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The Spanish Flu and the Sanitary Dictatorship: Mexico's Response to the 1918 Influenza Pandemic

Published online by Cambridge University Press:  04 July 2019

Ryan M. Alexander
Ryan M. Alexander*
Affiliation:
State University of New York Plattsburgh, Plattsburgh, New Yorkralex006@plattsburgh.edu
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The influenza of 1918, the disastrous global pandemic known to many as the Spanish Flu, could not have come at a worse time for Mexico. The nation was eight years into its decade-long revolutionary struggle, a conflict that claimed the lives of well over a million citizens. Of those lost, several hundred thousand perished due to the influenza alone, usually from secondary complications such as pneumonia or bronchitis. Along with exposure, famine, and a myriad of other wartime ailments, the 1918 flu ranked as one of the leading causes of death in the Revolution, far surpassing combat casualties.

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The Americas , Volume 76 , Issue 3 , July 2019 , pp. 443 - 465
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Copyright © Academy of American Franciscan History 2019 

The influenza of 1918, the disastrous global pandemic known to many as the Spanish Flu, could not have come at a worse time for Mexico. The nation was eight years into its decade-long revolutionary struggle, a conflict that claimed the lives of well over a million citizens.Footnote 1 Of those lost, several hundred thousand perished due to the influenza alone, usually from secondary complications such as pneumonia or bronchitis. Along with exposure, famine, and a myriad of other wartime ailments, the 1918 flu ranked as one of the leading causes of death in the Revolution, far surpassing combat casualties.

The onset of the flu, as it was chronicled in daily newspapers, was sudden and horrifying. At first, it traveled overland on the rails, striking towns like Ciudad Juárez that sat along the permeable US-Mexican border before spreading throughout the country's vast north.Footnote 2 The contagion gained strength as it arrived on incoming ships docking at the Atlantic seaports of Tampico and Veracruz.Footnote 3 From there, it reached every region of the country—the fertile Bajío, the extreme south, and eventually Mexico City.

In a matter of days in early October, stories of whole families falling victim, then entire populations of peasants, miners, and urban dwellers, began to appear daily in long articles. Within a few weeks, the severity of the epidemic was clear: people were perishing, often by the dozens, sometimes by the hundreds, across the republic.Footnote 4 In cities, piles of bodies decomposing in the midday sun, with blood coming out of their eyes and ears, created an arresting sight and an even worse stench as they awaited their departure to mass graves dug by prison inmates.Footnote 5 In the countryside, hacienda owners allowed burials and established makeshift lazarettos (isolation chambers) to quarantine sick workers.Footnote 6 Whole sectors of the economy faltered. Coahuila's coal mining zones collapsed, as did petroleum production in Veracruz.Footnote 7 Without coal and oil, transportation ground to a halt.Footnote 8 Workers, unable to pay rents, were forced into the streets.Footnote 9 By late October, the press was reporting 1,500 to 2,000 deaths per day.Footnote 10

Through October and November, readers encountered increasingly bizarre stories in the print media. One, for instance, told of a pair of Red Cross nurses claiming to bring an inoculation serum to El Paso, Texas, which had been gripped by the flu. The two were apprehended upon crossing the border on a train coming in from Juárez after a fellow passenger reported suspicious activity. Upon their arrest, police discovered that the two women were in fact disguised German men seeking to infiltrate nearby Fort Bliss.Footnote 11 In another example, passengers on the Tampico-San Luis Potosí line witnessed a grotesque scene. As the train chugged up a range of mountains, a visibly distressed mother inside opened the window and pitched one of her two babies into a deep ravine. Wailing and trying to comfort the remaining child, the mother, when confronted by another passenger, simply looked up and said, “It was dead.” What seemed a callous, criminal act was really an act of desperation. In the next car, an artisan, feverish and doubled over, had died in his seat.Footnote 12

Such stories are hard to verify and perhaps even harder to believe. In all likelihood, they were often entirely fictional. Nevertheless, they suggest the extent to which fear of the flu (or the fear of Germans using Mexico to stage an invasion of the United States during World War I, a fear no doubt amplified by the discovery of the Zimmermann telegram the previous year) became the subject of macabre popular lore, and the degree to which mainstream print media teetered between faithful reporting and gratuitous sensationalism.

The purpose of this article is to move beyond such sensational storytelling, and past a primary focus on the statistical implications of the disease, and instead to examine the national response to the epidemic through the experiences of the major stakeholders in that process. Despite the devastation wrought by the pandemic, various individuals and interest groups found opportunity in the crisis. For President Venustiano Carranza, the flu presented an opportunity to demonstrate the competency and ultimately the legitimacy of his fragile revolutionary government.Footnote 13 For health authorities, it provided a chance to make public health one of the central mandates of the revolution. Officials in the nation's health system offered a response filled with contradictions, one that was coordinated and aggressive but also prone to regressive modes of medical thinking that were out of step with the times. Mexico's chief public health official, Gen. Dr. José María Rodríguez, used the epidemic to implement what he called a “sanitary dictatorship,” a term he had introduced in the prior year's constitutional debates. In his view, the national public health service would be most effective if it operated free from cumbersome regulation and slow-moving bureaucracy, even if that meant adopting an authoritarian approach that would be unacceptable in other circumstances.

Beyond these state responses, the rapid onset of the influenza also activated various organs of civil society. Non-governmental interests, ranging from Catholic charitable organizations to local chambers of commerce, pooled their resources to create a socially equitable response to the epidemic. Credentialed medical professionals, along with lay healers and homeopaths, offered their various therapeutic approaches to combatting the disease. Entrepreneurs, among them pharmacy owners, retailers, and inventors, used the flu as a chance to spin a profit. And moral crusaders, whether they were anticlerical local politicians invoking stereotypes of fanatical Indians to justify closing churches, or zealous newspaper columnists blaming the epidemic on the vices of the poor to justify closing taverns, used the flu to promote beliefs fraught with racial and class implications. Lamentably, the voices of the most important stakeholders of all—those who suffered the disease—are largely absent in the documentary record.

Much of both the popular and the academic literature on the 1918 flu has focused on the areas most directly affected by World War I: the United States and Europe. Footnote 14 Both suffered a heavy human toll as a result of the combined hardships imposed by the Great War and the flu. Crowded military barracks allowed the disease to spread quickly in the United States, where 675,000 died, while wartime devastation made Europe's population highly vulnerable. Globally, the mortality pattern occurred more unevenly, but the total numbers of deaths, as well as the rates of death in various places, prove that the war was not the lone or even primary determinant of loss of life. The Indian subcontinent, for instance, suffered more than anywhere else in the world; as many as 20 million people, or 40 percent of the estimated global death toll of 50 million, perished there. Russia and Iran both saw about seven percent of their populations lost. China's numbers are unreliable; we know only that they spell devastation. And in Mexico, somewhere between 300,000 and 600,000 people, with the number most likely closer to 500,000, died as a result of the flu.Footnote 15

Statistics from the period, both in Mexico and globally, range widely. Nevertheless, it bears noting that Mexico's numbers appear to be consistent with the estimated global average mortality rate, with somewhere between 2 and 4 percent of the population succumbing to the disease. Wartime conditions during the earlier years of the Revolution had been far worse, leading to a host of other epidemics, perhaps most notably a 1915–16 typhus outbreak during the so-called “year of hunger.”Footnote 16 The 1918 influenza, by contrast, increased the Revolution's death toll in a moment that was otherwise marked by relative calm, which explains the epidemic's apparent consistency with the global mortality pattern. It also bears noting that the epidemic unfolded in three waves: the first, and smallest, happened in the summer; the second, and deadliest, roughly between October and December; and the third, again comparatively small in terms of body count, the following spring. Due to the availability of sources from the ministry of health, whose campaign against the flu was undertaken during the epidemic's second wave, this study focuses primarily on the October-December period.Footnote 17

