Entre la marginalidad social y los orígenes de la salud pública: Leprosos, curanderos y facultativos en el Valle Central de Costa Rica (1784–1845)

Resumen

The history of leprosy offers rich terrain for social analysis. The uncleanliness associated with biblical scripture has resulted in dense legal and social efforts to isolate lepers from “healthy” society throughout the Western world. Not until 1874 did Gerhard Henrik Armauer Hansen isolate the organism (Mycobacterium leprae) that caused the disease, and not until the 1950s was an effective treatment developed. Until that time, persons afflicted with various skin diseases were labeled as lepers and often forced into asylums, known as San Lázaros in colonial Latin America, the largest of which was located in Cartagena.Ana Paulina Malavassi Aguilar has penned a bold analysis of efforts by public officials in Costa Rica to develop institutions to isolate lepers in the late colonial and early national periods. She employs a Foucauldian analysis, seeing pubic health efforts as objectifying socially marginalizing victims. While the author has conducted extensive archival work, her labors are complicated by the fact that very few people suffered from the disease, so that the asylums had a low financial and policy priority. She lacks, for example, the rich context explored so effectively by Diana Obregón Torres in Batallas contra la lepra: Estado, medicina y ciencia en Colombia (2002), a work that Malavassi Aguilar seems not to have consulted. Nevertheless, the reader can be quite confident that Malavassi has located most relevant materials and placed them into a plausible interpretive context.The book’s five chapters adhere to a rough chronological sequence, beginning with the “relative exclusion” of the colonial period, followed by the development of the Lazareto General and including official and social perceptions of leprosy, medical culture, and marginialization in the early national period. Three appendixes list official lepers and mendigos in the colonial and national s periods, respectively, and several medications for leprosy. Colonial authorities proved unable to establish an effective lazareto. The governor successfully petitioned officials in Guatemala for the authority to found a small lepers’ asylum in Cartago, but funding for the project never developed. The small number of the afflicted, in combination with a preference for family-based care, reduced the urgency for colonial action. Colonial authorities worried the most about indigent lepers, which seemingly served as the motivation for national authorities as well. An 1826 statute implored municipal officials to establish a refuge for the indigent, a project that few authorities completed, which further linked lepers and mendigos in the class of the marginalized. Various false starts in the 1820s preceded the founding of a Lazareto General in 1833.Much of Malavissi’s work focuses on the decade and a half during which the Lazareto General operated. Significantly, it seldom housed more than two dozen people, often including the children of women identified as lepers. Municipal authorities balked at paying for the institution, and most families would release their kin to the lazareto only in times of their own financial need. The shortage of funds led officials to try to make the lazareto self-sufficient, a project that did not succeed. The author covers in great detail the forced nature of the commitment to the lazareto, including the threat of the death penalty for those lepers who escaped from their seclusion. She makes it clear that most families ignored the institution without penalty from local authorities.Malavissi does a fine job situating this project within early Costa Rican history. The social marginality of her argument, however, appears to be quite sound. Still, one is left wondering that since no one was sure of whether a person had leprosy, syphilis, or some other skin disease, perhaps the social isolation was more important than the disease itself. Since families and cabildos regularly ignored lazareto statutes, the true public-health capacity of the state appears somewhat marginal as well.