bottom, left), bestower of goddess of the agave.

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

Xipetótec (top), patron of doctors and of skin diseases, clad in the flayed skin of a sacrificial victim; and the major Aztec god, Quetzalcóatl, the Plumed Serpent. Both ancient sculptures are in the National Museum of Anthropology, Mexico City.

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

Aztec medical practices, as depicted in a mural at the archeological site of Teotihuacán.

Secretaría de Salubridad y Asistencia

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The Aztecs revered tradition and feared that here the quality of newness might affront the gods. More specifically, they may have believed that it was presumptuous for a mortal to wed a virgin; that only a god had that prerogative. (Virgins were regarded as fitting gifts for gods. Only they were deemed worthy of sacrifice by the ancient Mayas, in the cenotes, or sacred wells, on the Yucatán Peninsula. ) The Aztecs, then, had not one god of medicine but a veritable pantheon of deities individually identified with various medical specialties. These included Tzapotlatena, goddess of pharmacy; Tonantzin, goddess of medicine; Xipetótec, god of dermatology; Xoaltecuhtli, god of psychiatry; and Tlazoltéotl, busy goddess of gynecology, obstetrics, pediatrics, and venereology. In addition, many gods and goddesses who presided over nonmedical fields were associated with one or more diseases and with their cure. The specific remedies endorsed by the deities and prescribed by Aztec physicians will be discussed in a later chapter. Principal Sources William H. Prescott, History of the Conquest of Mexico; Bernal Díaz del Castillo, The Discovery and Conquest of Mexico, 1517-1521; and other histories and historic source material listed in the Selected Bibliography. Dr. José Alvarez Amézquita, et al., Historia de la Salubridad y de la Asistencia en México; Martín de la Cruz, The Badianus Manuscript.

CHAPTER THREE

Aztec Public Health and Welfare

The Aztec Empire was a prototype of the modern welfare state. In 1519 Cortés and his conquistadores were astonished not only by the splendor of the Aztec capital, Tenochtitlán, but by its many measures and installations to promote the health and welfare of the population. Old World cities of the time had virtually no sanitary facilities. Water supplies were generally so contaminated that few people drank the stuff and infants were weaned on wine or ale. Alleys were heaped with filth and were rat-infested. Periodically plagues and pestilences took a deadly toll. Assistance for the poor, ill, and handicapped in almost all of Europe at that time consisted only of desultory private charity to those who humbly begged it—a humiliating, demoralizing, and extremely imperfect solution to the problem, involving no obligation on the part of the ruling class. Some churches and charitable orders did what they could with the meager funds allotted to the purpose, but it remained private charity and on a hit-or-miss, drop-in-the-bucket basis. Unwanted infants were deposited at the doors of certain convents, whose nuns cared for them until they reached working age. Countless homeless orphans searched the gutters and begged or stole for food, or were relentlessly exploited under an oppressive apprentice system. Ragged beggars, including the sick and the dying, were everywhere, and their outstretched hands constantly reminded the more fortunate that a sizable proportion of the population was always half-starved. Soldiers who had lost eyes or limbs for prince or king generally received in recompense no more than the slight advantage a tattered uniform gave them in their alms-seeking.

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Contrast this situation with the contemporary scene in Mexico, as reported by eyewitnesses, including Cortés and his men-at-arms, various Catholic priests, and Aztecs who survived the Conquest. Aztec Veterans

Hospitals

The Aztec emperors had established a network of "war veterans' hospitals" strategically located throughout the Empire and staffed by government-paid surgeons and physicians. These hospitals were set up not only to care for soldiers wounded in the Aztecs' continual wars, but also to serve as a permanent refuge for disabled veterans and those retired from active duty because of age. Military hospitals were located in the principal cities of the Empire, including Tenochtitlán, Texcoco, Cholula, and Colhuacán. Wounded soldiers were invalided to such hospitals after having had emergency repairs performed upon them on the battlefield by surgeons and physicians attached to the armies. (Aztec military medicos were skilled in stopping hemorrhages, in setting and splinting broken bones, and in administering herbal potions and poultices which apparently healed wounds in a considerable proportion of cases.) These hospitals also accepted civilian patients who wished to be treated in them. It seems almost certain, however, that the majority of sick civilians were treated at home, by the physicians and specialists in private practice. Possibly, the nonveterans who sought cures in the state hospitals were chiefly charity patients. William H. Prescott, in his classic work, The Conquest of Mexico, quoted the sixteenth-century Spanish clerical scholar Torquemada as having written that the surgeons placed over the Aztec hospitals . . . were far better than those in Europe, in that they did not protract the cure, in order to increase the pay. Inasmuch as doctors and surgeons in the state hospitals were in the employ of the government, and free medical care was provided to soldiers and veterans (and perhaps also to needy civilians), the conclusion seems inescapable that this Aztec set-up was one of history's earliest examples of socialized medicinei Aztec Public Assistance The Aztec emperors had established a public assistance department for distributing food to the needy in their empire, which made

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begging unnecessary and minimized the undesirable concomitants of charity. The state hospitals for war veterans were utilized as regional headquarters for such public assistance. Maize—paid as tribute to the emperor by the subject nations—was distributed, at the hospitals, to the poor who requested it. (Tribute in the form of cocoa, foods, cotton, rubber, precious stones, gold dust, quetzal plumes, etc., was paid, twice annually, by 371 cities and towns, and, as in any empire, there was considerable grumbling in the provinces that taxation was excessive.) Murals in the ruins of Aztec temples depict this public assistance program in operation: The poor, wearing simple cotton shifts and barefoot, are shown receiving measures of free corn from public assistance agents, who, appropriate to their higher economic level, are pictured wearing elaborately decorated clothes and sandals. Care of the Malformed The Aztecs' solution to the minor problem of congenital cripples and human monstrosities also demonstrated a consciousness of social responsibility. On the other side of the Atlantic, deformed humans then were "exposed" to die immediately after birth, were sold to be exploited by street beggars, or remained a lifelong burden to their families. Only a few attained what for such unfortunates was regarded as the highest niche to be hoped for—a post as court jester or "pet freak" to some king or nobleman. Moctezuma II, however, established a refuge for human monstrosities, where they were cared for by the state as long as they lived. That this refuge adjoined the imperial zoo—and therefore shared the attention of the curious who came to see the captive wild animals, birds, and reptiles—while not commendable, does not nullify the basic fact that the Aztec state took care of all its malformed instead of callously ignoring them. Epidemiological

Controls

Although in the fourteenth to sixteenth centuries (and much later) Europe's crowded cities were periodically ravaged and their populations decimated by plagues and epidemics, Mexico's Aztec emperors already had evolved effective epidemiological controls within their huge empire.

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The principal reason for the recurrent outbreaks of disease that killed vast numbers in Europe during the Middle Ages and the Renaissance was the cities' almost complete lack of public sanitation facilities. However, another important factor was that European cities attempted virtually no epidemiological controls. Nevertheless, the royalty and nobility usually escaped unscathed during onslaughts of plague, by fleeing to their country estates and remaining isolated from the foci of infection until outbreaks had worn themselves out among the commoners. (It is noteworthy that, during an epidemic in England in 1563, well after the fall of the Aztec Empire, Queen Elizabeth I and part of her court took refuge in Windsor Castle, whereupon the Queen had a gallows specially erected on which to hang anyone else, sick or healthy, who might have the audacity to come out to Windsor from plague-ridden London. And a full century after that, in 1665, the Great Plague of London killed 68,000 people who, for economic or other reasons, had been unable to flee the city.) In contrast, Moctezuma II, upon coming to the throne, instituted an effective means of epidemiological control based on the valid principle of quarantine: He directed physicians to dispatch patients with unusual or very infectious or contagious diseases to isolation compounds, where they were held, sometimes permanently. He had one asylum for persons with incurable diseases built near his own palace at Tenochtitlán. Cortés reported that the main state isolation compound, which was located near the Great Pyramid in the Aztec capital, contained cases of what the Spaniards took to be leprosy, buboes, and elephantiasis. This main isolation building was dedicated to Nanáhuatl, the god of loathsome diseases. Patients taken here were treated chiefly with a tar preparation, teocotl. (Since some such patients very likely had psoriasis and no doubt during treatment all were exposed to sunshine, this may have constituted an early application of the principle of the Goeckerman treatment.) The public health policies of Moctezuma II thus evidenced a high degree of social consciousness and the Emperor's sense of responsibility for the welfare of all his people, commoners as well as nobles— an attitude then almost completely absent among ruling classes in other parts of the world. This emperor, incidentally, had established his quarantine system of epidemiological control as a presumably more effective, and cer-

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tainly more humane, substitute for the ruthless system in operation during the reigns of his predecessors. Previous emperors had effected epidemiological control merely by requiring physicians to turn over all persons with incurable or transmissible diseases to the priests, who speedily sacrificed them to the Aztecs' multiple gods. Shocking and drastic as was that policy, as a public health measure it was quite effective, and it constituted a realistic application of the democratic principle that government should aim always at benefiting the majority of its citizens. In the total number of deaths involved it undoubtedly cost the nation far less than if the Aztec emperors had followed the irresponsible, devil-take-the-hindmost attitude of so many Old World rulers and simply permitted epidemics to run their course among the commoners. Fumigation Whenever they honored the gods, the priests in ancient Mexico's cities burned oil of copal and the aromatic oils of cedar, pine, and the ahuehuetl tree in huge censers that sent pillars of black smoke skyward from atop the temple pyramids. The people burned the pleasant-smelling pine resin in their homes. Emperor Moctezuma II even smoked pine resin mixed with his tobacco. And, when Cortés and his soldiers arrived in the capital they noticed that wherever they were ceremoniously received many Aztec priests stood about waving censers from which billowed clouds of pungent smoke. It was a dual-purpose ritual: The Indian hosts were not merely honoring the newcomers with incense, as the Spaniards supposed; they also were attempting to protect themselves with the fumes from any diseases the strangers might be carrying. 1 The Aztecs were convinced that all illnesses not caused by some god's displeasure—for which, of course, there was no remedy other than placating the offended deity—were somehow mysteriously transmitted by humans through personal contact, or by the air and wind. Thus, although to an extent still the credulous dupes of the ancient "curse of god" rationalization of personal catastrophe common to all 1

The Indians' dread of diseases borne by strangers soon proved all too warranted.

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but the most modern cultures, the Aztecs' hypotheses actually had brought them close to the germ concept of disease. Their use of incense fumes "against infection" was an attempt at, and a forerunner of, modern fumigation and disinfectant practices. Their smoky, pine-scented incense doubtless was valueless as a germicide; nevertheless, it possessed some efficacy as a disease preventive, in discouraging the presence, in homes and wherever the Indians congregated, of mosquitoes, gnats, and flies—the principal vectors of several important diseases in Mexico. Governmental Facilities for Medical Research A field of medical knowledge in which the Aztecs were much farther advanced than their European contemporaries was dependent chiefly on the fabulous botanical gardens and zoos Moctezuma I (grandfather of Moctezuma II) had established in the capital city and elsewhere, most notably at Huaxtepec. Cortés and his Spanish soldiers were truly awed by these, for nothing comparable existed in all Europe, nor would there be anything similar until centuries later. The zoos contained animals, birds, and reptiles representative of virtually all the fauna of Mexico and Central America—from great restlessly padding jaguars and pumas to jewel-like quetzals and hummingbirds to hideous iguana "dragons" and poisonous serpents. Also included were thirty-foot boa constrictors from steaming swamps far to the south, giant condors from the remote snowy heights of the Andes, and a single bison, brought from the vast plains north of the Rio Grande. The botanical gardens, as described by Cortés, were no less than five miles in circumference. The number of different species of plants they contained—from towering deciduous trees, firs, cedars, and palms, to shrubs, cacti, water plants, vines, grasses, mosses and fungi —was estimated by various Spanish writers to be as high as two thousand. It should be emphasized that the Aztec emperors did not maintain the zoos and botanical gardens merely to provide something for "Sunday strollers" to gape at. Although emperor and nobility occasionally visited the imperial zoos and botanical gardens for diversion, these originally had been established and were maintained principally to provide the Aztec medical profession with raw materials for (1) medicinal formulae, and (2) even more important, medical research and experimentation.

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Moctezuma I had instructed his physicians constantly to experiment with all these plants as possible curative agents (using, in clinical testing, prospective sacrificial victims and/or members of the lower classes) and subsequently to treat patients among the nobility with those which proved most efficacious. The animals, reptiles, and birds in the imperial zoos were employed for the same purposes of experimental medical research, though to a somewhat lesser extent. Aztec physicians fairly often used animal matter in their therapeutic preparations. The huge number of plant species in the imperial botanical gardens, like the zoo animals, had been collected from Mexico, Central America, and even (via trading) the northern part of South America. In fact, Moctezuma I had a large staff of trained plant-hunters— the historical ancestors of our pharmaceutical firms' globe-circling pharmacognosists—crisscrossing the Aztec Empire, continually seeking additional species, whose flowers, fruit, seeds, leaves, barks or roots might possess medicinal value, for inclusion in the imperial botanical gardens. (It is significant that many pharmacognosists today consider Mexico to be richer in medicinal plants than any other comparable area in the world.) Thus, five centuries ago, the Aztecs had in operation what amounted to governmental medical-research laboratories. Manned by physicians assigned by the chief of state to conduct medical research and experimentation, these laboratories were supplied from enormous collections of live plants and animals painstakingly assembled from great distances by constantly traveling field teams. And the collections were maintained at the peak of natural condition by staffs of hundreds of gardeners and horticulturists and two hundred zoo keepers. Never until modern times was there another such extensive, wellorganized, and coordinated endeavor on the part of any government to widen the scope of medical knowledge. Public Works The water-bound, mountain-ringed Aztec capital, Tenochtitlán, housed a tremendous population for its time—at least 300,000 and perhaps far more. Its layout evidenced sound city planning and rather skillful civil engineering. From a beginning as mere mud-and-reed huts on un-

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desirable marshy islands, it had evolved, after extensive filling in and leveling of land, into a huge, gleaming, "garden city" metropolis— with a vast central plaza surrounded by great pyramidal temples, ornate palaces, stately mansions, and many thousands of smaller dwellings, all geometrically cross-hatched with straight paved streets and straight canals. It was connected to the mainland by several mileslong, broad stone causeways, whose removable bridges afforded passage to the canoes that plied the lake and served also as a defense measure, cutting off access to the island in the event of attack. The city was protected from floods by dikes with sluicegates. In addition, a long dike separated fresh-water and salt-water lakes, keeping one free of salt for irrigation purposes. The sanitary facilities equaled in excellence the other physical aspects of this well-designed and strikingly beautiful capital city. Public Water Supply Although Tenochtitlán was over eight thousand feet high in the mountains and in the center of a large lake, its inhabitants did not drink lake water as had their ancestors. Instead, there was a municipal water works (and sanitation system) that might have served as a model for most Old and New World cities for the next several centuries. The Aztecs conducted fresh potable water to their capital from springs in the Chapultepec hills several miles outside the city, by means of an impressive aqueduct that arced across the lake and was comparable to those that brought fresh water to ancient Rome. This Aztec aqueduct, as described by the Spaniards, really consisted of two clay-piped aqueducts, built side by side—each six feet wide and as high as a man. One was in use while the other was being cleaned or repaired. The fresh spring water then was piped to all the palaces and large mansions, and to public outlets and fountains throughout the city, from which housewives and servants carried it home in large clay ollas. In contrast, in most European cities at that time, public facilities for supplying inhabitants with potable water were almost always nonexistent or woefully inadequate. Usually, the only source of water was the river upon the banks of which the city was built—a prime source of disease, since it also served as the city's principal sewage conduit. Supplementary private water sources, such as shallow wells and cisterns in which rain collected after washing off the roofs, also

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often were contaminated by surface drainage and seepage from rotting garbage and excrement dumped in the streets and alleys. Public Sanitation and Sewage Disposal The strict sanitation observed by the Aztecs in Tenochtitlán was almost beyond belief. It was forbidden by law to dump refuse into the lake or into any of the canals which interlaced the city. (These canals, some adjoining streets, others serving as the only thoroughfare, caused the Spaniards to deem the Indian capital "the Venice of the Western World." But it was incomparably more hygienic than Venice. Even today, the atmospheric canals of the immortal Italian city smell like the open sewers they are.) "Night soil" was collected daily from Tenochtitlán's householders by crews of sanitary workers and transported by barges to the mainland, where it was profitably used as fertilizer on farms. Urine was sometimes collected separately, since it was used as a mordant in dyeing the cotton cloth.2 And—there were public latrines throughout the Aztec capital and even at strategic intervals along the causeways, so no pedestrian on a two-mile hike to the shore, no matter how slowly he plodded beneath whatever heavy load, or how inadequate his renal function, had excuse to defile the sparkling lake. In Europe in this era, where there were not only no public latrines but no sanitary sewers or garbage collections, the city streets were literally obstacle courses for anyone traveling on foot. (The wealthy went out in closed coaches or curtained sedan chairs. A gentleman was deemed inseparable from his horse, even in name: he was a cavalier in England, a chevalier in France, a caballero in Spain, etc. And with reason!) The pedestrian had to skirt rotting garbage heaps or wade ankle-deep in mire and keep a wary eye cocked upward, as well, to avoid being drenched head to foot whenever a chambermaid carelessly upended a chamberpot from an upstairs window—raining the household's excreta upon any passerby who could not leap quickly aside. Bernal Díaz, a soldier of Cortés' and well acquainted with the 2 A point of possible interest to today's tourists who buy the handsome but sometimes non-colorfast, hand-loomed cambaya cloth. For vendors nowadays recommend (somewhat more effetely) that nonfast material be specially washed in a solution of salt and vinegar.

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generally filthy condition of Europe's garbage-and-sewage-clogged cities, marveled in his eyewitness chronicle at the amazing cleanliness throughout the Indian capital. "In the streets in the vicinity of the Great Pyramid," he wrote, "not a straw or even a speck of dust could be found." Of all the streets, the Spaniards said: "A man could walk through them with as little danger of soiling his feet as his hands." The streets of Tenochtitlán were swept and watered daily by a reported one thousand street cleaners. All of this was supervised by the Aztecs' Public Health officials. And the "sanitary police"—health officers and inspectors—patrolled the city to enforce all the sanitary regulations and laws. The water-bound city that might so easily have become one vast cesspool and focus of infection was, instead, unpolluted and as clean as the proverbial hound's tooth. It is little wonder, what with pure drinking water and rigorously maintained civic sanitation, that the great Aztec capital escaped the periodic decimations by pestilences that cursed the capitals of Europe. Sic transit gloria! Soon the splendid city of Tenochtitlán was rubble. And, sure enough, soon pestilences were killing off the surviving Indians like flies. Personal Hygiene An important factor contributing to the Aztecs' high public health standards was the personal cleanliness of the population. The Emperor himself popularized bathing. As earlier noted, Cortés and his comrades-in-arms had been rather dumbfounded to learn that Moctezuma II bathed and donned fresh wearing apparel four times a day. Even the common people bathed daily. The Spaniards were impressed by the many bathhouses throughout Tenochtitlán, which Moctezuma I and his successors had established for the poorer classes, and to discover that homes of the Aztec nobility and middle classes all had their own bathrooms. (As the bug-eyed visitors continuously gaped at such "marvels," a disinterested observer might have found it increasingly difficult to remember just who represented the flower of European civilization and who the "ignorant barbarians.") Baths then were a rarity in the Old World. In fact, it has been said,

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without excessive exaggeration, that many a European in those days had only two all-out baths in a lifetime—the first at birth and the second on the eve of his wedding day. Otherwise, except for an occasional inadvertent wetting in a downpour or when forced to ford a stream, the upper classes usually doused themselves well with perfume and the lower classes philosophically observed that God obviously intended men and women to smell that way. The Aztecs not only washed themselves daily but were extremely fond of steam baths. Their manner of constructing their steam rooms and their protocol of the sauna would almost prove their Asiatic origin even if no other evidence existed. For there was a great similarity between their bathing habits and those of both the Japanese and another onetime Asiatic people, the Finns. The typical Aztec steam bath, known as temazcol, was taken in a closed, windowless room, under or upon whose stone or tile floor was an oven in which a fire was built. When the floor became sufficiently heated, cold water was thrown on it, and the bather then stood or sat in the resultant clouds of steam. The bather always was accompanied into the sauna by a physician, friend, or attendant—customarily of the opposite sex—who lashed him, or her, with branches of certain bushes or plants to stimulate circulation. The Aztecs took steam baths for a variety of reasons: for ritual purification, for general hygiene, and for simple relaxation. Steam baths were deemed especially salubrious for soldiers, pregnant women, and new mothers. And steam baths also were given to "sweat out" fevers and the venom of poisonous snakes and insect bites. The personal hygiene of the Aztecs included not merely daily bathing but additional measures aimed specifically at eliminating offensive body odors. In fact, the Aztecs of 1519 appeared nearly as concerned with the deleterious effects of unpleasant body odors upon social popularity and career as the Madison Avenue hucksters managed to make U.S. citizens in the 1930's. The Aztecs' preoccupation with deodorization, however, was not the artificially stimulated result of mass-media propaganda exhortations, cleverly geared to make millions of dollars for soap and deodorant manufacturers. The Aztecs apparently were fastidious—simply by personal preference.

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Halitosis, too, was a bugaboo of the Aztecs at least four hundred years before some razor-sharp intellect on Madison Avenue stumbled onto its potentialities for lucrative exploitation. The Aztecs had their own, noncommercial treatment for "fetid breath"—using salt and the leaf of a certain aromatic plant. They also cleaned their teeth regularly, using a noncommercial toothpaste composed of wood ashes (for abrasive effect) and honey (for its sweet taste and smell, as well as its cohesive effect on the ashes). The Aztecs even had a special prescription for eliminating sickroom odors and "the fetid odor of the infirm." It consisted chiefly of anointing the patient with a perfume composed of the mixed juices of crushed flowers, fruit, grain, and pine needles. And finally, regarding as highly objectionable any odor from the armpits, the Aztecs recommended, according to the Badianus Manuscript: A rank and goatish-smelling person is to enter a carefully-prepared bath, where he is to wash his armpits with great diligence. Then he must be washed with herb juice, and with a human bone and a dog bone ground up with sweet-smelling flowers. The herb juice and pulverized bone, the latter with abrasive qualities, mixed with "sweet-smelling flowers," constituted an effective perfumed cleanser and perspiration counteractant. The Aztecs extracted a "soap," or cleanser, for ordinary daily use, from the bruised leaves of the "soap tree." On reflection, it seems that the social task of entertaining the farless-washed, heavily clothed and armored Spanish soldiers must indeed have taxed the good manners of the fastidious Aztec Emperor and his retinue of nobles. It probably was more than fear of contagion that caused them to burn so much incense whenever in the company of their European visitors. The Aztecs' fortunate freedom from the plagues and pestilences that partially or totally wiped out other civilizations (perhaps including the Toltec and Mayan peoples who had inhabited the abandoned temple cities) undoubtedly was due to their epidemiological control and their extreme cleanliness. Inasmuch as the chief cause of today's population explosion all over the world, and particularly in underdeveloped areas, is the in-

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troduction of sanitation, plus antibiotics—and inasmuch as the Aztec nation both enforced a superior level of sanitation and managed to avoid epidemics—it follows that the Aztecs had the biologic preconditions for a "modern" population explosion, half a millenium ago! What might have happened in Mexico if the Spaniards had stayed at home is an interesting field for speculation Principal Sources William H. Prescott, History of the Conquest of Mexico; Bernal Díaz del Castillo, The Discovery and Conquest of Mexico, 1517-1521; and other histories and historic source material listed in the Selected Bibliography. Dr. José Alvarez Amézquita, et al., Historia de la Salubridad y de la Asistencia en México; Martín de la Cruz, The Badianus Manuscript.

CHAPTER FOUR

Aztec G.P.'s and Specialists

Not only swashbuckling conquistadores but Colonial administrative officials, Roman Catholic priests, and even Spanish doctors expressed their admiration of the medical knowledge of the Aztec physicians. They credited it with being advanced well beyond that of Europe in some fields, especially in the employment of medicinal herbs. Actually, the Aztec physicians were superior to the European physicians in another very important area—that of asepsis. Yet both groups employed some identical procedures and techniques, arrived at independently: Both utilized the same sort of medical instruments and equipment. Both practiced the standard therapy of the age, bleeding—which almost certainly killed as many patients as did any disease. But, to the credit of the Aztec doctors, they never used this type of quackery to the extent European doctors did. Both administered enemas. Among the Aztecs, though, the prescribing of enemas never attained the fashionable overemphasis it did among Europeans, then and later (viz., the jaded eighteenthcentury French court). Considering the overall picture, it appears that the Aztec physicians in the early sixteenth century came closer to modern concepts of medicine than did their European counterparts. This is all the more remarkable, in view of the indisputable fact that our modern "Western" medicine eventually evolved from Europe. Source Material Tragically, during and immediately after the Conquest, the Aztecs'

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own written records of their accumulated medical knowledge were totally destroyed. However, the first Spaniards to arrive in Mexico sent back such glowing reports of Emperor Moctezuma's botanical gardens—and of the skill of the Aztec physicians in obtainings cures through utilization of various of the huge number of species of medicinal herbs grown in them—that both the King of Spain and the Pope dispatched emissaries to learn everything possible about Mexico's plants and their usage. Among the more important results were: 1) The Badianus Manuscript, titled An Aztec Herbal of 1552. This small, hand-inscribed book bound in red velvet is preserved in the Vatican library. 1 Written originally in the Náhuatl language by Martin de la Cruz, an Indian physician who was a teacher at the Imperial College of Santa Cruz of Tlaltelolco, and translated into Latin by another Indian teacher at the college, Juan Badiano, it includes 118 pages of beautifully colored paintings of medicinal herbs and its text describes the pharmaceutical treatments employed. 2) A Brief Treatise on Medicine. This book was written by Fray Agustín Farfán, who was graduated from the University of Mexico as a doctor of medicine in 1567 and later became an Augustinian friar. First published in 1579 in Mexico City, 2 and reprinted with revisions in 1592, 1604, and 1610, it covers "Anatomy, Medicine, Pharmacology and Surgery" as practiced in Mexico by the Aztecs. 3) History of the Plants of New Spain. A monumental herbal thesaurus was the work of a Spanish physician, Dr. Francisco Hernández, whom Spain's King Philip II sent to Mexico in 1570, a half century after the Conquest, with orders to try to recover more of the valuable Aztec medical lore which had been lost or destroyed in the subjugation of Mexico. Dr. Hernández, working with educated Aztecs, spent five years on the task and returned to Spain with drawings and descriptions—in Náhuatl, Spanish, and Latin—of three thousand plants, a large proportion of which the Aztecs had used for medicinal 1 It long remained unpublished. In 1940, an edition with fine color reproductions of the original pages, translated and annotated by Emily Walcott Emmart, was put out by the Johns Hopkins Press. 2 By the Casa de Antonio Ricardo, as Tractado Breue de Chirvrgia y del Conocimiento y cvra de algvnas enfermedades q. en esta tierra mas comunmente suelen auer.

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purposes. The total was reduced to approximately one thousand species before the work finally was published, in 1649.3 The above books, plus medical references in various contemporary Spanish works and additional data recorded by Indians—supplemented by ancient murals and other archeological findings—are the source of our present-day knowledge of Aztec medicine, and, of course, of Aztec physicians. Two Categories of Aztec Physicians Although their functions sometimes overlapped, there were two general categories of physicians in Aztec Mexico: One was comprised of the tepati, or "legitimate," physicians, whose therapies were principally pharmacological. They might be regarded as "empiricists" and "physicians of the new school," so to speak. It was for them that the Aztec Emperor's magnificent botanical gardens had been established and planted with an estimated two thousand species of trees, shrubs, and herbs. The second category of Aztec physicians comprised the older, "classic" type usually found among Neolithic peoples—the ticitl, or sorcerers, who were comparable to the shamans, or "medicine men," of the nomadic North American Indians and the "witch doctors" of African Negro tribes. They carried a bag of the weird props usually associated with their ilk—charms, amulets, "magical" devices—and relied on hypnotism and/or their patients' belief in their supposedly magical powers. They were effective, therefore, where a psychosomatic factor was involved. Medical

Education

Medical education among the Aztecs was conducted almost entirely on a master-apprentice basis, under which the established physician used his son, or protegé, as his assistant, and, over a period of years, taught the youth all he need know to eventually take over his 3 In Rome, as the 951-page Rerum Medicaram Novae Hispaniae Thesaurus seu Plantarum. However, earlier works based on extracts of the doctor's writings were published in Mexico; for example, the four-volume De la Natvraleza, y Virtvdes de las plantas, y animales que estan receuidos en el vso de Medicina en la Nueua España y la Methodo, y corrección, y preparación, que para administrallas se requiere con lo que el Doctor Francisco Hernández escriuio en lengua Latina . . ., Casa de la Viuda de Diego López Daualos, 1615.

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practice. This method of passing on medical education, as a family profession, was employed by both "new school" and "old school" physicians. However, another, specialized type of chiefly metaphysical "medical" education, distinct from the aforementioned, was formally taught by a division of the Aztec priesthood, in annexes of certain temples including the Great Teocalli in Tenochtitlán. The priest-instructors were called tepoxtlatl and their neophyte-priest students were known as momaxtli. The curricula of these schools consisted chiefly of (1) interpreting the sacred books, or codices, of the Aztecs which related to the role of the gods in various diseases and their healing, and (2) the study of astrology and the technique of casting individual horoscopes for newborn infants, for which nearly all Aztec parents sought their services. Women as well as men received medical educations and practiced medicine, particularly in certain fields. The Specialists in Aztec

Medicine

The "new school," or "legitimate," physicians almost all were specialists. They included the texoxtl, or surgeons; the tlamatepatli, or internists; the tecoani, or blood-letters; the temixiuitiani, or midwives and obstetrician-gynecologists, who also functioned as pediatricians; the papiani, or pharmacists; the panamacani, or pharmacognosists. Blood-Letters Blood-letting, which for many centuries was the most popular therapy in Europe, was practiced to a much lesser extent by the Aztecs. Aztec physicians who specialized in this technique bled their patients chiefly to reduce swellings (as in the case of bone fractures), but occasionally as disease therapy in the same dubious fashion as was prevalent then in Europe. In European countries, the eye-catching red-and-white striped pole designating a barbershop was originally a display of drying bloody bandages, advertising that the barber within was available on demand not only to trim beards but to tap veins. In fact, it has been said that the science of medicine made little progress until it finally "got out of the barbershop." The universally employed term then for all doctors and surgeons, whether practicing in or out of tonsorial parlors, was "leech."

49 The technique customarily employed by the barbers and "leeches" of Europe to treat any ailing patient was to attach at one of his veins, to suck out a considerable quantity of his blood, a voracious "medicinal leech" (Hirudo medicinalis), a species of European fresh-water leech, two or three inches long and formidably equipped with a sucker at both ends. The Indian specialists in bleeding, the tecoani, did not employ leeches. They used as their instruments to open a vein either the needlelike thorns of the maguey, or lancets of obsidian, the volcanic glass from which the Aztecs made most of their cutting instruments (including the priests' razor-sharp sacrificial knives). It is interesting to note that the Aztecs frequently bled themselves, or had themselves bled, not for medicinal purposes at all but as a small sacrifice to a god from whom they desired a favor. They seldom lost enough blood to endanger life. However, it is a historic fact that the third Aztec emperor, Chimalpopoca, felt so dishonored by an affront from another monarch that he decided he could make amends to his nation and gods only by offering all of his blood—and requested the high priests to sacrifice him in the traditional fashion. Which they did. AZTEC G.P.'S AND SPECIALISTS

Internists The Aztec internists specialized principally in gastrointestinal infections and infestations. The therapies utilized were chiefly pharmaceutical and included some effective remedies which will be discussed in detail in Chapter Five. These physicians also treated a variety of respiratory, genitourinary, hepatic, and cardiac ailments. Psychiatrists Aztec "psychiatrists" divided mental diseases into two main categories: passive insanity and active insanity, which they called, respectively, tlahuilocayotl and xolopeyotl. Probably with considerable basis in fact, they believed most of the cases of insanity they encountered resulted from abuse of one or another of Mexico's wealth of indigenous narcotic and/or poisonous green plants and fungi, many of which long had been used medicinally or in religious rituals. These included marijuana, or hashish; the jimson weed, which the Aztecs called toloatzin and botanists identify as Datura stramonium;

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certain hallucinogenic "magic" mushrooms; "buttons" of the peyote cactus. (Note that the Náhuatl compound name for active insanity actually included the word peyotl—Náhuatl for peyote.) The Aztec psychiatrists' often effective therapy for drug-induced insanity involved simply herbal anti-toxins, purgatives, and withdrawal. Aztec psychiatrists also recognized other types of mental illness, but usually lumped them together diagnostically as due to evil spirits having taken possession of an individual's mind. The Indian "headshrinkers" prescribed the hypnotic ministrations of a sorcerer, to lure the evil spirit from the patient's skull or, rarely, the surgical procedure of trepanation, to provide a physical exit site. Contemporary psychiatrists generally will concede that many psychoses, simply given time, eventually "cure themselves," or "run themselves out." Furthermore, the effectiveness of hypnosis with certain types of emotional disturbance has long been demonstrated. And, in some cases, a concussion relievable by surgery may have been involved. So it is possible that the Aztec psychiatrists' recovery rate may not have been too far below that of their present-day counterparts. Dentists A priceless secret of ancient Indian dentists—lost to the world since Cortés conquered Mexico—recently was rediscovered by the author of this book. It is the secret of painless and effortless tooth extraction. That the Mexican Indians should have possessed such a unique boon to dentistry, at the time of the Conquest, was truly remarkable. Europe's dentists then had nothing to administer to a patient to dull the pain of a tooth-pulling. A sufferer from a badly abscessed molar often would stride the streets for days with his face swollen like a football before he would finally muster the courage to stop in at that door behind the luridly striped barber pole. And understandably. For the barber-dentist's vigorous yankings, pullings, and pryings with his pincers at an obstinate tooth, the accompanying hairraising sounds of cracking bone, and the patient's yells and screams at the excruciating pain would bring citizens running from a block away to watch the spectacle, before the offending molar finally was wrenched loose (often landing the barber-dentist flat on his back on the floor in the process).

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The rediscovery of the priceless old Indian secret of painless-andstrainless dentisty, like most of the world's important discoveries, came about quite accidentally, by a series of coincidences: 1) Dr. Juan Vera, a dentist in the small city of Querétaro, 150 miles north of Mexico City, while working on the author's teeth, happened to mention that he had watched, more than once, an itinerant Indian "dental practitioner" set up shop in the open air with nothing but an old kitchen chair and pull teeth on a back street near the mark e t Dr. Vera (whose own offices and laboratories are furnished with the most modern, imported dental equipment) confessed he had been fascinated by the fact that the unlicensed tooth-puller extracted teeth painlessly—after merely moistening them with some unidentified liquid. "The man used no pincers or other instruments," the doctor explained. "After putting a bit of the liquid on a tooth, he informed his patient, usually a campesino, that it was necessary to wait a few minnues—'until the liquid softened the tooth/ "In about twenty minutes, he told the patient to open his mouth, then clasped the tooth between his thumb and forefinger and—after wiggling it back and forth once or twice—just lifted it out! "If I hadn't seen it, I wouldn't have believed it possible. The patient hadn't made a sound. And when I asked if it had hurt, he shook his head." Dr. Vera smiled. "Naturally, as a dentist, I was curious and asked the tooth-puller what he had in his little bottle. He said it was a mixture known only to his family and his ancestors. I tried to buy some of it, but he wouldn't sell. I've often puzzled about what it could be, but I haven't the faintest clue." The incident established that (and only that) a mysterious old Indian tooth-pulling technique actually did exist—and was still quietly being used. 2) Some weeks later, while perusing a rare published copy of the four-hundred-year-old Badianus Manuscript (only two exist in Mexico), the author's eye was caught by a brief annotated item. No source was cited; the item was preceded by a reference to Mayan texts giving toothache remedies. Here is the annotation: Another interesting remedy for pain of the teeth was the use of small quantities of rattlesnake poison diluted in vinegar. A rattlesnake was killed and the head removed and with the two fingers the fang was removed and laid across the aching tooth. The tooth then could be pulled painlessly with the finger tip. A special note at the end cautions against touching the gum

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around the tooth. If indeed any poison remained after dipping the fangs of the rattlesnake in vinegar it seems quite likely that the patient could not survive the treatment. [Italics added.] This somewhat garbled account of the ancient procedure exaggerated its seeming implausibility, and the final sentence clearly disclosed the annotator's skepticism. Readers were justified in discounting the remedy as either a mistranslation or an obvious barbaric absurdity, on a par with the "medicinar ingestion of live lizards. This author doubtless also would have dismissed the described remedy as dangerous nonsense—if he had not been in the unique position of knowing that at least one itinerant practitioner in Central Mexico today is using just such a technique to pull teeth: painlessly, with finger and thumb and the preliminary employment of some sort of liquid. And if the writer had not, by coincidence, possessed two additional bits of knowledge which served to substantiate the startling disclosure in the Badianus notation. 3) In New York City, years earlier, as the guest of a Hungarian family at a dinner wherein the pièce de résistance was roast ribs of beef, he had been informed that not only the meat but the ribs were to be eaten. The dish had been prepared according to an old recipe brought from Budapest, and the bones, prior to cooking, had been softened by being marinated in vinegar. (The ribs proved flexible, easily chewed, and highly flavorsome.) 4) From research done at another time for a magazine article on poisonous reptiles, the author had learned that the venom of a rattlesnake, upon injection into a victim, immediately begins a swift, potent process of predigesting the snake's prey. It seems probable, therefore, that vinegar spiked in the correct proportion with rattlesnake venom will "predigest" a tooth (and perhaps the surrounding tissue) to the point that, within twenty minutes, the tooth will become sufficiently "rubbery" to be manually—and painlessly—eased out of its bony socket. There you have it: The secret of the ancient Mexicans' strainless extractions, and probably also of the Querétaro-area tooth-puller's "magic medication." Aztec dentists were adept not merely at painless extractions but at treating inflamed gums, ulcerated teeth, and similar oral conditions, including what apparently was gingivitis. They customarily lanced

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the inflamed areas, then applied a poultice of astringent and curative herbs. Hot, stinging chile pepper applied to the gum sometimes was utilized as an eye-watering counterirritant. The Aztecs were clever also at drilling and filling teeth, though they did it more often for adornment than to repair caries. The wealthy had their dentists affix emeralds or pieces of jade in their incisors. Unfortunately, such decoration sometimes was so deeply inset it killed the tooth. Obstetricians and Gynecologists Aztec obstetrician-gynecologists—and midwives—were far advanced over their counterparts in Europe in that they made some attempt to achieve an aseptic field during childbirth. Both they and their patients practiced routine daily bathing— which was something in itself. Furthermore, they prescribed a hot (but not too hot) steam bath for pregnant women just before delivery and another soon afterward. To underline how remarkable and "radical" this procedure was: In Europe at the time of the Conquest and for several centuries later, physicians and midwives not only were completely indifferent to asepsis at childbirth (or any other time) but were ignorant of any need for it. Puerperal fever, the chief killer of women in childbirth, took a huge toll in mothers' lives—as doctors and midwives, without washing their hands, ignorantly carried the virulent infection from patient to patient. In fact, doctors sometimes came directly from a deathbed, or from dissecting a putrescent cadaver, to thrust an unwashed hand into the vagina of a woman in labor. (Well into the nineteenth century, in one Viennese hospital, 90 percent of the women whose babies were delivered by doctors died of infection. When Dr. Ignaz Semmelweiss there discovered, and irrefutably demonstrated, that mere disinfecting of doctors' hands with chlorine water slashed the death rate to less than one percent, hospital authorities not only refused to adopt the simple technique but expelled him from the hospital. And until he died, in 1865, Semmelweiss was bitterly attacked by the European medical profession for his life-saving one-man crusade.) Aztec physicians' advice to women during gestation and in the post-partum period did not differ greatly from that considered standard today: Expectant mothers, as soon as they were aware of their pregnancy, were warned not to overwork, lift heavy objects, or be-

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come emotionally upset. They were instructed to observe all the Aztecs' rules of cleanliness even more strictly than usual. They were placed on a diet which considered the unborn child's welfare, and, to further protect the fetus, sexual intercourse was prohibited. However, the medicaments given to ease labor pains sound a bit weird, although they may have been somewhat effective—at least, psychologically: During labor, the mother-to-be is given a potion of the powdered root of ciuapatli and the ground tail of an opossum. To ease or eliminate birth pains, place in the vulva a mash of the herb ayonelhuatl (calabash root), acid herbs, the root of quahalahuac (the soap tree), an Etztetl stone (bloodstone) and eagle's excrement. —Badianus Manuscript Following the post-partum steam bath, the new mother was given an herb drink to promote lactation, and various happy little ceremonies were staged. It is noteworthy that if normal birth proved impossible the unborn infant, not the mother, was sacrificed. An embryotomy was performed. Surgeons An earlier noted, Aztec surgeons skillfully performed emergency operations on the battlefields and cared for wounded and invalided soldiers in the military hospitals maintained by the government in a number of cities. Surgical procedures were performed also upon civilian patients. Most operations were relatively simple. Although we have no statistics on comparative recovery rates at that time, other factors indicate that the more favorable postoperative course lay in Mexico, not in Europe. There follow some of the operations performed, and surgical techniques employed, by Aztec doctors. Anesthesia Mexico's pre-Columbian surgeons were centuries ahead of Old World doctors in their use of anesthetic drugs during surgery and to deaden preoperative and postoperative pain. Unlike their contemporaries in other lands, they were fortunate in having at their disposal a large number of narcotic green plants and

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fungi, all of which they had utilized from remote times. (These will be discussed in Chapter Five.) Sterilization and Cauterization No surgeons in the world, in the early sixteenth century, operated in a sterile field, or made any serious attempt to do so. Whenever surgical instruments were first held in a flame or boiled, it was to eliminate some visible incrustation, not bacteria (which would not be discovered for hundreds of years). Nevertheless, in this as in all other matters involving cleanliness, the Aztec doctors scored higher than their European counterparts. Ordinarily, in Tenochtitlán, clean doctors with clean hands operated upon clean patients in clean surroundings. Whereas in some European cities—even in the nineteenth century —hospitals were totally lacking in sterile techniques, and patients died like flies from puerperal fever, tetanus, and gangrene, with which they became infected after admission. Many a filthy hospital failed to change blood-pus-and-excreta-stained bedsheets between patients. And many a European doctor proudly wore his blood-andpus-stiffened surgical gown on his rounds, unsullied by soap and water from one year's end to another, as a walking advertisement of his professional popularity! However, Cortés and his tough Spanish soldiers practiced far more antiseptic techniques than most European doctors. These Spanish men-at-arms were adept at treating battle wounds and keeping each other on their feet and fighting—some, according to Bernal Díaz, while as many as a dozen wounds were healing. If they had not thus managed to hold their fatalities and incapacitating wounds down to an astonishingly low rate, a few hundred Spaniards never could have conquered the mighty Aztec Empire. After each battle the conquistadores rendered fat in a big kettle and cauterized their wounds by pouring boiling oil into them. This painful treatment simultaneously stopped bleeding and sterilized and sealed the wounds. (As a historic footnote, Bernal Díaz wrote that a preferred source of the cauterizing agent was, if available, "a fat Indian." Presumably one already slain in battle.) The Aztec surgeons evidently never employed any such wholesale cauterization in treating wounds. But, unlike the Spaniards, they had countless medicinal herbs at hand. Their primary treatment for non-

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infected lesions was cleansing, followed by the application of poultices of various types, composed of herbs and pine oils. Some of the ingredients of these poultices, including the pine oils, possessed mild antiseptic qualities. Wounds that were already infected, and boils and abscesses, were cleaned out and treated with stronger herb poultices and ointments. Healing The Aztec physicians effectively used juice of the nopal cactus fruit, the tuna—and more often the juice of the papaya—to reduce swelling resulting from battle wounds and other injuries, and from surgical procedures. It is interesting to note that recently there has been put onto the market a new pharmaceutical product made from papaya—which, it is claimed, "speeds reduction of edema and accelerates resolution of extravasated blood and lymph." The Aztec physicians and surgeons also employed another treatment to promote healing of wounds which was remarkably advanced and in accord with the most recent discoveries about the healing process. As recorded in the Badianus Manuscript, this treatment of choice was an application of: The juice of the bark of the Ylin tree and of the root of the shrub called Tlalhahuehuetl, with wax and the yolk of an egg. The Ylin tree is the source of an antiphlogistic, an agent which counteracts inflammation and fever. Tlalhahuehuetl, a variety of cypress, is used as an astringent. And, as Alexis Carrel demonstrated centuries after the Badianus report, embryonic juices such as egg yolk contain a factor important in the proliferation of fibroblasts.4 Suturing Aztec surgeons were skilled at suturing, including in the delicate repair of nose and lip wounds. As suture material they used hair from the human head. Afterward they applied a paste of salt and honey to the wound. They also knew how to make ligatures in certain operations. Orthopedics The Aztec surgeons very capably set fractures and used casts to guarantee that broken bones healed in correct alignment. Often they 4

Connective tissue cells.

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first reduced the pressure and swelling in fractured limbs by bleeding. According to Bernardino de Sahagun, a sixteenth-century Spanish Franciscan friar, instructor in the College of Santa Cruz in Mexico City and author of The Universal History of New Spain: The broken bones were carefully set and the limb placed between splints of wood, tied tightly with cord. A plaster then was applied to the break, composed of gum of the ocozotl tree and resin and feathers. The limb and the splints together then were encased in a second covering of rubber-like gum.5 Trepanation The outstanding surgical procedure performed by the Aztecs, as well as by those advanced earlier American Indian civilizations, the Toltec and Mayan in Mexico and the Inca in Peru, was trepanation. Scholars differ as to the probable reason the Indian surgeons did their trepanning. Some believe they performed the delicate and dangerous operation to relieve pressure on the brain, caused by skull fractures, suffered chiefly in war, or by tumors. Others are convinced the trepanning was done principally in cases of insanity or epilepsy for the superstition-inspired object of releasing evil spirits believed to have taken possession of the patient's mind. Probably the operation was performed for both reasons. Mayan skulls found in an underground tomb at the Palenque ruins showed definite evidence of intercranial tumors and craniotomies. Regardless of the diagnosis upon which such operations were unundertaken, the surgery often was skillful, for not all the operations resulted in exitus totalis. Several of these skulls have been found with as many as three trepanation holes, and one or two with a bony overgrowth, indicating that the patient had survived at least the earlier operations. The trepanning technique used in Mexico (the Incas in Peru used a slightly different procedure) was to punch a series of small holes in the skull outlining the fracture, or the area to be removed, then to cut between these holes and lift off the depressed section of cranial bone. The exposed brain subsequently was protected with a thin plate of hardwood and cotton pads. In another Aztec procedure for treating skull fractures in which 5

Fray Bernardino de Sahagún, Historia General de las Cosas de Nueva España.

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trepanation was not utilized, the damaged section of the skull simply was encased in a protective "plaster" cast. The plaster was constituted of resin, egg white, and feathers, or, alternatively, of blood, egg white, and animal ash—strong binding agents, in either case. Ophthalmology In the field of ophthalmology, also, Aztec surgeons attempted some highly delicate operations. They performed surgery to excise from the eye what were described as fleshy growths and white opacities and they attempted to scrape off cataracts. To what extent they were successful in these procedures is unknown. Tonsillectomy Aztec surgeons lanced and/or excised superficial tumors on various parts of the body, including what were described as "spongy tumors of the throat," probably badly infected tonsils. Tumors also were treated with poultices. Urinogenital Surgery The Aztec and earlier Indian civilizations of Middle America were far more enlightened than their Spanish conquerors in their attitude toward circumcision. At the ruined temple city of Teotihuacán, for example, there is a mural graphically depicting a youth about to be circumcised by a Toltec surgeon whose instrument is a sharpened mussel shell. And from reports of Cortés and his soldiers and the contemporary historians it is known that many Aztec males were circumcised. After the Conquest, however, the Spaniards swiftly stamped out circumcision among the Mexican Indians. They themselves did not practice it, and the Catholic clergy then condemned any attention paid to genitalia as a barbaric and sinful obsession with sex. As a consequence, circumcision is not the custom today in Mexico, or in other Latin American countries. Significantly, Mexico and all of Latin America today have one of the highest incidences of penile cancer in the world. In view of cumulative recent medical research confirming that the most important carcinogenic agent in penile cancer is smegma long retained in the preputial cavity—principally due to phimosis and inadequate cleansing—the Aztec and other Indian surgeons who performed circum-

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cisions demonstrated creditable perspicuity. The Spanish (and Portuguese) conquerors by abolishing the hygienic Indian practice unquestionably contributed to a medical and public health retrogression throughout Latin America. The Aztec surgeons sometimes performed castrations, apparently principally for religious reasons. They also occasionally performed a surgical procedure, for which the purpose is unclear, which involved slitting open the penis. (The Australian Bushmen used to perform a similar penile mutilation—slitting open the urethra the full length of the penis—for the purpose of contraception. Thereafter, during sexual intercourse, semen was ejaculated at the base of the penis, external to the vagina. Conceivably the operation had the same purpose among the Aztecs.) Embryotomy When normal childbirth seemed impossible after protracted labor, because of a malformed pelvic opening, Aztec surgeons routinely performed an embryotomy. The surgeon, holding an obsidian knife, simply inserted his hand into the vagina and "cut up the body of the creature," then with a sort of tongs removed the pieces. The maternal survival rate is not a matter of record. Unrealized

Potentialities

Aztec surgeons apparently did not perform thoracic and abdominal operations. At least, no records remain of any. It is likely that no such major surgery was attempted, for the Aztecs had overwhelming faith in the power of their gods and in the efficacy of their herbal remedies to cure diseases of the vital organs. Nor, apparently, did the Aztec surgeons attempt to increase their knowledge by performing anatomical dissections. The Aztecs' strange disinterest in anatomy contrasts sharply with their highly developed curiosity about, and impressive knowledge of, pharmaceuticals. European doctors, while much less advanced than their Aztec counterparts in materia medica, were more absorbed, and more learned, than the Aztecs in anatomy. This is the more remarkable because in Medieval Europe anatomical dissection of cadavers could be conducted only secretly and illegally. The Catholic Church forbade it, and secular authorities regard-

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ed it as a serious crime and usually burned alive anyone unlucky enough to be caught red-handed. Nevertheless, despite this great handicap, many European physicians managed to learn much about human anatomy, both through surreptitious dissection of cadavers and by studying the medical writings of those ancient Greeks, Hippocrates and the anatomist Galen of Pergamus, impressive editions of whose works were published, respectively, in 1505 and 1507. Those dates, in fact, marked the beginning of an era of greatly increased interest among European physicians in the study of anatomy and surgery and of a limited relaxation by certain kings, princes, and clerical authorities of the ban on dissection. (Outstanding results were the publication of D'Ambrose's noted book on surgery, in 1507; Fabricius ab Aquapendente's work on orthopedics, the first known in that field, in 1520; Andreas Vesalius' fine book on anatomical dissections, with its superb illustrations reputedly done by Titian, though signed "deKalker," in 1545; Veslingius' text on anatomy, 1566; Gasparo Tagliacozzi's book on plastic surgery, also first in its field, in which the technique of building noses with arm grafts was detailed, in 1597; and Avicenna's work, closing the gap between Greek and Arabian medicine, in 1608.) It seems a pity that the Aztec surgeons were not more interested in discovering the full potentialities of their profession, for they enjoyed magnificent opportunities. In contrast to the long prohibition of dissection in Europe, in Tenochtitlán the medical profession not only was permitted, it was commanded, to experiment with humans. And Emperor Moctezuma I had established the famous botanical gardens and zoos specifically to provide pharmaceuticals for such experimentation. Obviously, from among the thousands of healthy humans irrevocably destined to die on the sacrificial altars each year, the researchminded Aztec emperors would have been happy to allot an adequate number to the nation's leading surgeons for experimentation. And, of course, following the sacrifices, there were cadavers unlimited for educational dissection. Had such an opportunity been fully exploited, who can put a limit to what the Aztec surgeons might have accomplished before their state was toppled?

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If Aztec experimenters in medicine and pharmacology and experimenters in surgery had collaborated for a few generations, it is not impossible that the problem of foreign-body rejection could have been solved and successful organ transplants could have become feasible—over four hundred years ago! Principal Sources William H. Prescott, History of the Conquest of Mexico; Bernal Díaz del Castillo, The Discovery and Conquest of Mexico, 1517-1521; and other histories and historic source material listed in the Selected Bibliography. Dr. José Alvarez Amézquita, et al., Historia de la Salubridad y de la Asistencia en México; Martín de la Cruz, The Badianus Manuscript; and other medical and herbal works listed in the Bibliography. Personal observations.

CHAPTER FIVE

Aztec Herbs and Therapies

The approximately two thousand different species of medicinal plants growing in the imperial botanical gardens when Cortés arrived in Tenochtitlán, in 1519, comprised by far the largest such collection in the world. As earlier noted, soon after the Conquest both the King of Spain and the Pope sent emissaries to Mexico to learn everything possible about the Aztecs' herbs, and this resulted in the famous Badianus Manuscript, Fray Agustín Farfán's treatise on Aztec medicine, and Dr. Francisco Hernández' monumental herbal thesaurus. These three volumes detailed the Aztec physicians' specific treatments for a wide variety of diseases and ailments. Some treatments were very effective and completely in accord with present-day scientific therapies; the effectiveness of others, it must be conceded, had to be largely or entirely psychological; and still others . . . Materia Nonmedica It is an amusing commentary on the astuteness of Mexico's Spanish conquerors that one of the first items in the entire wondrous Aztec pharmacopeia which they selected to adopt, become enthusiastic over, and make enormously popular throughout all Europe was the one which should have been the most obviously useless—the socalled magical stones. The belief that certain stones possess magical curative powers was almost universal with mankind in early eras and still persists in large areas of the world. The ancient Mexican physicians prized a green chalcedony spat-

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tered with red spots resembling drops of blood, which they called the etztetl, or bloodstone, and believed had the power to stanch hemorrhages. The Spaniards fell for this, too, and exported quantities to "stop bleeding" all over Europe. Like the Chinese even today, the Middle Americans believed that jade possessed general curative properties. Virtually all upper-class Aztecs, therefore, wore a piece of jade as an amulet or in a ring. Moreover, they shared with much of the world at that time a belief that bezoar stones, the calcareous concretions sometimes found in the organs of animals and birds, were curative and were a magical antidote to poisons. When the Spaniards discovered that the Indians possessed a considerable store of these varicolored objects, they sought them as avidly as they did the Aztec gold, silver, and emeralds, and a considerable export trade in them developed. The strange fad for bezoar stones among the wealthy in Europe, Asia, and North Africa may seem incomprehensible today—but mere shined-up gallstones and kidneystones long ranked as gems. In the age of the Medicis and Borgias and frequent mysterious royal demises by secret poisonings, the alleged inherent antidotal property of bezoar stones alone made them prized. The wary prince or nobleman was wont to carry one about on a gold chain to suspend into his wine goblet as a precautionary measure when dining out. The list of England's crown jewels at the accession of King James I included one enormous bezoar stone set in gold, which had been acquired by Queen Elizabeth I. And in the nineteenth century, the Shah of Persia sent three bezoar stones as appropriate gifts to Napoleon. The Aztecs' medical lore and pharmacopeia unquestionably included some nostrums that would cause today's first-year medical students to burst into guffaws: Patients with lichen or prurigo were treated with applications of small live frogs. Individuals afflicted with scrofula were counseled to gulp tiny live lizards. Sufferers from scabies were advised to munch young alligators and wash their skins with urine. And the Aztec physicians' therapy of choice for epilepsy may have caused substantial inroads in the imperial zoo, for, according to Sotuta, the specifics to be taken orally included deer's antler roots, the

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brains of a fox and a weasel, the bile of a dog, and a bird's testicles. The Aztecs even compounded nostrums containing the pulverized bones of prehistoric mammoths, which they believed, not illogically, to be the remains of a vanished race of giants. European doctors at that time were similarly using the dust of Egyptian mummies. The Aztecs utilized in a few nostrums an ingredient that the "medicine men" of primitive races invariably employ as what might be termed a pharmaceutical staple, and that, in the case of the Aztecs, doubtless represented a carry-over from a less enlightened era: the dried excrement of certain animals and birds. However, it is no longer fashionable in medical-research circles to ridicule all such items which seem to be mere "witch-doctor's placebos." Not since the anti-pernicious-anemia factor, B-14, was isolated by a U.S. doctor from chicken excrement. Yesterday's nostrum which is today's big joke may well be tomormorrow's top miracle drug. Most of the Aztec remedies that might seem unquestionably ineffectual at least were no worse; they were not inherently harmful. They fall into the same innocuous category as, for example, a folkloric treatment for "chest colds" still commonly used in areas of New England which consists of rubbing hen fat on the patient's chest and hanging an onion around his neck. Arthritis Cures? A few of the Aztec nostrums which, superficially judged, seem as absurd as those earlier mentioned nevertheless pique the interest. One is a remedy cited in the Badianus Manuscript for what was described as "weak" or "lame" hands, very likely an arthritic condition. The most interesting part of the therapy was preceded and followed by the soaking of the patient's hands in a herbal extract not identified in the four-hundred-year-old record. As the main treatment, the patient was directed to find an anthill and permit the ants to bite his ailing hands. It is very possible that a secretion of the ants (some species possess a mild venom; others eject a fluid containing formic acid) might have a remedial effect on an arthritic condition. Unfortunately, the species of ant preferred by the Aztec physicians was not indicated. The herbal extract may have contributed to the effect or may have

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been included merely to reduce the smarting or itching sensation incidental to the ants' attentions. A treatment that the Aztec physicians used specifically for arthritis employed venoms—in exploitation of a physiological principle that has been used with considerable success in modern therapy: The stiffened arthritic joint first was punctured. Then a poultice was applied which was a mixture of nettles, serpents, scorpions, and millipedes that had been ground up and boiled together. Nettles, of course, are the source of a revulsive, or counterirritant. And, inasmuch as the scorpions, millipedes, and probably also the snakes, contributed a virulent poison to the mash, the application undoubtedly set up an inflammatory reaction with local fever, thus paralleling a modern therapy. Gastrointestinal

Ailments

It is probable that dysentery and diarrhea were endemic in Middle America before the Conquest. At least, the Aztec internists had a considerable number of treatments for them. A favorite remedy consisted of administering an enema to "one whose bowels are murmuring because of diarrhea," then a suppository composed of soot, oil, and allspice. (Aztec physicians used a funnel-like apparatus in several sizes to administer enemas, vaginal douches, and ear medications.) Another treatment, still used by the country people, consisted of pulverized avocado seed, which is an astringent, mixed with plantain water, administered orally. Pulverized charcoal, often made of animal matter, also was prescribed for "murmuring intestines and diarrhea" to absorb gases and prevent gastrointestinal irritation. It was given in a drink. Still another remedy was oral administration of an extract of the bark of the guava tree, which has astringent properties. On the other hand, some Aztecs suffered from constipation—presumably largely the scholars, scribes, and bureaucrats who led sedentary lives. Although there were no commercially packaged laxatives to relieve this bane of urban civilization, the physicians possessed several effective cathartics: One was an extract of the herb quauhayohuachtli, administered orally. Another was an extract of the "hummingbird flower." Yet another efficient cathartic used by Aztec internists—and employed in

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modern medical practice as well—was an extract of the bark of the tree Picamnia antidesma and of the shrub Rhamnus purshiana. The Aztec doctors effectively expelled intestinal parasites with infusions of herbs of the genus Artemisia—which, it is interesting to note, are the source of some of the most efficacious anthelmintics 1 employed in modern medicine. The Aztecs also used papaya, in treating persons with worms. And papaya is still used in modern medical practice as an anthelmintic and a digestant. Aztec physicians treated gastrointestinal diseases with emetics, antiemetics, purgatives, antidysenterics, and anthelmintics. As an emetic they utilized an extract of the root of Cephaelis ipecacuanha, which is employed for that same purpose in modern medicine. Respiratory Diseases The Aztec physicians had several techniques with which they controlled asthmatic spasms, techniques still employed by licensed medical doctors. Most effective was the herb commonly known as the jimson weed (Datura stramonium), a narcotic and antispasmodic. The Aztec physicians burned leaves of this plant and directed the patient to inhale the smoke. Copal, a resin of tropical American trees (Hymnea), because of its depressant and antispasmodic properties, was utilized similarly (but less effectively). As an alternative therapy, the Indian physicians sometimes administered orally extracts of several other herbs, including tlapalachíotl, and sarsaparilla, which was used in conjunction with chia and tlatlacizpatli. Aztec doctors treated pneumonia with oral administration of an extract of ezptli (Croton sangiglum) and with cataplasms 2 of chilmecatl. For bronchial infections and laryngitis, they employed a wide range of remedies, including infusions of tlacotequilizpatli, the juice and seed of quamochitl, and (as with asthma) the smoke of burning jimson-weed leaves. 1 2

A medicine that kills worms. Poultices.

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They recognized and had a treatment for tuberculosis, which they called tetzauhcocoliztli. For coughs and bloody sputum they employed Calliandra anomala. Like present-day sufferers from the common cold, the Aztecs resorted to inhalants. They sniffed two pungent herbs, one of which was, and presumably still is, known as "the cold-in-the-head plant." Fevers The technique most commonly employed by Aztec physicians to reduce fever almost exactly duplicates a method that many licensed medical doctors all over the world use—450 years later. The Aztec procedure included: (1) oral administration of part of a jar of water in which were steeped willow leaves (that contain acetylsalicylic acid); (2) pouring the remainder of the liquid over the patient's head; (3) laving the patient's body with a cooling lotion; (4) administering a cold enema. Today, that water poured over the patient's head has become an ice bag, and the acetylsalicylic acid is provided by an aspirin pill instead of steeped willow leaves. Otherwise, the techniques are the same. The Aztec physicians recognized various types of "fever," and had special remedies for infectious fevers, for recurrent fevers, and for those "caused by excessive heat." One particularly virulent type of high fever that frequently had a fatal outcome was described as being accompanied by disturbances in the vision and vomiting of blood. It was treated with a complex herb potion. The juice of the xaltomatl was used for most fevers. A number of tropical fevers were treated with an extract of the root of the herb taxaxauitlan. Dermatology When the Spanish physicians who came to Mexico with the viceroys observed the effectiveness of the Aztecs' medications for sebaceous cysts, they abandoned the technique they had learned in Spain for this dermatosis and adopted that of the Indian doctors. It consisted simply of the application of a poultice of the herb tlacopalli. The Spaniards conceded the superiority of Indian therapies for several dermatoses. The Aztecs, for instance, reportedly controlled the chronic scaly

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dermatosis, psoriasis, through external and internal administration of a variety of herbs and resins. Although their treatments for other dermatoses involved principally the utilization of various herbs, resins, and wood tars, they sometimes combined this with balneotherapy, in the form of both steam baths and bathing in hot mineral springs. They treated jigger bites with surgical extraction and an application of a cataplasm of agave (maguey) leaves. And it so happens that the medical profession today treats dermatitis actinica with an extract of agave leaves. The Aztec physicians also impressed the Spaniards with their treatments for flea bites, scabies, and head, body, and pubic pediculosis. 3 Prurigo and lichen were treated with green papaya—and papaya well may have produced cures, since it has proved extremely effective in treating various other conditions today. It is used to reduce edema and as an anthelmintic and a digestant. Burns were treated with an application of a paste composed of the yolk of a raw egg, the juice of the nopal cactus, and honey. Mayan physicians used a slightly different formula—egg yolk and lime juice. In the treatment of ulcers the Aztecs utilized an extract of the bark of the guava tree, which has an astringent property. Healing

Ointments

Aztec doctors had devised an effective ointment which possessed the properties of both a vulnerary 4 and an analgesic and the components of which were the same as those of a popular and efficacious salve prescribed 450 years later, by our present-day doctors, for hemorrhoids. However, the Aztecs, who traveled entirely by foot, used this efficient unguent not so much for hemorrhoids (the stigma of a sedentary people) as for cracks in the soles of their feet. The ingredients of the Aztec ointment were: oils of turpentine, which served as antiseptics and mild irritants; the herb Artemisia, which is of value as a vulnerary; and the herb Datura stramonium, which has a strong narcotizing property. Genital Eruptions An ambiguously diagnosed ailment which may have been either 3 4

Infestation by lice. A wound-healing agent.

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a venereal disease or a fungoid infection was described by Mayan physicians, according to Sahagún, as including the symptoms of "burning sensation, swelling and eruptions of the genitalia." Primary therapy comprised application of a poultice made of a mash of the bark and flower of the "hand-flower tree" (Chiranthodendron pentadactylon), the stamens of which resemble a wrist and hand. If this treatment was unavailing, the swollen and painful parts were lanced, cleaned, and annointed with the extracts of various other herbs. Lightning

Injury

Inasmuch as the temples atop the Aztecs' truncated pyramids were by far the highest edifices in the city, it is probable that sacrificial priests who happened to be conducting rites during an electrical storm were sometimes struck down by "a bolt from the heavens" while in the midst of their grisly butchery. (Such "Acts of God" may have been interpreted by the priesthood not as evidence of heavenly displeasure with their activities but simply to mean: "Don't be so s l o w ! . . . Send 'em faster.") Lightning bolts certainly were more of an occupational hazard for priests than for all others, who worked on less exalted levels. And the bolts must have hit humans fairly regularly. The Aztec physicians catalogued a wide variety of treatments for persons struck by lightning. Their most common treatment was not dissimilar to that employed as late as the Victorian era: To restore consciousness, they held under the victim's nose "the pungent fumes of burning copal" (or burned "feathers, hair or mouse nests" to produce a nasty stink) and tried to induce the stricken one to drink "a hot, stimulating solution of aromatic cypress." Next, to stimulate peripheral circulation, they applied to the victim's body the Aztec version of a mustard plaster—a poultice containing fiery chile peppers. Deafness The Aztec physicians treated progressive loss of hearing by inserting in the ear a paste composed of rue oil and the pulverized bone of an armadillo's tail. The oil undoubtedly softened accumulated cerumen, 5 facilitating its subsequent removal, and to that extent effected 5

Earwax.

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improvement in hearing. (All too often modern medicine can do little more.) Heart Trouble A tea brewed from Chiranthodendron pentadactylon was sipped as a tonic for the heart. Heart pains were believed to be alleviated by ingestion of the ash of a stag's heart. And both the flowers and the bark of the Mexican magnolia (Talauma mexicana)—called yoloxóchitl, "heart flower," in Náhuatl—were used for certain heart ailments. The latter reportedly has an effect on the heart similar to digitalis. Miscellaneous

Medications

The ancient Aztecs had special herbal remedies for virtually every other ailment—from gout to freckles. (The Spaniards reported that the Indians definitely considered freckles a disease and had several medications for same.) They treated hepatitis with the juice of the nopal cactus, mixed with pitahaya. They treated both sterility and mental stupor with a tonic prepared from dried blossoms of magnolia. And the remedy for a bleeding nose was to apply the juice of the nettle, which is a counterirritant. The list of miscellaneous remedies could be prolonged almost endlessly. Anesthetics In the field of anesthetics, the Aztec physicians and surgeons unquestionably were several centuries ahead of the rest of the world. It was not until 1846 that William Morton, in Boston, first publicly demonstrated the original general anesthetic—ether. Even so, nearly a generation later, during the United States' Civil War, tens of thousands of soldiers suffered amputation of ball-shattered limbs in field hospitals with nothing more given them to deaden the pain of the surgeon's knife and saw than a stiff shot of whiskey and a lead bullet to bite on. In contrast, when Cortés invaded Mexico in 1519, the Aztec surgeons already possessed not one but a wide spectrum of long-proven narcotics, from which they were able to select the anesthetic of choice for any specific surgical procedure or patient.

