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

How does one reinvigorate an ailing empire? This question had vexed many observers of the Spanish Empire since at least the late sixteenth century. In the early decades of the eighteenth century, under the auspices of a new ruling dynasty, the Bourbons, advisors and officials initiated a series of reforms aimed at restoring Spain's standing as an imperial power, an effort known to historians as the Bourbon Reforms. Many proponents supported some combination of greater political centralization, increased tax revenue from the colonies, and stronger military defenses in Spanish America. In Lima, however, a small but vocal group of creole (that is, American-born Spanish) physicians suggested that a different approach was needed for Peru; in their view, its sparse population was the main obstacle to regional and imperial prosperity. More people, they argued, would mean more economic productivity, which in turn would mean more tax revenue. These physicians also believed (albeit incorrectly) that Peru's population was in decline and that disease was the culprit.

Adam Warren's book explores the contentious and largely unsuccessful efforts of these creole physicians, from 1750 to 1850, to implement a series of measures to prevent disease and promote health while strengthening their own professional authority. In the first chapter, Warren explains how the Bourbon Reforms created the conditions in which creole physicians could assert themselves as the new leaders of the healing community in Peru after 1760. The Crown's general efforts to further limit the power of the Church in Spanish America undermined Peru's existing tradition of "religious medicine," in which religious organizations ran hospitals where healing was generally understood as a form of "Christian piety and charity" (16-17). In Lima, creole physicians were quick to step up as the influence of religious institutions seemed to be in decline.

Creole physicians' efforts to assert their authority took many forms. In the second chapter, we learn how, from 1760 to 1810, they contested the authority of Lima's surgeons in an effort to establish themselves as Peru's preeminent medical experts. Since most surgeons were black or mulatto, there was also a racial and ethnic dimension to their professional contests with creole physicians. The following chapter shows how the latter, at the end of this period, even challenged the medical authority of the Crown's representatives, exploring the contention surrounding the arrival of the Royal Philanthropic Vaccine Expedition in Lima in 1806. Whereas government officials and healers elsewhere in Peru had greeted José Salvany y Lleopart, one of the expedition's leaders, with much fanfare, Lima's creole physicians were much less enthusiastic. It turns out that in the decades preceding Salvany's arrival, they had come to understand themselves as experts in treating smallpox as a result of their own experiences with variolation and even the smallpox vaccination, which arrived in Lima before Salvany did. Consequently, creole physicians viewed Salvany's arrival as a threat to their own medical authority. While there is much more depth to this episode in the book, this brief sketch gives a sense of the style of Warren's approach, which foregrounds local conditions over trans-Atlantic ties. Regarding the smallpox vaccine, he suggests that the reaction of creole physicians is better understood as an attempt to safeguard their recently established and still fragile medical authority, rather than some knee-jerk attempt to resist royal power.

Overall, Warren does an excellent job of emphasizing the complex local conditions in which these creole physicians operated—an approach that nicely eschews the overly simplified dualities between metropole and colony or creole and Crown which pervade much of the literature on the Bourbon Reforms. This feature is most apparent in the second half of the book, in which Warren shows how these physicians had to take into account local healing practices and popular customs as much as they did royal policies. The fourth chapter recounts the fascinating case of Balthasar Villalobos, a creole...