medical of the new world · medicate after i646 were the professors ofmedicine in mexico and peru,...

MEDICAL COLONIZATION OF THENEW WORLD

by

FRANCISCO GUERRA*

THE discovery of America afforded the European nations vast opportunitiesfor conquest and colonization, but two great powers among them, Spain andEngland, were foremost in taking up this challenge. Although both nationsapparently had a similar background ofwestern culture, it must be rememberedthat their systems ofcolonization were rooted in different religious and politicalphilosophies, and that the state of medical science in those two countries variedaccording to their political development.

Historical analysis seems to indicate that the transfer of European medicineinto America during the centuries of colonial administration was influencedmore by religious and political factors than by the advanced level of medicinein the colonizing power, and, furthermore, that until the end of the eighteenthcentury, medicine in America depended almost entirely on European initiative,although it was adapted to the peculiar circumstances of the area.

Spanish ColonizationAt the dawn of the sixteenth century, Spain was the strongest defender of the

Catholic faith which had been the paramount element in the struggle againstthe Arabs, the expulsion of the Jews, the fight against Reformation, and theproclaimed motive for the evangelical conquest of the American Indians. Thepolitical unity around the Castilian king was a secondary factor, which, how-ever, enhanced the absolute monarchy, and provided a single-minded directionto the American adventure. From the scientific point ofview the seven centuriesof association with the Arabs, before they were finally expelled from Spain,together with the influence of the Jewish translators on her soil, contributed togive Spanish medicine a most distinguished place in the sixteenth century.

In Spanish America medicine was subservient to the spiritual and politicalaims of the government. The conquest, beginning as the private enterpriseof the conquistadors, was followed by the foundation of cities governed byCabildos, similar to the Brtish town councils, but as a result of the royal appoint-ment of viceroys assisted by Audiencias, the authority of the Cabildos soonwithered.

Medical colonization there can only be understood by tracing its roots in theSpanish tradition of Roman Law established in the Iberian peninsula whenSpain was itself a colony of Rome; indeed Spain transplanted those same legaland administrative standards into America. By virtue of the Leyes de Indias orAmerican Laws issued from I542 the administration ofevery territorial conquestby the Spaniards in the New World fell under the direct control of the Crown,

* Wellcome Rceearch Fellow in the Wellcome Historical Medical Library.I47

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Francisco Guerra

in spite of the privileges originally granted to the conquistadors and the demo-cratic nature of the Cabildos. Western medicine was channelled within the samelegal framework of centralized power by means of the royal Protomedicato whichhad absolute authority in medical matters. The Protomedicate was a council,presided over by a head physician, which was empowered to examine practi-tioners in medicine, surgery, obstetrics, pharmacy and phlebotomy. From theirroyal foundation in 1570, these councils kept records of every professionalmedical man in their area, inspected pharmacies and hospitals, collectedreports on local materia medica, and decided on quarantine measures in casesof epidemics. In order to avoid duplicate functioning, the heads of the Proto-medicate after I646 were the professors of medicine in Mexico and Peru, thelargest viceroyalties, which also had the finest medical schools.As a result of the Protomedicate being imported into Spanish America, most

of the regulations emanated from metropolitan sources and were included inthe Leyes de Indias and Ordinances of the Protomedicate, published in Madridin I 751; these were supplemented by local proclamations of great interest. Theinfluence of the Protomedicate was such that many years after independence,the former colonies preserved not just the institution, but its officials as well,sympathizers in many cases with the royalist cause.The Spanish conquest was consolidated by the intermarriage of the indi-

genous population with the European immigrants; and also by the Encomienda.This system placed under the care of Spaniards a certain number of the nativepopulation engaged in work in the fields and mines, in return for some economiccompensation and compulsory instruction in the Catholic faith. This methodof obtaining labour allowed an exchange of European and American diseasesbetween both groups, and handed the medical care of the destitute Indian tothe Spaniards as a Catholic charitable duty. In this way, both monastic ordersand priests became involved not only in the spiritual, but in the corporeal healthof the masses, so that from that time religious influence has persisted in medicalcare throughout Spanish America.