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This was the result of three factors: Middle America's great wealth of medicinally useful flora, the Aztec emperors' program of statesupported scientific research, and the experiments by the sacrificial priests—on a scale never attempted before or since—with narcotics and their effects on humans. Toward the end of their bitter fighting for the Aztec capital, Cortés and his soldiers were horrified and incredulous when they saw several of their comrades, who had been captured in battle and taken to the top of the Great Pyramid to be sacrificed, actually join in an abandoned dance, just before their chests were slit open and their hearts were torn out. And some historians have found it difficult to believe that in 1486, when the Emperor Ahuítzotl had dedicated that same Great Pyramid, the seventy thousand war prisoners sacrificed, during festivities lasting nearly a week, all waited as meekly as cattle for their turn to ascend to the dripping sacrificial stone. The explanation is that all these captive fighting men who displayed such passivity and indifference to their imminent horrible death almost certainly were drugged. The Aztec priests did not want any show of fear and terror by the prospective victims, for that would offend the gods. Furthermore, they could not permit each sacrifice to become an exhausting, time-consuming death struggle. Therefore, the priests administered narcotics to sacrificial victims at dawn of the day they were to be put to death and again just before they were immolated. Aztec surgeons often were called in to aid the priests in their more difficult and esoteric rites, such as those involving the flaying of certain sacrificial victims. Thus, in addition to experiences in their normal medical practice, the surgeons periodically benefited from special opportunities to explore the potentialities of the various narcotics. The priests and surgeons together possessed an impressive battery of effective anesthetizing agents. Some undoubtedly were the discoveries of the Aztec state scientific-research department's indefatigable workers; others were inherited from far older Middle American civilizations. They included: 1) The plant yoyotli (Thebetis yoyotli), hurled in powder form into the faces of sacrificial victims, for inhalation, before they were flung onto the sacrificial stone. 2) Numerous species of the plants comprising the genus Datura,

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including the best-known, the jimson weed (Datura stramonium). In recent years, the narcotics hyoscyamine, scopolamine, solandrine, and atropine have been isolated from these plants, once widely used by the Aztecs. 3) The leaves of marijuana (Cannabis sativa), burned and the smoke inhaled. 4) A species of mushroom which contains a powerful narcotic, psilocybin, ingested to induce hallucinations during rituals, and still used in certain regions by primitive Indian groups in secret ceremonies. 5) Mescaline, an extract of the mescal, or peyote, cactus (Lophophora williamsii),6 also widely used as a narcotic, as a stimulant and antispasmotic, and for its hallucinogenic properties, especially in religious ceremonies. (Cowboys of the U.S. Old West occasionally chewed peyote "buttons" to "go on a binge" and called peyote "dry whiskey.") Other sources of narcotics employed by the Aztecs included the lesser known: 6) Cochiztzapotl, or white zapote 7) Oily seeds of tlalcapolin (Karwinskia humboldtiana) 8) Seeds of tzompatli, a species of Erythrina 9) Mixitl plant 10) Coapotli root (Comolina tuberosa) 11) Totoncaptli plant (Platango major).7 The aforementioned list of Aztec narcotics—like the Aztec pharmacopeia of herbal remedies discussed in the preceding pages—may have been larger than indicated or than records show. It is not only possible but probable that some truly amazing discoveries have been lost without a trace. We know that the Aztecs, the Mayans, and the other ancient Mexicans kept voluminous records. In fact, they consumed an enormous quantity of the various types of paper they fabricated in inscribing records in their ideographs of nearly everything they did. If, as is often said, a people's consumption of paper is an index to its literacy, they could be considered a very literate people. 6

Not to be confused with the drink mescal, which is distilled from pulque and obtained from the agave, or maguey, plant. 7 These drugs are variously narcotic (sleep- or stupor-producing), anesthetic (sensation-deadening), analgesic (pain-relieving), hallucinogenic (vision-inducing), and/or psychedelic (mind-"expanding" or disorienting) in their effects.

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But in the fanatical book-burnings conducted after the Conquest almost everything written was lost to the world. Bishop Diego de Landa, in Yucatán alone, burned an estimated 100,000 Mayan books or codices! Fray Juan de Zumárraga made a nationwide collection of all the remaining Aztec and other books and codices he could find— believed to total several hundred thousand—completely emptying the royal library at Texcoco, the cultural center, in the process—and had all but fourteen books tossed into the flames. All the medical writings we have are mere post-Conquest reconstructions—what a few individuals remembered of the Aztecs' vast medical knowledge. Principal Sources William H. Prescott, History of the Conquest of Mexico; Bernal Díaz del Castillo, The Discovery and Conquest of Mexico, 1517-1521. Martín de la Cruz, The Badianas Manuscript; and other early medical and herbal works listed in the Selected Bibliography. Comments in doctors' papers.

CHAPTER SIX

Legacies from Aztec Medicine

The ancient Middle Americans' contributions to the world's store of medical knowledge were great. The pharmaceuticals they gave to humanity, that are in medical use today, include, in part: Datura stramonium Chaparro Chenopodium Artemisia Condurango Cascara Damiana Papaya Lobelia Ipecac Krameria Agave Haltada Cacao Balsam Sarsaparilla Copal Guava Tolu Tobacco Avocado Peyote Barbasco Cinchona Tlacopalli All of the aforementioned herbs, trees, and shrubs, or their products, possess at least one, and, in many cases, several, valuable medicinal properties which the Aztecs discovered and/or employed and thus passed on to the world. In addition, both quinine and curare, although native to South America, well may have been known and used by the doctors of the Aztecs and other Indian nations of Middle America, for a substantial trade was carried on by the far-traveling Aztec merchants with the Incas of Peru. It is known that these merchants, with their caravans

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of hundreds of slaves bearing packs of trading goods on their backs, crossed mountain ranges and hacked their way through hundreds of miles of jungles and rain forests to bring the Aztec emperors Andean condors for the imperial zoo and probably emeralds, as well, for the emperors' gemsmiths. Untapped Aztec Medical Lore Although many Aztec pharmaceuticals are being employed in modern medicine, much Aztec medical knowledge is still untapped. As pointed out in the preceding chapter, the vast body of the Indians' medical knowledge was lost in the Conquest. And although, by orders of the King of Spain and the Pope, early attempts were made to re-create as much as possible of the vanished records of the Aztec physicians, that which was salvaged very likely was only a fraction of the original amazing total. Furthermore, until very recently, a great deal of what is known of the Aztec medical lore has remained totally uninvestigated by research laboratories and ignored by the medical profession. The Era of Pharmacognosy Today, however, many of the world's big pharmaceutical houses have corps of trained plant-hunters, or pharmacognosists, roaming the globe in search of strange plants that may yield a new "miracle cure" for some of the ills of mankind. Like the prospecting "FortyNiners" of the last century, these world-roving plant-hunters know that "gold is where you find it"—whether it is yellow or green. And, like the grizzled old sourdoughs of Cap'n Sutter's California, they are following all leads and leaving few leaves unturned. Old folk remedies, ancient medical "receipts" buried in the faded script of musty tomes, the "magical" herbs employed by witch doctors as they mumble their hoary rituals by the dim light of candle or moon in some jungle fastness or mountain cleft—many of these are being studied as promising prospects. Or a pharmacognocist may simply trek into field, forest, or jungle on his own and collect specimens of untested plants which appear to have interesting potentialities. And, theoretically at least, every one of the half-million different species of plants in the world is a prospect. Steroids and Synthetic

Hormones

The greatest example, to date, of a lucky strike in "green gold" is

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the discovery and production of synthetic steroid hormones. 1 This occurred in Mexico. In 1940, a vacationing American, Dr. Russell Marker, professor of organic chemistry at the University of Pennsylvania, was so impressed by the enormous variety of flora in the jungles around Veracruz that he decided Mexico was just the place to test a radical theory of his. At that time, the medical profession was first becoming excited over utilization of the recently isolated female hormone progesterone to prevent spontaneous abortions in gravid women. But the only commercial source of progesterone was animals freshly killed in meat-packing plants. The limited amount available, plus the complicated processing technique, kept the price at a virtually prohibitive eighty dollars a gram. As an organic chemist, Professor Marker believed it feasible to extract progesterone from plants. He was convinced that if he could find the ideal plant and could devise an extraction process he would have an unlimited and enormously cheaper source of the hormone. Hurrying back to the States, he tried to persuade various pharmaceutical companies to finance the research. But one after another refused. "A plant with hormones? A 'sex' plant?" one executive asked incredulously. "Perhaps you expect to find a vine growing human ova and testes, like grapes?" another jibed. Dr. Marker resigned his position on the university faculty, drew all his savings from the bank, and returned on his own to Mexico. He started tirelessly hunting that "ideal" plant which very possibly did not exist—plodding along the steaming, jungle-clad banks of the Papaloapan ("River of Butterflies"), where parrots screamed, alligators bellowed, and monkeys chattered; climbing the mountain slopes of Chiapas, where the roar of a jaguar or puma often broke the night's silence as he huddled before his lonely campfire; crossing barrancas choked with vines so thick it was difficult to distinguish them from the occasional boa constrictor waiting for some unwary prey. Eventually, he set up a small laboratory and started analyzing the 1 Not all hormones are steroids. The sex hormones and the adrenocortical hormones are. (Steroids are compounds chemically resembling cholesterol and having in common a particular basic molecular structure.)

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specimens he had collected. After many frustrating disappointments, he found one that contained the chemical constituents he wanted—a black root of a species of Dioscorea that the Indians called "cabeza de negro9 and used in a "magical" remedy. And finally Marker devised a method of chemically altering the basic molecular structure and produced 4.5 pounds of synthetic progesterone! Worth, at the going market price, $160,000. It was an achievement equal to those of Pasteur and Lister. By then he had met Dr. Emeric Somlo, a Hungarian refugee who had fled when Hitler invaded his country and who had become a Mexican citizen. Marker took Somlo in as partner in 1944 and set up Syntex, S.A., a company to manufacture and distribute the hormone derived from a vegetable. After a year, however, Dr. Marker walked out. Although left in complete control, Dr. Somlo was in a predicament: The secret Marker had discovered was worth millions, but Marker had departed without disclosing it. Dr. Somlo reorganized the company, taking in some Mexican financiers. Then he called in another Hungarian, Dr. George Rosenkranz, who had been studying the chemistry of hormones in Switzerland. Rosenkranz worked with the root cabeza de negro until he was able to reproduce Marker's chemical process, and soon he could extract not only the female hormone, progesterone, but the male hormone, testosterone. The company's botanical department in time discovered another plant in the same family that had higher values of diosgenin, the raw material which is the source of the hormones. This was the Mexican wild yam commonly known as barbasco, a large white, pink, or yellow root of which nearly two hundred varieties grow in the states of Veracruz, Tabasco, Chiapas and Oaxaca. Additional sex hormones, and cortisone, were produced. At first used chiefly to treat menstrual disorders and arthritis, steroids soon were being employed in a wide range of ailments. And then, in the 1950's, came the development of the compound, norethindrone, used in manufacturing the now highly popular ovulation-preventing oral contraceptives. (Principal producers of the contraceptive pills in Mexico are Syntex, and Searle of Chicago.) Strangely, the source of the synthetic hormones still is uncultivated. The wild yam is dug up wherever it happens to be found by

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individual peasants, who sell it to "collectors" for about one cent per pound. Local processors pulverize it and truck it to Mexico City to the big pharmaceutical companies. This lowly uncultivated yam has become one of Mexico's most valuable vegetables—and an important source of export revenue (estimated at $10 million for 1966). Syntex, which for some years enjoyed a world monopoly in the field, is still the world's largest producer of synthetic hormones and steroids and now is a $30 million corporation whose stock is one of the fastest-rising blue-chip stocks listed on the American Stock Exchange. This is just one example of the "green gold" potential of the Mexican flora. Typical Research Projects It is interesting to note the nonscientific, purely folkloric, starting point for some typical research projects on which enterprising U.S. pharmaceutical firms are working, as this is written: 1) A pharmacognosist learned that, in accordance with a traditional custom in tropical South America, a male native who wants to render himself sterile for a twenty-four-hour period chews a leaf of a certain wild plant and swallows the juice. The plant was identified as the dumb cane, a common ornamental house plant in the United States, of the genus Dieffenbachia. Male mice are being tested with extracts of the plant—with the objective of developing a new oral contraceptive. 2) Another popular belief that launched a pharmaceuticalresearch project involved a "virility vine" called pega palo, which grows in Haiti and the Dominican Republic and, when steeped in rum, allegedly was responsible for the highly touted sexual prowess of a much-married international playboy who also grew to maturity in one of these countries. The androgenic activity of the vine currently is being tested with rats. In preliminary testing, an extract of a minute quantity was administered to six rats; when several weeks later the rats were sacrificed, they were found to have testicles five times normal size. 3) Folklore also first inspired research into the anti-carcinogenic properties of Vinca rosea, a tropical plant that grows principally in India and was found to have four anti-carcinogenic alkaloids (vincaleukoblastine, leurocristine, leurosine and leurosidine). Researchers now are conducting experiments with Vinca lancea, a related

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plant known as the Madagascar periwinkle, in the hope that, since it belongs to the same (dogbane) family, it may possess even more anti-carcinogenic activity than Vinca rosea. 4) Other research projects being conducted with tropical plants— to whose possible medicinal potentialities world-traveling pharmacognosists were tipped by their use as centuries-old "home" remedies —involve one plant believed to have an anti-leukemic property, another reputed to possess anti-diabetic action, and a third purported to have values in the treatment of epilepsy and other mental diseases. These were obtained from as widely separated areas of the earth as Southwest Africa, Java, and Formosa. Mexico—A Medical Treasure House According to leading pharmacognosists, Mexico very likely is the richest country in the world in the variety of its natural plant life. And today, with the world's pharmaceutical houses feverishly competing to discover herbs, shrubs, trees, and fungi that have valuable new medicinal properties—and with government-conducted and government-subsidized medical research also greatly expanding—the potentialities presented by this wealth of flora seem breathtaking. The dozen and more different narcotics the Aztec physicians utilized at the time of the Conquest—when Europe had not even one— hint at the perhaps even greater wealth in other medicinal plants awaiting discovery, or rediscovery, in Mexico. Mexico's flora certainly provide a rich and challenging field for scientific research. The Aztecs9 Greatest

Contribution

Like the Spanish conquerors first glimpsing it at the height of its splendor, modern man can but marvel at the Aztec civilization, that developed and rose swiftly from a low nomadic level into mighty dominance over a huge segment of Middle America, while simultaneously acquiring an astonishingly high culture. One must marvel, also, at the fact that the physicians of this Indian civilization were making vital discoveries in medicine and pharmaceutical research long before the Genoese navigator who "discovered" the New World was born. Amazingly advanced and precise as was their knowledge in the fields of mathematics and astronomy, the Aztecs' greatest contribu-

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tion to history was in the field of medicine—more specifically, in the field of pharmacology. For in this, although their civilization vanished overnight from the earth, they benefited all subsequent generations of mankind. Principal Sources Interviews with pharmacologists and pharmacognosists.

Introduction When Mexico fell to Cortés and his conquistadores in 1521, it became the Spanish colony known as "Los Reynos de Nueva Espagña," or The Kingdoms of New Spain.* Later, it was called "Las Provincias de Nueva España" and official· ly categorized as outright overseas provinces of the European nation. Nevertheless, New Spain had no self-government and invariably was ruled for the Spanish throne by Spanish-born administrators. Vast New Spain—which included not only present-day Mexico but all of Central America, plus Texas, California, Arizona, New Mexico, Nevada, Utah, and parts of Colorado and Wyoming—remained a Spanish colony for the next three hundred years. What of the public health and welfare, medical facilities, and the practice of medicine during these three full centuries under the Spanish Crown? Despite the destruction and havoc wrought by a ruthless military conquest, and despite the defects and abuses of the colonial system, it must be conceded that the Spaniards made a remarkable start at establishing the most advanced European-type medical facilities of that age in New Spain. Nevertheless, the enormity of the country, the abrupt dissolution of the indigenous social structure, the forcible imposition of European rule, the increasingly ruthless exploitation of Indian labor, the very limited medical knowledge, and, above all, the recurrent appalling decimations of the population by lethal epidemics of diseases brought by the conquerors—all posed staggering and often insurmountable problems. * The plural was used because the Spaniards seized not only the Aztec Empire but the domains of other Indian nations.

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CHAPTER SEVEN

Medical Progress in New Spain

In 1521, when the Conquest of Mexico was completed, Spain was a world power nearing the zenith of her ascendancy. Having but recently thrown off centuries of Moorish domination, Hispania was rife with mighty ambitions and fanatical zeal to fulfill them. Like Caesar's legions, swashbuckling Spanish adventurers sighted, conquered, and colonized one far-flung country after another —simultaneously enriching the King's coffers, subjugating and converting the heathen to Christianity, and building "transplanted" Spanish cities (virtually indistinguishable from those of their homeland) in each of the lands that fell to them. In addition to entering the most glorious period of its tenure as a world power, Spain in the early sixteenth century led all Europe in medical progress. Medicine in Spain Spanish medicine had been greatly enriched by the extensive medical knowledge of the Arabs—the most outstanding of whom was Avicenna, the eleventh-century physician and philosopher surnamed "the Prince of Physicians." European medicine had remained woefully stagnated during the Middle Ages. However, new schools of medicine had been established in the thirteenth, fourteenth, and fifteenth centuries in a number of Spanish cities—all strongly influenced by the ancient Arabic medical works. And, embodying the accumulated Arabic knowledge, medicine in Spain by the sixteenth century had become Europe's most advanced.

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In Spain, too, Europe's first governmental council of leading physicians to supervise and regulate the practice of medicine had been founded, in 1498. This high status of medicine in the homeland explains why Spain, of all colonial powers, was the most progressive-minded and industrious in establishing medical facilities and in regulating medical practice in its colonies. New Spain's First Physicians Strange as it may seem today, no doctor of medicine had accompanied Cortés and his conquistadores to Mexico to treat the wounded in their military campaigns. Hence, as earlier noted, officers and men had doctored themselves by successfully cauterizing wounds and staunching hemorrhages with boiling oil. However, according to some old chronicles, one Isabel Rodríguez, wife of a soldier, had arrived from Spain shortly before 1521 and had cared for wounded soldiers during some of the fighting. In return for this service she later was granted permission to practice medicine in New Spain. No doctors came overseas in the first years of the Colony, either. In fact, Cortés early had written King Charles I 1 not to send physicians from Spain "because those already in the country [were] sufficient." Cortés had had opportunity to observe the skill of the Aztec doctors in the uneasy peace when he and his soldiers were guests of the indecisive Emperor Moctezuma before the bloody battle for Tenochtitlán and he had intensely admired the native doctors' proficiency. Accordingly, in New Spain's first years, rather than Spanish doctors, the Spanish priests of various orders attended the sick in Mexico City. And Spanish missionaries fanned out across the provinces and traveled far into the sparsely inhabited north, bringing both a new religion and a new medical care to remote and primitive tribes at the padres' isolated adobe missions. The priests, friars, and missionaries also operated the many hospitals the Spaniards constructed. So it was the clergy who were chiefly responsible for introducing and promulgating Spanish concepts of medicine among the natives and persuading them to accept alien standards. 1 King Charles I of Spain, more widely known as Emperor Charles V (of the Holy Roman Empire, Germany, The Netherlands, Austria, Naples, Sicily, and most of the Americas).

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Not until 1525 did the first Spanish physician—Diego Pedraza— set up practice in New Spain. And on January 13 of that same year, the Mexico City government issued a disposition assigning to "Francisco de Soto, barber and surgeon," an annual salary of fifty pesos "to reside in this city and serve in the said offices." Thus this barber-surgeon became the first salaried medical official in New Spain. In June, he was authorized to teach others his profession. The rebuilt capital grew rapidly and the need for trained physicians and surgeons increased correspondingly. Fusion of Medical Concepts Gradually after the Conquest a new concept of medicine, an informal but integrated body of doctrines and conduct separate from the traditions of Hippocrates and Galeanos, evolved in New Spain. Neither indigenous nor wholly Spanish, it was unique in the world and had both beneficial and undesirable results. Through it, the Spaniards acquired a part of the ancient Aztec medical knowledge, and many of the Indians adopted Spanish practices—each group accepting both the sound and the unsound. Despite the dedicated medical work of the padres, the religious fanaticism of medieval Spain continued to operate as a negative force. Among other things, it discouraged healthful native practices such as circumcision and frequent bathing. And, among the Indians, the lurid European superstitions of the era proved far more popular, and were accepted far more avidly, than the sound medical precepts. Furthermore, as the fusion of Spanish and Indian concepts progressed, the practice of purely indigenous medicine correspondingly declined. The old empirical knowledge of Aztec medicine, the tested therapeutic practices and scientific experimentation, died out among the Indians. Thus, while medicine under the Spaniards maintained a formal aspect in the cities, among the rural populations it swiftly degenerated into mere "magic and witchcraft," blending deplorable elements of both Indian and European magico-religious folklore. There was a constructive side, however. The surviving Aztec doctors who worked with the Spaniards were highly cooperative, not only in disclosing and recording their own medical lore but in adopting Spanish methods. They quickly accepted and learned Latin as the language of science, in addition to learning their rulers' Spanish.

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And, while some Spanish doctors were reluctant to accept any native concepts, royal orders required them, both jointly and individually, to experiment with the indigenous pharmacopeia and to inform the Crown of curative properties. In general there was strong interest in and acceptance of the Aztecs' advanced botanical and pharmaceutical knowledge. And before long, as previously described, a thriving export commerce was conducted in Mexican plants and remedies, which Spain rapidly extended throughout Europe. (A large proportion of the new European medical therapies of the sixteenth, seventeenth, eighteenth, and part of the nineteenth centuries was based on new medicines imported from the Americas.) Meanwhile, in New Spain, not only two cultures but two races were fusing. Immediately upon the Conquest, many Spaniards began marrying Indian women, and soon there were a sizable number of mestizos among the population. (These persons of mixed Spanish and Indian blood eventually would comprise the vast majority of the population of Mexico.) In this connection, it is interesting to note that October 12, which in the United States is celebrated as the anniversary of the discovery of the Americas by Christopher Columbus, in most of Latin America is celebrated as "The Day of the Race"—the anniversary of the first meeting and mingling of the Indian and the European races; i.e., of the day from which an entirely new race was born. Construction of Hospitals The Spaniards of the sixteenth century were not only conquerors but builders, and they excelled at Colonial construction. Before the Aztec capital fell in August of 1521, it had been razed, stone by stone, in the last-ditch combat. Its canals were clogged with rubble and tens of thousands of putrefying corpses. Those Indians who survived the final siege were homeless and dying of famine, while the hordes of vultures that had inherited great Tenochtitlán were too gorged to flap off the ground. The conquerors immediately began cleaning up and rebuilding this tragic wasteland. Coyoacán (then an outlying mainland village; now within the huge Mexican capital's city limits) served temporarily as the Spaniards' capital and headquarters. But by 1523, in little more

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than a year, Mexico City's principal buildings already were erected (by Indian labor, largely supplied by Cortés' Indian allies, who had helped conquer the Aztecs). These edifices included Cortés' first palace, a fortress, military-government structures, and many mansions for the Spaniards, all massive and of stone. The National Cathedral and lesser Roman Catholic churches were literally being built upon, and from, the ruins of Aztec temples. And by then, too, the Hospital of Jesus already was in existence. Hospital of Jesus The first hospital on the American continent—and the oldest in the Western Hemisphere still in existence—was built in Mexico City at the order of Hernán Cortés. Officially and rather overwhelmingly named the Hospital de la Limpia y Pura Concepción de Nuestra Señora y Jesús Nazareno (Hospital of the Clean and Pure Conception of Our Lady and Jesus of Nazareth), it soon became known simply as Hospital de Jesús. Some sources say construction began in 1521; others, in 1523. In any event, the hospital was in operation as early as 1524. It was built at the site of a water fountain to which an Aztec conduit had brought water from Coyoacán. But the location had greater importance than this. A commemorative plaque on the lateral part of the hospital's central stairway today marks the spot where: The 8th of November of 1519, in a place called Huitzilán, there met for the first time the Emperor Moctezuma and Hernán Cortés; according to tradition, on this same site, and five years later, the Conqueror of Mexico founded the "Hospital of Jesus" . . . Huitzilán, Náhuatl for "the place of hummingbirds," is an appropriate name, when it is recalled that hummingbird feathers were linked to Huitzilopochtli, the Aztecs' god of war. There, on the enormous causeway that connected the water-bound Aztec capital of Tenochtitlán with Coyoacán and Ixtapalapa, the armor-clad Spanish captain had been ceremoniously welcomed by the splendidly garbed, haughty ruler of the mighty Indian nation he soon would conquer. Then and there had occurred the first real meeting and top-level confrontation of the European and the Aztec cultures. Thus, this history-making site was the most appropriate and symbolic possible for Cortés to erect his hospital. Especially in view of his principal motive in founding it.

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In his last will and testament—undoubtedly recalling the least savory aspects of the Conquest, particularly his one totally unjustifiable act, the torture-murder of the last Aztec ruler, Cuauhtémoc— Cortés emphasized that he had been moved to found and maintain the Hospital of Jesus . . . For the discharge and satisfaction of whatever fault or burden might grieve my conscience. In his will, he meticulously specified those of his estates whose income was to sustain the hospital, the type of staff to be employed (and its duties; even the hour at which the night watchman was to light the lanterns), and the hospital's future directors. He stipulated that the patron and head of the hospital always was to be a direct descendant of himself, who (like himself) would bear the title of Marqués del Valle de Oaxaca (Marquis of the Valley of Oaxaca). This tradition was respected for the next four hundred years: The last Marqués del Valle who served as patron of Mexico City's Hospital of Jesus was Prince Pignatelli de Aragón Cortés, who died in Hollywood, California, in 1930. The first hospital in Mexico City (and on the continent) was built with funds provided by Cortés, but, as an old account relates, "with the cooperation of the city authorities, the clergy and secular persons." Even the King entered the act: A royal prescription decreed that the hospital "operate for the convenience of all, and dispense Christian charity." Few Mexican institutions are so rich in tradition as the Hospital of Jesus. Its patrons, the successive Marqueses del Valle, were prominently involved in the history of New Spain. And in this hospital, beginning in 1646, the first anatomical dissections in the New World were performed. When major epidemics struck Mexico City it was a refuge for many hundreds of afflicted natives and creoles. Throughout the entire Colonial era it was a center of medical-surgical knowledge. And, during those three centuries of Spanish rule, the Hospital of Jesus was the seat of the Protomedicato, the governmental board which regulated Colonial medicine and public health. Subsequently, during the long War for Independence from Spain, and still later, during the War between the United States and Mexico (known in

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Mexico as "the North American Invasion"), the Hospital of Jesus became a so-called hospital de sangre, or "hospital of blood"; it cared for large numbers of battle-wounded. The archives of this ancient hospital once contained over two million historic documents. By presidential decree, these have been transferred to the National Archives. Cortés—who died December 2, 1547, in Castilleja de la Cuesta, Spain—had wished that his remains repose forever in Mexico. His will had ordered the completion of the church adjoining the Hospital of Jesus (to be paid for by the rents from his houses on the Plaza and on the streets of San Francisco and Tacuba). This church, the Church of Jesus of Nazareth, was a logical site for his interment, but it was many years before the edifice was finished. Returned to Mexico fifteen years after his death, Cortés' remains first were interred in the Church of San Francisco, in Texcoco. In 1629, they were borne with great pomp in an ecclesiastical and military procession to Mexico City, where they lay in state for nine days at the palatial State House (now the Monte de Piedad, or National Pawnshop) before being interred in the capital's Temple of San Francisco. Not until 1794—at the instigation of the viceroy, the Count of Revillagigedo—were they finally laid to rest (in a crystaland-silver coffin) in the presbytery of the completed Church of Jesus of Nazareth, where it was intended they would remain permanently. However, within only a few years, the colony Cortés had won for Spain rebelled and went to war with the mother country to end its long subjugation. And in the ensuing period of high passions, of hatred for Spaniards, of social ferment and bloody warfare, the memory of the Spanish Conqueror inevitably became distasteful to Mexicans. It was vehemently said that there was no longer room in any Mexican soil for him. On the night of the fifteenth of September, 1823—two years after Mexico won its independence from Spain; on the very eve of the nation's newly established Independence Day—Cortés' bones were surreptitiously exhumed from their church crypt. Did officials or vandals exhume them? And what became of them? The authorities had no interest in dispelling the mystery. But rumors seeped out that Cortés' mortal remains had been secretly rushed to the coast and aboard a waiting ship and dispatched not back to his

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native Spain but to Italy. It was reported as recently as 1936, in Los Hospitales de México, published in Mexico City, that Cortés was still interred in Italy. However, just after World War II, a group of historians, following a clue in an old manuscript, chiseled into a thick wall in the disused chapel of the Hospital of Jesus and discovered behind an unmarked stone slab a small casket containing a moldering skull and blackribbon-bound bones and a notarized document which presumably confirmed that these were indeed the remains of Hernán Cortés. There evidently had been unheralded room in Mexico for the Great Conquerer all the while. The often-transferred relics this time were resealed with little ceremony into the chapel wall. The Conqueror of Mexico, not too surprisingly, still goes unhonored by the nation. But interested persons may seek out his last resting place in the chapel of the Hospital of Jesus—virtually at the site of his initial confrontation with Emperor Moctezuma. Today, the museumlike Hospital of Jesus—built in typical Spanish Colonial style of volcanic tezontle stone and cedar beams, with thick fortresslike walls and echoing stone floors—is redolent of its age and history; somber despite the two courtyards with arched-and-colonnaded arcades, fountains, and flowers; austere, but steeped in latterday tranquility. The Hospital of Jesus is not merely the oldest hospital in the Hemisphere; it is also unique in having continued in operation, without interruption, since its founding—for over 440 years, as this is written. And it is still operating with funds from the endowment set up by the Spanish Conqueror. The First Leprosaria In 1526 (or 1528), just five (or seven) years after the Conquest, on one of his estates at Tlaxpana, Cortés also founded the first leprosarium on the American continent, the Hospital de Tlaxpana—a "hospital of St. Lazarus," as institutions of its type euphemistically were known. There is some debate today as to whether this hospital's first patients really were lepers. (The question of just when leprosy was introduced into Mexico, and by whom, will be discussed shortly.) However, the hospital at Tlaxpana was established "for lepers" and

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"for those with a horrible appearance" to isolate such unfortunates from the general population. The Hospital de San Lázaro, New Spain's second leprosarium, was founded in Mexico City in 1572 by Dr. Pedro López, one of the Colony's leading early physicians. It sheltered victims of leprosy for three hundred years. Hospital for Natives In 1530, or 1534, the Hospital Real de San José de los Naturales, or Royal Hospital of St. Joseph of the Natives, was established to care for "the poor Indians." It was founded by Franciscan monks and directed by Fray Pedro de Gante. The King sent some funds for it. Built specifically to benefit the natives, by the same token it served to segregate them from the Spaniards. Hospital of the Buboes In 1534 a particularly interesting institution, the Hospital de San Juan de Dios (Hospital of St. John of God, or St. John the Divine), was founded in Mexico City. It was more often known as the Hospital of the Love of God, or, informally, the Hospital of the Buboes. Friar Juan de Zumárraga, the first archbishop of Mexico, in conjunction with the construction of the National Cathedral, founded and had built nearby (on the present site of the Palacio de Bellas Artes, in downtown Mexico City) the Hospital of the Love of God, "where," as on old account put it, "with much care were cured and sustained the poor afflicted with morbo gálico [syphilis], and only with this disease, because it is the most noxious and dangerous in these parts." During the sixteenth century syphilis and other venereal diseases were rampant in Europe and presented a much greater virulence than they had previously. In this connection, it is illustrative of human nature that, whereas the Spaniards then delicately referred to syphilis as "morbo gálico" or "mal francés" (the "French malady")—the French in turn persistently called it the "Neapolitan sickness," and the Italians, equally determined to attribute the universally unpopular disease to another country, dubbed it the "Spanish sickness." (Bringing the little word game full circle.) In the same vein, despite the great prevalence of the disease in Europe, Spaniards in the New World often snidely

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termed it the "Indian sickness," (Actually, syphilis had originated in none of these places, but had been brought to all from the Orient— as will be discussed.) The Hospital of the Love of God, although it "attended to charity patients assembled from within Mexico City, the archbishopric area and the provinces," nevertheless cared only for Spaniards. And by no means were all the Spaniards it treated charity patients. Many were well-to-do. Indeed, numbered among them were some distinguished priests. The Love of God did not take in Indian patients. (Indigenes suffering venereal diseases were treated separately, until as late as 1736, at the Royal Hospital of the Natives.) The exclusive Love of God, "a very well-built edifice," apparently provided true luxury facilities for its syphilitic Spaniards. "It was the best-served hospital anywhere in the Indies. 2 Patients were supplied with doctors, surgeons, medicines, food, bed and servants—all extremely clean and punctual." The hospital was administered by its founder, the Archbishop. In his name, a diligent major-domo admitted the charity patients and collected the "rents," or fees, of those who paid. A salaried staff included doctors, a druggist, a surgeon, and a barber. Spiritual needs were administered to by the curates of the Cathedral, and Mass was said to these favored syphilitics by the Canon Gaspar de Mendiola. The Hospital of the Buboes continued in operation for over 250 years. It finally was incorporated into another hospital, to which its patients were transferred, in 1788. (A special hospital for the treatment of prostitutes was established in 1868 and is still in existence, now known as the Hospital Dr. Jesús Alemán Pérez.) Hospital for the Insane The Hospital de San Hipólito, the first hospital in America for the mentally ill, was founded in 1566 at the instigation of Fray Bernardino de Álvarez. Bernardino de Álvarez was one of the more colorful figures in the medical history of New Spain. A native of Utrera, he had arrived in the Colony as a young man—early enough to participate in the conquest of the Zacatecas Indians. He is reported to have lived "a li2 "Indies" formerly was loosely employed to mean "Indian lands," both the islands and the mainland.

Courtesy Johns Hopkins Press

A page from the facsimile edition of The Badianus Manuscript: An Aztec Herbal of 1552.

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

First hospitals on the North American continent established in the Colony of New Spain, in Mexico City. Hospital de San Hipólito (top), established in 1566 for the insane (lithograph). Patio of the Hospital of Jesus (bottom), founded by Hernán Cortés in 1524. The oldest hospital on the continent, it is still in operation.

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

Patio of the Hospital of San Juan de Dios (top), founded in 1534. Popularly known as "The Hospital of the Buboes," it specialized in caring for syphilitic patients. Chapel of Hospital de San Lázaro (bottom), first leprosarium on the continent.

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

Street scene typical of Colonial Mexico City (top; lithograph). Like many convents of the Colonial period, the Convent of San Cosme (bottom; lithograph), Mexico City, operated a hospital.

From the Archivo Fotográfico of the Instituto Nacional de Antropología e Historia

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centious life," and, after a long sequence of dangerous and questionable adventures and escapades, he was condemned to ignominious exile. However, he was protected and hidden from the authorities by "a beautiful mulatto" until he fled to Acapulco, from where he embarked on his own for Peru. And what happened there? He made a fortune! He reappeared in Mexico many years later, whereupon instead of luxuriating in his wealth, he repented of past sins and worked humbly as a male nurse for ten years, distributing his money among needy convalescents. One of his most important benefactions was his founding of the first hospital for the insane in America, where the mentally ill among the poor could be sheltered. Provincial Hospitals The bustling capital was not the only site of hospital construction in Colonial Mexico. King Charles I of Spain ordered, on October 7, 1541: Asistencia Hospitalaria [Welfare Hospitalization]: First law. That Hospitals be founded in all the Cities of Spaniards and Indians. We charge and order our Viceroys, Court law officers and Governors to take special care that, in all the Cities of Spaniards and Indians in their Province and Jurisdiction, Hospitals be founded where the sick poor will be cured and Christian charity will be exercised. Thus, in this case the Crown made no distinction between Spaniards and indigenes, and free hospital care was to be made available to both. The decree was extended by King Philip II, in Ordinance 122, on July 13, 1573: Law IX. That the Hospitals founded conform to this law. Wherever is founded or settled any City, Town or Place, there shall be set up Hospitals for the poor and infirm suffering illnesses that are not contagious, attached to the Churches and cloistered with them; and, for those ill with contagious sicknesses, in elevated places and places where no dangerous winds, passing the Hospitals, might proceed to endanger the populations. Note that even the smallest towns and "places" were to construct hospitals for the poor, and, moreover, that there were to be facilities for isolation of contagious-disease cases. The plan was admirably advanced—on paper, at least. Whether this extensive public assistance hospitalization program was completely admirable in actual operation is questionable. In the sixteenth

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century the standards of hospitals in Europe (on which those in Mexico naturally were modeled) in almost all instances were appalling. There was not only no knowledge of or attempt at asepsis but an utter lack of hygiene. Conditions had not improved much from the earlier period when, in big city hospitals like the Hotel Dieu in Paris, patients were crowded four and five to a bed, and young children and pregnant women were indiscriminately mixed with adults dying from such diseases as typhus and tuberculosis. Patients who expired in the nightmarish wards often were left in bed with the living or were shoved out by the latter and left to decompose on the floor, for days. Nevertheless, it is true that in New Spain hospitals were constructed for the poor in virtually all the small provincial cities and towns. In fact, as early as 1533—just a dozen years after the Conquest, and well in advance of the above-quoted royal orders—hospitals were being built hundreds of miles from Mexico City, in towns in Guanajuato and Michoacán, among the Otomí, Tarascan, and other more primitive Indians. Before the end of that century, hospitals were established all over Mexico—including in the small cities of Acapulco, the Pacific-coast port; Mérida, near the Mayan ruins of Chichén Itzá on the Yucatán Peninsula; Real de Chiapas, in the jungle; at Pátzcuaro, on the shore of the big lake; in mountain-ringed Puebla; and in Veracruz, the Gulf port Cortés had founded where he first landed. Contrasts in Colonialism Thus, long before the first English colonies were founded in the New World, in Virginia and Massachusetts—as tiny settlements of rude log cabins, with a wooden stockade the only municipal structure —New Spain had a large and flourishing capital city, with impressive government buildings, palaces, churches, and general hospitals, plus specialized hospitals for lepers, for syphilitics, for the insane, and for persons with various contagious diseases. And, too, it had an extraordinary number of provincial hospitals in operation, in cities and towns from coast to coast. Furthermore, New Spain almost immediately had strict governmental regulation of all phases of medical practice. Also well before the first English colonies were founded, it had the first university and medical schools on the American continent. (In explanation of the long-continuing relative "backwardness" of

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the English colonies, it should be pointed out that the English colonists settled in a wilderness, thinly populated by nomadic savages, not among the survivors of a highly developed Indian civilization; that they totally lacked the large-scale native labor for construction work and mining, from which the Spanish so profited; that they found no treasure in gold and silver; that they immigrated chiefly as individuals, to carve small farms from the forests by their own toil and to live in self-sufficient independence, not as privileged representatives of the Crown, sent out to consolidate a military conquest and to rule, and extract riches from, a large and docile native population.) Medical Schools In June of 1525 Francisco Soto, the "barber and surgeon" who was appointed as the first salaried medical official of Mexico City (and of New Spain), was authorized to teach his profession to anyone who wanted to learn. This was the first official act regarding medical instruction in Mexico City. Otherwise, however, all teaching of medicine remained for some years in the hands of the Franciscan friars. The College for Indians The famed old Colegio de Santa Cruz de Tlaltelolco (College of the Holy Cross of Tlaltelolco) was founded between 1533 and 1536 as a school for Indians. Operated by Spanish friars, it was established as a center of European culture—the first in America dedicated to the humanities. Its graduates in turn disseminated European culture and customs among their own people. In addition to its humanities curricula, Santa Cruz de Tlaltelolco taught the medical sciences and specialized in the ancient medical knowledge of the Aztecs. These courses were taught by eight experienced old Indian doctors. Among the school's instructors who won fame and immortality were Martín de la Cruz, the Indian physician who wrote the original text of the Badianus Manuscript, and Juan Badiano, the Indian Latin teacher who translated this manuscript from the Náhuatl into Latin. But the school's most outstanding instructor was Fray Bernardino de Sahagún, whose extensive writings on pre-Hispanic culture 3 are rich 3 Historia General de las Cosas de Nueva España. A facsimile edition was published in Madrid (Fototipia de Hauser y Menet) in 1905.

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source material and who is considered the father of American ethnology. The National

University

On September 21,1551, a royal order established the National University of Mexico, the first university in the Americas. (Some authorities claim that the first royal order to establish the University was signed as early as 1539.) Even before the founding of the National University, however, the Royal College of Physicians had been established. (After 1833, the Royal College merged with the school of Medicine of the National University and was located in the building once occupied by the Inquisition. In the 1950's the School of Medicine finally was moved to the present site of the National University, the autonomous enclave University City.) The University of Mexico, like most of the universities of the world in the sixteenth century, was dedicated to the humanities. Nevertheless, it began teaching the science of medicine as early as 1553, just two years after its official establishment. By 1575 medicine was an important part of the curricula. The first chair of medicine was created that year, and Juan de la Fuente, the most eminent doctor of the period, received this post. In 1571 he and Dr. López Hinojosa y Hernández performed the first autopsy in the New World. The teaching of anatomy became obligatory at the University in 1621. In 1645, Viceroy Palafox issued detailed instructions that the medical instructors and students must regularly assist at anatomic dissections. During the first centuries of the Colony, the University not only offered courses on the same level as the Universities of Salerno, Paris, and Oxford, but taught some courses prohibited in Europe, such as anatomic dissection. The teaching of medicine at the University of Mexico at that time must be regarded as one of the most important advances in the intellectual and scientific world. Regulation of Medical Practice As soon as Mexico City's municipal government was formed, some attempt was made to regulate medical activities and to protect the public health. The city government sought competent doctors to supervise medi-

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cal matters—to serve as protomédicos, in the Spanish custom. Accordingly, in 1527, six years after the Spanish Conquest, an effectual protomedicato was set up in Mexico City. This governmental council to supervise the practice of medicine was the first such on the American continent. (It was a precursor of the more enduring and famous Protomedicato, which would not be established in the Mexican capital until 101 years later.) In 1527, its initial year in operation, that first protomedicato imposed penalties for malpractice and for practicing without a license: "For a first offense, 20 pesos in gold, for a second, a mark of gold, and for a third, removal from office and banishment from New Spain." In 1528 and 1529 higher fines for practicing without a license and new regulations were instituted. These regulations provided for inspections of pharmacies to see that medicines and drugs sold conformed to such standards as existed—and even to see that prices were fair! As Mexico City grew in population, more doctors entered private practice, and medicine evidently became a fairly rewarding profession. Soon there was a public clamor for the city officials to standardize the doctors' fees. As the result, on October 3, 1536, the municipal government ordered "that doctors charge patients for a consultation un tostón [half a peso], under pain of [a penalty of] 50 pesos of gold from the mines." This extremely high fine was approved by Viceroy Mendosa. Regulations increased. By 1540 even the old Indian crones who had always presided at neighborhood births came under control. A committee was charged with supervising "doctors and surgeons and those women who serve as midwives and to examine them, and give or withhold licenses, and also to inquire as to the cost of medicines and fees, and see that the midwives do not charge excessively." The Protomedicato—New

Spain's "Public Health

Department"

The second, enduring Protomedicato, established in Mexico City in 1628, was a tribunal or college of King's physicians—a council constituted to supervise and regulate the practice of medicine in all its forms, and, in addition, to maintain strict vigilance over hygiene and public health. Its president was the head of the faculty of medicine at the National University. Its many functions were supervised by three doctors, who were appointed by the government for two-year terms.

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The Protomedicato examined and licensed graduate medical students and anyone else who wished to practice medicine. It selected the medical-school textbooks. Like its predecessor, it imposed fines and other punishments (usually banishment or temporary exile) for malpractice and for practicing medicine or selling pharmaceuticals without a license. The Protomedicato, also, like its predecessor, inspected and supervised pharmacies and regulated the prices of simple and compound medicines. And it was in charge of preventing the spread of contagious diseases, the setting up of quarantines, and the proper isolation of lepers. The Protomedicato, in addition, had much broader duties than the foregoing. It was the council's responsibility to inspect, and maintain the good condition of, foods and beverages sold in the city. It was charged with maintaining in proper condition the city's streets, plazas, buildings, and cemeteries. It supervised a long list of other matters affecting public hygiene. And it handled certain aspects of police medicine. In 1788 the medical tribunal took over supervision of the maintenance of the botanical garden established in the Viceregal Palace and of the organization of formal botanical studies. It would seem that the few doctors of the Protomedicato would have required a staff of scores of eagle-eyed inspectors to attempt to carry out such a variety and multiplicity of duties on a city-wide scale. However, they handled much of their work with the aid of various other government officials and employes. Some of the most distinguished doctors in New Spain served on the Protomedicato, which functioned from 1628 until 1831—until after New Spain had ceased to exist. This medical council, with its many fields of directorial and regulatory activity, obviously fulfilled the functions of an entire Public Health Department and was a precursor of Mexico's present Department of Public Health and Assistance. New Spain's Medical "Firsts" New Spain, then, could claim: The first hospital on the American continent The first leprosarium on the American continent

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The first insane asylum on the American continent The first medical school in the Western Hemisphere The first university in the Western Hemisphere The first governmental council regulating medical practice on the American continent The first autopsies performed in the New World. In addition, the first medical book written and printed on the North American continent was Opera Medicinalia, by Dr. Francisco Bravo, published in Mexico City in 1570. (The second, published in Mexico City in 1579, was A Brief Treatise on Medicine, by Fray Agustín Farfán.) The first professor of medicine in the Americas, Juan de la Fuente, of the University of Mexico, as early as 1577 made some pathological studies of typhus. The first caesarean operation in the New World was performed in Mexico in 1779 by two friars of Santa Clara. (An edict in 1772 had declared a caesarean "was a licit operation.") The first medical magazine in America was established by José Ignacio Bartolache, a famous doctor and mathematician born in 1739. New Spain indeed had a proud and splendid history of medical "firsts." Principal Sources William H. Prescott, History of the Conquest of Mexico; Dr. José Alvarez Amézquita, et al., Historia de la Salubridad y de la Asistencia en México; Dr. Mario González-Ulloa, La Medicina en México-, Dr. Gilberto F. Aguilar and Dr. Roberto Ezquerro Peraza, Los Hospitales de México; and other relevant books listed in the Selected Bibliography.

CHAPTER EIGHT

Centuries of Killer Epidemics

Despite the impressive construction of hospitals throughout New Spain, the strict governmental regulation of medical practice, and all the public health laws on the books, the Spanish administrators were unable to control the deadly epidemics that continually plagued Spain's richest colony. Most, if not all, of the epidemic diseases had been introduced into Mexico by the conquerors. Virtually from the day the bearded Europeans first set foot on the Gulf Coast, luckless Indians began dying off from "new" bacteria and viruses against which their bodies had no natural resistance. It was almost as though the newcomers from the Old World were beings from another planet, so lethal were the alien microbes they carried. There is some evidence that a few of the diseases which swept Mexico in epidemic proportions after the Conquest may have existed in America at a much earlier date. And this is a matter of more than academic interest to many Mexicans. The Great Origin-of-Diseases

Controversy

The diseases suffered by Mexico's pre-Hispanic inhabitants are far from a dead issue in Mexico today. In fact, certain such diseases probably are more controversial now than they were over four centuries ago—when the first Spanish barber-surgeon in Mexico asked his first sick Indian to say "Aaaah!" In particular, whether leprosy and/or syphilis were initially introduced by Europeans, or whether one or both previously existed in the New World—presumably brought from Asia by prehistoric In-

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dian tribes in their waves of migration across the Bering Sea—has long been hotly debated in Mexican medical circles. Mere mention of the topic at a convention or "cocktail" in the nation's capital can touch off a lively debate. Similarly, it is also argued whether mal de pinto1 was introduced into the Western Hemisphere from Africa by Negro slaves, or whether it previously was endemic in America. Both sides in the running medical controversy can advance some convincing arguments. One noted authority on the subject, Dr. Fernando Latapí, director of the Pascua Dermatological Center, in Mexico City, and head of Mexico's National Program for the Control of Chronic Diseases of the Skin, is convinced that neither leprosy nor syphilis was present in the Western Hemisphere before the Conquest and that both were brought to Mexico by the conquistadores of Hernán Cortés. However, he believes mal de pinto was prevalent among the American indigenes well before Cortés landed. Whence Syphilis? "Although some evidence seems to indicate syphilis previously existed in Mexico," Dr. Latapi points out, "an overwhelming mass of evidence leads to the conclusion that it was initially introduced by the Spaniards." The first type of evidence includes a recent archeological discovery at an ancient Indian burial site at Ixtlán, Nayarit: Among small clay figurines, each traditionally modeled as a likeness of the deceased and buried with the body, was found one of a pregnant woman with stigmas suggesting prenatal syphilis—saddle nose, frontal protuberance, 2 and Hutchinsonian teeth. 3 "However," Dr. Latapi stresses, "it hasn't been incontrovertibly established that this little clay figurine antedated the Conquest." He also notes that until 1525 no writer even suggested that syphilis had existed among the Indians prior to the Conquest. Oviedo, in 1525, first advanced that hypothesis. But Oviedo's veracity was questioned by his contemporaries, including Columbus' son and the historians Las Casas and Clavijero. 1

A disease producing permanent, patchy discoloration of the skin. No symptom of pregnancy: a bulging forehead. 3 Centrally notched teeth. 2

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"There was a severe epidemic of syphilis in Europe at the time of the Conquest," Dr. Latapí emphasizes, "and undoubtedly a significant proportion of Cortés' soldiers had the disease. In addition, a virtual epidemic of syphilis erupted in Mexico soon after the Conquest. In fact, in the early 1530's, two hospitals were opened in Mexico City to treat syphilitics—one for the Spaniards and one for the natives. "It seems to me beyond reasonable doubt that, in the words of the medical historian I. Chávez, 'Mexico received both civilization and syphilization from Europe/ " However, those with opposing views cite the following to bolster their stand: Recently some Mayan skulls with luetic 4 lesions were found in a tomb in the ruins of Palenque, in the southern state of Chiapas. These ruins, significantly, long antedate the Conquest. In La Candelaria Cave, an archeological site outside Saltillo, in Northern Mexico, a bone was discovered with luetic lesions of the radioulnar type. Bones indicating syphilis also have been found in archeological sites in Guatemala and other Central American countries. Furthermore, regarding the question of the age of some of these bones: Dr. Guillermo Velasco Polo—-chief surgeon of the Mexico City Shriners' Hospital for Crippled Children, an anthropological buff, and honorary consultant on osteology to the Mexican National Institute of Anthropology—points out that the Institute has on display twenty-eight Mexican syphilitic skulls taken from various archeological sites, in all stages of the disease, some of which are believed to date from the second century B.C. Whence

Leprosy?

Dr. Latapi is even more strongly convinced that the Spaniards first brought leprosy to Mexico. He points out that the claim that leprosy existed in Mexico before the Conquest rests solely on the writings of historians—Clavijero and Francisco Hernández, physician to King Philip II—who assumed that the inmates of a walled asylum founded by Emperor Moctezuma II as an annex to the Great Temple were lepers, since they were segregated. He emphasizes that the Aztecs segregated even al4

Syphilitic.

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binos and freckled persons, perhaps supposing them pinto victims. He also says that if leprosy existed in Mexico before the Conquest, the characteristic nodules and mutilations of the disease would have been observed among the natives; yet, although Cortés minutely described those Aztecs suffering from albinism, he described none with stigmas characteristic of leprosy. "Cortés did establish the Hemisphere's first leprosarium, on one of his estates, at Tlaxpana, as early as 1528," Dr. Latapi adds. "But it's possible most of the hospital's patients actually were suffering from syphilis or pinto, since these diseases often must have been confused at that time." Regardless, Dr. Latapi says, there is strong positive evidence that leprosy was introduced into Mexico from Spain. Leprosy was endemic in the very Spanish provinces from which many of the conquistadores came. "Later, leprosy also was carried to Mexico from the Philippines, in the commerce between the two countries when both were Spanish colonies," the doctor notes. "And also from China, through immigration. It's probable that these two sources are responsible for Mexico's highest incidence of leprosy being found in the western regions." Bolstering Dr. Latapí's contention that the Spaniards first introduced leprosy to the New World, there is the situation in the United States, where leprosy is endemic in only three regions: Southern California, the New Orleans area of Louisiana, and the Texas border areas, particularly the Rio Grande Valley. All these regions originally were settled by persons of Spanish blood. Significantly, in the Rio Grande areas where three-quarters of the population consists of Mexican-Americans and Mexican nationals, leprosy derives not from the Mexicans of Indian blood but from those of Spanish blood. The wealthy Guerra family, for example, formerly imported Spanish peons to work on its ranches, obtaining them from areas of Spain where leprosy was endemic. Mal de Pinto It is generally agreed that mal de pinto most probably was introduced into Mexico, by Negro slaves, immediately after the Spanish Conquest. Nevertheless, some writers assert that the disease previously was known to the Aztecs, who (perhaps only in the Colonial era?) called

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it tzatzayanolixtli and treated it with applications of a macerated plant, ixtenextic. So the great debate on the origin of certain diseases continues in Mexico, and the question may never be resolved to the satisfaction of all. For with many the argument is less scientifically than emotionally based. Mexico is justifiably proud of its Indian heritage, and some of its people view the Spaniards as in all things the corrupters and despoilers of a noble indigenous race. Others adopt the opposing argument, less to whitewash the Spaniards than to emphasize the "universality" or common state of mankind. Deadly

Epidemics

There is no room for doubt that the Spaniards first afflicted Mexico's native inhabitants with many contagious diseases previously unknown in the Americas. Or that these diseases proved far more lethal in New Spain than they had in Europe and exacted a far more ghastly toll upon Indians than upon European colonists. Following the Conquest, the inhabitants of Mexico died by the hundreds of thousands, even by the millions, from virulent epidemics of the rapidly fatal diseases brought by conquerors and colonists— including smallpox, typhus, influenza, yellow fever, and cholera. For the Indians had no natural immunity to these "new" diseases suddenly carried to them from Europe and Africa. It was an immense and unprecedented national catastrophe. And for a century and more, epidemic after epidemic continued to sweep Mexico, recurrently decimating the luckless indigenes. Smallpox took the first great toll. With lightning speed, it already had wiped out virtually the entire native populations of the Caribbean islands. (Hence, the vanished Indian laborers were replaced by Negro slaves from Africa.) In the first years of the sixteenth century, the disease had been carried from the Caribbean islands to the Yucatán Peninsula by the Valdivia expedition. However, the first officially recorded smallpox epidemic in Mexico occurred in 1519, at the beginning of the Conquest, touched off by an afflicted Negro slave brought by the Spaniards. This epidemic scourged both Mexico and Central America, the continent's most densely populated areas. And one of the later epidemics, in 1576, killed an astronomical number of Indians, estimated at perhaps as high as two million.

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Epidemics of various diseases constituted one of the principal worries and greatest problems of the Colonial authorities. The health situation was so grave, particularly during the first half of the sixteenth century, that the officials often took drastic measures to effect controls and quarantines. Yet these generally proved woefully ineffectual, and the dread of sudden severe illnesses and mass deaths was a nightmare specter that constantly stalked the sunny cities and towns of New Spain. There was a long succession of killer epidemics in the Spanish colony. As a sampling: In 1520—a great smallpox epidemic throughout most of Mexico. In 1526—an epidemic of typhus in California, "observed by John Cabot during his stay on Catalina Island." In 1527—a very severe yellow fever epidemic in Yucatán. In 1530—typhus epidemics throughout New Spain. In 1533—another typhus epidemic. In 1537, and again in 1545-1546—devastating epidemics of what may have been either pneumonic plague or influenza. Dr. Miguel E. Bustamante, Undersecretary of Public Health during the administration of President Adolfo López Mateos, believes it was influenza. The later epidemic killed an estimated 800,000 persons. And Grijalva reported: "Five-sixths of the Indians died." In 1559-1560—an epidemic of influenza. In 1560—an epidemic of mumps causing considerable mortality. In 1577—a horrible unidentified plague that struck the Indians, especially, killing huge numbers. It was characterized by severe headache, fever, and nasal bleeding; death occurred within a week. Weakened survivors frequently died of starvation. In 1588—an epidemic of typhus in Toluca, chiefly striking with fatal effect just one tribe there. The others by that time evidently had developed a certain immunity, following exposure to mild cases in infancy. In 1592—another smallpox epidemic among the Indians, especially in Sinaloa. In 1599-1618—yellow fever rampant in Yucatán. In 1648—another outbreak of yellow fever in Mérida. In 1732—severe epidemics of yellow fever, typhus, and influenza. In 1736-1737—a great epidemic of what was reported to be yellow fever. (Dr. Bustamante, however, believes this, too, was influ-

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enza.) Fatality figures vary greatly, but Father Alegre declared that two-thirds of the population died. In 1762—another epidemic of influenza, which in six months killed over 10,000 persons. Although the various control measures imposed by the authorities were largely as ineffectual as the amulets of the witch doctors, over the generations the population eventually acquired a sufficient degree of immunity to effect a decline in the frequency and extent of the epidemics and a sizable reduction in the number of fatalities they caused. The Ship-of-Children Vaccination Project As the nineteenth century dawned, Europe was being liberated from the dreaded scourge of smallpox, against which mankind for uncounted millenia had been defenseless. In 1800 both Napoleon Bonaparte and the Czar of Russia ordered the vaccination of their entire armies with cowpox vaccine, via Jenner's method. 5 In 1801 this immunization technique was adopted in Spain. But getting the vaccine overseas was a more difficult matter— when an Atlantic crossing took a month or more. Nevertheless, just two years later, in 1803, the Spanish Crown undertook a scientific and humanitarian project that had no precedent: It equipped and outfitted a special "expedition against smallpox" to transport the precious vaccine overseas, primarily to benefit its subjects in America and the Philippines, but also to disseminate it around the world. The expedition was actively directed by a Spanish commission, composed of Dr. Francisco Javier de Balmis, its head; Dr. Antonio Gutiérrez, a professor of medicine and surgery; a Señora Doña Isabel Cendal, generally regarded as "Mexico's first public health nurse"; and two others. The expedition also included twenty-six children "of tender age," taken from a Spanish foundling home, the Casa de Expósitos de Santiago de Galicia y La Coruña. The youngsters were vitally important to the project, for in them "the pus was to be conserved" during the long sea voyage. 5

The method was new, but not the principle. Well before Jenner was born, Lady Mary Wortley Montagu, wife of the English ambassador to the Sultan's court, had reported the practice in Turkey of preventing smallpox by inoculation —further evidence of the advanced state of Arabic medicine.

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Despite the faint overtones of the ill-fated Children's Crusade of the Middle Ages, there was no real resemblance, for this ship-ofchildren expedition was a carefully managed scientific undertaking, with a realistic and humanitarian goal, and the children, under the direct supervision of Señora Cendal and accompanied by doctors, were well cared for. Nevertheless, the voyage must have been long and wearisome, at least for Señora Cendal. (No matter how dedicated and motherly, the lady must have had her hands full, with twenty-six seasick little orphans, some perhaps also homesick for the orphanage that was the only home they had ever known.) The Balmis Expedition set sail from Spain toward the end of 1803. At the time of embarkation, two of the children were already vaccinated. During the trip, the lymph, or vaccine, was passed from arm to arm as the orphans were inoculated, in pairs, when their turns came. In this manner, the vaccine was brought to the Canary Islands for propagation. There, too, the twenty-six Spanish children were replaced by the same number of Canary Island orphans. (The Spanish orphans evidently remained permanently in the Canary Islands. Whether they were merely placed in another foundling home after their contribution to the public health had been effected, or were given homes among the Canary islanders as a reward, does not appear to be a matter of record.) The ship, with its medical commission and Señora Cendal's new small charges, sailed on. And on. And the priceless vaccine continued to be conserved in the children as it was passed from arm to arm by "relay inoculation" throughout the voyage, while the ship was battered by a series of severe winter storms. On February 9,1804, the ship of children reached Puerto Rico with the vaccine. From that island, it sailed to South America, making port at La Guayra-Caracas, where it delivered the vaccine, via inoculated children, to Spanish colonists in Venezuela. (Later, in 1808, a second party carried the vaccine, via another group of orphaned children, from Venezuela down the west coast of South America to Peru and Chile, and around the Punto del Fuego to Argentina.) The expedition, headed by Dr. Balmis, arrived at the Mexican port of Veracruz on July 24,1804—well over half a year after setting out from Spain with the first group of youngsters. Upon disembarking at hot, frequently epidemic-ridden Veracruz,

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the doctors at once began vaccinating large numbers of people, starting with the soldiers quartered in the garrison and the children in the local hospicio, or foundling home. This immediately threw the port city into an uproar. Instead of welcoming the arrival of the life-protecting vaccine, the citizens were highly suspicious of it. A public clamor arose against civic authorities for permitting even soldiers and charity children to be vaccinated. (Probably never before had so much concern been expressed for these two oft-neglected and scorned groups.) Wild rumors sped from door to door, carried alike by servants and substantial householders, and protest meetings fanned the flames. Feeling ran high not only against the vaccine but against the expedition's Spanish doctors. Amid denunciations of them as "infectors of our defenders and of our children" and as "poisoners" and "medical assassins!" Dr. Balmis appealed to the city doctors to reassure the public. But the city doctors, instead of upholding the inoculation project as a vitally necessary public health measure, cavalierly declared: "The principal of the vaccine is false. Moreover, it not only is false; it is harmful!" (More than ignorance or bigotry may have been involved. By now, in many parts of the Colony, there was long-pent-up resentment of Spain and all things Spanish; only six years later the War for Independence would erupt.) Thereafter, the entire population of the port city understandably resisted further vaccination. Into this potentially explosive situation stepped no less a personage than the viceroy of New Spain, Don José de Iturrigaray. The Viceroy, an enlightened Spanish gentleman, hurried to Veracruz, bringing with him his family and many of his retinue. In Veracruz, the Viceroy immediately scheduled an official ceremony, to which he summoned the nobility, the town's officials, the judiciary, the National University's professors and teachers, and members of the Colony's Protomedicato. In short, everyone who mattered in New Spain. When his guests had assembled, instead of immediately staging the planned ceremony, the Viceroy first conducted New Spain's elite in a procession through the principal neighborhoods of the city—to make his presence in Veracruz unmistakable to all citizens. Then,

111 with his impressive viceregal carriage in the lead, the glittering cavalcade proceeded to the hospicio. And there, in a large salon of the charity home, in a never-to-beforgotten gesture, a medical professor, Dr. Juan Alejandro Arboleya, inoculated with the vaccine—the Viceroy's greatly beloved small son! While the haughty, elegantly garbed father reassured the child with a tight-lipped smile, the distinguished guests gasped with horror or pity. The news raced through the city like wildfire that it assuredly was impossible the boy would live. But the boy did live. And because the Viceroy thus voluntarily and dramatically had exposed his own son, the inhabitants of the city finally were convinced of the beneficent qualities of vaccination. Viceroy Iturrigaray then personally took the vaccine to Mexico City—and just in time, for a new smallpox epidemic even then was striking down the capital's population . . . . It is interesting to note that the Catholic Church was in the vanguard in endorsing and promoting this medical innovation. A placard still exists which had been posted in Mexico in 1804, wherein Bishop Don Manuel Ignacio González del Campillo in large bold type exhorted the people of his diocese "to lend themselves with docility to the important practice of vaccination." CENTURIES OF KILLER EPIDEMICS

Dr. Balmis and his fellow expedition members next toured New Spain and brought the vaccine to Guadalajara, to Valladolid (now Morelia), to Zacatecas, to San Luis Potosí, to Guanajuato, to Querétaro, to Puebla, to Oaxaca, and to the Yucatán Peninsula. Relays of Mexican children now were participating in the expedition's project. In their arms, the vaccine was transported from city to city and thence disseminated among the people—to check, at long last, the terrible smallpox epidemics that for centuries had been cutting huge swathes in the population of New Spain. Mexican children also carried the vaccine far beyond the shores of their own country. On February 5, 1805, the Balmis Expedition—having completed its mission in New Spain—re-embarked at Acapulco and sailed across the Pacific to Manila, carrying the precious vaccine to the Spanish Crown's Philippine subjects.

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With it this time went twelve Mexican children—just four to six years old. Five were from Morelia, five from Guadalajara, one from Querétaro, and one from Zacatecas. (And did these little tots ever return to their native land? It seems unlikely. Probably they lived out their lives in the Philippines—and whatever their subsequent contributions to their new land may have been, they would have been hard put to surpass their initial contribution of saving the islanders from the periodic ravages of smallpox.) Today, in the headquarters of Mexico's Department of Public Health and Assistance, in Mexico City, a large bronze plaque commemorates the Balmis Expedition and the Mexican children who participated in this humanitarian project. From the Philippines, the ship of children voyaged on, to Canton, China, and other distant places—"not excluding hostile lands." Eventually the expedition against smallpox (except for the director of the second expedition to South America, who died in Peru) returned to Spain. Thus closed what was the most notable scientific project of the era. Through it, Spain had apostolized and brought the vaccine to the rest of the world. The Balmis Expedition against smallpox was unique in another way. As an example of enlightened concern by the Spanish Crown for its colonial subjects, it stood out like a ray of sunlight in the midst of the storm that had been gathering for nearly three centuries and now was about to break in New Spain. Principal Sources William H. Prescott, History of the Conquest of Mexico; Dr. José Alvarez Amézquita, et al., Historia de la Salubridad y de la Asistencia en México; Dr. Mario González-Ulloa, La Medicina en México; Dr. Gilberto F. Aguilar and Dr. Roberto Ezquerro Peraza, Los Hospitales de México; and other relevant books listed in the Selected Bibliography. Early source material. Interviews with Mexican doctors on origins of diseases.

CHAPTER NINE

The Last Years of the Colony

It is a long, long way from Madrid to Mexico City, and it was incomparably longer in the days of the viceroys than today. This distance between mother country and colony doubtless was one reason the vast number of laws and royal decrees regarding Colonial administration that sounded so enlightened on the books (i.e., on the elegantly penned parchment documents affixed with the King's seal) so often were observed only "in the breach," or utilized as a license for further oppressions. Additional reasons for the inequitable state of affairs in New Spain were the Spanish Crown's insatiable appetite for riches pumped out of its most financially rewarding colony and the greed of many of the Spanish aristocrats, administrators, and bureaucrats, who flocked from overseas. Such "carpetbagger" prototypes were far less eager to serve sovereign or country than to enjoy the luxurious Ufe of the Colony's ruling elite and to pile up personal fortunes, no matter at what cost in sweat, suffering, and deprivation to the native-born Mexicans. Public Health and Sanitation Throughout the Colonial period the Protomedicato in Mexico City continued functioning as a Public Health Department in virtually every modern respect—regulating all facets of medical activity, plus countless matters involving civic sanitation and public health. However, under certain of the viceroys, the laws and regulations were enforced far more rigidly than under others.

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Juan Vicente, Count de Revillagigedo, one of the last of the viceroys, was one of the most conscientious and efficient. But his predecessors evidently had been lax. In 1789, when Count de Revillagigedo first arrived from Madrid as the newly appointed viceroy of New Spain, and was being officially escorted in the viceregal coach into downtown Mexico City, his aristocratic nostrils abruptly were assailed by a horrible stench from an old canal in the very heart of the capital. Ancient Aztec law had absolutely prohibited the dumping of any refuse into Tenochtitlán's sparkling canals and lakes, but now, some 270 years after the Spanish take-over, this canal had become a foul open sewer. Revillagigedo saw his duty clearly, and he was not one to procrastinate. He abruptly interrupted the welcoming pomp and ceremonies to issue a stern order—as his first viceregal act—that the offensive canal be totally filled in "within 24 hours" under pain of severe penalties. The feat was accomplished, and overnight the waterway became a street—Revillagigedo Street, as it is still named. (It runs beside the stately Del Prado Hotel and abuts the city's principal downtown thoroughfare, Avenida Juárez, and the Alameda Park.) Count de Revillagigedo upon his arrival also was shocked to observe that, as he later put it, "The police had abandoned enforcing cleanliness in Mexico, having gone to the extreme of permitting pigs and cows to wander in the streets." The new broom speedily swept clean. In 1793, one of Viceroy de Revillagigedo's ever-extending reforms was to rehabilitate and place under more stringent regulations the numerous public baths, steam baths, and laundries which had been such a prominent feature of the ancient Aztec scene. The first change was to separate the sexes when bathing: Each bathhouse summarily was required to specify "on a prominent exterior plaque" whether it operated exclusively for men or for women. The previous casual mingling of the sexes in the baths, it was alleged, had led to frequent disorders. In addition, each room of a bathhouse now was required to have a lock on its door, a petate (straw mat) or mattress on which a bather could rest, a candle if light were needed, a bell to summon an attendant, and two faucets, with both hot and cold water. The fireplaces of the steam baths had to be constructed with proper precautions

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against burning up or otherwise damaging the neighborhood, and the pipes or chimneys had to be sufficiently elevated to carry off all smoke inoffensively. (Thus in New Spain, back in the year of 1793, civic authorities already were concerned with air pollution and effecting smog control!) Also, toilets, or latrines, had to have pits or covered conduits and proper ventilation, to minimize unpleasant odors. All public bathhouses and steam baths, furthermore, were required to be licensed and were subjected to regular government inspections —and, in addition, to a special police vigilance. Penalties for infractions of the many regulations were stiff fines, cutting off of water, and/or complete shut-downs. These regulations make it evident that centuries after the Conquest the Spaniards were still uneasy about and suspicious of overmuch "traditional" bathing on the part of the indigenous population —and fearful that bathhouses unless carefully watched would degenerate into bawdy houses. (For why would the humble Indians flock to bathhouses just to wash themselves? Kings and emperors, even at the end of the eighteenth century, still put no great premium on personal cleanliness.) The Count was a great reformer of both public health and of medical laws. And he gave women more privileges, both in education and jobs. In this he was clearly ahead of his time. Medical Progress The surgeon finally got out of the barber shop—in New Spain, as elsewhere. In 1799, Viceroy Miguel José Avanza ordered that henceforth the surgeon was to abandon the job of barbering: No longer need he set aside scalpel and lancet to scissor and curl the hair and trim the beards of his hirsute patrons. And the barber, in turn, no longer was to be required to take any medical examination, but must refrain from all medical duties, specifically including bleeding. (The Viceroy also directed that both surgeon and barber put up differentiating symbols on their shop doors. The red-and-white striped pole no longer served its ancient dual role.) Thus surgery, at long last, became a separate, recognized profession. The Royal College of Surgeons was founded in Mexico City, in 1770.

