"LOS CULPABLES DE LA MISERIA": POVERTY AND PUBLIC HEALTH DURING THE SPANISH INFLUENZA EPIDEMIC IN CHILE, 1918-1920 A Dissertation submitted to the Faculty of the Graduate School of Arts and Sciences of Georgetown University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in History By Hugo Alberto Maureira, M.A. Washington, D.C. March 26, 2012 Copyright 2012 by Hugo Alberto Maureira All Rights Reserved ii "LOS CULPABLES DE LA MISERIA": POVERTY AND PUBLIC HEALTH DURING THE SPANISH INFLUENZA EPIDEMIC IN CHILE, 1918-1920 Hugo Alberto Maureira, M.A. Thesis Advisor: Erick D. Langer, Ph.D. ABSTRACT During the Spanish influenza global pandemic, of 1918-1920, tens of thousands of people died in Chile. From the moment that the first cases appeared in Chile, in late September 1918, Chilean physicians argued over the nature and cause of the outbreak. Some argued that it was not Spanish influenza, but epidemic typhus. This study chronicles the events and impact of Spanish influenza on Chile. It also examines the country's public health response as it targeted the working-class and poor. In some cases the response was brutal. In Parral and Concepción, the Brigadas Sanitarias forcibly evicted thousands of people and burned down their homes. The historical record strongly suggests that Chile was struck by Spanish influenza, not a typhus epidemic. Yet, typhus served as a convenient diagnosis for physicians at the time. It fit a certain profile that Chileans had of their country. As a disease, typhus normally affects societies on the verge of collapse. By October 1918, the era of "Chilean exceptionalism," which had begun at the end of the War of the Pacific and the start of the Nitrate Boom, was coming to an end. Various social, economic, and political events made Chileans question the exceptionalism narrative and led them to proclaim “moral crisis,” “economic inferiority,” and national decline. When the mysterious symptoms of disease arrived in Chile, in 1918, it was easy for politicians and physicians to proclaim that it was typhus notwithstanding that, in the rest of the world, the disease was recognized to be Spanish influenza. For Chilean physicians and politicians, the country was in a state of decline. iii This misdiagnosis had a profound effect on Chile: it led to a stigmatization of working- class people for decades to come; it drew needed attention to the plight of the working-class and their abysmal living conditions; and it intensified calls for social reform which led to the election of Arturo Alessandri in 1920. iv Acknowledgements To my wife, Wendy, and our beautiful children, Yannick, Thaddeus and Archer: you endured a lot while I completed this work. Thank you for your sacrifice. This work is just as much yours as it is mine. To my parents, Hugo Maureira (Sr.) and María Tapia: I thank you for your physical effort and financial support in helping me achieve this milestone. Most of all, thank you for your unconditional love and for your unshakeable faith in my human potential. Words cannot express my gratitude to my in-laws, John and Marilyn Ekins, for their kindness and self-sacrifice in helping me complete my degree. To my grandparents, Irma Henríquez and Isidoro Tapia†: thank you for your love, patience, and hospitality while I completed my field research in Chile. Thank you to my sister, Pamela Ferguson, and my aunt, Georgina Maureira, for their love and moral support throughout this journey. Thank you to my thesis supervisor, Dr. Erick Langer, for his unflinching support, encouragement and wise insight. I am also grateful for the insight, flexibility and commitment of my committee members Dr. Bryan McCann and Dr. John McNeill. I completed this dissertation while working full-time to support my family. Part of my success in completing this program was having two employers that were accommodating of and amenable to my needs. Thank you to RBC Dexia, my current employer, and Aon Reed Stenhouse, my past employer. My program had to be extended several times to respond to the challenge of satisfying competing family, work, and study priorities. I am grateful to the staff and faculty of v Georgetown University's Graduate School and the Department of History for their patience and compassion. Thank you to the staff of Georgetown University’s interlibrary loan service for their help in locating many articles that were used in this dissertation. I wish to thank a number of people in Chile, particularly Mónica Muñoz León and Italo Henríquez Barcelo for their friendship, thoughtful insight and efforts in compiling and digitizing copious amounts of archival and source material, much of which was used in this dissertation. Although he may not share the arguments and conclusions presented in this dissertation, I am also grateful to Dr. Enrique Laval Roman for the time he took to talk with me about my research and for his gracious hospitality. Thank you also to the staff of the Cementerio Playa Ancha (Valparaíso), Cementerio General (Santiago) and Cementerio Católico de Santiago. Thank you, also, to the staff of Biblioteca Nacional, Biblioteca Eduardo Budge (Universidad Católica de Valparaíso), Museo Nacional de Medicina Enrique Laval, Archivo Nacional de la Administración, Biblioteca Histórica de la Armada - Museo Naval y Marítimo Valparaíso, Departamento de Historia Militar – Ejercito de Chile, and Biblioteca del Congreso Nacional de Chile. Finally, thank you Lord for never abandoning me, even though I often deserved much less. vi To Wendy, Yannick, Thaddeus and Archer vii Table of Contents List of Figures .............................................................................................................................................. xi List of Tables ..............................................................................................................................................xiii List of Abbreviations .................................................................................................................................. xiv Chapter 1: Introduction ................................................................................................................................. 1 1.1. "to slanderously doubt the Fatherland" ......................................................................................... 1 1.2. Literature Review ........................................................................................................................ 10 1.2.1. Historiography of Disease in Latin America ...................................................................... 11 1.3. Contribution to the Literature ..................................................................................................... 20 1.4. Sources and Methods .................................................................................................................. 22 1.5. Structure ...................................................................................................................................... 23 Chapter 2: Perceptions of National Decline and the Re-evaluation of Chilean Exceptionalism during the Early 20th Century ....................................................................................................................................... 28 2.1. The War of the Pacific (1879-1884): Roots of Chilean Exceptionalism .................................... 30 2.2. Post War Chilean Exceptionalism ............................................................................................... 32 2.2.1. The "Roto Chileno": The Ethnic/Racial Basis of Chilean Exceptionalism ......................... 34 2.3. The Decline of Chilean Exceptionalism and the Coming “Moral Crisis” .................................. 37 2.3.1. Social Malaise: "La crisis moral" ........................................................................................ 38 2.3.2. Economic Decline ............................................................................................................... 42 2.3.3. Monetary Policy – The "Orero-Papelero" Debate ............................................................... 45 2.3.4. Dependence on One Product ............................................................................................... 51 2.4. Political Dysfunction: Civil War and the Parliamentary Republic ............................................. 55 Chapter 3: Daily Life of the Marginalized .................................................................................................. 58 3.1. Demographics of Santiago .......................................................................................................... 60 3.2. Housing ....................................................................................................................................... 63 3.3. Living Conditions of Infants and Children ................................................................................. 67 3.4. Prisons ......................................................................................................................................... 70 Chapter 4: The Pandemic at Chile’s Doorstep. Spanish Influenza Unfolds around the World .................. 72 4.1. Overview ..................................................................................................................................... 72 4.2. Influenza Virus ............................................................................................................................ 73 4.2.1.