"Sanitizing the State: The Rockefeller International Health Board and the Yellow Fever Campaign in Veracruz" by Andrew Grant Wood
Andrew Grant Wood is Associate Professor of History at the University of Tulsa. He is the author of Revolution in the Street: Women, Workers and Urban Protest in Veracruz, 1870-1927 (SR Books/Rowman and Littlefield, 2001), and co-editor of Holiday in Mexico: Essays on Tourism and Tourist Encounters (Duke UP, 2009). He is now completing a study of composer and musician Agustín Lara. Email:
Rockefeller Foundation Memorandum, September 24, 1920
By the end of 1924, Mexican public health officials, in conjunction with agents and considerable funding from the Rockefeller Foundation (RF) International Health Board (IHB), had waged a successful campaign to eliminate yellow fever in the state of Veracruz, Mexico. This achievement represented no small feat as the disease, along with smallpox, cholera, and other viral invaders had plagued the population of the Mexican Gulf Coast for more than four centuries.
Recent interpretations of the yellow fever campaign by historians Armando Solórzano (1992, 1996, 1997) and Anne Emanuelle Birn (1996, 2006) have looked closely at the activities of the Rockefeller Foundation (RF) and its International Health Board in revolutionary Mexico. Added to the work of Marcos Cueto (1994) and others researching public health efforts in Latin American and the Caribbean as a whole, Solórzano and Birn come to an overall conclusion that Rockefeller sponsored public health efforts generally had the effect of helping to pave the way for a “more resilient” US-led capitalist development in the hemisphere (Birn 1996). Rightly refusing simply to paint the RF as a blunt and unreflective agent of US imperialism, these scholars painstakingly describe how foundation personnel and Mexican authorities negotiated the terms of the yellow fever campaign and what that relationship meant in larger national and international terms. This is a complex history that traces RF initiatives first being rebuffed by the revolutionary government of Venustiano Carranza eventually followed by official invitation on the part of Carranza’s successors; interim president Adolfo de la Huerta and then Álvaro Obregón in early 1921 (Solórzano 1997; Birn 2006).
My aim here is to offer additional detail to our broader understanding of the yellow fever campaign undertaken by Mexican and RF public health agents by first taking a longer view of the history of the disease in Veracruz and then by turning to a consideration of the diaries and personal correspondence produced by North American doctors stationed in Veracruz—particularly RF head of operations in Veracruz, Dr. Bert Caldwell. In doing so, I argue that the Foundation’s activities aimed at eradicating yellow fever in Veracruz ostensibly comprised a non-governmental, US diplomatic effort requiring considerable negotiation—particularly on the Mexican side—but also providing for a high degree of cooperation and satisfaction.
Background: A Local Legacy of Dangerous Disease
Alexander von Humboldt, 1811
During 19th Century, the city of Veracruz stood as a key geopolitical site in Mexican history because of its role as Mexico’s primary Atlantic port. At the same time, however, the city also represented one of the nation’s most dangerous areas in terms of public health (Knaut 1997). As had been the case nearly every spring and summer, yellow fever regularly visited the Gulf Region. To combat this situation, monitoring of public health conditions in Veracruz gradually came under the governance of local health commissions (Juntas de Sanidad) beginning in 1829-1830. Yet despite these early efforts, deaths caused by yellow fever reached such high proportions by mid-century that state officials and businessmen feared a potential collapse of the entire regional economy. While major epidemics of smallpox and cholera ravaged central Veracruz, it was yellow fever which loomed largest as a threat to public health (Mayet 1992). This was especially true for foreigners living in or traveling through the port of Veracruz.
As Alexander von Humboldt noted early in the 19th Century, the early symptoms of yellow fever appeared as “a pain in the lumbar region… a yellow coloring of the conjunctive and signs of congestion toward the head.” For those individuals stricken with the disease who do not suffer a rapid death, the gruesome prolongation of their struggle with the fever tended to take place over a period of a week or so. As von Humboldt vividly describes:
In the case (of rapid death) the disease shows itself in all its simplicity, appearing only to act on the nervous system. To the excitation of this system, a total prostration of the forces succeeds: and the principle of life is extinguished with fearful rapidity. The bilious complications cannot in this case show themselves, and the patient experiences as he dies strong hemorrhages (sic); but his skin does not assume a yellow color, nor are those matters vomited which go by the name of black bile. At Vera Cruz the yellow fever generally lasts beyond six or seven days; and this is sufficient for the irritation of the nervous system, to lose the true character of the adynamical (sic) fever (Political Essay on the Kingdom of New Spain. Vol. 3, 1966).
