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

2 Professionalizing Healers and the Bourbon Politics of Reform,1760–1810

49 Professionalizing Healers and the Bourbon Politics of reform, 1760–1810 2 In November 1792, creole doctors, high-ranking members of the Church, government officials, and other prominent residents of Lima inaugurated a facility that they believed would transform the role of medicine in society and improve the health of the colony: an anatomical amphitheater . An inaugural speech by the city’s leading physician, Hipólito Unanue, made evident the degree to which these collaborators on medical reforms saw themselves as heroic, patriotic, enlightened subjects working on the Crown’s behalf. Unanue proclaimed that they advocated a new medical model, one based on the value and transformative potential of medicine as “useful knowledge” and one that would soon replace the less scientific view of medical care that was more focused on religious principles . This new model, he added, would solve many of the problems colonial officials and the colony’s elite had faced in recent years. In particular, it would address ways to deal with diseases and epidemics, the insufficient number of doctors, the poor conditions of hospitals, and the regrettable state of medical training in the colony. A creole physician born in Arequipa and trained in medicine in Lima, Unanue declared in his speech that this moment constituted a turning point because Peru had languished for centuries due to its inadequate warren text i-290.4.indd 49 7/23/10 10:42 AM 50 Professionalizing Healers and the Bourbon Politics of reform system of medical education and knowledge production. As a result, the colony suffered from dramatic depopulation, its farms remained uncultivated and its mines unproductive, and its urban residents endured innumerable maladies and the consequences of poor hygiene. These conditions also hindered the colony’s progress by reducing labor output and limiting revenues. In calling for greater intervention by properly trained doctors, Unanue thus compared Peru to other empires around the world that were thought to have too few subjects. He described such territories as “vast spaces of solitude that, far from increasing the reputation of the throne, undermine its vigor; they are a grave and prejudicial thing to bear.”1 Throughout his speech, Unanue stressed the need to develop doctors’ professional knowledge, expertise, and influence so that medical reforms could be successfully implemented and population growth could begin. He proposed overhauling the woefully inadequate medical curriculum at the University of San Marcos and giving doctors more prominent roles in elite society and politics. More specifically, he emphasized developing proper instruction in anatomy through the practice of dissection in the new amphitheater. He argued that solid anatomical training would provide doctors with a clearer understanding of the workings of the human body. Such training would enable them to make more precise diagnoses and give them the necessary knowledge to develop more successful preventative measures, treatments, and cures. He stated without hesitation that through “enlightened instruction of this science that preserves humanity, you will restore the colony’s opulence and splendor.”2 As with other creole physicians, however, Unanue also believed that transforming the status of their profession depended on subordinating other groups. For years, physicians and government officials had advocated limiting the authority of various kinds of unlicensed practitioners and establishing the superiority of medicine over surgery, a rival profession that enjoyed considerable popularity among various sectors of eighteenthcentury Limeño society. By basing the reform of medical training on dissection , a surgical art, in order to teach doctors anatomy, Unanue hinted in his inaugural speech at tensions between physicians and surgeons that had intensified by the 1790s. Fueled in part by racial animosities—the majority of Lima’s physicians were creole Spaniards, and the majority of its surgeons were blacks or mulatto castas—such tensions hindered the formation of alliances across the professions and ultimately undermined physicians’ own reform efforts. For their own part, Lima’s surgeons persistently challenged Unanue’s warren text i-290.4.indd 50 7/23/10 10:42 AM Professionalizing Healers and the Bourbon Politics of reform 51 new campaign for medical professionalization between 1792 and 1810, and they disputed his attempt to control the teaching of anatomy. Under the leadership of an ambitious surgeon named José Pastor Larrinaga, their efforts culminated in 1804 with the opening of an alternative venue for anatomical instruction in the Hospital of San Bartolomé, Lima’s treatment facility for blacks and mulattoes. To flaunt and publicize their attempts to challenge physicians’ expertise in...