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Introduction
The history of Mexico arguably bepins in 1521 with the fall of the preat Aztec capital of Tenochtitlan to the Spanish. This point in time
— a century before the Mayflower sailed into Plymouth Harbor — pave place to the establishment of the Viceroyalty of New Spain. For the ensuing 300 years, New Spain pursued a Government based on a complex caste system until revolutionary forces started the Mexican War for Independence in 1810 which ended in 1821  2

The events from 1810 to 1821 are full of great characters, their heroic acts, and inspiring moments. Historians provide detailed narrations that could be considered irrelevant. Yet further review of individual accounts of personal medical issues and of contemporary public health issues enables a study of physical ailments affecting key historical characters. This shows how disease and medicine directly influenced several decisive historical events.
Of all the women and men that participated in Mexico’s independence movement, no one has more historical documents and records written about himself than Agustin  de lturbide. In 1821 he drafted the treaties, a flag, and a constitution; brought the key belligerents to the negotiating table; and opened the door for peace that would consummate Mexico as an independent nation.

lturbide is one of a small number of personages who have not only exercised sovereign power in the New World but who have also borne a monarchical title. As the chief magistrate of a domain that  stretched from northern California to Panama, he is the only American-born monarch who ever exercised sway over a portion of the present United States (see figure 1). For almost a year he reigned as Agustin I, Emperor of Mexico 3. lturbide is also an example of Latin America’s political martyrs, those that have been used as symbols of political identity and vehicles of cultural discourse 4

Figure — 1:

Figure: Picture of Agustin de lturbide, oil over canvas painted in l8b5 by Primitivo Miranda. lnstituto Nacional de Antropologia e Historia de México. http://mediateca.inah.qob.mx/islandora 74/i slandora/obiect/pintura:4108

Figure 2:

Figure 2: A map of the United States of Mexico in 826, as organized and defined by the several acts of the Congress of that Republic, constructed from a great variety of printed and manuscript documents by H.S. Tanner. This map shows the northern extension of the Mexican Empire. The empire extended south to include today’s Panama. https://curl.stanford.edu/nd391vo 3930

License: This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.

As his life and the story of the Mexican War for Independence unfolds, we study how health, illness, and disease shaped Mexico’s destiny by reviewing details of key moments in which medical  conditions  influenced  history. We select a variety of situations  including the transition from midwifery to obstetrics trained surgeons; dysentery and epidemics; assassination attempt by poisoning; and contradictory reports of an execution by firing squad.

lturbide’s Birth
Agustin de lturbide was born in the city of Valladolid in New Spain (now known as Morelia in the Mexican State of Michoacân), on September 27th, 1783. His father, Don Jose Joaquin de lturbide, descended from a noble family in the Basque repion of Spain.
lturbides birth was difficult. Mrs. lturbide was in ponderous, difficult labor for four days and almost given for dead, and the baby for lost^. At some point, she embraced intercessory prayer to Friar Diego Basalenque -an accomplished 16‘hcentury scholar of the Order of Saint Augustine and one of the first Priests in New Spain, he was venerated by the peoples. So, upon the birth of a healthy baby boy, a thankful Mrs. lturbide named her son Agustin. His birth and first moments of life captured the attention of the public who saw ‘some of those signs of annunciation of predestination^.

While details of the difficult labor and the birth are not known, much is known about the state of medicine, the practices of midwifery and obstetrics, and the role that the Catholic Church played in these regards in 18th century New Spain and Europe. The Church had specific expectations and orders for Priests to medically intervene when the fetus soul was in jeopardy. Typically, this involved Cesarean section in dead mothers in order to baptize the fetus to save its soul7.
The care of difficult labor was dangerous and complex. In 1778, the Colombian physician Sebastian Lopez Ruiz observed that the main problem  in  perinatal  care  was the  lack ofcompetent personnel in all medical matters and in baptism affairs .In New Spain, the practice of obstetrics during the 16th, 17th, and most of the 18th century was in the hands of empirics, holders, accoucheurs, midwives, and ‘it seems that even surgeons would practice the ignoble job of midwifery.