To date, the literature on Mexico's experience with the 1918 flu has either focused narrowly on its demographic effects or on discrete regional case studies.Footnote 18 This article approaches the topic from a broader perspective. Its richest base of primary sources is the archive of the ministry of health, whose ample files on the epidemic provide various kinds of documentation from every state in the republic. These include detailed reports from the “sanitary brigades” of young doctors sent to combat the disease across the provinces; telegrams and letters from everyday citizens expressing their demands and fears to public officials; documents detailing the regulatory and educational efforts of public health officials; and descriptions of the charitable acts of philanthropies, churches, and social organizations. Coupled with newspaper reports, these sources tell a grim but nonetheless hopeful story of how a nation in the throes of revolutionary turmoil responded to an unanticipated crisis.

Waging War on an Invisible Invader

The flu's ferocious onset knocked state and local officials onto their heels. The letters and telegrams they sent to federal health authorities confirm what we know about the 1918 flu elsewhere, namely that it did not follow the more familiar pathologies of previous influenza or other viral epidemics. Rather than disproportionately afflicting the very young, elderly, infirm, or poor, it struck hardest at young and middle-aged adults at their most robust—the segment of the population that by all conventional logic should have been most resistant to the disease.Footnote 19 Nor did the flu solely affect cities, where dense population allowed for its rapid proliferation. Rather, the rural sector appears, if anything, to have been harder hit. In their correspondence, local leaders pleaded with health authorities to send medicine, citing a combination of general poverty and avaricious pharmacy owners as the primary causes of drug shortages.Footnote 20 As one joint letter signed by the federal deputies representing the state of Zacatecas put it, the flu had caused a “genuine depopulation of the towns and ranches, which completely lack the elements to combat the spread of this disease.”Footnote 21 The legislators’ frenzied words captured what scores of similar correspondence also conveyed: the provinces were looking to the federal government for help.

Every bit as much as it conveyed the egalitarian principles of the revolution that was currently underway, the official response to the flu reflected the modernizing impulses of the recently overthrown regime of Porfirio Díaz, as well as more universal developments in the field of medicine. The prerevolutionary liberal dictatorship, known as the Porfiriato, which lasted from 1876 to 1911, overlapped a watershed in the history of medicine that at the global level saw both a shift from miasma theory to germ theory and the rise of state-led public medicine.Footnote 22 For their part, the technocrats of the Porfirian regime—young advisers who called themselves científicos, or men of science—embraced these trends by promoting health, hygiene, and sanitation as national priorities.Footnote 23 Guided by an amalgam of Positivist and social evolutionist ideologies, the Porfirian regime fostered the expansion of the Superior Council of Public Health, created the National Bacteriological Institute, passed a series of sanitary codes, and funded the creation of a massive citywide water drainage system in the capital.

Beyond these institutional efforts, Porfirian officials promoted education campaigns emphasizing hygienic behaviors such as bathing and avoiding alcohol. Often these initiatives were suffused with assumptions about the relationship between disease and factors such as the behaviors of the poor or the supposed characteristics of certain races, blurring the line between sound science and moral condemnation. Increased regulation of prostitution, for instance, represented one such instance of a combination of public health initiative and moral crusade.Footnote 24 As was true of most other Porfirian developments, the benefits of these efforts extended only to a fortunate few.Footnote 25 Nevertheless, many of the advances in public health that came in the wake of the 1910 revolution had their roots in the self-consciously modernizing dictatorship that the revolutionaries overthrew.

Rather than attacking or substantially altering these developments, public health officials in the revolutionary era built upon them. Indeed, while national political culture and institutional structures underwent dramatic change between the nineteenth-century Porfirian regime and the height of revolutionary reform in the 1920s and 1930s, the process of developing an expansive public health apparatus during those years was defined more by continuity than by rupture.Footnote 26 The leading figure in expanding the nation's public health capabilities, Gen. Dr. José María Rodríguez, envisioned a “sanitary dictatorship,” an idea that signified the marriage of centralized executive authority with modern advances in bacteriology, epidemiology, and hygiene.Footnote 27 Rodríguez, a distinguished surgeon-turned-revolutionary, and a close friend and the personal physician of President Venustiano Carranza, rose to national prominence for his role in public health campaigns against yellow fever, smallpox, typhus, and influenza during the early years of the revolutionary decade.Footnote 28

Rodríguez also served as a delegate to the convention that in 1917 drafted Mexico's revolutionary constitution. While the document is most commonly celebrated as the blueprint for major social and political reform in the coming decades, Rodríguez made sure that the political architecture for a centralized public health service was also included. Among its provisions were guarantees of universal access to health care, clear guidelines establishing federal responsibility for ensuring sanitation and medical services in both urban and rural settings, and the assumption of legislative authority over state and local entities in all matters related to health education.

Behind these commonsensical reforms was a larger project at the heart of Rodríguez's sanitary dictatorship ideal. His mission was twofold. First, he unapologetically sought to organize the federal public health service along authoritarian lines, arguing that it could function effectively only if it were freed from the political process.Footnote 29 Second, he used his position to fight what he called the “degeneration of the race,” code for the rampant alcohol consumption among the society's poorest ranks.Footnote 30 In this regard, he carried much of the Porfirian establishment's civilizing mission, a multi-front effort to save the most vulnerable from themselves.Footnote 31 Thus, Rodríguez, and by extension the revolutionary public health bureaucracy, identified issues such as alcoholism not in socioeconomic terms, but rather in behavioral ones. Such assumptions guided both official and popular discussions of the epidemic as the relief effort unfolded, and informed broader public health reforms in the era.

Rodríguez, successful in his mission to create a sanitary dictatorship, oversaw the response to the 1918 flu as head of the Superior Council of Public Health.Footnote 32 Officials in the Superior Council seized the moment to carry out a response that was highly aggressive. Its centerpiece initiative was the formation of sanitary brigades to be sent to every state in the republic, something that had been done during earlier epidemics in the Porfirian and early revolutionary years. Using the sanitary brigades as their local agents, public health officials, led by Rodríguez, enacted a series of behavioral protocols through a national education campaign and established proscriptive regulations on public gatherings and personal mobility, especially on trains.

The specific actions taken by the council blended two schools of medical thought that are now recognized as not only distinct from one another, but entirely contradictory. Recommendations such as the irrigation of unpaved streets with water, infusion of the air with sulphuric compounds, and daily cleaning of frontage property basis harkened back to the miasma-centered theory of disease that predominated until the mid nineteenth century. Followers of this theory, often called infectionists, held that generally unsanitary conditions—above all, putrid air—could propagate disease. The intellectual opponents of the infectionists, known as contagionists and identified with what is now regarded as some of the earliest articulation of modern germ theory, stressed that communicable disease was spread person-to-person, irrespective of such external conditions. Their recommendations manifest as policies such as maritime quarantines, train closures, and limits on public gatherings, all with an eye toward minimizing human contact. In the most advanced cases, experimentation with crude vaccines and other serums presaged advances in virology that would be made in coming decades. In the history of medicine, the move toward germ theory represented a stark shift in paradigm. In practice, state responses tended to mix the two, especially in times of crisis.Footnote 33 The Mexican federal response to the 1918 flu followed a similar pattern.