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The first Academy of Medicine in New Spain was organized in Mexico City in 1735. The Academy (of Medicine) of Puebla was formed in 1798. After Mexico achieved its independence, both the Academy of Practical Medicine (1824) and the Academy of Medical Surgery (1832) were organized. The Academy of Medicine began publishing between 1836 and 1843. The present Mexican National Academy of Medicine was founded in 1864—while Mexico was briefly ruled by Emperor Maximilian— and recently celebrated its centenary. In 1795 Count de Revillagigedo transmitted to his successor a large number of reports and documents which included some surprisingly advanced medical studies made during his viceregency. For instance, he reported: The infirmities of the liver and diarrhea, so very frequent in this climate, have caused many deaths, especially among Europeans here. . . . The Protomedicato therefore proposed [obtaining] treatises on the curing of same. . . . On the 20th of February, 1793 [when there was a sizable epidemic of diarrhea, accompanied by another no less severe of hepatic abscesses] . . . the Protomedicato convened a triumvirate [of doctors] . . . And in the resultant treatises, the relationship between diarrhea and hepatic abscesses was established. Note that this was achieved, in Mexico, more than a century before Entamoeba histolytica1 was known. The authors in addition performed numerous autopsies to establish the basis of a correct surgical intervention. It is further noteworthy that the conclusions of Eguia and Serrano, two of the three doctors, were based on the anatomico-pathological theory of diseases, at a time when the ancient theory of humors 2 still prevailed. The "Evils' of Drinking Chocolate Chocolate had a rather remarkable importance in the life of New Spain, making it worthy of (somewhat tongue-in-cheek) consideration here. The ancient Aztecs had employed chocolate as a medicine for the 1

Microorganism causing amebic dysentery and, in advanced cases, abscesses of the liver. 2 The theory that supposed imbalances of the four humors, or body fluids— blood, phlegm, choler (yellow bile), and melancholy (black bile)—determined temperamental variations and caused all diseases.

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sick—among other things to treat, and "fortify," an ailing stomach. But it was also the early Mexicans' favorite beverage. They consumed vast quantities of it, seasoned with vanilla, honey, cinnamon, clove, anise, pepper, and other spices, whipped into a thick foam, right in the cup, with a special ringed wooden baton twirled between the palms. (Moctezuma II allegedly downed forty cupfuls a day, served in a solid-gold chalice.) And hot chocolate ever since has been the preferred beverage in Mexico—still whirled into a froth with the traditional wooden baton, at home and in the nation's little cafes, restaurants, and lunchrooms. After the Conquest, large quantities of chocolate were exported to Europe—where it also became popular, both as a drink and for medicinal purposes. Reportedly, there it was the friars who were the principal populari z e s of this beverage, "which they liked so well that not even on the most solemn fast days could they abstain." In any event, there was a running debate for centuries—among both doctors and clerics—about whether chocolate was beneficial or harmful, or neither. In addition, drinking it became a hotly disputed moral question. Was, or wasn't, an "addiction" to chocolate a sin? Strange as it may seem today, chocolate once had as fervent partisans and as stern-voiced opponents as tobacco. The Sorbonne, the Spanish casuists, and the Roman congregation entered the dispute, praising or damning the innocuous drink; the Jesuits were pro, but those of Port Royal were con. Nor was it only in Europe that chocolate was as controversial as it was widely consumed. This was evidenced, for example, by a curious account written by the English traveler Thomas Gage, a Dominican friar who had lived a dozen years in Mexico.3 The story, first published in 1838, followed these lines: The ladies of the Royal City of Chiapas (in Mexico's southern "hot country") had such great weakness of the stomach that it was impossible for them to hear Mass without pausing in the midst of it to drink a jicara de chocolate—a cup of hot chocolate—together with another little cup of syrup or preserved fruit. They had their maids bring this refreshment to them during Mass, which naturally created great interruption and confusion. The bishop had exhorted them 3

Los Viajes de Tomás Gage en la Nueva España. T. I. París, 1838.

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many times to cease, but the ladies refused to relinquish the custom. Finally, the bishop barred from the cathedral "all who insisted on eating or drinking in the temple of God during divine services." The excommunication disgraced all the women and particularly the señoritas, the unmarried young ladies. Accordingly, the city's leading dowagers made strong protests, and the prior obligingly reduced the severity of the measure, trying to obtain an indulgence in favor of "the custom of the country and the debility of the women and their stomachs." But the bishop remained adamant. As a consequence, a terrible riot erupted in the cathedral when the maids tried to enter with the cups of hot chocolate for their mistresses and were physically barred by the acolytes. Following the riot, everyone abandoned the cathedral, and the people instead went to hear Mass at the churches of the convents, where they gave their pesos and presents to the ancient friars, to the loss of the deserted cathedral. The bishop now not only refused to capitulate but publicly issued an order excommunicating all who refused to attend services at the cathedral. The women then ceased to gather at the convents, but still would not go to the cathedral, stubbornly staying in their homes. In the midst of this continuing dispute—"between the bishop and the friars, the canons and the chocolate, the maids and the acolytes" —the bishop abruptly fell seriously ill. He retired to the Convento de Santo Domingo, persuaded that no one could cure him better than the prior, in whom he placed all his confidence. Doctors were summoned from various points—and all concurred in the diagnosis that the bishop had been poisoned. The poor man, realizing he would die, asked God to pardon the authors of his death and declared that he voluntarily offered the sacrifice of his life. After eight days he expired. "By then, all of his face and body were greatly swollen. And wherever the cadaver was touched, matter burst out, signifying the putrefaction of the whole corpse." There was in the city a señorita ("whom I knew," the English Dominican chronicler commented) who was accused of familiarity with one of the bishop's pages. And through this page, it was said, the young woman had been the authoress of jicarazo (jicarazo is "a large chocolate cup" and, as dar un jicarazo, means "to give poison to a person")—allegedly having administered the poison in a small quantity of chocolate.

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The bishop, too, must have been fond of the beverage to which the ladies were addicted. From this singular affair (the account concludes) originated the little song afterward heard in all parts of Mexico: "Cuidado con el Chocolate de Chiapas!"—"Beware the Chocolate of Chiapas!" That particular chocolate, at least, was not reputed to have any beneficial medicinal properties. Unique Public Assistance In the latter part of the eighteenth century—about the time the Thirteen Colonies far to the northeast began their war for independence from another mighty European colonial power—two unusual institutions were established in Mexico that never have had any counterparts in the United States or in most other countries. These two institutions still exist, on a greatly expanded scale, in present-day Mexico. Mexicans consider them indispensable. Rightly so. Other nations would do well to study and emulate them. For these institutions in their separate ways fill a "universal" need and at the same time function to actively benefit the public—the one supplying direct assistance to the needy and the other providing ever-expanding public health facilities and services for the nation's poor. Both, in doing so, also prevent exploitation of the poor by society's vultures. These two respected Mexican institutions are the National Lottery and the National Pawnshop. The National Lottery The Lotería Nacional, Mexico's National Lottery, was founded by decree of King Charles III of Spain in 1770. Honestly run, at the best possible odds, it fulfills that virtually universal urge of mankind to venture some small "pocket money" on the chance of huge winnings. In addition—win or lose—it serves a worthy cause in doing so. For its profits do not go to professional gamblers and racketeers, to further underworld criminal activities, or to any private individuals. From the very beginning, all of the National Lottery's profits have been assigned to public health projects. Originally, these were chiefly the control of smallpox and syphilis. Today the profits finance important public health projects of many

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types (as will be detailed in Part Three, together with some interesting stories about big winners). Down the centuries, various additional lotteries were set up to benefit individual hospitals and other special projects, but in the 1920's all these were ruled out. Ever since, only the National Lottery has been legal in Mexico. The National Pawnshop Mexico's Monte de Piedad ("Mountain of Charity"), or National Pawnshop, provides a public service available in very few countries. It was established in the 1770's when Don Pedro Romero de Terreros—Knight of the Order of Calatrava, Count de Regla, and owner of the Real del Monte mines in New Spain—"impelled by his fervent devotion to religion and the public welfare," donated 300,000 pesos "toward founding, with Royal consent and under Royal patronage and protection, in the City of Mexico, a Monte de Piedad, with the object of providing succor for the needy . . . " Ever since, for nearly two hundred years, Mexico's National Pawnshop has been lending money, on security—at fair valuation and with astonishingly low interest rates—to the poor, to the once-rich in straitened circumstances, and to all those in need of instant cash. Almost any object will serve as security. The establishment has totally eliminated private "loan sharks." The National Pawnshop will even finance a craftsman's work, then sell his product for him. End of the Colonial Era From the start Spain had waxed fabulously rich on the gold, silver, and other wealth it had siphoned out of its North American colony. Nor had its demands lessened with the passage of centuries. In the early 1800's, Old Spain was extracting nearly two thirds of all its revenues from New Spain. It held the colony that supported it in absolute economic subjugation, restricting its manufactures and forbidding it to trade even with other Spanish colonies. Under its sixtythree successive viceroys, New Spain was permitted no vestige of home rule and was governed exclusively by administrators sent out from Spain. By the year 1810, the estimated population of New Spain was about 6,000,000. Eighteen percent of these inhabitants were of pure Spanish an-

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cestry, 60 percent were pure-blooded Indians and 22 percent had the blood of both races. Thus, as the long Colonial period drew to a close—and after three centuries of immigration from Spain—over three-fourths of Mexico's population remained of unmixed blood. (Today, in contrast, the population generally is regarded as approximately 10 percent of European stock, 10 percent Indian, and 80 percent mixed.) In 1810 Mexico was plunged into its War for Independence from Spain. It was a fortuitous time, for the Spanish Crown was by then in dire straits at home: A weak monarch4 had been dethroned and replaced by Joseph Bonaparte. The small cities of Mexico's heartland, its mile-high central plateau, were the cradle of its independence. In them, a little group of native-born patriots—led by a dashing young captain in the Queen's Dragoons, Ignacio Allende, of the town of San Miguel el Grande (now San Miguel de Allende); Juan Aldama of the same town; Mayor Miguel Domínguez, of Querétaro, and, more particularly, his wife, Doña Josefa Ortiz; and a dissident priest, Father Miguel Hidalgo, of Dolores (now Dolores Hidalgo)—conspired to launch an uprising to free Mexico from its long centuries of ruthless economic exploitation by Spain and its haughty elite of Spanish-born administrators. The tiny handful of Mexican-born conspirators, like all creoles, bitterly resented their arrogant, "imported" Spanish rulers, whom they sardonically dubbed gachupines, or "spur-wearers." The European Spaniards, in turn, contemptuously referred to all Mexican-born whites as tecomates, or "gourd cups." (The ruling caste thus insultingly held that made-in-Europe Spaniards were eggshell-fine porcelain, whereas made-in-Mexico Spaniards were merely the crude drinking vessel of the primitive Indian tribes!) It was only one of a hundred rankling slights and social discriminations, added to the galling legal and economic restrictions imposed on the creoles—as well as on the mestizos, who were considered lower on the social scale, and on the pure-blooded Indians, who were lowest of all. The Spaniards prematurely discovered the conspirators' plotted 4

Ferdinand VII.

MEDICINE IN MEXICO 122 uprising. And so, on September 15,1810, Father Hidalgo desperately rallied a group of ragged peons before the church in Dolores, with his famed grito, or cry for independence: "Long live the Virgin of Guadalupe—and death to the gachupines!" Thus began the ill-organized, ill-armed march of rabble that finally would liberate a nation. Not, however, until long after the early capture and execution, in 1811, of four of the original leaders—Allende, Hidalgo, Aldama, and Jiménez. (For the next ten years the Spaniards, still entrenched, kept the heads of these four heroes of the independence gruesomely displayed on the corners of a granary in the city of Guanajuato, as a warning to other insurgents.) The banner of leadership was seized by another priest, Father José María Morelos, who brilliantly advanced and expanded the fight for national liberation, before he, too, was captured and executed. Father Hidalgo's rousing cry, el grito, echoed across the land to victory—and, down the pages of history, to immortality. Every year, on the eve of Mexico's Independence Day (September 16), the President of Mexico—and the mayor of every city and town and tiniest village in the nation—repeats to solemn celebrants assembled on the zócalo, or municipal plaza, a modern version of that historic cry, which ends with a ringing 'Ύινα México!" in which all join.

During the lengthy war against Spain there were several more epidemics of yellow fever. In 1814, despite the continuing war, provincial health councils were established in Mexico—as ordered from Spain for all its provinces, including the ones overseas. This council set-up was reorganized in 1819. (And, about 1832, the old Protomedicato, which for centuries had regulated all phases of medicine and public health in New Spain, went out of existence.) Mexico won its independence from Spain—after eleven years of bitter struggle—on September 28, 1821. This was exactly three hundred years after the mighty Aztec Empire had fallen to Cortés and his bearded conquistadores. So the Colonial era—with its royal decrees issued from across the ocean, its all-powerful viceroys and legions of lesser officials dis-

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patched from Spain, its immigrant grandees riding roughshod over the native-born, its billions of dollars' worth of gold and silver funneled overseas to glut the cofiFers of the Spanish Crown—finally came to an end. And the newborn independent nation—without a treasury of its own, without allies or protectors, eyed hungrily by avaricious foreign predators and upspringing domestic exploiters—set forth uncertainly but valiantly to make, and maintain, its place in the world. Principal Sources Dr. José Alvarez Amézquita, et al., Historia de la Salubridad y de la Asistencia en México; Dr. Mario González-Ulloa, La Medicina en México; Dr. Gilberto F. Aguilar and Dr. Roberto Ezquerro Peraza, Los Hospitales de México; and other relevant books listed in the Selected Bibliography. Early source material, and general histories listed in the Bibliography. Interviews with Mexican doctors.

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Introduction Mexico's successful War for Independence from Spain had made no significant changes either in the nations social structure or in the status of medicine in the country. The war had been fought chiefly to establish self-government, not to institute social reforms. The rigid class lines, based principally on racial origin and inherited fortunes—and the centuries-old concentration of most of the country's property in the hands of (a) a few hundred families of Spanish ancestry and (b) the Roman Catholic Church —were little altered by slashing the ties which had bound Mexico to Spain. The social injustices that had accumulated during three centuries of colonialism consequently were, if anything, exacerbated during most of Mexico's first century of independence. The result was an internally weak nation—which inevitably invited civil dissension and foreign invasions. Mexico had two outstanding statesmen during this period, who pursued almost diametrically opposed policies in their attempts to solve the young nations problems. Both were chiefly of Indian, not Spanish, derivation—evidence that the conquered race was regaining the dominant position in the nation which, by numbers and prior possession, rightfully belonged to it. These two were Benito Juárez and Porfirio Díaz. Benito Juárez—today Mexico's foremost national hero—often is compared with Abraham Lincoln, with whom he was a friendly correspondent and an ally in international matters benefiting both na-

MEDICINE IN MEXICO 128 tions. Juárez was an idealistic reformer as well as a nationalist, and his outstanding achievements were, first, ridding Mexico of Napoleon's puppet, the Emperor Maximilian, and his French army; and, second, inaugurating reforms aimed at ending the social injustices under which the vast majority of the Indian population of Mexico for so long had labored. Probably his most important measure was the expropriation of the bulk of the immense land holdings of the Roman Catholic Church, which by then possessed what variously has been estimated as from one-third to two-thirds of the most valuable land in Mexico. However, in the tide of reaction that followed Juárez, his idealistic reforms were largely perverted. The confiscated Church lands were not used as he had intended—to provide homesteads for landless peasants. Instead, some were returned to the Church, and the remainder were grabbed by the always-land-hungry hacendados. The peasants had no alternative but to continue to work, as virtual serfs, on the immense, largely absentee-owned, haciendas. The strongman who succeeded Juárez, Porfirio Díaz, although in his youth known to possess liberal ideas, soon brought to Mexico the kind of stability that the wealthy landowners desired. Díaz ruled as a more or less benevolent dictator for thirty-four years, collaborating to a maximum extent with foreign investors and adventurers, lavishly handing out land, mining, industrial, and commercial concessions. Throughout the Díaz dictatorship, Mexico was unified and tranquil. But for millions of luckless peones, it was a dreary tranquility not too different from the peace of the grave. And when "Don Porfirio"—the cork that for thirty-four years had stoppered the Mexican bottle of social ferment—grew old and careless, the inevitable consequence was the Revolution of 1910.

The Mexican Revolution, after having been so long delayed, rivaled in both bitterness and property destruction the U.S. Civil War and, even, Europe's tragic Thirty Years' War. An estimated one million persons were killed as it surged back and forth across the country for a decade. (It has been said that the zopilotes, or vultures, which are such a characteristic feature of the Mexican landscape, became so surfeited with human flesh that they finally deigned to dine only on corpses handily strung up to the limbs of trees.) The leaders in that long and bloody struggle, whose names today

129 rank after that of Juárez on Mexico's roll of heroes, were Madero, Obregón, Carranza, Zapata, Villa, and Cárdenas. The final concrete achievement was the forging of a system of government based on the Constitution of 1917, which had been adopted in the midst of the Revolution.

MODERN MEXICAN MEDICINE

Mexico's Constitution of 1917 called for reforms to guarantee social justice for all—specifically including improvement in the public health and welfare. Only in the last few years, however, has the nation made the majority of its tremendous advances in medicine and public health and welfare. And this is not surprising. For years Mexico continued to be wracked by revolution and financially destitute. The shaky new government was beset with dissensions and attempted counter-revolutions, including the bloody Cristeros revolts. Thus it was unavoidable that it would take generations to put many of the desired reforms into effect. In the 1930's,"to implement the Constitution and defend the principles for which the Revolution was fought," the surviving leaders of the Revolution formed the Partido Revolucionario Instituto, the Party of Revolutionary Institutions, or PRI, which ever since has governed the nation with a firm hand. (To guarantee that the human rights which were so hard won would not again be lost, PRI, at least until very recently, has effectively discouraged all political opposition. Nevertheless, within the party there has been ample room for political ferment, since the membership embraces all shades of political opinion—from Far Left to Far Right.) Under its PRI-dominated government, Mexico progressively has put into effect more and more of the principles of its idealistic Constitution. And, as a result of PRI's intelligent program of "gradualism" in implementing projected reforms, the nation today possesses the most stable, progressive, and financially sound government in Latin America. In no field has Mexico's progressiveness been better demonstrated —or have its achievements been more substantial and even spectacular—than in the field of public health. And particularly in the field of rural public health. This fact was confirmed by Dr. Abraham Horwitz, of Washington,

MEDICINE IN MEXICO 130 D.C, director of the Pan American Sanitary Bureau, the operating arm of the Pan American Health Organization, which supervises a far-flung complex of hemispheric public health projects, when he recently said: "In the field of elevating the public health and welfare levels in its rural areas, Mexico clearly leads all of Latin America."

CHAPTER TEN

The Problem of Quacks and "Witches"

Modern medicine by no means has eradicated primitive superstitious concepts of illness or entirely supplanted age-old folkloric remedies whose (psychological) efficacy stems from supposedly magical properties. This is as true in Mexico as in other parts of the world. While the nation precariously advanced into the twentieth century —through the upheaval of the Revolution, years of chaos, then years in which constitutional reforms were gradually applied—a large segment of Mexico's population continued to seek remedies for every illness from traditional practitioners of nonmedical and pseudomedical healing: the curanderos, or quack-curers, and the brujos, or witches.1 Moreover, even today—despite the wide-ranging Department of Pubhc Health and Assistance programs and nationwide network of clinics and hospitals that provide free medical care to the lowest economic levels—huge numbers of quack-curers and practicing "witches" still flourish. In fact, in many rural areas such persons with no legitimate medical education still treat the majority of illnesses. The curanderos and brujos and their practices warrant attention in considerable detail here, for they pose a special and serious obstacle to medical progress and the improvement of the public health in much of the Republic. 1

T ο differentiate between the sexes: Male quacks are curanderos and female quacks are curanderas; male witches (or warlocks) are brujos and female witches are brujas. However, throughout this chapter, in accordance with correct Spanish usage, the masculine forms—curanderos and brujos—are employed to refer jointly to males and females. It might be added that today's curanderos and brujos number far more females than males.

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Medicine

Presumably today's curanderos still are prescribing and administering a few of the age-old treatments and herbal remedies that the scientific-minded Aztec physicians, the tepati, utilized so efficaciously before the Conquest. For it is chiefly the tepati who are their historical ancestors. Nevertheless, it is certain that the knowledge and standards of present-day Mexican curanderos are markedly inferior to those of the ancient tepati. For, as noted in Part One of this book, in the desperate fighting that destroyed the entire capital city, most of the leading Aztec physicians were killed. The "blue-nosed" Spaniards subsequently restricted or banned some of the indigenes' admirable healthpromoting procedures (such as daily bathing and circumcision) and fanatically burned all written records of their medical lore and scientific research. This, coupled with the overall dissolution of the old order, made inevitable an immediate deterioration in the quality of the native medicine practiced. Today's brujos are the spiritual descendants of the old Aztec ticitl, or sorcerers. And they, too, represent a marked degeneration from the old Aztec professional standards: Unlike the modern witches, whose services often are engaged for malicious purposes, the old ticitl allegedly concentrated entirely on benevolent sorcery—the magico-religious aspects of healing—attempting with charms and incantations to produce a cure through the supernatural intervention of the Aztec god or goddess with whom a disease was associated. The ticitl were not supposed to use their powers for evil. In fact, the Aztecs regarded the practice of malevolent witchcraft—the attempt to cause harm to an individual through supernatural means—as the most heinous of crimes. Just as in Europe, it was punishable by death—after the infliction of extended torture. After the Conquest, however, as the true native medicine regressed, it was largely supplanted by the witch doctors' mumbo jumbo. And the ancient Indian superstitions immediately were supplemented with, and imaginatively combined with, all the freshly introduced superstitions and witch lore of Medieval Europe. Inevitably, witchcraft thus augmented expanded to gaseous new dimensions throughout New Spain. Curandero and Brujo—Which Is the Witch? Today in Mexico the popularly cited distinction between the cu-

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tandero and the brujo is that "the curer works good and the witch works evil." And the curanderos, or quack-curers, at least many of them, are well-meaning. They try to do good—for a fee. Their crimes are chiefly the consequence of their ignorance and superstitions. However, a considerable number of brujos, or witches, frankly make a career of doing evil—for a fee. Many morally ambidextrous individuals combine an open career as a curandero with secret operations in the province of the black arts. And this form of double-dealing may be the most profitable of all. Usually, in actual practice, the functions and techniques of both curandero and brujo overlap to the point where often there is practically no distinction between the two. Presumably, only the witch deliberately tries to work evil. But on every other count the technique of both are almost identical: Both commonly ascribe ailments to "evil spirits" or "evil spells." Both admittedly utilize so-called magical methods (the curer, "white magic," the witch, "black magic") to treat the sick. Even medicinal herbs are often employed for their supposedly magical attributes. And the curers are as totally lacking in medical training, and generally as ignorant of the most basic medical precepts, as the witches. A person who believes himself bewitched (or the victim of an illness malevolently caused) may consult either a quack-curer (who will attempt to offset the "spell" with "protective" rituals) or a witch of his own (who will attempt, similarly, to break the spell with "more powerful magic," or, taking the offensive, will attempt to lay a potent counterspell upon the enemy allegedly responsible for the bewitchment). In such cases, both curandero and "benevolent" brujo are practicing contrabrujería, or anti-witchcraft. Patrons of Quacks and Witches Enlightened Mexicans all over the Republic obtain all their medical attention from licensed doctors and nurses in consultation offices, at hospitals and clinics. This group includes not only the wealthy and the rapidly increasing middle class, but many of the poorest among Mexico's forty million citizens, inasmuch as facilities for medical attention are widely available and free of charge when needed. Nevertheless, huge numbers of more naive Mexicans still consult quacks and witches.

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At the very bottom of the cultural scale are the isolated, pureblooded tribes of indigenes, who dwell in remote areas unreached by missionaries or any aspects of modern civilization. In such "pockets of history," some literally still live in the Stone Age. Speaking only their ancient tribal language, they retain their traditional pagan beliefs and customs 100 percent—including their high priest, the tribal witch doctor, who operates just as his ancestors did down the millenia. Among these people, belief in old Indian deities, evil spirits, and the powers of sorcery is, naturally, absolute. And the witch doctor provides the only "medical" attention available. Far more typical, however, is the situation in many parts of rural Mexico, where the population is chiefly of mixed Indian and Spanish blood, speaks Spanish, is educated to varying degrees, and has been of the Roman Catholic faith ever since the Conquest. Among the less educated elements, various old Indian beliefs and superstitions often survive—curiously interwoven with Catholic precepts. It is chiefly this large group which patronizes today's (nontribal) curanderos and brujos. And, wherever memories of the ancient Indian mythology still hazily linger— While it is conceded that the Catholic Church and its saints represent the forces of divine creation and goodness, there is a corollary conviction that the Devil and his human advocates, the witches, personify nature's destructive forces. In fact, there is considerable continuing belief that the very "evil spirits" of the ancient Indian mythology are prime causers of disease and that modern-day witches have allied themselves with these ancient pagan evil forces. Such mythological spirits include the werewolf-like nagual, that supposedly can assume the form of man or beast; the tlacique, a kind of Indian vampire, said to be partial to "tortillas dipped in hot blood flavored with human hair"; and, above all, las aires, the malignant winds feared from pre-Hispanic days as bearers of illness. Many rural folk today will not stir from their homes after dark without first carefully covering their mouths and nostrils with their sarapes or rebozos, lest they be harmed by las aires, the wicked spirits abroad in the night air. An old verse philosophizes on such survival of ancient indigenous beliefs even among those who actually know better: Cuando el tecolote canta, El Indio muere.

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No será verdad— Pero sucede. When the owl hoots, The Indian expires. It cannot be true— Yet it transpires. This belief in evil powers as an important cause of illness sends the ignorant flocking to curanderos and brujos for treatment, rather than to doctors of medicine. For—the quacks slyly point out—M.D.'s, despite their university educations and framed medical licenses, are notoriously ignorant of the correct magic rituals to offset evil spells. The curanderos and witches, on the other hand, presumably know just how to deal with such tricky problems. And apparently they fairly often achieve psychological cures. In this they are shrewdly combining the functions of the primitive shaman and the modern psychologist. Old women sell medicinal herbs in the open-air markets all over Mexico. These herbs—some efficacious, some ineffectual, some harmful—are, of course, employed by the quack-curers and witches in their "professional" practice. (Vendors themselves very often are curanderos; some "moonlight" as witches.) The herbs also are bought by ordinary shoppers for use in home remedies. Herbs sold include not only those gathered from jungles, fields, barrancas, and mountains but those derived from such familiar adornments of town plazas and patios as: The bougainvillea (Bougainvillea glabra), whose magenta bracts are brewed into a tea to relieve coughs. The frangipani (Plumería rubra), whose juice is used to treat wounds and sometimes skin and venereal diseases. The poinsettia (Euphorbia pulcherrima), a few of whose red bracts, steeped in water, are taken daily by nursing mothers to increase their milk flow; an overdose is dangerous. The acacia (Acacia farnesiana), whose yellow flowers are applied in an ointment for headache, or drunk in a tea for dyspepsia; whose green fruit also is made into a tea, to treat dysentery and skin inflammations; whose leaves are used to dress wounds. The angel's trumpet (Datura candida), whose leaves are cooked into a poultice for suppurating sores. The cut-leaf philodendron and ceriman (Monstera deliciosa), a tea of whose leaves and rhizomes is used for arthritis. The lobelia (Lobe-

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lia laxiflora angustifolia), whose roots are employed to induce vomiting and to treat asthma; dangerous because of its paralyzing effect on the respiratory system. The Mexican magnolia (Talauma mexicana), a syrup of whose blossoms is used to treat epilepsy, paralysis, and heart diseases; the root allegedly is similar to digitalis in effect. The dwarf poinciana (Caesalpinia pulcherrima), whose flowers are used in a decoction both for coughs and for eye inflammations (and, powdered, as an insecticide); the leaves, roots, and bark sometimes are used to treat colds, fevers, skin diseases, and constipation, and to induce abortions. In addition to the ever-present stalls that sell the innocuous-looking dried herbs, in many markets there is a dingy hole-in-the-wall stall that features a gamey conglomeration of items useful only to wouldbe wizardry workers: snakeskins, dried lizards, armadillo shells, strung claws, teeth, birds' bills, and bits of bone; bloodstones and bezoar stones; variegated powders including "graveyard dust"; pickled intestinal parasites, dessicated animal organs, tufts of hair, etc.— all the vital ingredients for "magical" potions. It is not exclusively rural dwellers who dose themselves with herbs or patronize quacks and witches. As late as 1964, facing the caballito statue and the National Lottery building at Mexico City's busiest intersection (Avenida Juárez and Paseo de la Reforma), an old woman daily hawked medicinal herbs, spread out on the sidewalk in little piles and sacks, each prominently hand-labeled with the name of the disease it supposedly cured. Undoubtedly most of her customers were unsophisticated folk not long from the country—among the tens of thousands who flock to the capital each year in the hope of improving their lot. But even the "citified" employes of one of Mexico City's largest newspapers are cautioned by the management via a posted sign inside the building: "WHEN SICK, DON'T CONSULT A WITCH—CONSULT A DOCTOR!" And Magazine de Policía, the Mexican Police Gazette, has carried advertisements for all types of witches' paraphernalia: charms and love potions, booklets on magical remedies which include "data on poisons," etc. (Nor is any of this surprising. Today in sophisticated New York City, chiefly among Negro and Puerto Rican groups of the low economic level, openly merchandised love and hate potions and magic remedies constitute a $2-million-a-year business. (And in rural England, among a 100-percent white population

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there recently has been a faddish, pseudo-intellectual revival of serious interest in ritual white-magic witchcraft—"as a religion"—with covens of self-declared witches meeting monthly at the full of the moon for secret ceremonies. Plus widespread outbreaks of allegedly nonconnected, malicious attempts at black magic: In 1963, there were no less than 578 desecrations of English churches. Typical of such: In January, 1964, a small nude female image in modeling clay was found set up in a chapel at Sandringham, its breast pierced with a hawthorn thorn and flanked by a black candle and a sheep's heart— an extremely ancient "death curse," conceivably aimed at the Queen herself.) Witchery in San Miguel de Allende As an example of the role of so-called curers and witches in Mexico's small cities and towns, consider just one locale, in which the author of this book lived for some years. The historic Spanish Colonial town of San Miguel de Allende, in the state of Guanajuato, is situated on the high central plateau nearly two hundred miles northwest of Mexico City. With a population of some sixteen thousand, San Miguel has good medical facilities, which include half a dozen licensed doctors in private practice, a small new government-built municipal hospital, Social Security medical services, a free Department of Public Health clinic, and visiting nurses. Although today many of the town's poorest inhabitants, and the ranch workers who trek in from the surrounding countryside on market days, bring their ailing children to the Public Health clinic for treatment and inoculations, a large number still consult curanderos and believe in the supernatural powers of witches. Maids, gardeners, and repairmen will readily assure their employers of the existence of at least six practicing witches within the town limits. One crooked cobblestone lane for centuries has been popularly known as "The Street of the Witches." (Another, immortalizing some long-forgotten, presumably supernatural occurrence, is dubbed "The Street of the Ghosts of Pigs.") And it is well known that San Miguel's witches (including an elderly shoemaker) periodically gather at the boulder-strewn "Cave of the Witches," just beneath the three crosses topping the nearby Hill of Moctezuma, to stage occult midnight rites that reputedly include the burying of small, thornstabbed clay images of individuals on whom they are trying to place a curse.

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The witches of San Miguel, however, involve more than an intriguing bit of surviving folklore. Several years ago one young town doctor became interested in the subject after he was approached, in the drugstore he then operated in addition to his medical practice, by a campesino and his wife and child, who all had badly swollen faces. Under questioning, these country people disclosed that, feeling "unnaturally tired," they had consulted a witch, who had told them some enemy of theirs had hired another witch to put a spell on them. For a stiff fee, "their" witch had muttered protective incantations and prescribed Sloan's Liniment. They had used two bottles and now needed a third. When the doctor commented that the liniment obviously had not reduced the swelling, the campesino replied proudly: "On the contrary, it has caused the swelling. We swelled up only after we started drinking liniment. Now, each day we swell more." "You drink the liniment?" the startled doctor asked. The campesino explained that, yes, their bruja had instructed them all to drink liniment daily and had claimed that their resultant edema "was very good"—that it proved her magic was overpowering that of their enemy's witch! And, although the doctor sternly warned that internal use of liniment could be very dangerous and refused to sell them any, the country couple's faith in their witch was absolute. The campesino and his wife procured liniment elsewhere and continued drinking it— even after their child died. The doctor—often finding himself in conflict with behind-thescenes witches in treating uneducated patients—did some casual research into the subject in San Miguel de Allende and elsewhere. He was under something of a professional handicap: His more superstitious patients were close-mouthed, being reluctant to antagonize hostile witches or to inadvertently break the protective spells of friendly witches by disclosing anything to a licensed M.D. Nevertheless, he learned of a number of cases, and personally observed the alleged results in some, of the local witches' most dreaded purported power—that of producing the swift death of an individual through the so-called curse of the veintiunilla. Veintiunilla, Spanish for "little twenty-one," is the odd popular name for a tiny yellow flower that grows wild in the mountains of Mexico's central plateau. It is so named because it reputedly can cause death in exactly twenty-one days. The technique: A part of the

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plant is secretly put into the food of an intended victim. It allegedly causes him immediately to develop an insatiable craving for alcohol, and he presumably drinks himself to death—in precisely twenty-one days. "In the several cases I personally observed," the doctor disclosed, "I wasn't called in until the patients already were comatose and in a terminal stage. However, in each instance relatives informed me the patient earlier had stated his conviction that he was 'under the veintiunilla curse' and that nothing could save him from dying on the scheduled day." The patients, the doctor said, all subsequently died—apparently either from acute alcoholism or from a swift pneumonia that had followed a protracted drinking bout. And two never previously had been overly fond of tequila! "Obviously, these individuals' conviction that they would die on a certain day could have been a powerful psychological factor in causing death," the doctor suggested. "And also, obviously, in driving them to drink! On the other hand, the so-called veintiunilla flower may contain a slow-acting poison that requires about twenty-one days to obtain its lethal effect." Very likely the strange little yellow flower was included in the extensive herbal pharmacopeia of the learned Aztec doctors. But its properties to date are unknown to modern medicine. More Techniques of Brujos Whether it is in Mexico, New York City's Harlem, Haiti, the Congo, or Sandringham, England, apparently there is not much difference in the "magic" methods that "witches" use in attempting to harm humans. The universal technique of making a crude effigy of an intended victim is common in Mexico. The witch stabs the little muñeca with one or more thorns, recites an incantation, and prays to the Devil to cause the person a severe or fatal pain in the corresponding part of his body. The technique supposedly is more effective if a snip of the victim's hair can be attached to the doll's head. However, a brujo cannot carry on such hocus-pocus without some hazard. It is said that if a victim is lucky enough to find the hidden effigy of himself, mere removal of the thorns not only will break the curse but will kill the witch. Some Mexican witches mix religious practices into their dirty

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deeds: One may attempt to "hex" an intended victim by praying to the Devil at midnight, before a holy shrine in a cemetery, after first desecrating the shrine to please the object of her prayers. Another may wrap an image of a saint in a piece of the victim's clothing, together with the victim's photograph, and pile some pesos on the parcel to "obligate" the saint to cooperate. Then the brujo lights candles and prays to the saint to severely castigate the intended victim. Some witches utilize "magic" potions exclusively. Those most commonly employed in Mexico have the generic name sal, or salt. Such sal may be table salt taken from seven homes and unwittingly blessed by a priest, or pulverized rattlesnake skin, or the ground-up bones of a person who died unconfessed. A witch may claim to be able to curse an entire family simply by sprinkling sal on their street door or in a circle around their house so no member can leave without contacting it. This form of witchcraft is suspected if a family's economic situation suddenly worsens. Mexican witches, like those of other nationalities, have their "familiars" and supposedly can instantly turn themselves into an owl, cat, snake, or any small creature. (And if, on a windy day, you see a small whirlwind, or "dust devil," skittering along a cobblestone street —beware! This, too, supposedly is a favorite disguise of a witch on mischief bent.) Another pet technique of witches is to transform themselves into monstrous forms and then, at night, fiendishly attack their victims. In any small town, horror stories fly about, spread chiefly by servants, of hideous ghosts and witches disguised as ghosts, who appear and whisper dire warnings of approaching death into the ears of sleepers. To be on the receiving end of such a nocturnal experience is considered to be a major cause of el susto, the peculiar "fright sickness." The brujos do not expend all their "professional" activity on malicious projects. They are sometimes hired by persons who want them to break a spell cast by another witch. And they are consulted by individuals seeking a magical formula to snare the love of a popular beauty, to inspire a procrastinating suitor to propose, to win back a husband's straying affections, or simply to bring prosperity to a poor shopkeeper. For such purposes, a witch sells love amulets, lucky charms, and assorted powders and liquids to be secretly dropped into another's food —which items, of course, have been brewed from herbs and less savory ingredients by guess who, in her own little cauldron.

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Techniques of Curanderos The role of the curandero is generally less colorful and less exciting than that of the brujo. A quack-curer has had no more formal medical training than a witch (that is, none whatsoever), but he or she may have considerable knowledge of medicinal herbs and folk remedies. Curanderos employ these for simple afflictions and add assorted magico-religious rituals for more difficult infirmities. Their routine work usually lies in selling traditional remedies for such common ailments as diarrhea, colic, headache, backache, fatigue, poor appetite, and skin eruptions. A very large number of curanderos work full time, or part time, as midwives. And some have specialties, such as giving massages or steam baths and enemas. However, a substantial proportion of the work of most curanderos lies in "magically" combating the machinations of their more imaginative counterparts and professional rivals, the brujos; that is, in some lucrative contrabrujería. One reason for contrabrujería is that the people who patronize quack-curers are, of their own volition, prone to imagine that any indisposition they suffer has been produced by an enemy or witch. A second reason is that a curandero who cannot quickly cure a patient finds it very convenient to blame the failure on the malevolent magic of a brujo. Since the superstitious believe that witches derive their power from the Devil, curanderos routinely recommend that their clients protect themselves against sorcery by increased use of religious medals and holy images. If a hostile neighbor is involved, a curandero may advise a client to turn all religious images to face the neighbor's house and to sprinkle his own home with holy water filched from a church. In addition, a quack-curer uses various "magical" or mumbo-jumbo techniques to try to identify a "bewitched" patient's "enemy" (although the patient himself generally can be counted on to disclose, under simple questioning, whether the most likely "cause" of his malady is an envious relative, a business rival, a jilted mistress, or some other grudge-holder). The curer may toss a handful of corn kernels onto the ground and claim to ascertain from the pattern they assume the source of a sick-

MEDICINE IN MEXICO 142 ness and the course it will take—a slight modification of a very hoary Aztec horoscope-casting ritual. Or the curer may suck on the patient's skin; if blood is drawn, this is deemed proof that the subject has been bewitched. Certain quack-curers employ peyote, to "dream up" the origin of an illness, administering the hallucinatory drug in powder form mixed with water. Sometimes curer and patient and the patient's entire family participate in this enlightenment-seeking ritual (which must lead to a variety of conflicting diagnoses, if, indeed, the sufferer's malady is remembered by anyone). Other divining techniques involve sacrificing a chicken, or "cleaning" the patient. In the white-magic "cleaning" ritual, called the limpia, the curer may merely pass a live hen over the patient, to "transfer the evil spell" from the patient's body to that of the fowl. Afterward, the chicken may be killed and its blood sprinkled on the patient—a technique favored in the tropics, particularly the states of Chiapas and Oaxaca. In limpia con huevo, or "cleaning with an egg," the curer makes a big production out of hand-waving and passing a raw egg over a client's head and body. Next, the curer breaks the egg and drops yolk and white into jars of water, and, with more hand motions and mumbled words, affects to "read" in the shape of the egg white the "diagnosis" and "prognosis." Usually an entire series of "cleanings with an egg" are undertaken—which keep both the patient and his pesos coming. The final egg may prove to be rotten inside, which is purportedly visible evidence that the last of the evil has been extracted. In a similar vein, a quack-curer often claims that a client's illness is due to the unsuspected presence in his body of some foreign object magically introduced by a witch. But—aha!—the curer's magic will get it out. Whereupon the curer, a sleight-of-hand expert, will mutter some mumbo jumbo and seemingly remove the hexing object (a stone, a worm, a scrap of paper, on one occasion a whole mango) from the patient's mouth or ear, and with it, presumably, the ailment. All of these extremely simple, hocus-pocus methods are employed alike by curanderos and cure-minded brujos. And they are, also, all used by primitive tribal witch doctors the world over.

Curanderos fairly often are called upon to treat a peculiarly Mexican illness unlisted in medical dictionaries. El susto, the sickness of sudden fright—that may be caused by any

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distressing experience, such as a fall, a close brush with death, a heated argument, or simply seeing what is believed to be a witch in disguise—is an emotionally based illness common among the less educated Mexicans (and Mexican-Americans in the United States). Dr. William R. Holland, an anthropologist who investigated the subject while working with Mexico's National School of Anthropology and the University of Arizona's Department of Anthropology,2 reported his conclusion that this ailment is of Indian, not Spanish, origin. He noted that it is prevalent among primitive Indian tribes in Southern Mexico, where the concept of the disease is aboriginal. These people define el susto as "the loss of the spirit from the body." Mexicans describe it in more earthy terms—"the loss of the guts." (Se le fue la tripa, "the guts went away from him.") (One might wonder whether this expression spawned the U.S. slang term for a person lacking in courage.) El susto begins with stomach pains, diarrhea, vomiting, and high fever, followed by anorexia, languidness, and indifference to normal activities. The patient insists on staying in bed permanently. El susto may prove fatal. In such a classic example of a psychosomatic disease, the therapy employed by the curandero—since it consists chiefly of magico-religious ritual performed in the patient's presence and patently designed to lure his vagrant spirit (or his strayed intestinal fortitude) back into his body—should effect a respectable recovery rate. And, reportedly, it does. Tales from the tropical jungles of Quintana Roo, Chiapas, and elsewhere relate how curanderos or tribal witch doctors have cured persons bitten by deadly poisonous snakes and have done so by using no accepted medical technique. Such so-called supernatural cures no doubt are considerably multiplied in the telling. And, instances in which cures actually have occured may have a simple natural explanation: (1) Poisonous and nonpoisonous snakes often are confused, by those bitten; (2) the bite of most poisonous snakes ordinarily is fatal to humans in only 25 percent of the cases—even with little treatment—depending on var2

And who described some of the foregoing techniques of quacks and witches.

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iables such as the victim's size and constitution, the site of the wound, and the amount of venom injected (this last factor depending on the time elapsed since the snake's poison sacs previously were emptied). Thus a curandero need work no miracles, but simply rely on nature and the law of averages to win a reputation for magical curing of snakebites. Needless to say, the quack-curers and their reputations similarly benefit from the law of averages in many other types of injuries and illnesses which the gullible credit them with magically curing. How Effective Are They? According to Mexico's Department of Public Health, no less than 180,000 individuals in the nation are "practicing medicine" without a license. How effective, actually, are these curanderos and brujos in achieving cures? How many persons fail to improve under their administrations? How many are injured by their ignorant treatments or killed outright by their quackery? And how many of the cures popularly attributed to curanderos and brujos are in reality spontaneous cures (that would have occurred without any treatment whatsoever) ? How many are achieved simply through psychological influence? And how many are actually produced through the use of native herbs whose potentialities are as yet unexplored by modern medicine? It is impossible, obviously, to obtain specific answers to such questions, for no statistics of any sort are available. Neither brujos nor curanderos keep records. Nevertheless, it is possible to arrive at a number of overall conclusions and to sum up the situation quite accurately in general terms on the basis of what facts are known: 1) The curanderos' and brujos' mumbo-jumbo "magical" type of treatment undoubtedly has effected a fairly impressive proportion of psychological cures among highly suggestible clients who sincerely believe themselves bewitched. Even so, it is difficult to draw the fine line between psychologically induced cures and spontaneous cures. And while magic-ritual treatment usually is harmless in itself, it scarcely needs to be pointed out that serious consequences may result from mind-meddling by the "psychiatry" of untrained practitioners. 2) Certain of the lavishly administered native herbs and folk rem-

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edies well may promote nature's healing. Many others doubtless are ineffectual but harmless. Still others unquestionably are extremely harmful, as is any strong drug when administered indiscriminately and in unregulated dosages. Therefore, the ignorant employment of herbs and other medications by the quack-curers and witches is always questionable, frequently harmful, and all too often fatal. 3) Very few brujos or curanderos observe proper sanitation. They examine and treat patients in septic surroundings (the curer's home, his place of business, even on the street), using unsterile equipment, unwashed hands, and bacteria-ridden concoctions. The majority of quack-curers—many of them part-time street vendors or dirty old crones—function basically as midwives, and it is standard procedure for such unlicensed midwives to thrust an unwashed hand into the vagina of a woman in labor. This practice obviously can and does result in the fatal infection of patients. 4) Furthermore, large numbers of quack-curers and witches do a profitable business in inducing abortions—in this Catholic country that has one of the highest birth rates in the world. The recently established Maternal Health Association (Asociación Pro-Salud Maternal ) in Mexico City reports that, in a study of 1,000 of its women patients, who are mostly very poor, 307—almost one-third—admitted to previously having had from one to twenty artificially induced abortions! Dr. Edris Rice-Wray, the director of the Maternal Health Association, explains about such impoverished, fecundity-beset women: "In their desperation, they buy herbs from a witch doctor. Or they have a midwife try to perform the abortion by introducing a sound into the womb. Sometimes the midwives introduce potassium permanganate tablets, which are very caustic and cause burns and bleeding. Every day, every city hospital treats women who arrive hemorrhaging, at the point of death, from provoked abortions." And, of course, numerous other women aborted by quack-curers and witches die without ever reaching a hospital. 5) Many curanderos and all brujos make a lucrative practice of fanning the flames of their clients' superstitions, thereby, with their constant harping on "personal enemies" as the "causers" of illness, increasing the hostilities in a community. This all too often brings about bitter feuds, more attempts at "retaliatory" witchcraft, even

MEDICINE IN MEXICO 146 shootings, knifings, or poisonings. All quacks who thus drum up trade for themselves by exploiting the ignorance and gullibility of those who come to them for help are, per se, enemies of society. 6) In treating their clients with folk remedies and/or "magical" tricks, the quacks and witches effectively prevent them from consulting licensed M.D.'s or obtaining medical care at Public Health clinics. Duped into believing they will be healed by supernatural means, many seriously ill persons never attempt to obtain the proper medical attention that could save their lives. Furthermore, a large number of curanderos and brujos have gone much farther than merely "pre-empting the doctor's role." Personally hostile to doctors of medicine, who, they fear, soon will supplant them in treating the sick, many quack-curers and witches in rural areas have actively obstructed the M.D.'s in their life-saving work and sometimes have viciously inflamed an entire community against them. Barely a generation ago, young doctors bringing badly needed medical care for the first time to isolated villages instead of being welcomed were stoned by the witch-led populacel And, in extreme cases, also at the direction of long-entrenched witches or quacks, some such luckless doctors were murdered. In summary: Some of Mexico's legions of quacks have effected psychological cures among their highly superstitious clientele, and probably a lesser number of physiological cures of simple ailments. But most of their popular reputation as "curers" is baseless. And it is almost certain that—by preventing the sick from consulting licensed doctors, by ignorantly administering dangerous drugs, by infecting clients via unsanitary practices—the quacks and witches have harmed or killed more persons than they have helped. Thus, on the balance, Mexico's curanderos and brujos do far more harm than good. They are a surviving facet of Medieval Europe and pre-Hispanic America—the least desirable, most retrogressive product of the fusion of the two cultures. And, of course, unhappy testimony to the superstition and lack of education that still persist in many parts of Mexico. For the good of the nation, it is obvious that quacks of all types must be replaced as rapidly as possible by licensed doctors and nurses and trained public health workers.

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The Public Health Department Attacks the Problem The curanderos and brujos understandably pose a very difficult and delicate problem for Mexico's Department of Public Health, and have ever since the Department was created. The problem of combating them is at least threefold and embraces: 1) Providing (educating) enough licensed doctors, nurses, and public health workers to supplant the 180,000 quacks and serve all the communities that still lack adequate medical facilities 2) Eliminating the obstructionism of the quacks to medical progress 3) Educating the general public to the dangers of consulting quack-curers and to the importance of obtaining medical care only from trained personnel. During the administration of President Adolfo López Mateos (December 1,1958-December 1, 1964), Mexico's Public Health Department began an intense attack on this long-standing problem, which previous administrations had attempted to combat with no marked success. Under the persistent urging of Dr. José Alvarez Amézquita, Secretary of Public Health and Assistance, the Department worked out and began operating an entirely new and imaginative solution. In fact, it appears that at last the final solution to the problem has been found. It is an interesting story that will be covered in the next chapter. Principal Sources Martín de la Cruz, The Badianus Manuscript; Helen O'Gorman, Mexican Flowering Trees and Plants. Doctors' papers, interviews with Mexican doctors, and personal observations.

CHAPTER ELEVEN

Rural Medicine—With Hazards

At the turn of the century it was a considerable achievement in Mexico merely to live to become an adult. The infant mortality rate was a staggering 392 per 1,000 live births. The annual mortality rate was 33.6 per 1,000 persons. And the average life expectancy for Mexicans was only 26.5 years. The common epidemic diseases which today are little more than bad memories then ran riot every year, taking an awesome toll. In 1902, for example, there were 39,570 recorded deaths from malaria; 20,036 from smallpox; 2,982 from yellow fever. (Obviously, with a scarcity of medical doctors, and with roads and communications in rural areas extremely poor or nonexistent, the actual number of deaths from these diseases was far, far higher than recorded.) And this in a nation with a population of under 14,000,000! There were less than 2,500 medical doctors in all Mexico—and they were concentrated in the cities. Seventy-five percent of the nation's population lived outside the cities and towns—on ranches, in mining camps, and in tiny settlements or isolated hovels widely scattered over Mexico's huge desert, mountain, and jungle areas. These people were almost totally without trained medical doctors and hospital facilities. During the tragic decade of the Revolution (1910-1920) and throughout the difficult early post-revolutionary years, when federal administrations erratically changed hands and the national treasury almost always was bankrupt, there was, understandably, no improvement. In some ways the situation deteriorated even further.

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Nevertheless, the Mexican Revolution—basically fought to obtain social justice—established the principle that good health was not the patrimony of a minority but the right of all Mexicans. And it brought forth the conditions, the Constitution, and the new laws under which a high level of health eventually would be made available not merely to a small privileged class but to all Mexicans throughout the Republic. Evolution of the Public Health

Department

As earlier discussed, throughout Mexico's three centuries as a Spanish colony, all medical practice and public health matters had been supervised and regulated by a small governmental council of leading physicians, known as the Protomedicato. This respected and authoritative small body effectually had fulfilled all the functions of a modern Public Health Department (with the cooperation and aid of civic authorities). After the Protomedicato was abolished in the early days of Mexico's independence, various other councils carried out parts of its functions. But the new nation's treasury was desperately short of funds to maintain its hospitals, and many were sold or went bankrupt. (San Andrés Hospital had an annual deficit of 40,000 pesos.) By 1846 only eight such hospitals were left—six serviceable. Under a decree of February 2,1861, all ecclesiastically owned hospitals and charitable institutions were secularized and thereafter were administered by Federal District officials (in Mexico City) or by the various state authorities. Although throughout the sixteenth, seventeenth, and eighteenth centuries many hospitals had been constructed (by the Church, or by Church and Crown), during the nineteenth century there was virtually no new hospital construction. And, of course, there was none in the revolutionary period of the twentieth century. Not until the 1930's was construction resumed. Mexico's Constitution of 1917—an enlightened document adopted in the midst of bloody civil warfare—provided for reforms in all fields to achieve the goal of full social justice. Its principles gradually have been implemented by successive presidential administrations. Fraction XVI of Article 73 of the Constitution established the executive character of Mexico's Council of General Health.

MEDICINE IN MEXICO 150 The Council of General Health might be regarded as the modernday counterpart of the old Protomedicato. For it, too, is the governmental executive council supervising the nation's public health, and it, too, is composed of a small number of prominent physicians—appointed by, and accountable only to, the President of Mexico. One of its chief functions is to govern Mexico's various "autonomous" federal medical institutions, including the National Institutes of Cardiology, Nutrition and Tropical Diseases, the Children's Hospital, and the General Hospital. This council is composed of seven members (six medical doctors and an engineer), and the Secretary of Public Health and Assistance is always its chairman. The Secretary of Public Health and Assistance is one of the most important members of the presidential Cabinet. The huge ministry he heads, the Secretaría de Salubridad y Asistencia, actively supervises, regulates, conducts, and finances operations in the various fields of public health, medicine, and welfare, throughout the nation.

Mexico's Department of Public Health and Assistance unavoidably operated on a very modest scale for years. But, after surviving revolutionary leaders founded the Party of Revolutionary Institutions in the 1930's, and this dominant new political party produced an uninterrupted succession of stable and progressive presidential administrations, increasing funds became available for public health and welfare. In 1959, the first year of the six-year administration of President Adolfo López Mateos,1 the Department of Public Health and Assistance was drastically reorganized, to provide more integrated federal control and increased efficiency in the carrying out of its far-flung operations. As one part of this reorganization, a Directorate General of Coordinated Services of Public Health and Assistance was created, integrally linked with the Public Health Services in the states and territories. During the full 1958-1964 administration of President López Mateos, the Department of Public Health and Assistance was headed by Dr. José Alvarez Amézquita. Secretary Amézquita, himself a promi1 Mexico's Presidents assume office on December 1 of the year in which they are elected. Thus, although 1959 was López Mateos' "first year" in office, his term ran from December 1, 1958, to December 1, 1964.

151 nent Mexico City surgeon, directed the sweeping reorganization of the Department and personally planned and supervised a number of innovations in its broad field of activities. The Undersecretary of Public Health throughout this period was Dr. Miguel E. Bustamante, a career health officer who previously had served with distinction at home and abroad. During the six-year period, the Department of Public Health and Assistance concentrated the major part of its resources on launching new programs to benefit the nation's long-neglected rural areas. And in this field of rural operations, Mexico's Public Health Department now leads, and is an admirable operational model for, all the rest of Latin America. RURAL MEDICINE

WITH HAZARDS

Directorate of Coordinated Services Under the Public Health Department's new Directorate General of Coordinated Services and its subsidiary organizations, the programs and techniques of previous administrations generally were continued, but in many cases were altered radically to achieve greater efficiency. Subsidiary to the Directorate General and responsible for carrying out its policies and programs are the regional Bureaus of Coordinated Services in each of the states and one federal territory (Baja California Sur). During the López Mateos administration, the Bureaus together administered funds totaling 591,321,799 pesos2—not including the funds expended on the hundreds of Public Health centers. Sanitary Districts Mexico's Sanitary Districts are an intermediate unit between the Bureaus of Coordinated Services and the many Public Health centers. The Sanitary Districts are rural areas in which Public Health offices function and which have roughly homogeneous geographical characteristics, communication facilities, and environmental and socioeconomic conditions—and where, because of isolation or other adverse conditions, sanitation is particularly difficult to achieve. The primary task in these Sanitary Districts consists of educating rural 2 Since the last devaluation of the Mexican peso, in 1954, the exchange rate has been 12.50 pesos to the dollar. One peso is worth eight cents U.S.

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populations in hygienic practices—on the importance to their wellbeing of "hygienic transformation of the ambience in which they live"; specifically, on the necessity of establishing a public water supply for drinking, bathing, and laundering clothes, and of constructing and utilizing latrines. The next step is to secure the physical and economic cooperation of the community in the execution of these basic works. In 1959, there were 39 Sanitary Districts conducting intensive work in 319 rural communities. By the end of 1964 these had been increased to 60 Sanitary Districts, benefiting 948 rural communities. Public Health Center Mexico's Public Health centers, or sanitary offices, are of several categories: Class A health centers, Class Β health centers (with hospital), and rural health centers. Class A Health Centers. These major health centers provide basic health services to the inhabitants of an area centering on an important city—a state capital or a city with over 50,000 population. They operate in the fields of epidemiology and control of transmissible diseases, fomenting of public health, maternal and infantile hygiene, sanitary engineering, improved nutrition, mental hygiene, rehabilitation of invalids, dental care, and social work, and their facilities include laboratories and clinical archives. These Class A health centers were increased from 35 in 1959 to 100 in 1964, and are located in every federal entity in the Republic. Class Β Health Centers (with hospital). These smaller health centers provide similar services in areas of less population density. Each Class Β health center includes a small hospital with at least twelve beds and serves a basically rural population of approximately 25,000. The 372 Class Β health centers functioning in 1964 served 9 million persons in rural areas, and their 372 hospitals provided one bed for every 2,000 persons. This represented a remarkable expansion. Six years earlier there had been only 55 tiny federal rural hospitals in the entire Republic. Rural Health Centers (with outpatient services). During the same six-year period the Public Health Department set up 741 rural health centers with outpatient-service facilities (but no hospitals). Urban Health Centers (with outpatient services). At the same time 118 urban health centers, with outpatient-service facilities, but no

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hospitals, were established in various low-income neighborhoods of the larger cities. Rural Cooperative Medical Services Mexico's Rural Cooperative Medical Services and Health Centers function for the benefit of the ejidos, or government-established communal farms. Like the large, organized, producing ejidos, they were first established during the administration of President Lázaro Cárdenas, who is more famous internationally for his expropriation and nationalization of Mexico's vast petroleum wealth, in the hectic 1930's. In the 1958-1964 period, the Rural Cooperative Medical Services concentrated on extensive development in the Ixtlera area—100,000 square kilometers in the states of Coahuila, Nuevo León, San Luis Potosí, Tamaulipas, Zacatecas, and Chihuahua, with an estimated population of 40,000 families—4.5 percent of the national territory. As a result of the federal government's recently launched Colonization Program, additional developments have been made in the states of Oaxaca, Sonora, Tamaulipas, Puebla, Veracruz, and Chihuahua. During this period, Public Health Secretary Amézquita reorganized the Rural Cooperative Medical Services and increased the number of its facilities from 274 to 343. The 69 new services thus provided were made available not only to ejido members, but also to nonmember campesino families in adjacent areas. Social Service of Medical-School

Graduates

In the late 1930's, also during the administration of President Lázaro Cárdenas, an important initial step was taken to extend the benefits of modern medicine and hygiene to even the nation's most remote and primitive areas. A law was passed requiring that all medical students, upon completing their studies and before receiving their license to practice, must serve six months as employes of the federal Public Health Administration, in whatever post was assigned them. This required government service was known as servicio social, or social service. It was, in effect, the government's method of exacting some payment from its medical-school graduates for the virtually free education the government had given them, and of thereby extending medical benefits in the boondocks.

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Most of the young medical-school graduates were given servicio social assignments in distant mountain, desert, or jungle areas. Their mission was to introduce basic hygienic practices and to provide modern medical care, at government expense, to ignorant peasants and tribes of primitive Indians—almost all of whom never previously had so much as glimpsed a trained medical doctor. Tragic Early

Consequences

Mexico is a nation of sensational contrasts and differences—not only in climate and scenery but in cultures and socioeconomic levels. In fact, the frequent, unexpected juxtaposition of some of its widest divergences is one of the factors which make it such a flamboyant and fascinating country. However, sometimes when primitive Mexico and modern Mexico are thrown together, the consequences are startling and demonstrate how enormous is the task still before the nation's leaders—who are so eagerly attempting to telescope centuries and speed all the varied peoples of this nation into the space age. The primary reaction to the launching of the servicio social program, repeated over and over in nearly every part of the country, was both shocking and frightening. And not merely because it revealed a vast gulf between the condition of the relatively sophisticated inhabitants of the cities and that of the millions of illiterate peasants and tribal Indians who comprised the majority of the population. Imbued with the ideals and enthusiasm of modern crusaders by their medical-school professors and Public Health Department superiors, the young doctors in the 1930's set out hopefully on their lonely assignments into the Mexican wilds. Undoubtedly, like early explorers and missionaries the world over, each must have felt somewhat apprehensive about invading a primitive and alien environment, yet reassured by his awareness that his professional services were badly needed and his confidence that, since his purpose was simply to care for the sick and to teach the healthy how to stay well, he surely would be welcomed. Instead, however, the young doctors almost without exception were greeted with unconcealed hostility. Often they were not even accorded time to set up their tents, open their saddlebags, and call out for volunteers to be the first patients in their free clinics, before the men, women, and children of the settle-

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ment they were visiting, suddenly and mysteriously metamorphosing into an angry mob, furiously set upon them. Scores were stoned by the people they had come to help—and they managed to save their lives only by leaping on their horses and fleeing, leaving all their equipment behind. Other young doctors were killed—beaten to death, hacked to pieces with machetes, or hanged from the limbs of trees. Several were literally crucified, on wooden crosses erected on the brooding hillsides by semipagan Indians—many of whom were slowly dying of the gross malnutrition, tropical diseases, and parasitic infestations from which their victim had hoped to save them. What was the reason for such seemingly senseless attacks and killings? As in most primitive societies, a male or female "witch doctor" usually dominated and effectively ruled each isolated little settlement, largely by instilling fear of himself or herself. The ignorant, superstitious villagers believed that their witch doctor not only could cure them but could cast evil spells that would cause them to waste away and die. And it was, of course, the witch doctors who violently opposed the entrance into their little kingdoms of the young servicio social medical doctors. For they correctly gauged the young M.D.'s as rivals who threatened their own livelihoods. The witch doctors therefore aroused the fearful villagers to kill or drive away the first servicio social doctors who attempted to substitute scientific medical care for such "magic" medicaments as ground bats' wings, owls' knucklebones, or a necklace of strung vulture claws. Nevertheless, as an eminent Mexican gerontologist remarked with a wry smile at the May, 1964, celebration of the one hundredth anniversary of the Mexican National Academy of Medicine: "At least, no Mexican doctor has been lynched in the last twentyfive years!" His dry assessment was a vast understatement of the enormous changes and improvements that have been made in the last quarter of a century. Progress in the Doctors' Social Service In recent years the servicio social program has become astonishingly effective.

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The Mexican government continues to require all medical-school graduates to spend six months in social service—working with Public Health Department units in rural areas—before granting their license to practice. This requirement is far from unreasonable. The government, as earlier noted, has provided these young doctors, virtually free, an education that would be extremely costly to them in most countries. And during their six months of social service it pays them 600 pesos per month, plus free board, room, and uniforms. Also, if the doctors are assigned to regions in which Petróleos Mexicanos (Pemex), the nationalized petroleum industry, or another big government entity is operating, the government agency usually pays something additional. Pemex, for example, adds 1,500 pesos per month to the young doctors' pay when they work in its areas of operation, increasing their cash income to 2,100 pesos monthly ($168 U.S.). This compares not unfavorably with what they might earn in beginning private practice. The achievements of the doctors' social service are so highly regarded today that there is a plan afoot to soon lengthen the medicalschool graduate's period of obligatory service to the nation to one year. This will mean that double the present number of medical missions—1,100 instead of 550—can be sent out by the Public Health Department to bring modern medicine and medical care to the tens of thousands of tiny villages, isolated ranchos, and tribal camping grounds that dot the nation's rugged mountains, endless deserts, and steamy jungle areas. Mobile Medical Brigades Since its inception, the program has undergone considerable organizational changes. No longer are the medical-school graduates sent out to brave the wilds alone. Instead, they generally are dispatched as members of a Public Health Department brigada médica. Each mobile brigade usually is comprised of seven persons—an experienced physician, a recent medical-school graduate, a hygienist, and four nurses. Instead of riding a horse, with a pack-laden burro trailing behind, as the lone medical crusader originally did, today the medical brigades travel by jeep, helicopter, or special riverboat—although they

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still traverse the last difficult lap to some nearly inaccessible places on foot. Each mobile brigade is assigned a specific area, often several hundred square miles, and makes regular rounds of its territory. And so where, only yesterday, no "outlander" ever set foot, now an efficient little medical team regularly drives in by jeep over rough mountain trails; or suddenly appears in a Health Department helicopter that hovers above a jungle-hidden village like a gigantic cousin of the myriads of jewel-hued hummingbirds; or slowly chugs up the sluggish Grijalva and Hondo Rivers in one of the Health Department's two aptly named riverboats, Messenger of Health Number One and Messenger of Health Number Two. A riverboat brigade brings to the tiny clusters of thatched huts along the vine-draped riverbanks an entire floating clinic, complete with X ray and laboratory. Upon their arrival at each forlorn outpost of humanity, the khakiuniformed young doctors and nurses set about such everyday tasks as medicating a feverish oldster comatose upon a straw sleeping mat, treating a youth's horribly infected foot that had been slashed by a machete, performing an emergency appendectomy, administering smallpox and other inoculations, and painstakingly demonstrating to the often unreceptive womenfolk rudimentary sanitation and infant care. These brigade members, on their "medical safaris," are the prime bearers of civilization and hygiene to thousands of isolated mountain folk and tribal forest dwellers, and they employ their medical skills not under the optimum conditions of well-equipped hospitals but in the open air or in their patients' hovels, on the farthest frontiers of the nation's sanitary operations. The young medical-school graduates fulfilling their social service stints in mobile medical brigades acquire personal experience with the special medical problems of their country's least-privileged peoples, attain a better awareness of their nation's socioeconomic problems and sometimes are inspired to specialization or research in such fields as tropical diseases. Public health officials from other parts of Latin America and elsewhere currently are studying the Mexican program. Mexico's system of small, mobile medical brigades is ideal for adoption in undeveloped, thinly populated, and difficult-of-access areas in other parts of the world—such as the Amazon basin, the Congo, and large parts of

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Asia—where establishing health centers and clinics accessible to all inhabitants would be as impractical as attempting to provide a resident M.D. for each tiny settlement. Language Barriers Mexico's Public Health Department has evolved novel and amazingly successful solutions to some problems that also exist in other developing countries whose populations include multiple tribal entities. In the more primitive areas of Mexico, most members of the various Indian tribes still speak and understand no Spanish. In the southern state of Oaxaca, for example, eight Indian languages and some sixty dialects are in use. The Public Health Department's social service organization solved the difficult communication problem by distributing twenty thousand free transistor radios in the region, then setting up its own radio station. This broadcasts, in the different Indian languages and dialects, programs giving instructions in such elementary hygienic measures as the digging of latrines, plus advice on maternity care, child feeding, and water purification. "Thus, when a servicio social brigade arrives on its rounds, much of the 'spadework' already has been done," Public Health Department doctors point out. "Rudimentary sanitation principles have been made known, if not yet adopted, and there is decreased resistance to the brigades when their coming has been explained in advance." The personnel of many social service brigades also includes linguists proficient in several Indian languages and dialects. The Persistent Witches However, the biggest obstacles that have continued to hamper the Public Health Department in its tireless campaign to extend modern standards of hygiene and medical care to even the most inaccessible regions have been the brujos and curanderos. It is true that for over a quarter of a century they have not been responsible for any actual lynchings of doctors. Nevertheless, in virtually all parts of the Republic, they have tenaciously retained their influence over the unlettered. And, despite the government's "alphabetization" campaigns, 28.9 percent of Mexico's population (according to the last national census, in 1961) still is illiterate. Being constantly "in residence," the quacks and witches have had

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a considerable advantage over the social service brigades, which are able to visit each tiny settlement only periodically. And by continually inspiring distrust of the medical brigades and the rural health center doctors, the quacks in some areas consistently have sabotaged much of the work of the Public Health Department. One particularly favored propaganda lie, slyly initiated by brujos and curanderos and circulated among alarmed illiterates from coast to coast, was that "government agents" secretly were "kidnaping and murdering poor Mexicans, by the millions," and "draining out all their blood to sell as red ink!" The "proof," hombre, was that one could see bottles of red ink on a shelf in every little stationery store in the Republic! Within recent years, this fantastic tale was rather cleverly updated: It was claimed that "the poor victims' blood" now was being "collected to sell to foreign nations," where it presumably was in extraordinary demand—and the "proof" of this was to be found in the existence, in many cities and towns, of openly operating blood banks! Naturally, such crude manipulation of facts, and such childlike maligning of government Health Department personnel, have been believed (or half believed) only by the most pathetically gullible, but it is among just these people that the quacks and witches have flourished. An example of the unusual hazards occasionally still faced by Mexican doctors working among ignorant and superstitious people is the shocking incident that occurred in the late 1950's in Celaya, a small city on Mexico's central plateau. A husky country youth, an amateur boxer, came with an injured eye to the Celaya Eye Clinic (an institution built for a Celaya ophthalmologist by Mexico's former President Miguel Alemán, in appreciation of the doctor's successful operation for cataracts on the former Chief Executive's mother). A young associate ophthalmologist successfully operated on the campesino, bandaged his eyes, and directed the nurse to bed him in the clinic's unoccupied ward. Later the young doctor, while on solitary night duty, stopped in to see how his patient was. It was a tragic mistake. Brooding in the darkness—probably over the fact that, though only one of his eyes had been injured, both were bandaged—the patient

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apparently had fed his imagination on what he recalled of the inflammatory stories circulated by the region's witch doctors ever since the clinic was built. And then he heard the voice of the doctor, asking, "How are you, my friend?" The patient lunged at the startled M.D., shouting hysterically, "You stole my eyes!" In a moment, the two crashed to the floor and were rolling about in a fierce clinch, the campesino repeating his accusations with maniacal fury; the doctor, helpless in the grip of his much stronger attacker, calling desperately for help as, with a sudden searing pain, he felt the patient's thumbnails digging at his eyeballs— Before the night nurse ran in, the hulking campesino had gouged out both of the doctor's eyes! The campesino's own injured eye healed perfectly. But the ignorant youth had blinded the young ophthalmologist and in an instant ended his professional career—senselessly, baselessly, due to nothing but credulity in witches' tales. Consider these startling statistics: In 85,000 tiny Mexican communities scattered thinly over the cactus-pocked northern desert and high central plateau, clinging precariously to the precipitous slopes of the rugged Sierra Madre mountains or hidden in the lush southern jungles, the only medical care ten million Mexicans received in the very recent past was from the local witch doctor or quack. And, as earlier mentioned, it is estimated that no less than 180,000 curanderos and brujos still are practicing in rural Mexico. Although the majority of these individuals call themselves curanderos, which is translated as "quacks," and only a small number are self-styled brujos, or "witches"—according to Public Health doctors, it is a distinction almost without a difference. Dr. José Alvarez Amézquita, who, as Mexico's Secretary of Public Health and Assistance, became an authority on the subject and who disclosed the above statistics, has said flatly: "They're all witch doctors!" However, for the sake of better public relations, the Public Health Department officially refers to these unlicensed practitioners not as quacks or witch doctors, but as "untrained midwives." Midwifery is,

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after all, one of their most active roles. It is probably also the role in which they possess the greatest potentiality for harm. Certainly, until a few years ago, one of the commonest sights encountered in driving through the tiny adobe villages was a procession of campesinos trudging toward the burying ground, with a bereaved father in the lead, bearing a small white wooden coffin on his head. Emphasizing that the practices of the untrained midwives have been in no small part responsible for the fact that Mexico's infant mortality rate, maternal mortaUty rate, and neonatal mortality rate are all still relatively high, despite the ever-increasing activity of the Public Health Department, Dr. Amézquita described the typical untrained midwife as follows: "She is ignorant of the importance of cleanliness of her hands, clothes, and the instruments she uses—including the knife with which she cuts the umbilical cord and the string with which she ties it. She uses her unclean hands in all manner of external and internal manipulations during parturition. She applies ashes and grease, or worse, to the umbilical stump. And she indiscriminately administers, frequently with fatal results for both mother and child, such empiric oxytocic agents as the potent native herb zoapatle."3 In view of these facts, it is obvious that the witch doctors still constitute a serious problem for Mexican Public Health administrators. Transmuting the Witches Soon after Dr. Amézquita became Mexico's Secretary of Public Health and Assistance, he devised and launched an imaginative program that may achieve the complete and final solution to the problem. Thus far, it has proved to be extremely successful. The Secretary proposed that, instead of merely opposing and trying to displace the quacks and witch doctors, the government educate and make use of them. He pointed out that, after all, the witch doctor-midwife must support herself in some way, and frequently she is the most important and influential individual in her little community. Making her an ally of the Public Health Department would be a worthwhile objective, in more ways than one. 3 Or cihuapatli, meaning "woman medicine," a variety of sunflower (Montanoa tomentosa). A decoction of the leaves is given to women in labor to increase uterine contractions.

