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

Histories of the medical profession in whatever country—especially former European colonies—tend to emphasize the great doctors, the emergence of professional associations, the advent of licensure, the rise of clinics and hospitals, and the ways in which that country's tradition matched up with or was influenced by the development of medical traditions in France, Germany, and England. While From Popular Medicine to Medical Populism does not stray far from this tradition, Steven Palmer does show us that along with a distinctive "biomedical vanguard" in Costa Rica, a broad landscape of healers existed until at least the mid-twentieth century that reflected a vibrant medical eclecticism there. He argues that this medical eclectism was also central to the role that physicians played in populist politics in this small nation that straddles the Central American isthmus.

Palmer identifies three chronological stages in this story of the creation of a community of physicians. When still a Spanish colony, Costa Rica had neither lucrative mines nor extensive plantations. It existed as a backwater of empire, and so attracted few physicians. The forty-year period from independence to 1860 is the first notable stage in the narrative, and sees the arrival of foreign-born and foreign-educated doctors ready to set up practice, especially in the newly emerging city of San Jose. The next forty years, until the turn of the century, constitute the second notable period, with native-born "patrician lads" educated in Europe and the United States supplanting the earlier generation of immigrants. This generation brought biomedical science to Costa Rica as well as the trappings of the modern medical profession—journals, associations, and medical instruction. The third phase covers the next forty years, which saw physicians from the elite social strata come to play leading roles in national politics. In fact, we learn that between 1920 and 1948, 39 percent of the legislative deputies were trained as physicians (p. 216), and several physicians served as president of Costa Rica as well.

The author stresses the point that despite their social standing and political clout, not only were professional physicians unable to bring the power of the state to bear to eradicate the practice of medicine by nonlicensed, irregular healers, but the state actually "promote[d] empiricism in medicine and surgery" (p. 233). He draws the conclusion that the medical profession in Costa Rica "is best understood as a nationalist and . . . decolonizing" (p. 234) instrument. This may be a moot point in a country where infant mortality was "hovering" at about three hundred per thousand between 1890 and 1914 (p. 146), the period that witnessed "a veritable golden age in Costa Rican medical professionalism" (p. 80).

It may be that the chronological approach ensnares the author in historiographic debates that downplay a most intriguing problem, namely the "implementation [in 1941] of social security as a historical enigma" (p. 207). Whereas the history of social security programs in Latin America usually lies within the context of industrialization, the rise of cities, and labor history, Palmer asserts that in Costa Rica, social security "can also be told as medical history" (p. 208). It is unfortunate that this insight comes in the last chapter, because it makes a terrifically engaging starting point. Once you encounter this chapter, you need to go back through the book to retrace the milestones, data, and players to reconfigure a new plot—one less involved in the emergence of a recognizable medical profession, and more centered on issues of public health. While Palmer's book certainly sets a new standard for scholarship on the medical profession in Costa Rica, his work is not done. With his in-depth knowledge of the...