This comprehensive study of the regulation and politics of the medical profession in colonial Spanish America, published posthumously, represents the culmination of years of archival research by the late cultural historian of the Spanish Empire, John Tate Lanning. Edited with style and grace by his student and colleague, John Jay TePaske, it offers not only a synthesis of the institutional history of colonial medicine, but also a fascinating look into the workings of corporate society through its analysis of self-government in the medical profession.
The royal Protomedicato in colonial Spanish America, the focus of this study, was a board of physicians appointed by the crown and charged with safeguarding public health and regulating the medical profession. Its story, told here with insight and amplitude, encompasses not only the Protomedicato itself, but a broad range of topics, from foreigners and limpieza de sangre to specific chapters on pharmacy, surgery, and obstetrics. Lanning rightly warns in his preface that this is not a history of medicine as such (indigenous and folk medicine are seldom mentioned). While the narrative is rich in anecdotal material, it contains little on the actual practice of medicine, and less in the way of social analysis of physicians as a class. Nevertheless, this volume is one of the most comprehensive histories of medicine at an institutional and intellectual level yet written.
Colonial Spanish medicine faced two related problems: a severe shortage of physicians and surgeons, and a wealth of poorly trained, ignorant practitioners, many mere quacks, who found they could fill the gap. Not surprisingly, the Protomedicato, whose primary worry was the lamentable prestige of the medical profession, was more concerned with weeding out incompetents, those who practiced medicine “without fear of God our Lord and without a bachelor’s degree” (p. 135). than with increasing the supply of qualified professionals. Given this priority, its well-meaning efforts to compel licensed physicians to serve the poor without compensation were woefully inadequate. The Protomedicato shared in the failure of Spanish colonial society to solve immense social problems through regulation alone: unable to restrain free market forces, it failed in its efforts to enforce rigorous standards on the profession, and never successfully assured minimal medical care to colonial society.
Lanning, however, takes the Protomedicato on its own terms. We see well-intentioned bureaucrats struggling to cope with a situation that sixteenth-century professional priorities left them ill equipped to handle. We also enter the complex, often petty, world of jurisdictional squabbles among colonial governments, New World and peninsular professionals, and higher education in which precedent and concern for privilege reigned supreme. Ironically, the Protomedicato in America was more autonomous from government control than its counterpart in Spain and less divorced from the university, thereby eliminating that separation between the degree and the license to practice that was unique to Spain.
The Royal Protomedicato will undoubtedly become the standard reference on the medical profession and a starting point for future research on colonial medicine.