Von Humboldt further observes that it was the port’s well-deserved reputation as a hot and humid place that sustained conditions particularly ripe for infection:
The city of Veracruz is situated in an arid plain, destitute of running water on which the north winds, which blow with impetuosity from October til April, have formed hills of moving sand. These downs (meganos de arena) change their form and situation every year. (They)…contribute…(to)…the suffocating heat of the air of Vera Cruz. Between the city and the Aroyo Gavilan, in the midst of the downs, are marshy grounds covered with mangles and other brushwood. The stagnant water of the Baxio de la Tembladera, and the small lakes of la Hormiga, el Rancho de la Hortaliza, and Aronja, occasions intermittent fevers among the natives. It is not improbable that it is also not one of the least important among the fatal causes of the vomito prieto (Political Essay on the Kingdom of New Spain. Vol. 2, 1966).
Thus it was the tropical conditions in Veracruz, combined with a general lack of the potable water in the port that created a particularly insalubrious environment. Adding to this, von Humboldt noted that crowding among the popular classes and a lack of fresh air added to the city’s disposition toward infection. On the city’s water supply, von Humboldt observes the real difficulty ordinary people experienced:
The lower people…are obliged to have recourse to the water of a ditch (zanja) which comes from the meganos, and is somewhat better than the well water… People in easy circumstances, however, drink rain water collected in cisterns, of which the construction is extremely improper… This want of good potable water has been for centuries looked upon as one of the numerous causes of the diseases of the inhabitants (Political Essay on the Kingdom of New Spain. Vol. 2, 1966).
Thus, as von Humboldt and most residents knew well, Veracruz had consistently suffered from the disease from the first recorded outbreaks of yellow fever during the late 18th Century. Following his visit, porteños would endure repeated outbreaks in 1867, 1872, 1875, 1877, 1881, 1889, and 1899-1900. As one might suspect, the incidence of yellow fever often wreaked havoc upon not only the city but also much of the regional economy. Yet despite the seriousness of this situation, it would not be until 1902 that the Mexican government officially launched a campaign against the disease. In the meantime, more temporary measures were undertaken to help improve the situation.
Modern Public Health Initiatives
While state leaders had enacted a few basic health reforms over the years, such as entrusting convicts with street cleaning in the port, as well as calling for the relocation of cemeteries to the outskirts of towns, it was not until the administration of President Porfirio Díaz (1876-1911) that the condition of public health in Veracruz began to improve in any significant way. During this time, the razing of the Veracruz city wall in 1873 and modernization of the port facility in 1900 represented two important local events that helped lead to positive strides in the battle against disease (Wood 2001). Additionally, new water service and a sewer system in Veracruz improved the quality of life for residents living in the city’s central districts. Yet while these efforts offered relief, they remained quite limited.
Despite the modernization of the port and the city’s central district, officials found they could not keep pace with the demand for urban services in other areas of the city. Attempting to combat deteriorating conditions in outlying areas, Veracruz elites soon established new sanitation codes that they hoped would alleviate problems for many of the port’s working class residents. In conjunction with municipal efforts, state legislators passed new laws that identified popular housing sites as “foci of infection,” and required landlords to provide for basic sewage and sanitation. These measures represented some of the first efforts by the urban elites to address what soon was becoming a major social problem: the condition of popular housing. In the first four years of the new century, more than 2500 cases of the fever were identified and nearly 900 people died. Working to remedy the situation, public health pioneer Dr. Eduardo Liceaga adopted various methods of modern sanitation and by early 1904 successfully brought the threat under control (Castillo Nájera 1921). Following this, until 1920 Veracruz enjoyed a period relatively free from yellow fever.
When North Americans invaded Veracruz in April 1914 and subsequently occupied the port for nearly eight months, a company of 1,000 US Marines was dispatched to dispose of tons of garbage that had accumulated throughout the city. In their clean up campaign, the occupying force endeavored to sweep every street, inspect all residential areas, collect refuse and transport it to a designated area to be burned. Troops sealed old wells, dug ditches, drained stagnant pools, and sprayed nearly 69,000 gallons of petroleum in an attempt to kill off insect larvae. The army quartermaster distributed cans to be used for refuse in hotels, restaurants, and public areas. The North Americans also added public toilets, flytraps, and screens, while occasionally repairing broken windows, doors, roofs, walls, and floors. Every night, sanitation agents rinsed the main public areas of the city with seawater. To help realize their plan, they hired hundreds of local laborers.
On May 15, 1914, the New York Times proudly reported that the American “house and street cleaning department has made a great record.” Veracruz, the correspondent stated, “today is the cleanest place in the tropics as every house has been cleaned; every puddle has been filled; every street and by-way have been flushed clear; all refuse has been incinerated, and every mosquito breeding place oiled or abolished.” Not only did they comb the city; they also imposed strict sanitation regulations, a matter which infuriated many residents. As the writer from the newspaper described in the same edition:
Proprietors of hotels and cafes have been told that if their places are not kept clean they will be closed, and fines will be imposed: The scale of punishment provides for permitting refuse to gather without incineration, twenty days in jail: ten days for allowing cesspools to form and five days for expectoration.