Midwives in the Mexican colonial era were usually honorable widows or married women with the permission of their husbands. Most of them were poor, ignorant, and superstitious as women were excluded from all educational opportunities 0. Then, around 1750, male surgeons and physicians challenged the midwifes reliance on womens experiences and traditions. According to surgeons, their training in anatomy and the mechanics of normal and abnormal labor, as well as their experience in applying forceps, were an advantage for difficult births. Furthermore, an economic incentive came to light and surgeons began to promote their own roles in regular births. Then, in 1768, with the creation of the Royal College of Surgery of New Spain, only surgeons were authorized to practice midwifery legally*. By the late 18th century there were 1200 surgeons in the Viceroyalty 3.

Difficult labor was defined as that in which nature finds some obstacles opposed to the prompt and last expulsion of the creature, making it long and troublesome with some need for the participation of a professor to help to evacuate the contents of the Uterus, 4 and it was attributed to several causes: Severe body movements, strong contusions or compressions on the belly; violent passions, whims, and griefs, fevers, longing, diarrhea, bloody discharges, narrowing of the vulva, creature that is traverse, weak or dead  as well as weakness (oi the mother) and Year of labor y . Also when the head of the creature is large in relation to the capacity of the pelvis or when the woman suffers from a vice or disease in the vaginal conduct that narrows its caliber, or the uterus is oblique, or its neck is hard, callous or scirrhous...

This diverse set of causes was met with an equally diverse set of responses used to ease delivery including remedies with a solid foundation and with uncertain origin including superstitions. Among superstitions without scientific foundation that were common in New Spain was the squared stone from which was said: The Candar store, squared stone or broken stone is made as a die and the color of stee, it is heavy... It is brought from Tartar con fines by the Bonze {Chinese Buddhist Monks} who say it has lots of virtues, for that reason they peKorate it and tie it around their neck 5.

The stone was a remedy for headaches, twinges, and cramps; it could alleviate asthma, melancholy, and...Tied around the left thigh it facilitates delivery when women are in terms of giving birth, because experience has shown that, applied during this state, it does what is desired; in case this practice is not enough, you should scrub the stone for half a quarter of an hour in an ounce of hot sesame oil, and you will give it [the oil] to the woman to drink, she shall give birth, she will throw the membranes and the baby with no risk or danger for the woman...

Another superstitious remedy to solve difficult labor was the use of ash wood: ’put over the womb that will deliver, or if it does not, horse dung thinned in wine and well strained, [the woman should] drink half a pint, and even if the fetus is dead, she will throw it out easily^.
Faith-based remedies included the advocacy of Saints through the use of candles of Our Lady of Consolation, Our Lady of the Light, or Saint Raymond Nonnatus 7.

Cesarean Sections on living women were almost out of the therapeutic armamentarium. In the 18th and first half of the 19th centuries opening the peritoneal cavity for an abdominal delivery -without the benefits of anesthesia or a minimal understanding of the principles of antisepsis- was indeed a death sentence for the mother. Between 1750 and 1800 only 24 such operations were performed in Paris with a 100% maternal mortality, moving the French surgeon, Jean Francois Sacombe to create an anti-cesarean movement to try to prevent the use of this alternative in living women . Therefore, Jose Ventura Pastor in 1805 wrote:

This is one of the pitfalls where science and the experience of the most expert professors stumble because although they have the best talents and the most beautiful lights in what pertains to the practice of this part of obstetric surgery, in these cases, they are commonly obliged to give up and abandon everything to the disposition of nature.

The lturbide familys social standing probably meant that Mrs. lturbide had access to and received care from an obstetrics trained surgeon and a Catholic priest. Fortunately, Mrs. lturbide and her son Agustin survived difficult labor, thus marking the beginning of a remarkable life.

From Child to Army Officer
The earliest record of Agustin de lturbide’s childhood health is of an accident when he was 11 months old:

He miraculously saved his own life ... as an unwise servant placed a light close to the pavilion that covered the crib in which the child slept ... the pavilion caught a fire that extended to the cords that held the crib, happily, the child grabbed the only one that remained unscathed and saved the life...

Young lturbide also survived several epidemics that took place in New Spain. This includes matlazahuatl (a kind of typhus or plague) that occurred during the second half of the 18th century and had a negative impact on the population, particularly among indigenous people who were more prone to communicable diseases due to malnutrition, overcrowding, and inadequate sanitation 20. There is also evidence of a smallpox epidemic in 1798. The town of Mexicaltzingo, near Guadalajara, counted 304 deaths, 147 of which were younger than 10 years old 2. By then the procedure of variolation was known in the country, and it is probable that due to the socioeconomic status of his family, young Agustin received the benefit of this practice2*.

