From Popular Medicine to Medical Populism: Doctors, Healers, and Public Power in Costa Rica, 1800-1940 (review)

From Popular Medicine to Medical Populism represents the maturation of a new narrative of the history of medicine in Latin America. Beginning in the late nineteenth century, a "progressive" analysis underpinned most volumes on the history of medicine, an account of fundamental advances begot by the introduction of scientific medicine into the region. This historiography tended to focus upon "firsts" (the first microscope, type of surgery, etc.), achievements by leading physicians, the professionalization of the field, and the construction of institutional edifices that helped to "modernize" the region. Anthropologists, sociologists, postmodernists, and others have critiqued this narrative, seeking to recuperate indigenous and African medical practices, "popular" beliefs, women, and power relations generally absent from the progressive tradition. This critical approach, which has dominated the literature over the past generation, has tended to construct a "bipolar field of vision" characterized by attention to contestations and popular practices. Palmer seeks to correct this "dichotomous representation," arguing that in Costa Rica, "the relationship between popular and conventional practices was characterized by coexistence, complementarity, and dialogue more than outright rivalry and ideological warfare" (p. 9).

Palmer pays consistent attention to two analytical threads through the 1800- 1940 time span: changes in medical practices in a "secondary, Hispanicized" region and medical politics in the context of an emerging nation-state. The relative dominance of Hispanic influences and the strong social welfare system that was crafted in the mid-twentieth century both speak to Costa Rican exceptionalism, but Palmer takes pains to indicate features that this Central American nation shares with others in the region. He suggests, for example, that the lay and popular nature of early-nineteenth-century medical practice is common to much of Latin America, whereas the late colonial academic influences in Mexico City, Rio de Janeiro, and Lima were exceptions. Palmer mined a broad array of primary and secondary materials to describe healing practices before the introduction of scientific medicine, displaying a mastery of comparative analysis. He is particularly skilled at demonstrated how the protomedicato of the nascent state utilized curanderos in what might be seen as the initial stages of public health initiatives, even as biomedical practitioners gained increased acceptance in San José and other cities. Palmer is careful to indicate that popular medical practices never came under direct attack by scientific practitioners but instead evolved to incorporate many aspects of scientific approaches, leading to clear medical pluralism by the 1880s.

Costa Rica's national antihookworm campaign (1907-13) is both exceptional and characteristic of the region. Its exceptionality stems from the fact that national physicians began the campaign, at least in part to reduce the influence of foreign physicians in the countryside. Microscopic images of the hookworm assisted in the promulgation of germ theory, and the success of treatment regimens demonstrated the relative efficacy of scientific physicians. The national network of clinics, state organizations, and physicians continued the construction of the Costa Rican public health system. Building upon this foundation, and more characteristic of Latin America, the Rockefeller mission achieved widespread success in the control of hookworm and assisted in the nationalization of scientific management of health.

The case of Carlos Carballo Romero (aka Professor Carbell) enables Palmer to elaborate the concept of "medical populism" in the 1930s and 1940s. Carbell arrived from Cuba in 1931, offering his medical skills (an eclectic mix of spiritualism, curanderismo, and orthodox medicine) to a receptive public. Palmer examines the records produced when Carbell was arrested for practicing medicine without a license in order to explore, with great sensitivity, the broad range of medical services available to the San José public in the 1930s. The fact that biomedical specialists could not craft a system of hegemonic control sustains the author's assertion that...