The city’s public market also received extra special attention. Putting their methods to the test, the North Americans endeavored to improve health conditions in one of the most difficult of all local sites. To the inspector’s chagrin, however, vendors sometimes appeared unwilling to cooperate. Yet despite foot dragging in the market, as well as more generalized resentments felt toward gringos elsewhere in the city, strong anti-American feelings generated by the 1914 invasion would soon be tempered by other important local concerns, including a growing housing crisis and outbreak of two new public health epidemics in the early 1920s. Dealing with these emerging problems, public health experts soon came to realize that, for better or worse, the North American occupation had served as an important precedent for local sanitation work in the 1920s (Silva 1922).
The first public health scare came in May 1920, when public health official Dr. Mauro Loyo detected what he thought was the reappearance of bubonic plague (peste bubónica) in Veracruz (García Díaz 1992). By the end of the month the local newspaper El Dictamen had reported several cases. Once notified of the outbreak, authorities from the Public Health Department in Mexico City dispatched Dr. Octaviano González Fabela to combat the disease. By early June, officials had suspended traffic in and out of the port and created a sanitary cordon around the city. Soon, however, measures undertaken by sanitation agents would contribute to growing popular resentment felt toward national public health officials (Wood 2001).
After the first week of August 1920, Veracruz residents had reported no new cases of the plague. By the end of the epidemic, however, a total of thirty-six porteños had died, suggesting that while significant, the city’s brush with the bubonic plague proved less catastrophic than initially thought. This information seemed to confirm suspicions that health officials had exaggerated the seriousness of the campaign. For all the trouble residents had endured, the fact that health workers had failed to improve the condition of the city only added to their frustration. Following this, the return of yellow fever to the port that summer confirmed doubts regarding the effectiveness of local public health campaigns. Over the next three years, however, efforts on the part of the Mexican Department of Public Health, as well as a new alliance between Mexican and North American doctors, established to eradicate yellow fever, would help to restore public confidence.
The first case of yellow fever in nearly twelve years appeared in July 1920. Quickly, the fever spread throughout Veracruz, while also traveling north to Papantla and Tuxpan and south along the Gulf Coast to Yucatán. By the end of the year, 148 porteños had died. The return of yellow fever required that new and more vigilant measures be taken. Initially, the revolutionary government under President Álvaro Obregón took steps to combat the disease by assigning the Mexican Public Health Department to the job. The Mexican campaign first began in June 1920. At that time, of the 505 cases counted nationwide, nearly two-thirds were reported in the state of Veracruz.
From June to December 1920, the Mexican Public Health Department (DSP) worked to bring the outbreak under control through the practice of spraying oil (and sometimes kerosene) in rain water barrels, cisterns, wells, gutters, and other water containers where bacteria was found to be most prevalent. Outside the city, serious infection was found in neighboring areas to the north, including Papantla, Tuxpan, and Tampico; in various sites along the Interoceanic and Mexican Railroads to the west; and nearly every area to the south near the Papaloapan Valley (Caldwell 1922). Responding to the situation, health workers inspected the city’s water supply and hundreds of storage containers. Sanitation agents also sprayed thousands of gallons of petroleum on stagnant pools in an effort to prevent the breeding of mosquitoes. Gradually, their efforts during the summer and fall of 1920 paid off, effectively reducing the number of yellow fever cases by approximately eighty percent (Lyster 1921). Soon, however, an agreement between the Obregón administration and members of the Rockefeller Foundation International Health Board established a new bi-national commission to battle the disease.
Earlier, public health efforts supported by Rockefeller Foundation had begun in 1909 with a campaign to eradicate the parasitical small intestine hookworm disease in the US south. With countless visits to rural communities, combined with educational programs designed to convince poor Southerners to wear shoes and build latrines, the effort also required that health workers cooperate with local governments, health boards, and various community associations. Although not a total success, the campaign served as an important precedent for future international ventures. Shortly thereafter, the hookworm campaign became part of a larger Rockefeller Foundation in 1913, which three years later was renamed the International Health Board (IHB). Soon, trust in the power of modern medicine had given rise to a number of invitations from different countries all asking the IHB for public health support (Birn 1996). By 1920 the RF had helped control yellow fever in Brazil, various parts of the Caribbean, Peru, Columbia, Venezuela, Ecuador, and Panama. Following a series of earlier attempts to establish a relationship which had been overwhelmed by political conditions, Mexico would soon take up relations with the RF as well (Birn 1996, 2006; Solórzano 1990, 1992, 1994, 1997).
