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date: 01 October 2023

Public Health in Uruguay, 1830–1940sfree

Public Health in Uruguay, 1830–1940sfree

  • Anne-Emanuelle BirnAnne-Emanuelle BirnDepartment of Global Development Studies, University of Toronto
  •  and Raquel PolleroRaquel PolleroPrograma de Población, Facultad de Ciencias Sociales, Universidad de la República


Little examined, Uruguay’s public health trajectory offers an important window on the country’s larger societal dynamics and the possibilities and limits of public health across Latin America. On one hand, Uruguay lagged behind public health efforts and overall institutionalization compared to other countries in the region, through much of the 19th century. On the other hand, tiny Uruguay became highly engaged with international health, medical, and social policy developments, and it modernized, urbanized, and secularized early, with important implications for health and welfare state-building, epitomized in early 20th-century Batllismo. Still, the country’s economic, epidemic, demographic, social, and political vicissitudes meant that public health efforts, too, oscillated between fulfilling aspirations for an up-to-date and far-reaching hygienic apparatus and seeing these expectations dashed during economic downturns, periods of political repression, and when health successes seemingly turned into failures, as with its prolonged infant mortality stagnation. Uruguay also moved from being an importer of public health models and practices, especially from Europe, to exporting its own innovative approaches, as per its internationally renowned rights-based approach to improving child health, embodied in its 1934 Children’s Code and diffused via the pathbreaking Montevideo-based children’s protection institute. Also sui generis were the multiplicity of roles played by the country’s minuscule pool of public health experts, who served at one and the same time as epidemiological observers, institutional leaders, clinicians, and policy elites, making their impact and interactions both fruitful and fraught. The article traces Uruguay’s public health history across three eras, revealing the untold stories and ups and downs of a small but significant public health actor.


  • History of Southern Spanish America
  • 1824–c. 1880
  • 1889–1910
  • 1910–1945
  • Science, Technology, and Health


The historical dynamics of public health in Uruguay both reflect and are reflected in developments in Latin America and well beyond. Yet Uruguay’s experience—framed by its particular social and economic situation, demography, geography, and state/institutional conformation—is sui generis. Both late—in terms of (public health/medical) institutionalization—and precocious in its urban modernization and secular health and social welfare state-building, this small country with big aspirations, limited resources, and porous borders (with neighboring Brazil and Argentina) faced multiple contradictions. In public health and other arenas, it was simultaneously outward-looking, influenced by European cultural and scientific interchange and trade, and pathbreaking in innovating wide-reaching policies. To elucidate this trajectory, the country’s public health course is tracked across three eras.

Creating a State, Coping with Outbreaks, 1830–1880s

Uruguay was founded in the late 1820s after liberation from rival Spanish/Portuguese colonization and then Argentinean/Brazilian occupation. Its small Indigenous population was devastated, displaced, and forcibly assimilated under Iberian conquest and colonial rule. Following independence, tiny Uruguay, particularly its capital Montevideo, became a major immigration and trading port, taking advantage of its privileged fluvial and maritime location near the mouth of the Río de la Plata—the Atlantic Ocean. Known for its Spanish, Italian, and French population origins (with especially large immigrant waves in the late 19th century), descendants of sizeable contingents of enslaved Africans brought by colonial authorities also had an important influence on social and civic life.

The new republic was quickly confronted with dual challenges of establishing a new public health authority and dealing with health problems, arising from both domestic conditions and the slew of epidemics accompanying the global context of mounting trade, migration, and urban misery under accelerating imperialism, industrialization, and capitalism.

Nevertheless, public health organization was not without precedent. During the colonial period, Montevideo’s governor, who reported to the Río de la Plata Viceroy, was formally responsible for public health. But Municipal Councils (especially in Montevideo) actually oversaw urban hygiene and epidemic disease surveillance. With few other tools, municipal authorities (the Cabildo) resorted to maintaining the cleanliness of streets and public squares and vigilance of food and wells. Sometimes physicians were involved, as with inspection of fruits, grains, and public fountains. These activities overwhelmingly heeded miasmatic explanations, driving concerns around stagnant water and fetid refuse, including the accumulation of carcasses. In pressing situations—for instance during droughts—other measures were considered, such as public appeals to attend Mass and pray to Montevideo’s patron saints.1

As across the Spanish empire, the Tribunal del Protomedicato’s local outpost regulated professional medical practice and licensing for physicians, pharmacists, surgeons, and phlebotomists. Another entity, the Sanitary Board (Junta de Sanidad) was charged with port sanitation, particularly of slave ships. This priority rose after 1791 when Montevideo became the region’s sole entry port for enslaved people, who were blamed for propagating infectious diseases, especially smallpox. Sanitary Board members interrogated ship captains (obliging them to swear to God and the Spanish King) about the trajectory and shipboard health conditions of each vessel.2 As a striking reflection of prevalent racialized fears, vigilance of maritime spread of infectious diseases focused on ships trafficking enslaved Africans, overlooking practically all other vessels.3

After independence, some public health activities were grafted onto existing entities; other institutions were fashioned anew. Municipal councils were replaced by administrative and police headquarters and departmental economic and administrative boards, which together shared public health duties. Additionally, an honorary Public Hygiene Board with national purview was connected to the Ministry of Governance but had no paid staff. Comprised of four physicians and surgeons, the Hygiene Board took over the duties of the Protomedicato, as well as sanitary policy, surveillance of infectious diseases, and a newly established vaccination board. Notwithstanding these administrative ambitions, public health was a second-tier priority, due to the fiscal constraints posed by war debts. To illustrate, two-thirds of the 1831–1832 government budget went to the Ministry of War, 0.02 percent to public education, and just 0.002 percent to health.4

Such lack of investment would prove shortsighted, given that Uruguay’s birth as a state coincided with early waves of the cholera pandemic. Starting c. 1820 and continuing for a century, cholera outbreaks followed imperial trade routes from Asia through Europe, reaching the Caribbean and Mexico in 1833, and wreaking havoc down the continent in successive waves.5

With impeccably problematic timing, the Public Hygiene Board was dissolved in 1834 due to disagreements among its members, and another board only temporarily reinstated. Two years later, Montevideo experienced a deadly epidemic, initially labeled cholera based on a single diagnosis, and generating public alarm. Subsequently the outbreak was deemed to be scarlet fever (less lethal). The episode highlighted the problem of inadequately organized public health authority. Amid the crisis, Uruguayan president Manuel Oribe launched a replacement seven-member Public Hygiene Board, but denied its three consulting physician members voting privileges.6

In 1839, upon reports of an epidemic in the Canary Islands (a significant embarkation point to Uruguay), the Public Hygiene Board urgently recommended the establishment of sanitary boards in the ports of Montevideo and Maldonado. Although concerns regarding disease spread among and via ship passengers and goods remained, these matters were soon overshadowed by thirteen years of civil war (the Guerra Grande).

Medical Statistics and Public Health Legislation

As in neighboring countries that were navigating state-building amid civil conflict and economic vicissitudes, Uruguayan authorities were intent on developing modern legal-administrative frameworks even as instability hindered full implementation. In the realm of medical statistics, parishes initially continued to compile registries of baptisms, marriages, and deaths, relaying the information to the statistical agency of the country’s new Ministry of Governance. In 1837, with the Public Hygiene Board now involved, physicians were required to submit a daily table to the board documenting the age, sex, and diseases of patients they saw as well as a death tally. The board, in turn, produced three sets of statistical tables (initially quarterly, later annually) listing, respectively, births and marriages, deaths by sex and age, and deaths by causes.

This policy put public health authorities in charge of vital statistics, transforming collection of medical statistics into an important function of public administration. While parish-based registries were not eliminated, the epidemiological information gleaned from cause-of-death data gave state medical authorities a formidable tool that transcended the role of parishes. This transition was less tortuous in Uruguay than in countries where the Catholic Church retained a larger governance role. In 1858 cemeteries began to be secularized, moving under the purview of municipal authorities and death registrars, a process that unfolded gradually until the Civil Registry’s founding in 1879. Even so, problems of incomplete and irregularly submitted information persisted until the late 1800s. Still Uruguay’s administrative framework, together with such factors as its small size, accessible geography, and “lay” state, would eventually make it a Latin American frontrunner in collecting demographic and epidemiological information.

Meanwhile, legislation was afoot. In 1838 new sanitary police regulations spawned yet another Public Hygiene Board, comprising four physicians abetted by four permanent commissions. Beyond medical statistics, the Board’s reinforced roles and powers included: (a) advising the government on public health measures necessary to safeguard pure air and prevent the spread of epidemic disease; (b) recommending measures to maintain the cleanliness and ventilation of hospitals, barracks, and prisons; (c) ensuring the national supply and administration of (smallpox) vaccine; (d) preventing abuses related to medical and pharmaceutical practice; (e) conducting annual inspections of pharmacies; and (f) providing forensic and legal medicine advice.7 The new regulations further specified the composition and role of sanitary boards at the nation’s ports: inspection, quarantine, and issuance of bills of health for ships arriving from countries with plague, yellow fever, cholera, or typhus.8

Yet given underfunded mandates, unpaid services of board members, and concentration of authorities in Montevideo (resulting in relative neglect outside the capital), public health’s reach remained limited. It differed little from other governance areas in this regard, except that recurring epidemic diseases pressured the government to act, especially after the Guerra Grande subsided.

Epidemic Crises and Regional Agreements

Uruguay, as elsewhere, experienced repeated disease outbreaks throughout the 19th century, including smallpox, scarlet fever, yellow fever, and cholera. Epidemic eruptions of infectious/contagious diseases were generally time-delimited and resurged only sporadically. But as the population and international interchange grew, these diseases became endemic or appeared more often, albeit with different levels of intensity and impact.9

Smallpox was a major problem. Considered epidemic during the 18th century, by the 1840s it became endemic, with frequent outbreaks. In 1829 a vaccine preservation commission was established to prevent outbreaks but was understaffed (with just one vaccinator), lacked adequate regulations, and experienced problems with the serum itself. Ten years later, a new Central Vaccine Administration—run by local sanitary authorities country-wide—amplified the reach of smallpox vaccination.

Although public schools instituted a vaccine mandate in 1829, expanded vaccine efforts generated resistance, especially in rural areas. For instance, in the early 1840s the Public Hygiene Board president blamed both unvaccinated European immigrants and rural populations for the long duration of a smallpox epidemic in Montevideo.10 Rural–urban differences in vaccination rates persisted throughout the 19th century.

Particularly terrifying were a string of yellow fever epidemics, which hit Montevideo especially hard in 1857, when perhaps one-third of the population was infected, killing one-third of those—estimated at 60 percent of all deaths that year.11 Yet the Public Hygiene Board did not recognize the outbreak as yellow fever, instead attributing it to severe gastrointestinal fever arising from environmental factors, and advising “atmospheric” measures consistent with miasmatic theories.12 In the early 1870s, yellow fever struck both banks of the Río de la Plata. The infamous 1871 Buenos Aires epidemic decimated immigrant-dense areas and provoked panic, prejudice, and chaos (a subsequent Montevideo outbreak caused over three-hundred deaths).

The epidemic also prompted Argentinean officials to propose a sanitary convention with Uruguay as a bulwark against yellow fever from Brazil. This posed a dilemma: Uruguay’s sizeable trade in dried beef to feed Brazil’s enslaved and other immiserated populations centered on the yellow fever-endemic region of Bahia. Still, since most ships arriving to the Río de la Plata docked first in Montevideo (closer to the Atlantic), and abundant traffic crisscrossed the waterway, a harmonized bilateral response with a system of shared isolation hospitals was deemed highly useful.