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Accordingly, an entirely new Health Department program was set up. Training Centers for Midwives Eight special training centers for nurses were constructed—one each in the states of Tlaxcala, Morelos, Oaxaca, Hidalgo, Yucatán, Michoacán, Jalisco, and Nayarit. In each of these centers—staffed by a faculty of Public Health Department doctors and registered nurses —both middle-aged, long-time witch doctor-midwives and young girls of sixteen and seventeen who want to enter the midwife (or nursing) profession are given a free one-year training course. They live on the premises and receive free board and room. Upon graduation, they are certified to serve as auxiliary nurses in any Public Health Department hospital, clinic, or rural health center. If they prefer, they may work as independent midwives, with the facilities of the local rural health center available whenever needed. Simultaneously, the Public Health Department is beginning to enforce a regulation barring anyone from practicing as a midwife unless certified by the Department, under penalty of fine and imprisonment. "During the first three years of this program," Secretary Amézquita reported, "6,245 midwives completed the Department's training course and were qualified as auxiliary nurses." The first 6,245 midwives thus qualified by the Public Health Department constituted a very impressive accomplishment, even though they represented only slightly more than 3 percent of the total of 180,000 individuals "practicing medicine" in Mexico without benefit of any formal medical education. And the particular beauty of the training program is that it effects a double benefit: It not only continues to provide the nation with more than 2,000 new trained auxiliary nurses and midwives each year, but simultaneously eliminates that number of ignorant quacks (and potential quacks) who otherwise would jeopardize the health and lives of the rural populations by their unscientific and unsanitary treatments. Unquestionably this new training program for rural nurses and midwives (like the improved servicio social medical brigade establishment) has been at least partially responsible for the fact that Mexico's infant mortality rate—that hovered around a horrifying 400 per 1,000 in 1900 and was still extremely high less than a generation ago—dropped to 68 per 1,000 in 1963.

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And for the fact that the general mortality rate also dropped spectacularly. The annual death rate that had stood at 33.6 per 1,000 persons in 1900 was down to 9.2 per 1,000 in 1964. Principal Sources Public Health Department records and statistics. Interviews with doctors. News stories and personal observations.

CHAPTER TWELVE

Fomenting Proper Hygiene

During the three hundred years that Mexico endured a burdensome colonialism, its Spanish rulers looted it of an estimated five billion dollars in gold and silver. In fact, the enormous wealth produced by the sweat and lives of Mexican miners at once made Spain the dominant world power and helped finance the European Renaissance. 1 This "multi-billion-dollar foreign aid" that Mexico was forced to contribute to Spain and Europe eventually drained off a large percentage of the country's silver and practically exhausted its huge gold deposits. Then, after gaining its independence, Mexico suffered a tragic century of internal strife, foreign invasions, and a dictatorship, during which much of its remaining natural wealth was handed out in concessions to foreign adventurers and nothing was achieved to erase the fantastic differences in living standards between the masses and the ruling elite. Finally, the long and tremendously destructive Revolution left Mexico virtually prostrate. And so, when (barely forty years ago) the Republic entered its constructive post-revolutionary era, the vast majority of its population was incredibly poor—the barefoot, ill-fed, ill-clothed, and ill-housed descendants of a people that had been systematically 1 The term is used here according to the following definition: The Renaissance, "stimulated [in part] by the discovery of America, spread in the sixteenth century to France and northern Europe. . . . By some writers, . . . the term Renaissance [is] restricted to its 16th-century development in western and northern Europe" (Webster's New International Dictionary, Second Edition, Unabridged).

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oppressed, exploited, and denied basic necessities for over four centuries. The "Diseases of the Poor9 In view of Mexico's extraordinarily difficult past, it is understandable that the biggest, most important problems which today confront the nation's Public Health administrations, and undoubtedly will continue to confront them for a considerable time to come, are the direct and indirect consequences of those centuries of abysmal, grinding poverty—and are, in fact, "the diseases of the poor." These diseases of the poor include (a) those that are principally the result of a lack of potable water and/or a lack of hygienic practices, such as epidemic diarrhea, parasitosis, amebiasis, typhoid, and even penile and cervical cancer; ( b ) those largely due to malnutrition, such as tuberculosis, urinary lithiasis, goiter, and cretinism; (c) those in which an important factor is inadequate housing and/or a bad environment, and which include toxoplasmosis, rabies, and what is known in Mexico as escorpionismo. This chapter will deal with the first category. Combating Contaminated

Milk

Labeling offending dairymen as "infamous assassins," Dr. Rigoberto Aguilar, director of Mexico City's Hospital Infantil, disclosed in 19642 that contaminated milk and milk products cause the deaths of approximately twenty thousand Mexican children each year, by disseminating the bacteria of undulant fever, typhoid, dysentery, tuberculosis, and other diseases. However, as a Public Health Department spokesman hastened to emphasize, virtually all the offending dairymen are the difficult-tosupervise "one-burro" peddlers of what is known as "third-grade milk" or "clandestine milk" (leches clandestinas)—the raw, unpasteurized product of unlicensed dairies and one-or-two-cow producers. Most such milkmen, especially in small towns and rural areas, still picturesquely transport their tepid raw milk from door to door in one or two battered big tin cans slung over the back of a plodding burro —dipping out whatever amount a housewife desires, and pouring it into her clay olla, or pitcher, at her door—a manner of distribution followed, unchanged, for centuries. Though millions still buy milk 2

At the Mexican Academy of Medicine's Centenary Congress.

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thus hawked, the harmful effects of its contamination are considerably diminished by the common Mexican practice of boiling milk before use in hot chocolate or the popular breakfast drink café con leche. Unfortunately, many children apparently get the milk unboiled. "We are trying to drive all peddlers of raw milk out of operation," the Public Health Department spokesman said. "But there are tens of thousands of them, and our personnel is limited." He emphasized that today by far the larger part of the milk (and milk products) sold in Mexico's cities is bottled or packaged and of the "first" or "second" grade—"all produced by dairies licensed and periodically inspected by the Public Health Department, and all required to be pasteurized." Cleaning Up on Prepared Foods As easily can be appreciated, the literally hundreds of thousands of peddlers and small-scale vendors of food and drink—including those established in the one-man or one-woman hole-in-the-wall shops, stalls, and sidewalk stands throughout the country—constitute a constant and monumental problem for the Public Health Department. The conditions under which their food and drink are prepared and sold almost dictate the inevitability of contamination. And, understandably, any attempt aimed at cleaning all of them up in one fell blow would be as futile as the legendary King Canute's try at sweeping back the incoming ocean tide with a broom. The Public Health Department is convinced that its most effective long-range policy is to educate the public to the dangers of patronizing such food and drink vendors. Thus, periodically, it feeds the metropolitan newspapers press releases disclosing the findings of its most recent survey on one or more such sources of infection. For example, a recent news release cautioned that no less than 98.8 percent of Mexico City's ambulatory or sidewalk-stand taco vendors were selling food infected with from one to a half-dozen varieties of harmful bacteria. The Department furthermore has caused such information, together with strict warnings to children against buying food, unwrapped candies, etc., from sidewalk hawkers, to be included in the textbooks printed by the government and distributed free to all elementary school pupils. And, periodically, the Department mounts campaigns aimed at closing down, at least temporarily, as many as possible of such long-

167 standing foci of infection. During the summer of 1964, the Department carried on simultaneously in Mexico City four separate campaigns, against: (1) peddlers of unpasteurized milk; (2) hole-in-thewall shops, sidewalk stands, and ambulatory peddlers selling tacos; (3) pushcart purveyors of paletas, the vividly colored ices-on-a-stick so popular with youngsters; and (4) pulquerías, the shabby little bars which sell to the lowest-income citizens the sour, mild magueyderived "beer" known as pulque. Inevitably, upon this clamp-down, a few newspapers could not resist publishing uncooperative satiric cartoons showing furtive sidewalk characters surreptitiously slipping "bootleg tacos" from under their sarapes to guiltily drooling taco aficionados. But thousands of unsanitary operators were put out of business—a considerable share of them, permanently. FOMENTING PROPER HYGIENE

The Problem of Epidemic Diarrhea The most serious of the diseases of the poor—not only in Mexico but in all Latin America—is epidemic diarrhea. This disease, according to Dr. Abraham Horwitz, director of the Pan American Sanitary Bureau, is still the worst killer disease in the Western Hemisphere south of the Rio Grande, taking a toll in Latin America estimated at 500,000 deaths and upward each year, the great majority of victims being children. In Mexico, as in Central and South America, it is still the primary cause of infant mortality. Dr. Carlos Ortiz Mariotte, director of the Mexican Public Health Department's Epidemiology and Sanitation Campaigns, disclosed that during the last ten-year period for which national statistics were available (1949-1958), epidemic diarrhea in Mexico was responsible for an average of 68,267 deaths annually—76.1 percent being of children under five years of age. (The average national mortality rate from this disease during the ten-year period was 243.3 per 100,000 population.) Epidemic diarrhea, Dr. Mariotte pointed out, is caused by one or more of the Salmonella and Shigella bacilli and various ecologic pathogens and viruses, and is a product of the poor sanitation, inadequate nutrition, poverty, and ignorance of much of the population, especially in the rural areas. In Mexico, the seasonal peak of the disease is signaled each summer, during the worst heat waves, by newspaper accounts of the sudden deaths of scores of children and the hospitalization of hundreds

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more—largely in the arid north-central area which includes the city of Monterrey—from what usually is described as "heat dehydration" —and/or epidemic diarrhea. These news stories seldom give a hint of the magnitude of the problem. The typical home from which epidemic-diarrhea victims come is that of the poorest rural peasant or city slum dweller: a tiny sunbaked, dirt-floored adobe hovel, roofed with thatch or tin, often situated beside a shrinking pond of stagnant rain water (which very likely is the only source of drinking water for humans and their burro and chickens). Or, in the city, an overcrowded single room in a tenement, or a thrown-together shanty of packing cases; there is no burro here, but very possibly chickens or a pig live on the roof. It is estimated that up to 10 million Mexicans still live in such squalor. And throughout Latin America, approximately 100 million persons. In Mexico, however, the end is finally in sight for the long-endured scourge of diarrhea that each year takes such a terrible toll of children's lives. In 1959 the Public Health Department launched an aggressive campaign aimed at (1) preventing the disease and/or abating its effects in those tiny sufferers who have already contracted it, and (2) eliminating the most important source of infection—contaminated drinking water. Under direction of the Public Health Department's National Campaign Against Diarrhea, during the summer of 1959 there were distributed in seventeen of Mexico's twenty-nine states a total of 500,000 packaged doses of an effective anti-dehydration medication (sodium chloride, 3 Gm; potassium chloride, 1 Gm; excipient, 46 Gm—to be dissolved in a liter of water and taken orally). Distribution of such medication has continued each summer. Hospitalized patients have been given the standard therapy of injections of either Hartman's solution, Ringer's solution, or the Mixta solution. Results of the campaign thus far have been not only significant but highly encouraging: In 1959, the first year the anti-epidemic diarrhea measures were in effect, deaths from the disease in Mexico totaled 54,100, which, although still a shocking number, represented a decrease of no less

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than 14,000 from the annual average for the preceding ten-year period. And in a pilot area comprising the previously severely afflicted city of Monterrey and the adjacent rural area, results of the campaign are illustrated by the following steadily declining mortality rate from epidemic diarrhea: 1960, 101.6 per 100,000; 1961, 81.37; 1962, 75.0; 1963, 69.1 (est.); 1964, 60.8 (est.). Providing Potable Water Simultaneously, in 1959, the Public Health Department launched that part of its anti-epidemic diarrhea campaign aimed at permanently eliminating the most important source of infection—the contaminated drinking water. It sent out crews, with heavy modern equipment, to drill a deep communal well in every village of less than 2,500 population that did not already possess an adequate source of pure potable water. By September, 1964, it had completed 1,318 such systems, benefiting 2,136,000 people living in small towns. In addition, it installed 885 new water-distribution units, 12,000 water-purification units, 395 communal watering troughs, and 193 kilometers of water pipe. During the same period, the Federal Hydraulic Resources Secretariat, with a supplemental program of similarly aiding communities of more than 2,500 population, drilled deep wells and installed community water systems in another 1,224 towns, and sanitary sewer systems in 82 more. The projects completed by the Public Health Department during the López Mateos administration benefited an estimated 5,000,000 persons and those installed by the Secretariat of Hydraulic Resources, an additional 2,000,000. At Punta del Este in 1961, representatives of the nations of the Western Hemisphere began mapping plans to raise both living and health standards throughout Latin America under the newly launched Alliance for Progress program. And, significantly, the Mexican Public Health Department's communal well-drilling program was recognized there as an ideal method for speedily and inexpensively bringing potable water to those millions of inhabitants of Latin America who, in the words of one of the leaders at that historic conference, "live in rural areas under public health conditions which are two centuries behind those of the cities."

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Accordingly, under the Punta del Este Charter, internationally financed programs for all of Latin America's long-ignored rural regions were blueprinted. And, at the September, 1964, meeting of the Directing Council of the Pan American Sanitary Bureau, among the most important programs recommended for 1965 implementation, to help attain the long-range, overall objective of elevating public health and living standards throughout Latin America, was "a $710 million plan (to be financed by international loans to member nations) for construction of water supplies (by means of drilling communal wells), for 50 million rural Latin Americans." This was a further tribute to, and was modeled on, the Mexican program. The Problem of Parasitosis Almost equally as devastating a disease of the poor throughout Latin America, especially since it afflicts all ages, is parasitosis. Throughout Latin America, the incidence of various parasites prevalent among the inhabitants on the lowest economic levels is appallingly high. This high incidence, like that of epidemic diarrhea, is the direct product of all the factors usually associated with substandard living conditions: ignorance and disregard of basic hygienic principles, lack of sources of uncontaminated drinking water, lack of latrines, wretched housing, inadequate diet, and, of course, the huge percentage of persons already infested with, and continually transmitting, the parasites. A few random statistics will indicate the probable overall incidence among the lowest economic levels of Mexico's population: Dr. Jesús Salgado Rodríguez, a captain in the Mexican Naval Corps, reported 3 that when medical officers of the Mexican Naval Hospital on the Isla de Mujeres—in the sparsely populated, primitive federal territory of Quintana Roo, in Mexico's Seventh Naval-Military Zone—examined fecal matter from one hundred civilian residents selected at random, all one hundred were found to be suffering from one or more types of intestinal parasites. "More than 85 percent of the civilian population on the island were 3

At the First Mexican Congress of Naval Medicine, in 1963.

171 practicing fecalismo in the open air; in other words, had no facilities of any type for sanitary disposal of excreta," Captain Salgado disclosed. "This, of course, explains the amazingly high incidence of intestinal parasites." He advanced his theory that the same factor is principally responsible for the high incidence of parasitosis throughout the country among the population's lowest economic levels: "A study made in 1961 by Mexico's Secretary of Industry and Commerce," he noted, "disclosed that only 61.3 percent of Mexico's urban population, and only 18.7 percent of its rural population, possess any facilities for the disposal of excreta." FOMENTING PROPER HYGIENE

Countering Amebiasis Dr. Javier de la Riva, of Mexico's Department of Public Health, disclosed4 that Public Health Department laboratory examinations of the feces of 67,691 persons from among Mexico City's poorest inhabitants had revealed that no less than 56.11 percent were aflSicted with parasites. In fact, more than half—52.86 percent—were afflicted with two or more kinds of parasites. And 17.05 percent were suffering from amebiasis. Dr. de la Riva blamed, as chiefly responsible for the high incidence of parasitosis throughout Mexico among the lowest socioeconomic levels: (1) insufficient water and contamination of much of the existing supplies, (2) contamination of the ground, (3) deficient diet and the way of life of much of the population, and (4) difficulties of diagnosing and treating parasitosis. He noted that amebiasis held first place among the various parasitic infections among adults. But it was only in third place among the total number of persons examined in the survey, inasmuch as the subjects included a large proportion of infants and children and the incidence rises sharply with age. Although the amebiasis incidence "peaks" at the age of twenty years (22.18 percent) and subsequently descends, it does not descend as rapidly as that of other parasitic infections. Among adults, its incidence was 11.2 percent. "However," Dr. de la Riva emphasized, "it's a misconception to suppose that amebiasis is a disease found exclusively in tropical and semitropical countries. 4

At the National Reunion of the Mexican Society of Proctology, in 1963.

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"In fact," he pointed out, "Craig, in a study of all areas of the United States, in which 50,000 persons were examined, found no less than 11.6 percent were infected with Entamoeba histolytica." (This is the most commonly encountered amoebae parasitic in man—at least, in the U.S.) When this finding is compared with the previously cited statistics for Mexico City, it appears that amebiasis is not much more of a hazard in Mexico than in the United States. Dr. Francisco Biagi F., chief of the Department of Microbiology and Parasitology of Mexico's National University Medical College, reported that, among 2,202 necropsies conducted in Mexico City's General Hospital upon cadavers of adult patients from low economic strata, in 109, or 5 percent, death was found to have been caused by amebiasis. In only 11 of these 109 cases, or 10 percent, were any other diseases involved. Approximately 90 percent of the 109 patients who had died from amebiasis were found to have multiple hepatic abscesses. A principal problem in the management of amebiasis, according to Dr. José Ruiloba of Mexico's National Hospital of Nutritional Diseases, is that there still is no standard treatment which can be utilized in all clinical forms of the disease. "However," he said, "in cases of acute amebiasis, we employ products of fast absorption that reach in sufficient concentration to the intestinal wall, such as intramuscular emetine and the antibiotics with anti-amebic action. For the chronic form of the disease, we use various series of products alternately—especially the derivates of oxyquinoline, the arsenicals, and dichloriacetemide. And in all cases, we use antispasmodic agents, mucilages, and light diet." Dr. Ruiloba said he considered a cure effected if, following treatment, during repeated examinations over a forty-five-day period the ulcer lesions were consistently revealed to be cicatriced, and no trophozoites were found in the feces. Progress Fortunately, as the result of an aggressive campaign launched by Mexico's Department of Health in 1960, the national morbidity rate from amebiasis and amebic dysentery has been steadily declining. Effecting this has required a recent great extension of the Department's services. One of the most important measures has been its

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program to educate the people in personal hygiene. Such education has been carried out by the Department's mobile medical brigades, which, traveling by land, air, and water (jeep, helicopter, and riverboat ), bring educational motion pictures into even the most primitive and nearly inaccessible areas and man strategically located Public Health Department radio stations that broadcast educational programs about hygiene in a score of different idioms. In addition, as described earlier, the Public Health Department has greatly improved public health facilities in nearly 15,500 communities of under 2,500 population by drilling deep communal wells to supply potable water, or installing water-purification units and sanitary sewage-disposal units, and, in the very smallest communities, even building rows of model concrete latrines. Furthermore, in the cities and towns the Department drastically tightened its regulations on public eating places and increased its staff of inspectors who periodically check on same. Finally, it formed a special staff which makes swift epidemiological investigations and tracks down sources, following any reported significant outbreak of new cases of amebiasis or amebic dysentery. Another important factor in causing the national morbidity rate from amebiasis and amebic dysentery to turn sharply downward has been the Public Health Department's impressive recent proliferation of Public Health hospitals and health centers. In 1958 it operated a total of 1,100, distributed more or less equally in urban and rural areas. Within the six years that followed, it constructed 6,090 new units, with a total of 14,304 beds—representing an increase, in bed capacity, of 57 percent. Eighty percent of the new construction—providing 10,412 beds—was located to benefit rural areas. The very impressive result of this aggressive, multilateral Public Health Department campaign against parasitosis and, particularly, amebiasis and amebic dysentery is that—as disclosed by President Adolfo López Mateos in his sixth and final State of the Union address—the national mortality rate for amebic dysentery in just six years was cut to a third of its previous figure: It dropped from 19.1 deaths per 1,000 population in 1958 to 6.6 per 1,000 in 1964. Reassurance for Tourists In concluding this discussion of the problem of amebiasis, which is

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largely restricted to the lowest socioeconomic levels of Mexico's populations, the following words of reassurance to foreign visitors seem in order: Some Stateside tourists and other foreigners who visit Mexico and find themselves victims of what they wryly dub "the Aztec trot" or "Moctezuma's Revenge" are prone to fear that the amoebae have got them. But this is rarely the case. The mere fact of traveling—the sudden change in altitude, climate, mineralization of the drinking water, and perhaps new foods—in itself can produce a temporary upset stomach and/or diarrhea. And this malaise, it should be noted, occurs among a sizable proportion of travelers in any part of the world. (In fact, Mexicans first visiting New York City quite often complain of such a digestive upset.) And although some visitors to Mexico immediately suffer this temporary and minor, but annoying, disability, many people from the States and other foreigners have remained months, or even years, without a single bout of diarrhea. Personal Hygiene and Genital Cancer It scarcely need be emphasized that the lack of personal cleanliness is a major factor in the spreading of a large array of diseases. Obviously, mere thorough washing of the hands before preparing food and before eating would do much to curtail the spread of intestinal parasites and the wide range of bacteria commonly conveyed by foods contaminated in handling. It is also obvious that simple frequent bathing is a factor in the prevention of a number of minor and major infectious diseases, from tinea capitis to mycetoma. Less generally known, however, is the fact that poor personal hygiene appears to be a major factor in the development of cancer in the genital organs of both men and women. In not only Mexico but most other Latin American countries, significantly high incidences of both penile cancer and cervical cancer exist, particularly among population groups of the lowest socioeconomic levels, which groups, of course, practice the most lax hygiene. Penile Cancer Dr. Jaime Woolrich, professor of urology at the University of Mexico Medical School, reported 5 some significant conclusions from a study of 3,620 carcinomas of male genitourinary tracts. 5

At the 1964 World Union Against Cancer sessions.

175 Of 389 cases of cancer of the penis, virtually all were found among males of a low economic strata: rural farm workers, 55.8 percent; factory workers and laborers, 30.9 percent; white-collar workers, 5.6 percent; business and professional men, 2.1 percent. "In the pathogenesis6 of cancer of the penis," Dr. Woolrich said, "we are now almost certain the etiological agent7 is the action of smegma,8 which is intensified by phimosis,9 lack of hygiene, and redundant prepuce."10 Commenting that "Latin American countries are underdeveloped, most outstandingly, probably, in the field of individual hygiene," he emphasized that practice of circumcision is not customary among these countries' lower economic levels. He noted that 98 percent of the cases of penile cancer studied "had phimosis or redundant prepuces, thus affording the requisite condition for the retention of smegma, which, it is generally conceded, has carcinogenic11 action. Only two of the 389 patients with penile cancer had been circumcised. And, in one of these two exceptions, circumcision hadn't been performed until the patient was an adult—at which time the cancerous lesion was discovered." Dr. Woolrich observed that there probably was a much lower incidence of penile cancer in Mexico before the Spanish Conquest than at any time since. "There are numerous references in historical records of the Aztecs that indicate circumcision was practiced among them and the other Indian nations—if not universally, to a wide extent," he explained. "After the Conquest, however, the Indians were forbidden by the Spaniards to continue the practice. This was due to the Roman Catholic clergy's teaching at that time that circumcision indicated a sinful obsession with sex." Mexico today has one of the world's highest incidences of cancer of the penis, the doctor noted; penile cancers constitute approximately 2.1 percent of all cancers found in males. Dr. Woolrich has urged the Mexican Society of Urology to recomFOMENTING PROPER HYGIENE

6

The beginning of a disease. Causative agent. 8 Cheesy secretion of sebaceous glands of the foreskin. 9 A too-tight, nonretractable foreskin. 10 Excessive foreskin. 11 Cancer-causing. 7

MEDICINE IN MEXICO 176 mend legislation requiring all male infants in Mexico to be eircumcized at birth. Such a law, he said, would virtually eliminate cancer of the penis.

Cervical Cancer Various doctors attending the 1964 sessions of the World Union Against Cancer, in Mexico City, disclosed significantly high incidences of cervical cancer in women in several of the largest Latin American countries. Report after report indicted a low socioeconomic level and its attending living conditions as a major probable cause. For example: In Brazil, while cervical cancers constituted only 29 percent of all cancers found in females in São Paulo and Rio de Janeiro, where living standards are highest—in Bahia and Pernambuco, in the nation's poverty-stricken northeast, they constituted 60 percent. In Venezuela, cancer of the cervix killed 28.9 percent of all females who died from cancer in 1962. An early-cancer-detection examination of 18,468 young women in 1963 disclosed an incidence of 2.24 percent of cervical cancer cases. The picture in Mexico, though less extreme, roughly paralleled that in other Latin American countries: A 1959 Public Health Department report, for example, disclosed that cervicouterine cancers constituted 39.9 percent of all cancers found in Mexican females. And a recent nationwide survey conducted by the Public Health Department for the early detection of cancer—in which, by early 1964, over 160,000 women had been examined—found on cytological evidence an incidence of 1.02 percent of uterine cancers. However, in the first year of an early-cancer-detection campaign simultaneously conducted by Mexico's Institute of Social Security, in which 55,176 women were examined, the incidence of uterine cancers found was only 0.76 percent. This considerable difference in findings reflected the pattern reported from other Latin American countries: Women examined in the Public Health Department's campaign were largely of the lowest economic level; whereas those examined at the Social Security Institute's clinics (which reported the much lower cervical cancer incidence ) were of the middle and lower-middle classes. The high susceptibility to cervical cancer of women of low economic levels was attributed by various doctors to: initiation of sexual in-

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tercourse at an early age, frequent childbirth, chronic inflammation of the gynecological tract, gynecological infections, and existence in unhygienic living conditions. Another clearly important factor is years of coitus with uncircumcized, smegma-accumulating males. Mexico's early-cancer-detection campaigns will, of course, reduce the death rate from genital (and other) cancers. Doctors stress, however, that reducing the incidence of genital cancers is largely a matter of preventive medicine—of educating the public to the vital importance of proper hygiene. Widespread adoption of improved personal hygiene obviously should and will considerably reduce the incidences of penile cancer and cervical cancer, now so disproportionately high among the lowest economic levels in most of Latin America. The provision of potable water supplies and the widespread institution of general hygienic practices (individual, familial, and communal) will drastically reduce the death rates in Mexico and throughout Latin America. This also will do much to elevate the level of life of the populations. For adequate sanitation is as basic a necessity as food and shelter. Principal Sources Public Health Department records and statistics. Interviews with doctors. Individual doctors' papers. President López Mateos' 1964 State of the Union speech. News stories and personal observations.

CHAPTER THIRTEEN

Moving In on Malnutrition

Other diseases that must be included in the "diseases of the poor" are those which are the product of dietary deficiencies. For, despite Mexico's substantial economic achievements during recent years, the nation continues to be harassed by a serious national nutritional problem among the lowest-income components of its population. This is particularly true in rural areas, where the nutritional bases have been little changed since the days of the Aztec Emperor Moctezuma II. The Poor Rural Diet Quoting from the sixteenth-century historians, Bernardino de Sahagún, Alvar Núñez Cabeza de Vaca, and Alcocer, who graphically described conditions among the poorest Indians of New Spain shortly after the Spanish Conquest, Dr. Salvador Zubirán, director of Mexico's National Institute of Nutritional Diseases, declared1 in 1964: "Although the upper classes in the old Aztec Empire dined very well on a variety of dishes of birds, fish, animals, vegetables and fruits, the diet of the indigenes on the lowest economic level often constituted only tortillas containing roasted maguey and nopal cactus leaves and enchiladas filled with cooked larvae and eggs of the axayacatl flies. "And, actually, the diet of our poor in many rural areas has been little improved since." Citing results of a continuing nationwide study of diets being 1

At the Mexican National Academy of Medicine Centenary Congress.

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made by the Institute, the Director said that the daily ingestion of food per capita in rural areas averages 2,115 calories—only slightly under the minimum recommended by UNESCO. "However," he explained, "this gives an illusory picture of conditions, inasmuch as 1,170 calories, or more than half of the daily total, is provided by corn, which is far from an ideal food. Furthermore, more than 10 percent of our rural families exist on a daily diet of less than half the aforementioned 'average'—both in protein and total caloric content." The protein content of the Mexican rural diet averages only 56 grams daily, he said, and corn and beans provide 80 percent of it. He pointed out that therefore the protein content of the rural diet, besides being minimal, is substandard in quality, for the Mexican vegetable proteins are deficient in varying degrees in some or all of the essential amino acids, tryptophe, methionine, lysine, threonine, and sometimes also in valine. The survey made by the National Institute of Nutritional Diseases disclosed that the average daily caloric content of the diet of preschool-age children in rural areas is 885. The comparative figure for preschool-age children in urban areas is 1,250. This chronic malnutrition in the rural areas, Dr. Zubirán noted, is held responsible for the high incidence in Mexico of several important diseases. Dr. Zubirán also emphasized that widespread malnutrition among the rural population poses more problems than those of disease. While poverty and ignorance are the chief producers of malnutrition, malnutrition, conversely, effectively perpetuates poverty and ignorance. For the reduced desire and ability to advance of persons debilitated by lifelong undernourishment are a formidable barrier to their education and economic betterment. Dr. Zubirán reiterated that the seeming indolence and lack of ambition of many individuals on the lowest economic level are most often pathological symptoms produced by dietary deficiencies and/or disease—not the cause, but the effect, of a substandard and miserable existence. ! (The once-popular, tourist-trade-disseminated stereotype of the Mexican rustic as a seated or supine figure with a big sombrero shading his face while he siestas his life away—a justly resented caricature—is no more typical of a healthy Mexican than would be a cor-

MEDICINE IN MEXICO 180 responding wood-carving, bookend, or ashtray image depicting the modern U.S. farmer as a barefoot, ragged, pellagra-sapped hillbilly. Neither figure is typical; both, representing an ill segment of the population, are fitting objects of pity, rather than derision.) The elimination of malnutrition among Mexico's underprivileged will achieve far more than improving the health of the individuals directly involved. It will work wonders toward, and is essential to, the nation's economic advancement.

Anemia One of the most serious pathological results of the chronic malnutrition in Mexico's rural area is the prevalence of anemia. It has been found that, among Mexico's rural population, one out of every eight men, one out of every five women, and one out of every four children are anemic. Stunted Growth Another important consequence of the protein-deficient, monotonous corn-and-beans diet of Mexico's rural population of the lowest economic level, according to the Director of the National Institute of Nutritional Diseases, is that seven out of ten Mexicans are deficient in stature. Reporting on findings of a five-year study on national nutritional conditions, he commented: "The most striking growth deficiency is found in the near-sea-level, tropical state of Yucatán, among the descendants of the ancient Mayas who built the magnificent pre-Columbian cities of Chichén Itzá, Uxmal, and Kabah. There, where the rural diet is most lacking in essential nutrients, the average stature of adults has been found to be only 4 feet 10.5 inches. "In contrast, in the state of Chihuahua, in the high-altitude northwest, where the diet of rural inhabitants is least deficient in essential nutrients, average adult stature is 5 feet 6.5 inches." Urinary Liihiasis Another result of poor diet is the high incidence of urinary lithiasis2 in much of Mexico. One of every three genitourinary patients treated in Mexico City 2

Formation of stones within the urinary passages.

181 hospitals and clinics during the last ten years has been afflicted with urinary lithiasis, Dr. Aniceto Orantes recently told the Mexican National Society of Urology. "Although the incidence is highest in the Federal District," he said, "the national incidence also is relatively high, especially in children up to ten years of age, of whom 17.13 percent are afflicted." Dr. Orantes said he considered the principal causative factor to be the heavy daily intake of lime by those among the population who live almost exclusively on tortillas. This daily heavy intake of lime, he pointed out, is the result of the traditional home method of preparing tortillas—which is by soaking dried corn overnight in limewater to soften it before grinding or mashing it into the coarse flour that is patted into thin disks and briefly baked over a charcoal brazier. (Mexico's "most typical sound" has been held to be not marimba or mariachi music but the rhythmic soft slap-slap of a woman flattening tortilla dough between her palms, to be heard in patios, doorways, and marketplaces all over the nation. During the Conquest an Indian army drawn up on a distant hill signaled its desire to surrender when hundreds of its women waved their rebozos, then made the classic palm-clapping gesture to indicate they were willing to make tortillas to feed Cortés' Spanish army. Nowadays, each Mexican city has its neighborhood tortilla factories, where the staple is massproduced and sold hot. Even in small towns, to supplement homemade and market-hawked tortillas, there may be a little open-fronted factory featuring a huge drumlike iron griddle and an awesome threshing-machine-like contraption—which all day long turns out legions of traditional tortillas and impressively dispatches them in single file, to waiting customers at the shop front, on an anachronistic-seeming conveyor-belt.) In support of his hypothesis about the cause of the high incidence of urinary lithiasis, Dr. Orantes noted that outside the capital—which presumably includes among its many poor people the nation's biggest tortilla consumers—the highest incidence of the disease among genitourinary patients is in the state of Yucatán, where it averages 28.91 percent. "In that state," Dr. Orantes pointed out, "there exists the additional causative factor of the high mineral content of the water, which is derived almost exclusively from underground streams and natural wells, or cenotes, in the limestone-underlaid Yucatán Peninsula." MOVING IN ON MALNUTRITION

MEDICINE IN MEXICO 182 It is interesting to note that the Mexican government regards a "corn-based diet" as the most important index to whether members of the indigenous population still live on the tribal level or have been assimilated into the Mexican mainstream, for this, of course, is the traditional and very ancient Indian diet. Once beans and/or rice, or (later) potatoes, are added as regular foods, the diet no longer is deemed corn-based. Nevertheless, tortillas (eaten plain or rolled up around cooked vegetables and peppers, bits of fried meat, cheese, and lettuce, etc.) remain a regular part of the diet of practically all Mexicans. Even in the capital's most exclusive restaurants, they are available as a side dish, daintily served in a napkin-wrapped, steaming-hot stack, and eaten like bread or rolls. While tortillas (or, more accurately, the steeping-in-limewater technique of preparing them) may be injurious to persons who eat almost nothing else, there is no danger in very ample "supplementary consumption" of the delicious tortilla, which in recent years has become increasingly popular in the United States.

Goiter An important disease of the poor that presents Mexico with an unusual public health problem is endemic goiter. Goiter afflicts an estimated four million persons, 10 percent of the nation's population. The disease, however, is prevalent only in one geographic area. Most frequently seen among peoples who live on the slopes of the world's great mountain ranges, goiter has a shockingly high incidence in what is known as Mexico's "Belt of Fire." This is the area, extending from the Caribbean to the Pacific and including nine states and the Federal District, which embraces most of Mexico's dormant volcanoes, including its two most famous ones—Popocatepetl and Ixtacíhuatl. When our planet was considerably younger, the roughly threehundred-mile-wide mountainous region, stretching from sea to sea, literally was a "Belt of Fire," with many thousands of volcanoes belching flames, smoke, and molten lava. And today, in this region of extinct volcanoes where foods produced are almost totally lacking in iodine, nearly a third of the population has goiter. Dr. Herbert Stacpoole, chief of the National Campaign Against

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Goiter, in discussing the problem at length, said that in some mountain villages the goiter incidence ran as high as 90 percent. In addition, Dr. Stacpoole emphasized that more than one out of every thirty infants born in the "goiter belt" is a cretin. This, of course, is no coincidence. In 1958 Mexico's Public Health Department first launched its campaign to eradicate goiter and made Dr. Stacpoole campaign director. As a first step, the doctor conducted a survey of cretinism and associated syndromes in six towns in the state of Puebla, in the heart of the goiter belt. All six towns were located on the slopes of Mexico's best-known volcanoes—"Popo" and "The Sleeping Woman." "Out of these towns' total population of 9,328," Dr. Stacpoole said, "we examined one-third. Cretinism afflicted 3.4 percent of the population. In every instance, we found that the cretins' mothers had advanced goiters; two-thirds of the cretins themselves had goiters. "The affected offspring showed typical symptoms: They were dwarfed—many adult cretins being no more than three or four feet tall, with very short femurs and malformations of the pelvis, ankles, and knees. Even some of the youngest had deeply wrinkled faces. All had speech difficulties, which in nearly half amounted to deafmutism. Many had a mental age of roughly one year." Dr. Stacpoole declared that the incidence of goiter in these six mountain villages ranged from 58.5 percent to 94 percent. The horrifying record here went to San Juan Tetla, a village with a population of 1,337, of whom 40 also were cretins. Atzumpa, with a population of 1,131, had almost as high an incidence of goiters and even more cretinism. The difficulties faced by Mexico's Public Health Department in carrying on its campaign against goiter aptly illustrate the gigantic problems encountered in many other public health programs for developing nations. Obviously, since the responsible deficiency in the diet of the goiter-belt population is iodine—almost totally absent in the food grown there—the indicated remedy is to supply the missing iodine. A method long utilized in other parts of the world is simply to add a small quantity of iodine to the salt consumed by the affected population. 3

Before the Second Mexican National Public Health Congress, in 1963.

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However, Mexico's goiter belt is an area in which it is extraordinarily difficult to employ this simple solution, for the four million mountain villagers of the goiter belt, largely an uneducated, semiprimitive people, obtain their salt not from a few big salt processors, but from a myriad of small producers. The latter conduct crude operations by digging holes in salt beds along the Pacific coastal lands of the state of Guerrero, filling them with water and simply letting solar evaporation do the rest. Public Health Secretary Amézquita had resolved to propose enactment of a law requiring the injection of iodine in all salt sold for human consumption in Mexico. But he was convinced that the need for such a law first must be graphically demonstrated. And he realized that, even if such a law were enacted, any program to first supply the large number of small salt producers with the iodine, and then to "police" them to guarantee they add it to their product, would require a considerable budget and personnel—far more than the Department could devote to this single campaign at that time. It was decided, therefore, to start by exploring, on a modest scale, the practicality of selective operations plus an educational campaign. In 1959 the Public Health Department began a small anti-goiter program by distributing iodized candies, two to be taken each week. Because of lack of funds, the candies went only to children and pregnant women living on the outskirts of Mexico City. In 1960 the Department launched another voluntary, but somewhat more ambitious, campaign. Dr. Stacpoole personally designed an apparatus to iodize salt cheaply. This ingenious device, which can be hauled around in a small truck, injects potassium iodide into the salt being processed, at the rate of 20 milligrams per kilogram of salt. Four such machines were put in operation. The original machine was taken first to San Luis Potosí, in Central Mexico. From this base it was trucked to the various villages and towns in the area, and the salt on merchants' shelves was iodized, free of charge. Another portable machine was sent to the coastal regions of the state of Guerrero, where most of the small salt producers operated. The salt they produced was similarly processed, free of charge. A third, nonportable machine was taken to Iguala, Guerrero's largest city. And a fourth, together with a training station for personnel, was

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built in the Mexico City suburb of Xochimilco, near the famous floating gardens. On installation of this fourth unit, merchants in the six goiter-prevalent sections of the Federal District were informed they must sell iodized salt exclusively, either buying it or exchanging their stock of noniodized salt, free of charge, for treated salt. However, budget and personnel shortages soon forced the program to be restricted to half of this sector of the Federal District, and forced the termination of the San Luis Potosí operation. In the diminished Mexico City area on which Dr. Stacpoole's personnel then concentrated their efforts, there were about fifty small towns with a total population of 90,000. Yet even in this shrunken field of operations, results were disappointing: At the end of a year's operations, when samples of salt were taken from homes in Xochimilco, only one-third proved to be iodized. Nevertheless, progress has since been made. During 1962 at least 6,168 tons of iodized salt were produced, which are believed to have benefited 1.5 million people. And the Department increased its distribution of iodized candies to include sixteen small settlements in heavy goiter areas of the states of Puebla and Hidalgo. And finally, on October 9, 1963, President Adolfo López Mateos, declaring that the prevention of goiter was a matter of national interest, issued a decree requiring that all salt produced in Mexico for human consumption must be iodized. The policing of salt producers, to compel them to inject potassium iodide into their salt, then was stepped up, as was the distribution of iodized candies. The educational campaign throughout the extensive goiter belt was greatly expanded: In every little settlement in the former Belt of Fire, there is a prominently displayed poster explaining the need for iodine in the diet and warning against buying noniodized salt. It is significant that, on September 1, 1964, when President López Mateos made his sixth and final State of the Union address to the Mexican people, he said, "Results of the October 9, 1963, decree which made it obligatory to add iodine to salt for human consumption have been shown in a 50 percent decline in the incidences of newly discovered goiters." Tuberculosis The most important disease of the poor that is principally the prodduct of chronic malnutrition among the lower economic levels of the

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population—in Mexico as in all of Latin America—is tuberculosis. In fact, in all of Latin America, on the basis of its annual death toll, tuberculosis is the most important disease next to epidemic diarrhea. In recognition of this fact, the Pan American Health Organization in 1964 named tuberculosis its "next major target for eradication." Dr. Abraham Horwitz, of Washington, D.C., director of the Pan American Sanitary Bureau, gave the reason: "Because, after infant diarrheal disease, tuberculosis is the most communicable, most avoidable and most curable disease, causing the most deaths, the most cases, and the most social and economic damage." Currently the death rate from tuberculosis in Latin America is six times that of the United States and Canada—which latter countries, together, have a comparable population. (Tuberculosis in Latin America, according to the 1963 Report of the Pan American Sanitary Bureau, currently kills an average of 60,872 persons each year; in the U.S. and Canada, 10,296. (And in Mexico in 1961, the most recent year for which accurate statistics are available, deaths from tuberculosis totaled 9,403—virtually equaling the total that year in the United States, which was 9,938). "One of the biggest handicaps in fighting tuberculosis in Latin America," Dr. Horwitz pointed out, "is that the existing facilities for detection of the disease are so far from adequate. This is obvious in comparing the ratio of newly discovered cases of the disease to deaths, which is far lower in Latin America than in Northern America. (While the U.S. and Canada in 1963 reported an annual average of 60,470 new cases, Latin America's total—with six times as many deaths—was only 126,688 new cases reported. (In Mexico, from 1957 to 1961, while deaths from tuberculosis totaled slightly more than 9,000 each year, new cases reported each year totaled only slightly more than the death toll—between 10,000 and 13,000 each year.) "If the case/death ratio obtained in the U.S. and Canada were applied to the 60,872 annual deaths from tuberculosis reported for Latin America," Dr. Horwitz pointed out, "there should be 359,144 new cases becoming known each year—of which less than half, or only 126,688, actually are disclosed. "This means that with the actual number of new cases becoming

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known each year and the probable additional undiscovered new cases each year, there currently are at least one million active cases of tuberculosis in Latin America. "And it may be that there are twice that number. Only a very tiny percentage ever receive treatment." The Campaign Against Tuberculosis In 1963, Mexico's Public Health Department launched an aggressive campaign against tuberculosis. Mobile units, a part of the Department's famed mobile medical brigades, were sent out to make spot radiological surveys. The results were disturbing. For example, in the total of 30,746 radiological examinations made in the cities of Veracruz, Salina Cruz, Mérida, and Los Mochis, 3 percent of the films revealed shadows indicating possible tuberculosis. And in another 17,220 radiological examinations made in Querétaro and San Juan del Río, 2.3 percent showed abnormal shadows. The survey is continuing in the Querétaro locale. And it is planned to make this a demonstration area for the special training of personnel to be used in the fight against tuberculosis, not only in Mexico, but throughout Central America and the Caribbean islands as well. In this effort the Mexican Public Health Department and the Pan American Health Organization are cooperating. At the same time, Mexico's Public Health Department, as earlier mentioned, has been greatly increasing its hospital and public health center facilities throughout the nation, including specialized facilities for the care of tuberculosis patients, both bed cases and ambulatory cases. The Rural Migrants Problem The special national problem created by the enormous numbers of rural inhabitants who have migrated to the cities' "shanty towns" is only partially solved, but the federal government is taking determined steps to resolve it. "Although for generations dissatisfied rural Mexicans have been migrating to Mexico City in huge numbers in the hope of improving their economic and social status, most fail to achieve more than the move," Dr. J. Gabriel Heredia of the Public Health Department recently reported. 4 4

At the Second Mexican National Health Congress.

MEDICINE IN MEXICO 188 He based his conclusion on a study of 675 families, living in a slum area in the city's Colonia Zacahuizco district, who were contacted through the nutritional educational program of the Dr. Francisco J. Balmis Public Health Center Hospital.5 The 675 families comprised: migrants, 15 percent; first-generation descendants of migrants, 22 percent; second-generation descendants of migrants, 26 percent; third-generation descendants of migrants, 37 percent. Only 27 percent of the heads of families were legally married, the remainder living in "free unions." Ninety-seven percent of the migrants could neither read nor write. Illiteracy decreased to 89 percent in the first-generation descendants; to 61 percent in the second generation; to 59 percent in the third generation. "The overwhelming majority of the men among the migrants remained more or less permanently unemployed, except for occasional odd jobs," Dr. Heredia disclosed, "since invariably their only former means of earning a livelihood had been in agriculture, forestry, hunting or fishing, and there was no place for this in the city. They were largely supported by their women—83 percent of whom obtained jobs doing laundry, unpleasant work few other women sought. "However, the migrants' first-, second-, and third-generation male descendants were able to find jobs—in factories, stores, transportation and various services. And the majority of first-, second-, and third-generation female descendants of migrants abandoned the hard job of washerwoman for that of a servant in a private home or a restaurant waitress." (In another study of a group of 165 Mexico City families of the same low economic level, Dr. Agustín García Camberos, of the Public Health Department, reported that 80 percent of the families lived in one-room dwellings; only 24.2 percent possessed water closets; 74.5 percent had access to a community water closet; 1.2 percent had neither.) Dr. Heredia noted that the migrants' diet actually was poorer in the nation's capital than it had been in the country, and it was not until the second generation that the rural level was equaled, and not until the third that it was surpassed. Daily average caloric intake per capita was found to be: migrant 6 Named after the head of the ship-of-children expedition against smallpox, sent out from Spain in 1803.

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in rural environment, 1,850; migrant in city, 1,650; first-generation descendant of migrant, 1,470; second-generation descendant of migrant, 1,867; third-generation descendant of migrant, 1,948. "Clinical evidence of malnutrition was found in the children of all 675 families (averaging 5.2 persons per family)," Dr. Heredia pointed out. "However, the incidence of third-degree malnutrition was much higher in the children of recent migrants and of the first-generation descendants of migrants." He reported that a comparative study of the relation of children's weight and height to the family income—among a group of children all seventy-two months old—produced important findings: With the monthly family income less than 500 pesos ($40 U.S.), the children's weight averaged only 80 percent of normal and their height 85 percent of normal; with the monthly family income 501 to 1,000 pesos, the children's weight averaged 94 percent of normal and their height 90 percent of normal; with the monthly income 1,001 to 1,500 pesos, the children's weight and height both averaged 98 percent of normal; with the monthly family income 1,501 to 2,000 pesos, the children's weight averaged 99 percent of normal and their height 99.5 percent of normal; with a monthly income of 2,001 to 2,500 pesos, the children's weight rose spectacularly to an average of 112 percent of normal, and their height to 110 percent of normal. Governmental Nutrition Projects Although, all observers concede, the problem posed by the rural migrants and their fellow slum dwellers in the capital and other cities is one of Mexico's greatest, strenuous efforts are being made to solve it. In Mexico City the Public Health Department operates fifty-six health centers, located principally in the poorer districts, and in these, as in the large Mexico City General Hospital, thousands of the city's poorer residents are cared for free of charge each year. Outside the capital, the nationwide network of health centers, hospitals, and clinics provides comparable free care for the poor. In addition, of course, the Department operates a complex of specialized hospitals and clinics—mental hospitals, hospitals for tuberculosis patients, dermatological clinics, etc., which similarly provide free medical attention. The problem presented by the chronic malnutrition of the hun-

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dreds of thousands of migrants from the rural areas, and their fellow city slum dwellers, is of such magnitude that all efforts at aid inevitably have fallen short of a resolution of the problem. Nevertheless, much has been done. The Department of Public Health and Assistance, for instance, has set up a complex of maternal-infantile centers in the capital's poorer districts. In these it not only gives prenatal, obstetrical, and postobstetrical care to tens of thousands of mothers, free of charge, but, if needed, provides free supplemental food for mother and baby for many months following the birth. As earlier discussed, Mexico has a similar problem in the chronic malnutrition in its rural areas, and this problem is being tackled in various ways. In particularly depressed rural areas, for example, the Public Health and Assistance Department often provides employment for jobless persons (and for farmers during their slack periods) on special Public Health construction projects. It spends 150 million pesos annually on this special work. In addition, in these areas, it distributes 58 million pesos' worth of free supplementary food rations each year. In its efforts to improve the nation's nutrition—and also in its campaigns against those diseases that are principally products of malnutrition—the Department of Public Health and Assistance has been aided by the programs of several other federal government units. These include the following: Free Breakfasts for School Children The National Child Care Institute—Instituto Nacional de Protección a la Infancia, or INPI—was established January 31, 1961, to increase the breakfasts being distributed free to primary school children from eighty thousand daily to one million. By 1964, however, the total number of school breakfasts being distributed daily throughout the nation had soared to three million—representing 30 percent of Mexico's entire school registration. The school-breakfast program has been headed by Mexico's recent First Ladies. Previously a special project of the wife of President Adolfo Ruíz Cortines, the program was reconstituted and vastly extended under the direction of Profesora Eva Sámano de López Mateos, the wife of President Adolfo López Mateos, and is continuing

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under the Institute's new board chairman, Señora Guadalupe Borja de Díaz Ordaz, the wife of President Gustavo Díaz Ordaz. It is a massive project. The breakfasts are distributed to the school children chiefly by sixty-five thousand nonpaid women volunteers, imbued with a crusading spirit by the First Lady's example. The three million daily breakfasts are prepared in 252 special breakfast-producing plants and 138 nutritional orientation centers. They are distributed in 24,468 areas throughout the nation—mostly rural and many of these inhabited by primitive indigenes. Thus rural youngsters—and also, of course, all school children from depressed city neighborhoods—are provided with at least five good meals weekly. Prepared hygienically and largely by automatic process, the breakfasts include milk, banana, bread, meat, egg, peanut butter or liver paste, and gelatine or custard, and supply the children's daily nutritional requirements as follows: of vitamin A, 100 percent; iron, 65 percent; thiamin, 65 percent; calories, 25 percent; proteins, 50 percent; calcium, 35 percent; riboflavin, 40 percent; niacin, 20 percent; vitamin C, 60 percent. Improving Agricultural Products The Mexican Department of Agriculture has launched a program based on the very plausible hypothesis that the rural protein malnutrition might be remedied most feasibly through popularization of strains of corn and beans genetically selected for higher protein yield. This, it is pointed out, will make possible an improvement of the rural diet without any change at all in the population's dietary habits. The Agriculture Department already has determined that, of the nine common varieties of corn grown in Mexico, one, for example (Jalisco 236), contains three times as much tryptophane as the variety most deficient in that respect (Veracruz). Similarly, analyses of the seventeen common bean strains disclosed that one (Negro 151) contains nearly twice the tryptophane of the most deficient (CH 56-1-2). High-protein supplements such as chickpea oleoprotein also are being recommended. The Burgeoning National

Economy

Meanwhile, the sensational and continuing economic advances

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that, since 1950, have each year increased Mexico's Gross National Product, are creating more and more jobs, at better and better wages —which, it is hoped, in the not too distant future will finally and permanently eradicate malnutrition from the nation. It should be emphasized that, as this is written, Mexico is the only country in the world with an extremely high birth rate where all national economic progress is not automatically canceled by the annual population increase. Other countries with a high birth rate, no matter how impressive their annual increase in Gross National Product, have found it impossible to "hold their ground" because of their galloping birth rate. Mexico, despite its huge annual population increase of approximately 3.6 percent, has maintained an astonishing increase in Gross National Product of approximately 6 percent each year. In fact, in 1964 this annual increase in Gross National Product climbed to 7 percent. Furthermore, Mexico's industrial production has been growing at the sensational rate of 10 percent per year! All this constitutes real and phenomenal progress. And it makes eradication of malnutrition in the nation, within the next few years, a very achievable goal. Principal Sources Public Health Department records and statistics. Interviews with the directors of Public Health Department campaigns, the director of the National Institute of Nutrition, and other doctors. Individual doctors' papers. President López Mateos' 1964 State of the Union speech. News stories and personal observation.

CHAPTER FOURTEEN

Improving Poor Environments

A third category of "diseases of the poor" in Mexico involves those diseases that are the product of inadequate housing and/or bad environment. This category could be extended to cover a very wide range of maladies. Endemic and epidemic diseases obviously often are involved in the poor environment. And, in parts of the tierra caliente, or "hot country," a number of tropical diseases—some still little known—pose especially difficult problems. (These will be discussed in the next chapter.) A poor environment, particularly in the cities, may be responsible also for psychological disorders, and is inseparable from sociological problems of the first magnitude. In the unfavorable environment everywhere—whether teeming big-city slum, backward rural area, or primitive jungle village—the widespread lack of sanitation is a constant major factor in the spread of disease. (The problem of improving sanitation was discussed in Chapter Twelve.) Another major disease-transmitting factor in the poor environment is the usual abundant presence of vectors and intermediate hosts— mosquitoes, flies, gnats, fleas, bedbugs, rodents, and other vermin. Still another, less obvious but important factor in the spread of disease is domestic animals—particularly dogs, and most particularly the huge numbers of roving, scavenging mongrels that constitute such a problem in all Latin American countries. These may infect humans with more than a score of diseases, including cysticercosis, toxoplasmosis, and rabies.

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And finally there are the poisonous creatures which infest some localities and invade unprotected dwellings. The multiple unhealthful aspects of most unfavorable environments—again, in urban slums, tiny rural settlements, and remote Indian tribal villages—frequently present staggering problems for Mexico's Public Health authorities. The solution, in every locale, generally requires a combination of actions: education of the affected people, creation of a potable water supply, construction of latrines, suitable new housing, better medical facilities, launching of campaigns to control and eradicate endemic diseases—plus, of course, more and more trained personnel and the funds to finance all this. The Mexican government has been doing a heroic job in the above fields. Naturally, in view of the enormity of the task throughout the nation, much remains to be done. But the achievements in recent years have been formidable. Here, we will consider the special difficulties posed by two of the less obvious "environmental" problems and the campaigns the Mexican government currently is conducting against them. One is more of a problem in the congested slum districts of the big cities, and the other is important only in small towns and rural areas in certain parts of the country. These two problems are, respectively, rabies and what Mexicans call escorpionismo. The Campaign Against Rabies The relatively high incidence of human fatalities from rabies in Mexico (the high point was 78 deaths in the Republic in 1960, constituting a national fatality rate of .1702 per 100,000) is a product of the conditions under which many Mexicans of the lowest economic levels exist. Worst trouble spots have been (a) the nation's overcrowded capital, with its population of more than six million, and (b) the cities along the Mexico-United States international boundary, in Mexico's so-called Northern Frontier Region. Since 1950, Mexico's "Okies," impoverished country people and their large families, have been migrating in increasingly large numbers from their depressed home areas to all the aforementioned cities, in the hope of bettering their miserable living conditions. As a result, during the decade 1950-1960 the populations of the six Mexican bor-

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der cities of Tijuana, Ciudad Juárez, Mexicali, Tecate, Reynosa, and Matamoros more than doubled. And that of Mexico City increased at nearly as great a rate. These migrants are principally blamed for the exacerbation during recent years of Mexico's chronic rabies problem. As Dr. Amézquita, the Secretary of Public Health and Assistance, explained in 1964: "There are an estimated 500,000 dogs in Mexico City alone1—an average of virtually one to every 10 persons. One-fifth of these are the so-called perros de los pobres, or 'dogs of the poor'—the half-starved, emaciated curs that live in the streets and alleys, eating garbage, offal and what rats they can catch. Including rabid rats. These curs are the prime transmitters of rabies to humans. "Although dog-catchers and police long have been allied in attempts to keep down their numbers, the homeless mongrels' natural fecundity has made it a tough battle. And in recent years, with an estimated 10,000 rural families migrating to the capital each month in the hope of bettering their economic condition, the problem has become more difficult. For most migrants bring along the family dog —swelling the capital's already huge horde of potentially rabietic, four-footed scavengers. Similar conditions exist in the northern frontier cities." In a virulent outbreak of rabies in 1961 in the Tijuana area, the disease was contracted not only by dogs but by wild animals and thus carried over the international boundary into California, where several hunters were bitten by rabid foxes. This inspired plans for a joint Mexico-U.S. anti-rabies campaign in the frontier regions. The campaign was mapped when officials of the Mexican Public Health Service met, in November of that year, at the Third International Congress for the Control of Rabies, in Mexico City. In the resultant 1962 Mexico-U.S. anti-rabies campaign, Mexican Public Health Department rabies-control teams, using both U.S.- and Mexican-made live vaccine, inoculated 70,000 canine pets and destroyed 80,000 ownerless dogs in Mexico's northern border cities—an estimated 80 percent of those states' total canine population. The teams also posted many warning placards and distributed educational literature on rabies control. In Mexico City in 1962 Mexico's Public Health Department 1

Subsequent estimates have placed the capital's canine population at as high as one million. This would be one dog to every six persons.

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launched an aggressive anti-rabies campaign which it has maintained since then: A new 1,300,000-peso Anti-Rabies Center, the Centro Antirábico, was built on the outskirts of the city. Under direction of the Center's chief, Dr. Alfredo Cortés, a fleet of ten small trucks, each manned by a driver and a young veterinarian, systematically tours the capital, offering householders its services in inoculating canine pets for a nominal fee or, in some cases, free of charge. (Inasmuch as Mexico does not require owners to buy dog licenses, the inoculation certificate becomes, in effect, a substitute for a license; the owner attaches a tag to the dog's collar, confirming that the animal has been inoculated.) Another fleet of small trucks, manned by swift-footed, athletic young men with dog-catching equipment, scours the city, picking up strays. These animals are held and observed for symptoms of rabies for ten days at the Anti-Rabies Center; then, if not called for by owners, they are sent to the medical schools to be utilized as experimental animals, or are destroyed. The Public Health Department also launched an educational campaign, warning that anyone bitten by a dog should immediately inform the Anti-Rabies Center and then himself go to one of the capital's fifty-six Public Health Department clinics for a series of rabies shots, free of charge. "Since 1962, we have inoculated more than 300,000 pets in Mexico City," Dr. Cortés recently disclosed. "In 1962, we picked up and destroyed 23,700 stray dogs; in 1963, 21,600; and we collected them at about the same rate in 1964. "During 1962, an average of 84 dogs each month turned out to be rabid; in 1963, an average of 70 per month. However, in 1964, the number dropped to an average of 40 a month." As the result of the Public Health Department's anti-rabies campaigns, the human mortality rate—both in the capital and in the nation as a whole—has been reduced to half of what it was in 1960. During the six-year administration of President Adolfo López Mateos, the national human mortality from rabies was reduced from 0.2 per 100,000 inhabitants in 1958 to 0.1 per 100,000 in 1964—a decrease of 50 percent. However, complete eradication of the disease in Mexico, as in other Latin American countries, is improbable in the near future. This is because of the large numbers of uninoculated dogs

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still remaining in the cities—and because of the people's failure to recognize the seriousness of the situation. The latter point is illustrated by the situation in Mexico City, where the human mortality rate, although greatly reduced, nevertheless still averages about one death per month. "Between 10,000 and 11,000 persons, mostly children, were bitten by dogs in Mexico City in 1964," Dr. Cortés explained. "Nevertheless, despite our continuing educational campaign urging bitten persons to immediately obtain free treatment at one of the Public Health Department clinics, no more than 8,000 individuals presented themselves for the life-protecting injections." The Campaign Against

Escorpionismo

Scorpions constitute a serious problem in certain parts of the Republic. It should be understood that in Mexico—as in the southwestern United States, where scorpions also are prevalent—the sting of most species is not fatal to humans. The more lethal species are encountered only in a small part of the country. And the sting of virtually all species rarely is fatal to an adult. Nevertheless, over one thousand children are killed annually in Mexico by scorpions. It is encouraging to note, however, that in the last twenty years the national mortality rate from this cause has been reduced by 40 percent. And a campaign currently being pushed by Public Health officials is expected to drastically slash the present mortality rate. These facts were disclosed in two recent reports by Drs. M. A. Bravo-Becherelle and Luis Mazzotti, of the National Institute of Tropical Diseases. "Escorpionismo, as it is called here, long has been a serious problem in some parts of the nation," Dr. Mazzotti pointed out. "During the 1940-1950 decade, the national mortality from scorpion stings averaged 1,775 deaths annually. And, though fatalities decreased during 1957-1958, the most recent years for which national statistics are available, scorpions then killed an annual average of 1,301 Mexicans—a national mortality rate of 4 per 100,000 population. Although this rate has been further reduced, it's still estimated at more than 1,000 deaths annually."