The new bi-national public health effort against yellow fever in Mexico took shape in late 1920 when President Álvaro Obregón and Theodore C. Lyster from the Rockefeller Foundation International Health Board agreed to work together to combat the disease. The agreement represented a significant breakthrough in US-Mexican relations, given the fact that official US diplomatic recognition of revolutionary presidents Venustiano Carranza and Obregón had not been forthcoming—and would not be until 1923—due in large part to disagreement over subsoil property rights as recently determined by the new Mexican Constitution of 1917.
Veracruz society in the early 1920s was still very much in the throes of change caused by the Mexican Revolution. From the state capital in Xalapa, Governor Adalberto Tejeda rallied peasants in an agrarian reform campaign that would eventually prove to be one of the most significant in the nation. Organized labor assumed a powerful position throughout Veracruz, particularly in the textile producing Orizaba area, located in the center of the state. In the Port of Veracruz, workers took control of local government, while joining in a number of strikes including a tenant boycott that spread to several other cities and lasted nearly a decade. (Wood 2001).
Efforts to win an invitation to work in Mexico on the part of the Rockefeller Foundation had proved unsuccessful during the Carranza administration. Yet following Carranza’s assassination in May 1920, Sonoran Adolfo de la Huerta took over as interim president until elections could be held. During de la Huerta’s last months in office, then secretary general of the Mexican Department of Public Health, Dr. Alfonso, Pruneda, along with Mexican Military Medical Corps liaison Dr. Francisco Castillo Nájera, sought out Rockefeller assistance in combating a new outbreak of yellow fever that had recently been reported in and around the Port of Veracruz. In early 1921 after Álvaro Obregón had taken office, his government formed a special yellow fever commission and established a modest budget for its operation. When Rockefeller representatives offered to contribute a significant share of their own money, Obregón felt assured that the collaboration would bolster the country’s public health infrastructure while also helping to strengthen his political power. Obregón’s decision to work with the Rockefeller Foundation may have also constituted a strategy aimed at warming otherwise chilly diplomatic relations with the US. The reason behind these difficulties stemmed from Mexico’s still relatively recent claim to all subsoil resources (embodied in Article 27)—a significant policy change that had caused authorities in Washington (not to mention US oil lobbyists) to withhold official recognition of Mexico’s revolutionary administrations. (Solórzano 1997; Birn 2006).
Moreover, the political situation in Mexico and Veracruz, specifically, was particularly challenging for any public health campaign that involved US participants given the still fairly recent memory of the 1914 gringo occupation of the Port of Veracruz. More generally, Mexican pro-nationalist sentiment (and a corresponding distrust of US organizations and businesses) ran especially high in the 1920s after a decade of revolutionary struggle motivated, at least in part, by a desire to wrest political economic control of the country from “foreigners” and return it to “the Mexicans.”
Nevertheless, the RF/DSP partnership was defended by the Obregón administration who characterized it as a politically “neutral” and eminently “scientific” endeavor. Despite the fact that many within the DSP felt that the most recent outbreak of the disease had largely been brought under control by the time of the Special Comission’s founding in early 1921. Perhaps because of the significant amount of money promised by the RF as well as the potential influence in Washington that admitting a Rockefeller (and thus Standard Oil) related enterprise into otherwise relatively hostile Mexico would have, the DSP and RF set an ambitious goal of not only controlling but eliminating yellow fever in Mexico altogether (Baldridge 1987). If successful, the undertaking would prove mutually beneficial for both Obregón and his administration, the RF, and larger US business interests who by then had identified Mexico as the last foci of yellow fever contamination in the hemisphere (Solórzano 1997; Birn 2006).
The RF-Mexico agreement served as the basis on which the Special Commission for the Campaign against Yellow Fever was created on January 19, 1921, with T. C. Lyster as director, respected DSP staffer Ángel Brioso Vasconcelos sub-director, and Enrique Osornio, Emmett Vaughn, M.E. Connor, and Bert Caldwell, as members. With this, government officials made railway, telephone, telegraph, and postal service available to the Commission staff and hoped that Mexicans would give their full cooperation. Obregón also provided 50,000 pesos to the Special Commission as a start-up budget while the RF initially dedicated $50,000 (close to $600,000 US dollars today) of their money for the project and would continue to invest more than $100, 000 over the next three years (Ferrell 1941, cited in Birn 1996). Dividing the country into seven zones, over the next four years Mexican and North American health workers conducted a campaign against yellow fever that eventually proved successful.