British ColonizationThe colonies and trading companies established from England in North

America during the sixteenth century lacked the expanding aggressiveness oftheir southern neighbours. Only with the arrival of the Puritans in I620 did thereligious and political factors that were going to shape the medicine of NorthAmerica become apparent. The religious concern of the late arrivals was not,however, evangelical, being paradoxically the result of the intolerance of thedogmatic compromise ofthe Anglican Church. Politically, the English emigrantshad a tradition of several centuries of constitutional development before thediscovery of America, and they took care to settle in lands outside royal juris-diction. In this way the Puritans were able to evolve as a political entity withlaws emanating from the rights ofassemblies rather than the will ofthe monarch.This philosophy ofgovernment spread through the British colonies, taking formonly after Locke's propositions in defence of natural rights had been published.This physician and philosopher influenced American political systems indelibly.

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Medical Colonization of tke New World

The religious influence in medicine among the British was not direct; church-men, it must not be forgotten, had a much higher education than the settlers,and even in medical matters were sometimes superior to medical practitioners.Most ofthese lacked a medical diploma or proper university training and learnedtheir profession by apprenticeship.

In New England the basic institution ofcolonial administration was the towncouncil; farther south, the assembly. The settlers remained in groups of similareconomic and social extraction, without interest in great territorial expansionor a desire to mix with the Indian population; therefore, their medical problemswere similar to those in a homogeneous European village-without the sanitaryproblems of the large indigenous population-interested in preserving theirreligious principles and promoting mercantile prosperity. Their communityproblems, including those of a medical nature, were discussed and decided bythe popular vote at the town council. In spite of the royal annulment in I684of the Charter of Massachusetts, not only New England, but all the Britishestablishments developed a popular legislature, which also dealt with medicineindependently of metropolitan control.The establishment of British settlers in America early in the seventeenth

century coincided with the first medical demonstration of the experimentalmethod in England. Meanwhile, science declined in Spain during the sameperiod owing to dogmatic influences.

The Transfer of Western MedicineCertain significant medical data for the period of colonial administration in

the New World may be arranged under headings grouping medical practice,hospital establishments, educational institutions, medical publications andresearch on natural resources with special emphasis on materia medica. Theinformation recording dates and locations may be plotted on the Americanmap allowing a comprehensive view of the events.The maps show, in the first place, the political organization and boundaries

at the height of the viceroyalties' prosperity in the seventeenth century. Thedates under the colony's name indicate the span of colonization, although itmust be realized that Canada began as a French colony, to become afterwardsa British dominion; the Spanish colonies, except for Cuba and Puerto Ricowhich remained under Spanish rule until I898, won independence betweeni8I 3 and I82I. The heading of New England actually embraces the thirteenBritish colonies in North America which, after their independence in 1783,greatly expanded their territory. Heavy lines mark the boundaries during thecolonial period, and the lighter lines present-day frontiers, including, in somecases, several independent nations which sprung from a single viceroyalty.With this compact information available as a visual aid, it is easier to check

the impact of religion and politics upon the evolution ofAmerican medicine.

PraticeTrained graduate physicians reached America with Columbus's first ships,

andmore followed byeverySpanish expedition; qualified practitioners, however,.'49



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were seldom found in the early British and French settlements. The reasonbeing that under the Spanish crown everything of military importance, includ-ing sanitary factors, was carefully considered beforehand, whereas Britishcolonization began as small private enterprises.The surgical tradition of the Arabs and the use of iron instruments gave the

Spaniards considerable advantage in surgery over the Indian use of flintimplements, but in the field of clinical medicine, humoral pathology and thetherapeutics based upon it were a poor substitute for the aboriginal idea ofdisease and the treatment available.

Notwithstanding the Spanish priorities in medical practice, the fact remainsthat large masses ofthe indigenous population were wiped out in the Caribbeanislands and the continent. Smallpox was the greatest scourge among theIndians, and both European nations were equally responsible for its spread, theSpaniards introducing the disease during the conquest of Mexico in I529, andthe British in North America after I633. The spread of epidemics from Europethrough America was accelerated in Spanish America by the administrativeorganization and the close relationship between both races. The origins ofsyphilis and yellow fever are still under discussion, but the Europeans in turnsuffered from the effect of several other new native diseases.The observation of epidemics at the ports of entry provided an important

contribution to medical practice in America; the handling of, for instance,smallpox epidemics by both British and Spaniards gives a clear understandingofhow political institutions may affect the evolution ofpopulation by the extentof their sanitary measures. From I 720 on, Massachusetts witnessed the inocula-tion controversy, where the use of smallpox inoculation to prevent naturalinfection was discussed at the town halls. The procedure, published in thePhilosophical Transactions of the Royal Society, was supported in America mostlyby the clergy and opposed by some qualified physicians on grounds thatinoculation tended to increase the spread of the natural infection. The accep-tance of inoculation, in spite of the high mortality attending the technique,followed the whimsical vote of the city fathers in the British colonies, someopposing, others promoting the procedure to control smallpox. Not until muchlater, when statistics were clearer, was inoculation generally accepted.