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Since 1940, deaths caused by scorpions have been reported from twenty-one of Mexico's twenty-nine states, but the fatality rate consistently has been highest in the three Pacific-coast states of Colima, Nayarit, and Guerrero and the inland state of Morelos. These have had an average annual mortality rate of, respectively: 83.7, 41.6, 41.5, and 37.3 per 100,000 inhabitants. Drs. Mazzotti and Bravo-Becherelle pointed out that most fatalities are concentrated in certain rural localities. They said a "very serious" problem exists in only one percent, and a "serious" problem in just 2.2 percent, of the total area of the Republic—an area inhabited by 1,050,000 people. Small towns and villages with abnormally high mortality rates from escorpionismo include Cabo Corrientes, Tomatlán, La Huerta, Cihuatlán, and Cuautitlán, all in the state of Jalisco, where the average annual mortality rate per 100,000 population since 1940 has been, respectively, 156.3,162.3,128.5,134.3, and 124.1; Manzanillo and Tecomán, in the state of Colima, with rates of 111.2 and 162.2; and Coahuayana, in the state of Michoacán, with a rate of 217.7. In some of these towns, during the rainy months, escorpionismo is the largest single cause of death. "Mortality from scorpion stings," Dr. Mazzotti emphasized, "is confined almost exclusively to children. In fact, 95.7 percent of the deaths have been of children under ten years old; 74.9 percent, children under three years old; 31.0 percent, infants under one year old." It should be remembered, though, as earlier noted, the national mortality rate from scorpion stings has been reduced during the last two decades by 40 percent or more. The Mexican National Institute of Hygiene in recent years has been distributing approximately fifteen thousand doses of anti-scorpion serum annually. And this is considered to have been a factor in the decrease in the mortality rate since 1957. Treatment of stings obviously is not the final solution of escorpionismo. The value of anti-scorpion serum, even when immediately available, often is questionable. Consider the observations of Dr. Efrén C. del Pozo, also of the staff of Mexico's National Institute of Tropical Diseases. In a recent report to the Department of Public Health and Assistance, Dr. del Pozo revealed that—despite twenty years of experi-

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mental studies of scorpion venom—he has failed to discover a completely satisfactory anti-scorpion serum or therapy. "Devising a single standard serum or therapy which can be effectively used in every case is made extremely difficult," he said, "by the low antigenic property of scorpion venom and the multiplicity of scorpion species in Mexico." He stressed that the color and size of the scorpions—ranging from pale yellow to jet black, and from less than an inch to several inches —are no clue to the potency of their venom. Dr. del Pozo pointed out that whereas the sting of many species, including some large ones, merely makes its human victim ill or produces the minor discomfort of a bee sting—as with the species most commonly encountered in the state of Guanajuato, on the mile-high central plateau—the venom of certain other species is almost invariably quickly lethal to small children. "There is no substance of animal, vegetable or mineral origin whose toxicity can compare with the poison of a small yellow scorpion of Nayarit, the Centruroides noxius" Dr. del Pozo asserted. "It is the most active known poison." He reported that the popularly recommended therapies for scorpion stings merely diminish the symptoms of poisoning and fail otherwise to benefit the victim. "Calcium injections, for instance," he explained, "reduce the cardiac fibrillations and muscular spasms. And atropine and ergotamine modify some peripheric phenomena under control of the autonomous nervous system, such as the hypersecretion of saliva. But none alter the magnitude of the lethal dosage of the poison. "And the cause of death from scorpion venom intoxication," Dr. del Pozo said, "as we have experimentally demonstrated with animals, is respiratory palsy of bulbar origin." Thus, the problem of escorpionismo is better resolved by prevention than by cure. And this, fortunately, has now become possible. Dr. Luis Mazzotti, after considerable experimentation, has devised an inexpensive and simple but effective technique for scorpion-proof home construction. This, it is expected, eventually will save one thousand lives yearly in Mexico and may prove of comparable value in other scorpion-plagued areas of the world. "During the rainy season, in certain localities, scorpions constitute a grave hazard in unprotected homes," Dr. Mazzotti explained. "In

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the dry months, these arachnids, which prey nocturnally on insects, spend the daytime hidden under rocks, logs, etc. But in the rainy season, they seek higher sleeping places—trees and the tile or thatched roofs and beamed ceilings of human habitations. And often when a scorpion descends from its hideout at night to prowl its host's home for insects, it encounters a child, asleep on a mat on the floor. If the child suddenly moves and thus alarms the scorpion, the result may be tragic." Concentrating on the observation that most human fatalities from escorpionismo occur when the scorpions invade homes, Dr. Mazzotti finally succeeded in discovering a method of keeping scorpions out. This is based on the experimentally determined fact that, though scorpions can climb plaster, cement, and wooden walls, they, unlike flies and mosquitoes, cannot ascend a perfectly smooth surface. The simple, inexpensive scorpion-proofing the doctor devised consists of adding a narrow strip of sheet aluminum, or glazed tile, or merely of high-gloss enamel paint to encircle the house and all supporting posts and pillars at ground level or higher. This strip must run below all doors, windows, and other openings. It is important also that no tree branches overhang the roof and no shrubbery or vines touch the walls above the slippery protective band. "The National Institute of Tropical Diseases has constructed twenty model homes with scorpion-proof stripping," Dr. Mazzotti disclosed. "These are in two areas with high escorpionismo mortality rates—the Tepalcatepec Valley in Michoacán and Manzanillo in Colima." The model homes have proved so successful that the Institute is planning construction of one hundred more in other critical areas. The Border-Area Problem Across the international bridges that span the sluggish waters of the Rio Grande a river of humanity flows in both directions: Mexican border-town dwellers trudging across to shop in U.S. dimestores and clothing and appliance stores, or to visit their Stateside relatives for a few hours; tourists arriving by the busload; wealthy Mexican families up from Monterrey or Mexico City in chauffeur-driven limousines, bound for U.S. vacation resorts or shopping sprees in Dallas and Los Angeles; U.S. servicemen taxiing down for a tequila-drenched night on a Mexican border town; U.S. tourists returning from the length and breadth of Mexico, their cars bulging with straw hampers of

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colorful Mexican clothing, pottery, glassware, and other craftwork; nationals of other countries, on business or pleasure bent— These constant two-way border crossings of masses of Mexicans, Americans, and others generate special conditions and problems in the border towns—aside from the problem of immigration, customs, police, and public health officers' inspection and control of the international traffic. The situation along the Mexican side of the border is considerably different from the situation in the rest of Mexico, for a border town— on either side of the border—is never truly "national" in character: Much of its population is transient, and its permanent residents include citizens of both nations and their descendants. It may have dual customs and even a hybrid dual language evolved from longtime bilingualism. Usually more tawdry than colorful, some such towns are notorious for their sleazy construction, "tourist-trap" souvenir shops, and "divorce mills, gin mills and sin mills"—all geared to quick-turnover trade. The general unstable honky-tonk atmosphere of such a town is not the ideal environment for family life. Nor is this the whole of the poor-environment problem. The international-boundary area and its cities also present special public health and sanitation problems. The tremendous economic development since 1950 in the 1,600mile-long Mexico-United States international-boundary area has resulted in serious deterioration of the area's sanitary conditions, which have failed to keep pace with the mushrooming population growth— on both sides of the border. This was disclosed and discussed at the First International Conference Between Mexico and the United States on Environmental Sanitation, held in Mexico City in 1963. Attending were top officials of the U.S. Public Health Service, the Mexican Public Health Department, and the Pan American Sanitary Bureau. According to Mexican and U.S. census figures, population of the international-border area increased, during the 1950-1960 decade, at a rate approximately 2.5 times as great as the national population increase for both the U.S. and Mexico. (On the Mexican side, the border-area population increased 83 percent, compared to a national increase of 34 percent; on the U.S. side, the border-area population increased 69 percent, compared to a national increase of 27 percent,) The border area, comprising 87,120 square miles, in 1963 had an

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estimated population of 2,756,057—1,144,057 on the Mexican side and 1,612,000 on the U.S. side. Six Mexican border cities more than doubled their population during the decade (Tijuana, Ciudad Juárez, Mexicali, Tecate, Reynosa, and Matamoros). The urgency of the international sanitation problem is heightened, the International Conference emphasized, by the fact that the larger part of the exploding border-area population is concentrated in fourteen Mexican and fourteen contiguous U.S. towns and cities along the border—many of which form single and practically indivisible, border-straddling metropolitan units. Major problems include those of water supplies, sewage and garbage disposal, atmospheric pollution, control of disease-transmitting rodents and other vectors, urban renewal, and construction of assistencial sanitation centers. It was disclosed at the conference that nearly all border-area cities were being forced by their exploding populations to modernize and enlarge inadequate water-supply and sewage-disposal systems, install or enlarge chlorination plants, stabilization lakes for sewage treatment, etc. Nevertheless, a number of towns on the Mexican side, including Matamoros and Piedras Negras, still were dumping raw sewage into the Rio Grande; and Nuevo Laredo's sewage was being used, untreated, for irrigation. (Agua Prieta and its U.S. counterpart, Douglas, Arizona, and the Mexican and U.S. towns of Nogales cooperatively treat their sewage in international plants.) Plans were outlined at the conference for more extensive international cooperation, on national, state, and local levels, to attack the continuing border-area public health problems. A number of these since have been implemented. Public Housing During the six-year administration of President Adolfo López Mateos, the Mexican government made some giant strides toward the elimination of festering slums and the alleviation of housing shortages in the overpopulated national capital. It completed a number of huge slum-clearance and low-cost-housing construction projects and had more on the drawing boards. When finished, these will provide modern housing for approximately 100,000 families. Various departments of the federal government independently con-

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structed large public housing developments for low-income families among the general public. In addition to such housing projects of a completely public nature, much low-cost and moderate-cost housing was erected by or with the help of other governmental entities for special groups, such as government workers and the membership of certain labor unions. In this latter category, for example, is the very impressive housing erected by Mexico's National Social Security Institute, which may be occupied by the families of any workers covered by Social Security. The Social Security Administration already has completed a number of such handsome, low-cost housing developments for its members, all set in parklike surroundings. (These are described in the later section on Social Security.) There is also the Graphic Arts John F. Kennedy Housing Unit in Mexico City, built chiefly for members of this labor union, with the help of a loan from the AFL-CIO in the U.S., guaranteed by the Alliance for Progress. For the general public no less than 48,121 new low-cost habitations were completed by the government during the López Mateos administration. Of the new public housing developments, the outstanding examples—both in magnitude of construction and in the extent of their rectification of grave sociological problems—are the San Juan de Aragón, the Nonoalco-Tlaltelolco, the Independencia, the Viveros de la Loma, and the Santa Cruz Meyehualco housing centers. Nonoalco-Tlaltelolco, located in a central zone of the capital, covers 1,250,000 square meters and has 102 apartment buildings for sixty-nine thousand persons. It also includes nine primary schools, two secondary schools, a technical preparatory school, thirteen nurseries, three clinics, three social clubs, six parking lots, a cultural center, a museum—and even a carillon tower for concerts! Furthermore, 60 percent of the total area is dedicated to gardens, parks, and plazas. And San Juan de Aragón has ten thousand individual homes with two, three, or four bedrooms, plus ten primary schools, four large covered markets, a children's hospital, three sports centers, and an extensive forest, complete with big splashing fountains, an artificial lake, and a new modern zoo housing the city's zoo animals, moved to the housing center from historic Chapultepec Park. The ten thousand homes of San Juan de Aragón, built by the De-

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partment of the Federal District, and the 11,916 apartments of Nonoalco-Tlaltelolco, built by the National Mortgage and Public Works Bank, a government institution, are being sold on low-payment terms in line with the wages of the purchasers and complete with life-insurance policies. Both of these projects have simultaneously alleviated the capital's housing shortage and regenerated slum areas. All of these handsomely designed public housing developments would be a credit to any metropolis in any country in the world. Principal Sources Public Health Department records and statistics. Interviews with the directors of Public Health Department campaigns, the director of the National Institute of Nutrition, various medical officials at the National Institute of Tropical Diseases, and other doctors. Individual doctors' papers. President López Mateos' 1964 State of the Union speech. News stories and personal observations.

CHAPTER FIFTEEN

Combating Tropical Diseases

The Mexican government in the last few years has been very active in conducting campaigns to control and eradicate epidemic and endemic diseases. The diseases under its multipronged attack range from those, such as poliomyelitis and tuberculosis, that constitute universal problems and to whose control the resources of a number of countries have been applied, to others, such as the little-known leishmaniasis, that pose a unique, localized problem. Unlike the United States but in common with other Latin American countries, Mexico has—in addition to the problem of controlling the general epidemic and endemic diseases—a sizable problem in combating those diseases occurring chiefly or exclusively in the tropics. The Importance of Tropical Diseases The subject of tropical diseases is "exotic" and fascinating. Much of it has not yet been extensively explored, and it is a matter with which most physicians in the United States and other countries with temperate climates have had little or no experience. Tropical diseases, however, are no longer merely abstractly interesting outside the world's tropical areas. They are becoming of increasing importance everywhere. (In evidence of this, New York City, which before World War II had nothing but a single advisory epidemiologist, now has four tropical-disease centers studying parasitology.) The reasons are as follows: First of all, there has been a tremendous increase in the quantity,

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and speed, of global travel. Today jet airliners can transport inhabitants of once-isolated tropical countries to any world metropolis in mere hours—making quarantines increasingly ineffective. Second, due to present-day political, economic, and military factors, larger and larger numbers of people from temperate-climate countries are living for extended periods in the world's more remote and backward tropical areas. Great numbers of U.S. citizens—members of the Armed Forces, diplomats, Peace Corps workers, members of various U.S. government aid agencies and missions, employes of U.S. firms, archeologists, engineers, scientists, missionaries, and, of course, tourists—are spending months or years in distant tropical places, many of which seldom previously were visited by any foreigner. These Americans are exposed to tropical diseases while abroad and sometimes bring them home. Third, the continuing "population explosion" obviously sooner or later will necessitate the settlement and development of the globe's still unpopulated tropical areas—for which the conquest of tropical diseases will be a prerequisite. For all these reasons, and because the subject to date has received far less attention in print than its interest and importance warrant, tropical diseases will be given detailed consideration here. (And accordingly, in this one chapter, some technical information on diseases is included that, although probably of relatively little significance to laymen, should especially interest the medical profession. ) Tropical Diseases in Mexico In Mexico tropical diseases are a problem most particularly in certain rural and jungle areas of the tierra caliente, or "hot country," where they are linked generally with sanitation problems, the centuries-long isolation of affected regions, and the inbreeding and ignorance of the populations. Thus a torrid climate is far from the only factor involved in the tropical-diseases problem. Almost all of the Mexican government's campaigns against epidemic and endemic diseases are mapped, supervised, and conducted by the Public Health Department. In the case of tropical diseases, however, the Public Health Department works closely with the National Institute of Tropical Diseases, an autonomous governmental unit with its headquarters in Mexico City, which has become worldfamous for its research and discoveries in the field of tropical diseases.

In the Public Health Department's program to bring medical care to inhabitants of isolated villages and jungle and mountain areas, a member of a mobile medical brigade examines a sick child on the sidewalk of a village plaza.

Secretaría de Salubridad y Asistencia

A mobile medical brigade doctor dresses the machete wound of a campesino.

Secretaría de Salubridad y Asistencia

In a remote and nearly inaccessible area, a mobile medical brigade doctor examines a victim of pinto.

Secretaría de Salubridad y Asistencia

Secretaría de Salubridad y Asistencia

Among the many terrains in which the medical brigades operate is this typical thick jungle area. Bottom: Brigade workers in Veracruz spray beside a stream and cocoanut palms in the Campaign Against Malaria.

Secretaría de Salubridad y Asistencia

Secretaría de Salubridad y Asistencia

Messenger of Health Number One, a floating clinic that provides the only health service available to dwellers along many jungle rivers. Bottom: In service on a jungle river in Tabasco.

Secretaría de Salubridad yy Asi; Asistencia

Secretaría de Salubridad y Asistencia

Various rural activities of the Public Health Department include nurses in Oaxaca (top) making diagnostic skin tests in the National Campaign Against Brucellosis; and a doctor treating a rural patient in his adobe home.

Secretaría de Salubridad y Asistencia

Secretaría de Salubridad y Asistencia

A play (top), demonstrating basic sanitation and hygiene, performed for indigenous groups; and rural midwives being instructed in a special nurses' training class.

Secretaría de Salubridad y Asistencia

Secretaría de Salubridad y Asistencia

Searching for pinto victims among the most primitive Indians of Mexico (pictured, left, is Dr. López García); and public washstands established by the Health Department (pictured here are women in Dios Padre, Mezquital Valley, Hidalgo).

Secretaría de Salubridad y Asistencia

Secretaría de Salubridad y Asistencia

A hut (top) that has been scorpion-proofed in the fight against escorpionismo; and members of a mobile unit teaching inhabitants of a rural area proper hygiene during the National Campaign To Eradicate Malaria.

Secretaría de Salubridad y Asistencia

Secretaría de Salubridad y Asistencia

Medicine and public health in the city. Left: Preparing a patient for treatment with a betatron are Dr. Rafael Martínez González (right), and Dr. Guillermo Cassab. Right: Children at dinner, being served free meals provided by the Health Department at a shelter for children and poor families.

Instituto Mexicano del Seguro Social

Medical Tribune photograph by Gordon Schendel

Top: Mural by Nishizawa representing the battle against respiratory diseases among workers, in the foyer of the Hospital of Pneumology and Thoracic Surgery. Bottom: Detail of mural by David Alfaro Siqueiros depicting treatment of a cancer patient with cobalt, in the lobby of the Oncological Hospital. Both hospitals are in the National Medical Center.

Medical Tribune photograph by Gordon Schendel

Instituto Mexicano del Seguro Social

The National Medical Center, Mexico City. Top: Auditoriums of the General Hospital. Exterior bas-reliefs by Chávez Morado, illustrating the history of medicine. Bottom: Scale model of the complex.

Instituto Mexicano del Seguro Social

Instituto Mexicano del Seguro Social

Operations of the Social Security Institute. Top: Hall of Congresses, National Medical Center. Bottom: La Independencia, housing unit complete with its own schools, market, theaters, clinic, and family welfare center.

Instituto Mexicano del Seguro Social

Secretaría de Salubridad y Asistencia

Health and welfare units serving all parts of Mexico. Top: Sanitary Unit in San Blas, Nayarit, under construction by the Health Department. Bottom: Social Security Clinic, La Paz, Baja California.

Instituto Mexicano del Seguro Social

Secretaría de Salubridad y Asistencia

Top: Rural Health Center in Ixtacuixtla, Tlaxcala, a standard prefabricated structure built by the Health Department. Bottom: Urban Health Center in La Piedad, Michoacán. Expressive of the contrasts of Mexico, its modern architecture is strikingly juxtaposed to an old Spanish Colonial Church.

Secretaría de Salubridad y Asistencia

Two faces of medical activities. Top: The doctors' bullfight, a benefit for the Red Cross, starring Dr. Francisco "Pancho" Rivera Α., otorhinolaryngologist. Bottom: A medical congress, presided over by Dr. José Alvarez Amézquita (right) and Dr. Miguel E. Bustamante, respectively Secretary and Undersecretary of Public Health and Assistance from 1958 to 1964, and collaborators with Gordon Schendel, the author, in preparing this book.

207 The campaigns against several tropical diseases (including the Campaign Against Escorpionismo described earlier) are directed by the Institute and conducted by its personnel. COMBATING TROPICAL DISEASES

Tropical Dermatoses—A Preface Hot and humid climates particularly promote the pullulation of all kinds of organisms, pathogenic and nonpathogenic, and the circumstances under which the inhabitant of the tropics usually lives favor his being attacked by these organisms, both microscopic and macroscopic. This general thesis was stressed by Dr. Antonio González Ochoa, of the National Institute of Tropical Diseases.1 "The frequency with which dermatoses2 are caused by these animate agents, plus various physical agents, deficiency conditions, and so forth," Dr. Ochoa emphasized, "greatly supports the tropical regions' general reputation for insalubrity." He disclosed that, among all chronic tropical dermatoses caused by bacteria, three have special significance for Mexico on a sociosanitation level: "Two of these are caused by a mycobacterium—leprosy and tuberculosis. The third, pinto, is caused by a treponema." His summary of aspects of the tropical dermatoses situation in Mexico follows. (Some of the diseases involved subsequently will be discussed in more detail.) Leprosy Dr. Ochoa estimated there are fifty thousand cases of leprosy in Mexico. And that, of these, 45 to 55 percent are of the lepromatose type, 30 percent of the tuberculoid type, and the remainder of undetermined and adimorphous types. "Diffuse lepromatosis is particularly observed in the state of Sinaloa," he noted. "It is a generalized process manifested by a layer of diffuse cutaneous infiltration and acute episodes of intense fever— accompanied by congestive and painful spots in which necrosing phenomena are produced and which originates blackish eschars3 that leave atrophic scars. The disease appears at all social levels, but predominantly in the peasant population." 1 2 3

At the First Mexican Congress of Naval Medicine, in 1963. Skin diseases. Hard crusts over a raw surface.

208 Cutaneous

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Tuberculosis

Dr. Ochoa reported that cutaneous tuberculosis, 4 unlike cutaneous syphilis, has not been reduced in incidence despite the "magnificent tuberculostatic medicines presently available." He explained that while he and his colleagues at the Institute of Tropical Diseases rarely see cases of cutaneous syphilis, they encounter new cases of cutaneous tuberculosis every day, most of them originating in the rural tropical areas. "All clinical forms can be observed frequently," he declared, "the highest incidence being for ganglionic colliquative tuberculosis and for Bazin's induration erythema. Next most frequently seen are tuberculosis verrucosa cutis and tuberculosis ulcerosa. "Many cases of primary cutaneous tuberculous infection are extraordinarily similar to lymphangitic sporotrichosis.5 However, it is possible to establish the clinical difference by regional adenopathy 6 in tuberculous infection and the deficiency in sporotrichosis. The problem this disease presents is that of diagnosis, since cutaneous lesions are very poor in bacilli. Therefore, cutaneous lesions are of little significance in the epidemiology of tuberculosis." Pinto Pinto, 7 Dr. Ochoa pointed out, unlike leprosy, is not a disease of world-wide importance. Nevertheless, in Mexico it extends to various humid and hot zones, principally those of the Balsas River basin. He estimated that there are 500,000 sufferers from pinto in Mexico— including those presenting initial lesions, disseminated early lesions, and achromic residual lesions. "However," he said, "evidence that pinto is transmitted by direct contact, having as highly significant factors miserable living conditions, lack of personal hygiene, and promiscuous grouping of healthy and infected persons—plus the fact that this treponematosis 8 easily can be cured by penicillin—enables one to hope it soon can be eradicated from Mexico through a determined national campaign of the type recently launched." 4

Tuberculosis of the skin. A chronic fungus infection. 6 Swelling or disease of a lymph gland. 7 Or mal de pinto, the disease that produces patchy discoloration of the skin and permanently depigmented areas. 8 A disease caused by a spirochete. 5

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Leishmaniasis Dr. Ochoa named leishmaniasis as the most important tropical disease of protozoan origin in Mexico. It is commonly known in this country as "chicle-plantation workers' ulcers" and is contracted each year by thirty-five out of every one hundred persons working on the chicle plantations. "This large number of cases indicates the importance the disease possesses in sanitation campaigns," the doctor stressed. "Its social importance lies in the mutilations produced in the ear of the majority of persons contracting the disease, or in ulcerations in other cutaneous regions. However, it has not been observed in the oral mucosa. And the clinical forms of anergic leishmaniasis described by Convit, Reyes, and Kerdek in Venezuela are only rarely observed in Mexico in the same form of disseminated warty and nodular lesions, similar to lepromatosis. "The vector of leishmaniasis is a sandfly of the genus Phlebotomus." Cutaneous

Amebiasis

Cutaneous amebiasis,9 an exclusively tropical disease, also is found in Mexico, though not frequently, Dr. Ochoa said. He described it: "Lesions appear in the perineum, sacrum, and gluteus regions, in thighs and trunk; they adopt the form of profound fistulizing abscesses and produce ulcerations which are particularly painful; the suppurative mobile vegetative forms of Entamoeba histolytica can be easily identified, if the examination takes place immediately after the sample is collected. Emetine is the specific treatment in the vegetative stage. If the lesions communicate with the intestine and rectum, where the Entamoeba is found in the cystic stage, it is necessary to use vioform, arsenical derivatives, and chloroquine, together with antibiotics of wide spectrum." Mycoses Dr. Ochoa noted that diseases caused by fungi are numerous in Mexico's tropical regions, though many are not exclusively tropical in habitat. He explained that, among the superficial mycoses, the most frequently encountered is the mild dermatosis pitiriasis versicolor. There are coastal communities along the Gulf of Mexico, he dis9

Amebic infection of the skin.

MEDICINE IN MEXICO 210 closed, where nearly 50 percent of the population has at least a minimal manifestation. It presents a diagnostic problem, since its mycotic etiology is unknown in some of the affected regions. "However," Dr. Ochoa said, "the profound mycoses [as distinct from the superficial] constitute impressive diseases, due to their unpleasant aspect and their unavoidable stages leading to death, except for the few that can be cured if early diagnosed and treated. Fortunately, there is not a very high incidence and they are not very contagious. But their chronicity, the invalidism they cause and the psychic impact they produce on the patient and persons surrounding him are chiefly responsible for the bad reputation of the tropical areas." The three most important profound mycoses in Mexico, which are most frequently encountered in the tropical areas and always have cutaneous manifestations, are actinomycosis mycetoma by Nocardia brasiliensis, chromomycosis, and sporotrichosis. "The solution to the problem lies in the early diagnosis of mycetoma," the doctor emphasized. "The main obstacle to treatment of mycetoma in the extremities is in the early osseous invasion, and, when located in the thorax and abdomen, in the lung and viscera penetration. Considering the frequency with which mycetoma is located in the back, it is important that it be diagnosed before pulmonary penetration. Diaminodiphenosulfone (DDS) 8 , as well as dimetoxi-sulfanilimide-diazine and sulfa-metoxi-pyridaxine, is efficient in early cases, but when the osseous, pulmonary, or visceral invasion is already extensive, these products are ineffectual. "The same thing happens in chromomycosis," Dr. Ochoa said. "Recent and not very extensive cases can be cured with this same DDS8, calciferol, or Amphotericin B, but old and extensive cases resist even surgical removal of the sick tissue, the lesion reappearing on the graft. "Sporotrichosis has its specific and economical treatment in potassium iodide. The important thing is to suspect the disease, since verification of the diagnosis by a cutaneous test or even by culture cannot be simpler; in the lymphangitic type the clinical diagnosis is easily effected, but not so in the fixed and hematogenous types which are proteiform."

The Campaign Against Leprosy Under the National Program for the Control of Chronic Skin Diseases—inaugurated in 1960 by Secretary of Public Health and As-

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sistance Dr. José Alvarez Amézquita—an ingenious new type of campaign was launched to eventually eradicate leprosy from Mexico. It has already achieved dramatic results. The new program replaces the government's previous Service for the Treatment of Leprosy, which had been set up in 1930 but was abandoned after years of attempting drastic restrictions and isolation of cases in leprosaria. The aggressive new campaign to stamp out Hansen's disease (leprosy) instead utilizes regional Public Health clinics and ten mobile medical brigades, to try to locate all cases throughout the nation and treat them in their home environments. Furthermore—and here is the key to the success of the new campaign—the mobile medical units are sent into isolated rural areas ostensibly only to offer "free dermatological considerations." Through this strategy—which pointedly involves no mention of a search for lepers—many cases long in hiding have been discovered. Since the campaign was launched in 1960, more than half of the estimated fifty thousand cases in the country have been detected and started on effective therapy. This striking progress was disclosed10 by Dr. Fernando Latapí, head of the National Program for the Control of Chronic Diseases of the Skin. (Dr. Latapi also is director of the government's Pascua Dermatological Center in Mexico City, chief of the Public Health Department's Division on Leprosy and Skin Diseases, and professor of dermatology at Mexico's National University Medical School.) Dr. Latapi said that the tempo of the campaign continues to accelerate: "During the last two years, four times as many cases have been discovered and started on therapy as during the first two years. And, in four states, mobile units have discovered twice as many cases as have the 'static' clinics." The doctor pointed out that until recent years, in Mexico, as in the United States and most other countries, Hansen's disease was treated more as a "curse" than as an illness; that cases were hunted down and compulsorily placed in isolation. The predictable result was that, instead of seeking a cure, new cases and their families went to great lengths to conceal symptoms and to avoid doctors. 10

At a 1964 session of the North American Clinical Dermatologic Society, in Mexico City.

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"Mexican leprologists," Dr. Latapí stressed, "now have a different approach to leprosy—which, after all, is no worse than many other diseases and very slightly communicable. We are against leprosaria and all drastic regulations that cause concealment of the patient and, thus, spreading of the endemia—a 'prophylactic paradox.' For years, we have been managing leprosy on an ambulatory basis, in Mexico City, Guadalajara and Culiacán." Unjustified fears of Hansen's disease, he noted, still constitute the main obstacle to its eradication. Hence, as already mentioned, the present campaign to locate all hidden cases carefully avoids use of the words "leprosy" and "leper" and instead is publicized simply as a program to give advice and treatment for dermatological problems. Dr. Latapi explained that small mobile medical units, staffed with doctors and nurses, have been working on this project since 1960 in the nine states in Central and Western Mexico in which the disease is endemic. "Driving a jeep, riding a horse or mule or walking is the way our staffs get to the ranchos," he added. "The country people are conquered by friendliness and offers to solve all types of skin problems free of charge. The work of the mobile units in treating lepers then is integrated with that of regional Public Health centers. "We have used DDS in low dosage (25-50 mg. daily, over a prolonged period) for Hansen's disease for many years," he reported. "This results in less unfavorable reactions and less desertions. "Our new program to control and eradicate leprosy," Dr. Latapi emphasized, "is based on the known low transmissibility of the disease—which, we have found, is contracted only through intimate and protracted association in the familial medium—and embodies early discovery of cases, continuous treatment, no coercive methods, and an effort to combat public prejudice." The Campaign Against Pinto There is an old folk saying among the country people of Mexico: "Pinto is the only faithful friend of man; it accompanies him until his death." If this is credible, no less than 500,000 men, women, and children in Southern Mexico can count on at least one lifelong amigo—for that is the present estimated total of mal de pinto cases in the coun-

213 try, according to Dr. Blas Sosa-Camacho, of the Public Health Department. However, if a campaign being launched by Public Health Department dermatologists and epidemiologists is as effective as hoped, a large proportion of those 500,000 will be separated from their most faithful friend within the next few years. Dr. Sosa-Camacho disclosed11 that the campaign is aimed both at eradicating the disease and at rehabilitating victims by camouflaging their depigmented skin areas and reintegrating them into normal community life. "Pinto, a benign, nonvenereal treponematosis highly prevalent in tropical North America, seems to be transmitted by direct contact or insect bites," the doctor explained. He emphasized that, although it usually is contracted in childhood and never disappears spontaneously, it never is fatal. "It is a public health problem only because of the large number of its victims and the fact that they are feared and ostracized by the normally healthy part of the population." The initial lesion is a papule, and after weeks or months secondary squamoerythematous12 lesions appear. The final stage develops slowly over the years into a generalized dyschromia13 with symmetric hyperpigmented brown, blue, and black spots mixed with hypochromic and achromic14 lesions. There are no systemic symptoms or visceral lesions. "Serologic tests for syphilis are strongly positive," Dr. Sosa-Camacho pointed out, "and treatment is with penicillin, as in the case with syphilis." The standardized treatment with penicillin administered by Public Health mobile medical units causes active pigmented lesions to gradually fade away, but the more achromic areas are resistant to therapy. "Cure of the disease is only half of the public health problem," he noted. "A cured case is permanently stigmatized with achromic blotches on face and/or body—which causes others to shun him and constitutes a serious threat to his economic and social well-being. "Therefore we have devised a technique of dyeing and tattooing the achromic skin areas and have used it experimentally on a conCOMBATING TROPICAL DISEASES

11

At a session of the North American Clinical Dermatologic Society. Scaly, red. Abnormal coloration. 14 Lacking normal skin pigmentation.

12

13

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siderable number of pinto cases, following their cure with penicillin treatment. Thus far, this has not been too successful, as the skin often has rejected the pigment. We are working with new techniques which should show better results. "And," he emphasized, "we hope, through the intensive treatment campaign, to entirely eradicate the disease in Mexico." Details of the "fairly successful" attempt to rehabilitate cured victims of pinto by tattooing the blotched portions of their skin were disclosed by Dr. Antonio González Ochoa, of the Institute of Tropical Diseases. Dr. Ochoa emphasized the magnitude of the problem by pointing out that already an estimated 200,000 pintos blancos, or "white pintos," exist in the country. The white spots remain after a cure has been effected and cause the victims to be ostracized by their communities, which are convinced the white spots are evidence that they still have the disease. Dr. Ochoa reported that he and his associates tattooed a number of the achromatic spots with a Congway Model Β apparatus, but their experimental tattooing resulted in two problems: (1) They had difficulty introducing the pigments into the skin, and (2) pigments in tattooed zones often were expelled through peeling of the skin. "However," Dr. Ochoa said, "we've found the first problem apparently can be alleviated with the use of oil pigments in a mixture of several densities. We believe the second problem can be obviated by using pigments in nonirritating vehicles, together with corticosteroids. Histopathological studies of the tattooed skin demonstrate that lineal contiguity is produced by penetration of the needle in a vertical directiton to the skin surface, which penetration in the most part stops at the stratum granulosum where a great quantity of dark pigment can be observed; pigment exists in a lesser amount in the germinative layer, in the vasal layer, and in the dermis, in free state or in the cells (histiocytes and giant cells). This histological image suggests that the introduction of the pigment does not result in a reaction sufficiently intense to cause its eventual elimination." Dr. Ochoa said that he and his colleagues hope soon to resolve the remaining problems. He emphasized, however, that the rehabilitation program must also include work by psychologists, to convince the cured pinto victim he no longer is sick, and an educational program, to persuade his community to regard him as normal. Approximately 90 percent of Mexico's 500,000 sufferers from pin-

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to are found in the primitive, isolated communities of the nation's 3,500,000 indigenes, where the present mode of life, unchanged since very ancient times, makes eradication of the disease almost impossible. This additional aspect of the problem was stressed by Dr. José F. Garibay Ávalos, professor of dermatology at the University of Puebla.15 And he warned that, unless the tribal Indians' primitive manner of living is altered and these groups are integrated into Mexican national life, ill pinto victims are likely to increase, not decrease. Most tribal indigenes live in the valleys of the Balsas, El Grande, and Grijalva river basins, which constitute the principal pinto endemic zones. These cover parts of the states of Oaxaca, Guerrero, Veracruz, Morelos, México, Puebla, Michoacán, Jalisco, and Colima. "The base of each of the indigenes' communities is the tlalmilpa, or family corn plot," Dr. Garibay Ávalos explained. "On each tlalmilpa, a family, including several generations, lives together in a tribal state —in poorly constructed, earthen-floored huts and in close intimacy and promiscuity—providing maximum opportunity for the transmitting of a disease like pinto. Even the mother-child relationship, in which nursing customarily is continued as long as the child demands it, is a factor in increasing transmissibility of the disease." Dr. Garibay Ávalos warned: "An integrated campaign for the eradication of pinto cannot be effectively executed if the economic and cultural aspects are forgotten as social causes of the disease." In the six-year campaign against pinto conducted from 1958 to 1964, during the administration of President López Mateos, 489,962 persons reportedly were treated, representing 98 percent of the estimated 500,000 cases in the country. Mycetoma Mycetoma, an extremely destructive fungus-caused disease heretofore believed to be confined in Mexico almost exclusively to rural workers of the lowest economic level, increasingly is being discovered among urban residents, including those of the middle economic strata, according to Dr. Fernando Latapi. Dr. Latapi said that in a study, made at the Pascua Dermatological 15

At the Second Mexican National Congress on Dermatology, in Guadalajara in 1963.

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Center and at the Mexico City General Hospital Dermatological Service, of 197 cases of mycetoma, only 123 cases, or 62 percent, were of farm workers, who had come to the capital for medical treatment; that the remaining 38 percent included: domestic servants, 18 percent; factory workers, 8 percent; salesmen, 5 percent; students, 4.5 percent; professional people, 2.5 percent. The 197 mycetoma cases, Dr. Latapi disclosed, were found among the total of 42,597 patients treated at the two institutions from 1947 through 1961—an incidence of 4.6 cases of mycetoma per 1,000 dermatological patients. While males represented 79 percent of the cases, Dr. Latapi explained, this merely might reflect the greater freedom of male rural workers than of their wives to travel to the city for medical treatment. "Most of the mycetoma cases involved individuals in the third and fourth decades of their lives," he reported. The clinical manifestations in the 197 cases were localized as follows: lower limbs, 75 percent; upper limbs, 10 percent; dorsal side of trunk, 10 percent; neck, 5 percent. "In general," Dr. Latapi said, "the patients have the idea—which, as we know, is correct—that this disease is acquired by man through contact with nature in certain areas. In one case of mycetoma of the hand, the patient had been cut with a machete and the cut had developed a profound scar. In a case of mycetoma of the back, the patient said that, working as an automobile mechanic in a tropical rural area, he had spent many hours flat on his back on the ground under vehicles. Another victim with mycetoma of the back claimed infection followed a quarrel in which his opponents had flung him onto a cactus and his back had been pierced by the spines. "A few years ago," Dr. Latapi revealed, "it was believed that mycetoma was a slow-invading illness, but in the last few years we have observed special clinical forms—nonlocalized, metastic types, with ganglia, in upper and lower limbs." The 197 cases studied were diagnosed as: N. brasiliensis, 92 percent; S. madurae, 6 percent; S. somaliensis, 0.5 percent; Monosporium apiospermum, 1.0 percent; Cephalosporium, 0.5 percent. Sulfones were used in treating 53 percent of the cases, sulfamides in 15 percent, and isoniazid in 6 percent. Surgery was resorted to in a few cases, with fair results. "Since 1951," Dr. Latapi explained, "we have used diamenodifenil-sulfone in a daily dosage of 200 milligrams, subsequently re-

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ducing the dose to 100 milligrams and continuing this dose, or a dose of 50 milligrams, indefinitely. We have found DDS the ideal medication for mycetoma as well as for leprosy, providing there are no advanced bone lesions. With DDS, in the cases in which early diagnosis was possible, we have achieved apparent cures in two, three, or four months, though recidivation is always a threat if the treatment is stopped. "In 1955, we began treating some cases with isoniazid, using it as the sole medication in dosages of 5 milligrams per kilo of weight. The results have been equally favorable. "We have been able to bring 75 percent of the cases under control." Dr. Latapí emphasized that only 350 cases of mycetoma had been found in the nation by 1964—250 in Mexico City and 100 in Guadalajara. The Campaign Against Onchocercosis Some encouraging progress in Mexico's campaign to eradicate onchocercosis, the blindness-producing disease common among coffeeplantation workers in the states of Chiapas and Oaxaca, and the magnitude of the remaining problem were reported by Public Health Secretary Amézquita. A survey revealed that three endemic zones remain (two in Chiapas; one in Oaxaca), with a total of 39,800 known cases. Government medical brigades since 1933 have examined an estimated 200,000 persons and treated 25,000. "Today, new techniques greatly reduce the probability of blindness among those infected," Dr. Amézquita pointed out. "And the possibility now exists that this disease will be extirpated within the next decade." Onchocercosis first was recognized as a Mexican public health problem in 1925, when, in the southern part of the country, several isolated mountain villages were discovered in which all inhabitants were partially or totally blind. To compound the horror, in one of these villages, the blind or nearly blind inhabitants were found in a greatly weakened and pitiable condition because of the nightly harassments of vampire bats, which evidently had sensed their uniquely vulnerable state. (The only creature in this unhappy village that escaped the nightly attacks of the bats was a cat, which shrewdly slept in an oven.) The blind villagers were found to be suffering from an infestation

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of nematodes of the genus Onchocerca, which produce fibrouswalled cysts that appear as subcutaneous nodules and eventually cause blindness upon invasion of ocular tissues. (Prevalent also in Guatemala, Venezuela, the Congo, and Ghana, onchocercosis is believed to have been introduced into the Western Hemisphere from Africa by Negro slaves.) In a study of 9,889 individuals from one of the two endemic zones in the state of Chiapas, 49.95 percent were found to be infected. The infection rate was shown to increase with age: Of children from one to four years old, 17 percent were infected; of adults, 60 percent. "While at first excision of the nodules was exclusively employed, today drug therapy is increasingly utilized, particularly diethylcarbamazine," Dr. Amézquita explained. (Dosage: 10 milligrams per kilogram of patient's weight, orally, daily for eight to ten days; treatment repeated in six months.) "However, surgical excision of the nodules remains the best method for preventing the most severe ocular complications." The greatest obstacle to speedy eradication of the disease has been the difficulty of persuading the victims, many of whom are illiterate Indians, to continue with the treatments until their final discharge as cured. This is due to the pain involved both in excisions and in medication with diethylcarbamazine (which causes four or five days of pruritis, inflammatory edema, fever, etc.). Reluctance among many of the onchocercosis sufferers to return for a second painful treatment, as requested, six months after the initial treatment, often has had tragic results. A recent study of 157 onchocercosis-blinded individuals revealed that the majority had refused or prematurely discontinued treatment, years earlier. Another factor hampering the government's campaign to eradicate the disease has been the scarcity of physicians in the endemic zones, which lie in sparsely populated and rugged mountainous terrain. However, eighteen medical stations have been set up to care for onchocercosis patients. Although most transmission of onchocercosis is believed to be oral, several species of Simuliidae (principally ochraceum, metallicum, and callidum), whose larvae are aquatic, have been indirectly convicted as vectors by the discovery of microfilarae in females which 16

Roundworms.

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had fed on an onchocercosis patient. The medical brigades of the Department of Public Health and Assistance accordingly recommend use of insecticides, principally DDT, in dwellings, in the endemic zones. Histoplasmosis Some diseases which are not exclusively tropical in origin are nonetheless more prevalent, and often far more virulent, in the warm countries than elsewhere. This appears to be true of primary pulmonary histoplasmosis. Although U.S. medical circles became acquainted with primary pulmonary histoplasmosis barely a generation ago, the disease long has been prevalent in Mexico, where its virulence and popularly recognized origin in caves and mines have earned for it such colorful sobriquets as "Cave Sickness." "Abandoned-Mine Fever," and "The Miners' Widow-Maker." South of the Rio Grande, this pneumonia-like disease also has been known, paradoxically, both as "God's Punishment" and "the Devil's Curse"—the idea being that those stricken, particularly after entering long-deserted gold mines which date from the days of the conquistadores, were being punished by God (or the Devil) for daring to seek treasure which rightfully belonged to God (or the Devil). It is noteworthy that since antiquity a similar superstition has been associated with a fatal malady which mysteriously felled looters of the Egyptian pharaohs' tombs and was credulously termed "the Pharaohs' Curse." Sunday-supplement readers of a generation or two ago will recall how in modern times this dread "Pharaohs' Curse" was credited with striking down, one after another, many of the archeologists and manual laborers who had broken into and scientifically stripped "King Tut's tomb." Some Sunday-supplement writers theorized that such deaths were self-induced by superstitious fear; others that the ancients actually may have "seeded" the pharaohs' treasure caches with bacteria or spores that remained dormant but virulent for thousands of years, ready to attack all who dared violate the sealed tombs. It is highly probable that the "Pharaohs' Curse" which took its toll over the millenia among Egyptian grave-robbers, and the "Devil's Curse" which has taken a similar toll of Mexicans seeking gold in the Spanish Conquerors' long-abandoned mines, are the same—the fun-

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gus Histoplasma capsulatum. And that the vector is the same—the bats which notoriously inhabit old tombs and caves and abandoned mines and in whose excreta the fungus flourishes. According to a recent report by Dr. Antonio González Ochoa, of the Mexican National Institute of Tropical Diseases, there has been official recognition of primary pulmonary histoplasmosis in Mexico since 1895, when it was noted in Public Health records of the state of Nuevo León. And infection in Mexico, Dr. Ochoa disclosed, invariably has been traced to bat excrement—in abandoned mines, caves and irrigation tunnels. In the United States, however, the disease was first clinically observed at Camp Gruber, Oklahoma, in 1944, and not identified until 1950 (by Larsh and Furculow) as due to an infection by H. capsulatum. In the United States, in 117 (nonfatal) cases subsequently recognized in thirteen additional localities, all infections reportedly were traced to pigeon and chicken excrement in poorly ventilated and disused enclosures. Recently Furculow noted widespread traces of H. capsulatum in the dust of farms in the Ohio River valley. (Nevertheless, it is not impossible that in at least some of these instances in the United States bats also were involved, since bats well may have had access to disused enclosures containing pigeon or chicken excreta.) Primary pulmonary histoplasmosis is both much more prevalent and much more virulent in Mexico than in the U.S. Dr. Ochoa reported he and his collaborators found that thousands of persons have had the disease, in eleven of Mexico's twenty-nine states. Since 1955, when he began studies of primary histoplasmosis, he has observed 235 cases in twenty separate outbreaks of the disease, plus 3 isolated cases. Dr. Ochoa and his associates discovered that survivors apparently acquired immunity and therefore recommended that only workers with positive reaction to histoplasmin inoculation be employed in bat-infested mines and tunnels. The Federal Bureau of Mines subsequently issued an order implementing this recommendation. However, facilities for its enforcement were inadequate. And, with workers eager to retain their jobs and employers often willing to wink at employes' disregard of the ruling, at first it had little effect. But the validity of the recommendation soon was confirmed when,

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in the Cardona Irrigation Tunnel project in the state of Colima, through negligence 10 histoplasmin-negative workers were included among the histoplasmin-positive workers hired. Ten new cases of histoplasmosis broke out—all histoplasmin-negatives. Dr. Ochoa reported on another outbreak of the disease, in a reopened old mine, also in the state of Colima: "Fifty of 59 exposed workers acquired the disease," he said. "Gross rate of attack was 88 percent, but the rate among 35 of the exposed workers in whom histoplasmin reaction was studied was 100 percent for histoplasminnegatives and 0 percent for histoplasmin-positives. Incubation period was 7 to 10 days or more. Degree of infection was: 6 severe cases and 44 ambulatory, of which latter 31 were moderate and 13 slight. Three of the severe cases died—giving a mortality rate of 6 percent." The mortality rates have varied greatly. In a series of five outbreaks, 74 of 121 exposed persons became sick, and there were 21 deaths—a mortality rate of 28.4 percent. Dr. Ochoa reported that in the 235 cases he and his associates have studied, there has been an overall mortality rate of 17 percent. He observed: "Symptomatology of the severe cases was characterized by dyspnea, 17 so severe it caused death by asphyxia. X rays in all cases were amazingly alike: numerous micronodules in both lung fields, varying in size and number according to severity of infection. Relationship between symptomatology and radiological findings showed discordance in 27 percent and presence of precipitins in 29 percent. It was possible to isolate Histoplasma capsulatum from the blood of two patients one day before they died. The fungus was isolated from several superficial soil samples taken at the site of infection, more abundantly in those with pH 5.2 to 6 and organic matter content 2.12 to 4.44 percent. Pathology of the lungs in fatal cases consisted of alveolar destruction and blockage by accumulation of inflammatory cells and necrosis, with very few elements of H. capsulatum." Dr. Ochoa noted that he and his colleagues had had encouraging results in treating cases of primary histoplasmosis with Amphotericin B, by slow (six hours) intravenous diffusion. Starting with 10 milligrams of this new antifungal antibiotic in 1 liter of 5 percent glucose solution, they increased the dosage by 5 milligrams daily until it reached 50 or 60 milligrams. To avoid toxic reactions, from 50 to 100 17

Difficult respiration.

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milligrams of corticosteroids were included in the solution. Dr. Ochoa said that unless a corticosteroid like sodic hemisuccinate of hydrocortisone was used in conjunction with the antibiotic, severe toxic reactions resulted, including anorexia, fever, chills, headache, nausea, and vomiting, plus renal inflammation producing an increase of urea. The treatment was continued from one to three months. Dr. Ochoa reported that in the 5 cases in which cures thus were obtained, observations two to four years later disclosed healed scar tissue—fibrose micronodules on the lungs. Favorable results with the employment of corticosteroids in the treatment of histoplasmosis were reported by Dr. Antonio Mier y Torcida, of Morelia, Mexico.18 The patients were from the tierra caliente region of the southwestern state of Michoacán—an area in which histoplasmosis is endemic: Recent studies disclosed positive reactions to histoplasmin in 4 percent of the 804 students in a seminary; 14 percent of the 274 patients in a civil hospital; and 18 percent of the 780 convicts in the state penitentiary. Dr. Mier's report was on the cases of nine adult males who, in January, 1964, explored an abandoned old mine eighty-five kilometers from Morelia and who, twelve days later, became ill with initial symptoms of chills, sweating, fever, diarrhea, and pain with vocal articulation—which developed to include coughing and hemoptysis, dyspnea with sibilance. On the assumption that the men had contracted salmonellosis, they were treated with the various antibiotics available, but without improvement in their condition. "Approximately forty days after appearance of the initial symptoms," Dr. Mier said, "we gave the patients a clinical examination which disclosed abundant disseminated rales, tachypnea, diminished clarity of percussion, lightly edematized and painful articulation, and loss of weight up to 20 kilograms. "We investigated the possibility of histoplasmosis with sputum and hematic biometry tests, tests for renal and hepatic function and histoplasmin reaction, and made radiographs of the thorax. "Leukocytosis was found up to 16,000, and the radiographs were suspect. Inasmuch as the clinical history of the nine patients included exposure to dust and simultaneous explosion of the infection in all 18 At the Eighth International Congress of Diseases of the Chest, in Mexico City, in 1964.

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members of the group which had visited the old mine, we concluded they were suffering from histoplasmosis." Death of the nine patients from the excessive bronchopneumatic inflammation appeared imminent, Dr. Mier said. Amphotericin B, the favored drug, was not available. Such drugs as were available were of known ineffectiveness with histoplasmosis. "Therefore," the doctor explained, "despite the fact there have been published assertions discouraging their employment in histoplasmosis, we decided, as a last resort, to try corticosteroids." The results, he said, were "spectacular." Following administration for three days of 8 milligrams of parametosona every twenty-four hours, and subsequent progressive reduction of the dosage, there was prompt recovery in eight of the nine cases; in the ninth, there were relapses requiring prolonged treatment. Dr. Mier concluded this experience indicates that, contrary to accepted medical opinion, corticosteroids can be used effectively in emergencies in histoplasmosis—"perhaps while Amphotericin is being obtained." He added, "It is hoped that, if low doses of the corticosteroids are employed, they will not affect the immunological process." The Vampire-Bat

Problem

As noted, all histoplasmosis in Mexico has been linked to bat excrement. And bats recently made lurid headlines in Mexico for constituting another hazard—in an account strongly reminiscent of Eastern European werewolf legends and early Hollywood horror films: In April, 1965, Public Health Department authorities in the state of Chihuahua began using flame-throwers and poison gas in their fight against a plague of "monster" vampire bats that were reported to be terrorizing some mountain villages near Chihuahua City. A posse of bat-killers, led by Dr. Blas Ibarra, of the Public Health Department, headed into the mountains—after three persons from the remote villages of Morelos and Batopilas were hospitalized for shock, loss of blood, and observation (as the bats frequently are infected with rabies). The posse later sent a presumed fourth victim down the mountain and to a hospital. Bats, it is said, have been a menace to the cattle in this sparsely populated ranching country for years, but seldom have attacked humans, and then usually only by slipping up on sleeping victims.

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However, the hospitalized villagers insisted that the bats, which they described as attaining, in some instances, a wing spread of three feet, recently have become so daring, or hungry, that they have attacked humans walking through fields at twilight. The Public Health Department posse headed by Dr. Ibarra planned to use their flame-throwers to kill the bats in the caves in which they sleep during the day. However, the first report sent back by Dr. Ibarra from the front Unes, in his mountain warfare against the bats, revealed the posse had found more effective the strategy of sealing up the mouths of the caves and then pumping poison gas inside. It was definitely not the sort of campaign the Public Health Department takes on every day—but it illustrates how varied is its work. The Campaign Against Tuberculosis Tuberculosis, always particularly troublesome in the tropics, presents a grave problem throughout Latin America, as the Pan American Health Organization findings have confirmed. In Mexico, the National Campaign Against Tuberculosis was reorganized in the 1958-1964 period and adopted a dynamic approach to permit consolidation and use of uniform techniques in the thoracic clinics which are dependents of both rural and urban health centers and in the hospitals operated by the Public Health Department. Programs aimed at control of tuberculosis were extended to all parts of the country, particularly in rural areas, to protect the campesino population, and in the important nuclei of the indigenes—in the Sierra Tarahumara, in the state of Chihuahua; on the Yucatán Peninsula; in the Valle del Yaqui, in the state of Sonora; on the Isthmus of Tehuantepec; and in the Valle del Mezquital, in the state of Hidalgo. The Public Health Department estimates that, in round numbers, there are 500,000 persons in Mexico currently afflicted with pulmonary tuberculosis (out of a population of 40,000,000). The death rate recently has been slowly descending: In 1959, there were 23.6 deaths from tuberculosis per 100,000 inhabitants; in 1963, 21.9 per 100,000. The number of new cases reported, on the contrary, has been sharply increasing: In 1959, there were 33 new tuberculosis cases recorded per 100,000 inhabitants; in 1963,47.3 new cases per 100,000. However, this increase in great part merely reflects better detection

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—the far larger number of X-ray examinations being made throughout the nation. Public Health Secretary Amézquita reported, after four years of the new national anti-tuberculosis campaign, the allocation of 110 clinics, 27 hospitals, and a number of mobile units (including three well-equipped, special riverboats), to conduct mass examinations for tuberculosis and to administer B.C.G. vaccine. The advances made in six years are reflected in the following comparative statistics: In 1959, 313,033 patients were attended in a first consultation; in 1964,1,569,987. In 1959, there were 144,077 administrations of B.C.G. vaccine; in 1964, more than 2,000,000. In 1959, 398,499 X rays were taken; in 1964, 2,149,200. In 1959, 4,821 new cases were discovered; in 1964, 22,349 new cases (through the great increase in examinations by mobile and other units in previously unreached areas). Treatment generally was of the ambulatory type. And, in specialized, children's, and general hospitals throughout the nation, sections of preventive medicine (against tuberculosis) were created. The Campaign Against Polio The Campaign Against Poliomyelitis waged by Mexico's Department of Public Health and Assistance has had immediate and highly gratifying results. On October 23, 1960, the Public Health Department launched an all-out campaign to inoculate Mexico's children against polio and thus eliminate the disease within its borders. During the campaign's first stage, from October, 1960, to May, 1962, Salk dead virus procured from the United States was used; and, counting first, second, and third inoculations, a total of 8,193,548 doses were administered. During the second stage, from October, 1961, to May, 1963, Sabin attenuated live virus produced in a new Mexican government laboratory was used, and 5,685,734 doses of vaccine were administered. By early 1963, 3,394,226 children under six years of age, or 45.7 percent of Mexico's children in that age group, had been protected against polio. In the Federal District, where the incidence of polio

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had been highest during not only epidemic years but normal years, 72.1 percent of children under six had been vaccinated. And, as a result of this aggressive campaign, Mexico's polio incidence—which had risen to as high as 30.79 cases per 100,000 population in the Federal District in 1951, and to an incidence of 6.25 per 100,000 for the country as a whole in 1953—dropped, in 1962, to .064 per 100,000 in the Federal District and to 1.31 per 100,000 for the nation. Undersecretary of Public Health Dr. Miguel E. Bustamante reported 19 that a twelve-year study of statistics of epidemic polio in Mexico, from 1951 through 1962, revealed key facts which are enabling the Public Health Department most efficiently to maintain control over the disease. For example, it was found that the northern states, adjoining the United States, consistently had the highest incidence of polio, while the southern and southeastern states had the lowest. However, the incidence was far higher in the big cities than in the country as a whole. It was highest in Mexico City, Guadalajara, Monterrey, Torreón, and Aguascalientes. Furthermore, it was highest of all in the above cities' most heavily populated districts. (In the epidemic year of 1951, of the 1,044 cases reported in the Federal District, 864 originated in the twelve most densely populated Sanitary Districts, while only 180 originated in the twelve least densely populated Sanitary Districts. But in 1962, after mass vaccinations, the ratio was far less startling: Of the total of only 42 cases reported in the Federal District, the twelve most densely populated districts provided 24 cases and the twelve least populated provided 18 cases.) However, the most significant findings of the study were that, during the twelve-year period, 96 percent of polio cases reported in the nation were of children under six years old. Furthermore, in the Federal District, 84.4 percent of the reported cases were of infants less than one year old. These findings influenced the Public Health Department, in launching its vaccination campaign, to concentrate on children in the under-six age group (although older children and adults also were vaccinated). And the Department especially stressed the desirability of vaccinating infants. 19

At the Second Mexican National Public Health Congress, in 1963.

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In fact, Dr. Bustamante emphasized: "If the elimination of polio in Mexico depends fundamentally upon the vaccination of Mexicans less than one year old, as our statistics indicate, it appears worthwhile to experiment with the administration of Sabin vaccine to the infant at birth, by the method of Credé. Surely, the objective of vaccinating the entire population of infants can be carried out much more efficiently at birth, in hospitals, sanatoriums, state and private maternity homes, than in later attempting to seek out the infants in crowded cities and rural collectives." And, on November 16, 1963—in what was believed to be the first such action by a head of state—President Adolfo López Mateos by presidential decree made obligatory the inoculation of all newborn babies in Mexico against poliomyelitis. The presidential decree included substantial teeth to guarantee enforcement: No child's name may be inscribed in the Civil Registry unless its parents present a certificate to prove it has been administered vaccine against polio. The decree furthermore provides that failure to comply with the new law will result in fining of parents. The Department of Public Health and Assistance supplies the necessary vaccine free of charge to physicians, health centers, and hospitals throughout the nation. The vaccine is deemed most effective when given in three stages. "The first stage should be administered within twenty-four hours after birth," the decree stipulated. "The second should be administered at between four and five months and the third between eight and nine months of age." The decree also specified that Sabin oral polio vaccine should be employed. The Mexican government opened its own laboratory for the production of Sabin oral polio vaccine early in 1963 and produced 58,000,000 doses. The Mexican government, incidentally, later also donated 1,050,944 doses of the vaccine to Colombia, Costa Rica, Nicaragua, Panama, Peru, and the Dominican Republic—for use in inoculating children in those countries against polio. The program of vaccinating Mexican children, of course, continued. By late 1964,13,108,967 youngsters had been vaccinated. In 1959 there had been 1,870 cases of polio in the nation, or an incidence of 5.6 per 100,000 children. In 1964 there were only 138 cases, or 0.8 per 100,000 children.

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The Campaign To Eradicate Malaria Malaria until very recent years took a huge annual toll in lives in many of Mexico's tropical lowland areas, where, in steamy jungle swamps and thickets, the Anopheles mosquito bred unchecked. As recently as 1958, the disease affected 2,500,000 persons and caused 25,000 deaths each year. Since then, however, the Campaign To Eradicate Malaria mounted an all-out attack against the deadly insect vector. Jungles were sprayed with DDT, up and down the coasts and far inland, by small Public Health Department planes roaring in low over the palm fronds (doubtless to the amazement of many a drowsing jaguar or peccary). Mobile teams of khaki-uniformed Malaria Campaign workers, with spray tanks on their backs, appeared at cities, villages, and crossroads hamlets throughout the nation's malarial zones (the southern tierra caliente, at altitudes below five thousand feet) and sprayed (at government expense) every room, window, and doorway of every home, from the humblest thatch and adobe huts in rustic settlements to the most luxurious villas of the wealthy in the bougainvillea-draped resort cities of Cuernavaca and Acapulco. For the spraying with DDT of all dwellings in the malarial zone had been made mandatory. This spraying of dwellings by the Public Health teams was repeated, annually or semiannually, and still continues. As a result, malaria has been entirely eliminated from 88 percent of the former malarial zones. It now exists to a limited degree only in the nation's most remote areas. And, President López Mateos confidently predicted in his final State of the Union speech, it will be entirely eradicated as soon as the primitive indigenes in the still-unreached areas can be raised from the tribal existence level and incorporated into the mainstream of Mexican life. Meanwhile, Public Health authorities point out that even in the isolated pockets in which malaria has not yet been wiped out, the disease has lost its former virulence. For there no longer are any fatalities from malaria in Mexico. The mortality from malaria in 1958 was 45.1 per 100,000 inhabitants. In 1964 it was 0. As a postscript to the foregoing, it should be noted that the anti-

229 malaria campaign entered a new phase in 1965, at the beginning of the administration of President Gustavo Díaz Ordaz: Due to the resistance to DDT which has been developed by the responsible vector, the Anopheles albimanus mosquito, the Public Health ministers of Mexico and Guatemala decided at a 1965 meeting in Campeche City, Mexico, to change the direction of their campaigns to wipe out "residual malaria" in their respective countries. They agreed henceforth to concentrate on frequent periodic checkups of the populations in the small areas in which malaria still is endemic—in order to quickly catch and cure any cases that may develop. This new strategy, they agreed, should outwit the DDT-resistant mosquito by depriving it of malaria-infected victims upon which to feed. The decision was made at the Fifth Annual Reunion of the Mexican-Guatemalan Public Health Association. Attending the session were Mexico's current Secretary of Public Health and Assistance, Dr. Rafael Moreno Valle; Guatemala's Minister of Public Health, Dr. Alfonso Ponce Archila; Mexico's current Undersecretary of Public Health, Dr. Pedro Daniel Martínez; and the governors of the Mexican states of Campeche and Yucatán. One of the most important pockets of endemic malaria remaining in Mexico exists along the Pacific coastal lowlands adjacent to the Mexico-Guatemala boundary, and extending into Guatemala. This region, comprising the southwest corner of Mexico's state of Campeche, contains rich coffee-growing plantations. Among the important foci of infection are the considerable numbers of Guatemalan peasants who seasonally migrate across the international boundary to work on the Mexican coffee plantations. Therefore, there has been close integration and coordination of the respective anti-malaria campaigns of both nations. The Mexican Public Health Department's large fleet of mobile units, which were principally responsible for the nearly complete success of Mexico's Campaign To Eradicate Malaria, subsequently have concentrated on giving monthly examinations to all persons in the affected area—including especially the Guatemalan migrant coffeeplantation workers. Curative drugs are administered on the spot. And records of the patients, in the cases of the migrants, are forwarded to the Guatemalan Public Health Ministry, for follow-ups in COMBATING TROPICAL DISEASES

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the patient's familial environment. The Guatemalan Public Health Ministry is carrying on a similar campaign in its territory. "Considering that as recently as 1955, when Mexico's Campaign To Eradicate Malaria was begun, malaria was Mexico's fifth greatest cause of mortality," Dr. Moreno Valle emphasized, "we can be very proud of the work of our Public Health Department personnel." Dr. Moreno Valle disclosed that 1970 has been set as the target date when the Public Health Department expects to have totally eradicated the disease in Mexico. He noted that, in addition to the aforementioned small area on Campeche's Pacific coast, residual malaria still exists in Quintana Roo and in the Balsas River valley— both sparsely populated areas. "However, the residual malaria which still exists," he pointed out, "is almost always of a mild, benign type, and therefore often is overlooked, even by the patient. But we must not diminish our efforts at complete eradication of this disease. If ignored, it well may regain its former virulence." The Campaign Against Yellow Fever As the result of the successful conclusion of a campaign launched in 1956 to eradicate Aëdes aegypti, Mexico in 1963 became one of the few Caribbean countries free of that dreaded vector of yellow fever. This was reported by Dr. Carlos Ortiz Mariotte, director of the campaign. 20 However, Dr. Mariotte emphasized, this position requires unrelenting vigilance against reintroduction of the yellow fever carrier, since, according to the Pan American Sanitary Office, as late as August, 1962, A. aegypti still existed in the U.S.A., Venezuela, Colombia, Cuba, Haiti, the Dominican Republic, Puerto Rico, Curaçao, the Bahamas, and the tiny islands of Cristóbal, Santa Lucia, and Guadalupe. And a particularly virulent strain of the mosquito that exists in Jamaica has proven resistant to DDT—the introduction of which into Mexico could create a very serious problem. Other Latin American countries that have eradicated A. aegypti and maintain a vigilance program against its reintroduction into their territories are Brazil, Chile, Ecuador, El Salvador, Guatemala, Honduras, Paraguay, Uruguay, French Guiana, and the Panama Canal Zone. 20

At the Second Mexican National Public Health Congress.

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Nevertheless, Dr. Mariotte pointed out, there are countries, including one bordering on Mexico, which have eradicated A. aegypti but do not maintain vigilance programs against reintroduction of the yellow fever vector. He listed them as Bolivia, Costa Rica, Nicaragua, Panama, and British Honduras. Until 1923, when the Mexican government, with aid from the Rockefeller Foundation, carried on an aggressive campaign against A. aegypti, yellow fever had killed hundreds annually in Mexico. The mortality rate was high: From 1900 to 1923, there were 7,037 reported cases, resulting in 3,086 deaths—a mortality rate of 43.85 percent. Since 1923, Dr. Mariotte said, there have been no reported cases of yellow fever in Mexico. The vigilance program, being maintained on a permanent basis, provides for inspection of all ships coming from countries infested with A. aegypti; their spraying with DDT if considered advisable; similar inspection and spraying of planes from infested countries landing at airports situated on terrain less than one thousand meters above sea level (above which altitude the vector does not flourish); also, periodic spraying of Mexican ships and planes which make contacts with countries infested with A. aegypti. It was in preparation for the launching of this vigilance program that the National Anti-Mosquito Service conducted a four-year cleanup campaign, at a cost of 8,426,100 pesos, to eradicate any A. aegypti which had gained a foothold on Mexican territory since 1923. With a personnel of ninety-six, and equipment in thirteen mobile units, it concentrated on surveying, and spraying with DDT where needed, those areas in which A. aegypti might be found and which had not already been sprayed with DDT by anti-malaria campaign personnel. These included Baja California Sur and parts of the states of Sonora, Coahuila, Nuevo León, Tamaulipas, and Yucatán. Dr. Adrian Torres Muñoz, chief of the National Anti-Mosquito Service, disclosed that his personnel inspected 262,088 houses of the 777,596 in the aforementioned areas, and surveyed 4,244 communities, or 53 percent of the area's 8,000. He said that in the 4,033 rural and 211 urban communities they surveyed, they found A. aegypti in 12 percent of the former and 45 percent of the latter, and that, in spraying of houses with D D T twice in six months, they carried out a total of 313,349 sprayings. Subsequently, to verify efficacy of the treatment, reinspection

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teams were sent out. The 579 initially positive localities now are free of infestation with A. aegypti, Dr. Torres Muñoz reported. Control of Other Diseases The achievements of Mexico's Department of Public Health and Assistance in the control or eradication of killer diseases has been remarkable—particularly in view of the relatively short period of time in which these achievements have been made and the severe economic and sociological handicaps that impeded the Department's work until very recently. Space does not permit details on campaigns against other diseases. However, some of these accomplishments should be noted: Typhus has been reduced to a few small foci hidden in remote mountainous areas and very soon will be eradicated. Smallpox has been entirely wiped out. (It was officially reported eliminated from Mexico in 1952.) The program of smallpox vaccination naturally is continued throughout the nation; free vaccinations are available at all Public Health clinics and other facilities. And Mexican law requires that all infants be vaccinated during their first month of life. The progress made in the control of other important diseases, just during the six years of the López Mateos administration, has been impressive. For instance: The death rate from typhoid was reduced from 9.8 per 100,000 inhabitants in 1958 to 3.7 per 100,000 in 1964—a decrease of 62.24 percent. The death rate from paratyphoid was lowered during the same period from 3.6 per 100,000 to 2.3 per 100,000. And the national death rate from all forms of dysentery was slashed from 19.1 deaths per 100,000 to 6.6 per 100,000. By December, 1964, at the conclusion of the López Mateos administration, the population of Mexico had soared to 40,000,000. And this was due in no small part to the Public Health Department's successful battle against long-time killer diseases. Colonizing the Jungle One final point should be mentioned here. The Public Health Department's eradication of yellow fever and virtual eradication of malaria have made possible a very important and significant new development in Mexico:

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Beginning in 1962, the López Mateos Administration established several Colonization Program projects in previously uninhabited areas of two southern states. Such an undertaking previously had been debated and considered as a possible solution to a pressing agricultural and economic problem, yet repeatedly rejected as unfeasible. For certain large areas of the tropical states of Chiapas and Tabasco, despite their extremely fertile soil, always had been regarded as uninhabitable death traps because of the yellow fever and malaria that felled the few humans who penetrated them. Now, however, thanks to the Public Health Department's successful DDT-spraying campaigns, over five thousand Mexican farmers and their families are establishing homesteads and hacking out farmland from the primeval jungle. Not only is this rich southern land being brought into useful production for the first time, but a serious economic problem in another part of the nation is thereby being solved. Most of the new "jungle colonists" have been relocated, by the government, from Mexico's arid northern states—from the former cotton-growing Laguna region near Torreón and other areas where one-crop land depletion, plus years of drought and/or exhaustion of the underground water table, has made agriculture unproductive or impossible. In its first two years, the relocation project proved extremely successful. And many more thousands of colonists are expected to follow—exchanging the dusty, barren land of their birth for the lush, fabulously fertile soil along southern jungle rivers. The transplanting of more and more families into tropical areas and the creation there of new agricultural communities naturally make the control of all types of tropical diseases increasingly more important and essential—not only in Mexico, but in many other parts of the world. For the great reward in a finally triumphant battle against tropical diseases will be to make the world's tropics salubrious for man. And in this last well may lie the answer to the global population explosion. If and when the world's enormous areas of undeveloped, uncleared jungle (such as the Amazon basin) are made safe for large-scale colonization, this will (a) provide living room for vast numbers of people now barely existing on unhealthfully overcrowded and/or unproductive land areas, ( b ) enable these jungle areas to be employed

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for large-scale agriculture and to export food to the hungry in other parts of the world, and (c) enable the tropical areas' existing wealth of natural resources to be developed and utilized. Thus, the conquest of tropical diseases is one of today's great challenges—opening tremendous vistas of peaceful progress for the future. Principal Sources Public Health Department reports and statistics. Interviews at the National Institute of Tropical Diseases. Papers by campaign directors and other doctors.

CHAPTER SIXTEEN

Colorful Mexican Institutions

While public health activities may be roughly similar in many countries, and the practice of medicine by licensed M.D.'s is standardized throughout the Western World, there are, nevertheless, wide variations from country to country in the nature of traditional institutions, and in the attitude of doctors toward the public and toward their own role within the profession and in society. Much of this is related to the ambience of a country—its particular atmosphere, customs, and culture—not merely the special needs but the special outlook of its people. This is the case in Mexico. For instance, two government institutions that have no counterpart in the United States, the National Lottery and the National Pawnshop, contribute immensely to the public health and the public welfare. There is, in Mexico City, a private hospital exclusively for professional bullfighters. And, while Mexican doctors may or may not be more sportsminded than doctors elsewhere, many participate—for their own enjoyment, or to benefit charitable causes—in sports that would raise the hair of most U.S. physicians: Some Mexican M.D.'s, in addition to engaging in recreational sports enjoyed by their colleagues in other countries (from golf to deep-sea fishing), play a fast-paced, wall-climbing game of jai-alai in their own fronton courts; or stunt-ride as full-fledged charros in traditional exhibitions of daredevil horsemanship; or, in surprising numbers, even risk their lives fighting bulls in the bull ring.

