Strategic mercies: Physicians, the state and public health in Chile, 1875--1910

This dissertation examines middle-sector values at a watershed in Chilean history, the Civil War of 1891. In this conflict the emergent middle sector of Chilean society joined with an oligarchic Congress despite professionals\u27 dependence on jobs created by the Executive\u27s centralizing policies. This study delves into the world-view, science and work of physicians to uncover the roots of their behavior in 1891. ^ I focus on physicians as they were dependent on state-financed positions for remuneration, and because their work brought them into daily contact with Chile\u27s urban poor. Increased state expenditures in public health aided not only physicians, but also the poor through improved clinical care and sanitation. Many scholars contend that President José Manuel Balmaceda represented national interests, while the Congress was dedicated to enriching itself without regard for Chile\u27s poor or the nation\u27s future. Therefore, I assess not only the politics of physicians, but also the character of public health policy before and after 1891. Public health policy offers one test of government\u27s responsiveness to social problems. ^ Physicians, drawn from the middle sector, were also liberals in the nineteenth-century sense of the term. For the, nineteenth-century doctor, the health of an individual was explained by morality: Immoderate decisions that eschewed the frugality and sobriety of bourgeois conduct sickened the poor. Their liberalism led physicians to support Congress and its promise to halt an authoritarian president, restoring representative democracy to Chile. The liberal science of physicians also legitimized a transformation of policy after 1891 in which safeguarding health became a municipal responsibility rather than an obligation of the central government. ^ Health care atrophied after 1891, and within a decade of the Civil War, physicians observed that the provision of public health was beyond Chile\u27s municipalities. Their pleas to protect public health were ignored, and in 1925 they would support a coup by junior army officers to install a government that did provide social welfare.