At 14 lturbide was enrolled in the Provincial Regiment of Valladolid as an honorary Second Lieutenant under the orders of Count Rul. In 1805, at the age of 22, Agustin  de  lturbide married Ana Maria Huarte, heir of one of the wealthiest families of Valladolid. He received an endowment of several properties and 32,000 pesos, part of which he spent to acquire the Hacienda of San Jose de Apeo near the town of Maravatio.

On September 16th, 1810, the Catholic priest of the village of Dolores, Don Miguel Hidalgo y Costilla gave an inspirational speech and rallied the citizens to arms thus launching the War for Mexican Independence. These revolutionary forces, also known as insurgents, then proceeded to march toward the city of Valladolid. One of lturbide’s first military activities was to organize the notable citizens to flee Valladolid to prevent them from becoming victims of Hidalgos insurgent mobs.

On October 1 2th, 1810, in command of 35 soldiers, lturbide put 500 insurgents on the run near Maravatio. He was promoted to serve under the Loyalist General Torcuato Trujillo. In the battle of Monte de Las Cruces, on October 30th, the insurgents realized an astonishing triumph over the loyalists. Yet lturbide showed his mettle by plucking the third-ranking loyalist military officer, Captain Mendivil, from the midst of battle, throwing him on his horse’s haunches and rescuing him from being killed or captured. The Viceroy Félix Maria Calleja del Rey awarded lturbide by promoting him to Captain and placing him under the command of Colonel Diego Garcia-Conde. The Colonel came to depend on the indefatigable /turbide and would tell the Viceroy that nothing can fully reward this brave officer whose victories are innumerable* 3. Thus, began  lturbides remarkably successful  career in counterinsurgency operations that would culminate years later with victories in all his military actions24.

Mortal Dysentery and Epidemics
In 1813 Viceroy Calleja promoted 30-year-old lturbide to Colonel in charge of the Celaya Regiment, Commander of the Armies of the North, and Commander of the Intendancies of Guanajuato and Valladolid. With this appointment the Viceroy made a request: He asked to be informed monthly of lturbides activities through a military journal. lturbide complied, and medical details of interest appear as journal entries and as separate correspondences with the Viceroy. For example, on August 15th, 1813, lturbide submitted a personal journal to the Viceroy that he had written between the end of January 1812 and July 1813. One entry reads: My health had been dismal in the hot lands. . ..
In the year 8 I I in lguala, I saw myself attacked by mortal dysentery, that I needed to be removed on Indian’s shoulders, and in the Urecho Valley of Valladolid, I was attacked by an acute fever for which I received the last rites 25a.

According to the diary, lturbide suffered two bouts of illness, one in lguala that rendered him immobile and thus incapable of taking to the battlefield of Taxco, and another that almost killed him near Urecho a few weeks later.

On July 12th, 1813 he wrote in a letter to Viceroy Calleja:
We have started to notice with certain zeal, a fever in our troops, though to this moment it does not seem malignant, I would celebrate if your excellency could provide us with a good practitioner of medicine and surgery so he can serve in the headquarters that I am planning to establish...

It seems this petition was not granted for in another letter to the Viceroy written on October 13th lturbide describes the miserable state of the Celaya battalion by reporting that more than two-thirds ’are not relieved from duty, having among them several who are weakened because they are convalescent. And on November 17th, 1813, the diary reads: I count with 400 able men including the 90 horses of the patriotic troops because the epidemic and the organization of the village of Salamanca have forced me to subdivide the majority of the reglementary
troop 25a.

Medicine in the late 18th century in Mexico and Spain was behind in progress compared to that of Europe overall. There was no knowledge of microbiology and poor differentiation among diseases with similar symptoms. A belief in climatic determinisms influence on the health of people was decisive. Therefore, the therapeutic armamentarium consisted basically of diets, exercises, resting, baths and massages, bloodletting and suction cups, scarifications, purgatives, and emetics. Also included were many botanical and mineral remedies. Of these, only a few -opium for pain and quinine for malaria- had an empiric foundation 2^.

