This is an intensely interesting book with extensive specific details, which condensed are as follows: the colonial period extended from the end of the 15th century to the beginning of the 19th, but this narrative deals primarily with the 17th and 18th centuries. It is based on the Archives of the Indies, of the Archdiocese of Caracas, and of the Nation; records of the Academies of History and of Medicine; and private sources. Few physicians settled in the sparsely populated country till the end of the 16th century. Adapting to aboriginal customs curanderos—medicine men—were the only recourse in illness. Malaria and smallpox were the chief scourges, and respiratory ills were due to the climate. Except the few infirmaries attached to churches, the only hospital of this century was at Barquisimeto. Hunger decimated expeditionary forces until the Spanish learned to live off the country. Medicine developed slowly in the 17th century. The cultural decadence of Spain was reflected in the colonies. America produced valuable drugs—quina, ipecac, and other specifics—but practice remained at the level of curanderos, midwives, and charlatans. The poverty of the colony was due to the scarcity of minerals and dependence on agriculture for maintenance. Eleven other capitals had well established universities; that of Caracas came much later, and its chair of Medicine long afterward. During this century physicians began to immigrate, but settled in Caracas and other towns, ignoring rural areas. Fifty-six names are classified as doctors of medicine, surgeons, barber-surgeons, medico-pharmacists, and pharmacists. Most of them needed a secondary occupation; all were victims of social prejudice. Purging and bleeding were part of every therapy. Medical stagnation reflected domination of Spain. Weaknesses were: mediocre doctors, curanderos, and lack of scientific institutions. Positive factors were: founding of 10 hospitals, separate pharmacies, contract physicians at the copper mines, and initiation of measures for public health precipitated by epidemics of bubonic plague and yellow fever. This was a transitional century for medicine.
The 18th was the century of systematic medicine, released from galenical dogmatism and religious and political domination. But “decadent Spain gave little substance to the glory of the Spanish character.” Deteriorating universities weakened medical faculties and were reflected in poor physicians. Medicine was eventually saved by the founding of Colleges of Surgery and Academies of Medicine. Medical progress in Venezuela was retarded till the autonomous provinces were united in 1786. The economy continued almost wholly agricultural. People were of 4 classes: white, mulatto, Indian, and Negro. Till after mid-century doctors were immigrants, chiefly from Spain. Fees were fixed by the Tribunal. Negative aspects: Surgeons were usually mulattos, since whites would not do manual work, and there were no surgical graduates from the College till later; preponderance of curanderos before establishment of protomedicato; doctors centralized in Caracas; insufficient hospitals; lack of scientific literature; and interference by Inquisition. Positive aspects: Chair of Medicine in Caracas, 1762, with Lorenzo Campins y Balester; protomedicato, 1777, to licence medical and pharmacy practice; and only one protomedico, always united to the Chair of Medicine. Extensions from the 17th century include: hospitals separated from asylums; contract physicians in the mines; pharmacies established in Caracas. Public health: aqueducts; control of epidemics; prophylaxis in infectious disease; and medical care of disembarking slaves.