In 1873, Brazilian authorities—concerned at the prospect of lengthy quarantine measures against its vessels—quickly jostled their way into an initial conference in Montevideo, over the objections of Argentinean diplomats. After several months of etiological and political tussles, especially vis-à-vis the familiar theme of quarantine length (Brazil forcing a three-day reduction during winter months), medical and diplomatic delegates managed to hammer out an accord. However, larger Argentine–Brazilian hostilities (regarding Brazil’s occupation of Paraguay following the War of the Triple Alliance) impeded its ratification.13

Cholera, too, remained a periodic menace, with a brutal 1868 epidemic linked to over one-third of Montevideo’s deaths that year.14 This time, Uruguayan officials were compelled to act. Sanitary authorities attributed the disease to vessels arriving from Brazil, Argentina, and Europe and accelerated opening of a lazaretto to isolate sick ship passengers.

In the mid-1880s, with tensions tempered, sanitary coordination was once again attempted. Now Brazil blamed cholera on its southern neighbors. In late 1886 Brazil closed its ports (except for one quarantine station) to all vessels from Argentina and from all other cholera-infected ports. Uruguayan officials, alarmed at the interruption of beef exports, dispatched a diplomat–physician–pharmacist trio (the last delegate charged with scientifically demonstrating that beef could not transmit cholera) to Rio. Argentineans soon joined the deliberations.

By then, medical specialists, their authority rising, met separately from—and informed the decisions of—the diplomats. Pursuing the region’s own priorities around trade and immigration, the three countries (under imperial Brazil’s dominant hand) came to agreement, years before hyper-competitive European powers were able to cooperate in this manner. With unanimity regarding the transmission of cholera (but not yellow fever), the ratified 1887 convention and accompanying health regulations stipulated preventive sanitary control measures in ports and on shipboard, and the use of lazarettos with quarantine lengths staged differentially for cholera (the shortest), yellow fever, and plague (the longest).15 Although the accord ended after four years (a 1904 replacement included reciprocal notification), it resonated across the continent and beyond: in quick succession, Andean countries signed the 1888 Lima Convention.16 South America’s developments foreshadowed the international (mostly European) sanitary conferences that began in 1851 but only resulted in conventions (initially for cholera) in the 1890s.

In sum, if Uruguay’s post-independence efforts at public health state-building yielded inadequate results amid civil conflict, budget shortfalls, and administrative vagaries, by the later 19th century the legislative and policy scaffolding that had been created, bolstered by regional agreements, put Uruguay at the cusp of sanitary progress.

Elements of a (Health and) Welfare State: Advances and Setbacks, 1880s–1910s

After a half-century of post-independence political and social vicissitudes—economic crises, civil wars, and disease outbreaks—Uruguay’s drawn-out state-building process turned into an advantage, enabling both prosperity and stability, as well as auspicious health conditions. Between the 1880s and 1910s Uruguay entered an era of rapid capitalist expansion—the global economic transformation led by Great Britain. Uruguay gained access to trade routes and foreign investment, mostly British (in the banking sector, transport, communications, energy, and waterworks) and saw mounting immigration. Modernization in the realm of production enabled sizeable economic growth, mostly concentrated in Montevideo.

Uruguay’s Modernizing Push

Uruguay gradually increased its participation in international markets, supplying food and primary materials. The backbone of the economy was export-oriented livestock agriculture, principally hides, wool, and meat, with Europe, the United States, Argentina, and Brazil as leading trading partners. Technological developments (including wire enclosures of private farmlands, animal breeding, and incipient mechanization) resulted in high rural unemployment, stimulating urban migration. This, combined with waves of immigration, spurred the growth of both Montevideo (which comprised 30 percent of the country’s total population by 1908) and regional capitals and larger towns. Early urbanization was accompanied by “modern” reproductive practices, reflecting the values of societal elites favoring lower fertility, in turn shaped by European ideologies and practices. Such values then diffused (initially) in urban settings.17

Alongside these economic and population trends, the main political forces, influenced by liberal and positivist ideas, were solidifying. Political elites implemented important policies that contributed to the country’s stability, peace, productivity, and progress, such as free, lay, and compulsory education for 6–14 year-olds (both boys and girls) and the secularization of schools, health facilities, and other institutions.18

Policies geared to public health and urban order meanwhile helped drive down mortality, especially among infants and children.19 In the 1880s Montevideo became the first Latin American city to install clean water, drainage, and sanitation systems, as well as street paving, electric street lighting, and routine garbage collection. The situation was so propitious that from 1890 to the early 1910s leading hygienists bragged about low infant and overall mortality was compared to most places that were then clocking such data in Europe and the Americas.20

As one author put it optimistically, Uruguay merited the label “Promised Land.”21 Into this self-confident scenario, the 1908 Census, up to then the most comprehensive in the country’s history, was conceived as a tool to scientifically gauge progress, calculate the country’s population and economic growth, and plan for the future. It was also a wakeup call.

Conducted in the aftermath of Uruguay’s last two post-independence civil wars (1897 and 1904), the census showcased the country’s consolidation as a modern, democratic, legitimate state. However, the population was smaller than expected (contemporaries hoped it would greatly exceed one million inhabitants, but just one million were counted).22 Making matters worse, after Montevideo’s initial urban-planning successes, it was not adequately prepared for subsequent population growth: it experienced an “urban penalty,” that is, a relative excess of mortality due to poor living conditions.23 The 1908 Census found that more than 10 percent of Montevideo’s population lived in tenements in the city center or in suburban shacks built from tin and wood. Because of greater crowding and deteriorated sanitary and living conditions, Uruguay’s health situation, as gauged by infant mortality, was worse in the city than the countryside.24

Health, Well-Being, and an Incipient Social Welfare State: Institutional Developments

Uruguay’s pioneering social welfare reforms—associated with overall improvements in social conditions—are generally dated to José Batlle y Ordoñez’s early 20th-century administrations, but crucial developments presaged this period.25 The government statistics office was strengthened in 1874 under director Adolphe Vaillant, who modeled Uruguay’s annual volumes on exemplars from his native France. The Civil Registry was instituted in 1879, assuming responsibility at a national level for registering births and marriages (from parishes), and deaths (from municipalities). This milestone in reliable, secular vital statistics collection enabled, starting in 1885, the publication of cause-specific mortality data based on a local 1874 adaptation of the nomenclature used in Paris’s Bulletin de Statistique Municipale.26 In 1895 Uruguayan authorities adopted the classification developed by Jacques Bertillon and became active in periodic discussions around its revision.27

In the meantime, confusing and overlapping responsibility for public health prompted various efforts at rationalizing and centering power in the hands of the Public Hygiene Board (Junta de Higiene Pública). As Vaillant argued, “public hygiene could and should form the basis of a bona fide national Ministry as is the case in several European countries.”28 By 1895, pressure from the press and parliamentarians to emulate Europe and Argentina finally led to the creation of the National Public Health Council (Consejo Nacional de Higiene [CNH]) as a centralized sanitary authority with power to dictate and enforce domestic and maritime health policies. It still reported to the Ministry of Governance, and its members were contractual physicians.

The CNH set norms and regulations regarding epidemic disease, vaccination, prophylactic measures for prostitutes, environmental hygiene, and animal health, in addition to recording health statistics. It was also charged with coordinating efforts to prevent infectious diseases. As such, quarantine and isolation facilities and their equipment were all under the CNH’s aegis. To ensure the nationwide reach of CNH policies, provincial-level councils were created across the country, later replaced by roving health inspectors. In sum, the CNH had a broader purview than its predecessor, though its direct provision of care only spanned border inspections and quarantine administration.29

The formation of the CNH reflected a larger medicalization tendency, which began in Europe in conjunction with medical and biological advances, the professionalization of physicians and scientists, and industrial needs. Uruguay’s medical elites trained in European hubs, such as Paris, Montpellier, Vienna, Berlin, and Edinburgh, bringing their learning to the University of the Republic’s Faculty of Medicine, organized in 1875.30 In 1895, also heeding European influences, the new Institute of Experimental Hygiene was founded, with a star Institut Pasteur graduate, Italian Giuseppe Sanarelli, at the helm, briefly placing Montevideo at the cutting edge of bacteriology and parasitology research to combat prevalent infectious threats. The institute was involved in serum preparation (against diphtheria, typhus, etc.), public health and microbiology training, and clinical research.31 The belated launch of Uruguay’s medical faculty (compared to other Latin American countries) meant that medical hierarchies were less entrenched and more receptive to the latest scientific developments.

To note, at this time the state lacked a defined healthcare delivery role. Under colonialism, imperial authorities had focused on the health of soldiers, constructing three hospitals in the stronghold of Montevideo. After independence and until the early 20th century, healthcare services for the impoverished and newcomers were run by civil society actors. The well-off received care at home.

Montevideo’s charity hospital, founded in 1788, continued to serve poor and unhoused populations, with care provided by nuns. Starting in 1878 the medical faculty operated specialized clinics, mainly for instructional purposes, but also proffering care.32 There were also two asylums (for orphans and the destitute) and a mental hospital. Not all institutions were located in the capital: for example, the Paysandú Hospital, some 250 miles north, was inaugurated in 1862. In the late 1870s, three maternal asylums were established, inspired by European institutions. They functioned only during daytime hours, as a daycare-like arrangement for small children whose parents worked outside the home.33

Meanwhile, mutual aid societies proliferated wherever immigrants conglomerated. Atop providing assistance for the unemployed and for burial costs, they purveyed medical care. The first such collective solidarity society, the Asociación Española de Socorros Mutuos, was set up in 1853, followed by French (1854), Italian (1862), and Neapolitan (1880) variants, among others. Initially, they covered principally laborers and owners of small businesses, serving as the origin of the early 20th-century healthcare delivery infrastructure.34 The first immigrant hospital, the British Hospital, was founded in 1857, with ensuing Italian and Spanish counterparts decades later.

It was only in the context of a series of social reforms, under Batlle’s first presidency (1903–1907) and his successor Claudio Williman, that state responsibility for healthcare was decreed.35 An early measure targeting the most vulnerable populations was the 1908 creation of the first gotas de leche (child health clinics), modeled on French clinics. In 1910, the national charity commission was replaced by a modern National Public Assistance agency (Asistencia Pública Nacional [APN]). The APN was fashioned after—but even more expansive and centralized than—France’s Assistance Publique, with indigent persons granted the “right to free services provided by the State.”36 Care for the chronically ill, the aged, abandoned children, and poor pregnant women and new mothers was organized via a coordinated system of orphanages and foundling homes, maternal asylums, charity hospitals, and other establishments (see figure 1).37 In essence, these reforms refashioned traditional understandings of motherhood and placed maternal and child protection policies at the service of reproducing the Batllista state through fit and healthy future citizens.38 The new law’s conceptual shift was crucial: health was now both an individual right and a state responsibility that guaranteed free care to needy populations in public, secular institutions, even as private (charity and mutual aid) and municipal services for the sick and the indigent continued to operate.39

Figure 1. APN First Aid Kiosk on Playa Ramírez in Montevideo.

Source: Colección Ministerio de Salud Pública y Asistencia Pública, Archivo Nacional de la Imagen y la Palabra (SODRE), Montevideo, Uruguay

A flurry of other laws followed, rounding out the state provision of social welfare: workers’ compensation, an eight-hour workday, a mandatory rest day, paid pregnancy leave, and tax-free essential goods. Batlle’s ambitious agenda unleashed decades-long redistribution and protectionist policies: old-age pensions, occupational safety, unemployment insurance, publicly funded higher education, and so on.40 Together, these measures made Uruguay an early social welfare leader in the Americas and beyond.

