introduction
This
book is a history of popular and conventional medical practi-
tioners in Costa Rica, a dynamic periphery of Latin America. It
begins in the late colonial era when none of the fifty thousand inhabi-
tants of this southernmost province of the kingdom of Guatemala had
access to a titled physician, surgeon, pharmacist, or midwife. In the
early 1800s, all Costa Rican medicine was popular medicine. The book
closes in the 1940s when the figure of the qualified medical doctor,
once extraordinary and alien, was a part of everyday life for a great
many Costa Ricans. A people approaching the one million mark were
increasingly likely to be treated by licensed doctors and allied health
practitioners numbering over a thousand. Almost half the legislators of
this relatively prosperous coffee republic were medical doctors, and in
1940 Costa Ricans had elected by an overwhelming majority Dr. Rafael
Angel Calderón Guardia, a charismatic physician whose populist pro-
gram was built on the introduction of medical benefits under Social
Security.
The story told here, however, is not the rise and triumph of the
modern biomedical doctor. Instead, the book documents the exploits
of an ever wider variety of healers over this long period, and maps the
interactions among them in a modern medical universe characterized
by increasing stratification and heterogeneity. By 1940, schooled and
titled practitioners had made an indelible mark on health care in the
country, but these included not only doctors in medicine and surgery,
not only midwives, pharmacists, and nurses, but also homeopaths, os-
teopaths, and spiritists. Moreover, the indigenous curer, the empiric
midwife, the curandero who specialized in herbal medicine or minor
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