Title not available in English.

Abstract

Despite the arrival of a large contingent of foreign immigrants to the State of São Paulo at the end of the 19'" century, especially during the first two decades of the Republic, the government of the State of São Paulo did not guarantee health care to the new inhabitants. The liberal political model of the First Republic did not contemplate the offer of individual health care, a fact that only occurred starting in the 30's. The health actions most often implemented at the time were directed at urban sanitation and at the regulation of dwellings, in addition to the isolation of patients and the disinfection of their belongings during the epidemic outbreaks of transmissible diseases, especially yellow fever and smallpox. Private medical care was expensive and the urban and rural poor only had access to quacks and to religious health institutions. With mortality rates often higher than 30% of the total number of patients admitted, hospitals were seldom used. Obstetrical care for rural women was also Iimited by the high cost and only 0,3% of the births in the state occurred in hospital at the beginning of the 20th century. It was only with the Sanitary Code of 1918 that rural dwellers started to receive more attention from state authorities, with emphasis on the prophylaxis of endemic diseases such as malaria and Chagas' disease through the regulation of the hygiene and salubrity conditions of the dwellings and of the rural environment.