In Spanish America the advantage of using the inoculation of human small-pox as a preventive method in the disease was known late in the eighteenthcentury, and immediately approved by the Protomedicate and therefore thewhole medical profession. The importance of a high policy in medical practice,directed by professional bodies, became apparent in this case of the smallpox.After the British discovery ofvaccination, the Spanish crown readily arranged,through the Protomedicate, the vaccine expedition from Europe to America,which, in an unbelievably short time, established vaccination all throughSpanish America in 1804.

Medical practice was a free-lance occupation in the British colonies until wellafter independence; not so in the Spanish area where the Protomedicate kepta watchful control. However, aboriginal medicine, being a great part of thereligious and cultural background, was used-as it is still nowadays-by large

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Medical Colonization of the New Worldmasses of the population steadfast to the Indian tradition. It may be wise atthis point to recall that even the greatest conquistador of all, Cortes, had a greatrespect for the ability ofthe Mexican aboriginal physicians and resorted to theirtherapeutics.

HospitalsExcellent hospitals were founded at an early date throughout Spanish

America, as is shown in the map. The first was opened in I50I at SantoDomingo and after that there was no community with an average populationwithout a hospital throughout the colonial period. Some of them, such as theHospital de Jesus in Mexico City, are still in daily use. It would not be possibleto explain the flourishing ofhospital institutions and their deep catholic meaningwithout the charitable work of the religious orders in charge of them. Printedregulations give a clear idea of their organization, personnel and methods oftreatment; some large cities, like Lima, had more hospitals than churches, andin some viceroyalties there were fifteen beds ready to account for the care ofevery thousand inhabitants. Going through some printed statistics it is possibleto gather information on the quality of their services, such as in the case ofhospitals attended by members of the order of St. John ofGod, where mortalitywas under seven per cent, computed for a population of over one hundredthousand patients.The foundation of the Pennsylvania Hospital at Philadelphia in 1750 is the

first establishment in the British Colonies that may be compared with sisterinstitutions farther south, because the pest-houses and inoculation hospitalswhich spread throughout the thirteen colonies were not 'hospitals' in our senseof the term. They were opened, often in private houses, on the spur of themoment, under the menace of epidemics, and the practice of the inoculatorsgave them more the character of dispensaries.

EducationAlthough Santo Domingo had, in 1538, the earliest institution of higher

learning in America, the Universities of Mexico and Lima, founded in I55I,share the glory of being the mothers of western culture in the American hemi-sphere. Medical education was available, at least in Mexico, even before theChair of Medicine was created in I58o; Lima had one in I62I and Havana inI726. Medical students came there from the Spanish or creole classes, althoughby the eighteenth century, in spite of the regulations on 'blood purity', manya mestiso and mulatto can be found in their rolls.The controversy between medicine and surgery in Europe was also echoed

in Spanish America, and the divisions can be observed in the teaching of thosesubjects. The identity of the examining board of the university with the one atthe Protomedicate gave colonial education there a procedure similar to thatstandard in the present day. The methods of teaching, the texts, and thedoctrines were very much those used in Spain during the sixteenth century,although some clinical work at Lima under Unanue appears really as moreadvanced in scope than the metropolitan model. The weight of institutional

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tradition and the rule of the Protomedicate accounts for both the early appear-ance of medical schools and their subsequent atrophy within the old patternduring the eighteenth century.

In North America, on the other hand, it was during the eighteenth centurythat young Americans like Morgan and Bard returned to Pennsylvania andNew York after being trained at Edinburgh or Leyden, to start medicalteaching with a new, modern curriculum. The lack of centralized authority orexamining board with power to restrict practice to graduates of the recentlycreated institutions, together with the fact that a great majority of the medicaland pharmaceutical profession in those British colonies were self-trained oreducated under apprenticeship, limited the social prestige and influence ofuniversity education until very recently.