The regulatory efforts of the Superior Council were predicated on four related objectives: controlling public space, limiting human movement, influencing common behavior, and educating the public. The decision to impose maritime quarantines often stirred controversy, given the commercial implications such orders carried. The most notable case involved the Spanish steamship Alfonso XII, which was forced to undergo quarantine at the Isla de Sacrificios, a small island just off the port of Veracruz.Footnote 34 The ship had traveled from Spain to Havana, then set sail for Veracruz. During its transatlantic voyage, it was rumored to have seen approximately 30 deaths, with as many as 300 infected, out of the initial 1,200 on board when the ship left Spain.Footnote 35

Another ship, the Manzanillo, out of New York, had stopped at New Orleans before continuing on to Veracruz, carrying a crew whose condition was described by the chief sanitation official in Veracruz as “grave.”Footnote 36 While documentation does not confirm deaths, a half dozen crew members were put into lazaretto at the Isla de Sacrificios while the ship speedily dropped off its cargo and departed. The crew of the Gene Crawley, en route from New Orleans, was not permitted to disembark after docking in Tampico. With nowhere to go, the ship headed back to its port of origin.Footnote 37 The steamship Santa Alicia, upon arrival in Puerto México, Veracruz (today called Coatzacoalcos), failed to declare that it had sick passengers before they had disembarked. Upon learning of this, a local agent, citing the sanitary code, fined the captain 500 pesos.Footnote 38

Most quarantining operations went smoothly, as was the case with the US vessel Fairhaven and the Mexican ship Pinotepa.Footnote 39 Other cases proved more contentious. A citizens’ group representing mine workers in Santa Rosalia, Baja California, sent a letter to President Carranza, claiming that two American ships, the Korrigan III and the Jim Blutter, both arrived in Guaymas with flags indicating that the ships’ crews were healthy, when the officers knew otherwise. According to the workers’ accusation, the port's maritime authorities, preoccupied with promoting commerce and claiming import duty revenue, collaborated to get the ships past the sanitation officials, to the detriment of the port and its surrounding regions. As a consequence, they asserted, the Santa Rosalia mining region had lost several workers and children. A cursory reply letter from Rodríguez simply assured the group that the Superior Council was working to ensure that all laws were obeyed.Footnote 40

The regulation of train travel proved more difficult to carry out. The nation's extensive rail network, a symbol of progress in the pre-revolutionary regime, posed considerable danger in the face of an acute viral epidemic. For example, Felipe Pescador, the director general of the Constitutionalist Railway of Mexico, wrote Rodríguez to report that he had received a letter from his Torreón supervisor stating that in 48 hours in early October, 300 local residents had died, and virtually all of the rail workers and telegraph operators had fallen ill.Footnote 41 As the disease raged through the northern part of the country, Rodríguez initially insisted that municipal officials halt the rails to limit the spread of the disease. His demands were met with mixed levels of compliance.Footnote 42 The mayor of Torreón, Coahuila, Celso Castro, told Rodríguez that some train travel had stopped, but that shipments to Saltillo, the state's capital, continued with vigor.Footnote 43

Ultimately, economic pressure and the realization that the disease was too widespread to be affected by restricting train travel led officials to back off from shutting down the trains.Footnote 44 In Puebla, for instance, President Carranza explicitly recommended that train travel continue, arguing that total disruptions would be debilitating.Footnote 45 Instead, officials pushed stricter regulation and oversight, and recommended cessation of train travel only in cases where substantial numbers of sick people would bring the disease to unaffected populations. The Constitutionalist Railway agreed to fumigate cars that had transported infected passengers (a useless remedy that was based on miasmatic precepts; the influenza virus did not linger in the atmosphere of train cars, and thus could not be removed from it through any chemical process), and the company's hospitals and clinics stockpiled medicines to treat its workers.Footnote 46 In one directive, the Superior Council recommended to the Sur Pacífico line that potentially sick passengers be detained and barred from travel without disruption to regular service.Footnote 47 In another, it recommended that basic customs such as shaking hands be avoided.Footnote 48 One letter to Rodríguez expressed frustration that simple directives to avoid smoking and spitting on trains were routinely ignored, even by educated citizens.Footnote 49

In addition to trains and ships, officials targeted urban public spaces in which large numbers of people congregated, closing theaters, cinemas, schools, nightclubs, churches, cantinas, and pulquerías.Footnote 50 Curfews were established, and violation of them carried a modest but not insignificant fine, especially for the poorest citizens. The Superior Council banned the common practice of dry-sweeping streets (again a moment of reversion to outdated miasmatic theory), recommending instead that dusty streets be irrigated nightly to avoid airborne spread of the disease. Such actions, in places ranging from Torreón to Ciudad Juárez, made cities, especially provincial capitals, nodes in a coordinated national effort, even if some of the efforts were futile or even counterproductive. In addition to these regulatory acts, the sanitary brigades conducted educational campaigns that included tediously detailed instructions on how to prevent and confront the flu in non-public spaces. Owners of hotels and guesthouses were required to forbid those with symptoms to leave, or face penalties ranging from 5 to 500 pesos. Instructions for wearing masks, disinfecting objects and surfaces in homes, ensuring proper ventilation and isolation of the sick, and other prophylactic measures all formed part of the Superior Council's public health education campaign.Footnote 51

Public education, from the perspective of the Superior Council, represented a crucial component of its effort to combat the flu. After all, most people would take ill in their homes, putting those around them at high risk. Consequently, the sanitary brigades usually brought hundreds of copies of instructions on how to confront the disease in domestic settings, and worked with local authorities to convey those recommendations to common people, particularly those who could not read. Among the instructions: those caring for victims should wear cotton masks and wash their hands with a dilution of creolin and phenol. Spaces should be fumigated with vapors of sulphuric acid and objects disinfected with formaldehyde. Handkerchiefs should be disinfected. Dirty dishes and glasses should be avoided. Sleeping in the bed of a sick person was out of the question.

As for prophylactic measures, healthy people should avoid spending prolonged time in the spaces occupied by the sick, indulging in excesses that might debilitate the body's defenses, and lingering in the cold. Moreover, they should wash their mouths at least twice daily with a combination of water and glycol-thymoline or a dilution of phenol, gargle with Argyrol or Protagol (silver proteinate, which has bactericidal properties), and disinfect the nose with a mix of boric acid and menthol, or with liquid Vaseline and menthol. Finally, healthy people could take quinine—even by dissolving it in alcoholic spirits—as a preventive medication.Footnote 52

As mentioned earlier, many of these therapeutic measures had no effect whatsoever, since no vaccine or antiviral medication had yet been devised either to prevent or combat the influenza. Yet, even if none of the available medical therapies offered any definitive solution, the sanitary recommendations did. Hygiene and spatial isolation were, after all, the only effective means by which people could avoid the contagion. Thus, the instructions offered by the Superior Council were not without their merits, nor was the concern over the conditions of the poor entirely unfounded, since they tended to suffer less hygienic housing conditions.Footnote 53 Still, the intent of public health measures and their outcomes often differed widely, and the press was quick to criticize public health authorities for numerous failures, among them the inability to irrigate streets, inter bodies, dispose of trash, and close schools.Footnote 54

More important than parsing the strengths and weaknesses of the sanitary campaign is understanding what it represented: that the nineteenth-century global development of state-centered public medicine had come to fruition in early twentieth-century Mexico. But the state response to the influenza of 1918 presents only part of the picture, and quite possibly the lesser part, since people from various walks of life had their own interpretations of the causes of the flu and offered their own solutions to it.

