Carving a Niche

Luz María Hernández Sáenz's book presents a remarkable account of the factors that contributed to the reorganization of physicians as a modern profession in postindependence Mexico during the period from 1800 to 1870. Hernández Sáenz provides a lucid argument to explain how healers and medical practitioners opened a space in that society through which they emerged as one of the most important professional groups of the century. Hernández Sáenz's proposal is to deal with the notion of profession sustained in the historiography of Mexican medicine. In examining the medical profession, Carving a Niche revisits familiar topics in that historiography, discussed, as the author recognizes, in studies by Ana María Carrillo, Martha Rodríguez, Claudia Agostoni, Fernando Martínez Cortés, and Xóchitl Martínez Barbosa, among others. The chaotic context of the epoch precluded applying any theoretical model of professionalization, since all such models assume a setting of “modern professions in industrialized and politically stable societies” (p. 268). The author explicitly opposes a “traditional” interpretation that would explain the professionalization of medicine in the nineteenth century as the result of a rupture with colonial obscurantism, an outcome of enlightened liberalism and thus far removed from conservatism. Instead, she focuses on historical continuity and competition among different practitioners to elucidate this profession in Mexico: medical knowledge and practice are subject to a gradual transition and, simultaneously, intense competition for space to impose themselves through institutions.Through five chapters, Hernández Sáenz examines the continuities and gradual changes that arose through struggles between individuals and institutions—the juntas de sanidad (health boards) and the Protomedicato—to re-create medical practice. The first two chapters review the strategies of medical doctors to reconfigure their relations with others involved in health. Medical doctors found it convenient to approach surgeons and then, once united with them, to make contact with other practitioners, such as midwives and dentists. By thus monopolizing healing power, this new group marginalized other practitioners of health care, such as traditional healers. Hernández Sáenz includes little-known histories of foreign physicians who fought for prestige against this guild. Chapter 3 discusses the relations of this medical monopoly with the Consejo Superior de Salubridad (Superior Health Council) and public hygiene policies in Mexico City and the provinces, while chapter 4—the longest in the book—portrays the battles to establish a curriculum for a school of medicine, which, as the author emphasizes, remained unchanged despite the desire of many to innovate. The chapter presents abundant information on the financial difficulties of hospitals in the capital, which impeded the teaching of pathological and clinical anatomy. By contrast, the medical guild succeeded in following the French example by imitating the study program of the Paris clinical school in terms of both organization (officiat) and textbooks. The chapter then decenters the capital by discussing the experiences of medical schools in Puebla, Morelia, and Guadalajara.In chapter 5, Hernández Sáenz provides a well-documented history of Mexican medical associations and their publications. She returns to the theme of French influence on Mexican medicine, a factor she considers central to the medical profession's consolidation in Mexico. The work carried out by the Commission Scientifique du Mexique and Mexico's own scientific, literary, and artistic commission organized by Achille Bazaine should not be interpreted as solely French cultural imperialism. Where others perceive colonialism, Hernández Sáenz sees collaboration and possibilities for innovation in the relations between French and Mexican doctors. Commenting on the activities of the Sección de Medicina (Medical Section), which were published in the Gaceta Médica de México, Hernández Sáenz argues that contact with the French provided Mexican physicians access to European theories and technologies, offered support for their research, and imbued them with professional confidence.Without question, the book also deals with topics central to earlier historiography, but from a perspective that obliges us to rethink medical professionalization in Mexico. Hernández Sáenz questions the historiographical argument that explains professionalization as a result of republican modernity opposed to colonial obscurantism, ignoring how this process of professionalization shows historical continuities between colony and republic. The author shows how physicians reinvented themselves as professionals without disrupting the social, gender, and even racial differences in which they had been immersed since colonial times.Hernández Sáenz's approach, however, does not address in sufficient depth the question of how representations of science structured the professionalization of those practitioners, though she does underscore that medical professionals adopted science as their battle flag when competing with other practitioners of the healing arts. In Hernández Sáenz's view, science arrived from abroad, specifically from Europe, so it remains to be seen how scientific ideas fit into her scheme of ongoing struggle and competition. Still, Hernández Sáenz succeeds in showing that the professionalization of medicine emerged not out of necessity but, rather, from a fluid, even chaotic, context and that the physicians involved did carve out a niche in a hierarchical, racist society, amid the tensions of global influences and local political struggles

Argument (complex analysis) · Art · Context (archaeology) · Historiography · Humanities · Ignorance · Political science · Professionalization · Social science · Sociology · History · Latin American history and culture · Law · Medicine

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