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Reviewed by:
  • Learning to Heal: The Medical Profession in Colonial Mexico, 1767–1831
  • Anne-Emanuelle Birn
Luz María Hernández Sáenz. Learning to Heal: The Medical Profession in Colonial Mexico, 1767–1831. American University Studies, series XXI, no. 17. New York: Peter Lang, 1997. x + 301. Tables. $48.95.

Oddly entitled Learning to Heal (like Kenneth Ludmerer’s 1985 classic account of U.S. medical education), Hernández Sáenz’s book has far more to do with the social economy of healing in late colonial Mexico than with the education of medical professionals. Drawing on extant records of colonial practitioners and their governing bodies, this volume offers a cornucopia of information and anecdotes about how healing was organized, who was allowed to practice, the theoretical and empirical basis for therapeutics, and the curious and creative admixture of Hippocratic, Galenic, and European Enlightenment influences with Nahuatl and other autochthonous healing practices.

The book is organized around major divisions of eighteenth-century healers: physicians; surgeons; pharmacists; the “lower echelons” of bleeders, midwives, and nurses; and illegal practitioners. Hernández Sáenz seeks to recount both intellectual developments and the social context of medical practice in the wake of the modernizing Bourbon reforms; beyond a kaleidoscopic background chapter, however, we hear little of the interplay between medical practice and Bourbon efforts to concentrate power and expand the economic output of New Spain through innovations in precious-metal mining and agricultural production, and social tolerance of mixed-blood subjects. The author is overly ambitious in this sense, for a book that deposits rich descriptive soil in the formerly fallow field of the organization of healing in colonial Mexico cannot easily realize the additional goal of tracking its modernizing trajectory.

The most interesting aspect of the book is Hernández Sáenz’s analysis of the hazy lines between licensed and illegal practitioners. She goes far beyond existing monographs to demonstrate that the rules of the Protomedicato (the Spanish royal medical board) could not be rigidly implemented, but were shaped by colonial exigencies. We learn that limpieza de sangre—literally “blood cleanliness,” signifying pure Spanish ancestry, and a major criterion for permission to practice as a physician—was frequently violated in New Spain. Limpieza de sangre was breached through bribery and deception, but also, according to the author, as a result of the shortcomings of legal physicians, whose often-limited healing success did not satisfy demanding criollo colonists and the increasingly influential mestizo population that was content to accept syncretist practices. [End Page 707]

Suggesting fruitful avenues for future scholars is the chapter on pharmacists and pharmacies documenting the varied origin of medicinal remedies imported to the port of Veracruz in 1808 from France, Spain, South and Central America, Manila, the Caribbean, and the southern United States. Unfortunately, the author makes ex post facto judgments of the “real” effectiveness of some remedies—a spurious path for this genre of work.

Most disappointing is the discussion of the lower echelons of healers (which, according to the author’s categorization, excludes shamans as indigenous healers not subject to the Protomedicato). The chapter enticingly introduces the important role of male nurses. Nursing was a point of entry to the medical profession, for it was the only area not subject to the Protomedicato or, consequently, to the barriers of limpieza de sangre. But evidence remains scanty. Like the investigator who loses his keys on one side of the street but searches for them on the other because the lamppost is there, Hernández Sáenz is limited in what she can find in colonial archives. Speculation about midwifery is especially frustrating, as only a small proportion of midwives were registered. The author states that the elitist Protomedicato’s contempt for lower-echelon practitioners was manifest in neglect and criticism, but then argues that obstetricians used tighter controls on midwives in order to exclude them from this lucrative area of practice. Recent case studies on the persistence of midwifery for at least another century—such as Ana María Huerta’s work on Puebla—suggest a more complicated story.

Notwithstanding these criticisms, Learning to Heal stands as a groundbreaking introduction to the organization of healing in colonial...

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