Coordination in a Fragmented Society

The hundreds of largely anonymous participants in the sanitary brigades, organized by the Superior Council of Public Health and sent to virtually every corner of the republic, became the public agents of the federal effort to combat the flu and proved crucial in coordinating the efforts of governmental and civil society responses to the epidemic. In addition to serving as on-the-ground representatives of the public health authority in Mexico City, the brigades, usually composed of 15 to 20 medical personnel (mainly resident physicians in training and medical students, often supervised by more senior doctors) and support staff, represented a significant step in the professionalization of the national public health service. Typically, the brigades set up makeshift headquarters in the state capital, then dispatched teams to various localities. The sanitary brigades organized Juntas de Socorros, or relief boards, that brought together previously uncoordinated local private sector and charitable organizations to provide medicine and care to the poor.Footnote 55

In cities such as Monterrey, Puebla, and Mexico City, members of each city's Chamber of Commerce, Industry, and Agriculture met to pool financial resources. They also sought to meet and work with foreign diplomats to get pharmaceuticals from the United States, the United Kingdom, France, and Germany.Footnote 56 Elite women formed groups such as the Women's Relief Society of Monterrey, with the state's first lady as its honorary president, to work with church organizations to care for the ill.Footnote 57 These organizations included the Association of Women of St. Vincent de Paul and the Board of Catholic Women, along with the Red Cross.Footnote 58

Whether out of a sense of noblesse oblige, civic responsibility, or fear that the flu would consume their ranks, the wealthiest segments of many regions dedicated substantial resources to the problem. In a number of places, it appears that socially prominent individuals were spurred to action only once members of their own social class began to fall victim. Tales of the flu afflicting society women in Monterrey, a well-known Spanish merchant in Tlaxcala, local congressional deputies in Coahuila, the governor's personal secretary in Monterrey, and a segment of the “better society” of Puebla demonstrate that members of old-money families feared for their lives, and suggest that this fear converted into charitable action.Footnote 59

Others’ motives appear to have been more altruistic. In the capital, for instance, approximately 100 wealthy members of the National Chamber of Commerce, led by Carlos Zetina, met to craft a plan. In a speech to the group, Zetina made a forceful argument in favor of cooperation between individual volunteers, the private sector, and the government, as well as the imposition of fines on those who did not help in basic affairs such as irrigating streets and cleaning frontage property. Ramón Riveroll, a member of the ayuntamiento (city council), agreed, noting that since the majority of the housing occupied by the city's poor was owned by wealthy capitalists, the responsibility for ensuring their sanitation should rest on their shoulders, since they alone would be capable of paying fines for negligence.Footnote 60

Corporations such as the cigarette manufacturer El Buen Tono created lazarettos for their employees, while prominent individuals, who had begun to see more and more news stories of high-society people falling victim to the flu, opened their homes as makeshift hospitals. The millionaire Juan M. García of Nuevo León, for instance, housed over a thousand afflicted people in his mansion. Non-elite groups also made significant contributions.Footnote 61 Interim Zacatecas governor Delfín Trujillo wrote that the local military garrison in Jerez had taken on philanthropic duties from the local government, which had become completely overwhelmed, while residents of the town of Piños had organized a corps of nurses to help combat the disease.Footnote 62

The effort to secure medicine represented the mutual priority of public health officials, charitable organizations, and wealthy oligarchs to prevail over greedy pharmacists who profited by running up the price of drugs in the face of increased demand, and to choke out charlatans and hucksters who claimed to have cure-alls for the flu.Footnote 63 These products included cotton masks, aspirin, strychnine granules, quinine salts, glyco-tymoline mouth solution, formaldehyde disinfectant, Creolin and other antiseptics, odiferous treatments like sulfuric acid vapors or menthol, and opiates like Dover's powder or sulfate of morphine, among many, many others.Footnote 64 It bears noting that while some of these products had palliative or antiseptic benefits, none were curative.

Residents of rural areas, who often did not have the benefit of immediate access to public health institutions or advanced medical care, were especially prone to improvising their own responses to the mounting presence of death. According to Daniel Sariol, a doctor and a delegate of the sanitary brigade in Querétaro, the state's governor was permitting burials in haciendas. Noting that such practices could not be sufficiently regulated or invigilated by officials, he wrote his supervisors at the Superior Council to ask if he should begin to arrange the construction of a new cemetery or allow the practice to continue out of necessity.Footnote 65 In Zacatecas, Governor Trujillo sent a similar letter to Rodríguez, noting that one ranch was burying 12 to 15 bodies per day. Another governor, J. F. Valle of Colima, resorted to asking Rodríguez not for medicine or some of the more conventional disinfectant aids, but for whole barrels of crude petroleum. The situation was so grim in one region of the state, the Laguna Cuyutlán, that he planned to burn it.Footnote 66 Rodríguez replied firmly that such measures were impractical, expensive, and ultimately useless.Footnote 67

The Epidemic in Popular Moral Discourse

Perhaps not surprisingly, both official efforts and popular discussion veered into familiar territory of race, class, and morality. Some of these tendencies were subtle. The closure of drinking establishments, for instance, can be read as both a commonsense policy aimed at limiting contagion, and as an affront to the poor, since they were often viewed as the ones most likely to while away their time drinking. The pattern of closures, as well as the language used to justify them, suggests that officials were preoccupied with the idea that recreational spaces—especially ill-reputed places where activities such as drinking, gambling, or sex took place—required an especially high degree of public regulation.

Moral and ideological assumptions, rather than strictly scientific considerations, also underpinned official views of religious establishments. In one study, the prominent scientist José Donaciano Morales found that the screens in church confessionals had traces of influenza, along with tuberculosis and malaria. He recommended that people either stop kissing saints and their vestments, or wipe them down with disinfectant.Footnote 68 Again the recommendations made sense, but they can also be interpreted as a slight against the piety of the poorer and more heavily indigenous populations, which were often viewed with disdain by an anticlerical Mexico City intellectual and political establishment. However sensible many of the Council's recommendations were—for example, that houses be equipped with functional latrines, or that horse stables be relocated from population centers—Rodríguez and his advisers could not have expected the majority of the population to be compliant with them.Footnote 69

If these efforts represented subtle affronts to the poor, others were more blatant. The mayor of La Villa de Guadalupe, site of the famous Basilica of Our Lady of Guadalupe, said that at the chapel one could find “fanatical and ignorant people who are convinced that the influenza is a punishment from God.”Footnote 70 He continued, “As is typical of aboriginal peoples, the Indians seem resigned to waiting their turn. Inside, they can be seen kneeling to the dark-skinned Virgin, asking for pity.”Footnote 71 The themes are familiar: a bourgeois political leader condemning poor indigenous peoples, whom he regarded as superstitious and irrational, with the mention of the Virgin's skin color adding an element of racism. Although Mexico never became the site of any kind of apocalyptic “end-of-days” cult during the flu epidemic, as happened in Jamaica and Southern Rhodesia, the topic of indigenous superstition, a familiar theme both in foreign and domestic elite discourse since colonial times, preoccupied various sectors of the population.Footnote 72