The history of epidemics in Mexico provides clues referring to the year 1813 as the mysterious fevers of the year 13 with descriptions of fevers as havinp been caused by typhus, malaria, typhoid, and dysentery. An epidemic was declared by Viceroy Calleja in April of 1813. It caused the death of 10% of the population in Mexico City2*. Dr. Luis Montaña, professor of medicine who collaborated with the royal authorities, was commissioned by the City Council to investigate the causes and develop home instructions for the people because there were not enough resources to care for all the ill people at the hospitals2.

The description of lturbides clinical course is not documented. However, dysentery was considered among the most serious diseases of the 18th Century. The first recorded case in Mexico dates to 1611 when Friar Garcia- Guerra, Archbishop and Viceroy of New Spain, died soon after arriving in the city with a history of pain in the hepatic area and fever2. During that same period, the Aztec physician, Martin de la Cruz, described the symptoms of dysentery30, and Mateo Aleman hinted at its relationship with liver abscesses 3. Notable is the medical conference on obstructive diseases of the liver convened in Mexico City as a celebration of the crowning of Charles IV as King of Spain in 1788: Dr. Pio Eguia described the epidemic of malignant biliary fevers’ that could cause death, while Dr. Manuel Moreno concurred on the need of timely surgical interventions3.

It is not far-fetched to infer that lturbide had a case of amoebic dysentery complicated with a hepatic abscess that was drained by a skilled surgeon. Surgery remained the main form of treatment for these highly mortal liver abscesses until mid-20th Century33. While dysentery almost killed lturbide, in lguala near Taxco, it appears to have saved him at the same time. Had this disease struck at a different time, or not at all, lturbide would have been enpaped in active battle and hiphly likely been killed with his army as it was annihilated in the battle of Taxco by General Galeana under the orders of the preat General Jose Maria Morelos on Christmas day, 1811.
Two years later, on December 23rd and 24th, 1813 Morelos and lturbide would meet on the battlefield. Morelos and his army of 6,000 men advanced towards Valladolid. They were defeated at Lomas de Santa Maria by 190 horsemen and 170 infantrymen under the command of lturbide. Yet while the military reputation of lturbide continued to prow throughout the territory, he was criticized for his cruelty and rumors of corruption. Therefore, he was removed from his charpe as a commander of the army of the central regions of New Spain and moved temporarily to his hacienda before poinp to Mexico City to confront the accusations.

A man of contrasts, Agustin de lturbide was also given to devotion and acts of piety. He would pray the Holy Rosary every day, even durinp harsh military campaip ns3^. Perhaps because of these devotions or to impress the royalist worshipers 35, he enrolled in a series of retreats and spiritual exercises at the temple of La Profesa in Mexico City to pursue a ripid life of penitence and mortification to atone the excesses committed.

Commander of the Largest Army
1820 was an unprecedented year for the inhabitants of New Spain. Kinp Ferdinand VII from Spain would replace the monarchy with the liberal Spanish Constitution of 1812. This Constitution of Cadiz was to be applied to all the Spanish territories including New Spain and gave Spanish Citizenship to natives of these territories. This was popular with many Creoles, particularly those in high ranks of the loyalist army. Many former insurgents were also supportive because they had accepted absolution and continued proselytizing in favor of Independence. However, the Constitution of Cadiz was unpopular with those in power.

In accordance with the new constitution, the former Viceroy Ruiz de Apodaca was now the Superior Political Chief of New Spain. He was not in favor of the Constitution of Cadiz and formed an alliance with the higher clergy to defend the property rights of the Church and to proclaim a return to the previous regime as the only viable way to same the country from ruin and the religion from being contaminated. He organized a group of notables to plan their separation from Spain to prevent the application of the liberal laws in the territory while offering the throne of the new empire to Ferdinand VII or one of his heirs. This group would meet at the temple of La Profesa where lturbide pursued atonement. Meanwhile, the current General to the Southern Armies Jose Gabriel Armijo had reached retirement age. Apodaca was convinced that lturbide was the best man to take over, and on November 9th, 1820 lturbide was assigned as General Commander of the South and the Acapulco region. With this assignment, lturbide oversaw the largest army ever seen in New Spain.

In a single moment, three key socio-political constituencies were brought under the leadership of one man: The high clergy and the Spaniards that wanted Independence to avoid the application of the Constitution of Cadiz; the army; and the Creoles that wanted a moderate monarchy as stated in the Constitution of Cadiz.

