Social Medicine and "Leprosy" in the Peruvian Amazon

Starting in the early twentieth century, Latin American physicians organized expeditions to study remote rural populations living in their own countries. These expeditions usually aimed to solve scientific mysteries, spread western medicine, protect urban populations from epidemic diseases coming from the countryside and increase the productivity of new areas of economic exploitation. They also produced fascinating knowledge, images and stereotypes on individuals and diseases considered rare in Latin American cities.¹

In this paper I will analyze a similar case: the medical dimension of an effort to "colonize" or modernize the Peruvian Amazon during the 1940s.² This region, an expanse of more than 500 square kilometers, was—according to a prominent Peruvian economist—"territorioinculto" scarcely populated by primitive tribes.³ Economic, nationalistic and political motivations coincided in the term Colonizaciónde la Amazonía used by governmental and international agencies. Its meaning included diverse proposals such as: to encourage the migration of Andean peasants, the implementation of scientific agriculture, the creation of rural schools and military posts, the "civilization" of local natives—a process developed by religious orders in the nineteenth century—and the construction of roads to facilitate access to urban markets.

The medical work related to the colonization of the Peruvian Amazon was not only an instrument of politics. It was also an effort to promote a holistic understanding of health and disease (not only centered on reductionistic biological causes), maintain a fluent interaction with diverse communities, demonstrate special care for patients, and use medicine as an instrument for national integration. This paper will analyze the context, goals and failure of this medical experience and the individual vicissitudes of "colonization" as they appear in VidadeLeprosa, a pamphlet written by an anonymous patient living with Hansen's disease (formerly known as "leprosy"). Although the illness never represented a significant percentage of national morbidity it carried a complex burden of suffering, fear, stigma and segregation. Its history has been usually told as a test of the humanity of a society and of the compassion of its medical professionals.⁴ During the 1940s, the disease was predominant in the Amazon and therefore considered a menace to the rest of the country.⁵

The physicians analyzed in this paper belonged to a heterodox European current labeled Social Medicine. Although a social perspective on problems of disease appears in medical writings of the nineteenth century, it was only in the early twentieth century when a group of medical doctors, university chairs and academic journals began using the term Social Medicine to distinguished themselves from other medical specialties.⁶ Social Medicine questioned the use of a narrow bio-medical perspective in medical education and practice, and emphasized environmental, social and cultural contexts to understand and control infectious and chronic diseases. These ideas developed against the hegemonic current of most professionals that concentrated on the biological, clinical and technical dimensions of disease. A group of doctors from Lima adapted Social Medicine to Peru, as other Latin Americans did during the twentieth century.⁷

The Context

The work of the Peruvian medical doctors was initially part of an attempt to modernize the relationship between the central government and the Amazon. It was also part of an effort to secure the access of the U.S. to strategic raw materials during World War II. These interventions, as García Jordán and Barclay demonstrate, were also encouraged by important local changes in the Amazon society of the post-rubber export-economy cycle (that came to its end in the 1920s).⁸ Various groups were interested in the Peruvian Amazon, such as the military, entrepreneurs, and business and official agencies. Their motivations were at times complementary: to exploit the natural resources typical of a tropical climate; to integrate a region to the modern centers of Peru; and to strengthen the frontiers. Only in the late 1930s Peru did define its Amazonian borders with Brazil and Colombia, and the 1941 war...