El hospital en Hispanoamerica y Filipinas, 1492-1898 (review)

Lest anyone on reading the title expect a major work of synthesis or critical analysis, this book is simply a census of exactly 1,196 hospitals founded by the Spanish between 1492 and the end of the nineteenth century in the New World and Asia. Although the entries vary considerably in length, from one paragraph to sometimes an entire page, the information supplied concerns basically dates of foundation, patrons, possible financial arrangements, location, institutional capacity, and staff. The text is well illustrated with drawings, architectural plans, and photographs—some in color—and printed hospital statistics.

To increase its usefulness as a work of reference, Guerra’s book is divided into twenty sections, geographically arranged from Santo Domingo to Japan and along colonial administrative lines. Moreover, an extensive bibliography with more than eight hundred entries (few from English-writing authors), two indexes (of illustrations and topographical locations), and a chronologically arranged list of hospital foundations provide valuable guidance. Readers will be immediately impressed with the scope and detail of the data presented here. Undoubtedly, this book has been a labor of love, an endeavor that, the author indicates, took close to fifty years to complete. As a collection of basic facts, it will prove invaluable to anyone researching the subject in decades to come.

In a brief introduction, Guerra acknowledges that in establishing hospitals after the conquest, Spain could draw on a variety of European models—from monastic infirmaries to leper houses, as well as specialized institutions devoted to the care of the mad and those afflicted by venereal syphilis. He also emphasizes the religious motives involved in hospital foundations, the multiple sources of patronage, and the uniqueness of the royal sponsorship. Less attention is given to the political and economic agendas linked to humanistic and religious concerns. Social control, especially in New Spain, was paramount when the demographic catastrophe fueled by the high mortality of epidemic diseases threatened to depopulate and disintegrate the colony. Here hospital foundations, especially the new “hospital-republics” or pueblos arranged around the activities of a central church/shelter and infirmary, managed to bring together the scattered natives orphaned by the wars of conquest.

In the end, Guerra declares that hospital assistance was the most important aspect of the colonizing effort of Spanish medicine in the New World and the Philippine Islands—a somewhat dubious judgment if one takes into account the small size of most hospital foundations and their chronic lack of funding. While millions of New World inhabitants perished—victims of epidemics, malnutrition, and exploitation—only a few thousand were able to find shelter and care in such establishments. Another glaring omission is the author’s failure to shift his focus from the hospitals as centers of love and charity to a much broader view of them as contact points and instruments of assimilation between two distinct cultures. The perspective remains ideologically Spanish, immune to the recent reexaminations and revisionist efforts exposed at the celebration of America’s quincentennial “encounter” rather than “discovery.” Such a perspective demands a new scaffolding capable of including all the participants in the colonial endeavor.