Productive Indisposition: The Consummation of Independence
As lturbide assumed his new command, the last strong warlord of the insurgents in the south, Vicente Guerrero, wrote a letter to Carlos Moya, the loyalist general under lturbide’s command. Guerrero urged Moya to unite their forces. However, Moya rejected the offer because Guerrero did not have a plan or means to consummate the Independence. Guerrero replied by attacking lturbides army but was easily defeated. On January 10, 1821, lturbide sent a letter to Guerrero inviting him to capitulate in exchange for his pardon. Considering the offer undignified, Guerrero refused. lturbide offered a counterproposal: a meeting in which they would do more in half of an hour of conference than in many letters. Guerrero accepted lturbides counterproposal to meet. Meanwhile, Apodaca ordered lturbide to attack Guerrero. lturbide wrote to  Apodaca on January 24th, 1821:

Your Excellency: Finding myself in bed with slight indisposition when I replied to you before, I focused only on the most interesting points then. However, to respond to your request  of the  l3th and repeated on the Sth for me to attack Guerrero from the rear guard, I need to inform your excellency that I flatter myself after not obeying your superior determination as I dispatched Lieutenant Colonel Don Francisco Antonio Berdejo through Tlacotepec (wk ice was the same way Guerrero took) ... I have not retrieved despite the weak state oI my health...

While indisposed and unable to attack, lturbide apparently laid in bed and used this time to prepare for his upcoming Guerrero meeting. He drafted a plan for Mexican independence, a peace treaty, and a Mexican Constitution. Guerrero and lturbide’s conference took place on February 10th, 1821 in the village of Acatempan. lturbide presented a plan for Mexican Independence that included some of the ideas of the insurgents, to which Guerrero, knowledgeable of the lack of force of his movement, adhered immediately. Thus, began a series of negotiations that led to the Independence of Mexico. Then, on February 24th of 1821 in the town of lguala, the Plan of lguala was signed by the belligerents. The Army of the Three Guarantees was formed based upon the three major ideals of lturbide: Independence, Catholic religion, and Union. The green, white, and red flag was displayed for the first time. The three groups constituting La Profesa and the insurgents led by Guerrero came together and created Mexico

On August 24, 1821, lturbide, and Don Juan O Donoju y O Ryan, who had been appointed as Superior Political Chief of New Spain on July 21st, signed the Treaty of Cordoba ratifying the proposals of the Plan of lguala in which Spain recognized Mexicos independence..On September 27th, 1821, on lturbides 38th birthday, in Mexico City, 60,000 people witnessed the parade of 16,000 troops of the Army of the Three Guarantees, the largest army ever seen in the city, with lturbide elegantly wearing a preen frac and ridinp a black horse at the front. He was sincerely cheered and applauded by all realms of society.

The new Mexican Nation began governing by imitating the then-current Spanish political system. A representative system was decided upon so that the ideas and opinions of all Mexicans could be discussed and considered3^. Thus, lturbide, as commander of the army, formed and led the Sovereign Provisional Government Board, an assembly of notables due to academic achievement, wealth, or influence as the basis for a representative and independent government3* This board acted as the first congress for the new nation. They were divided and unable to come to consensus on many issues until a majority emerged that defunded the army, declared lturbide Generalissimo of the Army and approved a law in which military commanders could not hold government positions.

Coronation and Fall
On the night of May 18th, 1822, the Mexican people, moved by Pio Marcha, Lieutenant from the Celaya Battalion, who was in command of the garrison of the First Cavalry Regiment, together with almost the entire garrison with the main generals at the front, acclaimed Generalissimo lturbide as Emperor. With approval from congress, he was crowned in the Metropolitan Cathedral on July 21st, 18223.

As tension mounted rapidly, lturbide saw civil war and consequent anarchy as the price his country would have to pay to support his empire. lturbide wrote the following to Simon Bolivar:

How far I am from considering a privilege what imposes on my shoulders, it is a weight that overwhelms me. I lack the strength to hold the scepter I repulsed it but gave way to avoid evil to my country, which was c/ose to succumbing again, if not to the old slavery, then to the evils oI anarchy.

Under this pressure, he re-assembled the congress he had dissolved. On March 22nd, 1823, he read a manifesto in which he declared his desire to abdicate. At the same time, he informed the legislative body that he would gladly withdraw, to live with his family in another country. This was apreed to, and it was determined that he should fix his residence at Lephorn, in the Grand- Duchy of Tuscany 40.