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And they do these things, at no loss of professional dignity, with flair and dash. The National Lottery Mexico's Lotería Nacional, or National Lottery, is a venerable and venerated institution, for through it anyone in any city or town in the nation, for only a few pesos, may buy himself a ticket to great wealth. And when a person buys a lottery ticket in Mexico, any twinge of conscience he may feel at risking his money in gambling can be salved with the thought that, whether he wins or loses, he is aiding a good cause. All profits of the National Lottery (since 1925 the government has allowed only one lottery, its own, to operate in Mexico) go to the Department of Public Health and Assistance. In fact, the institution's official name is the National Lottery for Public Assistance, and the Secretary of Public Health and Assistance always is also chairman of the board of directors of the National Lottery. As the government's second-largest single source of income (exceeded only by the Social Security tax on industry), the National Lottery provides the major part of the funds annually expended by the Public Health Department in its nationwide campaigns against epidemic and endemic disease. In 1964, the National Lottery turned over to the Public Health Department approximately $10,000,000; since 1920, it has provided the Public Health Department with some $282,000,000. Every buyer of a National Lottery ticket thus can claim a tiny part of the credit for the Public Health Department's eradication of smallpox, achieved in 1952; for its almost complete eradication of malaria; for its reduction of the polio incidence to figures only slightly higher than in the U.S. Today, the Public Health Department, with the pesos of the 500,000 Mexicans who regularly buy National Lottery tickets, is concentrating on eradicating pinto, onchocercosis, and tuberculosis. The Mexican National Lottery is older than the Republic of Mexico. As earlier mentioned, it was first set up by decree of King Charles III of Spain, in 1770, when Mexico still was the Spanish Colony of New Spain. And, from the very beginning, profits were assigned to public health projects—which then were principally the treatment of smallpox and syphilis. The profits of the National Lottery have remained a consistent 35

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percent of gross receipts. Administration costs, the 10-percent commission paid ticket vendors, and, of course, the prizes, consume 65 percent, according to José M. González Urtusuáztegui, general manager. Drawings are held three times a week and thirty thousand to forty thousand whole tickets are sold for each drawing. Every whole ticket is divided into ten or twenty "fractions"—which are the units most commonly sold, at from as low as two pesos (sixteen cents U.S. currency). The top prize for each drawing pays off 10,000 to one. Top prizes vary from 300,000 to 37,500,000 pesos ($24,000 to $3,000,000). Winnings are subject to a graduated federal tax of only 4 to 15 percent. Most of the interesting stories about big winners in the National Lottery never are disclosed, because worldly big winners avoid publicity, knowing that the sudden acquisition of a windfall always attracts hordes of salesmen, "con men," and thieves. By having their banks collect for them, they evade disclosure of their identity. Alberto Villaseñor, sales manager for the National Lottery, disclosed that the most recent big winner who was a medical man, so far as he knew, was his own cousin—Dr. Arturo Villaseñor, a Mexico City gastroenterologist. Dr. Villaseñor held four of the twenty fractions of the lucky number in the May 5, 1962, drawing which won the 10,000,000-peso top prize—netting him, before taxes, $160,000. After pondering for six months on how to invest this very tidy sum, Dr. Villaseñor finally put it into financing an exclusive gift shop which his wife long had wanted. In 1963, the May 5 drawing (like those of September 15 and December 24, one of the three drawings with the largest top prize) resulted in an amusing incident. One of Mexico City's wealthiest industrialists, having bought ten whole tickets, at 1,000 pesos each, just an hour before the drawing impulsively tore one ticket into its twenty fractions and distributed these as favors among his twenty dinner guests. And that was the ticket which won the 10,000,000 peso top prize! Each guest thus went home with a dinner favor of $40,000! Funniest recent story is about a shoemaker who, exasperated at his wife's frittering away his hard-earned pesos on lottery tickets, finally tore a ticket from her hand and, daubing it thickly with the stickum he used on sole leather, glued it fast to the inside of his shop door— so she "would be reminded every day" of her wasteful habit. You've guessed what happened. His wife's ticket won.

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The shoemaker took the door off its hinges and lugged it down to the National Lottery building. He expected that a look at the ticket would suffice. But the National Lottery officials informed him it was necessary to file permanently all winning tickets. They procured a saw and sawed the ticket out of the door. The shoemaker now has a door with a peephole. The National Pawnshop As earlier noted, Mexico's Monte de Piedad ("Mountain of Charity"), or National Pawnshop, was established in the 1770's, when a Spanish count who owned extraordinarily rich mines in New Spain donated 300,000 pesos toward its founding, "with the object of providing succor for the needy." The National Pawnshop is situated in downtown Mexico City on a corner of the Zócalo, in an enormous old rococo building, the onetime Spanish Government House (built on the site of an Aztec royal palace). For almost two centuries, it has been providing assistance to those in need of funds. It will lend money to anyone who can produce something as security—whether it be family jewelry, old or new furniture, a battered typewriter, old medical instruments, an ancient bell, a chess set, a brass door knocker, items of clothing, or a clock. Nor is it only the very poor who flock to exchange their possessions for pesos at the National Pawnshop. When well-paid federal government workers return to Mexico City from their annual year's-end vacations, hundreds of them head straight from railroad station or airport to the Pawnshop. For they have spent all of their generous Christmas bonus and savings on a glamorous vacation at an out-oftown resort—and, to get some eating money until their next paycheck, will queue up to pawn their raincoats or the suitcases they are carrying. It has become an amusing postvacation ritual (which newspapers delightedly photograph), and temporarily broke but happy holidayers invariably reclaim their possessions on the next payday. However, anyone who finds himself unable to reclaim a pawned object can console himself with the knowledge that he received a fair price for it. For the Pawnshop lends money on security for a specified time— at a fair valuation, set by experts in each field of merchandise—and at a very low interest rate. The National Pawnshop thus serves as a great boon to the needy—

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and not only in being a sure source of instant cash. The establishment has completely eliminated from Mexico—both obviated and made illegal—the rapacious loan sharks who, with exorbitant lending rates, prey on the poor in most countries of the world. The National Pawnshop provides an additional service, on occasion, in financing a craftsman's work by lending him money to finish it. In fact, if desired, the National Pawnshop even will sell his (brand-new) product for him. The Day of the Doctor In Mexico, nearly everyone—policeman, teacher, postal employe, waiter, construction worker, even the dead—has his day. Each such special day is celebrated annually with a holiday for all those concerned and perhaps with gifts, speeches, banquets, parties, and/or parades. (The Day of the Dead is no exception in this respect, for on it families gather to honor their dead, and in those areas where unsophisticated traditions are maintained many bring special foods, flowers, and little gifts for their departed relatives to the cemeteries, lingering to eat a picnic meal at graveside.) Doctors, not surprisingly, also have their day—October 24. Every year on this day, the nation honors its members of the medical profession. In 1964, for example, nearly two thousand Mexico City physicians attended three dinners given in the capital in celebration of the Day of the Doctor. At the largest, Mexico's President, Adolfo López Mateos, was guest of honor and made a speech in tribute to members of the Mexican medical profession and the achievements of medicine throughout the nation. "The governments of the Mexican Revolution," the President commented, "have given medical practice a deep social significance and thus made it more accessible to a greater number of people," The Bullfighters' Hospital Mexico City has a unique establishment in the "Bullfighters' Hospital"—a specially built institution whose patients are all professional bullfighters. It came about this way: A single Mexican medical family—three generations of the Doctors

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Ibarra—has been taking care of Mexico's injured professional bullfighters for more than a third of a century. In the over three thousand bull-ring injuries the doctors have handled, they have held the mortality to 0.1 percent. In appreciation, the Unión Mexicana de Matadores de Toros y Novilleros, the Mexican Bullfighters' Union, built a little private hospital in Mexico City exclusively for bullfighters—the Hospital Santa María de Guadalupe—and installed the Doctors Ibarra as the medical and surgical staff. In 1927, Dr. Javier Ibarra, who recently retired at age eighty, began his career as "the Bullfighters' Doctor." When his sons, Javier, Jr., and Eduardo, finished medical school, they joined him in this unusual practice. And, in 1963, the third generation, the son of Dr. Javier Ibarra, Jr., José, a fourth-year medical student, began assisting with matador patients. The Bullfighters' Union built its two-story, sixteen-room hospital, with a well-equipped operating room, in 1948, for fifty thousand dollars. Located on a tree-shaded residential street near the Plaza de Toros México, the world's largest bull ring, the hospital today is valued at more than twice that figure. "Twenty-five percent of the injured bullfighters we've treated were gored in one of Mexico City's two bull rings," Dr. Javier Ibarra, Jr., who succeeded his father as medical director of the hospital, explained. "Seventy-five percent were brought to us after having been injured elsewhere in the Republic." The Doctors Ibarra have attended bull-ring injuries of most of the world's greatest matadors, virtually all of whom have fought in the Mexican capital. The fiesta brava's all-time immortal, Manolete, after being gored in the left thigh in Mexico City in 1945, spent ten days under the Ibarras' care. (Manolete's death two years later occurred from loss of blood the day after he again was gored, in the femoral artery, in a small-town bull ring in his native Spain.) "We care for about one hundred bull-ring injuries annually in the hospital," Dr. Ibarra said. "This means that every Sunday, somewhere in Mexico, an average of two bullfighters are injured severely enough to require treatment here. However, less than one hundred matadors are involved each year, for many are injured more than once each season." He observed that 90 percent of bull-ring injuries are to a matador's

241 thighs—of which two-thirds are to the back of the thigh and the rest divided equally between front and sides. Five percent are leg injuries, and the remaining 5 percent are in the abdomen, thorax, face, or scrotum. When this writer toured the Bullfighters' Hospital in 1963, it held just one patient—Benjamín López Esqueda, thirty-four, who had a plaster cast on his broken right ankle, into which a steel rod had been inserted. The matador had been gored in the Acapulco bull ring while dangerously kneeling before the bull and making a farol cape pass. Mentioning that this was the seventh time he had been gored in six years of fighting bulls, he nonchalantly displayed his impressive collection of horn scars—one on his abdomen, five on his thighs. Two bullfighter friends who were visiting him, the brothers Luis and Félix Briones, watched silently. "This one hospitalized me for a month," López Esqueda explained, pointing out the largest of his long thigh scars. "It was when I was gored in Nogales, four years ago. Five minutes later, as I was being carried out of the ring on a stretcher, I heard a scream. I sat up and saw the same bull had just gored Luis here, in the rectum, and was carrying him about, thus, on his horn!" Luis Briones smiled rather grimly at the painful memory. Briones, then forty—who carries a scar on his forehead where a bull's horn pierced his cranium in 1945—commented that he had been gored "thirteen or fourteen times, but usually only in the thighs." His brother, thirty-eight, said he had been gored eight times—three times in the thigh and once each in leg, knee, neck, chin, and abdomen. Dr. Ibarra described one of the more serious bull-ring injuries the Ibarras have cared for in recent years—the case of matador Antonio Velásquez, who was badly gored in 1959 in Mexico City's new Plaza de Toros Quatro Caminos. The bull's horn had entered the right side of the neck, pierced the tongue, penetrated the roof of the mouth, and stopped only millimeters short of entering the cranium. "Velásquezwalked out of our hospital three weeks later," Dr. Ibarra recalled. "But he had to undergo six months of speech therapy to regain use of his tongue, and he still has difficulty pronouncing r and COLORFUL MEXICAN INSTITUTIONS

l."

The three bullfighters present agreed that the major cause of gorings is faulty preliminary capework or placement of banderillas by

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the matador's assistants, which tips the bull to the fact that his opponent is the man, not the cape, and thus makes him extremely dangerous when the matador goes in for the kill. Dr. Javier Ibarra, Sr., reviewed the only three fatalities among the over three thousand bull-ring injuries treated by his family in thirtysix years: 1) Félix Rodríguez, who died in 1938 of septicemia after being gored in the thigh 2) José (Joselillo) Rodríguez, who died in 1948 of pulmonary complications several weeks after being gored in the groin at Mexico City's Plaza de Toros México 3) Carlos Pavón, who died in 1960 of peritonitis three weeks after being gored in the abdomen at Mexico City's Plaza de Toros Quatro Caminos. Another complicated operation, or series of operations, performed at the Bullfighters' Hospital involved a matador injured in a bull ring far from Mexico City. The nightmare número uno of every bullfighter—that he might be gored in the genitals—befell a Mexico City matador on July 24,1960, in a bullfight in the small town of Xico, in the state of Veracruz. He had been married only shortly before the accident. The bull's horn effected total detachment of the scrotum and of an important segment of the penile skin. The local surgeon at the bull ring hastily repositioned and sutured the severed skin, and the patient was taken to Mexico City and placed in the Bullfighters' Hospital there, for observation. Six days later, however, examination disclosed necrosis of all layers of the scrotum, including the dartos, 1 as well as necrosis of the skin of half the penis and the adjacent pubic area. Dr. Javier Ibarra, as director of the Bullfighters' Hospital, called in Dr. Mario González Ulloa, Mexico City's famed plastic surgeon, who performed a series of three operations that marked a notable success in the long history of tauromachian surgery: On August 3, 1960, under general anesthetic, after a thorough cleansing with ether and soap and water, a wide resection of the necrotic tissues was made, removing the skin of the proximal half of the penis, scrotum, and pubis. Resection was carried out until normal 1

The small muscle which contracts the scrotum.

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bleeding tissue was exposed. The testicles and spermatic cords, completely exposed, were found in a state of severe inflammation. The margins of skin surrounding the extensive denuded area were undermined. The skin of the inner upper portion of both thighs was dissected from the fascia,2 in a baglike shape. Each testicle and its cord were introduced (as a temporary measure) into the corresponding bag, on the thigh. The lower pole of the testes was fixed to the skin with a wire suture tied over a button. The denuded area on the perineum 3 was covered by elongation and primary suture of the undermined skin. To cover the penis and pubis, a split-skin graft taken from the posterior aspect of the left thigh was applied. Margins of the graft were sutured with 5-0 Dermalon. Penrose drains were left in both thighs. A Foley catheter was applied with moderate pressure. Postoperative evolution was satisfactory. Once the primary step to protect the testicles thus was completed, Dr. Ulloa explained, he planned the following technique for reconstruction of the testicular bags: On the inner upper portion of the thigh an M-shaped incision would be made:

The external margins of the wound would be widely dissected. Undermining would be done toward the midline extensively enough to place the testicle in its normal site. The testicle then would be replaced from the inner side of the thigh to its normal position. It would be held in place by a wire suture tied over a button on the surface of the skin. The wider angle of the M-like incision then would be shifted toward the perineal region. The skin margins would be sutured with 4-0 steel wire and 5-0 Dermalon. To close the incision, the smaller angles of the M-like incision would be shifted opposite. Through this procedure, the central bag to contain the testicles would be constructed. On October 19,1960, Dr. Ulloa started this reconstructive surgery, 2 3

Connective tissue. Tissue between the anus and the scrotum.

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completing the right side. At the same time, he performed a Z-plasty operation on the proximal area of the penis to correct a cicatricial web. On November 28,1960, Dr. Ulloa performed the same operative technique on the left side. The patient had a good postoperative course and was discharged from the hospital two weeks later and allowed to resume his normal life. And on February 19, 1961, the patient returned to the bull ring, giving the best performance of the season. According to laboratory reports and the patient himself, good testicular function and normal sexual activity were restored. Doctors as Charros Whenever Mexico City's charros stage one of their spectacular charreadas, or internationally famed exhibitions of their daredevil horsemanship, any fears of possible accidents are lessened by the thought that they always have expert medical care immediately available; for not only do two of the capital's most eminent orthopedists serve as official surgeons to the Asociación Nacional de Charros, but the Asociación membership includes no less than twelve doctors. Accidents—principally fractures—happen with considerable frequency. However, in a quarter of a century there have been no fatal mishaps during the group's riding shows and practice sessions, according to their official physicians, Dr. Rafael Moreno Valle and Dr. José Manuel Álvarez Teña. Dr. Álvarez Teña, who is on the staff of the Durango Hospital and director of a rehabilitation center for the Public Health Department, has been an official charro surgeon nine years. Dr. Moreno Valle,4 who is a general in the Army, a federal senator, former head of Mexico City's big Military Hospital and present head of the Orthopedics Department of the Durango Hospital, has been official surgeon for the charros for twenty-five years. Both are charros themselves and frequently ride in exhibitions. "We care for an average of fifteen to twenty charro cases each month," Dr. Moreno Valle explained. "Nearly all are fractures. Most are the result of riders being thrown by unruly or frightened horses. However, a considerable number also are caused by riders' falls from 4 On December 1, 1964, Dr. Rafael Moreno Valle was appointed Secretary of Public Health and Assistance by Mexico's incoming President Gustavo Díaz Ordaz.

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their horses, by horses falling with their riders, by riders becoming entangled in their lariats and dragged by panicked horses, and, finally, by other mishaps in the course of the charros more dangerous stunts." Dr. Moreno Valle pointed out that a large proportion of the accidents are suffered by the teen-age sons and daughters of charros during the weekly riding lessons given them at the Rancho del Charro in Mexico City, to teach them to become charros and charras, "The most frequent accident occurring among our teen-age riders," he disclosed, "is a fracture of either the radius or the ulna, or both— as a consequence of the victim's naturally extending his arms to lessen the impact of a fall, or being thrown. Usually, these are simple fractures." "However, in the case of experienced charro riders," Dr. Álvarez Teña interjected, "the most frequent accident encountered is a fracture of the ankle joint, or astragalus. Next most often encountered is a rib fracture. And occasionally we get the graver fractures of the cranium or columnar vertebrae." The relatively high frequency of fairly serious accidents, the doctors pointed out, is due to the fact that the charreadas—the exhibitions of riding skills the charros stage periodically and for which they tirelessly rehearse—are at least as dangerous to life and limb as the rodeos of U.S. cowboys. "The spectacular riding stunts the most adept charros practice include the Paso de la Muerte, or Pass of Death," Dr. Moreno Valle explained. "In this, a man leaps from one horse to another while both are galloping at top speed. Charros also mount and ride untamed, bucking steers, bareback, as do U.S. cowboys. However, they have one famous stunt which U.S. cowboys do not do. This is performed by the coleadero, or 'bull-tailer.' The horseman, while riding at top speed, seizes a bull by the tail—and by this throws him!" Membership of the Asociación Nacional de Charros is composed almost entirely of well-to-do, prominent Mexico City business and professional men, plus a considerable number of Army colonels and generals (and, often, their families)—nearly all of whom are as fanatically ardent fans and practitioners of their chosen amateur sport as you will find on any U.S. golf course. The Asociación owns an impressive clubhouse and riding arena, with a grandstand that can seat ten thousand spectators, in which its charros and charras (the latter

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mostly the wives and daughters of charros) take their riding lessons and rehearse and stage their spectacular charreadas, in the colorful costumes of bygone centuries. The complicated riding drills of the charros and charras (the girls all ride side-saddle), and the sensational stunting of the stellar performers, have brought such fame to this uniquely Mexican aggregation that, in the last few years, they have given highly applauded exhibitions in most Latin American capitals. And in the spring of 1964 they staged a series of charreadas in Spain that earned them the personally bestowed compliments of Generalissimo Francisco Franco. The charros originated in the sixteenth century, when New Spain's second viceroy amended an earlier decree forbidding the conquered indigenes to ride horses, to permit a few "civilized" Indian leaders to do so—providing they used not Spanish, but distinctively Mexican, saddles. Eventually, further relaxation of the decree enabled a rapidly growing new caste, the mestizo (mixed Spanish and Indian) rancheros, to obtain horses and develop their own riding style and garb. And they became known as charros. One historian relates that, as the mestizos prospered, in their attempts to outdo the Spaniards in riding skills and, especially, in the magnificence of their riding garb, "they bestowed so much of their wealth and love on their horses and clothing that their families often suffered from want and neglect." Which may have been truth or mere contemporary slander. In any event, today it is a fact that foreigners seeing a charreada are greatly impressed by the charros' and charras' splendid costumes. These are authentic replicas of those of the Colonial period—when Mexico's caballeros achieved an international reputation as dandies in an age when Europe's fops were at their most flamboyant. And even royalty has strutted in charro garb: "Mexico's Emperor Maximilian himself designed the all-black charro costume which the charros still use as acceptable attire for formal occasions," Dr. Moreno Valle pointed out. "It was one of the Emperor's favorite uniforms. He was very clothes-conscious." "And we have a photograph in the clubhouse of Spain's late King Alfonso XIII in charro costume," Dr. Álvarez Teña reminded. There are charro associations in many other cities and towns in Mexico which also count doctors among their members. The finest charro costumes are made, traditionally, from gamusa, or thick deerskin, and heavily embroidered with gold and silver

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thread. Spurs, and even the heels of boots, often are trimmed in silver and gold. Charros frequently spend as much as 30,000 pesos ($2,400 U.S.) on their outfits—including, of course, a gold- or silver-trimmed pistola and holster—plus, perhaps, another 30,000 pesos on a blooded horse. It would seem to be a hobby best suited to doctors with a wellestablished medical practice—who have a taste for hazardous sport. The Doctors Bullfight Sixty doctors of Querétaro—three-quarters of the medical fraternity of that central Mexican city of 100,000—cheered by five thousand enthusiastic paying customers, staged a bullfight at the local Plaza de Toros on Sunday, October 25, 1964, for the benefit of the city's Red Cross. This was not as unique an event as it may sound. It was the fiftieth annual such corrida de toros put on for charity by the Querétaro College of Medicine—whose membership includes physicians and surgeons, dentists and veterinarians. The unconventional spectacle—billed as the Tradicional Corrida del Médico—as in each previous year, was presented exclusively by the city's doctors. Doctors assumed all the roles—including those of matadores, rejoneadores, sobresalientes, picadores, banderilleros, tancredos, monosabios, and the cambiadores de suertes. Four of the city's female doctors served as bull-ring medicos, to attend to injuries sustained by their performing male colleagues. The only participants without a medical license were the bulls. Five bulls were killed—two so bravely and skillfully that the doctors-matadors were awarded the bulls' ears. Three performers—one doctor-matador and two doctors-banderilleros—were injured by the bulls, none seriously. The star of the day was young Dr. Francisco "Pancho" Rivera Α., who not long before returned to Querétaro with his wife and small son, Francisco IV, after a year of postgraduate study at the University of Pennsylvania Medical School, to join his father, Dr. Francisco Rivera G., in the latter's practice of otorhinolaryngology. Dr. Rivera suffered a minor injury: He was knocked down by the bull and his left knee grazed by the bull's horn before cambiadores de suertes ("changers of luck") managed to distract the animal with their capes. However, the young doctor turned in such a polished performance in working the bull—executing pasos por alto, rechazos,

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veronicas, etc.—and in finally making the kill that the judge, persuaded by the crowd's thunderous applause, awarded him not one, but two, of the animal's ears. And, smiling widely and holding up his trophies for all to see, while the band blared fortissimo and the crowd cheered and sailed hats, programs, and seat cushions into the ring in tribute, Doctor Rivera then was given the traditional vuelta al rueda, or triumphal tour of the ring. "It was a great surprise to me," Dr. Rivera afterward told the writer. "You see, this was my first public bullfight!" However, Dr. Rivera comes from a medical-bullfighter family. His father was a matador in three Corridas del Médico, killing his bull with honor in each—the last time in 1961, when he suffered minor injuries. A single ear was awarded to Dr. Miguel Hernández Frías, pediatrician, who had fought bulls in several previous Corridas del Médico and turned in a skillful performance. Dr. Hernández, who is inclined to obesity, kept the crowd laughing uproariously with his clowning— pretending, with an agonized grimace, that he had been unable to maneuver his considerable paunch quite out of the way of the horns, each time the bull charged past him in response to his capework. The most seriously injured performer was Dr. Jesús Cisneros, who, while serving as a banderillero and attempting to place a pair of banderillas in Dr. Rivera's bull, sustained a broken arm. The bull lunged, driving a banderilla intended for it into the doctor's left arm with such force it fractured the radius. (The accident might have been headlined, "Bull Successfully Implants Bullfighter's Own Weapon in Bullfighter!") Dr. Hugo Simroth became the third casualty of the day while performing, with four other doctors, as a tancredo. In this performance, occasionally presented as an entr'acte at bullfights, several bullfighters, equipped with neither sword nor cape, station themselves in the center of the ring, just before the gate is opened to release a fresh bull. When the bull, abruptly freed, catapults into the ring, he usually charges straight at these men, as the nearest objects on which to vent his rage. For each of the tancredos, it is a test of nerve not to be the first to break and run. Dr. Simroth demonstrated before the spectators that he had plenty of nerve, but at the cost of being knocked down and trampled. Luckily, several other doctors managed to quickly divert the bull from his victim.

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And as Dr. Juan Vera, a banderillero, later commented to the writer: "Also, fortunately, it was not a heavy bull!" The corrida was a great success from the start: that impressive moment when, as the band blared out the stirring "Virgen de la Macarena," Dr. Francisco Alcocer, traumatologist, who served as alguacil (the official who carries the symbolic key to the Plaza de Toros and cuts and presents the trophies the judge awards), mounted on his handsome thoroughbred, led the parade of sixty doctors into the bull ring for their formal salute to the judge, his aides, the twenty pretty doctors' daughters who presided as queens of the corrida and the five thousand spectators. Dr. Alcocer subsequently gave a solo performance which displayed his fine horsemanship when, as a rejoneador, or mounted bullfighter armed with a short spear, he managed to hurl three rejones into a bull while harrying it in an ever-tightening, racing circle in the ring— his well-controlled mount staying so close to the bull it often brushed the animal's lethal horns. "It was a very gratifying corrida," Dr. Alcocer summed up. "Especially when it's remembered that all our sixty performers are amateurs. For," he added with twinkling eyes, "bullfighting is not included in the curricula of Mexico's medical schools! "Many of our doctors enthusiastically participate each year even though they've had little experience in the tauromachian art and no longer are in the perfect physical trim of young professional bullfighters. They do so because the Doctors' Bullfight is staged to benefit medical institutions. "And this year," he disclosed with satisfaction, "the Doctors' Bullfight brought in a net profit of 18,000 pesos for the Querétaro Red Cross." One wonders in just how many other cities of the world one could find sixty doctors all willing to face a charging bull—for the Red Cross! Principal Sources Private interviews with officials and individual doctors concerned, and personal observations. The author's original articles for the Medical Tribune on the National Lottery, the National Pawnshop, the Bullfighters' Hospital, Tauromachian Surgery, the Charros, and the Doctors' Bullfight.

CHAPTER SEVENTEEN

The Status of Medicine in Mexico

What is the true status of medicine in Mexico today? What is the status of the medical profession? Of medical education? How close is the nation to achieving optimum-level public health? To what extent has medicine become socialized? And what "gaps" in the progress made in medicine and public health most urgently need attention? On the basis of U.S. standards (which do not necessarily apply to Mexico), Mexico still has less than half as many doctors, nurses, and hospital beds as it needs, particularly in isolated areas. But a number of quite spectacular advances were made, in assorted medical fields, during the 1958-1964 administration of President Adolfo López Mateos. We have already discussed many of these, such as the creation of potable water supplies and sanitary facilities in thousands of rural communities, and the progress in campaigns against important diseases. The advances included, in addition, a truly tremendous amount of construction—completion of the National Medical Center in the capital, and of new hospitals, clinics, and health centers the length and breadth of the land. They included further expansion of Mexico's admirable Social Security systems for industrial workers and government employes. They included the government-subsidized education of ever-increasing numbers of medical students. And they included important steps toward elevating the status, and the standards, of the medical profession. Although all of Mexico's problems in the foregoing areas are not

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yet resolved, progress generally has been rapid and impressive. In fact, in recent years, the rate of advance has been continually accelerated. Mexico's "Showplace" National Medical Center Mexico's National Medical Center, in mountain-ringed, mile-anda-half-high Mexico City, certainly ranks as one of the world's most notable centers for medical therapy and research. The Medical Center was designed and largely constructed by the Public Health Department. Subsequently it was turned over to the Mexican Social Security Institute (IMSS) to complete and operate— under a top policy decision involving a division of prime areas of operation. Located on four integrated square blocks not far from the heart of the city, the 600,000,000-peso National Medical Center comprises a complex of eighteen buildings of modern design, grouped about a huge cylindrical auditorium. (The façade of the latter is emblazoned with a stylized Mexican eagle, its wings protectively shielding a mother and infant. This is the official symbol of the Social Security Institute and, of course, was added by Social Security after the transfer. ) With its spacious encircling lounge, two large auditoriums, and a series of smaller meeting and conference rooms, all equipped for simultaneous translation of speakers' addresses into several languages, this great auditorium—in fortuitous combination with Mexico's famed climate and tourist attractions—lures to the Mexican capital numerous hemispheric and world medical congresses each year. The entire National Medical Center, set in sweeping lawns and flanked by modern sculpture and fountains, is architecturally attractive. Its buildings are austerely functional but distinguished by enormous murals and bas-relief panels. The paintings and sculptures are valued at several million dollars. Some of Mexico's world-famous artists were engaged for the project—including Diego Rivera and David Alfaro Siqueiros—and created immense dramatic murals depicting various aspects of the historic struggle of the physician against the diseases of mankind. Equipment in the Medical Center is of the most advanced type and includes costly betatrons and "cobalt bomb" apparatus for radiological treatment of cancer in the Oncological Hospital. There are also such special features as attractive day nurseries for the children of women receiving treatment.

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Facilities include 2,197 beds for patients, plus 688 beds for personnel; 67 laboratories; 43 classrooms; 55 X-ray rooms; 88 consulting rooms; 44 operating rooms; and closed-circuit television from operating rooms to classrooms. In addition, adjacent to the National Medical Center and swelling the total of medical facilities grouped in a single complex, are three autonomous medical units operating in the fields of both medical research and therapy: the Children's Hospital, the National Institute of Nutrition, and the world-famed National Institute of Cardiology. These are supervised not by the Public Health Department but by a special board headed by the Secretary of Public Health and Assistance. Social Security An account of Mexican medicine and its achievements would be incomplete without a bow to the impressive accomplishments of the nation's Social Security system. First set up in 1944, the system has kept pace with the phenomenally rapid industrialization of Mexico and, by December, 1964, covered 6,383,137 persons. This total included over 2,300,000 workers, and members of their families, who are equally insured. The system is under direction of the Mexican Institute of Social Security, whose head is appointed by the President of Mexico and is a member of his Cabinet. The annual costs of operations of Mexico's Social Security system are limited by the enabling law to a maximum equivalent of 12 percent of the total salaries of the insured workers. However, the workers bear only one-fourth of the cost. The government bears another fourth, and the employers, the remaining half. Most other Latin American countries are modeling their Social Security systems on Mexico's. The Mexican system is actually one of the most advanced in the world. For the services it provides for its insured members and their families literally do protect them "from the cradle to the grave." The benefits provided for insured workers and their families (which may include a worker's spouse, children, parents, and brothers or sisters living in the same household) embrace prenatal, obstetrical, and postnatal care; all needed medical, surgical, hospital, and pharmaceutical services for every type of illness or accident; pediatric attention; preventive medicine; benefits for chronic invalidism; and,

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finally, old-age pensions, burial expenses, and survivors' benefits. This broad spectrum of services and benefits is handled by the Mexican Institute of Social Security—the Instituto Mexicano de Seguro Social, or IMSS—in a far-flung and costly network of wellequipped special hospitals and clinics, pharmacies, and other facilities, which the Institute has built, principally within the last few years. The impressive physical equipment of IMSS—each unit identified by its familiar symbol of mother, baby, and protective Aztec eagle— ranges from the world-renowned National Medical Center in the capital to scores of hospitals throughout the Republic in cities and towns that have one or more industries. During the administration of President Adolfo López Mateos (1958-1964), Social Security built 261 new hospitals and clinics with a combined capacity of 7,000 beds. And, at the close of 1964, its constantly expanding facilities covered 510 municipalities. According to Dr. Luis Méndez, Undersecretary and Medical Director, the Institute of Social Security then operated 157 hospitals and 600 clinics with a total of approximately 14,000 beds—and employs, on a full or part-time basis, 4,275 doctors. "In Mexico City," Dr. Méndez said, "approximately 25 percent of the population (of approximately 6,000,000) are covered by Social Security. In other of the nation's larger cities, the percentage varies from 10 to 20 percent." The nation's government employes are not included in the regular Social Security system. Government employes, including employes of the government-operated National Railways and the National Petroleum Industry, instead are covered by a separate Social Security system, the Institute of Security and Social Services of the Workers of the State, or ISSSTE. "The ISSSTE system," Dr. Méndez noted, "employs 1,641 more doctors." In addition to medical services, in pursuance of its objective of advancing its members' social welfare, Social Security has built for them a number of impressive, low-cost, nonprofit housing developments. One of these, for example, the Unidad Independencia, recently constructed by IMSS on the western outskirts of Mexico City, is a magnificent, parklike housing development of several square miles in area, including scores of apartment houses separated by am-

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ple expanses of rolling lawns shaded by centuries-old trees. The selfsufficient unit has its own medical clinic with beds, primary schools, supermarket, movie theater, an outdoor theater for amateur productions, billiard rooms, bowling alleys, basketball courts, swimming pools, and numerous play areas for children. The very attractive, modernistic apartments are rented to members of the Social Security system at the basic monthly rate of only seven dollars a room. What Mexicans get in return for the 3 percent Social Security deduction from their paychecks is incomparably more than what workers in the United States get in return for a deduction from their paychecks that, although figured at nearly the same rate, amounts to considerably more money. Proportionately, Mexico's Social Security systems cover far fewer persons than does the U.S. system. Since Mexico's systems principally cover workers in industry and the government, their operations have been restricted largely to the cities and larger towns. With a single exception, IMSS has not yet attempted to insure agricultural workers. That one exception is workers in the sugar-cane growing and processing industry, for which it set up a separate unit not long ago. The sugar-cane industry is one area in agriculture that is more integrated than most and therefore better suited for application of Social Security principles. IMSS also currently is organizing a separate Social Security unit for members of the nation's armed services and their families. Summing up, the Social Security systems' fields of operations to date cover Mexico's better-paid urban workers in industry and government—a large segment of the nation's fast-growing middle class and lower middle class. This leaves as the chief field of operations for the Public Health Department all those groups not covered by Social Security: the inhabitants of villages and settlements which lack a single industry; the widely scattered, and generally poor, small farmers and ranchers and agricultural workers; the workers in mining, fishing, and timber industries; the various tribes of primitive indigenes, usually living in wretched poverty in relatively inaccessible regions; plus, of course, the cities' unemployed and workers of the lowest economic level, including most service workers.

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Installations

The Department of Public Health and Assistance in 1958 launched a program to raise drastically rural sanitation and health standards. Under this program, it expanded public health services to the point where, in just the first four years, these were available to nearly all rural-area Mexicans—to 18,314,973 persons, or 49.3 percent of the nation's population. By the end of 1964 the Department had constructed the following impressive total of new Public Health facilities: 430 741 118 33 29 5 6 6 1 5 31 38 5 5

Rural Health Centers Rural Health Centers with outpatient services Urban Health Centers with outpatient services Zone Hospitals Regional Hospitals General Hospitals Pediatric Hospitals Mental Institutions Neurological Hospital Pneumological Hospitals Pneumological Services Neurological Services Oncological Services Dermatological Services

And, in addition: 97 39 460 2 692 620 29 10

Urban Social Welfare Centers Rural Social Welfare Centers Mobile Medical Land Units Mobile Medical River Units Water Works Water Supply Services Children's Nurseries Ejidal Centers (and major work in 183 others)

During the six-year period, a total of 2,037 facilities were built, 211 of them in 1964. And the number of hospital beds in Public Health Department installations was increased from 48,150 to 68,000. In discussing this impressive total of construction projects, Public Health Secretary Amézquita pointed out:

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"Concurrently, we set up an integrated training program, to insure that our Public Health standards would be maintained in new units. "We established a new School for Hospital Administrators, in which a two-year course prepares young doctors to become hospital directors. "We also founded a School of Public Health, in which we train physicians, nurses, nutritionists, sanitary engineers, and special workers. "And we have eleven training stations throughout the Republic for practical nurses, technicians, and social and sanitation workers. "A total of sixteen thousand Mexican youths are receiving special training in various community centers to equip them to serve as auxiliaries to our Public Health doctors, nurses, and technicians, in carrying out Public Health sanitation campaigns." Private Hospitals In the early 1960's, Mexico also enjoyed a building boom in private hospitals: By 1963 (the last year for which statistics were available) this had produced 29 new private hospitals, with 6,694 beds—increasing the nation's total of private hospitals to 840 and privatehospital beds to 29,040. In addition, an even greater number of old private hospitals were razed and replaced with larger structures. Aside from the American-British-Cowdray Hospital, the Spanish Hospital, and the French Hospital, originally built and operated by "foreign-colony" residents in the capital, the majority of private hospitals are doctor-owned and built, or rebuilt, without outside financing. Exemplifying the varied facilities of these small private institutions, which cater to the upper- and middle-income classes, are Mexico City's new Hospital Londres and new Hospital Dalinde. The 140-bed (with ten 6-bed wards) Hospital Londres, a general hospital and clinic built and operated by Dr. Fernando Molina Font and his eldest son, Dr. Olegario Molina Montes, cost $1,200,000 (U.S.), plus $480,000 for equipment. It has six operating rooms, a resident staff of 20 doctors and interns, 100 associated doctors, 150 nurses, and 15 Catholic nuns as supervisors. It specializes in contracting with banks and credit institutions for group medical care for their employes. Dr. Molina Font pioneered in the field of private group medical care and built his first hospital in 1936, eight years before the Mexi-

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can government launched its comprehensive Social Security system. Although Social Security provides medical care and hospitalization for all Mexican industrial and business employes, to date the government has allowed banks and credit institutions (and also General Motors Corporation) to opt for medical care at Hospital Londres. Hospital Londres charges each client company a fixed monthly fee per employe (and, if desired, his dependents). The monthly rate is $1.60 (U.S.) per person for a company with one thousand potential patients; it can be as low as 80 cents per person for a company with ten thousand insured, and as high as $4.00 for one with ten or less. The medical-care contract covers check-ups, all types of surgery, outpatient services with specialists, X rays, laboratory analyses, and other services. Drugs, hospitalization, and obstetrical services involve additional charges paid by the contracting company, but at minimum rates: $3.60 daily for a ward bed; $48.00 to $60.00 for an obstetrical case. For a private hospital room, $4.00 to $16.00 additional per day is charged the individual; for an executive's suite, $24.00 per day additional. The Hospital Londres currently has contracts with one hundred companies, covering thirty thousand persons. Company contracts represent 70 percent of its business; the other 30 percent is with private patients. It provides an average two hundred medical services daily. Dr. Olegario Molina Montes, the medical director, commented: "Bank employes constitute less insurance risk than industrial employes. However, bank employes have a high rate of psychosomatic illnesses, perhaps because, as white-collar workers with modest salaries, they worry too much about 'keeping up with the Garcías.' Sixty percent of our patients' illnesses involve a psychosomatic factor." In contrast to the strictly functional Hospital Londres is the plush Hospital Dalinde—with fifty private rooms, 110 employes including 10 staff doctors, and 40 associated doctors—owned and operated by Dr. Mario González Ulloa, an internationally known plastic surgeon. This hospital specializes in reconstructive and esthetic surgery, in luxurious surroundings. " O u r purpose," Dr. Ulloa explained, "is to blend art and the sciences, to make a hospital a place not merely to re-establish health but to give the patient a psychological boost."

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The physical plant suggests to patients that they have checked in not for surgery but for a vacation in a luxury hotel. The hospital boasts elegant "decorator's" furnishings, modern sculpture, and an eighth-floor lounge adjoining a roof garden, complete with palm trees, plashing fountain, and reflecting pools. Each patient's room has original oil paintings, a picture-window wall, a planter garden, and piped-in music. Patients have their choice of menus, and, in some cases, of wines. Motion pictures are shown nightly. Convalescents are provided expert instruction in painting, ceramics, chess, musical composition, even amateur theatrics. Private rooms here cost $15 to $18 (U.S.) a day. Surgical fees are tailored to a patient's means—and patients range from multimillionaires' wives who pay handsomely for total face and torso rejuvenation to young men and women who pay only very modest fees for correction of some handicapping facial deformity. And surgery is performed entirely without charge upon any members of the city's Fire Department who become burn victims. Surgery performed at the Dalinde Hospital includes rhinoplasty, 1 profileplasty, wrinkle correction upon the entire face, breast corrections, belt lipectomy,2 digital reconstruction, and skin grafts and facial reconstruction for burn victims. The Mexican Medical Profession While the Mexican government has been providing more and better medical facilities and medical care for the general public, it simultaneously has been providing some important benefits for the nation's doctors. The education of all medical students is heavily subsidized by the federal government. All medical schools are operated and equipped by the government. And (whereas the cost to the medical student in the United States today is almost prohibitively high) the tuition charged Mexican medical students is so minimal as to be virtually free.3 The government pays medical-school graduates adequate compensation for their required six months' social service in rural areas. It also pays nominal salaries to those who choose to serve internships or residencies in government hospitals. 1 2 3

Plastic surgery on the nose. Surgical removal of excess fat. As will be detailed later in this chapter.

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After completing their education, nearly one-half of Mexico's licensed M.D.'s are employed by the federal government. (The National University Medical School alone employs one thousand doctors as full-time or part-time instructors.) This fact—coupled with all the benefits provided to worker-members by the Social Security systems and all the free medical and public health care supplied to the low-economic-level part of the population—would seem to indicate a high degree of socialized medicine. However, there are no government restrictions upon members of the medical profession in exclusively private practice. And even those doctors working full time for the government are free to (and frequently do) conduct a private practice on the side. The National Academy of Medicine No discussion of the Mexican medical profession would be complete without mention of the Mexican National Academy of Medicine. The National Academy of Medicine, founded in 1864, is the medical profession's most prestigious organization. Its membership always has been composed of the nation's most distinguished physicians. Today's Academicians include university presidents, medicalschool deans and department heads, and directors of hospitals, governmental departments, and research institutes. Qualifications for membership include the stipulation that a candidate must have had published a minimum of ten papers on medical research. The National Academy celebrated its centennial in 1964, in a week of meetings and special events at the National Medical Center in Mexico City. This Centenary Congress was attended not only by the nation's Academicians but by diplomats and doctors from sixty-one foreign countries. RX from the M.D.'s Although the status of medicine and of the medical profession in Mexico has improved amazingly in recent years, a few traumatic areas remain about which many members of the profession will expatiate passionately at the drop of a tongue depressor. One is the salaries paid M.D.'s by the Mexican government, which employs approximately half of the nation's doctors. Another is the high price of imported medical equipment.

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A third is a phenomenon from which the Mexican medical profession, in common with that of nearly all developing countries, long has suffered, and which in Mexico has been dubbed malinchismo or snobismo— At the beginning of 1964, 9,740 of Mexico's then 20,277 doctors were employed on a full-time basis by the Mexican government. Of these, 4,275 served in hospitals and other medical facilities of the Institute of Social Security (IMSS), which supplies all-inclusive medical services to most commercial and industrial employes and their families. Another 1,641 doctors were engaged similarly by the Institute of Security and Social Services of the Workers of the State (ISSSTE), which provides identical medical services to federal employes and their families. And an additional 3,824 doctors were employed by the Department of Public Health and Assistance (SSA), which, as earlier noted, besides conducting its nationwide campaigns to eradicate epidemic and endemic diseases and improve public sanitation, operates a widespread network of urban and rural clinics and hospitals to bring basic medical care to the nation's lowest economic classes, free of charge. Salaries paid doctors by these three governmental units range from 1,500 to 4,000 pesos a month. (With one peso worth eight U.S. cents, this is $120 to $320 a month.) The average doctor's salary in Social Security is 3,000 pesos monthly ($240), and in Public Health, 2,500 pesos ($200). Many members of the Mexican medical profession complain that these government salaries are too low and point out that some bus drivers and specialized factory workers are paid as much. "Even though Mexico is hardly one of the world's wealthiest countries, the government can afford to pay the medical profession better salaries," one doctor asserted. "In the annual budgets of both Social Security and Public Health, only 2 percent of their funds is allocated for doctors' salaries, while 50 percent is allocated for administration." Government spokesmen counter with the reminder that the average salary paid government-employed doctors nevertheless is greater than the average of all Mexico's doctors, which was recently estimated at 2,300 pesos a month ($184). (In small towns and rural areas, fees charged by doctors in private practice commonly are 10 pesos [80 cents U.S.] for an office call

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and 20 pesos [$1.60 U.S.] for a house call. This fee scale is higher in the cities, and in the nation's capital often ten times as high.) Government spokesmen also point out that, since the working day for most government doctors ends at 2:00 P.M., many augment their income by treating private patients after hours, usually in a consultorium attached to their home. Income from such private practice is estimated to average an additional 2,000 pesos monthly ($160). Despite dissatisfaction with salary scales, Mexican doctors eagerly seek government employment. There is a "waiting list" of between 3,000 and 4,000 doctors at both Social Security and Public Health. A number of the resident doctors and interns in Mexico City hospitals also have been dissatisfied with their pay and went on a sporadic, long-drawn-out strike in 1964 and 1965. Before the strike, they were being paid from 60 to 300 pesos ($4.80 to $24.00 U.S.) a week, plus meals and room. "Obviously, on such wages, none of us can marry unless his wife gets a job," striking interns pointed out. They demanded the government set a much higher pay scale and provide various fringe benefits, including Christmas bonuses. Government spokesmen, however, reminded strike leaders that internship and residency are a form of postgraduate study which the government hospitals already were subsidizing 100 percent, and that, because the government needed the money for other projects, it could not afford to pay young men and women any greater sums for going to school. (Minor concessions eventually were made in hospitals operated by the Public Health Department, Social Security, and ISSSTE.) The strike received little public support and much criticism. Typical newspaper editorial comment appeared in the News, Mexico City's English-language daily: Observing that unmarried interns do not do so badly under existing financial arrangements, the newspaper suggested that in the future hospitals employ only unmarried interns and require they remain single during their service. It added tartly: As for those already wed who cannot live on what they earn, there is a solution: The Public Health Department reportedly has a number of vacancies in remote parts of the country. Strikers could be offered these jobs. The pay is higher, and money goes a lot farther in places where there is nothing to spend it on.

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Mexican doctors do not have to serve as interns or residents. Following graduation from a school of medicine and completion of their six months of social service (for which they are fairly well paid), they are free to practice medicine anywhere in Mexico. Nevertheless, the majority, not attracted by the role of a G.P. in the boondocks or elsewhere, for years instead have sought the internships and residencies always available in the fast-growing big complex of government hospitals in Mexico City, with the objective of there studying further, becoming specialists, and subsequently establishing a big-city practice in their specialty. In fact, although Mexico City's population is less than one-sixth of the nation's 40,000,000, more than half of the nation's over 21,000 doctors live in the capital. As a consequence, the capital actually has a surplus of doctors. Many barely eke out a living. In contrast, the rural areas always have suffered from a scarcity of doctors. As earlier emphasized, thousands of tiny villages still are dependent for medical attention upon the dubious services of the curanderos, untrained quack-curers, who in many cases also serve as witch doctors. The reluctance of doctors to leave the big cities and go out to practice their profession in the rural areas is a long-standing, basic medical problem, which Mexico has in common with all other Latin American countries. The Mexican government for many years has tried, by various methods, to level off somewhat the big differential between the urban and rural doctor-patient ratios (1:500 vs. 1:3,000): To create more M.D.'s, tuition at the National University's Medical School is virtually free. Students at the National Polytechnical Institute's School of Rural Medicine get not only free tuition but free board and room, in exchange for a (nonenforceable) promise to spend at least their first two years of private practice in rural areas. And, as earlier discussed, the government requires all medicalschool graduates to spend six months in social service—working with Public Health Department units in rural areas—before granting thenlicense to practice. This requirement soon will be increased to a full year, which will enable the social service activities to be extended to twice as many rural areas as presently are served. A chronic complaint of Mexican doctors in private practice is the

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almost prohibitively high cost of foreign-made medical equipment. "Medical equipment that costs, for example, $5,000 in the United States," several physicians declared, "invariably costs at least $11,000 in Mexico, when all the required import duties, special permits, shipping costs, etc., are added up." Perhaps the most bitter complaint of Mexican doctors, particularly those who do not work for the government and who rely for their livelihood entirely on private practice, is what aptly has been labeled snobismo or malinchismo—the former term Mexicanized from the English word "snob," and the latter derived from "Malinche," the name of the Indian maid who became the mistress of the Spanish adventurer Hernán Cortés, and, abandoning her own people, willingly helped him to conquer her country. A leading Mexico City surgeon defined the phenomenon as: "The conviction, among many well-to-do Mexicans, that anything foreign—including doctors and all medical facilities—necessarily is superior to its Mexican counterpart." As several prominent Mexico City physicians explained: "Eighty percent of the people obtain all their medical care from either Social Security, the Federal Workers' unit or the Public Health Department. And, of those who remain, the wealthy who need medical care almost invariably hop onto a plane for Houston, Los Angeles, or Rochester, Minnesota. . . . As a result, we Mexican doctors in private practice are almost totally restricted to a tiny minority of the middle-class population." However, it is only in the nation's capital that the proportion of the population that receives its medical care from government institutions approximates 80 percent. Elsewhere government coverage is far less extensive, and private practitioners have a proportionately larger field. And a medical career continues to be the most highly desired and sought after. The nation's medical schools are packed with eager students. Elevating Medical Standards Mexico's medical leaders recently launched a campaign to improve the standard of medicine practiced in their country, which increasingly is becoming the medical model for Latin America. The program has three principal goals:

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1) To raise the scholastic standards of medical schools 2) To provide Mexico with more medical specialists and generally to enrich and improve the medical knowledge of doctors who have been practicing for years 3) To raise the standards of the nation's hospitals and better prepare them for medical teaching. The program was blueprinted and is headed by Dr. Ignacio Ch-vez, rector of Mexico's National University since 1961.4 Previously, Dr. Chávez was founder, and for seventeen years director, of Mexico's world-famed National Institute of Cardiology. He has been assisted in the campaign's direction by Dr. Donato Alarcón, dean of the National University's Medical School; Dr. Luis Méndez, undersecretary and medical director of the National Institute of Social Security; and Dr. Bernardo Sepúlveda, director of Postgraduate Education at the National University's Medical School and chief of the Department of Medical Planning of the National Institute of Social Security. "Our program is based," Dr. Chávez explained, "on our conviction that our duty to our medical students does not end with their graduation from medical school, and that all of our citizens have a right to the same quality of medicine—the best quality available." He revealed that several other Latin American countries—Venezuela, Brazil, Argentina, and Peru—have launched similar programs, modeled on that of Mexico. These, however, still are largely in the planning stage. The Rector pointed out that Mexico, with a population of 40,000,000, was entering 1965 with nearly 22,000 doctors—one to every 1,800 persons. "This is a relatively high ratio," he noted. "Certainly it is higher than elsewhere in Latin America. However, while in some cities, and in some hospitals, the medicine practiced is modern and of high quality, in others, it is very old-fashioned. "The scholastic standards of our medical schools also vary greatly. And, while some hospitals, particularly those operated by the Institute of Social Security, are adequately financed, the majority are woefully under-financed and lack much necessary modern equipment." 4 Dr. Chávez continued as rector of the National University until his resignation from that post in 1966.

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The first and most important goal of the new program is to elevate scholastic standards in the National University's Medical School and, by example, in the other medical schools throughout the country. In this, Dr. Chávez is directly assisted by the University Medical School dean, Dr. Alarcón. "We are overhauling, improving, and enlarging the University Medical School's teaching staff," Dr. Chávez explained. "We are greatly increasing the total of our laboratory equipment, and we are altering our curriculum to place more emphasis on the objective teaching of medicine in the hospitals. At the same time, we are raising entrance requirements and insisting on a greater background in basic sciences." ("Left-handed" tribute subsequently was paid to Dr. Chávez' zeal for higher scholastic standards when National University students staged campus demonstrations to protest his more drastic rules to shake out slackers. In Mexico, as elsewhere in Latin America, student demonstrations ordinarily are staged only as a kite tail to some current domestic or international political controversy.) Dr. Alarcón, a thoracic specialist who has been a faculty member of the University for thirty-five years, pointed out that the program to upgrade medical standards in Mexico continues to be impeded by several peculiarly Mexican problems: "Largely because tuition in the University Medical School is virtually free, we have the largest medical-school student body in the world—eight thousand students. And most of our problems stem from this fact. "It obliges us to have a Medical School faculty of one thousand full-time and part-time teachers. And because of their unusually large number, our faculty members unavoidably are badly underpaid. A doctor who teaches a class three times a week receives the equivalent of $60 [U.S. currency] a month. Full-time professors in the basic sciences get $500 monthly. "In fact, whereas it costs an average $46,000 to educate a doctor in the United States, our budget limits us to spending just $2,500 to do the job. "And another uniquely Mexican problem that handicaps our efforts to raise medical standards," Dr. Alarcón explained wryly, "is the result of the superior potentiality for earning a living in the medical field in the United States. "Each year, several hundred of our average of eight hundred Na-

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tional University Medical School graduates serve their internships in the U.S. And an average of one hundred per year never return to Mexico." Considerable progress already has been made, Dr. Chávez said, toward achieving the program's second goal: providing the nation with more medical specialists and modernizing the medical education of doctors who have been practicing for years. Dr. Sepúlveda is directly in charge of this sector of the program. "For this," Dr. Chávez explained, "we have set up a program of medical education on three levels: For doctors who merely want to keep up with new developments in medicine, we are offering short refresher courses, plus symposiums, on new subjects and particularly on those medical concepts which have undergone the greatest recent changes. "On the second level, there is the program aimed at developing more qualified specialists in the various medical fields. "On the third level, we are offering long, intensive postgraduate courses leading to the degrees of Master and Doctor of the Medical Sciences, as preparation for teaching or research positions in the medical field." Dr. Chávez revealed that most of the above projects already are functioning, "although a few lacunae still exist." Dr. Sepúlveda noted that, under the program's plan for developing more Mexican medical specialists, certification of the specialists, upon completion of their one-, two-, or three-year postgraduate courses, will be by the National University Medical School. "From the professional standpoint, this is a departure," he said. "However, we are convinced that only by insisting upon such qualification by the Medical School can we maintain the standards of the various medical specialties at the superior levels we desire." He noted that, for some years, postgraduate specialty courses have been given at Mexico's National Institute of Cardiology, National Institute of Nutrition, and Children's Hospital. Many of the outstanding medical specialists in other Latin American countries have received their postgraduate training at one of these three institutions. In fact, Dr. Sepúlveda emphasized, more than three hundred of the leading cardiologists in other Latin American countries received their postgraduate training at Mexico's National Institute of Cardiology.

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"Now we are offering similar postgraduate courses in all the other fields of medical specialization, as well," he said. "Currently, largest enrollments for postgraduate courses are in applied radiology, ophthalmology, and laboratory research." As to the program's third goal—raising the standards of the nation's hospitals and better preparing them for medical teaching— Dr. Chávez said that one still unsolved problem is the lack of sufficient opportunity for medical students to receive objective instruction in hospitals: "We to date have no university hospital for standard hospital teaching. The Institute of Social Security until now has granted our students only very limited access to its hospitals. This is a heavily felt hardship because its hospitals are the nation's best equipped. However, we are seeking government action to permit medical students access to all hospitals. "When and if this is obtained, we will need to standardize all the hospitals' laboratories, libraries, patient files, the setting up of lecture rooms, internships, methods of study, etc. We should thereby raise the standards of most hospitals." Mexico's Medical Schools The National University's Medical School, the world's largest, dominates medical education in Mexico. Situated on the outskirts of Mexico City among the spectacular muraled exteriors of ultramodern University City, the National University Medical School has an enrollment of eight thousand and graduates an average eight hundred doctors annually. (The country's twenty other medical schools—those at the National Polytechnical Institute, the National Military College, and the various state universities—combined, graduate an average of only three hundred doctors a year.) The National University Medical School's freshman class, in fact, increased annually to the point where nearly seven thousand new students were enrolling each year. In the fall of 1963, to prevent further overtaxing of facilities, the Dean stiffened entrance requirements and restricted new enrollment to students from the Federal District. All others were advised to enroll in their state medical schools. The National University Medical School nevertheless is educating not only Mexican doctors but the future medical leaders of many

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other Latin American nations. Approximately 10 percent of its huge student body comes from elsewhere in Latin America, chiefly the Central American and Caribbean countries. It also averages about twenty students from the United States. Tuition at the National University Medical School is astonishingly low: 200 pesos ($16 U.S.) annually for Mexicans, and 2,500 pesos ($200 U.S.) for foreigners. In addition to carrying out the recently launched program to elevate its standards, the National University Medical School plans to greatly expand its facilities, in the immediate future. Medical-School

Expansions

In a move to forestall the ever-escalating shortage of medical doctors foreseen as a result of Mexico's enormous annual population increase, the National University is building a second medical school, which will raise its student capacity (already the world's largest) by 50 percent. The new Medical School will offer a shorter, intensified curriculum —one of four years, in contrast to the five-year curriculum of the National University's present Medical School. Dr. Donato G. Alarcón, director of Postgraduate Education at the National University Medical School, disclosed the plans. Construction will follow the modern trend in medical schools: The school and a one-thousand-bed university hospital, for training purposes, will be built as a single, integrated architectural unit. At the same time, a second one-thousand-bed university hospital will be built adjacent to the present Medical School, to serve as a training ground for its students. "The present Medical School long has suffered from the lack of a university hospital," Dr. Alarcón pointed out. "Our students now get their training in various hospitals throughout the capital, principally those operated by IMSS, the national Social Security organization, and those of ISSSTE, the national federation of federal employes unions. However, this arrangement has resulted in recurrent friction between the respective authorities involved and is far from ideal for other reasons—such as the considerable distance between the hospitals and the Medical School." The new Medical School and the two one-thousand-bed university hospitals together are expected to cost 300 million pesos, which, as Dr. Alarcón emphasized, because of lower labor and other costs in

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Mexico, is comparable to a $50 million project in the United States. The site for the National University's new, or auxiliary, Medical School and hospital had not been selected as this is written. However, Dr. Alarcón said it would constitute a second campus to be established by the National University—either within the extensive boundaries of the autonomous University City, or in the same general area of the southern outskirts of the capital. Although Mexico's National University, with a student body totaling eighty thousand, already is one of the world's largest, the nation's population explosion has resulted in most of its colleges presently suffering severely from overcrowding. (The new Medical School and hospital will be the initial construction project on the second campus, but their construction will be soon followed by the building there also of second Commerce, Biochemistry, and Veterinary Schools.) "Mexico today has a population of approximately 40 million and an annual population increase of 3.5 percent," Dr. Alarcón noted. "Currently, our population is mounting by 1,200,000 annually. Well have a population of over 50 million by 1970. "Reduction of the national annual mortality rate—through the wholesale introduction of antibiotics and improved public health facilities—is, of course, principally responsible. "And there is no diminishing of the rate of this population explosion to be foreseen in the near future. For the vast majority of our population is neither economically nor culturally ready for birth control. Most Mexican women have not yet attained the cultural level requisite for their being taught the effective use of diaphragms. And the cost of a daily birth control pill, in most cases, would be more than the woman spends on food. "Actually," he smiled, "to keep up with our population explosion, it looks as though we'll have to build an additional medical school every six years!" The University's projected new Medical School, which will have a capacity of 650 first-year students, is expected to graduate 400 and boost the annual national total of medical-school graduates in Mexico from 1,100 to 1,500. In addition to shortening the curriculum by one year, it is planned to inaugurate several new policies in the University's new Medical School. "With the overall aim of integrating the elective years with hospital

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work," Dr. Alarcón explained, "we will establish 'medical clerkships' for second-year students to early make them a part of the Tiospital machine' so that they can learn by observing—learn how to pass a catheter, for example. We plan to attach some pay to these medical clerkships. However, their principal value will be in building up the student's confidence. "Another new policy will be the early exposure of students to ambulatory as well as bed-ridden patients. We plan to handle 500 patients daily in the university hospital outpatient clinic, and here we will teach the second-year students, or medical clerks, how to distinguish between patients who can remain ambulatory, and those who should be placed in a hospital bed—as in cases of eye and skin diseases, streptococcus infections, tuberculosis, and diabetic conditions. "Thus we plan in our new Medical School, through these 'medical clerkships,'" Dr. Alarcón explained, "to begin the teaching of preventive medicine in the second year, rather than waiting until the fourth year. Today, too many students are taught only curative medicine until they reach their fourth year." In another novel policy, Dr. Alarcón said that, to try to cut down on the waste of school facilities and teaching personnel's time caused by "dropouts," it is planned also to inaugurate a program of having premedic students spend some time "auditing" such third-year medical-school classes as those in anatomy, physiology, chemistry, and hygiene. "Then, before they actually begin their medical studies, students will be able to find out if they really are temperamentally suited to a medical career, and capable of the work required," he pointed out. "However, even more important, the school thus can find out which of its premedic students are not fitted for a medical career—before years of teaching have been wasted on them." Dr. Alarcón said a selective policy will be followed in admission of patients to the University hospitals: Only patients will be admitted whose cases can contribute to the training of the medical students in what he describes as "the norms" of medical practice. "For example, we will not admit a cardiac patient who requires open-heart surgery," he said. "Such a case will be referred to a specialist. But a patient who has been stabbed in the heart will be admitted, since this constitutes an emergency every student should be taught to handle.

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"Similarly, we will admit cancer cases in which surgery is indicated, but we will refer elsewhere cases requiring Roentgen treatments. For we will use X ray at the University hospitals only for diagnosis. "And while we will admit a case with a brain abscess, in which a simple drainage technique is indicated, we will refer to specialists a brain tumor, or a case, interesting though it may be, requiring removal of an entire brain lobe. "We want to be the 'tops' in norms, but we will refer specialized work to the specialists." Dr. Alarcón said a complete department for teaching rehabilitation to surgical patients also is planned in the new medical school: "To teach patients how to walk again, how to use their hands again, following surgery, is very important." Better Nurses9 Schools Mexico currently needs 100 percent more registered nurses than it has. This shortage is largely due to the huge number of new hospitals, curity and the Federal Workers Social Security unit. Although many thousands of new nursing jobs thus have been created, facilities for the training of registered nurses have not begun to keep pace with the hospital expansion. Also, doctors blame the low wages paid graduate nurses for the fact that an overwhelming proportion of student nurses become disillusioned and drop out, long before their three-year training course ends. (The chief of staff of one of Mexico City's leading private hospitals disclosed that it is not unusual for a mere five or six young women to be graduated from a class in his hospital's training school which originally numbered up to two hundred. He said wages were 200 to 600 pesos a month [$16 to $48 U.S.] for ordinary duty nurses and no more than 1,500 pesos a month [$120 U.S.] for supervisors.) To make the nursing profession more attractive, the Public Health Department in 1964 carried out a nationwide survey of nurses, both registered and practical, to obtain information for a new program to improve and standardize educational requirements, wages, and workclinics, and rural health centers built by the Public Health Department in the last several years, and the many new hospitals and clinics constructed during the same period in urban centers by Social Se-

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ing hours and conditions, and to ascertain the present resources in equipment and teaching personnel of those hospitals operating nurses' schools, and their special needs. "There are approximately five thousand registered nurses in Mexico," Public Health Secretary Amézquita then disclosed. "And there are about six thousand midwives or practical nurses who have been qualified to work as auxiliary nurses, through completion of the Public Health Department's special one-year training course instituted for them. But Mexico needs far more registered nurses—at least five thousand more." The Secretary said that Mexico's eighty nurses' schools, most of which are affiliated with government-owned public hospitals, currently are graduating registered nurses after a three-year course, at the rate of approximately one thousand annually. He noted that around 5 percent of the nation's registered nurses are trained in nurses' schools operated by Roman Catholic nuns in government-owned hospitals in Guanajuato, Monterrey, Puebla, and Mexico City. "We don't need more nurses' schools, even though efforts currently are being made to open additional ones," Secretary Amézquita stressed. "Instead, the Public Health Department's program envisions fewer nurses' schools, but with higher standards." It was indicated that the Department of Public Health and Assistance planned to shut down those nurses' schools with the lowest standards, and to raise and equalize the standards of those remaining. The Social Conscience of Mexican Medicine Medicine stands in high repute in Mexico today. And this is due, in no small part, to the demonstrated social conscience of the medical profession, and of the government in its medical and public health role. The medical profession and the government have been working, jointly, with determination and dedication and often against almost insurmountable obstacles, toward a mutual goal—that of providing better health and a better level of life for all Mexicans. Mexico's medical activists already have come a long way along that road. President Adolfo López Mateos, in his sixth and final State of the Union address, stressed that Mexico's annual mortality rate for another year had continued its steady downward march:

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In 1958, the year before his Administration assumed direction of the Republic, the national mortality index stood at 12.52 per 1,000 population. By 1962, this had been reduced to 10.4, and, by 1963, to 10.1. In 1964, the Administration's final year, the mortality rate again dropped—to 9.2 per 1,000. At the same time, infant mortality declined from 81.52 per 1,000 in 1958 to 64.6 per 1,000 in 1964. And the average life expectancy rose to 64.5 years. President López Mateos credited these improvements to the aggressive campaigns carried out by the Department of Public Health and Assistance. He further emphasized: "The achievements in the field of health during this administration have modified the conditions of life which previously weighed down a great number of our people who lived in want, fear and ignorance. By coordinating efforts in national planning, we went far beyond preventive and curative medicine to a solution in improving basic surroundings." Principal Sources Statistics from the National Institute of Social Security. Statistics from the Public Health Department. Interviews with heads of private hospitals, leading doctors in private practice, the rector of the National University, heads of medical schools, etc.

CHAPTER EIGHTEEN

Medical Research and Discoveries

The goal of the world's developing countries at first necessarily is simply to catch up, as much as possible, with the world's already developed and industrialized nations. And this attempt to catch up is a tremendous task. Today's developing nations not only must bridge the gap of the advanced nations' head start of generations or centuries, but often must overcome far greater impediments than originally confronted the advanced nations: obstacles such as woefully inadequate financial resources in an age when astronomical sums seem prerequisite to national progress; a wide spectrum of tropical diseases that exact a high death rate and may totally bar development of large land areas; the debilitating effects of climate, diseases, and parasitic infestations, restricting the population's working capacity; the near starvation-level malnutrition of the majority; the predominance of illiteracy; the primitive tribal state of many of the population groups; the barrier posed by multiple indigenous languages; etc., etc. Mexico—despite having been plagued by virtually all these handicaps to some degree, and despite its relatively late start at modern development—after World War II became a very rapidly developing nation, with a sound, dynamic economy; involved not merely in economic progress but in seeking social justice for all its people. Moreover, Mexico no longer is exclusively engaged in catching up with the more advanced countries. In many ways, Mexico is fully their peer. For example, it already has advanced into the area of innovation—of research, discovery, and applied new techniques. This is particularly true in the medical field.

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There is the impressive research being conducted by the National Institute of Cardiology, the National Institute of Tropical Diseases, the National Children's Hospital, the National Polytechnical Institute's Center for Research and Advanced Studies, and also the discoveries or innovations of a number of individual Mexican doctors. Space will permit citing of only a few examples.1 Research at the National Institute of Cardiology The National Institute of Cardiology was established in 1944, during the administration of Mexico's President Manuel Ávila Camacho. By 1950, the Institute's facilities had become grossly inadequate, and Mexico's President Miguel Alemán launched a campaign to obtain private donations for expansion, which netted 5 million pesos. The physical expansion was completed in 1952. Visitors invariably pause to admire the huge Diego Rivera mural, which includes portraits of scores of pioneers in medicine, in the vestibule to the Institute auditorium. Mexico's National Institute of Cardiology is world famous for its research and innovations. One development for which it received a great deal of publicity and acclaim in recent years was a new therapy that has been experimentally demonstrated to be effective in heart infarcts2 and well may be of value in other cardiac disorders. The therapy is based on use of a "polarizing" solution to re-establish normality in injured and necrotic zones of acute infarction, in which, it is theorized, there exists a diastolic cellular depolarization. The new treatment was devised by Dr. Demetrio Sodi-Pallares, head of the Department of Electrocardiography of the Institute, and his co-workers (Drs. Bisteni, De Michelli, Medrano, Testelli, J. Ponce de León, and A. Oriol). The therapy essentially comprises the use of a solution—40 milliequivalents of KC1 and 20 units of regular insulin in one liter of 10 percent glucose in water—given by slow intravenous diffusion, at the rate of one liter per day for five days. 1

Nevertheless (as with the subject of tropical diseases, in Chapter Fifteen), in some instances technical data will be included as being of importance or special interest to members of the medical profession. 2 An infarct is an area of coagulation necrosis in a tissue that has been deprived of its blood supply by a clot in an artery. An infarct in the heart can cause sudden death.

MEDICINE IN MEXICO 276 The initial experiment for reduction of acute myocardial infarction was conducted with fifty cardiac patients chosen at random but meeting the following criteria: that the infarction from which they suffered was their first; that their electrocardiographic and clinical pictures were typical; that the infarctions were no more than five days old. Half the patients were given the "polarizing" solution for five consecutive days. The other twenty-five patients were used as controls. "Maximum improvement, as evaluated on the basis of ECG3 recovery, reduction in shock, angina, and arrhythmia, was achieved in an average 13 days among the treated group, as compared to an average 45 days among the controls," Dr. Sodi-Pallares reported. "We found a direct correlation in all cases between reduction of the injured area and employment of the 'polarizing' solution." He added that there was no appreciable difference between blood potassium levels prior to (4.2 mEq./L.), during (4.6 mEq./L.), and after (4.8 mEq./L.) therapy with the solution. Dr. Sodi-Pallares reported that, after the successful conclusion of the experiment, he and his associates theorized the same polarizing solution might be of benefit in many other cardiovascular diseases— particularly if the polarizing treatment were used in association with a sodium-free, or minimum-sodium, diet. For Dr. Sodi-Pallares and his collaborators long have been convinced that sodium is more harmful in heart diseases than cholesterol and other fats, and furthermore that the diuretics commonly employed to achieve soduim withdrawal are not wholly satisfactory. "Increasing evidence is being published," Dr. Sodi-Pallares pointed out, "that Κ depletion in the heart and other organs (both primary and secondary) may be a significant factor in maintaining or aggravating many heart disorders—such as heart failure, coronary insufficiency, hypersensitive heart disease, chronic cor pulmonale, myocarditis, digitalis and quinidine intoxication, overdoses of oral diuretics, various types of 'rebel' arrhythmias, etc. "In all such cardiovascular conditions, an 'isolated' potassium depletion is merely a simplified maimer of speech, since the entire electrolyte structure necessarily is altered when the concentration of one of its components is changed. According to what appears to be a general biological law, K1 (inside cell) loss by 'cellular damage' neces3

Electrocardiogram: a recording of the heart's electrical impulses.