The dominant national news media, more than the Superior Council, seemed to fixate on the dangers of superstition. One article, in the news section of Excelsior, claimed that poor residents of the La Laguna region of Coahuila had become so alarmed at the number of deaths that they thought they were caused by the medicines they were being given; their subsequent refusal to take the medicines was, according to the article, accelerating the pattern of deaths, creating a lethal cycle.Footnote 73 The mayor of Nácori Chico, Sonora, made a similar case in a letter to the Superior Council, in which he complained that his town's residents had become stricken with ignorance, fanaticism, and superstition to the point that they had become overwhelmed by terror and bewilderment.Footnote 74 Still another report, this time from Montemorelos, Nuevo León, suggested that ignorant peasants refused treatment because they were convinced the medicines they were being given were poisoning them.Footnote 75

Another Excelsior piece, titled “Prudence, but not Cowardice,” warned against the frenzied, irrational behavior that tended to follow the onset of disease epidemics. Ironically, this diatribe against superstitious and panicked behavior contained its own fair share of superstitions and half-truths including, for example, the idea that fear consumes more people than the actual disease and that anxiety increases susceptibility to disease by debilitating one's bodily systems. The ultimate point of the article was nonetheless compelling: that while reasonable precautions were necessary, and cavalier dismissal of risks was foolish, hysteria in the form of people accepting whatever kind of panacea offered to them, or drastically changing lifestyle habits such as diet, without reason, was an imprudent response to the influenza.Footnote 76

Newspaper editorialists occasionally published moralizing screeds linking the habits of the poor with the disease. One anonymous Excelsior columnist wrote such a piece, which he called “¡Miseria, vicio, influenza!,” that linked the flu with what he regarded as the persistent crisis of vice among the poor. He intended the title of his editorial to serve as a modern-day analog of Mane, Thecel, Phares, from the Feast of Baltazar, a biblical story involving an apparition of the fall of mankind.Footnote 77 After enumerating some of the more plausible links between poverty and disease, namely that the poor tend to suffer from malnutrition and inadequate housing, he launched into a condemnation of their lack of moral education. The poor's affinity toward “alcoholism, marijuana, and the nirvanas and artificial paradise of opium” was, in his estimation, chiefly to blame for aggravating the experience of the disease.

He further elaborated that no amount of knowledge of the pathology of the disease or medical remedies (short, he conceded, of a vaccine) would be enough to overcome the burden of vice. In his mind, only “a methodical life, scrupulous hygiene, impeccable cleanliness, and above all absolute sobriety”—all conditions woefully absent among the poor—would save them. In purple prose, he laid out his position: “If we cast away vice, we cast away disease. With every key, we must close the door to every house of perdition [presumably brothels and bars]. We will look at the addict and see a criminal and prevent him from further addiction by punishing his crimes. In doing this, we will save countless lives!”Footnote 78 The article's conclusions—that the poor were to blame for their own misery, that conditions such as addiction were crimes, and that rehabilitation meant punishment—are useful in understanding how some rationalized the epidemic.

Of course, poor victims proved far more sophisticated than the vulgar depiction they were afforded in the article described above, and they were far more adept at coping with the epidemic than many elite observers could conceive. La Villa de Guadalupe provides one compelling example. Like so many other areas, the town faced closure of its major public spaces. Its mayor, one Señor Galván, who owned a theater and a cinema and thus had a vested stake in keeping public spaces open, used the situation both to smear a political opponent and to promote his business interests. Upon closure of these areas, the mayor called a public meeting in which he blamed a political opponent, Edmundo G. Aragón, for shuttering the doors of the basilica. He deliberately incited a mob to stone the home of Aragón, a homeopath who had treated over 200 patients in that house.

Galván's petty maneuver worked more favorably for the townspeople than it did for him. A group of several dozen vendors, who depended on selling food and sundry goods in the plaza in front of the basilica, marched to the Department of Public Health headquarters, demanding to speak to Rodríguez about Aragón's decision. Upon meeting them, Rodríguez assured them that it was the Department of Public Health that had ordered the closure, not Aragón. Later the same day, Rodríguez received a petition from even more of the town residents, claiming that the vast majority of them lived and worked in the commercial zone near the basilica, necessitating its immediate reopening. Rodríguez acquiesced, provided that people agreed to adhere to a series of stipulations to avoid the risk of further contagion.Footnote 79 In this instance, humble people—the ones so maligned by Galván—quickly and spontaneously organized to promote their own material interests and to restore their access to the basilica, which must have been a comforting sanctuary in a moment of crisis.

If some used the flu as an opportunity to espouse their ideological or moral positions, others used it for economic gain. The Superior Council and the Department of Public Health dealt with constant examples of pharmacies hiking up the prices of drugs, antiseptic materials, and basic medical consultations. The problem was so severe that the Department of Public Health hastily built facilities to produce its own supply of calcium sulfate, phenazone, and Dover's powder to distribute at or even below cost.Footnote 80 As with so many other examples, health authorities worked with non-governmental interests to achieve their objectives. For instance, the chamber of commerce of Durango and the Department of Public Health in Mexico City cooperated to buy up extant supplies of drugs to protect citizens against further price hikes.Footnote 81

Various companies or doctors in private practice advertised their goods and services, claiming success in providing cures for the flu. One product, known as “Resurrección,” promised relief from a host of symptoms in an elixir pleasant enough for children to take.Footnote 82 A Japanese physician, who advertised himself only as Dr. Takabatake, claimed to have invented a mask that fully eliminated the possibility that the influenza might be transmitted from person to person.Footnote 83 Even the price of lemons—thought to prevent infection—increased in the capital.Footnote 84

Retail outlets also sought to cash in on the crisis. An advertisement for one Mexico City shopping center, El Centro Mercantil, implored consumers to save themselves from the Spanish flu. A picture of a mother and daughter in a pair of jaunty coats de moda, for only 30 pesos, accompanied a caption claiming that doctors recommend a good coat to avoid sickness.Footnote 85 The iconic department store El Palacio de Hierro ran a similar ad. “The Spanish Flu can be combatted effectively,” it claimed, since clients could buy “a medicine that never fails”: a good coat.Footnote 86 And just south of the city, the San Angel Inn offered its tenants tranquility, pure air, and a comfortable and hygienic stay.Footnote 87

These efforts to capitalize on the profit potential of the crisis, much like the earlier examples of others’ efforts to frame larger debates over race, class, and religion around the onset of the flu, demonstrate that there was far more at stake than straightforward, pragmatic considerations over how best to respond to the contagion. Rather, the flu drew out responses laden with ethical and moral implications.

Conclusion

The brief but chaotic influenza pandemic from October through December of 1918 tested Mexico's population and institutions at a particularly challenging moment in the nation's history. As a historical phenomenon, the flu provides a fresh perspective on a familiar context. Scholars have long been preoccupied with measuring the outcomes of the 1910 Revolution.Footnote 88 For the most part, they have described the period of armed struggle from 1910 to 1920 as a gruesome internecine conflict that produced little productive reform while it was in progress. According to common interpretation, the major reforms of the revolution got under way only after 1920, when the violence finally died down, even though they had been put into writing in the 1917 Constitution. Over the next two decades, national leaders haphazardly implemented the totemic achievements of the Revolution—labor and land reform, petroleum expropriation, public education campaigns, the cultural renaissance—while also laying the institutional groundwork for the single-party authoritarian regime that would govern until 2000. With few exceptions, those initiatives were carefully planned and executed.