Health and Mortality Dynamics

As these societal transformations were unfolding, Uruguay’s demographic profile shifted from high birth and death rates to lower ones. The principal motor of this transition was a decline in mortality, which began as early as the 1880s, succeeded by a drop in the birth rate, especially in Montevideo. In 1900 Uruguay was among the world’s healthiest countries, illustrated by its life expectancy at birth of forty-eight years, longer than most European and all Latin American countries.41 Infant mortality was less than a hundred deaths in a thousand births—besting every country then recording vital statistics except Norway and Sweden—almost a third lower than France’s rate.42

In 1896 Montevideo’s public health officer, Dr. Joaquín de Salterain, touted his country’s plunging mortality, noting that Montevideo’s death rate was lower than those of Paris, London, and Buenos Aires. According to Salterain, social conditions, public health institutions, and hygiene education, as well as the mild climate, were crucial elements of these “pleasing results.”43

An important aspect of the mortality decline was infectious and epidemic disease control. By 1900, a medico-political consensus on how to combat epidemics was emerging, with miasmatic notions displaced by bacteriological theory. Prior attention to purifying air in urban disease foci was replaced with identifying the source of epidemic outbreaks, such as contaminated water receptacles, and preventing the transmission of airborne diseases.

Interventions specified in CNH regulations included surveillance, quarantine, disinfection, border inspections of goods and travelers, systematic isolation in the lazaretto, obligatory physician reporting of certain infectious diseases, and, eventually, vaccination. Politicians supported these measures, recognizing that epidemics also engendered economic problems.

The aforementioned international sanitary conventions were aimed at preventing “exotic” diseases (yellow fever, cholera, plague), but the main epidemic diseases of the era were smallpox, diphtheria, scarlet fever, and typhoid, among others, which contributed far more to mortality than the frightening exotic diseases.

During the 1880s children faced repeated diphtheria outbreaks. Amid an 1887 episode, health authorities counseled, “Because croup and diphtheria are highly contagious and have no known medication, healthy children should avoid all contact with those infected.”44 Of course, isolation was impossible in low-income households. Pastorian Émile Roux’s diphtheria anti-toxin, announced in 1894, held great promise for treating sick children of all social classes. Within just a few months of its establishment, Montevideo’s Institute of Experimental Hygiene began producing the serum, quickly becoming self-sufficient and fully covering all social assistance needs. In 1930, a statue was dedicated to Roux in Montevideo’s central Parque Rodó “from thankful Uruguayan mothers.”

On other fronts, as late as 1904 and 1909 severe scarlet fever outbreaks motivated temporary school closures, and in 1907 Uruguay reported on the problem of school transmission of measles and whooping cough to what would become the Pan American Sanitary Bureau (PASB).45

Montevideo’s Municipal Vaccine Conservatory, founded in 1889, was Latin America’s first such institute. It both produced and supplied vaccines for the entire country.46 Thereafter, smallpox vaccination coverage escalated, but distribution remained unequal into the 20th century. In 1901 CNH member Joaquín Canabal warned that organization of the vaccine service outside of Montevideo lacked resources. Other than two national vaccinators who worked for the CNH, the various authorities responsible for vaccination (municipal vaccinators, municipal physicians, health inspectors) responded to outbreaks but only secondarily administered preventive doses during lulls between epidemics.47 The 1908 Census reported that 61 percent of Uruguay’s population was vaccinated, with rates varying from 87 percent in Montevideo to 55 percent in the countryside, and lowest of all in the most rural areas with poor literacy rates.48 Border regions with Brazil, where smallpox was endemic and vaccination rates low, experienced especially frequent outbreaks. Yet vaccine mandates were slower to come to Uruguay than many places due to two influential anti-vaccination movements: one focused on individual liberties, the other claiming that reducing the prevalence of smallpox would lead to spikes in other diseases.49 It was not until 1911 that vaccination and revaccination became obligatory at a national level, after a successful lobbying effort by a chorus of physicians led by the CNH. Sadly, this was too late to save public health officer Gabriel Honoré, who died while attending to a 1910 smallpox outbreak.

Throughout this time, tuberculosis (TB) was a major problem—as the endemic contagious disease associated with the greatest number of deaths. With its moral and disciplining dimensions directed to the working and popular classes, TB control was emblematic of the hygiene movement.50 Preventive measures were deemed essential to both recovery and minimizing contagion to others. Among these were required reporting of TB cases (1896), periodic disinfection of the clothing and dwellings of indigent people with TB (1903), inspection and hygienic renovation of tenements, and veterinary inspection of stables and dairy farms to address bovine TB.51 In 1902 Salterain, then director of the Municipal Census and Statistics Office, founded the non-governmental Uruguayan League against TB, which purveyed prophylactic advice to the sick, along with medical attention, medicines, clothing, bathhouse access, and nourishment.

Other diseases tied to poor social conditions included typhoid fever, stemming from deficiencies in clean water and sanitation. In 1908, other than in Montevideo’s oldest and wealthiest neighborhood, running water only reached between 1 percent and 14 percent of dwellings in most areas. Oftentimes, even if infrastructure was in place, the high cost of services precluded popular classes.52 In more remote regions and minor cities, cisterns and septic tanks were common.53 Only in the late 1910s did the typhoid vaccine begin to be distributed.

In sum, the optimism of the “Promised Land” concealed another reality. Despite institutional and modernizing advances, ever-aspirational plans, and the hubris expressed by health professionals, the country was continually struggling between success and failure. Rapid urban growth meant that Montevideo’s infrastructure could not keep up with population needs. A prime illustration of the gap between intentions and realization is the case of infant mortality.

Vicissitudes and Conundrums of a Budding Social Welfare State: Public Health and the Child Health Question, 1910s–1940s

The interwar and immediate post-World War II (WWII) periods saw ever-expanding social protections, institutional growth, and financial solidity (except during the Great Depression). But in actuality this era was characterized by vagaries and contradictions, including in the public health arena. The political stability and legitimacy achieved with the Batllista state ensured domestic peace and an export-oriented agrarian economy with valuable international markets during and after World War I (WWI). The country’s burgeoning social legislation, accompanied by new agencies and ministries, brought Uruguay into the company of leading world powers. Yet periodic economic crises, persistent poverty and health challenges—demonstrating the inadequacies of the country’s social welfare model—and rumblings of authoritarianism that came to a head in the 1930s suggest that the country’s advances were not as consolidated as they seemed. Here, public health conditions serve as an illuminating window on the country’s ups and downs.

Uruguay’s Growing Public Health Infrastructure and International Engagement

As elsewhere, Uruguay’s early 20th century was marked by growing health infrastructure, personnel, and institutions. Between 1910 and 1930, ten new medical facilities were created in Montevideo, with another twenty-eight in the main towns and cities of the country’s other eighteen departments (provinces). New bacteriological and chemical laboratories were established, and specialized centers, such as nutrition and preventive medicine clinics, also proliferated. Permanent provincial-level public health offices gradually replaced traveling health inspectors. In-country training of doctors accelerated, with physician per capita ratios doubling between 1910 and 1934.54 In the 1920s, health authorities prioritized training of visiting nurses and social workers. This period also saw increased public health personnel and purview over sanitation, housing, food and water inspection—including in prisons and school refectories—and milk hygiene (involving the regulation and monitoring of pasteurization, storage, and transport).55 Preoccupation with port and maritime outbreaks and the health of immigrants was ongoing, as were perennial concerns regarding sex workers and venereal diseases.56

Uruguay also became a player in the emergent landscape of international health. The PASB, initially International Sanitary Bureau, —founded in Washington, DC in 1902 as the world’s first international health organization and for several decades operating under the aegis of the US Public Health Service—set up a regional base in Montevideo in 1907 for the collection of South American health statistics.57 Although short-lived, the office’s location and Uruguayan management served as recognition of Uruguay’s public health capacity, as well as the Batlle era’s clear political alignment with the United States.58 In 1920 Montevideo hosted the PASB’s 6th Sanitary Conference, well before Rio de Janeiro or Buenos Aires did so.59 Uruguay was also a member of the Paris-based Office International d’Hygiène Publique, launched in 1909, which oversaw sanitary treaties and shared disease statistics among member countries. Additionally, in the 1920s, Uruguayans became active at the League of Nations and its Health Organisation (LNHO).

Back home, public health authorities continued their long-standing efforts to control infectious/contagious diseases. Diphtheria remained a significant problem: in the mid-1920s, treatment with anti-serum was coupled with preventive vaccination (produced at the Institute of Hygiene) and then neutralizing antitoxin.60 Anti-diphtheria educational campaigns and house-to-house administration stepped up in the 1930s, later followed by mandatory vaccination for schoolchildren.61

Warm weather epidemics were also concerning. Atop existing sanitation and clean water measures, preventive vaccination against typhoid fever, also prepared in Montevideo laboratories, began in the 1920s, initially focusing on the military and certain hotspots outside the capital. The vaccine was soon administered free of charge in Montevideo, but typhoid abounded in suburban areas where housing was cheaper but sanitary conditions worse.62

Trachoma, a highly contagious eye disease leading to blindness, was also prevalent among poor populations living in crowded, unhygienic conditions. Often associated with immigrants, trachoma concerns rose after 1900 as eye clinics mushroomed across Montevideo. Because late-stage trachoma lacked effective therapeutics, prophylaxis was emphasized via screening, health education, obligatory reporting, isolation, tenement inspections, and reductions in the cost of household water access.63 Most contentious was a 1915 decree blocking the entry of people with trachoma by maritime sanitary authorities. This practice became embroiled in controversy, with the APN director seeking to attenuate overly harsh rejections of family members or doubtful cases; others calling for tighter trachoma restrictions at land borders; and ophthalmologists advocating for their own professional purview of trachoma inspection and control at the border and within the country alike.64 Whether trachoma among immigrants exacerbated public dependency seems questionable. Unlike other disabilities, trachoma could be readily diagnosed by specialists. Moreover, for authorities, trachomatous immigrants (who constituted up to half of medical rejections at early 20th-century Argentinean borders, for example) were an easy target, unlike the cost and effort of improving living conditions in urban shantytowns.65

Meanwhile, TB remained a highly feared disease. Building on prior efforts, in 1927 a new Children’s TB dispensary produced, distributed, and administered Bacille Calmette-Guérin (BCG) vaccine to prevent infection in newborns of tuberculous mothers. Named in honor of BCG co-discoverer Albert Calmette, it was the first such dispensary outside France. Two years later, the APN launched a dedicated anti-TB service, coordinating ambulatory treatment centers in Montevideo and at regional hospitals staffed by pulmonologists, radiologists, laboratory technicians, and professional nurses, and operating a TB sanatorium.66

Uruguay did not escape the 1918–1920 influenza pandemic (at least the second and third waves), bearing both similarities to European and North American trends (the poor were hit in the earlier wave, the well-off subsequently) and significant differences: immigrants, more than troops, were seen as the primary conduits.67 Despite the apprehension surrounding influenza (and its high morbidity), endemic diseases persisted as Uruguay’s prime mortality drivers in this period.68

The burgeoning of institutions, personnel, and health measures culminated in the 1934 creation of the Ministry of Public Health, which unified the functions of the APN and CNH, streamlining regulations and centralizing governance in a single institution.

While promising, these developments masked an undercurrent of health problems that remained inadequately addressed.