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sarily is accompanied by a gain of Na, CI, and water. On the other hand, if the damage is reversible, an increased K1 must be followed by a loss of intracellular Na, CI, and water. Obviously, re-establishment of all transmembrane gradients can be obtained only if cellular metabolism also is improved. "It is our contention that cellular death cannot be conceived if the membrane can maintain a K 1 /K 0 (outside cell) ratio within certain limits. By the same reasoning, if intracellular concentration of Κ can be increased, the cellular function must be improved. "With this working hypothesis," Dr. Sodi-Pallares explained, "we have employed the polarizing glucose potassium insulin solution in cardiovascular conditions other than infarction—and our results have been most encouraging. Naturally, years of experimentation will be necessary to collect a statistically significant number of treated and control cases for all the aforementioned cardiovascular conditions. Nevertheless, our experiments represent a therapeutic approach at the transmembrane ionic equilibrium in normalcy and its alterations in disease." Dr. Sodi-Pallares eliminates salt entirely from the diets of his most severely ill heart patients. However, he permits some a half gram daily, others a gram daily, and the least sick a gram and a half daily. "We believe that sodium is a very aggressive ion, considerably more harmful to the heart than cholesterol," he said, re-emphasizing his basic postulate. Developments at the National Children's Hospital The National Children's Hospital, or Hospital Infantil, in Mexico City—although physically one of the least impressive of the nation's numerous medical institutions—has become so internationally famous in its fields of medical service, education, research, and preventive medicine that it is literally besieged with applications of medicalschool graduates from all over Latin America who want to serve their residencies in it. The unimposing and cramped quarters within which the hospital currently is conducting its almost incredibly numerous activities are due to a bit of hard luck. Established in 1943 by the federal government in a brand-new, handsome 525-bed hospital built expressly for it, together with an adjacent 120-bed maternity hospital (near the National Medical Center), the Children's Hospital was well set up until the earthquake

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of 1958. The quake caused such havoc with the hospital's foundations (fortunately, there were no fatalities) that it was necessary to evacuate the building, after which it was demolished. The hospital's badly shaken staff took over the maternity hospital and, by making use of every square inch, managed to transform its 120-bed capacity for mothers into a 325-bed capacity for children. Patients come mostly from the lower socioeconomic strata. Eighty percent are from Mexico City; the remaining 20 percent come from other parts of the Republic and from other Latin American countries. "We have just 25 beds for the private patients of our staff doctors, and the fees for these are very high," Dr. Lázaro Benavides, assistant director of the hospital, explained. "The overwhelming majority of our patients are children of the poor. "However, only 5 to 8 percent of our patients pay nothing, as we try to recover part of our costs from even our poor patients by charging whatever they are able to pay. We believe working with patients on a policy of mutual respect is preferable to a charity basis. Furthermore, our budget covers only two-thirds of our costs." Dr. Benavides, a graduate of Mexico's National University Medical School who did postgraduate work in public health at Tulane Medical School and was a resident at Chicago's Memorial Children's Hospital, pointed out that the Hospital Infantil is an autonomous institution, like Mexico's National University and the National Institutes of Cardiology, Nutrition, and Tropical Diseases. The Hospital Infantil is financed by the Department of Public Health and Assistance. It is governed by a board of trustees comprising the Public Health Secretary, the director of the hospital, and four prominent members of the city's business community appointed by the President of Mexico from nominees of the Public Health Secretary. Dr. Benavides noted that, since 1959, twelve new 100-bed children's hospitals have been built by the city government. "However, we have not lost patients. We are still considered the alma mater of pediatric services in the nation. We are always working at capacity, and we have a waiting list of two and three months in some specialized fields, such as orthopedics, neural surgery, and E.N.T. problems. We are handling 8,000 hospitalized children annually, and 120,000 outpatient consultations." He emphasized that the Hospital Infantil actually is a general hospital for the treatment and study of children's diseases. That is why

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it has all kinds of specialties, including prematurity, infectious diseases, hematology, nephrology, cardiology, urology, cardiovascular and general surgery, leukemia and cancer, etc. "We are best known, nationally and internationally, however," he said, "for our work on malnutrition, general surgery, and the treatment of diarrheas and renal diseases. This is a result of our continued research. "The patients in our hospital present special problems, since they come from the lower socioeconomic levels of not only this city but all parts of our country and foreign countries. Their problems must be studied with special relation to their environments. For example, most of our child patients are suffering from some degee of malnutrition, and their blood, electrolyte, and body compounds therefore differ somewhat from those of the normal children we read about in our textbooks. Because of their history of malnutrition, the treatment we give them when they come to us with diarrhea or another infectious disease cannot be the same as that recommended for, say, a normal child in the United States. "A one-year-old child who should weigh ten kilos, but only weighs six kilos, does not respond to the treatment recommended for normal children in the classical textbooks. "In addition to diarrhea—and, remember, gastroenteral infection is still the top killer in Mexico and all Latin America—we have much typhoid fever. And we have a higher incidence of prematurity in Mexico than in most countries. As a result, we have to study not only the clinical patterns of diseases, but also the social aspects favoring the appearance of such problems in our environment. And that is how the various research laboratories and departments in our hospital have been born." As this was written, the Hospital Infantil had twelve research departments. Two departments were studying malnutrition: One, investigating the clinical and biochemical aspects, was studying the effects of malnutrition on the central nervous system. The other, interested in the socioeconomic aspect, was working on the relative absorption of nitrogen in various foods. A third department, devoted to enteral infections, was studying the etiology of infectious diarrhea in relation to the viruses. A fourth, devoted to hematology, was studying hemophilia and the hematology of malnutrition. A fifth was working on cancers in children. A sixth department, devoted to immunochemis-

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try, was studying the nephrotic syndrome and experimenting with treatments with drugs such as Imeran. A seventh was working on the epidemiology of diarrhea. An eighth was working on the virology of encephalitis. A ninth, concerned with prematurity, was studying the acid base equilibrium in newborns and the oxygen capacity of newborns and prematures. A tenth was working with isotopes. An eleventh was working on protein transfers from mother to fetus and the metabolism of some bacterial antigens. And the twelfth was investigating thyroid problems in children in relation to the transfer of iodine and some congenital differences in thyroid hormones. (To further such research, the Hospital Infantil receives grants from the Rockefeller Foundation, the U.S. National Institutes of Health, the Academy of Science of New York, and various pharmaceutical companies.) In addition, virtually all of the hospital's clinicians and surgeons are working on some research project. Himself a specialist in infectious diseases, Dr. Benavides and several collaborators recently did considerable research on both measles and the Arbor viruses. "We developed a measles vaccine," he said. "However, a better one came out in the United States before we finished with our project, so we abandoned it.** Dr. Benavides, with Dr. José Sosa-Martínez and Dr. Jorge Hernández Rodríguez, in their research on measles, independently established that measles predisposed children to a large number of virulent sequelae diseases. They studied a group of 169 child patients, all from less than one to three years old, and all with a recent history of measles, who were suffering from a variety of subsequent complications, including bronchopneumonia (128 cases), gastroenteritis (67 cases), insufficient cardiac action (27 cases), and encephalitis (8 cases). The group as a whole had a mortality from the sequelae diseases of 14.2 percent. Dr. Benavides and Dr. Sosa-Martínez also collaborated on research on the Arbor viruses, specifically on their distribution in Mexico. "We found that in the southern part of Mexico and on both coasts there is a high incidence of persons who have been infected, principally with the tropical viruses, especially those common in Central and South America," Dr. Sosa-Martínez explained. "In some parts of Mexico, especially in the state of Nayarit on the Pacific coast, the incidence of infection reaches as high as 50 percent of the population.

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The clinical symptoms are not seen frequently, probably because the disease can easily be misdiagnosed as grippe, and the mortality rate apparently is very low. "A strain of Venezuelan equine virus widespread in South America recently was isolated in humans in Veracruz and Campeche, evidence that this virus strain is moving northward." The Hospital Infantil also conducts an extensive teaching program, in affiliation with the National University Medical School, for graduates, undergraduates, nurses, technicians, and rehabilitation personnel. Its classes for senior medical students in pediatrics and in infectious diseases total 150 students each. "Residents are taken for from one to five years," Dr. Sosa-Martínez noted. "The first year, they receive basic pediatric training, with emphasis on those fields so important to Mexico—nutrition, mental hygiene, preventive pediatrics, and pathology. Those who remain from two to five years go into the various specialties, including general and cardiovascular surgery, given the fourth and fifth years. "The hospital also provides two- and three-week refresher courses in the various specialties of pediatrics, for practicing pediatricians. "In addition, we have a program of education in basic hygiene for mothers—launched in 1964, as the result of a special study—that has spectacularly reduced recurrent infectious diarrhea among their children. The children previously were hospitalized an average two weeks with each infection—six or eight times a year. Of the 240 youngsters hospitalized for diarrhea during 1964 and whose mothers attended our classes, only two—less than one percent!—were rehospitalized for the same ailment. "We also have a large program of editorial activities," Dr. SosaMartínez pointed out. "We've published twelve books. Our medical bulletin, which is over twenty-two years old, is sent to all Latin American countries, the U.S., and England." When asked the long-range objectives of the Hospital Infantil, the doctor replied: "Although we already are, for all practical purposes, the Mexican National Institute of Pediatrics, we'd like to be so designated legally —as are the National Institutes of Cardiology, Nutrition, and Tropical Diseases. "And, naturally, we'd like to have a new 400-bed hospital, to re-

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place the one the earthquake wrecked—with adequate facilities for our research and teaching programs." The National Polytechnical Advanced Studies

Institute's

Center for Research and

The National Polytechnical Institute's Center for Research and Advanced Studies, besides providing training for masters' and doctors' degrees in the sciences, is inspiring solid achievements in scientific investigation—particularly in physiology and biochemistry. The Center, modeled on the Princeton (New Jersey) Center for Advanced Studies, is located on the Polytechnical Institute's spacious new main campus, on the mountain-flanked northeast outskirts of the capital. (The Polytechnical Institute now has a total of 80,000 students on its three campuses—an enrollment equaling that of its principal rival, the far older National University.) The Center for Research and Advanced Studies understandably has a small enrollment—currently about 150, principally from Mexico. It has a faculty of 70 full-time instructors, which gives it the phenomenal ratio of one instructor for every two students, approaching the Aristotelian ideal. Although, as part of the National Polytechnic Institute, it is financially supported by the Ministry of Education, much of its research funds comes from grants from public-spirited private citizens and from Mexican and U.S. foundations. It presently is receiving grants from the National Institutes of Health, Washington, D.C., and from the Ford Foundation. The Center has a program for exchange of faculty members with universities of other countries, for two- or three-month periods. It is headed by Dr. Arturo Rosenbleuth Stearns, a medical doctor and neural physiologist. He received his medical degree from the University of Paris, and, before being named to his present post in 1960, was for sixteen years chief of the Department of Physiology of Mexico's National Institute of Cardiology. Dr. Rosenblueth not only is an administrator but is known for his outstanding work in the field of neurological research and has published 149 scientific papers and three books on various subjects in this field. "Currently," he disclosed when interviewed, "my collaborators and I are investigating some of the electrical responses of the cerebral cortex, to learn more of how the cortex is organized."

283 Original research projects naturally are an integral and important part of the curriculum of the Center for Research and Advanced Studies. For example, Dr. Mario García Hernández, head of the Center's Department of Biochemistry, said that in his department 25 students currently are pursuing graduate studies—22 working for M.A.'s and three for Ph.D's—and that, under supervision of instructors, they are conducting six separate research projects: 1) Dr. Carlos Gitler and his student associates are studying the physical-chemical aspects of some of the enzymes in erythrocyte4 membranes, to learn more about the interaction between the protein molecules and the lipid matrix of that membrane. 2) Dr. Manuel B. Ortega's group is working on the mechanism of biosynthesis in vitamins, mainly nicotinic acid and biotin in microorganisms. 3) Dr. Jorge Cerbon is studying the organization of water in membranes. He has published several papers on his findings thus far. 4) Dr. Sara Eisenberg, who is interested in morphogenesis,5 recently began a study of the biochemical aspects of differentiation and regeneration of the lens of amphibian eyes. Before coming to Mexico, she worked in the United States with Dr. T. Yamada at the Oak Ridge Laboratories. 5) Dr. Victor Alemán, who is interested in neurochemistry, is studying qualitative and quantitative changes of some of the macromolecules in the central nervous system under visual and chemical stimuli. 6) Dr. García Hernández himself, with his student associates, is studying the organization of enzymes in the mitochondria.6 Dr. Juan Garczía Ramos, head of the Department of Physiology, revealed that his department presently has 11 postgraduate students, all similarly involved in research projects. Dr. García Ramos himself, with his associates, is studying "slowresponse phenomena—those with a time course of over one minute— induced in the cerebral cortex." He pointed out that: "In some normal subjects, when the cortex is occupied with the aforementioned slow-response phenomena, its sensory function is modified—sometimes to the extent of ignoring MEDICAL RESEARCH AND DISCOVERTES

4

Red blood cell. Evolution of structural organic types. Small granules or rod-shaped structures in the cytoplasm of cells, important in producing energy. 5

6

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electrical sensory signals. Some authors are convinced this is an abnormal reaction of the cortex. But we have found this reaction in normal subjects (cats, monkeys). "We are trying to learn if this slow-response phenomena may have a role in modulating the central nervous system's integration of information and response." Dr. Charles Edwards, of the University of Minnesota, currently on the faculty of the Center's Physiology Department under the exchange program, has as the subject of his group's research a study of the potentials of the skin of the frog and the ajolote, a lizardlike aquatic animal found in Mexico. "In the frog during its tadpole, or aquatic, stage, and in the ajolote during its entire life, the skin is an important organ, functioning as a kidney does in mammals," it was pointed out. "There is no change in the ajolote, since it remains aquatic. But when the frog becomes terrestrial, its skin loses this function, which is taken over by its newly formed kidneys." Dr. Edwards and associates seek to learn what causes the change in the frog's skin function. An interesting physiological research project that already has made considerable progress is being conducted by Mrs. Barbara Remolina, of Brooklyn, New York. (She and her husband, Dr. Joaquín Remolina, a Mexican medical doctor, both are working for their Ph.D.'s in physiology.) Mrs. Remolina is studying the chemoreceptors in the carotid body 7 to determine the mechanisms involved. She explained the study: "I am interested in the fact that the carotid body's chemoreceptor cells respond to very small changes in oxygen decrements in their regulatory function over respiration—yet at the same time apparently are extremely resistant to a lack of oxygen. For, when an animal is sacrificed and its brain dies within the usual four minutes, these chemoreceptor cells continue responding for a half hour. It is paradoxical that the carotid body, so sensitive that it responds to very tiny changes in oxygen tension, is able to withstand a lack of oxygen that would kill any other tissue quickly." Could a man whose pituitary gland has been excised be kept alive —even kept potent—by a bit of salivary gland transplanted at the 7 Small neurovascular structure at the bifurcation of the common carotid artery, in the neck.

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base of his brain? According to a doctor on the faculty of the Department of Physiology, it is very possible. Dr. Ramón Álvarez-Buylla has been working for seven years on what, at this writing, perhaps is the most advanced research project in the Department. A former pilot with the Spanish Loyalist air force, he came to Mexico in 1947 from the U.S.S.R., where he was educated as a medical doctor (University of Rostov) and a doctor of physiology and biophysics (Academy of Science of the U.S.S.R., Moscow). Dr. Álvarez-Buylla disclosed that he has demonstrated, through extended trials with dogs, that transplantation of a portion of the salivary gland as a substitute, following hypophysectomy, 8 maintains at a normal level almost all functions of the hypophysis cerebri. 9 In other words, that a transplant of part of a gland that simply produces saliva in the mouth can replace, and take over the complex regulatory functions of, the pituitary gland. Dr. Álvarez-Buylla explained his surprising findings in canines, and their significance, as follows: " W h e n the hypophysis is removed, experience shows that a dog will die within a few months. And, before death, a male dog's testicles will atrophy. "However, when a portion of the animal's salivary gland—in volume about twice the size of the excised hypophysis—is transplanted as a substitute, the dog retains at a normal level nearly all functions, including that of procreation. "We have demonstrated this in a total of thirty dogs, all of which have survived—with all body functions apparently unimpaired following the operation—for periods of up to seven years, to date." Dr. Álvarez-Buylla reported that one dog, a female, has survived seven years following hypophysectomy and the transplant; four dogs have survived the operation five years; and seven dogs have survived it by between two and three years. (All are living at this writing.) Furthermore, the doctor said, four male dogs who survived hypophysectomy and the transplant from two to four years each sired a litter of puppies with a normal female. He added that one male, which survived hypophysectomy and the transplant for four years, sired a 8

Surgical removal of the hypophysis, or pituitary. The pituitary gland, a very important endocrine gland, situated at the base of the brain. Its hormones regulate growth and the secretions of other endocrine glands, such as the adrenal, thyroid, and gonad. 9

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single puppy from the female that has survived the hypophysectomy and transplant for the record period of seven years. Dr. Álvarez-Buylla said he makes a temporoparietal surgical approach. "Evidently virtually all functions of the absent hypophysis are taken over by the salivary gland transplant," he reiterated. The doctor emphasized the potential value of his research in therapy for cancer of the hypophysis in humans. "Up until now," he pointed out, "when a human has a tumor of the hypophysis, a hypophysectomy ordinarily is performed and the patient subsequently is administered the different kinds of hormones he requires by injection. Despite that treatment, the hypophysectomized patient usually dies within a year after surgery." Dr. Álvarez-Buylla said he planned early clinical trials of his transplant procedure, in collaboration with one of Mexico's leading endocrinologists. Mexico's Cadaver Bone Bank Whether, as graft material for human patients, homogenous10 bone from cadaver or processed heterogenous11 bone provides the most effective substitute for the frequently unavailable fresh cancellous autogenous12 bone, often has been debated by doctors from various countries.13 Mexican orthopedists argue, on the basis of their years of clinical experience, that cadaver bone is the better substitute. Mexico is in the forefront in this area: It has one of the largest homogenous bone and tissue banks in the world. This is due principally to special enabling legislation, enacted a generation ago, which permits certain government hospitals in Mexico City to take bone and tissue from qualified cadavers and store this against the future surgical needs of both governmental and private physicians. The bone bank, established in 1947, is maintained at the Hospital Infantil and the Hospital Central Militar. The tissue bank, which stores arteries, cartilage, tendons, fascia lata, etc., and was started in 1957, is maintained at Hospital Dr. Rubén Leñaro. 10

Of the same species; in this case, human. Of another species; in this case, animal. 12 From the patient himself. 13 In the United States, processed calf or beef bone commonly is used as graft material in human patients. 11

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The bone and tissue are obtained from cadavers of persons between the ages of twenty and forty years, within six to seventy-two hours following traumatic death, and after standard tests have demonstrated freedom from syphilis, tuberculosis, virus diseases, and generalized cancer. Customarily about one-third of the skeleton is utilized. "After being cut into convenient lengths and sterilized, the material is preserved either by refrigeration or in solutions of merthiolate or paraphenol," Dr. Luis Sierra Rojas, chief of the Orthopedic Department of the Hospital Infantil, explained. "Bone has been stored, without deterioration, for as long as three years." On request, a segment of bone or tissue of the desired specifications is withdrawn from the bank of cadaver material, packed without refrigeration in a specially devised sterile double envelope of polyethylene, and mailed, free of charge, to a physician anywhere in the Republic or elsewhere. By mid-1964, 176 such requests had been filled by mail—including 12 from Cuba, 4 from Nicaragua, and 2 from Boston, Massachusetts. "Bone for grafts has been supplied from the bone bank to seventy Mexican surgeons for 2,650 operations," Dr. Sierra Rojas disclosed. "An analysis was made of the cases of 1,499 patients who were given cadaver bone implants. Of these, 1,104 received cadaver bone preserved solely by refrigeration; 204 received bone preserved at room temperature in an aqueous solution of paraphenol; 71 received bone preserved at room temperature in an aqueous solution of merthiolate. "The types of operations in which this cadaver bone from the bone bank was used varied widely: There were 78 cases of pseudoarthrodesis and osteoplasty, in which good results were obtained in 68 cases, or 87.1 percent. In 412 cases of arthrodesis, good results were obtained in 406, or 97.3 percent. And in 42 cases of osteosynthesis, good results were obtained in all 42, or 100 percent. "Nine bone grafts were kept under refrigeration between two and three years," he added, "and we subsequently obtained good results in all nine." Dr. Rafael Farrera Rojas, a colonel in the Mexican Army and chief of staff of the Orthopedic Department of the Hospital Central Militar, reported that, during the last fifteen years, orthopedic surgeons in the Army Hospital who employed cadaver bone utilized tibia, iliac, and rib bones, "from 15 to 20 centimeters in length and up to an inch thick," in transplants that were 95 percent successful.

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"And in 50 transplants of popliteal-femoral arteries, of from 25 to 30 centimeters in length, which were obtained from the bank of cadaver tissues, 80 percent of the operations were successful. "In approximately 100 operations in which cartilage from the cadaver tissue bank was used for implants in plastic surgery upon nose and chin, 80 percent were successful. "A rate of 80 percent of successful operations also was obtained," he said, "in 20 cases in which fascia lata from the cadaver tissue bank was utilized to reconstruct lateral and cross ligaments of an adult knee. "In 18 experimental operations in which cadaver tissue from the bank was used to attempt a reconstruction of the digital flexor tendons of the hand, 40 percent were successful." Dr. Enrique Suárez, orthopedic consultant to the Hospital de Nutrición, said that, while Mexican orthopedists agree that fresh cancellous autogenous bone is the best material for bone grafts, its rarity forces the utilization of a substitute material. "And homogenous bone from cadaver, stored in bone banks until needed, has proved the next best material for virtually any type of orthopedic operation." He noted that the technique of storing, and shipping, sterilized cadaver bone originated in Mexico. "Theoretically," he added, "bone graft material thus stored can last forever." Experiments with Influenza A The medical world currently is highly interested in the possibility that viruses may play a greater role than previously suspected in malformations of the human embryo. Mexican research is making original contributions in this area. For instance, a project at the National Institute of Cardiology has produced experimental findings that indicate Influenza A virus may be a cause of malformations in the human embryo. Dr. María Victoria de la Cruz, chief of the Department of Embryology of the Mexican National Institute of Cardiology, disclosed that experiments with chick embryos to determine what teratogenic 14 agents produce congenital heart disease and other malformations indicated Influenza A virus is a prime cause. "One of our most important findings," Dr. de la Cruz stressed, "was 14

Malformation-causing.

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that the teratogenic action of Influenza A virus occurs much earlier than had been presumed. In fact, it occurs at a period corresponding in humans to the third or fourth week of pregnancy—which may be before a woman has missed her first menstrual period and thus when she is completely unaware that she is pregnant." Dr. de la Cruz explained that Influenza A, rather than measles, had been chosen for the experiments because: (a) it is much more prevalent than measles, (b) it attacks persons of all ages, and (c) it can be contracted repeatedly. These factors, she pointed out, make it much more probable that a woman, early in pregnancy, will come in contact with Influenza A virus than with measles. In the experiment, 425 eggs, divided into four groups, simultaneously were incubated under optimal conditions. The first group, 105 eggs, was inoculated with Influenza A virus suspended in allantoic fluid and diluted in buffered saline (pH 7.2) to contain approximately 10 7 I D 5 0 per 0.05 ml. The second group, 108 eggs, was inoculated with the same strain of virus inactivated by heating in a 56° C. water bath for sixty minutes. The heat-inactivated virus lacked hemagglutinating ability when tested in the same way as the stock virus suspension, which showed it had lost its infectivity. The 107 eggs of the third group were inoculated with sterile allantoic fluid harvested after twelve days' incubation. A fourth group, 105 eggs, was inoculated with the buffered saline used as a diluent. A control group of 200 eggs was incubated at 37.65° C. with a constant humidity of 86 to 87 percent. "AH eggs were inoculated seventeen hours after the beginning of incubation," Dr. de la Cruz said. "A volume of 0.05 ml. was injected immediately beneath the blastoderm by introducing a 24-gauge needle through a puncture over the air chamber. "Incubated eggs were observed every two days, each time harvesting only dead embryos. The hearts were microdissected." Dr. de la Cruz noted that, in the control group of 200 eggs, 179 were fertile, and 50 of these died during incubation. Frequency of congenital heart disease among these dead embryos was 8 percent, and that of other malformations was 4 percent. "In contrast," the doctor said, "in the first group, of the 105 eggs inoculated with active Influenza A virus, 87 were fertile and 86 of these died shortly after the start of incubation. Frequency of heart disease in this group was 10.4 percent, a statistically insignificant dif-

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ference from the control group. However, malformations in other structures and systems were found in 34.88 percent of the embryos, a highly significant figure. Alterations included abnormal torsion of the body axis, microcrania, microcephaly, and other deformities of the nervous system and malformations of ears and eyes. More than half of the total altered had complete loss of normal morphology. "In the second group—108 eggs inoculated with heat-inactivated virus—101 were fertile and 88 died. The mortality distribution during incubation was similar to that under optimal conditions, but the mortality figure was significantly different. And the frequency of heart disease was 36.3 percent. Types found were: interventricular septal defect, 10.2 percent; valvular disease, 14.8 percent; other malformations, 11.3 percent. "The statistical significance of the finding of interventricular septal effect and of valvular disease is obvious, since neither of these lesions was found in the control group. Valvular disease was predominantly stenosis of the pulmonary artery (11 cases); two cases showed thickening of the mitral valve. In two cases pulmonary artery stenosis and interventricular septal defect were associated and the anatomy of the heart was similar to that in patients with Fallot's tetralogy." Malformations of other structures and systems were found in 14.77 percent of the embryos in this same group. In the third group—107 eggs inoculated with allantoic fluid—87 were fertile and 61 died. Again, the mortality distribution was virtually normal, although the mortality figure was significantly higher. "In this group," Dr. de la Cruz said, "heart disease was present in 49.2 percent of the embryos. Interventricular septal defect was found in 21.3 percent of the embryos; valvular disease in 19.6 percent; other malformations, 8.3 percent. Thickening of the mitral valve was seen in seven cases and pulmonary stenosis in five. Two of the latter cases also had ventricular septal defects and the Fallot-like morphology. Malformations of other structures were present in 13.11 percent. "In the fourth group, of 105 eggs inoculated with buffered saline," the doctor said, "70 were fertile and 56 of these died. Mortality distribution was approximately the same as in the group inoculated with inactivated virus. The mortality figure was significantly higher than the group incubated under optimal conditions. Interventricular septal defects and valvular disease were not found in this group. And other cardiac abnormalities were found in only 3.6 percent of the embryos, a figure even lower than in the control group. Malformations of other

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organs, however, were found in 28.6 percent, a significantly higher frequency than under optimal conditions." Dr. de la Cruz noted that the Influenza A live virus killed the embryo before the heart had developed to a recognizable stage (which occurs between nineteen and twenty-two hours after incubation starts), so it was impossible to determine if it caused cardiac malformations. However, the live virus did produce severe malformations of the central nervous system and general body morphology, including significant morphological changes in the "cardiac area"— where the heart would have developed had the embryo survived a few hours longer. And allantoic fluid produced congenital heart malformations. "The possibility that inoculation trauma (as in the experiment with allantoic fluid) caused the heart malformations was ruled out," Dr. de la Cruz said, "after inoculation of saline fluid did not produce heart malformations." Dr. de la Cruz next is attempting to determine what part of the allantoic fluid produces the cardiac malformations. She is also conducting an experiment to determine the effect during incubation of high and low temperatures—comparable to those induced in the alternating fevers and chills of virus infections—in causing congenital heart malformations in chick embryos. "Thus far, it's been observed that low temperatures during incubation produce interventricular defects," Dr. de la Cruz said. "And that high temperatures do not produce cardiac malformations." New Anti-convulsant for Epilepsy Three members of the faculty of Mexico's National Polytechnical Institute disclosed to the author of this book their discovery of two drugs that have "a very powerful anti-convulsant effect." As this is written, the agents, tested against both electrically induced and druginduced seizures in animals, currently are undergoing trials on epileptics in Mexico City's large mental hospital, La Castañeda. On the basis of experiments on rats and mice, Drs. Guillermo Massieu, Guillermo Carvajal, and Mauricio Russek, of the National Polytechnical Institute, believe the clinical trials will show the new drugs to be at least as effective as diphenylhydantoin (Dilantin, Parke-Davis). The new drugs may be more effective, since the experimental evidence indicates they can block convulsions induced by pentylenetetrazol and thiosemicarbazide, whereas Dilantin cannot.

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The investigators suggest that the drugs may be effective in petit mal, and grand mal, since they are active in controlling both electrically and drug-caused seizures. The doctors set out originally to find a drug that would prevent the enzymatic destruction of gamma aminobutyric acid (GABA) in the nervous system. "There was considerable evidence that GABA, which is widely distributed in the nervous system and is involved in inhibitory mechanisms, may be altered in convulsive states in some manner that affects the excitability of damaged areas," Dr. Russek explained, in reporting on his and his colleagues' investigations.15 "In nervous tissue from epileptics there is a tendency to a decreased GABA level. We believed that, by inhibiting the destruction of GABA and increasing its levels, its neural inhibiting actions would be enhanced." By varying one of the substituent radicals, Dr. Carvajal handtailored three derivatives of 5-phenyl-2-pyrrolidinone. In the test tube, the agents appeared to be good GABA inhibitors. In theory, the substituted pyrrolidinones would be hydrolized in the brain to yield analogs of GABA. These analogs would presumably inhibit the GABA transaminase reaction. Animal experiments showed that two of the three compounds—the 5-methyl and 5-ethyl derivatives—were effective anti-convulsants. But they failed to work in the predicted fashion. "In vivo they did not show any increase in cerebral GABA levels," Dr. Russek said, "even though they demonstrated a very powerful anti-convulsant effect, tested against the convulsions elicited by drugs and electro-shock. At higher dosages, they also inhibited conditioned reflexes." This unexpected result forced a re-evaluation of the original theory. The investigators decided that the total GABA level does not in itself correlate directly with neural excitability. If so, they reasoned, there must be an entirely different explanation of the undoubted anti-convulsant effect of the new drugs. They now believe that GABA is not the inhibitor but a precursor. "The true inhibitor is probably structurally so similar to both 15 At the Pan American Congress on Pharmacy and Biochemistry in Mexico City, in 1964.

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GABA and our substances," Dr. Russek theorized, "that it competes for the enzyme that catabolizes the factor that keeps a rein on neural excitability." He emphasized: "The new drugs have a powerful anti-convulsant effect at dosages that do not impair such subtle nervous activities as instrumental reflexes. This suggests that they will not derange or impair normal mental activity in man." New Treatment for Hyaline Membrane Disease A new treatment recently devised and tested in Mexico, if available earlier, might have saved the life of President John F. Kennedy's infant son, Patrick, who died two days after his premature birth, in August, 1963, of hyaline membrane disease.16 Successful employment of ethyl adrianol (Effortil) in the treatment of hyaline membrane disease has been reported, in Mexico City, by Dr. Frank Ivanhoe. This, incidentally, is a good example of how medical discoveries and innovations are being made today in Mexico in the atmosphere of scientific research stimulated by the federal government—being made, not only by doctors occupied in governmental research projects, but by individual doctors, who, however, often receive some form of governmental assistance in their work. Dr. Ivanhoe, a U.S. citizen who holds an M.S. in pharmacology from the University of California in San Francisco, obtained his M.D. in 1963 at the Mexican National University School of Medicine. He went to Mexico to obtain his medical degree because the cost of a medical education there (largely subsidized by the Mexican government) was so much lower than in the United States. Having worked on the problem of acute pulmonary edema produced by phosgene gas, Dr. Ivanhoe theorized that hyaline membrane disease is a similar form of "pulmonary shutdown"—a reflex paralysis of the nerves supplying the lung vessels, causing constriction of the small pulmonary blood vessels and producing edema 17 — and that, since the sympathetic nervous system responds to noradrenaline, treatment with noradrenaline would reverse pulmonary 16 A disease with a high mortality rate, in which a "glassy-appearing membrane" forms over the lungs of a premature newborn, making respiration difficult or impossible. 17 Excessive accumulation of fluid in tissues or body cavity.

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nerve paralysis, relieve blood vessel constriction, and prevent more extensive edema. (In an international essay contest in 1963, the American College of Chest Physicians awarded Dr. Ivanhoe first prize over approximately four hundred other contestants for a paper on phosgene poisoning and his concept of pulmonary shutdown, which included mention of his theory that hyaline membrane disease is a form of pulmonary shutdown. A condensation of this paper appeared in 1964 in the journal Diseases of the Chest). Dr. Ivanhoe was granted a five-month fellowship by the Mexican government. Under this, he recently conducted clinical trials of his treatment at the Mexican Institute of Social Security's No. 2 Hospital of Gynecology-Obstetrics, in the National Medical Center. Working with him were the hospital's chief of pediatrics, Dr. Juan Urrusti Sanz, and ward physician Dr. Pablo Yoshida Ando. During this trial period, Dr. Ivanhoe said, hyaline membrane disease was diagnosed and treated in a total of twenty-two infants. Of these, four, or 18 percent, died. (The diagnosis of hyaline membrane disease was confirmed in the two cases in which autopsy was authorized.) "The mortality rate for untreated hyaline membrane disease is 60 to 70 percent," Dr. Ivanhoe pointed out. "Thus our therapy clearly was successful. Furthermore, in each of the four fatal cases, treatment was started too late to be of benefit. It is essential that treatment of afflicted newborns be initiated within the first hour of life. Once edema becomes extensive, the condition is irreversible." The doctor described the treatment given the twenty-two infants as follows: Each tiny patient was placed in a heated incubator and administered oxygen. The specific treatment consisted of injection of 2 milligrams of ethyl adrianol (Effortil) every four hours; as breathing difficulty diminished, injections were continued at longer intervals. In most instances, the doctor said, marked improvement was noted within twenty-four hours. He explained that ethyl adrianol was used rather than noradrenaline because the former can be given intramuscularly (noradrenaline must be administered intravenously). The two drugs are similar in composition and action. Dr. Ivanhoe added that his theory that infants with hyaline mem-

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brane disease are in a state of generalized sympathetic paralysis has been demonstrated by findings that such infants have less noradrenaline in their urine than newborns with other forms of acute respiratory disease (pneumonia, etc.). He explained that tests, carried out with the aid of the Hormones Laboratory of the Mexican National Institute of Cardiology, revealed that newborns with other acute respiratory diseases excreted four times as much noradrenaline as newborns with hyaline membrane disease. Dr. Ivanhoe, who originally came to Mexico only to study medicine at the National University, says he intends to remain to practice medicine. Synthetic Hormones—And The Pill One of the more important medical discoveries of modern times was made in Mexico. It made possible, among other things, the first practical developments in a field that may have a profound and determining influence on the future of the world. Not only on the health of the world's peoples, but on their national economies and international relations—even, conceivably, on whether continuing warfare among overpopulated, underfed nations, or peace, finally will prevail. Important medical discoveries in other fields have vastly improved the health and life expectancy of mankind—and paradoxically have produced a monstrous situation in which man's fertility, no longer offset by a high death rate, may "crowd him off the face of the earth" —making any economic progress impossible, guaranteeing an increasingly wretched level of existence for the masses, indeed dooming ever more millions to die of starvation. Unlike most medical advances, which by increasing life expectancy compound the problem of uncurbed population growth, the recent development of a simple, reliable oral-medication contraceptive technique has the potential to solve the global population explosion and its attendant social and economic evils. (Simple oral medication at present is deemed the most practical contraceptive technique for mass usage by the unsophisticated, uneducated people who constitute the majority of the population in countries with high birth rates.) It was the discovery, in Mexico, of plants from which synthetic

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steroid hormones could be obtained, and also of the processes of extracting them (as described in Chapter Six), that made possible the development of the ovulation-suppressing pills.18 First placed on the market in 1960, the now-famous birth control pill—The Pill, that had its origins in the humble Mexican wild yam, barbasco—quickly became available under various brand names. By 1966, an estimated eight million women were taking oral contraceptives. Thus far, the pills are widely used only in the United States, Europe, and Japan. However, they gradually are becoming available, through private prescriptions and at maternal health clinics, in Mexico and in most other Latin American countries. And initial results in Latin America are highly encouraging: Low-income populations there overwhelmingly welcome birth control measures. 19 Furthermore, contrary to some predictions, it has been demonstrated that ignorant women of the poorest classes can be relied on to take the pills with the requisite regularity. (In fact, they do so more faithfully than well-to-do women, because they are more strongly motivated. They know from bitter experience that with a family of dozen or more living in one room, on an income too tiny to properly feed half its members, further pregnancies will lead to nothing but tragedy.) And, most important, it is no longer only Latin America's legions of wretched poor—and free-thinking intellectuals—who favor birth control. An abrupt attitude change among a substantial proportion of the governing elite—key politicians, businessmen, and churchmen— is swiftly reducing the long-standing official opposition to artificial contraceptive methods. (For example, the birth control program in Santiago, Chile, currently the largest in Latin America, has the approval of the Catholic Church.) Nevertheless, despite this very recent progress, to date less than 10 percent of the world's population of child-bearing age uses birth con18 Contraceptive pills are, of course, only one of the many important medical uses already established for the synthetic hormones. 19 Often as an alternative not only to overly large families but to multiple abortions. Catholic Latin American countries with some of the world's highest birth rates also have some of the world's highest abortion rates. Recent surveys indicate that in several, including Mexico and El Salvador, the number of illegal abortions may equal the number of live births.

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trol of any kind. Thus, the potential of the contraceptive pill barely has been tapped. Sooner or later (conceivably within the next generation), as religious and other opposition continues to diminish with realization of the extreme hazards of uncontrolled population expansion, the application of the pill and similar discoveries can restore a proper "natural" balance between humanity and the earth's natural resources. This, in turn, will solve a host of related global problems. It is worth noting also that research with steroids derived from Mexican yams is advancing rapidly in another large and important field, relevant to the population explosion: Steroids are being employed on animals and plants with the goal of increasing the world's food supplies. This is being done in two ways: directly, by stimulating growth and improving fertility in meat animals and agricultural crops; and indirectly, by inducing infertility in insect pests and rodents that currently consume or despoil huge quantities of the world's food. The potential benefits to humanity in such developments are, of course, enormous. To Summarize New medical techniques of world importance increasingly are being devised, tested, and employed in Mexico. And a significant proportion of the research and discoveries made in Mexico—in synthetic hormones and other medical areas—already has benefited the rest of the world. Principal Sources Interviews with doctors at the National Institute of Cardiology, the Children's Hospital, and the National Polytechnic Institute's Center for Research and Advanced Studies, and with other doctors engaged in research.

CHAPTER NINETEEN

Facing the Future

This, then, is the panoramic view of medical progress in the land over which so much splendor and tragedy have swept— The land where, in a gleaming lake city, the temples ran with the blood of sacrificial victims, but the streets were swept immaculately clean by a thousand sweepers and the sparkling canals were maintained undefiled; where the Indian inhabitants were extraordinarily advanced in public health and welfare—with government-maintained veterans' hospitals, isolation sanitariums, and standardized care for oldsters and indigents—and equally advanced in pharmacology—with botanical gardens containing thousands of medicinal plants for experimentation— Where the conquering Spaniards ruthlessly blotted out the Aztec civilization and brought deadly epidemics; yet also made their contribution to the country's medicine, in hospital construction (from the swiftly rebuilt capital to the padres' far-flung missions), and in establishing European standards and regulation of medical practice— Where, following the overthrow of the Colonial system and an unproductive first century of independence, the Revolution of 1910 killed a million Mexicans; yet was fought to obtain social justice and optimum health for all— Where, nowadays, the largest item in the annual federal budget is for education, and, although there still are not enough primary schools, anyone ready for a university education can get it free, often with room and board and a cash allowance— Where, furthermore, one of the major tasks of the National Army

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is to trek to isolated mountain and jungle settlements to distribute free textbooks for school children— And where the year of military service required of all eighteenyear-old males is deemed primarily a public health measure, as it gives many a peasant lad his first training in basic hygiene (surely of more future benefit to his family than his learning to fire a bazooka)— Where, while some ill persons still credulously seek cures from quacks and witch doctors, ever-increasing numbers are treated in the many hundreds of impressive new hospitals with ultramodern facilities— And where (perhaps representing even greater progress) thousands of middle-aged careerist "witch-women" are enrolling for a year's intensive Public Health Department training, to qualify for departmental licenses as midwives, or auxiliary nurses. From the obscure vistas of prehistory to the present, Mexico literally has progressed "from witches to betatrons"—and today some of its citizens are making that fantastic cultural leap virtually overnight. What of the future of this old-new nation? Not being engaged in an armaments race, Mexico is enviably free to expend its resources and energies on constructive projects to benefit its people. Its goals for the future are domestic goals: improved agriculture, development of natural resources, increased industrialization, a higher standard of living for all its people, satisfactory jobs, at fair pay, for workers, decent homes, adequate clothing, universal education, elimination of epidemic and endemic diseases, top-quality medical care available to all. And Mexico today is just entering full stride. Its long-desired better life for all is no longer an elusive generation or two ahead, but may be as close as tomorrow. The recent and current acceleration of medical progress will bring all the other gains more quickly.

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A SELECTED BIBLIOGRAPHY

Academia Nacional de Medicina, Libro conmemorativo del primer centenario. Vol. I. Mexico: Academia Nacional de Medicina, 1964. Aguilar, Dr. Gilberto F., and Dr. Roberto Ezquerro Peraza. Los Hospitales de México. Mexico: 1936. Alvarez Amézquita, Dr. José, and Drs. Miguel E. Bustamante, Antonio López Picazos, Francisco Fernández del Castillo. Historia de la Salubridad y de la Asistencia en México. Vols. I-IV. Mexico: Secretaría de Salubridad y Asistencia, Los Talleres Gráficos de la Nación, 1960. Anonymous Conqueror. Narrative of Some Things of New Spain and of the Great City of Temestitan. Translated by Marshall Saville. New York: The Cortés Society, 1917. Arteaga, Benito A. El Héroe Olvidado; Rasgos Biográficos de D. Ignacio Allende. Mexico: Ediciones Paulinas, 1953. Bravo, Dr. Francisco. Opera Medicinalia. Mexico: apud Petrum Ocharte, 1570. Bravo H., Dra. Helia. Las Cactáceas de México. Mexico: Universidad Nacional de México, 1937. Buschan, Georg. Über Medizinzauber und Heilkunst im Leben der Völker. Berlin: Oswald Arnold Verlag, 1942. Calderón de la Barca, Mme. Life in Mexico (First published in Boston and London: 1843). Edited, with an Introduction, by Camille Destillieres Comas. Mexico: Ediciones Tolteca, 1952. Cervantes de Salazar, Francisco. Life in the Imperial and Loyal City of Mexico in New Spain and the Royal and Pontifical University of Mexico, as Described in the Dialogues for the Study of the Latin Language Prepared by Francisco Cervantes de Salazar for Use in His Classes and Printed in 1554 by Juan Pablos (Mexico). Published in facsimile, with a translation by Minnie Lee Barrett Shepard and an Introduction and Notes by Carlos Eduardo Casteñeda. Austin: University of Texas Press, 1953. Clavijero, Francisco Javier. The History of Mexico, collected from Spanish

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and Mexican historians, from manuscripts, and ancient paintings of the Indians, illustrated by Charts, and other copper plates, to which are added critical dissertations on the land, animals, and inhabitants of Mexico by Abbe D. Francesco Saverio Clavigero. Translated from the original Italian by Charles Cullen. London: G. G. J. and J. Robinson, 1787. Cortés, Hernando. Five Letters, 1519-1526. Translated by J. Bayard Morris. New York: R. M. McBride & Co., 1929. Cruz, Martín de la. The Badianus Manuscript; An Aztec Herbal of 1552. Translated from Náhuatl into Latin by Juan Badiano. Published in facsimile. Introduced, translated into English and annotated by Emily Walcott Emmart. Baltimore: Johns Hopkins Press, 1940. Díaz del Castillo, Bernal. The Discovery and Conquest of Mexico, 1517— 1521. Edited from the only exact copy of the original manuscript (Historia verdadera de la conquista de la Nueva España), and published in Mexico, by Genaro García. Translated with an Introduction and Notes by A. P. Maudslay. Introduction to the American edition by Irving A. Leonard. New York: Grove Press Inc. [1956]. Dulles, John W. F. Yesterday in Mexico: A Chronicle of the Revolution, 1919-1936. Austin: University of Texas Press, 1961. Farfán, Fray Agustín. Tractado Breue de Chirvrgia y del Conocimiento y cvra de algvnas enfermedades q. en esta tierra mas comunmente suelen auer (A Brief Treatise on Medicine). Mexico: Casa de Antonio Ricardo, 1579. Gallenkamp, Charles. Maya: The Riddle and Rediscovery of a Lost Civilization. New York: Pyramid Publications, 1962. Gamio, Manuel. La Población del Valle de Teotihuacán. Mexico: 1922. González-Ulloa, Dr. Mario. La Medicina en México. Mexico: 1959. Hernández, Dr. Francisco. Rerum Medicarum Novae Hispaniae Thesaurus seu Plantarum (History of the Plants of New Spain). Rome: 1649. . De la Natvraleza, y Virtvdes de las plantas, y animales que estan receuidos en el vso de Medicina en la Nueua España y la Methodo, y corrección, y preparación, que para administrallas se requiere con lo que el Doctor Francisco Hernández escriuio en lengua Latina. Traduzido, y aumentados muchos simples, y Compuestos y otros mucho secretos curatiuos, por Fr. Francisco Ximénez. 4 vols. Mexico: Casa de la Viuda de Diego López Daualos, 1615. Malo, Miguel J., and F. León de Vivero. Guía del Turista en San Miguel de Allende, Oto., México. Martínez, Prof. Maximino. Las Plantas Medicinales de México. Mexico: Ediciones Botas. Memoria de la Secretaría de Salubridad y Asistencia, 1958-1964. With an Introduction by Dr. José Alvarez Amézquita, Secretary of Public Health and Assistance. Mexico: Secretaría de Salubridad y Asistencia, 1964. Mexico. (The World and Its Peoples.) New York: Greystone Press, 1964. México Arqueólogico. Mexico: Petróleos Mexicanos, 1963. "Morelos" Social Services Unit, San Juan de Aragón, D.F. Mexico: Mexican Social Security Institute, 1962.

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National Medical Center. Mexico: Mexican Social Security Institute, 1963. Nuttall, Zelia. The Gardens of Ancient Mexico. Mexico: Editorial Cultura, 1937. O'Gorman, Helen. Mexican Flowering Trees and Plants. Original paintings and text by Helen O'Gorman. Edited by Ella Wallace Turok. Mexico: Ammex Asociados, S.A., 1961. Parkes, Henry Bamford. A History of Mexico. Boston: Houghton Mifflin Company, 1938, 1950. Portes Gil, Emilio. Historical Evolution of the Territorial Property of Mexico. Mexico: Ateneo Nacional de Ciencia y Artes de México, 1948. Prescott, William H. History of the Conquest of Mexico. New York: Burt, 1843. Roeder, Ralph. Juarez and His Mexico. 2 vols. New York: The Viking Press, 1947. Rose, J. N. Notes on Useful Plants of Mexico. Washington, D.C.: U.S. National Herbarium, 1899. Sahagún, Fray Bernardino de. Historia General de las Cosas de Nueva España. Edición parcial en facsímile de los Códices Matritenses en lengua Mexicana que se custodian en las Bibliotecas del Palacio Real y de la Real Academia de la Historia. Madrid: Fototipia de Hauser y Menet, 1905. Standley, Paul C. Trees and Shrubs of Mexico. Contributions from the U.S. National Herbarium. Washington, D.C.: Smithsonian Institution. Townsend, William Cameron. Lázaro Cárdenas, Mexican Democrat. With a Foreword by Frank Tannenbaum. Ann Arbor: George Wahr Publishing Co., 1952. Unidad Independencia of Social Services and Housing. Mexico: Mexican Social Security Institute, 1961. Von Hagen, Victor W. The Aztec: Man and Tribe. New York: The New American Library, 1958. Von Humboldt, Alexander. Vues des Cordillères et Monuments des Peuples Indigènes de I'Amérique. Paris: 1810.

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INDEX

"Abandoned-Mine Fever." SEE histoplasmosis abortion: 136, 145, 296 n. abscesses: god of, 28; hepatic, 116, 172 Academy of Medical Surgery: 116 Academy of Medicine: first, 116. SEE ALSO National Academy of Medicine Academy of Practical Medicine: 116 Academy of Puebla: 116 Academy of Science of New York: 280 Academy of Science of the U.S.S.R.: 285 Acapulco, Guerrero: Álvarez in, 95; hospitals in, 96; Balmis Expedition re-embarks at, 111; anti-malaria measures in, 228; bullfighter injured in, 241 Aëdes aegypti: 230-231 AFL-CIO: and housing project, 203 Africa: survivor of ship from, 25; witch doctors in, 47; bezoar stones in, 63; research on plants from, 79; diseases from, 103,106, 218 agave. SEE maguey Agua Prieta, Sonora: sewage disposal in, 202 Aguascalientes, Aguascalientes: polio in, 226 Aguilar, Dr. Rigoberto: on contaminated milk, 165 Ahuítzotl: sacrifices under, 17, 71 ajolote: 284 Alameda Park: 21, 114 Alarcón, Dr. Donato: in campaign to

raise medical standards, 264; on medical education, 265-266, 268271 Alaska: Aztecs in, 23 albinos: 104-105 Alcocer, : on Aztec nutrition, 178 Alcocer, Dr. Francisco: 249 alcoholism: 139 Aldama, Juan: 121, 122 Alegre, Father: on epidemic, 108 Alemán, Miguel: 159, 275 Alemán, Dr. Victor: research by, 283 Alfonso XIII: 246 Allende, Ignacio: 121, 122 Alliance for Progress: 169, 203 Álvarez, Bernardino (Fray): 94-95 Alvarez Amézquita, Dr. José: directs solution to witch problem, 147; Public Health Department reorganized under, 150-151; on witches, 160, 161; on nurse training program, 162; action of, on salt iodization, 184; on rabies, 195; inaugurates National Program for the Control of Chronic Skin Diseases, 210-211; on onchocercosis, 217, 218; on new Public Health units, 255-256; on nursing, 272 Alvarez-Buylla, Dr. Ramón: research by, 285-286 Alvarez Teña, Dr. José Manuel: treats charros, 244; on riding accidents, 245; on charro costume, 246 Amazon River: 157, 233 amebiasis: as related to poverty, 165;

306 incidence of, 171-172; campaign against, 173; and foreign visitors, 173-174; cutaneous, 209 American-British-Cowdray Hospital: 256 American College of Chest Physicians: 294 American Stock Exchange: Syntex on, 78 Amézquita, Dr. José Alvarez. SEE Alvarez Amézquita, Dr. José Amímitl: 28 Amphotericin Β: in treatment of chromomycosis, 210; in treatment of histoplasmosis, 221, 223 anatomy: Farfán writes on Aztec, 46; European superior knowledge of, 59; at National University of Mexico, 98, 270 Andes Mountains: 37 anemia: pernicious, 64; malnutrition causes, 180 anesthesia. SEE narcotics; surgery animals: in medicaments and magical remedies, 13, 54, 63, 64, 65, 69, 136, 137, 142; zoo for, 34, 37, 38, 203; extraction of progesterone from, 76; steroids used on, 297. SEE ALSO birds; insects; reptiles; worms; entries under specific animals Anti-Malaria Campaign. SEE malaria Anti-Rabies Center: 196 Aquapendente, Fabricius a b : 60 Arboleya, Dr. Juan Alejandro: 111 Arbor viruses: research on, 280-281 Archila, Dr. Alfonso Ponce: 229 Argentina: smallpox vaccination in, 109; program in, to raise medical standards, 264 Arizona, University of: 143 Army Hospital. S E E Hospital Central Militar arsenicals: amebiasis treated with, 172 arthritis: treatments for, 64-65, 77 arthrodesis: treatment for, 287 asepsis: Aztec use of, 45, 53; lack of, in European hospitals, 96 Asia: Aztec migration from, 8, 23; style of bathing in, 42; bezoar stones in, 63; diseases from, 102; possibility of medical brigades in, 158 Asociación Nacional de Charros: 244, 245 Asociación Pro-Salud Maternal: 145

MEDICINE IN MEXICO

aspirin: in treatment of fever, 67 asthma: god associated with, 26; treatments for, 66, 136 astrology: Aztec physicians study, 48 astronomy: Aztec knowledge of, 14, 15,80 Atlantic Ocean: 25, 34, 108 atropine: escorpionismo treated with, 199 Atzumpa, Puebla: goiter in, 183 autopsy: first New World, 98, 101; and surgery for hepatic abcesses, 116; amebiasis found in, 172 Avanza, Miguel José (Viceroy): 115 Avenida Juárez: 114, 136 Avicenna: 60, 85 Ávila Camacho, Manuel: 275 Aztec Herbal of 1552, An. S E E Badianas Manuscript, The Aztecs: cultural background of, 5; arrive in Mexico, 8; conquests by, 8-9; impressions made by, on Spaniards, 10; government system of, 11-13, 22; mathematical knowledge of, 13; astronomical knowledge of, 14; welfare measures of, 32-34; segregation of diseased persons by, 35, 104-105; water supply for, 39; cleanliness of, 4 0 - 4 1 , 42-44, 53-54, 55, 114, 175; trade by, with Incas, 74-75; final battle of Spaniards with, 88; buildings of, 89, 238; last ruler of, 90; mal de pinto among, 105-106; use of chocolate by, 1 1 6 117; fall of Empire of, 122, 298; witches modify horoscope-casting of, 142; nutritional bases under, 178; eagle of, as IMSS symbol, 253. SEE ALSO religion, Aztec —, medicine of: as related to religion, 10, 24, 26-30, 3 1 ; fatigue treated under, 12-13; advanced degree of, 15; control of epidemics in, 34-36; fumigation in, 36; research facilities for, 37-38; bathing in, 42; compared to European, 45; loss of knowledge of, 46-47; education in, 47-48; specialists in, 47, 48-50, 5 3 54; surgery in, 5 4 - 6 1 , 175; ineffectual remedies in, 62-64; medications used in, 64-70; records of, 73; untapped, 75, 79; place of, in history, 80; Cortés' admiration for, 86; fusion of, with Spanish medicine,

INDEX

87-88; taught after Conquest, 97; descendants of practitioners of, 132; veintiunilla used in, 139 B-14: isolation of, 64 backache: folk remedies for, 141 Badiano, Juan: 46, 97 Badianus Manuscript, The: on deodorant, 43; described, 46; on dentistry, 51-52; on labor pains, 54; on healing of wounds, 56; compilation of, 62, 97; on treatment for "weak" hands, 64 Bahamas, the: A. aegypti in, 230 Bahia: cervical cancer in, 176 Baja California Sur: Bureau of Coordinated Service in, 151; mosquito spraying in, 231 Balmis, Dr Francisco Javier: expedition by, 108-112; hospital named for, 188 balneotherapy. SEE bathing Balsas River: diseases in basin of, 208, 215, 230 barbers: as surgeons, 48-49, 87, 97, 102, 115; as dentists, 50; at Hospital of the Buboes, 94 Bartolache, José Ignacio: 101 bathing: by Aztecs, 10, 11, 4 1 , 42, 43, 53; by Europeans, 41-42; as treatment for dermatoses, 68; religious discouragement of, 87; public, under Spaniards, 114-115; steam, 114-115, 141; Spanish restriction of, 132; water supply for, 152; as disease preventive, 174 Batopilas, Chihuahua: bat problem in, 223 bats: 155, 217, 220, 223-224 B.C.G. vaccine: against tuberculosis, 225 "Belt of Fire": goiter in, 182, 185 Benavides, Dr. Lázaro: on Children's Hospital, 278, 279; research by, 280 betatrons: in National Medical Center, 251 beverages: scented, 13; wine, 13, 19, 32, 258; ale, 32; cocoa, 34; whiskey, 70, 72; Protomedicato inspects, 100; herb teas, 135; tequila, 139, 200; milk, 165-166, 191; café con leche, 166; pulque, 167; gin, 201. S E E ALSO chocolate; water bezoar stones: 63, 136

307 Biagi F., Dr. Francisco: on amebiasis, 172 biochemistry: research in, 282, 283 birds: eagles, 8, 26, 54, 253, 255; quetzals, 10, 25, 34, 37; hummingbirds, 26, 37, 89, 157; in zoos, 34, 37, 38, 75; condors, 37, 75; testicles of, as medicine, 64; chickens, 64, 142, 168, 220, 288-291; parrots, 76; vultures (zopilotes), 88, 128, 155; owls (tecolotes), 134-135, 140, 155; bills of, in witchcraft, 136; pigeons, 220 birth: death in giving, 29, 53; Tlazoltéotl depicted giving, 30; rate, 30, 192, 206; defects, 34, 288-291; baths at, 42; horoscopes at, 48; asepsis at, 53; labor pains in, 54; control of, 59, 77, 78, 269, 2 9 5 297; midwives for, 99, 141, 145, 160-162, 299; caesarean, 101; aborted, 136, 145, 296 n.; circumcision at, 176; frequency of, 177; of cretins, 183; and maternal-infantile centers, 190; polio inoculations at, 227; premature, 279, 280, 293; treatment of hyaline membrane disease at, 293-295. SEE ALSO obstetrics Bisteni, Dr. : 275 bleeding: as therapy, 45, 48—49, 115 blindness: caused by onchocercosis, 217-218 blood banks: witches on, 159 blood-letting. SEE bleeding Bolivia: A. aegypti eradication in, 231 Bonaparte, Joseph: 121 Bonaparte, Napoleon: 63, 108, 128 bone bank: 286-288 books: Aztec, 10, 11, 15, 2 1 , 48, 73; Bible, 19; extant, on Aztec medicine, 46-47, 62; European, on anatomy and surgery, 60; first North American medical, 101. S E E ALSO Badianus Manuscript, The; entries under specific books Boston, Massachusetts: 70, 287 Bravo, Dr. Francisco: 101 Bravo-Becherelle, Dr. Μ. Α.: reports on escorpionismo, 197, 198 Brazil: cervical cancer in, 176; A. aegypti eradication in, 230; program in, to raise medical standards, 264

308 Brief Treatise on Medicine, A: 46, 101 brigada médica. SEE servicio social Briones, Félix: 241 Briones, Luis: 241 British Honduras: A. aegypti eradication in, 231 bronchopneumonia: as related to measles, 280 brujos. SEE witches (brujos) buboes: god of, 28; isolation of victims of, 35 Bullfighters' Hospital: 239-244 bullfighting: 235, 239-244, 247-249 Bureaus of Coordinated Services: 151 burns: Indian treatments for, 68; from potassium permanganate, 145; plastic surgery for, 258 burros: 156, 165, 168 Bushmen, Australian: penile mutilation by, 59 Bustamante, Dr. Miguel E.: on epidemics, 107-108, 226; service of, 151; on polio, 226, 227 Cabeza de Vaca, Álvar Núñez: on Aztec Empire diet, 178 Cabo Corrientes, Jalisco: escorpionismo deaths in, 198 Cabot, John: 107 cactus: nopal (tuna), 26, 56, 68, 70, 178; in botanical gardens, 37; peyote (mescal; Lopophora williamsii), 50, 72, 74, 142; mycetoma infection from, 216 calciferol: in treatment of chromomycosis, 210 calcium injections: escorpionismo treated with, 199 Calendar Stone, Aztec: 14 California: gold rush in, 75; in New Spain, 83; leprosy in, 105, typhus in, 107; rabies in, 195; mentioned, 90 California, University of (San Francisco): 293 Campaign Against Poliomyelitis. SEE poliomyelitis Campaign To Eradicate Malaria. SEE malaria Campeche, Campeche: 229 Campeche (state): malaria in, 229, 230; Venezuelan virus in, 281 Camp Gruber, Oklahoma: histoplasmosis at, 220 Canada: tuberculosis in, 186

MEDICINE IN MEXICO

Canary Islands: smallpox vaccine on, 109 cancer: penile, 58, 165, 174-176, 177; testing of drugs against, 78-79; cervical, 165, 174, 176-177; uterine, 176; radiological treatment of, 251; cases of, admitted to University hospitals, 271; at Children's Hospital, 279; of hypophysis, 286; and graft material, 287 Candelaria Cave, La: 104 Canton: smallpox vaccine in, 112 Cárdenas, Lázaro: 153 cardiology: at Children's Hospital, 279. SEE ALSO National Institute of Cardiology Cardona Irrigation Tunnel: histoplasmosis among workers on, 221 Caribbean Sea: 106, 182, 187, 230, 268 Carrel, Alexis: on embryonic juices, 56 Carvajal, Dr. Guillermo: research by, 291-293 Casa de Expósitas de Santiago de Galicia y la Coruña: 108-109 Castilleja de la Cuesta, Spain: 91 cats: 140, 217, 284 cattle: 114, 165, 223, 235, 239-244, 245, 247-249 cauterization. SEE surgery "Cave of the Witches": 137 "Cave Sickness." SEE histoplasmosis Celaya, Guanajuato: ophthalmologist blinded in, 159-160 Cempoalla: Totonacs of, 19 Cendal, Isabel: 108, 109 Center for Research and Advanced Studies. SEE National Polytechnical Institute Centro Antirábico: 196 Cerbon, Dr. Jorge: research by, 283 Chapultepec hills: 39 Chapultepec Park: 203 charcoal: medicinal use of, 65 Charles I: 86, 95 Charles III: 119, 236 charreadas: 235, 244-247 Chávez, I.: on syphilis, 104 Chávez, Dr. Ignacio: on medical standards, 264-265, 266, 267 Chiapas, Royal City of. SEE Real de Chiapas Chiapas (state): Dr. Marker's collecting in, 76; barbasco in, 77; skulls

INDEX

in, 104; curandero technique in, 142; snakebite cures in, 143; onchocercosis in, 217, 218; colonization in, 233 Chicago, Illinois: 77, 278 Chichén Itzá, Yucatán: as city-state, 8; hospitals near, 96; Mayans build, 180 Chihuahua, Chihuahua: bat problem near, 223 Chihuahua (state): Rural Cooperative Medical Services in, 153; average stature in, 180; bat problem in, 223; tuberculosis in, 224 childbirth. SEE birth Children's Hospital: government of, 150; site of, 252; postgraduate training at, 266; research at, 275, 279281, 282; described, 277-278; bone bank at, 286, 287 Chile: smallpox vaccine in, 109; A. aegypti eradication in, 230; birth control in, 296 Chimalpopoca: 49 China: attitude in, toward jade, 63; leprosy introduced from, 105; smallpox vaccine taken to, 112 chocolate: 10, 116-119, 166 cholera: 106 cholesterol: 276, 277 Cholula, Puebla: 33 Christianity. SEE religion, Christian; Roman Catholic Church chromomycosis: 210 Church of Jesus of Nazareth: 91 Church of San Francisco: 91 Cihuatlán, Jalisco: escorpionismo deaths in, 198 circumcision. SEE surgery Cisneros, Dr. Jesús: 248 Ciudad Juárez, Chihuahua: 195, 202 Civil War, U.S.: battlefield surgery in, 70; 1910 Revolution compared to, 128 Clavijero, Francisco: on Oviedo, 103; on leprosv, 104 clothing: of Moctezuma II, 10, 41; of gods, 28, 29, 30; military, 32; depicted in murals, 34; of doctors in Europe, 55; covers mouth and nostrils, 134; laundering of, 152; of poor, 164; rebozos, 181; souvenir, 201; Malaria Campaign uniforms, 228; pawning of, 238; bullfighter

309 capes, 240, 241, 242; of charros, 246-247 Coahuayana, Michoacán: escorpionismo deaths in, 198 Coahuila (state): Rural Cooperative Medical Services in, 153; mosquito eradication in, 237 Coatlicue: 29 cold, common: god associated with, 26; treatments for, 67, 136 Colegio de Santa Cruz de Tlaltelolco: 46, 97-98 Colhuacán: 33 colic: folk remedies for, 141 Colima (state): escorpionismo deaths in, 198, 200; pinto in, 215; histoplasmosis in, 221 Colombia: Mexico donates polio vaccine to, 227; A. aegypti eradication in, 230 Colonia Zacahuizco, México, D.F.: study of, 188 Colonization Program: of Mexican government, 153, 233 Columbus, Christopher: 88, 103 Congo, the: witches in, 139; possibility of medical brigades in, 157; onchocercosis in, 218 Congway Model B: tattooing with, 214 Conquest of Mexico, The: 33 constipation: remedies for, 65, 136 Constitution of 1917: 129, 149 contraception. SEE birth Convento de Santo Domingo: 118 Convit, : leishmaniasis described by, 209 copal: 36, 74 corn: drought threat to, 27; as tribute, 34; curanderos use, 141; importance of, 179, 180, 182; processing of, for tortillas, 181; varieties of, 191; plots, 215; mentioned, 19 coronary insufficiency: 276 cor pulmonale: 276 Corrida del Médico: 247-249 Cortés, Dr. Alfredo: 196, 197 Cortés, Hernán: Aztec Empire prior to, 7; arrives in Mexico, 9, 25, 70; in Tenochtitlán, 10, 15, 62; religious motives of, 20-21; humanitarianism of, 21 n.; attitude of, toward Aztec welfare measures, 32, 33; on isolation compound, 35; greeted with incense, 36; impressed by botanical

310 gardens and zoos, 37; Díaz serves under, 40; learns of Moctezuma's bathing, 4 1 ; conquest of Mexico by, 50, 83, 122; antiseptic techniques practiced by, 55; on circumcision, 58; sees sacrifice, 7 1 ; asks for no physicians for New Spain, 86; constructions ordered by, 89; founds hospitals, 89, 90, 92, 105; last will of, 90, 9 1 ; death of, 91-92; founds Veracruz, 96; diseases brought to Mexico with, 103, 104; tortillas for army of, 181; mistress of, 263 corticosteroids: 222, 223 cortisone: 77 Costa Rica: Mexico donates polio vaccine to, 227; A. aegypti eradication in, 231 coughs: treatments for, 67, 135, 136 Council of General Health: 149, 150 cowpox: as vaccine, 108-112 Coyoacán: 88, 89 Craig, Charles Franklin: on parasitosis, 172 Credé, Karl Siegmund Franz: inoculation method of, 227 cretinism: 165, 183 Cristeros, the: 129 Cristóbal: A. aegypti in, 230 Cuauhtémoc: 90 C u a u t i t l á n , Jalisco: escorpionismo deaths in, 198 Cuautlinchán: 27 Cuba: A. aegypti in, 230; graft material sent to, 287 Cuernavaca, Morelos: anti-malaria measures in, 228 Culiacán, Sinalóa: leprosy in, 212 Curaçao: A. aegypti in, 230 curanderos. SEE witches (curanderos) curare: possible Aztec use of, 74 cysticercosis: 193 D'Ambrose, : book by, on surgery, 60 damiana: 74 Datura stramonium: SEE jimson weed Day of the Dead: 238 Day of the Doctor: 239 Day of the Race: 88 DDS: S E E diaminodiphenosulfone (DDS) D D T . SEE poison deafness: Aztec treatment for, 69-70; associated with cretinism, 183

MEDICINE IN MEXICO

death: by human sacrifice, 7, 12, 17, 18, 20, 22-24, 26, 29, 30, 3 1 , 36, 49, 60, 69, 7 1 ; in war, 2 1 ; by execution, 2 1 , 22, 60, 122, 132; Aztec belief in life after, 29; goddess of, 29; in childbirth, 29, 53, 161, 162; from exposure, 34; in epidemics, 34, 35, 106, 107, 108; caused by hospital practices, 53, 55, 96; from tuberculosis, 96, 186, 224; Indian customs concerning, 103; from liniment, 138; from veintiunilla curse, 138-139; witches cause, 140; from el susto, 143; of doctors, 146, 155; rate, 148, 161, 162-163, 177, 269, 272-273, 295; from epidemic diarrhea, 167, 168-169; from amebiasis, 172; from dysentery, 172, 232; from rabies, 194, 195, 196, 197; from scorpion stings, 197-198, 199, 200; from histoplasmosis, 219, 221; from malaria, 230; from typhoid, 232; from paratyphoid, 232; from bullfight injuries, 240, 242; from gastroenteral infection, 279; following hypophysectomy, 285, 286; graft material obtained following, 287; of chick embryos, 289, 290, 291; from hyaline membrane disease, 293, 294 deer: 18, 63, 70, 246 deKalker: 60 de la Cruz, Dr. María Victoria: research by, 288-291 D e la Cruz, Martin: 46, 97 De la Riva, Dr. Javier: on parasitosis, 171-172 del Pozo, Dr. Efrén C : on anti-scorpion serum, 198-199 Del Prado Hotel: 114 De Michelli, Dr. : 275 dentistry: in Europe, 50; Aztec methods of, 50, 5 1 - 5 3 ; at health centers, 152 deodorization: Aztec practice of, 42—43 Department of Agriculture: promotes high-protein plants, 191 Department of Public Health and Assistance (Secretaría de Salubridad y Asistencia): precursor of, 100; witches practice despite, 131; San Miguel clinic of, 137; statistics by, on witches, 144; witches oppose program of, 146, 158-159; policy of, toward witches, 147, 160-162; his-

