Alberto J. Pani, Hygiene in Mexico: A Study of Sanitary and Educational Problems (New York: G. P. Putnam’s Sons, 1917).
Francis A. Countway Library of Medicine, 32.B.235
Published as simmering hostilities persisted across much of the country, Hygiene in Mexico: A Study of Sanitary and Educational Problems (1917), like the new constitution drafted that year, is a reflection of the nation’s revolutionary turmoil and hopes for a better national future. In his April 1916 prologue, author Alberto J. Pani explained that the project was “[u]ndertaken by express order of Citizen Venustiano Carranza, First Chief of the Constitutionalist Army.” The reference to Carranza, a leading figure of the Mexican Revolution (1910–1917) anchors the book’s premise that health and hygiene should be post-Revolutionary priorities. But for a nation recently torn apart by a protracted and bloody revolution, where does one begin to implement health policy?
In an attempt to solve this question, Pani undertook a meticulous study of the nation’s capital with the aim of proposing a new sanitary policy for the entire nation. Mexico City was an obvious choice, not simply because it was the nation’s capital, but, as Pani explained, because it had the largest concentration of inhabitants and physicians and, unsurprisingly, was the most studied urban site in the country. After years of battles, it also had high death rates and appalling hygienic conditions. Carranza would go on to become Mexico’s first post-Revolution president, and though he adopted the 1917 constitution (Mexico’s current governing document), he did not adhere to its most radical clauses concerning labor rights, land reform, or, crucially for our present purposes, health care for all.
The turn to a conservative future was not yet known when Hygiene in Mexico was commissioned, and so in many respects it reads as a hopeful—though occasionally skeptical—manual for a new society. After nearly a decade of fighting, much of it based in Mexico City, the city was in a severe state of disrepair. Its once busy boulevards, public gardens, and downtown buildings, modeled after their Parisian counterparts, lay in ruins. But as much as the city was ailing, more so were its people. Massive migration to the city during the armed phase of the Revolution had brought rural diseases to the city and exacerbated epidemics common in battlefields—typhoid, typhus, and dysentery. Pani’s strategy was apparently to first emphasize Mexico City’s dreadful situation and then, after shocking the reader with data, offer a solution.
To understand this approach, one must recognize that the focus on Mexico City’s sanitary faults was also political in nature. Before the Revolution, Porfirio Diaz governed Mexico (1876–1910) with a dictator’s zeal. While leaving much of the nation to languish, Diaz used a gleaming downtown Mexico City as the backdrop, and the display, to showcase his embrace of science and technology. His cabinet, Los Científicos, espoused dozens of modern sanitary practices, from a new, city-wide sewage system to asylums, hospital pavilions, and even a panopticon prison. The Científicos’ equally fervent embrace of degeneracy theory and racial supremacy that excluded Mexico’s Indigenous population from equal citizenship would, among other abuses, lead to revolution. For Pani, acknowledging the sanitary achievements of his public health–obsessed predecessors seemed counter to the post-revolutionary moment. He veered instead to focus on persistent health problems in Mexico City and their impact on the people and the environment.
Since colonial times, Mexico City was a node for international trade and exchange of knowledge. It is thus not surprising that Pani compared Mexico City to capitals in Europe, Latin America, and Asia, yet Pani concludes that Mexico’s capital was “assuredly, the most unhealthful city of the whole world.” The numbers for diseases and premature deaths are indeed shocking, but there is little initial effort to qualify this data, most of which is from 1904–1912, or to explain that revolutionary violence might be partly responsible for the alarming statistics.
