An associate professor in the History Department at the University of Western Ontario, Hernández Sáenz displays her vast expertise on the history of the Mexican health system in nearly 400 pages. The main objective of the book consists of tracing the emergence of the medical sector in Mexico in the aftermath of Independence. The seven decades examined were one of the most challenging moments in the history of the country and the hemisphere. The making of a public health system was shaped by political instability, economic crisis, foreign occupations, and epidemics. They also form a timeframe that enables readers to observe the difficult adaptations in a country that is desperately trying to abandon the colonial regime and embrace liberal principles, at least in appearance.

The book is very clear in transmitting the efforts of policy makers, physicians, and medical practitioners in building a monopoly while overcoming obstacles within a rapid changing sociopolitical environment. Rather than finding ways to implement a national public health system, the central preoccupation for physicians and surgeons was to secure control of the profession through educational reform, the displacement of other practitioners, and the forging of alliances with both foreign counterparts and government officials. In order to avoid a center-state approach, Hernández Sánchez investigates both the institutions and the actors, with documents from repositories located in Mexico City and regions such as Jalisco, Puebla, and Guanajuato, as well as abroad in the United Kingdom and France.

One major aspect of the process documented in the book is that many of the innovations conducive to the reform and the modernization of the medical profession were not initiated by physicians themselves. The imperial geopolitics during the Cortes de Cádiz and the return of absolutism played a decisive role in eroding colonial institutions and replacing them, albeit temporarily, with more active and efficient entities such as the Juntas de Sanidad. The proliferation of medical entities like the School of Medicine, the Academy, and many others were part of these efforts to consolidate the profession, yet many of them were ephemeral and brought confusion to existing institutional capacities and jurisdictions. The conflicts between physicians and the government escalated as the former sought to obtain more autonomy in their profession and the latter interfered in such goals or demanded rapid actions in confronting epidemics.

Despite the temptation one might have to read the book as a triumphant or teleological narrative of Mexican medicine in the aftermath of Independence, Hernández Sáenz carefully builds a narrative that highlights the many seeming contradictions embodied by the medical body. One of them, for instance, was the adoption of liberalism as a justification to develop a professional monopoly. The most problematic one consisted of the close contact and support of Mexican doctors to their French counterparts during the invasion. The book moves away from simplistic explanations and risks various paths to explain such alliance by invoking a particular interpretation of nationalism or professional bonds that stood above any other national issue in such a critical moment. Some institutions fiercely defended their realms and resisted any sort of innovation, for example, the Protomedicato, which managed to make drastic internal changes as a desperate attempt to survive. Not even modern doctors could foresee the outcome due to the ongoing precariousness and instability forced upon them.

Hernández Sáenz's study is a necessary work, not only for historians of medicine or those pursuing a career in the School of Medicine, but also for scholars who want to understand the complex emergence of infrastructure, scientific practices, and how public services were provided by semiautonomous actors. The book also sheds light on such vast topics as state-making processes in spaces like public health and medicine, where physicians had to operate often without the state but also against it.

Given the scope of the book, I would like to have asked the author to clarify the idea of Mexico as a “unique” case (6). It will be interesting to learn about how the creation of a medical monopoly in the nineteenth-century informs modern public health provision in Mexico, especially in a context of violence, global epidemics like Influenza A (H1N1) virus, and oscillating politics.