The 1918 flu, by contrast, was an entirely unanticipated event, one that arrived before the Revolution's reconstructive phase had gotten underway. Yet the national experience with the disease demonstrates that political authorities, especially José María Rodríguez as the nation's chief public health officer, sought to craft a response to the pandemic in a manner consistent with the mandates of the Revolution, even in the midst of the upheaval. The government's efforts to combat the flu, especially at the federal level, may have been improvised and inconsistent, but Rodríguez and those working under him, most notably the members of the sanitary brigades, worked to make that response inclusive and coordinated as well. An unforeseen public health crisis thus produced one of the first constructive applications of revolutionary reform.

This early effort, in turn, led to productive initiatives in public health and medicine in the decades to come, in areas such as anti-alcoholism campaigns, vaccination programs, and health education efforts.Footnote 89 Scholars have only recently begun to examine issues of medicine and public health as part of Mexico's revolutionary process. Nevertheless, the last two decades have been host to a splendid array of studies on topics ranging from the health dynamics of prostitution to Rockefeller Foundation initiatives to eradicate hookworm.Footnote 90 These and other studies demonstrate the importance of healthcare to the revolutionary projects of state consolidation and nation-building.

The efforts of Rodríguez and his colleagues nonetheless had a double edge. On the surface, the term “sanitary dictatorship” may appear to have represented little more than the slight pretension of a zealous public health reformer. But in reality, the consolidation of federal authority over matters concerning public health, beginning with the 1917 constitutional reforms and continuing into the reconstructive phase of the revolution after 1920, presaged a larger process of political centralization in the decades to come. In one sense, the way that Mexico reacted to the flu in institutional terms was consistent with most other places in the world; crises anywhere lend themselves to centralized executive decision-making out of necessity. Thus, states of emergency are hardly unique in the history of natural disasters or public health crises, nor have they been alien to Mexico.

Yet Rodríguez was especially keen to justify the creation of a public health service with an unprecedented degree of authority. While expressing his liberal convictions, he presented his case for making an exception for public health. As he put it during the constitutional debates, “In civilized countries, without exception, the sanitary dictatorship is the only tyranny that the people will tolerate, because it is the only way to free individuals, families, the state, and the nation from contagions; it is the only way to defend the race and it is the only way to increase the life expectancy of the people.” Throughout the convention, often in rebuttal to fellow delegates challenging his views, he insisted that an authoritarian approach to public health was not only permissible, but necessary. Otherwise, the responses required during epidemics, which needed to be split-second to be effective, would instead get caught in bureaucratic red tape.Footnote 91 After some squabbling, convention delegates gave Rodríguez what he wanted; the 1917 Constitution established, among many other things, a Superior Council of Public Health that was free of oversight by any government ministry (it previously answered to the Secretaría de Gobernación, the Interior Ministry). Thus, the 1918 influenza served as the first test of Rodríguez's revolutionary public health initiative.

The 1918 pandemic also illuminates another major historiographical issue: the theme of continuity and rupture. Mexico's experience proves that the 1918 flu pandemic arrived at a deeply transformational time. The official response to the flu certainly contained echoes of the Porfirian modernization scheme, but also a glimpse of the revolutionary project of state-led development that was to come. The flu also sat at a critical juncture within the revolutionary process. The decade of sustained violence was far from over, but was at the same time beginning to yield to a process of institutionalization that would lead to constructive action a few years after the ratification of the 1917 Constitution. And the methods employed by public health officers and medical professionals demonstrated that the rapidly evolving advances in modern germ theory often competed with the remnants of the slow-to-die assumptions of miasma theory. Taken together, these examples show that the 1918 flu belonged to a moment defined by political upheaval at home and epistemic flux within the medical profession.

Finally, the response from what might be called “civil society” tells us as much as about the national experience with the disease as any of the records of official actions do. While a few used it for less than compelling ends—to turn a profit, or perhaps to express reactionary social and political views that harkened back to the Eurocentric Porfirian worldview—the evidence confirms that the majority of Mexicans, from all social sectors, were committed to a response that was not only aggressive, but also socially just. In this respect, the influenza drew out the most egalitarian tendencies of the Revolution, demonstrating its character as a popular social movement, rather than as a narrow set of political reforms or simply a messy civil war.Footnote 92 The multiple civil society participants in the anti-influenza campaign, from religious charities to business associations and beyond, provide evidence of a broad, participatory civic culture. Together, their efforts were nothing short of revolutionary.

Footnotes

The author wishes to thank the following individuals and institutions for their support of this project: the John L. Myers History Endowment, the American Philosophical Society, the Dean of Arts and Sciences at SUNY Plattsburgh, the anonymous reviewers of the article, and the numerous colleagues and friends who read drafts or offered feedback at conference presentations.

References

1. This number is constantly debated, and the debate is far from resolved. Nevertheless, the number of deaths due to war, famine, and epidemics, combined with lost births and emigration, resulted in demographic catastrophe. See McCaa, Robert, “Missing Millions: The Demographic Costs of the Mexican Revolution,” Mexican Studies/Estudios Mexicanos 19:2 (Summer 2003): 367–400CrossRefGoogle Scholar.

2. “La influenza española se ha desarrollado en forma muy alarmante,” Excelsior, October 9, 1918, 1.

3. “Vienen a México muchos de los atacados de influenza española,” Excelsior, October 7, 1918, 1; Lourdes Márquez Morfín and América Molina del Villar, “El otoño de 1918: las repercusiones de la pandemia de gripe en la ciudad de México,” Desacatos 32 (January-April 2010): 126, 135.

4. Gómez to Rodríguez, December 27, 1918, Archivo Histórico de la Secretaría de Salud [hereafter AHSS], F-SP, S-Epid., C-11, Exp. 7.

5. “La capital de Nuevo León está siendo azotada con dureza por la influenza,” Excelsior, October 28, 1918, 1; “Puebla y Pachuca cruelmente flageladas por la influenza,” Excelsior, October 31, 1918, 1, 5.

6. Perrusquía to Rodríguez, October 23, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 7; Trujillo to Rodríguez, November. 7, 9, and 11, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 11.

7. “La influenza española se ha desarollado en forma muy alarmante,” Excelsior.

8. “En México han dádose muchos casos de influenza,” Excelsior, October 18, 1918, 1.

9. “Por falta de carbón están sufriendo las industrias de Coahuila,” Excelsior, October 2, 1918, 1; “La influenza española ha invadido la region petrolera a gran prisa,” Excelsior, October 24, 1918, 1.

10. Márquez Morfín and Molina del Villar, “El otoño de 1918,” 126.

11. “La influenza se ha desarollado en forma muy alarmante,” Excelsior.

12. “Escenas de horror en un convoy,” Excelsior, November 2, 1918, 1–2.

13. Molina del Villar, “México ante la pandemia,” 181.

14. Mateos, Miguel Ángel Cuenya, “Reflexiones en torno a la pandemia de influenza de 1918. El caso de la ciudad de Puebla,” Desacatos 32 (January–April 2010): 150Google Scholar. For examples of the tendency to focus on the United States and Europe, see the following works: Bristow, Nancy K., American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic (New York: Oxford University Press, 2012)Google Scholar; Pettit, Dorothy A. and Bailie, Janice, A Cruel Wind: Pandemic Flu in America, 1918–1920 (New York: Timberlane Press, 2008)Google Scholar; Barry, John M., The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Penguin Books, 2005)Google Scholar; Kolata, Gina, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It (New York: Farrar, Straus, and Giroux, 1999)Google Scholar; and Crosby, Alfred W., America's Forgotten Pandemic: The Influenza of 1918 (Cambridge: Cambridge University Press, 1989)Google Scholar.

