Protomedicatos y lazaretos como instituciones de control de la higiene pública en Chile entre 1879 y 1920 / Colleges of royal physicians and isolation hospitals to control public hygiene in Chile from 1879 to 1920

El presente artículo indaga la aparición de dos instituciones de control de la higiene pública en Chile entre los años 1879 y 1920: los protomedicatos y lazaretos. El objeto de estudio utiliza como caso la presencia de la viruela en La Araucanía. Se abordan las características y contexto que adquirió la instalación de estos dispositivos que permitieron al Estado de Chile operacionalizar el asunto de la higiene pública, lo que interpeló a los profesionales de la salud para avanzar a mayores niveles de perfeccionamiento del ejercicio profesional de la medicina. El Estado liberal positivista de fines de siglo XIX comprendió que el tema de la higiene no era solamente una cuestión de responsabilidad individual, sino que tenía una dimensión social, pública y medio ambiental. No sólo había personas que eran higiénicas, sino también ambientes higiénicos y antihigiénicos. Por tanto, se estudia la higiene, el tribunal del protomedicato, la hoja sanitaria, lazaretos, médicos y vacunadores; quienes estuvieron en permanente tensión con las autoridades del gobierno central debido a los insuficientes recursos proporcionados por el Estado para la atención de los enfermos contagiados con viruela. El estudio se orienta desde una metodología cualitativa con un diseño historiográfico con alcances descriptivos densos. Se han utilizado fuentes primarias y secundarias disponibles en archivos en Chile y Alemania. Los resultados evidencian que la presencia de viruela apareció violentamente en el centro sur de Chile en la segunda mitad del siglo XIX y permaneció en la Araucanía hasta la primera mitad del siglo XX. La violencia con que se desarrolló la viruela generó miedo e incertidumbre afectando a personas de diferentes clases sociales, y tuvo como una de sus causas principales las precarias condiciones de salubridad de la población.

This article investigates the emergence of two institutions for the control of public hygiene in Chile between 1879 and 1920: colleges of royal physicians and isolation hospitals using the case of smallpox in La Araucanía, a region located in the South of Chile. We cover the characteristics and context of these institutions that allowed the State of Chile to address the problems of public hygiene and to prompt health professionals to professionalize the practice of medicine. The liberal positivist state of the late nineteenth century understood that the issue of hygiene was not only a matter of individual responsibility but had a social, public, and environmental dimension. People practiced hygiene alongside the existence of hygienic and anti-hygienic environments. Therefore, hygiene, the royal colleges of physicians, health records, isolation hospitals, doctors, and vaccinators are studied. All of these components of the health care system of the time were in permanent tension with the central government authorities due to the insufficient resources provided by the state for the care of infected patients with smallpox. The study follows a qualitative methodology with a descriptive historiographic design. We used archival primary and secondary sources available in Chile and Germany. The results show that the presence of smallpox appeared ferociously in South-Central Chile in the second half of the 19th century and remained in La Araucanía until the first half of the 20th century. The extent to which smallpox spread, spawning fear and insecurity in people of different social classes, had as one of its leading causes the precarious conditions of health and hygiene of the population.

Entre vacinas, doenças e resistências: os impactos de uma epidemia de varíola em Porto Alegre no século XIX / Between vaccines, diseases, and resistances: the impacts of a smallpox epidemic in nineteenth-century Porto Alegre

Resumo Uma epidemia de varíola que vitimou fatalmente 1% da população de Porto Alegre em 1874 é o tema deste artigo. Com base em ampla pesquisa documental e no cruzamento de informações produzidas por ocasião da morte dos indivíduos atingidos durante o evento, buscamos problematizar as razões pelas quais a varíola apresentou-se em formato epidêmico na cidade. De posse dos mapas de vacinados nos anos anteriores à eclosão da epidemia, pudemos constatar a baixa adesão da população de Porto Alegre ao preventivo, cujo benefício poderia ser ignorado pelos distintos grupos sociais que teciam relações dentro da cidade. Com a chegada de soldados doentes, oriundos de outras localidades, a moléstia se espalhou rapidamente pela cidade, causando a morte de centenas de pessoas.

Abstract This article examines a smallpox epidemic which killed 1% of the population of Porto Alegre in 1874. Through extensive documentary research and comparison with data from those who died, we problematize why smallpox manifested as an epidemic in the city. Maps showing vaccination in the years preceding the outbreak reveal that only low levels of the population of Porto Alegre participated in prevention efforts, and the benefits of these efforts were ignored by the different social groups which were interconnected within the city. As sick soldiers arrived from other places, the disease spread rapidly through the city and caused the death of hundreds of people.