late 17th century, but their initiatives were individualized and localized. There is some continuity from their work to the broader work during the Age of Enlightenment, such as through the Colegio de Cirugía de San Carlos ("San Carlos College of Surgery") in Madrid. At the beginning of the 19th century, the Balmis Expedition (1803) to administer the smallpox vaccine throughout the Spanish colonies was a public health undertaking of unprecedented geographical scope. The Cortes of Cádiz debated a sanitary code (the Código Sanitario de 1812), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken. During the bienio progresista, the Law of 28 November 1855 established the basis for a General Health Directorate (Dirección General de Sanidad), which was created a few years later and which would last into the 20th century. The Royal Decree of 12 January 1904 approved the General Health Instruction (Instrucción General de Sanidad), which altered little of the 1855 scheme besides the name; the name would later change to General Inspectorate of Health (Inspección General de Sanidad). After the Spanish Civil War, the Ley de Bases de 1944 perpetuated this . The Law of 14 December 1942 create a system of obligatory health insurance under the already extant National Insurance Institute (Instituto Nacional de Previsión, INP). The system was based on a percentage tax linked to employment. This was further modified by the General Law of Social Security (Ley General de la Seguridad Social) in 1974, toward the end of the Franco regime. Social Security had taken on an increasing number of diseases within its package of services, as well as covering a larger number of individuals and communities. The General Health Law (Ley General de Sanidad) of 25 April 1986 and the creation of Health Councils (Consejerías de Sanidad) and a Ministry of Health, fulfilled the mandate of the Spanish Constitution of 1978, in particular Articles 43 and 49 which made protection of health a right of all citizens, and Title VIII, which foresaw that purview over matters of health would devolve to the autonomous communities. Laws regulating the Spanish National Health System The General Health Law of 1986 The General Health Law of 1986 (Ley 14/1986 General de Sanidad) was formulated on two bases. First, it carries out a mandate of the Spanish Constitution, whose articles 43 and 49 establish the right of all citizens