While there existed some initial fear and resentment of RF agents felt by Mexicans in some areas of the state of Veracruz (Solórzano 1994), when the campaign began there in early 1921, my reading of field reports suggests that the bi-national effort proved not only to be effective, but for the most part a fairly congenial and cooperative venture. In part, this assessment comes from conclusions drawn by Anne-Emanuelle Birn. (Birn 2006). As will be seen, my own tracking of head of RF operations in Veracruz Dr. Bert Caldwell also adds important on-the-ground testimony to the idea that US participation in the yellow fever campaign was generally appreciated by the Veracruz population as well as the government in Mexico City.
The Everyday Practice of Public Health: Negotiation and Teamwork
In the early 1920s, a decade of civil unrest, as well as the recent memory of the 1914 North American invasion, provided some early difficulties for RF agents in their desire to establish a rapport with Mexican citizens (Knight 1985, 1987; Solórzano 1994; Wood 2001). Nevertheless, a bi-national campaign against yellow fever got its start with the arrival of Lyster in Mexico City on November 29, 1920. A few days later, Lyster attended the inauguration ceremony of new President Obregón and then gave to Mexican officers a copy of the Rockefeller International Health Board’s plan for the yellow fever campaign. Then, on December 8, Lyster boarded a train for Veracruz where, upon arriving, he was met at the station by a team of Mexican doctors associated with the High Council of Health (Consejo Superior de Salubridad), including Loyo and Manuel Macías. The very next day, Lyster and his Mexican colleagues made an inspection of the city, examining streets, various outlying areas, the local water supply, and other areas. Here, Lyster’s journal entry from December 9 offered an initial impression of Veracruz and a developing strategy for controlling yellow fever in the port and neighboring areas:
The Northern [winter storms] here play havoc with the surface ditches on the outskirts of town. The water supply is temporarily lessened on account of faulty pumps, many of the street sewers are caving in, doing much damage to the streets. The town needs a thorough overhauling. A plan is on foot to do this. Two engineers are on their way here to make an estimate which will involve some 10 million pesos if such an amount can be secured which will cover 25 year maintenance… A thorough inspection and a few fines will bring the [yellow fever] index sufficiently low to have the disease disappear. The surrounding towns are now to be watched.
After this first inspection, Lyster joined with Dr. Loyo the next day at the local Beneficencia Hospital where the two visited with a young Spaniard who was in his third day of yellow fever. In discussing various treatment options, Lyster noted that Dr. Loyo had already given the patient a 20cc injection of serum, developed by Dr. Hideyo Noguchi from the Rockefeller Institute for Medical Research, the night before and then had repeated the dose that morning. Working for the Rockefeller Institute in connection with efforts in Guayaquil, Ecuador, Dr. Noguchi’s research had figured that the fever was caused by bacteria called Leptospira icteriodes. This led to the strategy of attacking breeding larvae in water tanks with minnows, sometimes oil, as well as the development of the serum.
Noting that Loyo appeared a little nervous because he had recently lost a previous patient to the fever, Lyster wrote that he urged him to repeat the dose at 5 and 10 p.m. “which [Loyo] did with no bad effect to our Southern friend” (Lyster 1921). Further establishing the working relationship between the two, they subsequently inspected the house of their patient and made preparations for fumigation with a solution containing the compound potassium cyanide. Meantime, an intensive effort throughout the city under the direction of Dr. Juan Graham Casasús gradually succeeded in reducing the bulk of the yellow fever cases. Still, however, further measures were needed to eliminate the disease.
Following this initial visit to Veracruz, Lyster returned to Mexico City where on December 17 he met with President Obregón. At that time, Mexico’s new leader welcomed Lyster and told him that “in times of plagues and epidemics political cooperation between neighboring states was necessary in order to bring an elimination of yellow fever from Mexico” (Lyster 1921).
Once back in Mexico in early 1921, after spending the Christmas holiday in Los Angeles, California, Lyster was thrilled to finalize an agreement with Obregón that granted permission for the Rockefeller Foundation to work in Mexico. With a round of toasts between the two sides, the coordinated campaign against yellow fever officially began. Shortly thereafter, Lyster’s associates Dr. Vaughn and Dr. Caldwell arrived in Veracruz to coordinate Special Commission operations. Receiving instructions from Lyster, the North American doctors were instructed to be sensitive to issues of national sovereignty and to “regard themselves as representing not the International Health Board but [rather] Dr. Malda of the Department of Health of Mexico” (Lyster 1921). While it is difficult to know for certain, it appears that Lyster’s directions were meant to avoid any confusion over exactly whose national jurisdiction the campaign would come under.
