Inválidos: Hospitals and Asylums in the Rise of Medical Professionalism in Guatemala and El Salvador, 1890–1944

For more than a century, the streets of Central American cities have been home to people with disabilities who sell lottery tickets, sing for donations, and beg for change. Often stepped over or passed by, these people rarely appear as historical actors worthy of study in themselves, despite their centrality to the construction of citizenship, labor, and race regimes. When too disruptive to public space or to their families, these citizens were remitted by police to asylums, where they fell under the authority of medical and legal professionals. Patient case files, medical journals, textbooks, and government ministry records for the Asilo de Alienados and Asilo “La Piedad” (for leprosy and elephantiasis patients) in Guatemala and the Manicomio and Asilo Sara (for orphans and poor women) in El Salvador show how conditions like epilepsy, alcoholism, psychosis, and leprosy enabled medical specialization and professionalization. This paper argues that early medical professionalization was characterized by two factors: 1) the measurement of population (especially the assessment of curability) and 2) state management (especially the licensure of practitioners and the growth of ministries of charity, public health, and sanitation). It also discusses the effects of professionalization, as the state wrested responsibility for care from families and religious institutions. Despite this secularization, the assumption that inválidos were morally suspect endured. Thus, this paper attends to the professional and moral dimensions of the early twentieth-century asylum system. Situating so-called “invalids” [inválidos] within professional medicine’s expansion, this paper tracks the development of biopower but also of patients’ resistance.