The Paradox of Infant Mortality

No domain better illustrates these tensions than infant/child health. As discussed, c. 1900 Uruguay’s precocious (for Latin America) and extensive Civil Registry coverage showed encouragingly low infant mortality rates, including compared to European frontrunners. Moreover, the country’s early investment in gotas de leche seemingly ensured continuation of this excellent record.

But just as Uruguay’s social welfare laws were flourishing, its infant mortality advantage began to unravel. Rather than declining, as in virtually every other setting then compiling and monitoring these data, Uruguay’s infant mortality rate stayed stuck around the same level (roughly 10 percent of births) as before 1910 and stagnated for over three decades. With both pediatric experts and government officials bewildered, health authorities tried almost every known measure to improve infant health.

A prime contributor was diarrheal infant mortality, perpetually alarming in summer months, and spurring successive targeted campaigns.69 Certainly, as contemporaries observed, milk quality deteriorated when the weather was hot. Health experts highlighted another factor, namely omnipresent flies—even worse in summertime amid poor sanitary conditions and due to the city’s sizeable (working) horse population and many stables—believing that flies were important vectors in the spread of disease.70 Addressing this, in 1919 health officials formed a special anti-fly commission, promoting a large-scale educational effort. The campaign lasted several years, yielding few tangible results.

In addition to the ever-increasing reach of the gotas and the APN, health leaders heeded a panoply of French child health approaches, founding a children’s hospital (1908), and introducing a maternal refuge and paid pregnancy leave (1915). Services were consolidated in an Infant Protection Office (1919) that regulated wet nurses, provided maternity subsidies, distributed breast-milk, and created a centralized Children’s Home to organize all of these services under a single roof (1925). Still, charity activities, usually operated by women elites—Catholic damas, liberal feminists, and, mostly, conservative “maternalists” (some married to the very men administering state maternal and child health and welfare services!)—did not disappear. Instead they accompanied social welfare measures, providing complementary material assistance, food, and shelter to poor women and their children.71

That infant mortality levels stayed essentially unmoved through all of these efforts sheds light on the limits and unspoken priorities of the Batllista state. It was, at least initially, conceived to protect workers and vulnerable populations. A specific focus on child health only emerged after the infant mortality paradox was detected and decried.72

Uruguay’s Rising International Role and the International American Child Protection Institute

Notwithstanding domestic disillusionment, Uruguayans sustained their international involvement, spanning both political and health realms. Batlle had famously journeyed to Europe after his first presidential term, studying the crafting and implementation of social and economic policies and adapting his learning during his second term. Although not directly party to WWI, Uruguay benefited from increased meat exports and saw many of its nationals join French forces, including a team of doctors under surgeon Eduardo Blanco Acevedo (later Uruguay’s first health minister), who spent five years at the helm of foreign medical-military support.

In parallel, Uruguayan child health and social welfare specialists consistently pursued relationships with French, other European, and Latin American colleagues—via conferences, visits back and forth, and publications—gradually becoming exporters of ideas and practices as much as importers. The APN’s founding director José Scoseria, for one, was much sought after as a speaker and delegate at international agencies and social welfare congresses.73

French physicians recognized Uruguayan savants, sponsoring a Franco–Uruguayan medical fraternity in Paris.74 By the 1920s internationally famed pediatrician Luis Morquio and his colleagues frequently published in European medical and child health journals.75 Morquio was named officer of the Légion d’Honneur, member of the Académie Nationale de Médecine, and was a regular invited lecturer to Italy’s nipiologia meetings and across Europe. The 25th anniversary of his pediatrics chair was applauded in Europe and throughout Latin America.76 Additionally, Uruguay was often the sole country outside North America, Europe, and Japan whose good-quality data warranted inclusion in comparative assessments of health statistics.

At the LNHO—formally established in Geneva in 1923 in the wake of a post-WWI epidemic control commission focused on helping war-torn nations—Uruguayan experts, among other Latin Americans, were convened to participate in an ambitious program of surveillance, research, standardization, professionalization, and technical aid.77 APN director Scoseria served on LNHO’s governing board, and in 1925 the LNHO vice president, Dr. Léon Bernard of the University of Paris, visited Uruguay to study the country’s public health organization and hygiene teaching.78 That year Uruguayan school health expert Rafael Schiaffino participated in a prestigious six-month North American and European tour consisting of nine Latin American doctors.79

Another high-profile League of Nations (LN) participant was Dr. Paulina Luisi, the first woman graduate of Uruguay’s medical faculty, the country’s leading liberal feminist, and a regionally and internationally renowned champion of women’s rights and children’s well-being.80 She was the only Latin American woman delegate to the first LN Assembly and participated in various treaty, disarmament, and labor conferences. Luisi also served as an expert delegate on the LN’s advisory commission on human trafficking and for ten years was one of only two Latin Americans on the Child Welfare Committee.81 She forcefully advocated for increased Latin American perspectives in the LN’s work for children, included in surveys of social conditions and policies, and for greater representation in governing bodies.82

Luisi paid special attention to the LNHO’s sponsorship in 1926 of an infant mortality survey of urban and rural districts in seven European countries.83 Using her savoir faire and perch at the LN to become a transnational interlocutor with South American child protection experts, she helped shepherd the realization of a Montevideo-based child protection institute. Originally the brainchild of the women-launched Pan American Child Congresses (first held in Buenos Aires in 1916) that convened reformers, nurses, policymakers, sociologists, physicians, lawyers, and social workers from across the Americas, Luisi and other feminist leaders were soon upstaged by Morquio and other male physicians. Even so, Luisi’s LNHO channels proved invaluable. Extending the LNHO’s infant mortality surveys to South America, with Morquio arranging for an LNHO conference in Montevideo to initiate this project, served as the ideal vehicle to inaugurate the International American Institute for Child Protection (IAICP).84

The momentous June 1927 “South American Conference on Infant Mortality” was the first LN conference of any kind held in Latin America, particularly notable given US antagonism to LN activities in the region. Attended by both its talented director Ludwik Rajchman, plus the LNHO’s president, the conference brought a prestigious world stage not only to the IAICP but to Uruguay and its child health experts.85

From the outset, the IAICP, co-founded by ten countries and encompassing the entire region by 1949, delineated a pathbreaking child rights approach to health and well-being. Foreshadowing Uruguay’s protagonism in this area, Minister of Education Enrique Rodríguez Fabregat called for full social rights to housing, parental recognition, education, nutrition, economic assistance, land, legal standing, happiness, and integrated well-being.86

The IAICP’s first major activity was overseeing LNHO-sponsored infant mortality surveys in Argentina, Brazil, Chile, and Uruguay. The results, presented at the 6th Pan American Child Congress in Lima (1930), called for enhancements in vital statistics coverage, centralization of services, and a range of public health, social assistance, economic, and educational measures, all well established in Uruguay itself.87

Uruguay initially underwrote the IAICP’s budget, enabling it to fulfill the scope of its activities: collecting and distributing research, laws, statistics, and practical information from around the world pertaining to the protection of infants, children, and mothers; publishing a widely circulated, multilingual journal; organizing periodic child congresses; and parlaying the region’s problems and policies into international debates.88 Uruguay retained a strong imprint on the IAICP. Morquio was the inaugural director, succeeded after his death in 1935 by his disciple, Roberto Berro, for over two decades.

Repression and Child Rights: Uruguay’s Children’s Code and Its International Reverberations

Until the 1930s, Uruguayan authorities had pursued an adopt–adapt–share approach to child health and welfare policymaking and institution-building, with the IAICP providing ever-greater access to overseas experiences and policies. But increasingly specialized medical approaches to child health remained inadequately integrated with social measures and, critically, failed to address stagnating infant mortality.89 The situation demanded a sweeping approach: when Uruguay’s liberal era abruptly ended with President Gabriel Terra’s March 1933 internal coup d’état, an opportunity materialized. Within Terra’s junta was Berro, who immediately maneuvered to create a pioneering Ministry of Child Protection and a commission to review child welfare legislation.

If the regime’s overall intent was to move the country from a cosmopolitan to a nationalist outlook, the child health arena deviated from the script. That Terra arose from Uruguay’s traditional pro-welfare state party—a Batllista, if one for “times of crisis”—helps explain his forwarding of social policies from previous decades, albeit under decidedly distinct political conditions (see figure 2).

Figure 2. Public health poster included in the “Cultural Crusade,” a 1934 nationwide traveling train exhibit during Gabriel Terra’s regime.

Source: Archivo Nacional de la Imagen y la Palabra (SODRE), Montevideo, Uruguay

Berro convoked Morquio, Bauzá, and others in the tiny but vibrant child health community to reorganize the country’s proliferating infant and child welfare measures and agencies, consistent with Terra’s penchant to rationalize and centralize power. Under Berro’s leadership, the commission did not simply merge overlapping efforts: it called for a Código del Niño (Children’s Code [CC]) to “defend all of the rights of the child,” based on the broad principles pronounced at the IAICP’s inauguration.90

The CC amalgamated Uruguay’s existing policies and institutions, covering child health, education, legal tutelage (of “delinquents” and abandoned children), nutrition, housing, social services, and other aspects of well-being. Also guaranteeing paid maternity leave and maternal care, it stipulated eugenic measures, such as prenuptial exams, similar to the “preventive eugenics” approaches of other Latin countries.91

Passed in April 1934, the CC maintained appeal for Batllista, union, and even some left-wing constituencies, demonstrating that despite political rupture, repression, the depression, and pro-business policies, Uruguay’s protectionist state would continue.92 Pro-government newspaper El Debate commended Berro and heralded the CC as “a magisterial consolidation” of children’s rights and a hallmark of “social prophylaxis carried out by a revolutionary government,” surpassed only by Mussolini’s national maternal and child health “masterpiece” and Britain’s 1933 Children and Young Persons Act.93

Uruguay’s CC quickly reaped international acclaim. Praise poured in from across Latin America, the United States, Belgium, Italy, Spain, and beyond.94 Nowhere were the accolades higher than in and from France, the very country that most shaped Uruguay’s child health approach. In 1934 prominent Assistance Publique physician Julien Huber wrote admiringly of Uruguay’s new CC in France’s Revue Médico-Sociale de l’Enfance, apologizing for the lengthy article, justified by Uruguay’s “unique” achievements.95 Paris’s La Presse Médicale and other periodicals followed suit, one asking, “Might it be possible for us [France] to obtain similar results with analogous methods? Assuredly no.”96 The assiduous “student” appeared to be outstripping its French “teacher.”

Undoubtedly Uruguay’s CC revealed a profound state patriarchalism. That this policy passed under an authoritarian regime, but was nonetheless couched in a language of child rights, underscores welfare reformers’ political opportunism and the paradoxes of early 20th-century child health and protectionism.

Indeed, the CC and its implementation arm, the Children’s Council (Consejo del Niño), established by the 1934 Constitution, seems mired in contradictions.97 A panoply of services was provided free of charge despite constrained state revenues. Castigating fathers, it protected mothers and children, helping secure state legitimacy through increasing social and economic rights under a repressive milieu, akin to a “sanitary dictatorship.”98

All the while, the Children’s Council’s expansive and expanding services (including via mobile units) offered an unprecedented level of protection, making Uruguay a world leader in assuring that children’s rights were not only rhetorically invoked but realized through public policies.99 Delivering free services by age group (prenatal, infant, childhood, and adolescent divisions) and jurisdiction (education, law, social services, and school health divisions), the Council was headquartered in Montevideo, eventually establishing offices throughout the country.100 Though headed by a series of doctors, the Council’s intentional separation from the new health ministry unambiguously confirmed the need to decenter medicine’s mounting armamentarium by foregrounding social approaches alongside medical ones.