Special Commission doctors Caldwell and Vaughan built on the earlier efforts by Mexican workers and soon managed to reduce the remaining number of yellow fever cases in the city of Veracruz. Testifying to the relatively positive state of affairs in the port, Caldwell noted in early 1922 that the city “was easy to keep in condition” (Caldwell to Le Prince 1922). Yet, while yellow fever had virtually been eliminated in Veracruz, it remained a significant problem in other towns and in many rural areas to the north and south. Caldwell also determined that their main task was to expand the scope of the campaign in order to attack infected inland bordering each side of the port. In his annual report from 1921-1922, Caldwell described the situation in the following terms:
Outside of Vera Cruz the whole area was badly infected. To the north Papantla and Tuxpan were experiencing formidable epidemics and a few cases had been previously reported in the city of Tampico. To the west the small cities and towns along the lines of the Interoceanic and Mexican Railroads were reporting cases, while practically every town and hacienda along the Papaloapan Valley from the Oaxacan mountains to the Gulf Coast was badly infected (Caldwell 1922).
Deciding how they wanted to address fairly high levels of infection in small towns and rural areas in the region, Caldwell and his Mexican colleagues deployed a strategy which placed a line of brigades across the Isthmus of Tehuantepec to the south as a way to keep the fever from spreading from Veracruz into the states of Chiapas, Tabasco, and parts of Oaxaca. To the north, the areas around Papantla and Tuxpan saw the establishment of “flying brigades” (brigadas volantes) that would conduct intensive “sweeps” through settled areas. In their contact with local residents, health workers sprayed water containers and sought to establish new sanitary practices. Although the RF personnel in the north headed up these efforts, it was Mexican sanitation workers who carried out the design (Caldwell 1922).
In addition to the emptying, cleaning, oiling, and subsequently covering all water containers during their regular (usually eight day) inspections, one of the techniques workers associated with the Special Commission employed with great success was the planting of fish in water containers. In larger tanks, where a sufficient amount of water supported the introduction of minnows (who naturally devour all existing larvae and pupa), the possibility of disease breeding was effectively eliminated. In addition to these measures, agents would also occasionally fumigate public areas as well as other “suspicious” places, where there existed a heavy mosquito infestation (Caldwell 1922). By September 1921, much of the work to disinfect the area around Tuxpan (also known Túxpam), for example, had been done—despite some resistance by local officials (Birn 2006). By early 1922, reports by the northern zone’s new chief Dr. M. E. Connor indicated that no additional cases of the fever had arisen. Further up the coast in Tampico, the campaign had been coordinated the year before by Dr. Tomás Cuarón, Dr. A. R. Stubbs, and engineer J. A. Le Prince–all connected with the Associated Oil Managers. Interestingly, public health workers in Tampico had found that depositing fish in water storage containers had proved a highly successful method in combating the spread of bacteria. As Caldwell notes in his report, “this accomplishment was of the greatest possible importance to the remainder of the Gulf Coast” (Caldwell 1922). Eradicating the disease from the area entirely, however, would continue to require the full cooperation of residents.
In public relations terms, members of the Special Commission observed that initially, Caldwell had been at work on “a difficult problem–mostly political” (Lyster to Bailey 1921). As it turned out, however, a letter from Lyster to RF head Dr. Wickliffe Rose in March 1921, reassured Foundation managers by suggesting that the issue with Caldwell was not so much a political matter but more one of personal style. According to one of his RF colleagues, the issue proved to be that Caldwell tended to worry too much about things and, on occasion, be overly sensitive about the fact that local officials would sometimes communicate directly to Dr. Malda rather than with him (Lyster to Rose 1921). Not everything was cheery for Caldwell in Veracruz, as on January 29, 1921, Connor wrote in his diary that he and Caldwell lost various amounts of currency and gold to a thief who had broken into their Veracruz hotel room. Despite occasional difficulties, Caldwell appears to have worked relatively well with his Mexican counterparts.
In terms of relating with not only local doctors but also city residents, Caldwell noted that initially, porteños had resisted the planting of fish in water containers, especially those used for drinking supply. Responding to this, Caldwell wrote in a letter to Dr. Alfonso Pruneda that “in order to control this situation, we undertook an educational campaign to counteract this” (Caldwell to Pruneda 1922). Presumably, their educational efforts included convincing residents that the fish would not die and foul their drinking water. Gradually, porteños would gain confidence in the Special Commission as they saw the number of mosquitoes significantly diminished by fish planting as well as fumigation of city sewers, latrines, and pit toilets. On his effort to improve public relations, Caldwell wrote: “the result was not long in coming [as] we soon had control of the situation and gained the goodwill of the inhabitants” (Caldwell to Pruneda 1922). A positive turn in bi-national relations more generally, Lyster had also noted earlier in a letter to RF head Dr. Wycliffe Rose when he stated that “prominent citizens, in committees and otherwise, have come forward with their full support, including the press and [thus] we are all getting behind Drs. Caldwell and Casasús in a way that gives promise of good cooperation and thorough work” (Lyster to Rose 1921).