To understand Pani’s assessment and his effort to tie data not to revolutionary upheaval but rather to the ruthless dictatorship that preceded it, we must look briefly on the author, himself. Pani was an influential politician and entrepreneur, whose background in civil engineering and economic policy landed him several key positions in post-revolutionary Mexico. When Hygiene in Mexico was published, he was serving as secretary of industry and commerce. He would later be named Minister of Foreign Relations in 1921 and later, in 1923, Minister of Finance and Public Credit, during which he was instrumental in funding the Banco de México and, a few years later, the Banco de Crédito Agricola, which helped transform the countryside by granting loans to small farmers. Historians consider him one of the most influential architects of Mexico’s modern financial system. In a recent editorial, he was described as “Keynesian before Keynes” and acknowledged for designing national welfare reforms attributed to Franklin Roosevelt a year before Roosevelt implemented them. Years later, in his 1955 book, Mexico’s Supreme Problem, Pani posited that federal spending should be curbed and monetary stability should be protected at all costs, incurring the ire of those politicians who wondered about his shift in policy. His 1950s writing, however, reflects the anxiety of a nation on the brink of economic collapse, high inflation, devaluations, and so called carestía or “shortage.” Hygiene in Mexico is a different type of book. It is highly critical of Mexico’s situation, while also laying out an ambitious plan for moving forward in the wake of the revolution. Pani, coming as he did from a prominent family and remaining part of the country’s governing elite (his nephew Mario Pani, was a celebrated architect and urbanist who designed many of Mexico City’s iconic buildings), was undoubtedly influenced by his position in how he perceived his country’s problems of health and disease.
The majority of the chapters have a comparative bend, such as “Public Health in the City of Mexico,” where he set out to examine mortality rates of 34 cities of Europe, Asia, Africa, and the Americas. Focusing on a single chapter, “Nutrition” (Chapter VII), allows us to reflect on this rich primary source as a whole, evaluate Pani’s biting ethnographic eye, and ponder his uncompromising critique of the nation’s capital. The “Nutrition” chapter has two main concerns: water and food. After a brief description of the vital role of water at the cellular and organ level, Pani launches into his reasons to examine water beyond the “three hydric illnesses . . . par excellence,” dysentery, cholera and typhoid fever: the link of contaminated water and the general health of a community. Not surprisingly, Pani devotes a significant amount of observation and experimentation of the city’s supply of fresh water. As he noted, the city’s drinking water had “been lately improved to a remarkable degree,” to the point that from December 1912 to December 1913, monthly samples of spring water and “samples analyzed from scattered houses throughout the city” were catalogued as “exceedingly pure water.” Despite these extraordinary results, Pani resorts back to his gloomy assessment by noting, “the isolated satisfaction of only one of the sad requirements, in view of the frightful infractions of elemental hygiene depicted in the pages of this treatise, has about the same effect as that of a weak ray of light projected into a pitch-dark abyss.”
Possibly one of the most useful data points in this chapter is his description of a laborer named Agustín López, who is used as an example to illustrate how different socio-economic classes ate. Pani draws up the laborer’s weekly budget, outlining, in a fascinating few pages, the price of corn, beans, tortillas, rent, and haircuts in October 1914. His discovery that López had precariously little left at the end of the week—19¢, when, for example, a kilo of meat was 35¢—resulted in Pani’s stunned acknowledgement that the laboring class could not afford to miss a day of work, including Sunday. In short, not working for a single day for any simple “disturbing cause” could lead to “untold suffering” by López and his family. The precariousness of poverty and its effects on health were tallied as insufficient calories and the somber conclusion that to receive adequate nutrition, the family’s budget would need to increase by 70 percent. In the final page of the chapter, Pani acknowledged that since October 1914, when this data was taken, “the economical conditions of the country have grown worse so rapidly, as a consequence of the internecine strife” that all articles of first necessity increased fourfold. One is left to wonder how someone like López, already teetering on the fringes of survival, fared in a calamity such as national social upheaval. Pani warned that as the revolution progressed, a new chapter heading would be needed “covering deaths through starvation.”
In a final coda to the “Nutrition” chapter, Pani explains that he wrote the chapter in July 1915 from the southern state of Veracruz, his refuge since the armed Zapatista forces took over Mexico City. As he feared, deaths by starvation had by then become a “horrible fact” as most articles of first necessity had increased tenfold. Accompanying hunger was an ongoing and relentless outbreak of typhus.