Within five years the Children’s Council’s budget reached almost 2 percent of total government spending. Given its wide mandate, the Council interacted with virtually every Uruguayan child, at minimum through school health checkups and, for poor and working-class children, via extensive coordinated services.101 In just a decade, children’s well-being improved markedly. For example, foster children numbers plummeted by 85 percent, and infant mortality resumed its decline.102

A Public Health Transition, 1930s–1940s

Various other public health improvements unfolded in the 1930s. The issue of milk hygiene had sparked an acerbic decades-old dispute between Morquio and fellow pediatrician Julio Bauzá regarding whether the gotas (under Bauzá’s watch) were distributing contaminated milk and discouraging breastfeeding, thereby jeopardizing infant health.103 Addressing this concern, several milk-processing plants, heeding hygienic pasteurization and storage practices, were established in Montevideo during the 1920s. However, only in January 1934 was pasteurization mandated by a Montevideo ordinance.104 The 1935 founding of the National Cooperative of Milk Producers (CONAPROLE) proved instrumental. With centralized milk hygiene standards and inspection, plus production controls, the cooperative gradually displaced independent dairy farms and raw-milk sellers, by 1944 supplying 84 percent of the capital’s milk consumption.105 Outside Montevideo, poor milk hygiene and inadequate bottle cleaning prevailed until the late 1940s.

Meantime, medical and social policy had synergistic effects. In the 1930s, use of sulfonamides—moderately effective anti-bacterial agents—became widespread, followed in the 1940s by intravenous therapy (to counter dehydration), and penicillin after WWII. These were amplified by resurrected anti-diarrheal public health campaigns, now more medicalized and more successful in the city than the countryside.106 Likely most impactful was a 1943 socioeconomic measure: family wage legislation.107 A small surge in birth registration (incentivized by subsidies for each registered child) made infant mortality rates appear to drop, given the larger denominator of births. The decline endured, indicating the policy’s long-term impact on poverty and inequality. By this time, both Terra’s dictatorship and the depression had passed. Abundant state coffers and a return to social welfare democracy ushered in a new wave of redistributive social policies, including minimum wages and housing and water improvements.


In sum, Uruguay’s relatively belated institutionalization put it in the vanguard of Latin American health developments c. 1900. Extensive overseas engagement stimulated regional cooperation to control epidemics and inspired the making of a secular state focused on social protections that bode well for public health, especially when the export-oriented economy was booming. But intractable poverty spawned setbacks, such as stagnating infant mortality. Ironically, the country’s minuscule pool of health experts—who served simultaneously as epidemiological observers, institutional leaders, clinicians, and policy elites—meant that innovative approaches transcended political regimes, as with the Children’s Code of Rights championed under a 1930s dictatorship. If Uruguay maintained its regional public health leadership (i.e., Latin America’s longest life expectancy) with postwar social welfare expansions and democratic renewal, swings between advances and stumbling blocks remained a recurring theme: political-economic crises in the 1960s and the 1973–1985 military dictatorship were accompanied by life expectancy stagnation, and Uruguay fell behind health levels in Costa Rica, Chile, and Cuba. In recent years, public health investments and a revitalized social welfare state have had more salutary effects, suggesting that longtime aspirations may yet be fulfilled.

Discussion of the Literature

Across most of the 20th century, studies in the history of public health—and medicine—in Uruguay were by and large produced by practicing and retired physicians and other health professionals, such as Rafael Schiaffino, Washington Buño, and Ruben Gorlero Bacigalupi. More focused on the history of medicine than of public health, these works serve a highly useful role in identifying institutional milestones, outlining chronologies, compiling biographical details of major individuals and institutions, and constructing narrative arcs of the field. The many publications of Fernando Mañé Garzón (1925–2019), founder of the History of Medicine Department and library (both in 1988) at the University of the Republic’s (Udelar) Faculty of Medicine, are emblematic of the most recent era of these studies.

At the same time, many of these studies might be considered old-fashioned, as they emphasize great (mostly) men and ideas—as opposed to the social and political factors shaping key moments, actors, and developments—and heed positivist (fact-gathering) rather than interpretive and contextualized historical approaches.

A crucial exception to this trend is the 1990s trilogy written by famed social and political historian José Pedro Barrán (1934–2009), under the overall title Medicina y Sociedad en el Uruguay del novecientos. In reality, Barrán’s interest in the history of public health and demography unfolded several decades before when he and co-author Benjamín Nahum were exploring the political, social, and economic history of Uruguay in a multi-volume pathbreaking book series (Batlle, los estancieros y el Imperio Británico) on the country’s modernization process. Barrán later embarked on a pair of Foucauldian-framed cultural and social histories of colonial and state-building periods, Historia de la Sensibilidad, which included questions of natality and mortality. Through these and many other works, Barrán was already a hugely productive scholar (even under the difficult conditions of the 1973–1985 dictatorship) and had a notable international reputation when he published his health and society volumes.

The impact of Barrán’s scholarship (and training), both within the country and in Latin America more broadly, was, and remains, enormous. He inspired and influenced multiple new generations of social historians, including those mentioned ahead, through his writings, talks, and teaching from his (post-dictatorship) position as Chair of the History of Uruguay at the Facultad de Humanidades y Ciencias de la Educación (Udelar).

One such arena of rich contextual research for the history of public health comprises historical demography. Professor Adela Pellegrino, having returned from abroad with dual training as a demographer and historian, founded Udelar’s first center of demographic studies (Programa de Población) in the early 1990s. As well as her principal interest in migration, Pellegrino has pursued various important studies of Uruguay’s population history.

Critically, in building the population program from scratch, Pellegrino gathered a dynamic, interdisciplinary set of young historians, anthropologists, sociologists, economists, and political scientists. In the late 1990s, two of these investigators, Raquel Pollero and Wanda Cabella, joined Anne-Emanuelle Birn (from the United States, then Canada) in multi-year studies of the history of infant mortality in Uruguay. The trio have presented and published numerous analyses of the social, epidemiological, and demographic history of infant mortality, furnishing an important contextual basis for the history of public health in Uruguay, and, indeed, this article.

Another relevant research venue is the Uruguayan Society for the History of Medicine, founded in 1970, which sponsors a monthly seminar and annual compilation of many of the presentations published as Sesiones de la Sociedad Uruguaya de Historia de la Medicina. The Society brings together physician- and nurse-historians, scholars with more formal training in the history of science and medicine, and, occasionally, social historians. Among those more sensitive to the social and political dimensions of the history of medicine and public health are Ricardo Pou Ferrari, Augusto Soiza Larrosa, Antonio Turnes, Herman Kruse, José Maria Ferrari, José Portillo, Juan Gil, Sandra Burgues Roca, and Eduardo Wilson. Their works on the history of epidemics and quarantine, and health/medical institutions, are helping build a broader context for understanding the dynamics of public health in Montevideo (and Uruguay) over time.108 Complementing such works, in the 1990s Diosma Piotti prepared a lengthy volume on the history of health policies, health reforms, and state institutions, and María Amelia Díaz de Guerra and Carlos Chabot published one of the rare volumes on healthcare history in a province outside of Montevideo.

A significant arena of research that crisscrosses with the history of public health is the history of women, feminism, and social welfare, pioneered with Asunción Lavrín’s 1995 comparative study examining reproduction, puericulture, motherhood, and feminist organizing in Argentina, Chile, and Uruguay.109 It has been joined by focused, highly original research by Graciela Sapriza on Paulina Luisi, eugenics, and abortion, among other topics; Christine Ehrick’s groundbreaking studies of feminist/women’s influence in the building of Uruguayan social welfare; and, most recently, by Inés Cuadro Cawen’s book on feminism and politics in early 20th-century Uruguay, and Lourdes Peruchena’s doctoral thesis on maternalism and the state in the same period.

Two final arenas warrant mention. The first is Udelar’s Pueblos y Números del Río de la Plata research group. A team of historians, directed by María Inés Moraes and Raquel Pollero, study demography, economic conditions, and society on both shores of the Río de la Plata across different time periods. Particularly germane to public health history are a project exploring the development of government statistical institutions during Uruguay’s first century of independence and a comparative study of epidemiological trends in Montevideo and Buenos Aires.

The second arena is an emerging literature on the international engagement and influence of Uruguayan child health, public health, and social welfare experts and policies. Here international scholars, such as Birn and Teresa Huhle, have played an instrumental role.110

It is notable that the rich and ever-growing literature on the history of public health in neighboring Argentina and Brazil greatly overshadows scholarship on this topic in Uruguay. Our hope is that, despite the relatively small size of Uruguay’s public health history community, upcoming generations will pursue and produce a similarly exciting body of work.


We are grateful to Carolina Luongo for research assistance and to Sandra Burgues Roca, Ana María Rodríguez Ayçaguer, and the outside reviewers for generously sharing their historiographical expertise.

Primary Sources

Propitious for further study of the history of public health in Uruguay are the country’s extensive archival repositories and library collections. The most important among these is the Archivo General de la Nación (AGN), which holds documentation of the Cabildo de Montevideo and of the different public hygiene boards, the Consejo Nacional de Higiene, and the Consejo del Niño. These materials refer to laws and decrees of the public health programs implemented throughout the 18th and 19th centuries. The AGN has the papers of many key 20th-century public health players as well, such as Paulina Luisi. The Museo Histórico Nacional also preserves manuscripts and correspondence of various key health professionals, such as Joaquín de Salterain.

A range of municipal libraries and archives have holdings on municipal statistics, ordinances, and regulations related to public health, such as the library of the Junta Departamental de Montevideo and the Archivo de la Intendencia Municipal de Salto.

Likewise, Udelar’s Instituto de Historia de la Facultad de Arquitectura Diseño y Urbanismo and the Faculty of Engineering have extensive documentation and journals on the city’s historical development.

The materials held by Uruguay’s leading libraries are noteworthy. In the Biblioteca Nacional, extensive journal and newspaper collections stand out. For example, it maintains the full series of many key public health journals. Within the Biblioteca Nacional, the Sala Uruguay preserves brochures and publications, among which are chronicles on epidemics, the Annals of 19th-century Sociedad de Medicina Montevideana, and the first statistical publications with information on mortality from the second half of the 19th century. The Biblioteca del Poder Legislativo holds publications of parliamentary sessions and legislation related to public health. Also meriting attention is the library of the Uruguayan Society of Pediatrics (Sociedad Uruguaya de Pediatría), which preserves Luis Morquio’s manuscripts. The archive of the Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes holds the publications of its predecessor, the Liga Uruguaya contra la Tuberculosis.

The Statistical Yearbooks (Anuarios Estadísticos) published annually since 1884 by the Dirección General de Estadística (today the Instituto Nacional de Estadística) contain relevant statistical information on health. These volumes can be found in different libraries in Uruguay, as well as overseas, such as at the New York Public Library and the Library of Congress (USA).

Another extremely important repository maintains the book and journal collections of the Faculty of Medicine (Udelar) comprising both the central library and the library of the Departmento de Historia de la Medicina. The Faculty of Medicine has published several highly useful bibliographic compilations based on these collections.111 Holdings include the complete series of the Boletín del Consejo Nacional de Higiene, Boletín de la Asistencia Pública Nacional, as well as publications of Uruguayan and Latin American health and medical congresses, and pediatric and other medical journals with significant public health content.

Lastly, for topics related to child health and protection, the Biblioteca del Instituto Interamericano del Niño, la Niña y Adolescentes has an extensive collection including the complete series of the institute’s own journal since its founding.