PublicationsPrinting was the most important instrument for the colonizing powers of

America, both for religious and political aims. Portugal did not dare to havea press in Brazil until I747, and this was closed immediately after publishingthree works, to be re-established only in i8o8. The British Colonies in NorthAmerica had a printing shop from I639, but considering the background of theSpanish colonization it is amazing to find printing shops operating in Mexicofrom 1539, and very shortly in many other places in Spanish America. In thoseyears the nailing of the ninety-five propositions of Luther in i517 could still beheard. It must be added that a good many of the earliest printers were comingfrom areas of the Spanish Empire tainted with Protestantism. The only answercould be the extended use of the early press in the publication of Catholicdoctrines for the Indians and of-books on Indian languages to help in thecolonization.

Medical publications started in Mexico with the Phisica Speculatio ofVeracruzin 1557 and by the middle of the seventeenth century show a superb repository.Mexico had also the first medical journal, the Mercurio Volante, in I772, but thepublications that give the characteristic flavour to medical literature in Americaare not the big books but the small pamphlets. In the British Colonies medicalimprints appear about a century later in Massachusetts, not until I785 inQuebec, Canada, and finally in I809 in Rio de Janeiro, Brazil. The map offersa varied landscape of cities with printing shops and the most important titles ofmedical works issued. A figure in parentheses is given for each area, indicatingthe approximate number of medical imprints published during the colonialperiod.

However, some notes are pertinent in this respect. The thirteen BritishColonies obtained their independence in I783 while most Spanish AmericanColonies did not gain it until I821. Cuba, on the other hand, remained underthe Spanish crown until the end of the nineteenth century. The knowledge ofmedical printing in America is far from complete and some Caribbean areas,such asJamaica or Haiti, were more important centres of medical printing thanmuch larger colonies like Canada or Brazil, and with more interesting subjectsto offer.

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0ue1mc M. 1847

Montreal M. 1824M. 1843

Toronto M. 1842

Boston U. 1636M. 1782

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No. York M. 1768

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GUADALAXARA Polo.ed.cato. N....o d. Vi,.ui-,. 1798 (1345PUEBLA Paejo. Theat- Apollirm,. 16.40

MEXICO Ve.c,.z. Phisica Spec.lt;o. 1557k0.o. Op.ro Medicinli.. 1570L .pez. S.mm. de Chirrgia. 1578F,o... T.octdo de Medici- 1592Bo.i.s. V.d4ed.o MAedicino. 1607X;m nez. Virtudes de las Plonmas. 1615C;sn ros. Sitio de Me.ico.1618/Solgodo. Cursus lAodic. Me.ican.s. 1727/b ,fol.che. Merc.rio Voloe. 1772

GUATEMALA FlRam, Metodo de Vi;.*Ia. 1734Leo.. Propi.dades del Bol,o.m 1756Ewp.r.,oa.. MItodo obstetico. 1798

STA. FE EOGOTA Mwti, Metodo de lIs Vi.,I.s. 1782

S. FCO. 0UITO Roso,io. I.s..ccio. del Saro,pio.. 1785

LIMA D..los. Misc-lan,o A.%#-I. 1602Fig..uro. AloIp y Gorotillo. 1616Amuzgo. Tro;-minto ocrompion. 1618N....ro. Songro y purg... 1645qotoni. Circ.lIcion de Io .ong.. 1723Unonu. Tfo.edo de Io Co.w. 1794UnIn... Clinmo de Lima. 1804VilIIlobos. Trto.do del Tobordillo. 1800

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NEW YORK 6. Angin Sffo..e... 1771Jone. T....,.. .f Weh.d.. 1775

