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

The beauty of Adam Warren’s Medicine and Politics in Colonial Peru is that it breaks apart two common misconceptions about exactly where the South American colonial era ends and where Independence begins. The study of dates easily leads scholars and students alike to situate Latin American independence on the heels of the Enlightenment, the French Revolution, and the US War of Independence. While this is obviously true on the time line, it is not necessarily so on the cultural trajectory formed by attempts to overcome what Aníbal Quijano has described as a coloniality of power, social hierarchies of power formed by racial constructions. Certainly, when General José de San Martín declared independence in 1821, or when General José Antonio de Sucre defeated the remnants of Royal troops in 1824, Peruvians did not eradicate coloniality of power. This has been known since the nineteenth century and has been probed by essayists as diverse as Manuel González Prada and José Carlos Mariátegui. Yet there has been insufficient investigation into the degree of coloniality or, inversely, of cultural emancipation, to overcome traditional notions of Independence. In Medicine and Politics in Colonial Peru, Adam Warren offers detailed evidence on the evolution of medicine in Peru that shows how the new Republic not only failed to prevail over colonial hegemony but actually slid backwards toward earlier colonialist constructions of medicine. Conversely, Warren documents how attempts at medical reform (although ultimately unsuccessful) were not concomitant with political Independence and can actually be traced back to Creole reformers operating in the context of the trans-Atlantic Bourbon Reforms. Warren shows that not all these elements of reform emanated from the Crown and, that in Lima, there were efforts by progressive Creoles who saw themselves, if not on the same level as the Peninsular Spanish medical establishment, then surely in a way that denoted Creole pride resulting from achievements cultivated locally in Lima.

Warren sets about to document this important revelation by examining a series of medical concerns that lend themselves to painting a picture of how medicine intersected with politics in the middle period of Hispanic Peru (Mark Szuchman fixes this phase in Latin American history as during the seventeenth, eighteenth, and nineteenth centuries). Warren begins in chapter 1 by reviewing the diverse hospitals and other medical institutions established in Lima during the early colonial era, and then gets underway examining the trend over the centuries toward professionalization in the medical establishment: the Peninsular-Creole disputation regarding the implementation of a new small pox vaccination, a claim of a treatment for leprosy, the conflict between Church and State and burial reform, and the friction between Creole broad-based notions of medical education and the “modern” idea of clinical practice in the medical curriculum.

Chapter 2’s discussion of the polemic on the professionalization of the medical establishment fits into coloniality of power politics with the struggle between elite physicians and middlebrow or lowbrow surgeons. Warren explains: “the majority of Lima’s physicians were creole Spaniards, and the majority of its surgeons were blacks or mulatto castas” (50). Despite the ethnic tensions that were obviously permeating the air, elites who edited and published in the prestigious Mercurio Peruano made every effort to work against metropolitan theories of social degeneration in the colony and proudly argued that “its inhabitants were more robust than many Europeans” (54); this, even though there were ongoing efforts to “displace surgeons and folk practitioners” (77) in the quest to professionalize the medical profession.

Chapter 3 depicts the evolution from one cure of smallpox, variolation, to another, vaccination, and the trans-Atlantic politics that occurred with the implementation of the latter. Warren clarifies just how “benevolent royal paternalism” (96) was received by the Creole establishment (not very well) and he demonstrates how trans-Atlantic tensions shaped medical politics in the first decade of the nineteenth century.

Chapter 4 deals with leprosy and how the Lima-born Baltasar Villalobos...