Julio Sánchez Álvarez, El protomedicato navarro y las cofradías sanitarias de san Cosme y san Damián: el control social de las profesiones sanitarias en Navarra (1496–1829), Temas de Historia de la Medicina, 9, (Pamplona: Departamento de Salud, Gobierno de Navarra, 2010), pp. 365, €9.00, ISBN: 978-84-235-3154-7.

Abstract

Navarre, one of Europe’s mediaeval kingdoms, was situated on both sides of the Western Pyrenees. In 1512, it was annexed by the Spanish monarchy but maintained its privileges and legislative capacities until 1841. This book deals with the regulation of the healthcare professions during the above period, a subject about which, up to now, we have had very little information due to the scarce documentary sources available. The author states that until the fifteenth century there were no bibliographical sources for the control of healers, that there was no university in the kingdom, and that there were flourishing Jewish communities in the main enclaves, which leads us to believe that the healers were from many different places. In 1496, when Navarre was still an independent kingdom, the first healthcare guild was set up under the protection of Saints Cosmas and Damian, and was awarded the monopoly to issue licences for the practice of physicians, chemists and surgeons in Pamplona and seven leagues around the city. The institution enjoyed royal protection and was extremely powerful for almost four hundred years. Since around 1430, the Protomedicato tribunal had existed in Castile; this institution was set up by royal decree to examine and license candidates for the healthcare professions. This tribunal hunted down professional quackery, imposed fines and sentences, and had legal responsibility on civil and criminal cases in which healthcare workers were involved due to their profession. Moreover, the members of the tribunal inspected the druggists’ and spice merchants’ stores. The author explains that the reasons behind the founding of the Protomedicato in Navarre (1525) were political: it was the only way for the Castilian authorities to intervene in the country, circumventing the complications of Navarrese law and the privileges of the Pamplona Health Guild. This book by Julio Sanchez Alvarez was originally written as an academic work for the author’s doctorate in medicine; his research was directed by Professor Pedro Gil-Sotres, who has written the prologue for this edition. Its main achievement is the use of abundant manuscripts and unpublished documentary material from the General Archives of Navarra, one of the richest and best-organised archives in Spain. Sanchez Alvarez has made excellent use of the legal actions taken by the tribunal members and the Pamplona guild members over the centuries in his reconstruction of the Navarrese Protomedicato tribunal from its foundation, and step-by-step has followed the activity of the healthcare guilds in Pamplona, Tudela and Estella. This work clearly and reliably describes the struggle for the different powers that the tribunal and guild members were not prepared to surrender; the conclusion is that the creation of the guilds in Estella and Tudela was a reaction to the Protomedicato tribunal; and it shows the significance, for the guild members, of being appointed members of the tribunal. It also describes the most important medical individuals in Navarre between the fifteenth and eighteenth centuries. Sanchez Alvarez shows how professional regulation was one of the areas where the Navarrese institutions, both civil – the government of the kingdom or the Navarrese court – and professional, fought to maintain their independence from the central powers. This meant that, although the Navarrese Protomedicato tribunal was based on the Castilian model, its course did not run parallel to it. There is no doubt that this book will be an essential work of reference for any future studies which may be carried out on the world of medicine and the medical institutions in the ancient Kingdom of Navarre. For all healthcare historians, reading this work will be worthwhile for its reconstruction of the past from archival sources, and because it is a perfect example of the confrontation of the different institutions in the shaping of the healthcare professions in Europe. The powers-that-be are often said to have watched over the preparation and training of healers because of the enormous effect of their work on society. Sanchez Alvarez’s work shows that there were other, more covert vested interests among individuals and the local or general politics of the kingdoms.