It would take three decades for Mexico’s population to bounce back from the losses of the Mexican Revolution. An estimated 1 million Mexicans perished, while another estimated 1.5 million fled to the United States. Hygiene in Mexico is a remarkable account of public health and disease during an extraordinary time in the country’s history. The book bridges the calamitous years of early fighting with the next-to-final years of uneasy peace. Under Pani’s pen it also reads as an occasional denunciation of social injustice and the impact of this inequality on the nation’s health.
 Alberto J. Pani, Hygiene in Mexico: A Study of Sanitary and Educational Problems (New York: G. P. Putnam’s Sons, 1917). The Mexican Revolution and its aftermath are arguably some of the most studied events in Mexican history. For a classic text on the Mexican Revolution, see Alan Knight, The Mexican Revolution, 2 vols (Lincoln: University of Nebraska Press, 1990). For a recent examination of the violence of the revolution and its effects on society, see Gema Kloppe-Santamaría, In the Vortex of Violence: Lynching, Extralegal Justice, and the State in Post-Revolutionary Mexico (Oakland: University of California Press, 2020). Other studies have examined gender in this period, for example, Jolie Olcott, Revolutionary Women in Postrevolutionary Mexico (Durham; London: Duke University Press, 2006). The classic novel of the period is Mariano Azuela, The Underdogs (New York: Penguin Books, 2008 ).
 Much has been written about hygiene and public health during the Porfiriato, over the course of the Mexican Revolution, and in the years that followed. See Claudia Agostoni, Monuments of Progress: Modernization and Public Health in Mexico City, 1876–1910 (Calgary: University of Calgary Press, 2003); Pablo Piccato, City of Suspects, Crime in Mexico City, 1900–1931 (North Carolina: Duke University Press, 2001); Andrés Ríos Molina, “Locura y encierro psiquiátrico en México: El Caso del Manicomio La Castañeda, 1910,” Antípoda, no. 6 (2008): 73–90; Gabriela Soto Laveaga and Claudia Agostoni, “Science and Public Health in the Century of Revolution,” in A Companion to Mexican History and Culture, ed. William H. Beezley (Chichester, West Sussex; Malden, MA: Wiley-Blackwell, 2011), 561–74; Claudia Agostoni and Elisa Speckman, eds., De normas y transgresiones. Enfermedad y crimen en América Latina (1850–1950) (México: Universidad Nacional Autónoma de México, 2005). For a history of the medical professions and health concerns before the Díaz regime, see Luz María Hernández Sáenz, Carving a Niche: The Medical Profession in Mexico, 1800–1870 (Montreal; Chicago: McGill Queen’s University Press, 2018) and Jethro Hernández Berrones, “Breaking the Boundaries of Professional Regulation: Medical Licensing and Foreign Influence in the Consolidation of Homeopathy in Mexico,” História, Ciência, Saúde, Manguinhos 26, no. 4 (2019): 1243–62.
The graphs and charts may be of interest to scholars who want to gauge what data was used as evidence to assert Mexico City’s insalubrious state. Pani, Hygiene in Mexico, 7.
 Benjamín Castro, “Alberto J. Pani el mexicano que se adelantó a Franklin D. Roosevelt en el uso de crédito nacional para salir de la depresión (I)” El Regio (September 6, 2017).
 Francisco Suárez Dávila, “Un gran debate económico a través de nuestra historia, los liberales frente a los keynesianos desarrollistas,” Economíaunam 15, no. 45 (2018): 3–28.
 Pani, Hygiene in Mexico, 43. Italics in original.
 Pani, Hygiene in Mexico, 44.
 Pani, Hygiene in Mexico, 45.
 Pani, Hygiene in Mexico, 54.
 Pani, Hygiene in Mexico, 56.