Examples of Mexican hospitality and care for the visiting North American doctors can be seen in September 1921, when Caldwell fell ill after suffering an insect bite on the right side of his forehead. Suspecting a possible anthrax infection, Veracruz medical personnel, including Dr. Loyo, operated on Caldwell to remedy the situation. Commenting on this, Lyster communicated in a letter to Dr. Rose in New York that Loyo had “done a most thorough” job and that Caldwell’s wound was “rapidly healing” (Lyster to Rose 1921). Local care for another member of the IHB staff also demonstrated Mexican appreciation and concern for the visiting North Americans, when in late 1921, Veracruz staffer Dr. Howard Cross contracted yellow fever and died. Observing the way local public health authorities handled the situation, Caldwell indicated that the Mexicans “afforded every care to Dr. Cross” and paid for the transportation of his body back to the United States. Wanting to reciprocate for their kindness, Caldwell recommended to IHB officials that the lab equipment of Cross be given to the sanitation personnel in Veracruz “who very much need it” (Caldwell to Rose 1922). Clearly their day to day relations involved a significant degree of both personal and professional give and take.
During this time, the work of the Special Commission had continued apace as sanitation agents maintained their watch on areas in the port of Veracruz and their flying brigades in rural areas. Reporting on the progress of the operation, Lyster wrote to Dr. Pruneda:
Dr. Casasús and I are going to a small neighboring town to see a suspicious case of yellow fever just reported. Dr. Caldwell is getting his part of the organization in shape to do effective work and we hope to get the people of Veracruz in full accord with him, so as to insure success here. To me Veracruz is now the keystone to the arch, and by lowering the index here, then working out to the alrededores (outlying areas), we should have elimination in sight (Lyster to Pruneda 1921).
By the fall of 1921 Rockefeller Foundation managers felt that their work in Mexico might be finished in a year or so. When they informed their zone coordinators of a desire to retire the Special Commission, Caldwell wrote to Dr. Rose arguing that this plan be reconsidered. His comments reveal not only a desire to remain on the project but also a desire on the part of Veracruz residents for the RF to remain in the country:
The desire of the Foundation to retire the activities of the Comision Especial is causing a great deal of adverse comment on the part of the Mexican people in the cities in which the Commission has been active. [The same is true for members of the] Consejo Superior de Salubridad. [In fact] Dr. White’s announcement that the Commission would cease its activities as of October 1  both surprised them and made their future plans uncertain. They [initially] had risked a great deal and had run counter to considerable adverse criticism on the part of the medical profession and the Mexican people in placing the campaign in the hands of the representatives of the Foundation. They felt [however] that the course which they had taken has been fully justified by the success which has attended the work of the Comisión Especial. The Mexican authorities do not want the Commission to cease its labors at this time (Caldwell to Rose 1922).
Believing that the Yellow Fever campaign had done much to win the hearts of the Mexican people, Caldwell’s appeal ended with the assertion:
Whatever their political faults, there are few people who need the Foundation activities more than the Mexicans and none who appreciate what is being done for them in a more generous degree… I want the Foundation to leave Mexico with the esteem and respect that the Mexican people now hold it in (Caldwell to Rose 1922).
Thus for Caldwell at least, whatever initial trepidation Mexicans may have felt toward the International Health Board’s activities, the overwhelming success of the Yellow Fever campaign had done much to alleviate fears and win the confidence of ordinary Mexicans. Despite Caldwell’s plea, the Foundation gradually turned the yellow fever operation over to local public health agents, while transferring after 1923 their interest to the problem of hookworm in Veracruz and elsewhere in Mexico. Just as the last case of yellow fever in Mexico was reported in Ciudad Victoria, Tamaulipas, in December 1922, Caldwell would leave Veracruz to be with his sick wife in San Antonio, Texas.
When Veracruz elected a new Worker Party mayor in early 1922, Caldwell wrote to a friend that “the city was in political turmoil” but that the new administration has “extended us a great deal more assistance than we experienced under the last and I believe they will continue to assist us” (Caldwell to Read 1922). While one of the very few explicit references to local, state, or even national politics in the Rockefeller correspondence, Caldwell’s comment suggests that Mexican relations with members of the Rockefeller Foundation were fairly resilient.