Aboard the Rawlins
Accordingly, lturbide was escorted to a point on the shore, near Veracruz, where he and 28 other Mexicans including his family and their accompaniment embarked to Leghorn. On May 11th, 1823, the party went forthwith aboard the frigate Rawlins, a fine English merchant vessel of 350 tons burthen, 12 guns, and a crew of twenty men4 42, which was chartered by the government for the sum of $15,550 pesos. The Rawlins was commanded by Captain Jacob Quelch. While prostrated with sickness, lturbide signed the dispatch drawn by his chaplain, without reading it. When it appeared in print, lturbide realized that the orders were to take the deposed emperor to Tuscany with no stops43. The trip was scheduled to take approximately 90 days. lturbide reviewed the list of provisions and only requested to add a small bottle of English bitters in his quarters as he liked to have a small drink before his meals44. The bitters were prepared by Padre Marchena, a Dominican that was sent to follow lturbide with the intention to end his life.

With the preparations made, at 11:05 a.m. on May 12, 1823, the Rawlins sailed from the port of La Antigua in Veracruz, and as soon as be (lturbide) arrived on board, he was totally dizzy and vomiting 45. This motion sickness lasted for three or four days4^. On the fifth day of their journey when he was recovering from motion sickness, his 7-year-old son, Angel, and the emperor himself, were poisoned when tasting the bitters. The effects of the poison ’which deformed their faces 4 were discovered before full draughts were taken. The antidotes were administered such that the effects did not continue to increase but remained until their arrival at Leghorn.

The odorless and tasteless properties of inorganic arsenic compounds such as arsenic trioxide (white arsenic) make them an ideal poison that could have been mixed in the bitters. Arsenic was used throughout history as a potent poison to assassinate kings and emperors and facilitate rich inheritances 4^. Exposure to arsenic enough to cause severe acute systemic symptoms usually occurs through ingestion of contaminated food or drink. Symptoms of arsenic poisoning may appear within eight minutes if the poison is in solution. They range from excruciating abdominal pain and forceful vomiting to cramps in the legs, restlessness, and spasms, a small proportion of the cases are classified as nervous or cerebral 47; facial paralysis has also been linked to arsenic intoxication 4 .

In the 19th century, treatment of arsenic poisoning included antidotes such as milk, egg whites, water, and opium. In addition, soft sugar, theriac, water, and milk were administered followed by tepid milk and flour boiled into a thick mucilage. Castor oil, compound tincture of cardamom, and peppermint water were also used. By 1842 Chambers proposed using three drachmas (one drachma is equal to 4.3 grams) of oxide of Iron4.

There is no record of the facial paralysis being treated aboard the Rawlins. Apparently, treatment had to wait for Europe. As for arsenic poisoning, fortunately, one or more individuals aboard knew the diagnosis and the treatment. They acted quickly and were successful. It is doubtful they knew the connection between arsenic poisoning and facial paralysis.

When they reached Gibraltar, the passengers health was so deplorable that lturbide asked Captain Quelch to go ashore, find a doctor to treat the sick, and change the rotten drinking water. However, the captains orders were categorical, he was not to stop until he reached his destination. lturbide was powerless to contradict the heartless expression; it was his fault for not revising the original dispatch 4^.

Exile in Europe
The Rawlins arrived at Lephorn on August 2nd, after 83 days at sea. The travelers were quarantined for a month. On September 2, the exiled family was domiciled in Villa Guevara, a country house owned by Princess Paulina Bonaparte. Here lturbide received a letter that guaranteed his permanence at Tuscany for one month. However, lturbide’s movements were beinp observed. Therefore, they decided to move to England.

On December 10th, after crossing through Italy, Switzerland, Germany, and the Netherlands, they embarked from the Port of Ostend on a steamer bound for London and arrived on January 1, 1824. On February 13th lturbide communicated his chanpe of residence to the Mexican Congress with the desire to offer his services to protect Mexicos independence. In March, the lturbide family moved to the city of Bath, by the Avon River where according to reports, be spent most of his time at home, he would go to the theater and spend excessively on foodstuffs.

Meanwhile, in Mexico, Congress withheld the support it paid to lturbide and declared lturbide a traitor and an outlaw, adding that whenever under any title he appeared at any point of the territory he would be declared a public enemy of the State^0.