Further Reading

  • Barrán, José Pedro. Medicina y Sociedad en el Uruguay del novecientos, Tomo 1: El poder de curar. Montevideo, Uruguay: Ediciones de la Banda Oriental, 1992.
  • Barrán, José Pedro. Medicina y Sociedad en el Uruguay del novecientos, Tomo 2: Ortopedia de los pobres. Montevideo, Uruguay: Ediciones de la Banda Oriental, 1993.
  • Barrán, José Pedro. Medicina y Sociedad en el Uruguay del novecientos, Tomo 3: La invención del cuerpo. Montevideo, Uruguay: Ediciones de la Banda Oriental, 1995.
  • Birn, Anne-Emanuelle. “Doctors on Record: Uruguay’s Infant Mortality Stagnation and Its Remedies, 1895–1945.” Bulletin of the History of Medicine 82, no. 2 (2008): 311–354.
  • Birn, Anne-Emanuelle. “De Montevideo au Monde: l’Institut International Américain de Protection de l’Enfance et la circulation des politiques uruguayennes de l’enfance.” Monde(s): Histoire, Espaces, Relations 20, no. 2 (2021): 67–97.
  • Birn, Anne-Emanuelle, Raquel Pollero, and Wanda Cabella. “No Se Debe Llorar sobre Leche Derramada: El Pensamiento Epidemiológico y la Mortalidad Infantil en Uruguay, 1900–1940.” Estudios Interdisciplinarios de América Latina 14, no. 1 (2003): 35–65.
  • Birn, Anne-Emanuelle, Wanda Cabella, and Raquel Pollero. “The Infant Mortality Conundrum in Uruguay during the First Half of the 20th Century: An Analysis according to Causes of Death.” Continuity and Change 25, no. 3 (2010): 435–461.
  • Burgues Roca, Sandra. “Centenario de la Asistencia Pública Nacional APN (1910–2010).” Sesiones de la Sociedad Uruguaya de Historia de la Medicina XXIX (2012): 264–279.
  • Ehrick, Christine. The Shield of the Weak: Feminism and the State in Uruguay, 1903–1933. Albuquerque: University of New Mexico Press, 2005.
  • Osta Vázquez, Maria Laura. La infancia del Torno: Orfandad, adopciones y prácticas olvidadas en Montevideo del siglo XIX. Montevideo, Uruguay: BMR, 2020.
  • Pellegrino, Adela. La población del Uruguay: Breve caracterización demográfica. Montevideo, Uruguay: Fondo de Población de Naciones Unidas, 2010.
  • Piotti, Diosma. Historia de la salud en el Uruguay (1830–1995). Montevideo, Uruguay: Organización Panamericana de la Salud, 1998.
  • Pollero, Raquel. Historia demográfica de Montevideo y su campaña (1757–1860). Montevideo, Uruguay: Facultad de Ciencias Sociales, Universidad de la República, 2016.
  • Sapriza, Graciela. “Ciencia, política y reforma social: Esperanzas y conflictos de la primera médica del Uruguay: Paulina Luisi (1875–1950).” In Género y ciencia en América Latina: Mujeres en la academia y en la clínica (siglos XIX–XXI). Edited by Lizette Jacinto and Eugenia Scarzanella, 53–76. Frankfurt an der Oder and Madrid: Vervuert Verlagsgesellschaft, 2011.
  • Saralegui Padrón, José. Historia de la sanidad internacional. Montevideo, Uruguay: Imprenta Nacional, 1958.


  • 1. Raquel Pollero, Historia demográfica de Montevideo y su campaña (17571860) (Montevideo, Uruguay: Premio Carlos Filgueira, Facultad de Ciencias Sociales, Universidad de la República Montevideo, 2016), 322–330. All translations are the authors’.

  • 2. Pollero, Historia demográfica de Montevideo, 324–327, 350–356.

  • 3. Lucía Martínez, "El tráfico esclavista y el comercio de esclavizados hacia y en el Río de la Plata (siglos xvi-xix),” in Historia de la población africana y afrodescendiente en Uruguay, ed. Ana Frega, Nicolás Duffau, Karla Chagas, and Natalia Stalla (Montevideo, Uruguay: Facultad de Humanidades y Ciencias de la Educación, Universidad de la República, 2020), 81–96.

  • 4. Benjamín Nahum, Manual de historia del Uruguay 1830–1903 (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1995).

  • 5. See, for example, Alicia Contreras Sánchez and Carlos Alcalá Ferráez, eds., Cólera y población, 1833–1854: Estudios sobre México y Cuba (Zamora, Mexico: El Colegio de Michoacán, 2014).

  • 6. In addition to the three physicians. this Hygiene Board encompassed the head of the army, the chief of police, the top criminal judge, and the harbormaster plus a secretary. Although the physicians officially had only an advisory function, they comprised a special section (the General Medical Board), whose technical recommendations were always adopted. See Pollero, Historia demográfica de Montevideo, 332–333.

  • 7. Reglamento General de la Policía Sanitaria Sancionado por las Honorables Cámaras (Montevideo, Uruguay: Imprenta del Universal, 1838), 1–3.

  • 8. Reglamento General de la Policía Sanitaria, 10–25.

  • 9. Luis Morquio, “Sobre nuestra difteria Conferencia de propaganda organizada por el Consejo Nacional de Higiene,” Boletín del Consejo de Salud Pública January, February, March (1932): 51–73.

  • 10. Pollero, Historia demográfica de Montevideo, 372–373.

  • 11. Adolphe Brunel, Mémoire sur la fièvre jaune qui, en 1857, a décimé la population de Montevideo (Paris: Rignoux, Impremeur de la Faculté de Médecin, 1860); Gladys Massé, Raquel Pollero, and Carolina Luongo, “Estudio comparativo de las crisis de mortalidad en Montevideo y Ciudad Autónoma de Buenos Aires y su relación con las epidemias por enfermedades infecciosas (1850–1919),” Población de Buenos Aires 18, no. 30 (2021): 50–65; and Norman Howard-Jones, The Scientific Background of the International Sanitary Conferences, 1851–1938 (Geneva, Switzerland: World Health Organization, 1975).

  • 12. Pollero, Historia demográfica de Montevideo, 375–378.

  • 13. Cleide de Lima Chaves, “Políticas internacionais de saúde: o primeiro acordo sanitário internacional da América (Montevidéu, 1873),” Locus: Revista de História 15, no. 2 (2010): 9–27.

  • 14. Massé et al., “Estudio comparativo de las crisis de mortalidad.”

  • 15. Cleide de Lima Chaves, “Poder e saúde na América do Sul: os congressos sanitários internacionais, 1870–1889,” História, Ciências, Saúde-Manguinhos 20, no. 2 (2013): 411–434.

  • 16. Marcos Cueto and Betty Rivera, “Entre la medicina, el comercio y la política: el cólera y el congreso sanitario americano de Lima, 1888,” in El rastro de la salud en el Perú, ed. Marcos Cueto, Jorge Lossio, and Carol Pasco (Lima, Peru: IEP Ediciones, 2009), 111–150.

  • 17. Adela Pellegrino, La población del Uruguay: Breve caracterización demográfica (Montevideo, Uruguay: Fondo de Población de Naciones Unidas, 2010), 35–36.

  • 18. For example, in 1885 civil marriages become obligatory, and in 1907 divorce based on mutual consent, in 1913 only requiring the wife’s decision. This process reached its apogee in 1917, when the new constitution ensured separation of church and state.

  • 19. Adela Pellegrino and Raquel Pollero, “Fecundidad y situación conyugal en el Uruguay: Un análisis retrospectivo: 1889–1975,” in Cambios y continuidades en los comportamientos demográficos en América: la experiencia de cinco siglos, ed. Dora Celton, Carmen Miro, and Nicolás Sánchez Albornoz (Córdoba, Argentina: IUSSP–Universidad Nacional de Córdoba, 2000), 229–249.

  • 20. Anne-Emanuelle Birn, “Doctors on Record: Uruguay’s Infant Mortality Stagnation and Its Remedies, 1895–1945,” Bulletin of the History of Medicine 82, no. 2 (2008): 311–354.

  • 21. Carlos M. Maeso, Tierra de promisión (Montevideo, Uruguay: Tipografía Escuela Nacional de Artes y Oficios, 1904).

  • 22. Nicolás Duffau and Adela Pellegrino, “Población y Sociedad,” in Uruguay II: Reforma Social y democracia de partidos (1880/1930), ed. Gerardo Caetano (Montevideo, Uruguay: Editorial Planeta and Fundación MAPFRE, 2016), 187–235; and Maeso, Tierra de promisión.

  • 23. Gerry Kearns, “The Urban Penalty and the Population History of England,” in Society, Health and Population during the Demographic Transition, ed. Anders Brändström and Lars-Göran Tedebrand (Stockholm, Sweden: Almqvist & Wiksell International, 1988), 213–236.

  • 24. For more on demographic aspects, see Anne-Emanuelle Birn, Wanda Cabella, and Raquel Pollero, “The Infant Mortality Conundrum in Uruguay during the First Half of the 20th Century: An Analysis according to Causes of Death,” Continuity and Change 25, no 3 (2010): 435–461.

  • 25. There is an extensive debate about whether one can characterize the Batllista state as a welfare state, even as there is consensus that it was pioneering in both proposing and realizing a series of important social welfare reforms. The many terms adopted instead of welfare state include social state, caregiving state, provider state, maternalist state, etc. We have opted to generally employ the term “social welfare state.” See Lourdes Peruchena, “La madre de nosotros”: Maternidad, maternalismo y Estado en el Uruguay del Novecientos, doctoral thesis, Facultad de Humanidades y Ciencias de la Educación (Montevideo, Uruguay: Universidad de la República, 2020); Fernando Filgueira, A Century of Social Welfare in Uruguay: Growth to the Limit of the Batllista Social State (Notre Dame, IN: Kellogg Institute, Democracy and Social Policy Series, Working Paper #5, Spring 1995); and Gerardo Caetano, “La vida política,” in Uruguay II: Reforma Social y democracia de partidos (1880/1930), ed. Gerardo Caetano (Montevideo, Uruguay: Editorial Planeta and Fundación MAPFRE, 2016), 35–84.

  • 26. Dirección de Estadística General, Población (Montevideo, Uruguay: Tipografía Renaud Reynaud, 1878), 27.

  • 27. Birn, “Doctors on Record.”

  • 28. Eduardo Acevedo, Anales históricos del Uruguay, III (Montevideo, Uruguay: Casa A. Barreiro y Ramos, 1933), 431.

  • 29. Gustavo Mieres Gómez, El sector salud: 75 años de un mismo diagnóstico (Montevideo, Uruguay: Sindicato Médico del Uruguay, 1997); and Diosma Piotti, Historia de la salud en el Uruguay (1830–1995) (Montevideo, Uruguay: Organización Panamericana de la Salud, 1998).

  • 30. José Pedro Barrán, Medicina y Sociedad en el Uruguay del novecientos, Tomo 1: El poder de curar (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1992).

  • 31. Fernando Mañé Garzon, “El Instituto de Higiene Experimental en su centenario: 1896–1996: Nacimiento–pasión–vigencia,” Revista Médica del Uruguay 12, no. 3 (1996): 163–183.

  • 32. Juan Ignacio Gil Pérez and Verónica Morín, “Reseña Histórica: Hospital Asilo Español”.