Conclusion: Close Encounters of the Largely Cooperative Kind
Caldwell and his associates’ impressions provide additional perspective on the Rockefeller Foundation’s presence in Mexico during the yellow fever campaign. Looking back, the early 1920s were not only a time of political tension and uncertainty in US-Mexican relations, but also opportunity for cooperation between public health agents on both sides of the border. Realizing the need to eradicate yellow fever from Mexico, officials in Mexico City affiliated with the Obregón administration enlisted the help of the International Health Board with the hope that the presence of Rockefeller agents would not spark controversy. Testifying to the relative success of RF doctors and their Mexican counterparts, a 1923 petition signed by more than twenty Veracruz residents to the Mexican Department of Public Health complained that since agents under the charge of the Rockefeller Foundation (“el Instituto de Nueva York”) had left the city the many positive strides made in eliminating mosquitoes, conditions in their neighborhood had lost ground (Inquilinos to Department of Health 1923). Reflecting on the relationship between the Rockefeller Foundation and Mexico in 1924, Dr. Connor wrote: “Mexicans in general are pleased when their national health agency co-operates with an organization like the I.H.B.” Telling of a conversation between himself and DSP staffer Dr. Brioso Vasconcelos, Connor remembered the two agreed that while Mexicans are a proud people “this cooperation is not only a source of local pride but assumes in their opinion an achievement which raises their country above others not enjoying this cooperation” (Connor 1924). While certainly there must have been instances of much less enthusiastic encounter between US doctors and their Mexican hosts (not to mention similar tension experienced elsewhere in Latin America and the Caribbean), the impression one is left with after reading the correspondence of public health personnel while working in Veracruz is that the matter of improving local health conditions by employing RF expertise and funding did not necessarily run contrary to the overall goals of revolutionary Mexican society. Quite the contrary, both Mexican officials in the Obregón administration, their allies (including governor Tejeda) and a majority of the Mexican public made effect use of the RF collaboration just as the IHB successfully paved the way for a sanitizing of Veracruz and, therefore, US and other international commercial interests in the process.
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- Solórzano Ramos, Armando. 1992. “Sowing the Seeds of Neo-Imperialism: The Rockefeller Foundation’s Yellow Fever Campaign in Mexico.” International Journal of Health Services 22, 3.
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- Solórzano Ramos, Armando. 1994. “The Rockefeller Foundation in Revolutionary Mexico: Yellow Fever in Yucatán and Veracruz.” In Marcos Cueto (ed.), Missionaries of Science: The Rockefeller Foundation in Latin America. Bloomington: Indiana UP.
- Solórzano Ramos, Armando. 1997. Fiebre dorado o fiebre amarilla? La Fundación Rockefeller en México, 1911-1924. Guadalajara: Universidad de Guadalajara.
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- von Humboldt, Alexander.  1966. Political Essay on the Kingdom of New Spain. Vols. 2 and 3. Trans. John Black. New York: AMS.
- Tarrytown, N.Y. Rockefeller Archive Center (hereafter RAC). International Health Board (hereafter IHB), Register Group (hereafter RG 5), Subseries 323, Box 147. Bert Caldwell to Pruneda, December 23, 1922.
- RAC. IHB, RG 5, Series 2, Box 33, Folder 197. Bert Caldwell, “The Conduct of the Yellow Fever Campaign in Vera Cruz and the Second Yellow Fever Zone, 1921-22.”
- RAC. IHB, RG 5, Series 1.1, Box 64, Folder 913. Bert Caldwell to Rose, January 2, 1922.
- RAC. IHB, RG 5, Series 1.1, Box 64, Folder 913. Bert Caldwell to Le Prince, January 16, 1922.
- RAC. IHB, RG 5, Series 1.1, Box 64, Folder 913. Bert Caldwell to Read, March 28, 1922.
- RAC. IHB, RG 5, Series 1.1, Box 65. Bert Caldwell to Rose, July 29, 1922.
- RAC. IHB, RG 5, Series 2, Box 33, Folder 194. M.E. Connor, “Narrative Report of the Yellow Fever Control Work in Zone 1, Mexico.”
- RAC. IHB, RG 5, File 194. M. E. Connor, “Yellow Fever Inspection Trip to Mexico, 1924.”
- RAC. T.C. Lyster, “Journal, 1921.”
- RAC. IHB, RG 5, Series 323, Box 147, file 195. T.C. Lyster, “1921 Annual Report to the Rockefeller Foundation International Health Board.”
- RAC. IHB, RG 5, Subseries 323, Box 147. Lyster to Bailey, February 7, 1921.
- RAC. IHB, RG 5, Series 1.2, Box 56, folder 807. Lyster to Pruneda, February 7, 1921.
- RAC. IHB, RG 5, Subseries 323, Box 147. Lyster to Rose, March 31, 1921.
- RAC. IHB, RG 5, Series 1.2, Box 56, folder 807. Lyster to Rose, February 7, 1921.
- RAC. IHB, RG 5, Subseries 323, Box 147. Lyster to Rose, September 19, 1921.
Mexico City. Archivo Histórico de la Secretaría de Salud, S.P., Epid., Box 34, Exp. 8. “Inquilinos de varios patios to Director General of The Mexican Department of Public Health,” May 24, 1923.
* Research support was provided, in part, through a grant from the Rockefeller Archive Center, Tarrytown, NY.