Medicine and Politics in Colonial Peru: Population Growth and the Bourbon Reforms

Abstract

A new generation of scholars is examining the complex outcomes of the Bourbon reforms in the Spanish colonies. Adam Warren’s Medicine and Politics in Colonial Peru: Population Growth and Bourbon Reform is a creative addition to this intriguing literature. Putting doctors and medicine at the center of the story allows Warren to expose the multiple and complicated interactions among numerous social and cultural groups in late Peruvian politics and society. The book takes as its initial premise a study of the role of physicians in constructing a vision (that ultimately failed in this period) of a modern Peru with a healthy, growing population. Exploring this question and its implications from a number of angles, the book also leads us to detailed discussions of a range of fascinating trends, such as conflicts among physicians and popular healers; late colonial, trans national dynamics of policy making and rule; tensions between doctors and the church, with the state as an intermediary; and a variety of popular beliefs and practices that intersected with medical ideas.An introduction that lays out the goals, historiography, and larger historical context of late colonial Peru is followed by six chapters and a conclusion. Chapters 1 and 2 discuss in detail the structural context of the proposed and enacted medical practices: first, a history of medical and hospital infrastructure as embedded in larger institutional changes in state and church policy; next, a look at the power struggle between doctors and other healers, including surgeons and Afro-Peruvian healers. The remaining chapters take on specific events or themes, all of which provide a window on the larger social and political struggles in the late Bourbon era and through the first decades of the postindependence period. A chapter on diverging strategies for smallpox vaccination in the first decade of the nineteenth century reveals the ambitions of creole (local elite) doctors as well as the limits of their power. Next, a chapter on leprosy demonstrates the hesitant progress made by physicians who tried to strip the disease of its Biblical stigma and “made it central to the processes of medical modernization and colonial scientific knowledge production” (p. 156). Chapter 5 takes on the clash between state reform and common burial practices. Warren uncovers the complex tensions between Bourbon medical ideas about health and disease prevention and popular religious beliefs about piety, a “good death,” and the afterlife. This chapter is enlivened by the details of popular funeral rites, including how those practices were cut through by difference in race, class, and age of the diseased. Chapter 6 reviews postindependence reforms in medical education, a subject of vital importance to the new nation. Despite their lofty goals and valiant efforts in the previous decades, doctors were unable to gain the political support to modernize, and to a certain extent, secularize the nation’s main medical school. (Warren points out that medicine in Peru, then and now, is highly centralized in the capital city of Lima.) This story of failure rested on a combination of factors, including the continued strength of the church, and the politicization of many prominent doctors, who themselves became enmeshed in politics to the detriment of their medical careers. Ultimately, the creole doctors’ vision was not strong enough to overcome the political, social, and cultural conflicts of the era.In a conclusion, Warren places the larger study in the context of the historiographies it intersects: the history of medicine, Peruvian history, and comparative colonial history. Indeed, the book is a rich contribution to these literatures. He also argues here that the study of medicine in late colonial Peru, until now largely overlooked, shows us that “the roots of medical modernization and innovation extend much deeper into the colonial period” (p. 223). While the ambitious visions of medical reformers failed in the face of larger forces, “creole medical politics and discourse nevertheless carried over into independence and influenced early concepts of public health” (p. 229). Medicine and Politics in Colonial Peru will be of interest to comparative colonialists as well as Latin America specialists. The book’s clearly written narratives and engaging detail make it a good choice for both undergraduate and graduate courses in colonial Latin America and the history of medicine.