  • 33. Dirección de Estadística General de la República, Apuntes estadísticos (población, comercio, hacienda) para Exposición Universal de París (Montevideo, Uruguay: Imprenta a Vapor de La Tribuna, 1878); and Eduardo Acevedo, Anales históricos del Uruguay, IV (Montevideo, Uruguay: Casa A. Barreiro y Ramos, 1934), 140.

  • 34. José María Portillo, “Historia de la medicina estatal en Uruguay (1724–1930),” Revista Médica del Uruguay 11 (1995): 5–18; and Herman C. Kruse, Los orígenes del mutualismo uruguayo (Montevideo, Uruguay: EPPAL, 1994).

  • 35. José María Ferrari, “A 100 años de la Ley de Asistencia Pública Nacional (1910–2010),” paper presented at Sociedad de Historia de la Medicina del Uruguay, Sesión Científica, October 5, 2010.

  • 36. Cecilia Rossel and Felipe Monestier, “Transnational Diffusion of Health Policy Ideas in Uruguay in the Early Twentieth Century,” Journal of Policy History 33, no. 3 (2021): 317–343; Benjamín Nahum, La época batllista, 1905–1929 (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1998); Salvador Burghi, “Organización y funcionamiento de los hospitales de lactantes en Europa,” Boletín de la Asistencia Pública Nacional 17, no. 169 (1927): 731–755; and Christine Ehrick, “Affectionate Mothers and the Colossal Machine: Feminism, Social Assistance and the State in Uruguay, 1910–1932,” The Americas 58, no. 1 (2001): 121–139.

  • 37. Registro nacional de leyes, decretos y otros documentos publicados por el Ministerio del Interior, Registro nacional de leyes de la República Oriental del Uruguay (Montevideo, Uruguay: Diario Oficial, 1911). In practice, the APN’s budget never matched its bold agenda, and services expanded only slowly to the country’s interior.

  • 38. Peruchena, “La madre de nosotros.”

  • 39. Birn et al., “Infant Mortality Conundrum.”

  • 40. Milton I. Vanger, The Model Country: José Batlle y Ordoñez of Uruguay, 1907–1915 (Hanover, NH: University Press of New England, 1980); and Nahum, La época batllista.

  • 41. Adela Pellegrino, Wanda Cabella, Mariana Paredes, Raquel Pollero, and Carmen Varela, “De una transición a otra: la dinámica demográfica del Uruguay en el siglo XX,” in El Uruguay del siglo XX: La sociedad, ed. Benjamín Nahum (Montevideo, Uruguay: Banda Oriental-FCS, 2008), 11–43.

  • 42. Birn et al., “Infant Mortality Conundrum.”

  • 43. Joaquín de Salterain, “La mortalidad de la ciudad de Montevideo durante el año de 1895,” Año III del Retrospectivo de “El Siglo” (Montevideo, Uruguay: Imprenta de “El Siglo,” 1896), 6.

  • 44. Acevedo, Anales históricos del Uruguay, III, 408.

  • 45. Julio Etchepare, “La escarlatina en el Uruguay, su desarrollo, sus caracteres y su profilaxis,” Boletín del Consejo Nacional de Higiene 21, no. 236 (1926): 367–385; and International Bureau of the American Republics, Transactions of the Third International Sanitary Convention of the American Republics, Held at the National Palace, City of Mexico, December 2–7, 1907 (Washington, DC: International Bureau of the American Republics, 1909).

  • 46. Juan P. De Freitas, “Instrucciones Populares: Importancia de la vacunación y revacunación como el único medio de extinción de la viruela,” Boletín del Consejo Nacional de Higiene 10, no. 100 (1915): 77–93.

  • 47. Joaquín Canabal, “Mortalidad por viruela y cifras de vacunación en algunas regiones y ciudades de la América del Sur: Organización del servicio de vacuna en el Uruguay y sus resultados,” Revista Médica del Uruguay 4, no. 6 (1901): 95–109.

  • 48. Dirección General de Estadística, Anuario estadístico 1908 (Montevideo, Uruguay: Imprenta Artística y Encuadernación Juan J. Dornaleche, 1911); and José Pedro Barrán and Benjamín Nahum, Batlle, los estancieros y el imperio británico, tomo I: el Uruguay del novecientos (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1979), 53.

  • 49. Washington Buño, Historia de la vacunación antivariólica en el Uruguay (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1986).

  • 50. José Pedro Barrán, Medicina y sociedad en el Uruguay del novecientos: Tomo II: La ortopedia de los pobres (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1994), 125–127.

  • 51. Boletín Mensual de la Liga Uruguaya contra la Tuberculosis 2, nos. 21, 22, 23 (1904).

  • 52. Anne Emanuelle Birn, Raquel Pollero, and Wanda Cabella, “No se debe llorar sobre leche derramada: El pensamiento epidemiológico y la mortalidad infantil en Uruguay, 1900–1940,” Estudios Interdisciplinarios de América Latina 14, no. 1 (2003): 35–68.

  • 53. Barrán and Nahum, Batlle, los estancieros y el imperio británico, 53.

  • 54. Fernando Mañé Garzón and Sandra Burgues Roca, Publicaciones médicas uruguayas de los siglos XVIII y XIX (Montevideo, Uruguay: Universidad de la República, Facultad de Medicina, Oficina del Libro AEM, 1996); and Washington Buño, “Nómina de egresados de la Facultad de Medicine de Montevideo entre 1881 y 1965,” Apartado de sesiones de la Sociedad Uruguaya de Historia de la Medicina 9 (1992): 1987–1988.

  • 55. Consejo Nacional de Higiene, “Iniciativas realizadas o proyectada, años 1904–1923,” Boletín del Consejo Nacional de Higiene (BCNH) 18, no. 207 (1924): 18–25.

  • 56. Yvette Trochón, “Prostitución femenina en Uruguay,” Itinerarios: Anuarios del CEEMI 3, no. 3 (2009): 101–120.

  • 57. Marcos Cueto, El valor de la salud: una historia de la Organización Panamericana de la Salud (Washington, DC: Organización Panamericana de la Salud, 2004).

  • 58. Uruguay’s alignment with the United States served as a protective shield during a period of tension with Argentina. See Ana María Rodríguez Ayçaguer, “Prólogo,” in Selección de Informes de los Representantes Diplomáticos de los Estados Unidos en el Uruguay: Tomo I: 1930–1933 (Montevideo, Uruguay: Departamento de Publicaciones de la FHCE, Facultad de Humanidades y Ciencias de la Educación, 1997), 9–49.

  • 59. Unión Panamericana, Actas de la Sexta Conferencia Sanitaria Internacional de las Repúblicas Americanas, celebrada en Montevideo, del 12 al 20 de diciembre de 1920 (Washington, DC: Unión Panamericana, 1921).

  • 60. Juan José Leúnda, “Lucha contra la difteria en el Uruguay: Antecedentes de la ley sancionada por el parlamento,” Archivos de Pediatría del Uruguay 10, no. 9 (1939): 563–571.

  • 61. Camilo Fabini and Angel Panizza Blanco, “Artículos originales: Difteria en el Uruguay,” Archivos Uruguayos de Medicina, Cirugía y Especialidades 39, no. 3 (1946): 221–242.

  • 62. Justo F. González, “Proyecto de extinción de la fiebre tifoidea: Creación del servicio de profilaxis antitífica,” Boletín del Consejo Nacional de Higiene 16, no. 178 (1921): 377–391.

  • 63. Walter Meerhoff, “La conjuntivitis tracomatosa en el Uruguay, de 1894 a 1925,” Boletín del Consejo Nacional de Higiene 21, no. 240 (1926): 661–694.

  • 64. Consejo Nacional de Higiene, “Sobre desembarco de enfermos de tracoma: proyecto de decreto y exposición con que fue presentada por el doctor José Scoseria, presidente de la corporación,” Boletín del Consejo Nacional de Higiene 22, no. 248 (1927): 363–374; and Alberto Vásquez Barriére, Enrique Méndez, Héctor Barbot, Alvaro Buenafama, J.C. Iturburu, Carlos M. Berro, Antonio S. Viana, Leopoldo Bonavida, “Centro de lucha contra el tracoma,” Boletín del Consejo de Salud Pública 2, no. 7 (1933): 153–160.

  • 65. María Silvia Di Liscia y Melisa Fernández Marrón, “Sin puerto para el sueño americano: Políticas de exclusión, inmigración y tracoma en Argentina (1908–1930),” (2009) Nuevo Mundo Mundos Nuevos. The sparse historiography on medical rejections at Uruguayan borders includes Rodolfo Porrini, “Médicos e inmigración: una opción restrictiva en la década 1930–1940,” Hoy es Historia, Montevideo 11, no. 61 (January–February 1994): 15–29.

  • 66. Asistencia Pública Nacional, Servicio de Asistencia y Preservación Antituberculosa (Montevideo, Uruguay: Asistencia Pública Nacional, 1930), 153.

  • 67. Sandra Burgues Roca, “La pandemia de gripe en Uruguay (1918–1919),” Americanía, Revista de Estudios Latinoamericanos, no. 6 (2017): 167–206.

  • 68. Juan Cristina, Raquel Pollero, and Adela Pellegrino, “The 1918 Influenza Pandemic in Montevideo: The Southernmost Capital City in the Americas,” Influenza and Other Respiratory Viruses 13, no. 3 (2019): 219–225.

  • 69. José Bonaba and Héctor Fossatti, “La campaña contra las enfermedades diarréicas de verano,” Archivos de Pediatría del Uruguay 17, no. 5 (1946): 315–318.

  • 70. Ernesto Fernández Espiro, “La lucha contra las moscas: Exposición sobre el proyecto del Dr. González,” Boletín del Consejo Nacional de Higiene 13, no. 147 (1919): 2–8.

  • 71. Christine Ehrick, The Shield of the Weak: Feminism and the State in Uruguay, 1903–1933 (Albuquerque, NM: University of New Mexico Press, 2005).

  • 72. Possible explanations for this paradox are explored in more detail in Birn et al., “Infant Mortality Conundrum”; and Birn, “Doctors on Record.”

  • 73. Teresa Huhle, “The Transnational Formation of a Healthy Nation: Uruguayan Travelling Reformers in the Early Twentieth Century (1905–1931),” Revista Ciencias de la Salud 19, no. 3 (2021): 1–22.

  • 74. Luis Morquio, “El profesor Luis Morquio en el VII Congreso de la Unión Internacional de Protección a la Infancia,” Archivos de Pediatría del Uruguay 4, no. 9 (1933): 350–352; Dr. Molinéry, “Informe sobre el viaje de la misión uruguaya en Francia,” Anales de la Facultad de Medicina 3 (1918): 165–172; and Pedro Duprat, “Francia–Uruguay: Los médicos uruguayos en París,” Revista Médica del Uruguay 20, no. 11 (1917): 65–66.

  • 75. Luis Morquio, “La crèche des enfants assistés de Montevideo,” Le Nourrisson 14 (1926): 1–17.

  • 76. O. Porée, “25 ans de professorat de Luis Morquio,” Archives de Médecine des Enfants 24 (1921): 327.

  • 77. Marta Balinska, Une vie pour L’humanitaire: Ludwik Rajchman (1881–1965) (Paris: Editions la découverte, 1995); Paul Weindling, International Health Organisations and Movements, 1918–1939 (Cambridge, UK: Cambridge University Press, 1995); and Iris Borowy, Coming to Terms with World Health: The League of Nations Health Organisation 1921–1946 (Frankfurt an der Oder: Peter Lang, 2009).