PHILADELPHIA Fmnklin. Ih.nylvon;i Hospital. 1754MA.g.. Medical Schools. 1765

HABANA Almo. Dietocion C.ns. 1707

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Medical Colonization of the New WorldResearchA striking characteristic of Spanish America is, perhaps, the numerous

expeditions undertaken during the colonial period aimed at enlarging theknowledge of natural resources. Historians seldom appreciate the fact that oneofthe motives for Columbus's voyages was the Spanish need to secure the spicesand oriental drugs direct, and so to avoid dependence on the Venetians foritems of high importance in the preservation of the food and health of theSpanish armies. The conquistadors and their writers described the New Worldnot only as the sources of gold and precious stones, but also as the land of themarvellous Balsam to cure wounds, the cathartic Jalap root and the strangeCoca. These three were well known to the Indians as also were the anthelminticproperties of Chenopod, the antidysenteric action of Ipecac and the paralysisproduced by Curare. However, the same cannot be said about Cinchona, whichwas known to the Europeans by the middle of the seventeenth century. It is abitter turn offate that a plant, the most American ofall, Tobacco, which startedto be used as a remedy for cancer, is now being accused of inducing the evil itwas expected to cure.The contributions made in other areas in the field of therapeutics were very

limited. Only in the south of the thirteen British Colonies did medicine try toincorporate local remedies used in the plantations, which brought into theEuropean pharmacies the root of Seneca.The religious influence on medical research becomes clear when it is realized

that, with the exception of a few highly qualified expeditions organized by theSpanish crown, most of the early geographical, botanical, ethnographic andgeneral descriptions of scientific interest came from the hands of Catholic friarsengaged in the propagation of their faith. Their chronicles have remained foralmost five centuries the best sources of reference for our basic knowledge ofAmerica and American civilization.

Politics also have an effect on medical research in that continent. TheSpanish government regarded all information pertaining to America as a matterofhigh political secrecy. It was important that the English, or any other foreignpower, should not learn of the movements of the Spanish treasure-ships, northe locations or resources of Spanish establishments, because that would be tosupply pirates and privateers with a guidance in their enterprises; but themedical information pertaining to American drugs was also a matter of greatpolitical interest, and the Spanish books referring to them were readily trans-lated into English or French.

Politics also had a curious twist because, during the sixteenth and seventeenthcenturies, the Spanish crown, in the hands of the Austrian dynasty, consideredboth British and French as its enemies and Germans and Flemish as its naturalallies. Exceptionswere made for the Catholic Irish during the eighteenth centurywhen many of them received high positions, and became viceroys and proto-medicates. Therefore, Spain handed the monopoly of the two most importantAmerican drugs, the antisyphilitic Sarsaparilla and Guayaco wood, to theGerman banker Fugger, and the Balm went to the Welsers. However, in theeighteenth century, when the Spanish crown fell to the Bourbon dynasty,

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French scientists poured into the Spanish institutions in the peninsula or wentto America, particularly under Charles III and IV, as a result of the so-calledBourbon 'pacte de famille'.

CONCLUSIONS

The religious denominations of the colonizing powers in America, bothCatholics and Protestants, had a considerable influence upon the developmentof medicine in the New World, and, furthermore, gave to the practice and tothe present-day institutions distinctive characteristics that evolved from thecolonial period. The political systems of the colonizers were also important informing medical policies and embodying them in legislation.

Finally, it was the European and not the indigenous element which domi-nated the shaping of medicine in the American continent during the years ofcolonization.

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CASCAR 76LOBELIA 1530

NEW ENGLA1606-170/

NUEVA ESPAA

COCOA 1525 Crz A o 550-2JALAPA 1569 Fro cisco Hernend^1571-7_

Brnerdine Sehogun 1580-9 _TOBACCO 1556 Nicol. M.ed., 156-71

5.,. & Moti0o 1796-99Xime..z & Niewberg 1615-35klimis & Sel 1803-06 Long... 6Ms iiz 1794-97

BALSAMUM 1570 Mwo61ls & Ponie. 1786-88INDIGO 1750 Cort & Sol 1781-56CHENOPODIUM 1570 Mti; & C.lds 1782-1806

Pio & Mon%.r 1799-1804Co.lri.* A Ju,i.u 1737-39

CINCHONA 1630 Hmb.oldt & Bonplene 1799-1804COPAIIBA 1641 Gurrero & AIc.do 1786-89

COLONIAL COCA 590 J- A-F.STUDIES jt, °

Juan & Ullo.

EXPEDITIONSDRUGS

1494-951526-35

CURARE 1741

Jose Gu;llo 1730-40

1635-391777-801735-36

WAl.spi.o & Pin.do 1794-95QEqisBRm6ACrIO 1745-52P*dre Monte.egro 1705-10

QUEBRACHO 1710



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medical of the new world · medicate after i646 were the professors ofmedicine in mexico and peru,...

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