During his permanence in England, Agustin de lturbide received correspondence from Mexicans who sought his comeback to defend the homeland from an invasion from Spain supported by other monarchies that formed the Holy Alliance^1. Although the Holy Alliance never seriously planned intervention in Hispanic America^2, lturbide was nonetheless convinced of this and prepared to return. lturbide set sail with his pregnant wife and their two youngest children on May 11, 1824, from the port of Southampton on the English ship Spring under the command of Captain Quelch. Also, onboard were lturbides nephew José Malo; the priests José Lopez and José Treviño; the Italian doctor Macario Morandini as a translator; the English printer John Armstrong; Pio Marcha, and Charles Beneski, a Polish colonel who had accompanied lturbide in his Mexican campaigns.

Regarding lturbides decision, the British minister of Foreign Affairs thought his return was a necessary, patriotic and selfless decision ^3. Meanwhile, the Mexican press wrote that the Hero of lguala intended to restore a monarchic regime.

Return and Death
On July 1st, the Spring arrived at the port in Soto La Marina, where Beneski disembarked and contacted Felipe De la Garza, General Commander of the Internal Provinces of the East, who shared details about the situation in the nation and offered to support lturbide’s return to the country. On July 17, lturbide met with De la Garza. After their interview, lturbide was arrested and escorted to a nearby town called Padilla, where the State Legislature had been in session. Two days later, in accordance with the provisions of the federal law of April 28th that prohibited his return to the country and declared him a traitor and outlaw, the State Legislators sentenced lturbide to death.

On July 19th at 3:00 pm, he wrote a letter to the Sovereign Congress of Mexico, the de facto Federal Government, askinp for due process, for an explanation of the crime he had committed, and why he deserved such punishment. Almost immediately, he was informed by the State Legislature that he would be executed by firinp squad at 6:00 pm. lturbide requested the execution be postponed a day so that he could attend mass and receive Holy Communion. The request was denied.

At 5:30 he made his confession and warned the guard that was holding him that his time had come. Lets see, boys, I will give the world the last sight 54, he said to the soldiers as he left his prison cell, looking everywhere as he walked toward his execution. There were no sipns of repret in his demeanor, walk, or voice. He proceeded to the gallows with integrity.

After a brief conversation with the accompanying clergyman, lturbide gave him a letter for his wife. He took off his watch and rosary for his eldest son, who had remained in London. He requested that three and a half ounces in small gold coins he had in his pocket be distributed among the soldiers who were to execute him. He requested a glass of water; this was granted. Then, turning to the authorities, he requested and was granted permission to address the troops assembled before him:

Mexicans! In the very act of my death, I commend to you the love of your country and the due observance of our holy religion; it is religion that will lead you to glory. I die for having blown to your assistance and die happily of expiring among you; I leave this world with honor and not as a traitor ‒ this foul stigma should not attach itself to the fair Name of my descendants. No, it should never be said that I am a traitor! Preserve strict subordination and be obedient to your commanders. By acting in conformity with their mandates you will obey those of your creator. I do not address you from any motives of vanity, for I am far from harboring them.

He prayed the Creed, made an act of contrition. He kissed the Crucifix presented to him and said, From the bottom of my heart I forgive all my enemies — really from my fieart 4. The officer in charge approached lturbide to blindfold his eyes.  lturbide declined saying it was unnecessary. The officer replied that this form must be observed. The former emperor drew his own handkerchief and blindfolded himself. He made some opposition to having his hands tied and acquiesced when the picketer mentioned that this, too, must be observed. Then lturbide knelt. Four soldiers took aim and discharged their muskets^^. lturbide was 40 years old.

It is widely written and believed that lturbide died of his wounds. Yet a detailed search yields only two reports of specificity, and they are contradictory. According to Malo44, three lead balls struck lturbide: A chest shot between the third and fourth left ribs, a face shot to the right side of the nose, and a shot deemed fatal to the left side of the forehead. Another witness, Beneski^^, affirmed that four balls impacted lturbides body: two balls in his forehead and two on his chest, and he tell dead.