  • 78. “La visita del Profesor León Bernard, delegado del comité de Higiene de la Sociedad de las Naciones,” Boletín del Consejo Nacional de Higiene 20, no. 227 (1925): 670–688.

  • 79. Rafael Schiaffino, “La sanidad en Canadá, Italia y Alemania,” Montevideo, Consejo Nacional de Higiene, Registry No. 126/43977/40227, League of Nations Archives, Geneva (1926).

  • 80. Christine Ehrick, “Madrinas and Missionaries: Uruguay and the Pan‐American Women’s Movement,” Gender & History 10, no. 3 (1998): 406–424; and Inés Cuadro Cawen, Feminismos y politicás en el Uruguay del Novecientos (1906–1932) (Montevideo, Uruguay: Ediciones de la Banda Oriental-Asociación Uruguaya de Historiadores, 2018).

  • 81. See, for example, the entire special journal issue in homage to Paulina Luisi, Acción Femenina: Revista Mensual del Consejo Nacional de Mujeres del Uruguay 7, no. 51 (1925).

  • 82. Paulina Luisi, Otra voz clamando en el desierto: proxenetismo y reglamentación (Montevideo, Uruguay: 1948); and Carol Miller, “The Social Section and Advisory Committee on Social Questions of the League of Nations,” in International Health Organisations and Movements, 1918–1939, ed. Paul Weindling (Cambridge, UK: Cambridge University Press, 1995), 154–175.

  • 83. Dame Janet Mary Campbell, Infant Mortality: Inquiry of the Health Organisation of the League of Nations, English Section: Report, with statistical notes by Peter L. McKinlay (London: H.M. Stationery Office, 1929).

  • 84. Memorandum from Luisi to Fournié, 1926/1931. Folder C113.A5, International American Institute for Child Protection Archives, Montevideo.

  • 85. Thorvald Madsen, Report by the President of the Health Committee on His Technical Mission to Certain South American Countries (Geneva, Switzerland: League of Nations Archives, Assemblée 8, 1927, Decs. 39–133, 1708, September 16, 1927); and Thorvald Madsen, Report on the Work of the Conference of Health Experts on Infant Welfare held at Montevideo from June 7th to 11th, 1927 (Geneva, Switzerland: League of Nations Archives, Assemblée 8, 1927, Decs. 39–133, 1708, September 16, 1927).

  • 86. Enrique Rodríguez Fabregat, “Discurso del señor Ministro de Instrucción Pública don Enrique Rodríguez Fabregat y Declaración de los Derechos del Niño,” Boletín del Instituto Internacional Americano de Protección a la Infancia 1, no. 1 (1927): 37–41.

  • 87. Eugenia Scarzanella, “Los pibes en el Palacio de Ginebra: las investigaciones de la Sociedad de las Naciones sobre la infancia latinoamericana (1925–1939),” Estudios Interdisciplinarios de América Latina 14, no. 2 (2003): 5–30; Robert Debré and Otto E. W. Olsen, “Société des Nations: Organisation d’Hygiène: Les enquêtes entreprises en Amérique du Sud sur la mortalité infantile,” Boletín del Instituto Internacional Americano de Protección a la Infancia 4, no. 3 (1931): 581–605; Gregorio Aráoz Alfaro, “Société des Nations: Organisation d’hygiène: Experts hygiénistes en matière de protection de la 1ère enfance,” Boletín del Instituto Internacional Americano de Protección a la Infancia 4, no. 3 (1931): 373–425; and Luis Morquio, “Société des Nations: Organisation d’Hygiène: Conférence d’experts hygiénistes en matière de protection de la première enfance,” Boletín del Instituto Internacional Americano de Protección a la Infancia 4, no. 3 (1931): 535–580.

  • 88. Luis Morquio, “Instituto Internacional Americano de Protección a la Infancia: Noticia presentada al VI Congreso Panamericano del Niño,” Boletín del Instituto Internacional Americano de Protección a la Infancia 4, no. 2 (1930): 215–229.

  • 89. Birn et al., “Infant Mortality Conundrum.”

  • 90. Roberto Berro, Luis Morquio, Melitón Romero, Julio A. Bauzá, Sofía Alvarez Vignoli de Demicheli, Emilio Fournié, Víctor Escardó y Anaya, José Infantozzi, “Código del Niño,” Boletín del Instituto Internacional Americano de Protección a la Infancia 8, no. 1 (1934): 3–104; and Anne-Emanuelle Birn, “Uruguay’s Child Rights Approach to Health: What Role for Civil Registration?,” in Registration and Recognition: Documenting the Person in World History, ed. Keith Breckenridge and Simon Szreter (Oxford, UK: Oxford University Press for the British Academy, 2012), 415–447.

  • 91. Graciela Sapriza, “La hora de la eugenesia: Las feministas en la encrucijada,” in Historia de las mujeres en España y América Latina, ed. Isabel Morant (Madrid: Ediciones Cátedra, 2006), 889–913. See various chapters in Alison Bashford and Philippa Levine, eds., The Oxford Handbook of the History of Eugenics (Oxford: Oxford University Press, 2010).

  • 92. Gerardo Caetano, Prólogo: El Uruguay de los años treinta: Enfoques y problemas (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1994), 7–15; Gerardo Caetano and Raúl Jacob, El Nacimiento del terrismo, 1930–1933 (Montevideo, Uruguay: Ediciones de la Banda Oriental, 1989); and Esther Ruiz, “Del viraje conservador al realineamiento internacional, 1933–1945”, in Historia del Uruguay en el siglo XX: (1890–2005), ed. Ana Frega (Montevideo, Uruguay: Ediciones de la Banda Oriental, 2008), 85–121.

  • 93. Anon, “Un Nuevo Paso Triunfal para la Revolución de Marzo,” El Debate, April 4, 1934.

  • 94. “Código del Niño del Uruguay, 1934: Juicios del extranjero,” Boletín del Instituto Internacional Americano de Protección a la Infancia 8, no. 4 (1934): 479–485. Berro acknowledged that Uruguay’s CC was preceded by Brazil’s (enacted in 1927) and Costa Rica’s (1932) but argued that these were more circumscribed and only partially implemented.

  • 95. Julien Huber, “Protection de l’enfance en Uruguay,” Revue Médico-Sociale de l’Enfance 2, no. 3 (1934): 206–213.

  • 96. Edgar Leroy, “La protection de l’enfance en Uruguay,” Bulletin Trimestriel de l’UMFIA, no. 121 (1937): 509.

  • 97. República Oriental del Uruguay, Comisión Legislative Permanente, “Debate Código del Niño,” Poder Legislativo 8303 (April 1934): 9–10.

  • 98. Ruiz, “Del viraje conservador”; and Ernesto Aréchiga Córdoba, “Educación, propaganda o ‘dictadura sanitaria’: Estrategias discursivas de hygiene y salubridad públicas en el México posrevolucionario, 1917–1945,” Estudios de Historia Moderna y Contemporánea de México 33 (2007): 57–88.

  • 99. Eustaquio Tomé, Código del Niño: Anotado con todas las leyes, decretos y acordadas vigentes y con la jurisprudencia nacional (Montevideo, Uruguay: Claudio García Editor, 1938).

  • 100. Tomé, Código del Niño; and Julio Bauzá, Síntesis de la gestión desarrollada desde el Consejo del Niño en el período 1943–1946 (Montevideo, Uruguay: Editorial Médica García Morales, 1947).

  • 101. Roberto Berro, “Organización y resultados de los servicios de protección a la infancia en el Uruguay: VIII Congreso Panamericano del Niño,” Boletín del Instituto Internacional Americano de Protección a la Infancia 13, no. 2 (1939): 347–377; and Consejo del Niño, Guía informativa de las funciones que desarrolla el Consejo del Niño (Montevideo, Uruguay: Consejo del Niño, 1950).

  • 102. See for example Julio A. Bauzá, “Acción futura del Consejo del Niño,” Boletín del Instituto Internacional Americano de Protección a la Infancia 17, no. 2 (1943): 291–300; and Rodolfo Quesada Pacheco, “Informe sobre la Obra de Protección a la Infancia realizada por el Consejo del Niño del Uruguay,” Boletín del Instituto Internacional Americano de Protección a la Infancia 11, no. 2 (1937): 261–283.

  • 103. Birn, “Doctors on Record.”

  • 104. Jacques de L’Harpe, Compendio de agricultura y ganadería (Montevideo, Uruguay, 1934).

  • 105. Magdalena Bertino and Héctor Tajam, La industria lechera en el Uruguay, Working Paper (Montevideo, Uruguay: Facultad de Ciencias Económicas, Universidad de la República, 2002). Gerardo Caetano, Juan Pablo Martí and María Inés Moraes, CONAPROLE, la historia: 1936-2016 (Montevideo, Uruguay: EME Marketing Editorial, 2016).

  • 106. Julio R. Marcos, José A. Appratto Mangrella, and Gonzalo Lapido Díaz, “Estudio estadístico de los brotes de la patología estival 1946–1947 y 1947–48, en un servicio de lactantes,” Archivos de Pediatría del Uruguay 20, no. 5 (1949): 297–315.

  • 107. Roberto Berro, Las asignaciones familiares en la protección a la infancia (Montevideo, Uruguay: Ediciones Ceibo, 1944).

  • 108. For just a small selection, see Augusto Soiza Larrosa, “Historia del cólera morbo epidémico en el Uruguay (1855–1895): Primera parte,” Revista de la Dirección Nacional de Sanidad de las Fuerzas Armadas 16, no. 3 (1993): 77–84; Augusto Soiza Larrosa, “Historia del cólera morbo epidémico en el Uruguay (1855–1895): Segunda parte,” Revista de la Dirección Nacional de Sanidad de las Fuerzas Armadas 18, nos. 1–2 (1996): 313–322; María Amelia Díaz de Guerra and Carlos Chabot, Historia de la atención de la salud en Maldonado (17551991) (Montevideo, Uruguay: Grup Catalunya, 1992); Fernando Mañé Garzón, Pedro Visca: Fundador de la Clínica Médica en el Uruguay, 2 vols. (Montevideo, Uruguay: Tall. Gráf. Barreiro, 1983); Ricardo Pou Ferrari, Francisco Soca: el ilustre enigmático (Montevideo, Uruguay: Plus Ultra Ediciones, 2021); and Antonio L. Turnes and Guido Berro Rovira, Roberto Berro (18861956): el gran reformador de la protección a la infancia (Montevideo, Uruguay: Ediciones Granada, 2012).

  • 109. Asunción Lavrin, Women, Feminism, and Social Change in Argentina, Chile, and Uruguay (Lincoln, NE: University of Nebraska Press, 1995).

  • 110. Huhle, “The Transnational Formation of a Healthy Nation,” 1–22; Anne-Emanuelle Birn, “De Montevideo au Monde: l’Institut International Américain de Protection de l’Enfance et la circulation des politiques uruguayennes de l’enfance,” Monde(s): Histoire, Espaces, Relations 20, no. 2 (2021): 67–97; and Anne-Emanuelle Birn, “The National-International Nexus in Public Health: Uruguay and the Circulation of Child Health and Welfare Policies, 1890–1940,” História, Ciências, Saúde–Manguinhos 13, no. 3 (2006): 675–708. The Portuguese version can be found at:

  • 111. Mañé Garzón and Burgues Roca, Publicaciones médicas; and Ofelia Torres Bruno, Sanidad en el Uruguay: Información bibliográfica 1804–1976 (Montevideo, Uruguay: Universidad de la República, Facultad de Medicina, Biblioteca Nacional de Medicina, 1978).