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17. As mentioned in the text, statistics from 1918, both in Mexico and around the world, are unreliable and range widely. But if we begin with most commonly accepted numbers for both cases, the rate of death and thus overall number of deaths in Mexico largely reflect the global picture. To illustrate: if the global population in 1918 was 1.8 billion, and 50 million died of influenza, then about 2.7% of the world's population perished. Similarly, in Mexico, if between 300,000 and 600,000 people of a population of 14.5 million died, then somewhere between 2 percent and 4 percent (about one standard deviation off the global number in each direction) of the population perished. Thus, Mexico's rate-of-death statistics largely reflect the global rate of death. See Taubenberger, J. K. and Morens, D. M., “1918 Influenza: The Mother of All Pandemics,” Emerging Infections Diseases 121 (2006): 15–22CrossRefGoogle Scholar.

18. Cuenya Mateos, “Reflexiones en torno a la pandemia de influenza,” 145–158; Molina del Villar, “México ante la pandemia de influenza de 1918,” 181–203; Márquez Morfín and Molina del Villar, “El otoño de 1918,” 121–144; Arratia, Leticia González, 1918: La epidemia de influenza española en la Comarca Lagunera: una crónica (Torreón, Coahuila: Dirección Municipal de Cultura, 2003)Google Scholar; Cano, Beatriz, “La influenza española en Tlaxcala (1918),” in Historia de la salud en México, Malvido, Elsa and Morales, María Elena, eds. (Mexico City: INAH, 1996), 97–114Google Scholar; Méndez, Marciano Netzahualcoyotzi, La epidemia de gripe de 1918 en Tlaxcala (Tlaxcala: Universidad de Tlaxcala, 2003)Google Scholar.

19. Cuenya Mateos, “Reflexiones en torno a la pandemia de influenza,” 155; Márquez Morfín and Molina del Villar, “El otoño de 1918,” 129–130. The puzzling tendency of the 1918 flu to afflict robust young adults can be explained by the fierce autoimmune response it provoked. As John Barry explains, the stronger the person's immune system, the more lethal the experience with the flu tended to be. See Barry, The Great Influenza, 247.

20. The following files from AHSS, F-SP, S-Epid. are a sample of this kind of correspondence: Various telegrams from Torreón, C-11, Exp. 4; Dr. Parra y Tejada to Rodríguez, October 18, 1918, C-11, Exp. 4; Munic. Pres. of Huayacocotla to Superior Council, October 29, 1918, C-11, Exp. 5; Valle to Superior Council, October 15, November 11, and November 16, 1918, C-11, Exp. 6; Munic. Pres. of Calpulalpam de Ocampo, Tlaxcala to Rodríguez, November 2, 1918, C-12, Exp. 8.

21. Federal Deputies of Zacatecas to Rodríguez, November 12, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 11.

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25. Cuenya Mateos, “Reflexiones en torno a la pandemia de influenza,” 146–148.

26. McGuire and Frankel found a similar degree of continuity in their examination of infant mortality rates before and after the Cuban revolution. While the revolutionary government after 1959 legitimately boasted the best absolute infant mortality rate in the region, the authors found that the pre-revolutionary government had greater success in reducing the rate than did its revolutionary counterparts, and that Cuba ranked only fifth in Latin America after 1959 at reducing its rate of infant mortality as measured in a percentage decline. See McGuire, James W. and Frankel, Laura B., “Mortality Decline in Cuba, 1900–1959: Patterns, Comparisons, and Causes,” Latin American Research Review 40:2 (2005): 83–88CrossRefGoogle Scholar, 109–110.

27. Cejudo, María Rosa Gudiño, “José María Rodríguez (1870–1946),” in 200 emprendedores mexicanos: la construcción de una nación, Ludlow, Leonor, coord. (Mexico City: LID Editorial Mexicana, 2010), 559–563Google Scholar; Soto Laveaga and Agostoni, “Science and Public Health,” 566.

28. Soto Laveaga and Agostoni, “Science and Public Health,” 566.

29. José María Rodríguez, Speech, 50th Ordinary Session, Diario de los debates del Congreso Constituyente, 1916–1917, Tomo III (Mexico City: Secretaría de Cultura, 2016), 136–140.

30. José María Rodríguez, Speech, 49th Ordinary Session, Diario de los debates del Congreso Constituyente, 1916–1917, Tomo III (Mexico City: Secretaría de Cultura, 2016), 106–110.

31. Córdoba, Ernesto Aréchiga, “Educación, propaganda, o ‘dictadura sanitaria’. Estrategias discursivas de higiene y salubridad públicas en el México posrevolucionario, 1917–1945,” Estudios de Historia Moderna y Contemporánea de México 33 (2007): 59Google Scholar.

32. Gudiño Cejudo, “José María Rodríguez,” 559–563; Ibarra, “The Spanish Influenza in Mexico,” 36–38.

33. Sidney Chalhoub, in his analysis of the response to two yellow fever outbreaks in Rio de Janeiro, found a similar occurrence. Public health officials blended miasmic and germ-based responses, along with moral preconceptions, all culminating in the destruction of the housing establishments of the poor. See Chalhoub, Sidney, “The Politics of Disease Control: Yellow Fever and Race in Nineteenth Century Rio de Janeiro,” Journal of Latin American Studies 25:3 (October 1993): 443–447CrossRefGoogle Scholar, 456. For a similar discussion involving typhus in Mexico City, see América Molina del Villar, “El tifo en la ciudad de México,” 1210–1211.

34. The ship was named after the nineteenth-century Spanish monarch. This made for an interesting coincidence, given that the current Spanish monarch, Alfonso XIII, had suffered the influenza. The fact that Spain did not have wartime censorship meant that people around the world were aware of the king's ailment, leading to the false assumption that the flu originated in Spain, hence the false nickname Spanish Flu.

35. Rodríguez to Rojas, October 8, 1918; Rojas to Rodríguez, October 8, 1918; Rodríguez to Mgr., Cia. Transatlantica Española, October 9, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 5; “La influenza española en el Alfonso XII,” Excelsior, October 6, 1918, 1; “Vienen a México muchos de los atacados de influenza española,” Excelsior; “La influenza española se está extendiendo mucho en el norte,” Excelsior, October 10, 1918, 1; “La epidemia está causando estragos en la region norte de la Republica,” Excelsior, October 11, 1918, 5; “Epidemia a bordo del Alfonso XII,” Excelsior, October 25, 1918, 1.

36. Rojas to Rodríguez, October 17, 1918; Rodríguez to Rojas, October 18, 1918; Rojas to Rodríguez, October 19, 1918; Rojas to Rodríguez, October 21, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 5.

37. “Hay dos barcos que están sujetos a cuarentena,” Excelsior, October 19, 1918, 1.

38. “Puebla y Pachuca cruelmente flageladas por la influenza,” Excelsior.

39. “La capital de Nuevo León está siendo azotada con dureza por la influenza,” Excelsior.

40. President of Sociedad Mutua de Obreros Aquiles Serdán to Carranza, January 13, 1919; Rodríguez to of Sociedad Mutua de Obreros Aquiles Serdán, January 24, 1919, AHSS, F-SP, S-Epid., C-12, Exp., 3.

