Introduction

The historical configuration of the Chilean State is a problem still discussed among historians and social scientists [1], predominantly considered by the order exercised from the capital, but with little emphasis on regional spaces. In particular, the Province of Coquimbo experienced an ostensible economic growth during the second half of the 19th century due to the exploitation and copper exports [2]. The scenario required establishing healthcare policies to regulate medical practice due to demographic growth and regional and national modernization. Therefore, the arrival of medical professionals marked a turning point in the system’s organization through the administration of the San Juan de Dios Hospital.

Fiscal participation would have been reflected in the gradual inclusion of licensed physicians in the regulation of healthcare practices and in the use of the hospital as the monopoly of medical practice [3]. Nevertheless, certain tensions between state modernization and local customary therapeutic uses can be observed. This article provides news of those early interactions and proposes an analytical vector of formal medical progress circumscribed to a territory in integrating into the national project.

Methods

The research is based on a qualitative inquiry that includes the review of historical sources from the Fondo Intendencia de Coquimbo, preserved in the National Historical Archive of Chile [4]. Records and correspondences have been collected that reveal the dynamics between physicians, local authorities, and the implemented healthcare policies. Considering the method based on the paradigm of indicial inferences, an inductive approach is proposed to establish conjectures based on documentary traces. In most cases, these traces are not systematized in their origin. Ginzburg proposed this methodology for historiography, which is also used in psychoanalysis and artistic criticism [5].

Sanitary context in the province of Coquimbo during the 19th century

The copper mining bonanza, in addition to generating individual fortunes, impacted the working class’s lives, favoring growing healthcare demands. The rampant urbanization of La Serena and Coquimbo became a priority for the State due to the need for productive spaces for growth [6]. Thus, colonial structures gave way to the organization of hospitals, the classification of diseases, and the curative strategies that the physicians trained at the University of Chile could provide [7]. Consequently, consolidating the Hospital San Juan de Dios in La Serena was a significant advance as part of the taxation. The creation of health institutions not only responds to health needs but is also linked to the push for multidimensional progress of the nation-state and the country as a builder of an identity based on citizenship and respect for institutions. Therefore, developing a sense of governmental responsibility for the population’s health is emphasized.

The arrival of medical professionals

As the hospital documents show, between 1840 and 1870, the first attending physicians arrived. To safeguard the “sacred duties imposed on me by my position”, as the physician Juan Valderrama pointed out to the intendant, in reference to a charlatan who practiced the profession of healer [8,9]. Physicians aspired to educate the population and establish a minimum disease classification standard based on symptoms. For its part, the political leadership, concerned about the spread of contagious and purulent miasmas, sought to control the sale of certain spoiled foods. Its purpose was to prevent the spread of common diseases, such as typhus, cholera, and dysentery.

As can be seen from the testimonies, the physicians took special care in suggesting and implementing vaccination campaigns and pushing initiatives to combat disease outbreaks. To this end, they turned to the provincial authorities. Thus, the physicians Antonio Mario Mendiburo and Carlos Schmithenner subscribed to the declaration that read:

"1° None of those who are currently practicing the medical profession without having presented their competent degrees that accredit their capacity and have been admitted by the protomedicato in the guild of State practitioners may continue in the practice of their profession, 2° The protomedicato of this capital will pass to this effect a nominal list to all the apothecaries of the physicians qualified as such so that any prescription that is signed by someone other than the physicians indicated in the aforementioned list, will not be admitted and will not be fulfilled” [10].

On the other hand, the hospital’s medical directors would have been concerned with regulating and controlling the pharmaceutical service and those involved in dispensing medicines. The period under study was marked by the discussion about the scope of the protomedicato in the framework of the modernization of the treatment of diseases; the local physicians were reluctant to the decisions taken by that institution. Their complaints were against the permits granted for installing apothecaries' shops. More specifically, they were against those in charge of establishing the lists.

In 1859, Juan Valderrama wrote to the intendant a descriptive note against Nicolás Osandón to practice as the city’s apothecary. Among the physician’s arguments was the fact that the city of La Serena already had several authorized dispensers. The arguments he expressed for not recommending him are striking due to the ample “reasons to believe that the applicant, who has never received his degree from the competent authority, does not possess the theoretical and practical knowledge of chemistry, which in this republic as in every civilized country, is indispensable for the pharmacist”.

In a later note, Dr. Valderrama himself indicated to the intendant that the apothecary, Francisco Olivares, filed a complaint with the physician authority of the hospital, accusing Mr. Osandón of malpractice. In the accusation, the incompetence of Mr. Osandón was noted: “(...) saying that this is a person who had ordered a pound of England salt (sulfate of magnesia), by mistake he has hidden sulfate of zing [sic] and by this oversight caused the poisoning and almost death of two people who had each taken an ounce of this salt”. Valderrama ends his letter with a categorical rejection of Nicolás Osandón’s request, sentencing in his message under the argument that what happened “...would have proved that he lacked the indispensable knowledge and care for the one who [re]wants an establishment of this kind” [11].

In short, these examples give an idea of how sanitary taxation was deployed. Likewise, the medical staff played a fundamental role in these purposes.

Conclusions

The stories and examples found in the Archive of the Coquimbo Intendancy documentations show how the central authority and the physicians worked together to improve sanitary conditions and professionalize the healthcare system in the province. They had to confront popular and informal medicine and control the pharmaceutical service to do so. The methodology used reveals the importance of the physicians' statements in legitimizing their profession, as well as the consolidation of the State in terms of health care. The advent of taxation, therefore, would have made it possible to initiate the modernization process of curative practices. This would have occurred in transitioning between traditional and modern scientific practice.

As mentioned above, all of this was centered on the administrative management of the Hospital San Juan de Dios. In this particular case, the emphasis was marked by the recommendation of food sales, the delimitation of the apothecary staff, and the generation of records that would later allow the creation of statistical mechanisms and even the establishment of a new relationship between physician and patient. In this way, the incumbent physicians promoted the application of norms that would set an agenda from a procedural, supervisory, executing, and ordering perspective of the fiscal presence in the Province of Coquimbo.