There are no records to help identify which bullet was (or bullets were) fatal. However, it is known that smoothbore muskets are inaccurate given that their absence of rifling makes for unpredictable trajectories. Furthermore, lead bullets are less lethal than expected because they deform upon impact and do not penetrate as deeply as bullets from rifles do. Thus, while a hit can cause significant damage, it is less likely to penetrate deep enough to damage vital organs and kill instantly. In the case of lturbide, there are too many unknown variables to discern what bullet was fatal.

This opens the possibility that lturbide received an additional fourth shot coup de grace (mercy blow) to the body, a close-range pistol shot typically administered by the commanding officer to the head or the heart, to end the victims suffering when the firing squad salvo fails to kill instantly. A coup de grace results from the failure of a select group of soldiers to shoot and kill the victim instantly, meaning that bullets missed or were not fatal. The resulting mercy blow is an unwanted, embarrassing outcome, and no one has much if anything to gain from reporting such a detail. This would account for Malos missing fourth bullet, with Malo purposely avoiding reporting the mercy blow.

This means there were five total bullets fired, with one of the four firing squad bullets missing lturbide, perhaps on purpose or due to inaccurate musket ballistics, and the coup- de-grace bullet being the fatal and fifth shot. The fact that four soldiers constituted lturbide’s firing squad is noteworthy as this suggests a poorly designed firing squad procedure. Eight firing squad members is a more realistic number to ensure success, especially given the inaccuracies of the smoothbore musket. It includes the concept of several muskets being loaded at random with a blank to ensure the anonymity of who fired the fatal round(s). These are several considerations of a well-designed execution procedure^5. Finally, consider that a coup de grace could have been administered by an lturbide sympathizer, for example, an army officer who served lturbide and who would be motivated to relieve lturbide of suffering.

Dressed in the Franciscan habit, lturbide’s body was laid to rest and veiled by the light of four candles in a chapel. General De la Garza covered the expenses of the funeral that took place the next morning. Father José Miguel de la Garza-Garcia, a member of congress who voted in favor of the execution, officiated a mass that was attended by members of congress. After lturbide’s body was walked through the town square, his remains were buried in Padilla in the old church.

Epilogue
In November 1833, during the first administration of President Antonio Lopez de Santa Anna, Congress recognized lturbide as a hero of independence and proposed that his remains be deposited in an urn in the country\\\'s capital. In 1838 under the presidency of Anastasio Bustamante, lturbide’s remains were laid to rest in the Chapel of Saint Felipe de Jesus in the Metropolitan Cathedral. The Spanish government officially accepted the independence of Mexico on Dec 28, 1836, with the signing of the treaty of Santa Maria Calatrava. From 1821 to 1921 Mexico had 82 different presidencies. In October 1921 Congress voted to remove lturbide’s name from the list of heroes of Independence, considering him the first contra insurgent.

Conclusion
lturbide survived three life-threatening major medical conditions (‘difficult labor’, epidemics, and amoebic dysentery with a hepatic abscess) with aid of the best available medical practices. Medical advances of the day stacked the odds of surviving life- threatening medical conditions in lturbides favor. Had lturbide succumbed, the history of Mexicos Independence would have been without lturbides unique leadership and actions, and Mexicos path to independence would have been delayed or perhaps lost forever. Medicine affected history in other ways. For example, in 1811 lturbide missed
the battle of Taxco due to illness. Arguably he avoided perishing with his army as it was annihilated.

The indefatigable lturbide is Colonel Garcia- Condes description of the 28-year-old lturbide in 1810. It seems unfitting that after surviving battles, disease, and an assassination attempt, lturbides cause of death is unclear. Two reliable, loyal lturbide aides provide different detailed accounts of his reported fatal wounds by firing squad. Yet perhaps he survived the firing squad, as he had all previous threats to his life, and instead died from a coup de grace, more on his own terms and at the hands of a faithful follower, and in a manner more fitting for a man of so many accomplishments.

lturbide’s life is a unique snapshot of life in New Spain in the early 1800’s including the state of medicine, politics roiled by revolution at home and wars abroad, and ongoing health developments and challenges. His own trajectory through life, together with the role of chance in determining historical outcomes including key battles and political turning points in Mexican and international politics, illustrate how individual actions can shape the course of nations and yet how unpredictable the outcomes can be.

Corresponding author:
Ricardo F Gonzalez-Fisher
Metropolitan State University of Denver, Denver, CO, USA
Email: [email protected]

Conflict of Interests: None

Funding:
None

Acknowledgements: None

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