41. Pescador to Rodríguez, October 9, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 4.

42. Estrada to Rodríguez, October 11, 1918; Rodríguez to Trujillo, October 9, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 11; Rodríguez to Castro, October 11, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 4.

43. Castro to Rodríguez, October 9, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 4.

44. “La epidemia está causando estragos en al región norte de la República,” Excelsior.

45. Rodríguez to Cabrera, October 14, 1918, AHSS, F-SP, S-Epid., C-11, Exp.-4.

46. “La influenza española se ha desarrollado en forma muy alarmante,” Excelsior.

47. Agent to Rodríguez, December 19, 1918; Rodríguez to Agent, December 25, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 8.

48. “La influenza decrece en parte,” Excelsior, October 15, 1918, 1.

49. Romano to Rodríguez, October 11, 1918, AHSS, F-SP, S-Epid., C-12, Exp.-1.

50. “La influenza española se ha desarollado en forma muy alarmante,” Excelsior.

51. “Muchos soldados están atacados de influenza,” Excelsior, October 23, 1918, 1; “La influenza española se está extendiendo mucho en el norte,” Excelsior; Sanitary Delegate in Nogales, Sonora, to Rodríguez, October 20, 1918, AHSS, F-SP, S-Epid., C-12, Exp. 15.

52. “La influenza española se está extendiendo mucho en el norte,” Excelsior. These instructions were published in all the major dailies, including Excelsior, El Demócrata, and El Nacional. See Márquez Morfín and Molina del Villar, “El otoño de 1918,” 136-139.

53. Márquez Morfín and Molina del Villar, “El otoño de 1918,” 142.

54. Márquez Morfín and Molina del Villar, “El otoño de 1918,” 142.

55. Rodríguez to Munic. Pres. of Torreón, October 11, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 4; Rodríguez to Munic. Pres. of Lerdo, Durango, October 14, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 4; Sariol to Rodríguez, October 29 and October 31, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 7.

56. Fuentes Cicero to del Pino, November 13, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 14.

57. “La influenza se inclina a extenderse,” Excelsior, October 20, 1918, 1.

58. Sanitary Brigade Delegate to Pres. of Alumni Soc. Of School of Medicine, San Luis Potosí, October 29, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 14; “Puebla y Pachuca cruelmente flageladas por la influenza,” Excelsior, October 31, 1918, 1.

59. “La influenza se inclina a extenderse,” Excelsior; “En México han dádose muchos casos de influenza,” Excelsior; “La influenza decrece en parte,” Excelsior; “La capital de Nuevo León está siendo azotada con dureza por la influenza,” Excelsior; “Es ahora en Puebla donde la influenza se recrudece,” Excelsior, October 29, 1918, 1; “En Monterrey mueren personas muy conocidas,” Excelsior, October 17, 1918.

60. “Se extiende a diario la epidemia,” Excelsior, October 30, 1918, 1.

61. “En la C. de Monterrey se han dado varios casos de fiebre amarilla,” Excelsior, October 13, 1918, 1.

62. Trujillo to Rodríguez, October 25 and 28, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 11.

63. “Es ahora en Puebla donde la influenza se recrudece,” Excelsior; “La influenza decrece en parte,” Excelsior.

64. Virtually all of the AHSS files cited in this article contain some mention of the pharmaceuticals or disinfectants listed above.

65. Sariol to Rodríguez, October 30, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 7.

66. Personal secretary of governor to Rodríguez, November 4, 1918, AHSS, F-SP, S-Epid., C-11, Exp. 6.

67. Rodríguez to Valle, November 19, 1918, AHSS, F-SP, S-Epid., C11, Exp. 6.

68. “Muchos soldados,” Excelsior.

69. Sanitary Delegate in Nogales, Son., to Rodríguez, October 20, 1918, AHSS, F-SP, S-Epid., C-12, Exp. 15.

70. The basilica in this case was the baroque structure built in the late seventeenth and early eighteenth centuries. The modern shrine, which honors the Virgin of Guadalupe, Mexico's patron saint, was built in the 1970s and is one of the world's most visited sites of religious pilgrimage.

71. “La capital de Nuevo León está siendo azotada con dureza por influenza,” Excelsior.

72. Ibarra, “The Spanish Influenza in Mexico,” 30.

73. “Se ha dado un carácter alarmista al desarollo de la influenza en la Ciudad de México,” Excelsior, October 22, 1918, 1.

74. Municipal president to Rodríguez, December 30, 1918, AHSS, F-SP, S-Epid., C-12, Exp. 3.

75. Netzahualcoyotzi Méndez, La epidemia de gripe, 107–108.

76. “Prudencia, no cobardía,” Excelsior, October 31, 1918, 3.

77. Curiously, this biblical story is also the origin of the phrase “writing on the wall.”

78. “¡Miseria, Vicio, Influenza!” Excelsior, October 12, 1918, 3.

79. “Es ahora en Puebla donde la influenza se recrudece,” Excelsior.

80. Ibarra, “The Spanish Influenza in Mexico,” 45.

81. “El gobierno de Durango desea pronto auxilio,” Excelsior, October 5, 1918, 5.

82. “¡No más gripa! Cúrese Usted de una manera rápida, radical y segura,” Excelsior, October 17, 1918, 8; “Contra la influenza,” Excelsior, October 12, 1918, 6.

83. Ibarra, “The Spanish Influenza in Mexico,” 47.

84. “La influenza decrece en parte,” Excelsior, October 15, 1918, 1; “Il limone come cura profilattica contro l'influenza spagnola,” Excelsior, October 12, 1918, 6.

85. Advertisement, Excelsior, October 25, 1918, 6.

86. Advertisement, Excelsior, October 30, 1918, 2.

87. Advertisement, Excelsior, November 1, 6.

88. The first and still best effort to measure, rather than merely describe, the long-term outcomes of the Revolution was by James Wilkie, who tracked federal expenditure over time on defined categories of poverty alleviation, economic development, employment, infrastructure, and so forth. See Wilkie, , The Mexican Revolution: Federal Expenditure and Social Change since 1910 (Berkeley: University of California Press, 1967)Google Scholar.

89. Soto Laveaga and Agostoni, “Science and Public Health in the Century of Revolution,” 566–567. On anti-alcohol campaigns, see Gretchen Pierce, “Sobering the Revolution: Mexico's Anti-Alcohol Campaign and the Process of State-Building, 1910–1940” (PhD diss.: University of Arizona, 2008).

90. On prostitution, see Bliss, Katherine Elaine, Compromised Positions: Prostitution, Public Health, and Gender Politics in Revolutionary Mexico City (University Park: Penn State University Press, 2001)Google Scholar. On hookworm, see Birn, Anne-Emanuelle, “Revolution, the Scatalogical Way: The Rockefeller Foundation's Hookworm Campaign in 1920s Mexico,” in Disease in the History of Modern Latin America, Armus, Diego, ed. (Durham: Duke University Press, 2003), 158–182CrossRefGoogle Scholar.

91. José María Rodríguez, Speech, 49th Ordinary Session, Diario de los debates del Congreso Constituyente, 136–147.

92. Scholars have long debated whether the 1910-20 upheaval constituted a genuine popular social revolution, a bourgeois political movement, an agrarian struggle, or simply a chaotic set of revolts and coups d’état. See Knight, Alan, “The Mexican Revolution: Bourgeois? Nationalist? Or Just a ‘Great Rebellion’?” Bulletin of Latin American Research 4:2 (1985): 1–37CrossRefGoogle Scholar.