INDEX

tory of, 150-151; types of health centers under, 152-153, 189; servicio social program of, 153-154, 156, 262; transportation by, 157; radio programming of, 158; food inspected by, 166-167; studies parasitosis, 171; cancer detection survey by, 176; officials of, on rural migrants, 187, 188; problem faced by, in regard to environmental conditions, 194; officials of, at international sanitation conference, 201; work by, in cooperation with National Institute of Tropical Diseases, 206; recommends insecticides, 219; bat control problem of, 223-224; miscellaneous diseases controlled by, 232; makes colonization possible, 232-233; lottery profits go to, 236; field of operations of, 254, 263; construction by, 255-256; medical salary scales of, 260, 261; survey by, on nursing, 271-272; López Mateos praises, 273; finances Children's Hospital, 278; mentioned, 112, 244, 252. SEE ALSO servicio social — , campaigns by: against epidemic diarrhea, 167, 168; against parasitosis, 172-173; against goiter, 183185; against tuberculosis, 186, 224225; against rabies, 195-196, 197; against escorpionismo, 197-200; against leprosy, 210-212; against polio, 225-227; against malaria, 228-230 dermatitis actinica: 68 dermatology: Aztec practice of, 27, 67-68; god of, 31; centers for, 103, 189, 211, 255; in folk medicine, 135, 136, 141 "Devil's Curse." SEE histoplasmosis Devourer of Dirty Things: 29-30, 31 diabetes: 79, 270 diamenodifenil-sulfone: in treatment of mycetoma, 216-217 diaminodiphenosulfone (DDS): in treatment of mycoses, 210; in treatment of leprosy, 212 diarrhea: Aztec remedies for, 65; connected with hepatic abcesses, 116; folk remedies for, 141; in el susto, 143; as related to poverty, 165; epidemic, 165, 167-169, 186; re-

311 search on, 279, 280; at Children's Hospital, 279, 281 Díaz, Porfirio: 127, 128 Díaz del Castillo, Bernal: on Tenochtitlán, 10, 40-41; on cauterization, 55 Díaz Ordaz, Guadalupe Borja de: 191 Díaz Ordaz, Gustavo: 191, 244 n. dichloriacetemide: used in treating amebiasis, 172 diethylcarbamazine: in treatment of onchocercosis, 218 Dilantin. SEE diphenylhydantoin dimetoxi-sulfanilimide-diazin: in treatment of mycetoma, 210 diphenylhydantoin: in treatment of epilepsy, 291 Directorate General of Coordinated Services of Public Health and Assistance: 150, 151 Discovery and Conquest of Mexico, The: 10 Diseases of the Chest: 294 diuretics: used in heart cases, 276 dogs: 18, 43, 64, 193, 195 and n., 196-197, 285-286 Dolores Hidalgo, Guanajuato: 121,122 Domínguez, Miguel: 121 Dominican Republic: pega palo in, 78; Mexico donates polio vaccine to, 227; A. aegypti in, 230 Douglas, Arizona: sewage disposal in, 202 Dr. Francisco J. Balmis Public Health Center Hospital: nutritional education program of, 188 Durango Hospital: 244 dysentery: god associated with, 28; Aztec treatment for, 65; spread in contaminated milk, 165; amebic, 172, 173; death rate from, 172, 173, 232 dyspepsia: folk remedy for, 135 Eagle Imperial Guard: 19 Ecuador: A. aegypti eradication in, 230 edema: papaya used in treating, 56, 68; liniment causes, 138 education: of Aztec nobles, 13; of worms, 20; De la Cruz' role in, 46; university, 96, 97-98, 298; Spanish colonies' lead in, 96, 101; textbooks

312 for, 100, 299; of women, 115; witchcraft due to lack of, 146; in health practices, 151-152, 166, 173, 184, 185, 194; and literacy, 158, 188, 274; of midwives, 161-162, 299; for nursing, 162, 256, 271, 272, 281; elementary, 166, 190-191, 203, 254, 298; secondary, 203; for pinto victims, 214; seminary, 222; postgraduate, 282, 283, 284, 285. SEE ALSO National Polytechnical Institute; National University of Mexico , medical: among Aztecs, 47-48; in Spain, 85; Spanish colonies' lead in, 96, 101; at Colegio de Santa Cruz de Tlalteloco, 97; by Soto, 97; by Franciscans, 97; placed early in curriculum of National University, 98; textbooks for, 100; servicio social at end of, 153-156; government support of, 156, 258, 261, 262, 293; experimental animals for, 196; in United States, 247, 265, 278, 293; status of, 250, 264-266; by Public Health Department, 256; number of physicians involved in, 259; in special fields, 266-267; enrollment in, 266-268; expansion in, 268-271; at Children's Hospital, 277, 281; mentioned, 135 Education, Ministry of: 282 Edwards, Dr. Charles: research by, 284 Effortil. SEE ethyl adrianol Eguía, Dr. : conclusions of, based on anatomico-pathological theory, 116 Egypt: 7, 9, 64, 219 Eisenberg, Dr. Sara: research by, 283 elephantiasis: god of, 28, isolation of victims of, 35 El Grande River: pinto in basin of, 215 Elizabeth I: 35, 63 El Salvador: A. aegypti eradication in, 230; abortion in, 296 n. emetine: amebiasis treated with, 172 encephalitis: 280 enemas: as therapy, 45, 65, 67, 141 England: epidemic in, 35; cavaliers of, 40; American colonies of, 96-97; witchcraft in, 136-137, 139; mentioned, 281 Entamoeba histolytica: 116, 172

MEDICINE IN MEXICO

epidemics: Aztec controls of, 22, 34, 35-36, 43, 44; in Europe, 32, 3 5 36, 41; come to Mexico, 41; role of Hospital of Jesus in, 90; Protomedicato sets up quarantine to prevent, 100; Spanish administrators' inability to control, 102; statistics on, 106-108, 226; in Veracruz, 109; vaccine stops, 111; during War for Independence, 122; turn-of-century, 148; study of, 152, 205, 280; as related to poverty, 165, 166-169, 170; investigation of, 173; as related to poor environment, 193; Public Health Department in charge of combatting most, 206; funds for campaigns against, 236 epilepsy: Aztec treatments for, 63-64; research on, 79, 291-293; folk remedy for, 136 ergotamine: escorpionismo treated with, 199 escorpionismo: as related to poverty, 165; importance of, 194; campaign against, 197-200, 207 ether: 70 ethyl adrianol: in treatment of hyaline membrane disease, 293, 294 Europe: civilization of, compared to Aztec, 11; concept of zero introduced in, 14; astronomy in, 14; Quetzalcóatl from, 25; epidemics in, 32, 34, 35, 41; lack of zoos and botanical gardens in, 37; drinking water in, 39-40; cities in, 40, 41; rarity of bathing in, 41-42; bloodletting in, 45, 48; dentistry in, 50; unsanitary medical practices in, 53, 55; surgery in, 54; superior knowledge of anatomy in, 59-60; magical stones in, 62-63; medical use of mummy dust in, 64; lack of narcotics in, 79; medicine of, brought to New Spain, 83; Spain's leadership of, in medicine, 85; first governmental council of physicians in, 86; American medicines exported to, 88; syphilis in, 93, 104; standards of hospitals in, 96; medical courses forbidden in, 98; diseases from, 102, 106; smallpox in, 108; chocolate exported to, 117; Thirty Years' War in, 128; witches in, 132; Mexican witches surviving facet of,

INDEX

146; Mexican wealth sent to, 164; clothing in, 246; birth control in, 296 eye inflammation: folk remedy for, 136 Farfán, Agustín (Fray): 46, 62, 101 Farrera Rojas, Dr. Rafael: on use of graft material, 287-288 fatigue: treated as disease, 12-13; folk remedies for, 141 feathers: medical use of, 69 Federal Bureau of Mines: health requirement set by, 220 Federal District: urinary lithiasis in, 181; goiter in, 182; salt iodizing in, 185; Department of the, 203204; polio in, 225-226; medical students from, 267 Federal Hydraulic Resources Secretariat: water and sewage provided by, 169 Federal Workers' unit. SEE Institute of Security and Social Services of the Workers of the State (ISSSTE) Ferdinand VII: 121 fever: remedies for, 67, 136; as symptom, 107, 143; drugs cause, 218, 222 First International Conference Between Mexico and the United States on Environmental Sanitation: 201202 food: of Moctezuma II, 10; human flesh as, 18-19, 20; distributed to needy, 33-34, 190-191; at Hospital of the Buboes, 94; Protomedicato inspects, 100; of vultures, 128; veintiunilla mixed with, 139; diarrhea caused by, 174; necessity of, 177; in Aztec Empire, 178; iodine in, 182, 183, 184, 185; of rural migrants, 188-189; produced in former jungle areas, 234; for Day of the Dead, 239; at Hospital Dalinde, 258; cost of, 269 , specific: beef, 18, 52; deer meat, 18; peccary meat, 18; dog meat, 18; yams, 19; bread, 19, 182, 191; honey, 43, 56, 68, 117; vinegar, 5 1 52; eggs, 56, 58, 68, 142, 191; vanilla, 117; cinnamon, 117; clove, 117; syrup, 117; preserved fruit, 117; anise, 117; pepper, 117, 182; tortillas, 134, 178, 181, 182; tacos,

313 166, 167; candy, 166; 184, 185; paletas, 167; enchiladas, 178; beans, 179, 180, 182, 191; rice, 182; potatoes, 182; cheese, 182; lettuce, 182; rolls, 182; peanut butter, 191; banana, 191; liver paste, 191; gelatine, 191; custard, 191; chickpea oleoprotein, 191. SEE ALSO corn Ford Foundation: 282 Formosa: research on plants from, 79 foxes: rabid, 195; mentioned, 64 fractures: acquired in riding, 244-245 France: chevaliers of, 40; enemas in, 45; syphilis in, 93; army of, in Mexico, 128 Franco, Francisco: praises charreadas, 246 freckles: considered disease by Aztecs, 70, 105 French Guiana: A. aegypti eradication in, 230 French Hospital: 256 "French malady." SEE syphilis fright sickness: 140, 142, 143 frogs: in research, 284; mentioned, 63 Fuente, Juan de la: 98, 101 Furculow, : on histoplasmosis, 220 gachupines: 121 Gage, Thomas: on chocolate controversy, 117-119 Galeanos: 87 Galen: 60 gangrene: 55 Gante, Pedro de (Fray): 93 García Camberos, Dr. Agustín: on Mexico City poor, 188 García Hernández, Dr. Mario: on biochemical research, 283 García Ramos, Dr. Juan: research by, 283-284 Garibay Ávalos, Dr. José F.: on pinto, 215 gastroenteritis: 280 General Hospital, Mexico City: government of, 150; necropsies at, 172; health centers compared to, 189; Dermatological Service of, 216 genital eruptions: Indian treatment for, 68-69. SEE ALSO venereal diseases Germany: 9, 21 Ghana: onchocercosis in, 218 gingivitis: 52-53

314 Gitler, Dr. Carlos: research by, 283 glucose potassium insulin, 275-277 Goddess of Filthiness: 29-30, 31 "God's Punishment." S E E histoplasmosis Goeckerman treatment: 35 goiter: 165, 182-185 gold: vessels of, 10, 18, 117; artisans in, 10, 28; Cortés' desire for, 20; as tribute, 34; Spanish export of, 63, 120, 123, 164; lack of, in English colonies, 97; fines in, 99; abandoned mines for, 219; in charro costumes, 246-247 González del Campillo, Manuel Ignacio (Bishop): 111 González Ochoa, Dr. Antonio: on tropical diseases, 207-210, 214, 220, 221-222 González Ulloa, Dr. Mario: 242-244, 257-258 González Urtusuáztegui, José M.: 237 gout: Aztec remedies for, 70 Graphic Arts John F . Kennedy Housing Unit: 203 Great Pyramid: 35, 4 1 , 71 Great Temple: sacrifice in, 12, 17; medical education in, 48; annex to, 104 Great Teocalli. SEE Great Temple Greece, ancient: 9, 60 Grijalva, : on epidemic, 107 Grijalva River: 157, 215 grippe: 281 Gross National Product: of Mexico, 192 Guadalajara, Jalisco: smallpox vaccine brought to, 111; and Balmis Expedition, 112; leprosy in, 212; mycetoma in, 217; polio in, 226 Guadalupe (island): A. aegypti on, 230 Guanajuato, Guanajuato: hospitals in, 272; smallpox vaccine in, 111; heads displayed in, 122 Guanajuato ( s t a t e ) : hospitals in, 96; witches in, 137-139; scorpions of, 199 Guatemala: bones found in, 104; onchocercosis in, 218; campaign against malaria in, 229-230; A. aegypti eradication in, 230 Guerra family: 105 Guerrero ( s t a t e ) : salt production in,

MEDICINE IN MEXICO

184; salt iodizing in, 184; escorpionismo deaths in, 198; pinto in, 215 Gulf Coast. SEE Gulf of Mexico Gulf of Mexico: coast of, 9, 10, 29, 102; Quetzalcóatl in, 24; Cortés sails, 25; Cortés founds port on, 96; mycoses along, 209-210 Gutiérrez, Dr. Antonio: 108 gynecology: goddess of, 29, 3 1 ; among Aztecs, 48, 53; hospital for, 294 hair: medicinal use of, 69; in witchcraft, 136, 139 Haiti: witches in, 139; pega palo in, 78; A. aegypti in, 230 hallucinogens. SEE narcotics Hansen's disease. SEE leprosy Harlem ( N e w York C i t y ) : witches in, 139 Hartman's solution: used against diarrhea, 168 headache: as symptom, 107; folk remedies for, 135, 141 heart disease: folk remedy for, 136; hypersensitive, 276; congenital, 288-291. S E E ALSO National Institute of Cardiology heart failure: role of Κ depletion in, 276 heat dehydration: associated with diarrhea, 168 hematology: at Children's Hospital, 279 hemophilia: research on, 279 hemorrhages: bloodstone believed antidote to, 63; battlefield treatment of, 86 hemorrhoids: modern remedy for, 68 hepatitis: Aztec treatment for, 70 Heredia, Dr. J. Gabriel: on rural migrants, 187, 188-189 Hernández, Dr. Francisco: compiles herbal thesaurus, 46, 62; on leprosy, 104 Hernández Frías, Dr. Miguel: 248 Hernández-Rodríguez, Dr. Jorge: research by, 280-281 Hidalgo, Miguel: 121, 122 Hidalgo ( s t a t e ) : nurse training center in, 162; iodized candy distribution in, 185; tuberculosis in, 224 Hill of Moctezuma: 137 Hinojosa y Hernández, Dr. López: 98

315

INDEX

Hipódromo: 27 Hippocrates: 28, 60, 87 histoplasmosis: incidence of, 219-221; treatment of, 221-223 History of the Ρlants of New Spain: 46-47 Holland, Dr. William R.: on el susto, 143 Hondo River: 157 Honduras: Aztec conquests in, 9; A. aegypti eradication in, 230 horses: 22, 155, 156, 244-247, 249, 281 Horwitz, Dr. Abraham: on Mexico's public health, 129-130; on epidemic diarrhea, 167; on tuberculosis, 186 Hospital Central Militar: 286, 2 8 7 288 Hospital Dalinde: 256, 257-258 Hospital de la Limpia y Pura Concepción de Nuestra Señora y Jesús Nazareno: 89-92 Hospital de Nutrición: 288 Hospital de San Hipólito: 94, 95 Hospital de San Juan de Dios: 93, 94 Hospital de San Lázaro: 93 Hospital de Tlaxpana: 9 2 - 9 3 Hospital Dr. Jesús Alemán Pérez: 94 Hospital Dr. Rubén Leñaro: 286 Hospitales de México, Los: on Cortés' remains, 92 Hospital Infantil. SEE Children's Hospital Hospital Londres: 256-257 Hospital of Jesus: 89-92 Hospital of St. John of God: 9 3 - 9 4 Hospital of the Buboes: 93, 94 Hospital of the Love of God: 93, 94 Hospital Real de San José de los Naturales: 93, 94 hospitals: provincial, under Spanish rule, 95-96; veterans', of Aztecs, 3 3 Hospital Santa María de Guadalupe: 239-244 Hotel Dieu: 96 Huastecs: 29 Huaxtepec: 37 Huitzilán: 89 Huitzilopochtli: temple to, 17; beliefs about, 26; associated with hummingbirds, 26, 89 human sacrifice. SEE religion, Aztec humors, the: 116 and n. Hungary: 52, 77

hyaline membrane disease: 293-295 hypnotism: Aztec use of, 47, 50 Ibarra, Dr. Blas: 223-224 Ibarra, Dr. Eduardo: 240 Ibarra, Dr. Javier: 240, 242 Ibarra, Dr. Javier, Jr.: 240, 241 Ibarra, José: 240 Iguala, Guerrero: salt iodizing in, 184 Imeran: experiments with, 280 Imperial College of Santa Cruz: 46, 97-98 IMSS. S E E Social Security Institute (IMSS) Incas: 57, 7 4 - 7 5 Independence Day, Mexican: 91 Independencia housing project: 203 India: 14, 78 Indians: shamans of North America, 47; hospitals for, 93, 95, 96; excluded from hospital, 94; education of, 97-98; as midwives, 99; viruses attack, 102, 106-108; burial sites of, 103; in Rio Grande area, 105; bathhouses of, 115; regain dominance, 127; and Juárez' reforms, 128; witches patronized by, 134; servicio social for, 154-155; language of, 158; surrender signal of, 181; diet of, 182; horseback riding by, 246. SEE ALSO entries under specific Indian groups Indian sickness. SEE syphilis influenza: epidemics of, 106, 107-108; research on, 288-291 INPI. S E E National Child Care Institute ( I N P I ) insects: maggots of, 30; flies, 37, 178, 193, 200, 209; gnats, 37, 193; sauna treatment for bites of, 42; ants, 6 4 65; jiggers, 68; lice, 68; fleas, 68, 193; poinciana used against, 136; bedbugs, 193; scorpions eat, 200; transmit pinto, 213; Simuliidae, 218-219; steroids used on, 297. S E E ALSO mosquitoes

Institute of Security and Social Services of the Workers of the State ( I S S S T E ) : covers government employees, 253, 263; medical salary scales of, 260, 261; medical students in hospital of, 268; nursing jobs created by, 271 Instituto Mexicano de Seguro Social.

316 SEE Social Security Institute (IMSS) Instituto Nacional de Protección a la Infancia. SEE National Child Care Institute (INPI) internists: Aztec, 48, 49, 65 Isla de Mujeres: hospital on, 170 isoniazid: in treatment of mycetoma, 216, 217 ISSSTE. SEE Institute of Security and Social Services of the Workers of the State (ISSSTE) Italy: 92, 93 Iturrigaray, José de (Viceroy): 110111 Ivanhoe, Dr. Frank: research by, 293295 Ixtacíhuatl: goiter on slopes of, 182, 183 Ixtapalapa: 89 Ixtlán, Nayarit: 103 Ixtlera area: Rural Cooperative Medical Services in, 153 Jaguar Imperial Guard: 19 jaguars: 37, 76, 228 Jalisco (state): plea for Tláloc statue from, 27; nurse training center in, 162; escorpionismo deaths in, 198; pinto in, 215 Jamaica: A. aegypti on, 230 James I: 63 Japan: Aztecs compared to natives of, 9; bombing in, 21; bathing in, 42; birth control in, 296 Java: research on plants from, 79 Jenner, Edward: vaccination method of, 108 jewels: of Moctezuma II, 10; artisans for, 10, 28; medicinal use of, 13, 54, 62, 63; as tribute, 34; set in teeth, 53; brought to Mexico from Peru, 75; in witchcraft, 136; pawning of, 238 jicarazo. SEE poison Jiménez, : 122 jimson weed: 49, 66, 68, 72, 74 Juárez, Benito: 127-128, 129 Kabah: Mayans build, 180 Kennedy, John F.: 203, 293 Kennedy, Patrick: death of, 293 Kepler, Johann: 14

MEDICINE IN MEXICO

Kerdek, by, 209

: leishmaniasis described

La Castañeda (hospital): 291 La Guayra-Caracas, Venezuela: smallpox vaccine in, 109 Laguna region: "jungle colonists" from, 233 La Huerta, Jalisco: escorpionismo deaths in, 198 Landa, Diego de (Bishop): 73 Larsh, : on histoplasmosis, 220 laryngitis: Aztec treatment for, 66 Las Casas, Bartolomé de: on Oveido, 103 Latapí, Dr. Fernando: on mal de pinto, 103; on leprosy, 103, 104-105, 211-212; on syphilis, 103-104; on mycetoma, 215-217 latrines: Aztecs' public, 40; regulations governing, 115; education in constructing and using, 152, 158; lack of, 170; Public Health Department constructs, 173, 194 leeches: as medical cure, 49 leishmaniasis: 205, 209 lepromatosis: 207, 209 leprosy: god of, 28; isolation of sufferers from, 35, 100; hospitals for, 92-93, 96, 100; origin of, 102, 103, 104-105; described, 207; campaign against, 210-212; medicine in treating, 212, 217 leukemia: 79, 279 lichen: Aztec treatment for, 63, 68 lightning: Aztec treatment for injury from, 69 Lincoln, Abraham: 127 liniment: used by witch, 138 Lister, Joseph: 77 London: Great Plague of, 35 López, Dr. Pedro: 93 López Esqueda, Benjamín: 241 López Mateos, Adolfo: Bustamante serves under, 107; attack under, of problem of witches, 147; Public Health Department under, 150-151, 232; water supply projects under, 169; on amebic dysentery mortality rate, 173; issues decree requiring salt iodization, 185; wife of, 190; rabies mortality rate during administration of, 196; public housing under, 202-203; campaign against pin-

INDEX

to under, 215; decrees polio inoculation mandatory, 227; on malaria, 228; colonization under, 233; on medical practice, 239; medical progress under, 250; Social Security under, 253; on mortality rate, 272-273 López Mateos, Eva Sámano de (Profesora): 190 Los Angeles, California: 200, 263 Los Mochis, Sinaloa: 187 Lotería Nacional. SEE National Lottery Louisiana: leprosy in, 105 Madrid: 113, 114 Magazine de Policía: 136 magic. SEE witches magical stones. SEE bezoar stones; jewels maguey: 49, 68, 74,167,178 malaria: epidemics of, 148; campaign against, 228-230, 231; eradication of, 232, 236; prevents colonization, 233 mal de pinto: origin of, 103, 105-106; cause of, 207; extent of, 208; campaign against, 212-215, 236 mal francés. SEE syphilis Malinche: as symbol of snobbery, 263 malnutrition: death from, 155; as cause of disease, 165, 178-192 passim; research on, 279 Manila: smallpox vaccine brought to, 111 Manolete: death of, 240 Manzanillo, Colima: escorpionismo deaths in, 198, 200 Mariotte, Dr. Carlos Ortiz: on epidemic diarrhea, 167; on yellow fever, 230-231 Marker, Dr. Russell: discovers progesterone extraction process, 76 Martínez, Dr. Pedro Daniel: 229 Massachusetts: 96, 287 Massieu, Dr. Guillermo: research by, 291-293 Matamoros, Tamaulipas: 195, 202 Maternal Health Association: study of abortion by, 145 mathematics: Mayan knowledge of, 13-14; Aztec knowledge of, 15, 80 Maximilian: 116, 128, 246 Mayans: place of, in Mexican history, 5; abandoned cities of, 8; Toltec

317 links with, 8 n.; mathematical knowledge of, 13-14; knowledge of astronomy of, 14; human sacrifice under, 20, 31; effect of epidemics on, 43; toothache remedies of, 51; trepanning by, 57; treatment for burns by, 68; on genital eruptions, 69; records kept by, 72; books of, burned, 73; ruins of, 96; skulls of, 104; descendants of, 180 Mazzotti, Dr. Luis: on escorpionismo, 197, 198, 199-200 measles: research on, 280; Influenza A compared to, 289 medical brigades. SEE servicio social Medicis, the: 63 Medrano, Dr. : 275 Memorial Children's Hospital: 278 Méndez, Dr. Luis: on Social Security medical facilities, 253; in campaign to raise medical standards, 264 Mendiola, Gaspar de (Canon): 94 Mendosa, Viceroy: 99 Mental Health Research Institute: flatworm experiments at, 20 mental illness: hospitals for, 94-95, 101, 189, 255, 291. SEE ALSO psy-

chiatry mental stupor: Aztec treatment for, 70 Mérida: hospitals in, 96; yellow fever in, 107; radiological examinations in, 187 Messenger of Health Number One: 157 Messenger of Health Number Two: 157 Mexicali, Baja California: 195, 202 Mexican-Guatemalan Public Health Association: 229 Mexican Naval Hospital: study of parasitosis by, 170 Mexican Society of Urology: and circumcision legislation, 175-176 Mexican War: 90-91 México (state): pinto in, 215 Mexico, University of. SEE National University of Mexico Mexico, Valley of: 8 Mexico City, México: Aztecs settle site of, 8, 26; Aztec Calendar Stone displayed in, 14; heretics burned in, 21; Tláloc statue brought to, 27; National Medical Center in, 28, 251; books published in, 46, 101; Saha-

318 gun teaches in, 57; barhasco yam shipped to, 78; priests attend sick in, 86; gives salary to Soto, 87: hospitals in, 89, 90, 9 3 , 104, 165, 235, 239, 240, 244, 256-258, 2 7 1 , 272, 286, 291; Cortés buried in, 9 1 ; hospitals outside of, 96; medical education in, 97; government regulation of medicine in, 98-99, 1 1 3 115; dermatological center in, 103, 211; smallpox vaccine brought to, 111; plaque to Balmis Expedition in, 112; Revillagigedo arrives in, 114; Royal College of Surgeons founded in, 115; Academy of Medicine founded in, 116; National Pawnshop in, 120, 238; witchcraft in, 136; Mental Health Association in, 145; Amézquita from, 151; taco venders in, 166; campaign against unsanitary food in, 167; parasitosis in, 171; amebiasis in, 172; urinary lithiasis in, 180-181; iodized candy distributed near, 184; salt iodizing in, 185; rural migrants to, 187-191; rabies in, 195-196, 197; visitors from, to United States, 200; U.S.Mexico sanitation conference in, 201; public housing in, 202-204, 253-254; National Institute of Tropical Diseases in, 206; leprosy in, 212; mycetoma in, 217; polio in, 226; lottery winners in, 237; bullfighters injured in, 2 4 1 , 242; charreadas in, 244; riding accidents in, 245; Social Security in, 253; National Academy of Medicine Centenary Congress in, 259; interns strike in, 261; surplus of doctors in, 262; doctors in, on malinchismo, 263; National University near, 267; Children's Hospital patients in, 278; treatment of hyaline membrane disease in, 293; mentioned, 5 1 , 137. SEE ALSO Tenochtitlán

mice: 69, 78, 291 Michigan, University of: flatworm experiments at, 20 Michoacán ( s t a t e ) : hospitals for, 96; nurse training center in, 162; escorpionismo deaths in, 198, 200; pinto in, 215; histoplasmosis in, 222 Mictlantecuhtli: 29 midwives. SEE birth; witches

MEDICINE IN MEXICO

Mier y Torcida, Dr. Antonio: on histoplasmosis, 222-223 "Miners' Widow-Maker, T h e . " S E E histoplasmosis Ministry of Education: 282 Minnesota, University of: 284 Mixta solution: used against diarrhea, 168 Mixtecs: 5 Moctezuma I: botanical gardens and zoos established by, 37, 60; instructions by, for medical research, 38; bathhouses established by, 41 Moctezuma I I : life-style of, 10-11, 36, 41, 117; legal system under, 11-12; human sacrifices under, 17; reaction of, to Spaniards, 25-26; establishes asylums, 34, 104; institutes quarantines, 35; Cortés' quest of, 86; meets Cortés, 89, 92; nutritional bases under, 178; mentioned, 14, 37 Moctezuma's Revenge. SEE diarrhea Molina Font, Dr. Fernando: 256-257 Molina Montes, Dr. Olegario: 256, 257 momaxtli: 48 monkeys: 76, 284 Montagu, Mary Wortley ( L a d y ) : on smallpox inoculation, 108 n. Monte de Piedad. S E E National Pawnshop Monterrey, Nuevo León: diarrhea in, 168, 169; visitors from, to United States, 200; polio in, 226; hospitals in, 272 Moon: pyramid of, 8; eclipses of, 14 morbo gálico. SEE syphilis Morelia, Michoacán: smallpox vaccine brought to, 111; and Balmis Expedition, 112; histoplasmosis near, 222 Morelos, José María: 122 Morelos, Chihuahua: bats in, 223 Morelos ( s t a t e ) : nurse training center in, 162; escorpionismo deaths in, 198; pinto in, 215 Moreno Valle, Dr. Rafael: at MexicanGuatemalan Public Health Association meeting, 229; on malaria, 230; appointed Secretary of Public Health and Assistance, 244 n.; on riding accidents, 244-245; on charro costume, 246 Morton, William: 70 Moscow: 285

INDEX

mosquitoes: 37, 193, 200, 228, 229, 230, 231 Mother Earth: 29 Mother of the Gods: 29 mucilages: used in treating amebiasis, 172 mumps: 107 mycetoma: bathing preventive of, 174; actinomycosis, 210; incidence of, 215-216; treatment of, 216-217 mycoses: 209-210. SEE ALSO mycetoma myocarditis: 216 Nahuas. SEE Aztecs Nahuatláns: 8 η. Nanáhuatl: 28, 35 Napoleon Bonaparte: 63, 108, 128 narcotics: given sacrificial victims, 1 7 18, 7 1 ; Aztec psychiatric treatment for, 49-50; used as anesthetics, 54, 7 0 - 7 1 ; in treatment of respiratory diseases, 66; in vulnerary ointment, 68; list of Aztec, 71-72; Aztec wealth in, 79; used by curanderos, 142 National Academy of Medicine: 116, 155, 259 National Anthropological Museum: 14,27 National Anti-Mosquito Service: 231 National Archives: Hospital of Jesus documents at, 91 National Campaign Against Goiter. SEE goiter National Campaign Against Tuberculosis. SEE tuberculosis National Cathedral: 89, 93, 94 National Child Care Institute ( I N P I ) : school-breakfast program of, 1 9 0 191 National Children's Hospital. S E E Children's Hospital National Hospital of Nutritional Diseases: 172 National Institute of Anthropology: syphilitic skulls in, 104 National Institute of Cardiology: government of, 150; site of, 252; Dr. Chávez directs, 264; postgraduate training at, 266; research at, 2 7 5 277, 288-291; Children's Hospital compared to, 278, 281; Dr. Rosen-

319 bleuth's work at, 282; Hormones Laboratory of, 295 National Institute of Hygiene: 198 National Institute of Nutrition: government of, 150; site of, 252; postgraduate training at, 266; Children's Hospital compared to, 278, 281 National Institute of Nutritional Diseases: study on diet by, 178-179; study on national nutritional conditions by, 180 National Institute of Pediatrics. S E E Children's Hospital National Institute of Tropical Diseases: government of, 150; officials of, report on escorpionismo, 197, 198; constructs scorpion-proof homes, 200; scope of work of, 2 0 6 207; cutaneous tuberculosis cases at, 208; tattooing by, of pinto cases, 214; study of histoplasmosis by, 220; research at, 275; Children's Hospital compared to, 278, 281 National Institutes of Health, U.S.: grants from, 280, 282 National Lottery: function of, 1 1 9 120; medicinal herbs sold near, 136; national character of, 235; operational methods of, 236-237; anecdotes about, 237-238 National Medical Center: statue at auditorium of, 28; completion of, 250; described, 251-252; Centenary Congress of National Academy of Medicine at, 259; Children's Hospital near, 277 National Military College: 267 National Mortgage and Public Works Bank: 204 National Museum of Anthropology: 14,27 National Pawnshop: Cortés' remains at, 9 1 ; function of, 119, 120; national character of, 235; operation of, 238-239 National Petroleum Industry: and Social Security, 253 National Polytechnical Institute: medical education at, 262, 267; research at, 275, 282-286, 291 National Program for the Control of Chronic Diseases of the Skin: 103, 210-211

320 National Public Health Congress, Mexican: 27 National Railways: and Social Securi- t y , 253 National School of Anthropology: 143 National Society of Urology: report to, on urinary lithiasis, 181 National University of Mexico: Farfán graduates from, 46; medical education at, 98, 99, 262, 268-271, 281; faculty of, 101, 110, 172, 174, 211, 259, 264-265; cost of, 262, 293; certifies postgraduates, 266; enrollment at, 267-268, 282; autonomy of, 278 Naval Corps, Mexican: study by medical officers of, 170 Nayarit (state): burial site in, 103; nurse training center in, 162; escorpionismo in, 198, 199; Arbor viruses in, 280 "Neapolitan sickness." SEE syphilis necropsy. SEE autopsy Negroes: witch doctors among, 47; and diseases controversy, 103, 105, 106, 218; buy magical items, 136 nephology: at Children's Hospital, 279 neurology: services for, 255; research in, 282. SEE ALSO surgery

New Orleans, Louisiana: leprosy in, 105 News, Mexico City: on interns' strike, 261 New York City: author in, 52; witchcraft in, 136, 139; Mexican tourists in, 174; tropical diseases in, 205 Nicaragua: Aztec conquests in, 9; Mexico donates polio vaccine to, 227; A. aegypti eradication in, 231; graft material sent to, 287 Nogales, Sonora: 202, 241 Nonoalco-Tlaltelolco housing project: 203, 204 noradrenaline: treatment of hyaline membrane disease with, 293-294 norethindrone: extracted from plants, 77 Noriega, Dr. Raúl: on Aztec astronomers, 14 "North American Invasion": 91 Northern Frontier Region: rabies in, 194 nosebleed: Aztec remedy for, 70; as symptom, 107

MEDICINE IN MEXICO

Nuevo Laredo, Tamaulipas: sewage disposal in, 202 Nuevo León (state): Rural Cooperative Medical Services in, 153; histoplasmosis in, 220; mosquito eradication in, 231 nursing: Álvarez' work in, 95; public health, by Isabel Cendal, 108; patronization of, 133; need for, to replace witches, 146; on brigadas médicas, 156, 157; training for, 162, 256, 271, 299; for leprosy, 212; shortage of personnel for, 250, 271272 Oak Ridge Laboratories: Dr. Eisenberg's work at, 283 Oaxaca, Oaxaca: 19, 111 Oaxaca (state): barbasco in, 77; curandero technique in, 142; Rural Cooperative Medical Services in, 153; languages in, 158; nurse training center in, 162; pinto in, 215; onchocercosis in, 217 obstetrics: goddess of, 29, 31; Aztec specialists in, 48; Aztec techniques of, 53-54; at maternal-infantile centers, 190; Social Security benefits for, 252; at Hospital Londres, 257; hospital for, 294. SEE ALSO birth Ochoa, Dr. Antonio González. SEE González Ochoa, Dr. Antonio Ohio River: 220 Oklahoma: histoplasmosis in, 220 Olmecs: 5, 8 n. onchocercosis: campaign against, 217219, 236 Oncological Hospital: 251 oncology: services for, 255 Opera Medicinalia: 101 ophthalmology: surgery in, 58; practitioner of, blinded, 159-160; postgraduate courses in, 267 Orantes, Dr. Aniceto: on urinary lithiasis, 181 Oriol, Dr. Α.: 275 Ortega, Dr. Manuel B.: research by, 283 orthopedics. SEE surgery Ortiz, Josefa: 121 osteology: consultant on, 104 osteoplasty: cadaver bone used in treating, 287

INDEX

osteosynthesis: cadaver bone used in treating, 287 Otomís: 8 n., 96 otorhinolaryngology: 247 Our Grandmother: 29 Oveido y Valdés, Gonzalo Fernandes de: on syphilis, 103 Oxford University: 98 oxyquinoline: derivates of, 172 Pacific Ocean: bounds Aztec empire, 9; Acapulco port for, 96; Balmis Expedition crosses, 111; goiter belt ends at, 182; salt production on coast of, 184; diseases on coast of, 198, 229, 230, 280 Palacio de Bellas Artes: 93 Palafox, Viceroy: instructions by, on medical education, 98 Palenque, Chiapas: as city-state, 8; skulls from, 57, 104 palsy: respiratory, 199 Panama: Mexico donates polio vaccine to, 227; A. aegypti eradication in, 231 Panama Canal Zone: A. aegypti eradication in, 230 panamacani: 48 Pan American Health Organization: operating arm of, 130; campaign by, against tuberculosis, 186, 187; findings by, on tuberculosis, 224 Pan American Sanitary Bureau: director of, 136, 167; water supply program of, 170; report by, on tuberculosis, 186; officials of, at international conference, 201; and A. aegypti, 230 Papaloapan River: Dr. Marker's collections on, 76 papiani: 48 Paraguay: A. aegypti eradication in, 230 paralysis: folk remedy for, 136 parasitology: studied in New York City, 205 parasitosis: as related to poverty, 165; high incidence of, 170-171; campaign against, 173. SEE ALSO amebiasis paratyphoid: death from, 232 Paris: hospitals in, 96 Paris, University of: 98, 117, 282 Parke-Davis: 291

321 Partido Revolucionario Instituto (PRI): 129, 150 Party of Revolutionary Institutions (PRI): 129, 150 Pascua Dermatological Center: 103, 211, 215-216 Paseo de la Reforma: 136 Paso de la Muerte: 245 Pass of Death: 245 Pasteur, Louis: 77 Pátzcuaro, Michoacán: hospitals in, 96 Pavón, Carlos: 242 Peace Corps: 206 pediatrics: goddess of, 29, 30, 31; Aztec specialists in, 48; hospitals for, 255; education in, 281; at Social Security hospital, 294. SEE ALSO Children's Hospital pediculosis: Aztec treatment for, 68 Pedraza, Diego: 87 Pemex: and servicio social, 156 penicillin: pinto treated with, 208, 213 Pennsylvania, University of: 76, 247 pentylenetetrazol: convulsions introduced by, 291 Pergamus: 60 Pernambuco: cervical cancer in, 176 Persia: 63 Peru: trepanning in, 57; Aztec trade with, 74-75; Álvarez makes fortune in, 95; vaccines brought to, 109, 227; program in, to raise medical standards, 264; mentioned, 112 Petróleos Mexicanos: and servicio social, 156 pharmacy: Aztec, 27, 31, 38, 46, 48, 49, 56, 59, 60, 64, 74, 75, 80, 88, 298; search for new plants for, 7579; Protomedicato supervises, 100; practiced by doctors, 138; Social Security benefits for, 252; facilities for, built by Social Security, 253 "Pharaohs' Curse." SEE histoplasmosis Philip II: 46, 95, 104 Philippines, the: leprosy introduced from, 105; smallpox vaccine transported to, 108, 111-112 phimosis: as cause of penile cancer, 58 physiology: classes in, 270; research in, 282, 283-286 Piedra del Sol, La: 14 Piedras Negras, Coahuila: sewage disposal in, 202

322 Pignatelli de Aragon Cortés ( P r i n c e ) : 90 pigs: 114, 137, 168 pinto. SEE mal de pinto pitiriasis versicolor: 209 Planaria Research Group: 20 plants: in botanical gardens, 37-38, 47, 60, 62, 100, 298; used in sauna, 42; in deodorant, 4 3 ; books describing medical, 46; for anesthetics, 54-55; extraction of progesterone from, 76-77; magic, 132; steroids used on, 297 —, specific: cocoa, 34; rubber, 34; cotton, 34, 40, 233; cedar, 36, 37; pine, 36, 37, 43, 56; ahuehuetl tree, 36; tobacco, 36, 74, 117; firs, 37; grass, 37; moss, 37; soap tree (quahalahuac), 43, 54; marijuana (hashish; Cannabis sativa), 49, 72; mushrooms, hallucinogenic, 50, 72; pepper, 53, 69, 117, 182; ciuapatli, 54; calabash (ayonelhuatl), 54; Ylin tree, 56; cypress, 56, 69; papaya, 56, 66, 68, 74; ocozotl tree, 57; onion, 64; allspice, 65; plantain, 65; quauhayohuachtli, 65; hummingbird flower, 65; guava, 65, 68, 74; nettles, 65, 70; avocado, 65, 74; Picamnia antidesma, 66; Rhamnus purshiana, 66; Hymnea, 66; tlapalachíotl, 66; chia, 66; tlatlacizpatli, 66; ezptli (Croton sangiglum), 66; tlacolequilizpatli, 66; quamochitl, 66; Artemisia, 66, 68, 74; ipecac (Cephaelis ipecacuanha), 66, 74; sarsaparilla, 66, 74; Calliandra anomala, 67; "cold-in-the-head plant," 67; willow, 67; xaltomatl, 67; taxaxauitlan, 67; tlacopalli, 67, 74; limes, 68; "hand-flower tree" (Chiranthodendron pentadactylon), 69, 70; rue, 69; magnolia, 70; Mexican magnolia ("heart flower"; Talauma mexicana; yoloxóchitl), 70, 136; digitalis, 70, 136, 276; yoyotli (Thebetis yoyotli),71; cochiztzapotl (zapote), 72; tlalcapolin (Karwinskia humboldtiana), 72; tzompatli, 72; mixitl, 72; coapotli (Comolina tuberosa), 72; totoncaptli (Platango major), 72; cascara, 74; cacao, 74; cinchona, 74; chaparro, 74; chenopodium, 74; condurango, 74; kra-

MEDICINE IN MEXICO

meria, 74; haltada, 74; balsam, 74; lobelia (Lobelia laxiflora angustifolia), 74, 135-136; cabeza de negro, 77; dumb cane, 78; pega palo, 78; Vinca rosea, 78-79; Vinca lancea, 79; ixtenextic, 106; vanilla, 117; cinnamon, 117; clove, 117; anise, 117; gourd, 121; frangipani (Plumería rubra), 135; poinsettia (Euphorbia pulcherrima), 135; acacia (Acacia farnesiana), 135; angel's trumpet (Datura candida), 135; cut-leaf philodendron, 135; ceriman (Monstera deliciosa), 135; bougainvillea (Bougainvillea glabra), 135, 228; dwarf poinciana (Caesalpinia pulcherrima), 136; hawthorn, 137; veintiunilla, 138139; mango, 142; sunflower (Montanoa tomentosa; zoapatle), 169; beans, 179, 180, 182, 191; potatoes, 182; rice, 182; lettuce, 182; peanut, 191; chickpea, 191; banana, 191; chicle, 209; coffee, 217; sugar cane, 254; palm trees, 258. SEE ALSO cactus; corn; jimson weed; maguey; yam, barbasco Plaza de Toros (Querétaro): 247 Plaza de Toros México: 240, 242 Plaza de Toros Quatro Caminos: 2 4 1 , 242 Plumed Serpent, the: 16, 25, 26 pneumology: services for, 255 pneumonia: god associated with, 26; Aztec treatment for, 66; epidemic of, 107; follows drinking bouts, 139 poison: creatures spread, 42, 65, 194, 199; insanity caused by, 49-50; rattlesnake venom, 5 1 ; bezoar stone antidote to, 63; use of, in treating arthritis, 65; of bishop of Chiapas, 118; "data on," offered, 136; insecticides, 136, 219, 228, 229, 230, 231, 233; by veintiunilla, 139; witches cause use of, 146; gas, 223, 224; phosgene, 294 poliomyelitis: campaign against, 205, 225-227, 236 Ponce de León, Dr. J.: 275 Popo. SEE Popocatépetl Popocatépetl: goiter on slopes of, 182, 183 Port Royal: in debate over chocolate, 117

INDEX

potassium iodide: in treatment of sporotrichosis, 210 potassium permanganate: abortion induced with, 145 Prescott, William H.: on Aztec government, 11; on human sacrifice, 21 n.; on Huitzilopochtli, 26; quotes Toquemada, 33 PRI: 129, 150 Princeton ( N e w Jersey) Center for Advanced Studies: 282 progesterone: extracted from plants, 76-77 Protomedicato: Hospital of Jesus seat of, 90; precursor of, 99; history of, 99-100, 113; members of, at Veracruz ceremony, 110; sponsors studies on diarrhea, 116; cessation of, of, 122, 149; modern counterpart of, 150 prurigo: Aztec treatment for, 63, 68 pseudoarthrodesis: cadaver bone used for, 287 psoriasis: Aztec treatment of, 35, 68 psychiatry: god of, 29, 3 1 ; Aztec practice of, 49-50; and brain surgery, 57; of witches, 144. SEE ALSO mental illness Public Health Department. S E E Department of Public Health (Secretaría de Salubridad y Asistencia) Public Health Ministry, Guatemalan: 229-230 Public Health Service, U.S.: 201 Public Health Services, Mexican: 150 Puebla ( s t a t e ) : hospitals in, 96, 272; smallpox vaccine brought to, 111; Academy of Medicine founded in, 116; Rural Cooperative Medical Services in, 153; survey of cretinism in, 183; iodized candy distributed in, 185; pinto in, 215 Puebla, University of: 215 puerperal fever: in Europe, 5 3 , 55 Puerto Rico: smallpox vaccine brought to, 109; natives of, in New York, 136; A. aegypti mosquito in, 230 pumas: 37, 76 Punta del Este, Uruguay: health programs mapped at, 169, 170 Punto del Fuego: 109 Queen's Dragoons: 121 Querétaro, Querétaro: itinerant tooth-

323 puller in, 5 1 , 52; smallpox vaccine brought to, 111; child from, on Balmis Expedition, 112; revolutionary leaders from, 121; radiological examinations in, 187; Doctors' Bullfight in, 247-249 Quetzalcóatl: legend of, 16; beliefs concerning, 24; theories about, 2 4 25 quinidine intoxication: 276 quinine: possible Aztec use of, 74 Quintana Roo: snakebite cures in, 143; study of parasitosis in, 170-171; malaria in, 230 rabies: as related to poverty, 165; dogs spread, 193; death rate from, 1 9 4 195, 196, 197; campaign against, 195-196,197; bats spread, 223 radiology: postgraduate courses in, 267 Rancho del Charro: riding accidents at, 245 rats: 32, 78, 195, 291 Real de Chiapas: hospitals in, 96; chocolate controversy in, 117-119 Real de Monte mines: 120 Red Cross: bullfight staged for, 2 4 7 249 Regla, Count d e : 120 religion, Aztec: human sacrifice in, 7, 12, 17-18, 20, 21-24 and n., 26, 28, 29, 30, 36, 38, 49, 60, 7 1 ; Spanish see temples of, 10; emperor heads, 11; role of priesthood in, 13, 48; gods in, 16, 22-23, 2 4 31, 48, 89, 132; incense burned in, 36; blood-letting in, 49; castration in, 59 religion, Christian: Holy Communion in, 19-20. SEE ALSO Roman Catholic Church Remolina, Barbara: research by, 284 Remolina, Dr. Joaquín: 284 reptiles: snakes, 8, 26, 37, 51-52, 65, 136, 140, 143-144; in zoo, 34, 37, 38; iguanas, 37; sauna treatment for bites of, 42; lizards, 52, 63, 136; alligators, 63, 76 Revillagigedo, Count of: instigates Cortés burial, 9 1 ; public health reforms of, 114-115; medical reports by, 116 Revillagigedo Street: 114 Revolution of 1910: bitterness of, 1 2 8 -

324 129; effect of, on public health, 148-149; situation at end of, 164; purpose of, 298 Reyes, : leishmaniasis described by, 209 Reynosa, Tamaulipas: 195, 202 Rice-Wray, Dr. Edris: on abortion, 145 Ringer's solution: used against diarrhea, 168 Rio de Janeiro, Brazil: cervical cancer in, 176 Rio Grande: bison north of, 37; leprosy in area of, 105; epidemic diarrhea south of, 167; border crossings on, 200; sewage dumped into, 202; histoplasmosis south of, 219 Rivera, Diego: murals by, 251, 275 Rivera, Francisco, IV: 247 Rivera Α., Dr. Francisco "Pancho": 247-248 Rivera G., Dr. Francisco: 247 Rockefeller Foundation: 231, 280 Rodríguez, Félix: 242 Rodríguez, Isabel: 86 Rodríguez, José (Joselillo): 242 Roman Catholic Church: burning of Aztec books by, 15, 21; cruel practices of, 21; charitable activities of, in Europe, 32; priests of, admire Aztec physicians, 45; Augustinian order of, 46; Franciscan Order of, 57, 93, 97; opposition by, to circumcision, 58, 175; dissection of cadavers forbidden by, 59; practice of medicine by clergy of, 86; as negative medical force, 87; building for, 89, 91, 96; services of, at Hospital of the Buboes, 94; promotes vaccination, 111; Jesuits of, 117; Dominicans of, 117, 118; attitudes in, toward chocolate, 117-119; priests of, lead revolution, 121-122; property held by, 127, 128; and witchcraft, 134, 139-140, 141; and birth rate, 145; hospitals built by, 149; nuns of, in hospitals, 256, 272; position of, on birth control, 296 Rome, ancient: 9, 11, 39 Rosenbleuth Stearns, Dr. Arturo: 282 Rosenkranz, Dr. George: 77 Rostov, University of: 285 Royal City of Chiapas. SEE Real de Chiapas

MEDICINE IN MEXICO

Royal College of Physicians: 98 Royal College of Surgeons: 115 Royal Hospital of St. Joseph of the Natives: 93, 94 Royal Hospital of the Natives: 93, 94 Ruiloba, Dr. José: on amebiasis, 172 Ruiz Cortines, Señora Adolfo: 190 Rural Cooperative Medical Services and Health Centers: 153 Russek, Dr. Mauricio: research by, 291-293 Russia: vaccination of army of, 108. SEE ALSO Union of Soviet Socialist Republics Sabin vaccine: 225, 227 Sahagún, Bernardino de: on Aztec orthopedics, 57; on genital eruptions, 69; as instructor, 97-98; on Aztec Empire diet, 178 Salerno, University of: 98 Salgado Rodríguez, Dr. Jesús: on parasitosis, 170-171 salina Cruz, Oaxaca: 187 Salk vaccine: 225 salt: medicinal use of, 56; used by witches, 140; iodization of, 183184, 185; in heart patients' diet, 277 Saltillo, Coahuila: 104 San Andrés Hospital: 149 Sandringham, England: witchcraft at, 137, 139 San Francisco Street: 91 Sanitary Districts: 151-152 San Juan de Aragón housing project: 203-204 San Juan del Río, Durango: radiological examinations in, 187 San Juan Tetla, Puebla: cretinism in, 183 San Luis Potosí, San Luis Potosí: smallpox vaccine brought to, 111; salt iodizing in, 184, 185 San Luis Potosí (state): 153 San Miguel de Allende, Guanajuato: 121 San Miguel el Grande, Guanajuato: 121 Santa Clara, Durango: friars of, perform caesarean, 101 Santa Cruz, College of (Mexico City): Santa Cruz Meyehualco housing project: 203

INDEX

Santa Lucia: A. aegypti on, 230 Santiago, Chile: birth control in, 296 São Paulo, Brazil: cervical cancer in, 176 scabies: god of, 28; Aztec treatment for, 63, 68 School for Hospital Administrators: 256 School of Public Health: 256 scorpions: 65. SEE ALSO escorpionismo scrofula: Aztec treatment for, 63 Searle: contraceptives produced by, 77 sebaceous cysts: Aztec treatment for, 67 Secretaría de Salubridad y Asistencia. SEE Department of Public Health and Assistance (Secretaría de Salubridad y Asistencia) Semmelweiss, Dr. Ignaz: 5 3 septicemia: bullfighter dies of, 242 Sepúlveda, Dr. Bernardo: in campaign to raise medical standards, 264; on specialized education, 266-267 Serrano, Dr. : 116 Service for the Treatment of Leprosy: 211 servicio social: instituted, 153-154; hostility to, 154-155; salary in, 156; medical brigades of, 156-158, 162, 173, 211, 212, 219; advantage of witches over, 159; extension of program of, 262 sewage: disposal of, 39, 114, 169, 173, 202 sex: Aztec code concerning adulterous, 11, 30; potency in, and foods, 20; religious abstinence from, 23; Aztec religious beliefs about, 29, 3 0 31; relations during pregnancy of Aztec women, 54; and attitude toward circumcision, 58, 175; plant causing prowess in, 78; relations, and cancer, 176-177; activity in, restored to injured bullfighter, 244. SEE ALSO birth; surgery shamans. SEE witches Shriners' Hospital for Crippled Children: 104 Siberia: Aztecs in, 2 3 Sierra Madre mountains: medical care in, 160 Sierra Rojas, Dr. Luis: on bone grafts, 287

325 Sierra Tarahumara: tuberculosis in, 224 silver: artisans for, 10, 28; Aztec Calendar reproduced on, 14 n.; vessels of, 18; Spanish export of Aztec, 63, 120, 123, 164; English colonies' lack of, 97; in charro costumes, 246-247 Simroth, Dr. Hugo: 248 Sinaloa ( s t a t e ) : smallpox in, 107; lepromatosis in, 207 Siqueiros, David Alfaro; murals by, 251 Sleeping Woman, T h e : 182, 183 smallpox: introduction of, into Mexico, 28; epidemics of, 106, 107, 111, 148; vaccination against, 108-112, 157; and lottery funds, 119; eradication of, 232, 236 Social Security Institute ( I M S S ) : medical activities of, 137, 176, 251, 252-253, 260-261, 264, 267, 268, 271, 294; public housing built by, 203, 253-254; tax for, 236; coverage of, 263 Sodi-Pallares, Dr. Demetrio: therapy developed by, for heart infarcts, 275-277 sodium: effect of, on heart, 276, 277 Somlo, Dr. Emeric: works on hormone extraction, 77 Sonora ( s t a t e ) : Rural Cooperative Medical Services in, 153; tuberculosis in, 224; mosquito eradication in, 231 soot: medicinal use of, 65 sorcerers. SEE witches sores: suppurating, 135 Sosa-Camacho, Dr. Blas: on mal de pinto, 213-214 Sosa-Martínez, Dr. José: research by, 280-281; on Children's Hospital, 281-282 Soto, Francisco de: 87, 97 Spain: conquest of Mexico by, 9, 10, 15, 21 and n., 28, 33, 79, 83, 85, 88-89, 9 1 , 92, 298; writers from, on botanical gardens and zoos, 37; writers from, on Aztec aqueduct, 39; caballeros of, 40; body odors of soldiers from, 43; attempt by, to recover Aztec medical knowledge, 46, 62, 75; antiseptic techniques practiced by soldiers from, 55; Sa-

326 hagún from, 57; attitude in, toward circumcision, 58, 59; treatment for sebaceous cysts in, 67; level of medicine in, 85-86; physicians from, in Mexico, 86, 87; fusion of Aztec medicine with that of, 87— 88; War of Independence from, 90, 91, 110, 121-122, 127; Cortés dies in, 9 1 ; syphilis in, 93; hospital foundings ordered from, 95; administrators from and epidemics, 102; leprosy introduced from, 105; smallpox vaccination in, 108; and Balmis Expedition, 108-109, 112, 188 n.; greed of, in regard to Mexico, 113, 164; National Lottery founded from, 119, 236; nature of government of, in Mexico, 120, 121, 1 2 2 123; Manolete's death in, 240; charreadas in, 246; Loyalists in, 285 Spanish Government House: 238 Spanish Hospital: 256 "Spanish sickness." SEE syphilis sporotrichosis: 210 SSA. SEE Department of Public Health and Assistance (Secretaría de Salubridad y Asistencia) Stacpoole, Dr. Herbert: on goiter, 182-183; designs salt-iodizing machine, 184; and anti-goiter campaign, 185 State House, Mexican: 91 sterility: Aztec treatment for, 70; plant causing temporary male, 78 steroid hormones: 76-78, 296, 297 St. Lawrence River: 25 Stone of the Sun: 14 "Street of the Ghosts of Pigs, The": 137 "Street of the Witches, The": 137 streptococcus infections: studies of, 270 Suárez, Dr. Enrique: on bone grafts, 288 sulfa-metoxi-pyridaxine: in treatment of mycetoma, 210 sulfamides: in treatment of mycetoma, 216 sulfones: in treatment of mycetoma, 216 Sun: as god, 8, 14, 16, 22-23; eclipses of, predicted by Aztecs, 14; psoriasis treated with light of, 35 surgery: importance of Aztec, 24; in

MEDICINE IN MEXICO

Aztec veterans' hospitals, 33; Farfán writes on Aztec, 46; Aztec specialists in, 48; by barbers, 48, 87, 97, 102; trepanation, 50, 57; battlefield, 54, 55-56; anesthetics for, 54-55, 70-72; sterilization for, 55; cauterization in, 55; suturing in, 56; orthopedic, 56-57, 60, 244, 278, 287, 288; for skull fractures, 5 7 58; ophthalmological, 58, 159; tonsillectomy, 58; circumcision, 58-59, 87, 132, 175, 176; castration, 59; slitting of penis, 59; thoracic, 59; abdominal, 59; books on, 60; plastic, 60, 242-244, 257-258, 288; experiments in, 60, 6 1 ; organ transplants, 61; limb amputation, 70; and Hospital of Jesus, 90; at Hospital of the Buboes, 94; caesarean section, 101; at Shriners' Hospital, 104; professor of, on Balmis Expedition, 108; separated from barbering, 115; for hepatic abcesses, 116; Amézquita practices, 151; appendectomy, 157; in treatment of mycetoma, 216; Social Security benefits for, 252; at Hospital Londres, 257; open-heart, 270; rehabilitation following, 271; neural, 278; cardiovascular, 279, 281; hypophysectomy, 285-286 susto, el: 140, 142, 143 Sutter, John Augustus: 75 Switzerland: 77 Syntex, S.A.: synthetic hormones produced by, 77-78 syphilis: national origin of, 93-94, 102, 103-104; hospital for, 96; confused with leprosy, 105; lottery funds for control of, 119, 236; cutaneous, 208; pinto compared to, 213; and graft material, 287 Tabasco ( s t a t e ) : 77, 233 Tacuba Street: 91 Tagliacozzi, Gasparo: 60 Tamaulipas ( s t a t e ) : Rural Cooperative Medical Services in, 153; mosquito eradication in, 231 tar: medicinal use of, 27, 35 Tarascans: 19, 91 Tecate, Baja California: 195, 202 tecoani: 48, 49

INDEX

Tecomán, Colima: escorpionismo deaths in, 198 tecomates: use of term, 121 Tehuanas: 19 Tehuantepec, Isthmus of: tuberculosis on, 224 temixiuitiani: 48 Temple of San Francisco: 91 Tenochcas. SEE Aztecs Tenochtitlán: Aztecs settle, 8, 16; canals in, 9 η., 114; Spaniards find, 10; Moctezuma II walks, 12; destruction of, 15, 88; sacrifices in, 19; Cortés marches to, 25, 62; welfare measures in, 32; veterans' hospitals in, 33; isolation compound in, 35; described, 38-39; water supply for, 39; cleanliness in, 4 0 - 4 1 , 55, 114; medical education in, 48; medical experimentation in, 60; battle for, 86; causeway connecting, with other towns, 89. S E E ALSO Mexico City, México Teocalli. SEE Great Temple teocatl: treatment with, 35 Teotihuacán: Toltecs found, 8 and n.; Aztec veneration for, 16; mural in, 58 Tepalcatepec Valley: escorpionismo deaths in, 200 tepati: defined, 47; and curanderos, 132 tepoxtlatl: 48 Terreros, Pedro Romero de: 120 Testelli, Dr. : 275 testosterone: extracted from plants, 77 tetanus: deaths from, 55 tetzauhcocoliztli. SEE tuberculosis Texas: 83, 105 Texcoco, México: 27, 33, 73, 91 texoxtl: 48 Tezcatlipoca: 17, 30 thiosemicarbazide: convulsions induced by, 291 Thirty Years' War: 1910 Revolution compared to, 128 thyroid: research on, 280 ticitl. SEE witches Tijuana, Baja California: rabies in, 195; population of, 202 tinea capitis: bathing preventive of, 174 tissue bank: 286, 287, 288 Titian: 60

327 tlahuilocayotl: 49 Tláloc: 26-27 Tlaltelolco, México, D.F.: college at, 46,97 tlamatepatli: 48 Tlaxcala ( s t a t e ) : 162 Tlaxpana: hospital at, 92, 105 Tlazoltéotl: 29-30, 31 toloatzin. SEE jimson weed Toltecs: place of, in Mexican history, 5; found Teotihuacán, 8 and n.; astronomical knowledge of, 14; religion of, 16; human sacrifice under, 20; Quetzalcóatl legend adopted from, 24; Quetzalcóatl rules, 25; effect of epidemics on, 4 3 ; trepanning by, 57; circumcision by, 58 Toluca, México: typhus in, 107 Tomatlán, Jalisco: escorpionismo deaths in, 198 Tonantzín: 29, 31 Tonatiuh. SEE Sun Torquemada, Juan d e : on Aztec surgeons, 33 Torreón, Coahuila: polio in, 226; "jungle colonists" from near, 233 Torres Muñoz, Dr. Adrian: on mosquito eradication, 231-232 Totonacs: 5, 8 n., 19 toxoplasmosis: 165, 193 Tradicional Corrida del Médico: 2 4 7 249 transportation: animals for, 8, 9 n., 40, 156, 212; canals for, 9 n., 10, 39, 40, 114; causeways for, 39, 89; bridges for, 39; canoes for, 39; coaches for, 40; sedan chairs for, 40; streets for, 4 1 , 100, 114, 137; roads for, 148; by jeep, 156, 157, 173, 212; by helicopter, 156, 157, 173; by riverboat, 156, 157, 173; by bus, 200; by automobile, 200; by airplane, 206, 238; by railroad, 238 tuberculosis: god associated with, 26; Aztec treatment for, 67; patients exposed to, 96; as related to poverty, 165; importance of, 185-187; hospitals for, 189; campaign against, 205, 224-225, 236; cutaneous, 207, 208; studies of, 270; and graft material, 287 Tula: 16, 25 Tulane University: 278

328 Turkey: smallpox inoculation in, 108 n. turpentine: medicinal use of, 68 typhoid: 165, 232 typhus: patients exposed to, 96; studies of, 101; epidemics of, 106, 107; eradication of, 232 Tzapotlatena: 27-28, 31 tzatzayanolixtli. SEE mal de pinto ulcers: Aztec treatment for, 68 Ulloa, Dr. Mario González. SEE González Ulloa, Dr. Mario undulant fever: 165 UNESCO: calorie minimum recommended by, 179 Unidad Independencia housing project: 253-254 Unión Mexicana de Matadores de Toros y Novilleros: builds hospital, 240 Union of Soviet Socialist Republics: 9, 285 United States: use of German scientists by, 9; B-14 isolated in, 64; folk remedy in, 64; Civil War of, 70, 128; use of peyote in, 72; Dr. Marker seeks research funds from, 76; dumb cane house plant in, 78; Columbus Day in, 88; war of, with Mexico, 90-91; leprosy in, 105, 211; War for Independence of, 119; el susto in, 143; amebiasis in, 172; tourists in Mexico from, 174; stereotype of farmers in, 180; tortillas in, 182; tuberculosis in, 186; border of, with Mexico, 194, 200-202; campaign of, against rabies, 195; scorpions in, 197; aid from, for Mexican housing project, 203; tropical diseases in, 205, 206; histoplasmosis in, 219, 220; Salk vaccine obtained from, 225; polio in states near, 226; Λ. aegypti in, 230; cultural difference of, from Mexico, 235; polio in, 236; rodeo riding in, 245; medical education in, 247, 258, 265, 293; medical standards of, 250; Social Security in, 254; medical equipment costs in, 263; Mexican doctors in, 265-266; medical students from, in Mexico, 268; costs of projects in, 268-269; and Childrens Hospital, 280, 281; grants from, for Center

MEDICINE IN MEXICO

for Research and Advanced Studies, 282; Dr. Eisenberg's work in, 283; birth control in, 296; mentioned, 237, 257, 260, 261, 271 Universal History of New Spain, The: 57 University City, México, D.F.: 98, 267, 269 urinary lithiasis: as related to poverty, 165; caused by diet, 180-181 urine: used as mordant, 40; medicinal use of, 63 urology: at Children's Hospital, 279 Urrusti Sanz, Dr. Juan: research by, 294 Uruguay: A. aegypti eradication in, 230 Uxmal, Yucatán: 8, 180 uxtli: used in dermatological treatments, 27 Valdivia expedition: 106 Valladolid. SEE Morelia, Michoacán Valle del Mezquital: tuberculosis in, 224 Valle del Yaqui: tuberculosis in, 224 Valle de Oaxaca, Marqués de: 90. SEE ALSO Cortés, Hernán Velasco Polo, Dr. Guillermo: on bones indicating syphilis, 104 Velásquez, Antonio: 241 venereal diseases: goddess of, 29, 31; desire to avoid, 30; hospital for, 93, 94; folk remedy for, 135. SEE ALSO genital eruptions; syphilis Venezuela: smallpox vaccine brought to, 109; cervical cancer in, 176; leishmaniasis in, 209; onchocercosis in, 218; A. aegypti in, 230; program in, to raise medical standards, 264; virus from, spreads to Mexico, 281 Venice: Tenochtitlán compared to, 10, 40 Vera, Dr. Juan: 51, 249 Veracruz, Veracruz: Cortés lands at, 9, 25; flora around, 76; hospitals in, 96; smallpox vaccine brought to, 109-111; radiological examinations in, 187 Veracruz (state): harbasco in, 77; Rural Cooperative Medical Services in, 153; pinto in, 215; bullfighter injured in, 242; Venezuelan virus in, 281

INDEX

329

Vesalius, Andreas: book by, on dissection, 60 Veslingius: book by, on anatomy, 60 veterinarians: in campaign against rabies, 196 Viceregal Palace: botanical garden in, 100 Vienna: discovery of asepsis in, 53 Vikings: and Quetzalcóatl legend, 25 Villaseñor, Alberto: 237 Villaseñor, Dr. Arturo: 237 Viveros de la Loma housing project: 203

Aztec physicians, 48; education of, 115. SEE ALSO birth; gynecology; obstetrics Woolrich, Dr. Jaime: on penile cancer, 174-176 World Union Against Cancer: 176 World War I I : knowledge on rocketry obtained after, 9; bombings in, 2 1 ; Cortés' corpse discovered after, 92; importance of tropical disease since, 205; Mexican economy after, 274 worms: flatworms (planaria), 20; intestinal, 66; in magical rite, 142; nematodes, 218

War for Independence, Mexican. S E E Spain Washington, D.C.: 129-130, 186, 282 water: quality of, 32, 39-40, 158, 165, 168, 169, 170, 171, 173, 177, 194, 250; brought to hospital, 89; supply of, in Sanitary Districts, 152; mineralization of, 174; closets, 188; problem of supplying, on border, 202; facilities for supply of, 255 witches: ticitl, 47, 132; use of excrement by, 64; pharmacognocists study cures of, 75; native medical practitioners become, 87; amulets of, 108; in England, 136-137; as midwives, 141, 145, 160-162; oppose doctors, 146, 155; Public Health Department trains, 161-162, 299 — (curanderos): defined, 131; Aztec precursors of, 132; function of, 1 3 2 133; patrons of, 133-136; in San Miguel de Allende, 137; techniques of, 141-144; harmfulness of, 1 4 4 146; attack on problem of, 147; malign Public Health Department, 158-159; Amézquita on, 160; villages dependent on, 262 —(brujos): defined, 131; evil worked by, 133, 144-146; patrons of, 1 3 3 136; in San Miguel de Allende, 137; techniques of, 139-140, 142, 143, magic combating that of, 141-142; attack on problem of, 147; malign Public Health Department, 158-159; Amézquita on, 160 women: status of, under Aztecs, 12; as therapists for fatigue, 13; baths prescribed for pregnant, 42, 53; as

Xico, Veracruz: 242 Xipe: 28, 30, 31 Xipetótec. SEE Xipe Xoaltecuhtli: 29, 31 Xochimilco, México, D.F.: salt iodizing in, 185 xolopeyotl: 49 X rays: on riverboats, 157; of histoplasmosis cases, 221; for tuberculosis, 225; in National Medical Center, 252; at Hospital Londres, 257; used to treat cancer, 271 yam, barhasco: 74, 77-78, 296, 297 Yamada, Dr. T.: 283 yellow fever: epidemics of, 106, 1 0 7 108, 122, 148; campaign against, 230-232; prevents colonization, 233 Yoshida Ando, Dr. Pablo: research by, 294 Yucatán ( s t a t e ) : books burned in, 73; yellow fever in, 107; nurse training center in, 162; growth deficiency in, 180; urinary lithiasis in, 181; governor of, 229; mosquito eradication program in, 231 Yucatán Peninsula: virgins sacrificed on, 3 1 ; hospitals on, 96; smallpox on, 106; smallpox vaccine brought to, 111; limestone underlying, 181; tuberculosis in, 224 Zacatecas, Zacatecas: 111, 112 Zacatecas ( s t a t e ) : 153 Zacatecas ( t r i b e ) : 94-95 Zapotecs: 5, 19 Zubirán, Dr. Salvador: on diet, 1 7 8 179 Zumárraga, Juan de ( F r a y ) : 73, 93