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

6 Medical Education and the End of Medical Reforms,1808–1840

192 Medical education and the end of Medical reforms, 1808–1840 6 Writing a series of narratives in the late 1830s and early 1840s about his time in South America, the Swiss traveler Johann Jakob von Tschudi provided a revealing assessment of Peru’s creole-led medical reform movement two decades after independence. Von Tschudi focused on medical education in particular and on the expertise of Lima’s doctors more generally. In his analysis, he blamed persistent health problems in the republic squarely on an institution physicians had founded in 1808 to assert their dominance over surgeons, improve the healing arts, increase the number of formally trained doctors, and expand the colony’s population : the Colegio de Medicina y Cirugía de San Fernando (School of Medicine and Surgery of San Fernando). Noting that the colonial-era school, which was introduced briefly in chapter 2, had been renamed the Colegio de la Independencia after the end of Spanish rule, von Tschudi suggested there was a certain irony to its new name. He wrote, “Effectively, it deserves this name, since the teaching there is distinguished by a strange independence of order, system, and rationality. The school of medicine is the worst of the three [schools] in existence. The professors, who never enjoyed a reasonable education, communicate what little they know to warren text i-290.4.indd 192 7/23/10 10:42 AM Medical education and the end of Medical reforms 193 their students in a fashion that is even more deficient. All their sciences are centered on Galen, Cellen [sic], and Broussais, all of them misunderstood and distorted.”1 Von Tschudi’s perspective as an outsider reveals the eccentricities and intellectual confusion of a school that had failed to modernize , train students thoroughly, or draw comprehensively on medical literature from Europe. It thus deserved little of the praise showered upon it during the planning stages several decades earlier, when one physician, Miguel Tafur, confidently predicted it would serve as a key medical reform , a school “where those dedicated to the rescue of humanity will be educated with exquisite discernment, with healthy judgment, [and] with a character of sweetness and strength.”2 Von Tschudi was not alone in articulating dismal views of medical education in the recently independent Peruvian republic. Although the conditions he described in the late 1830s had certainly left much to be desired, they had actually been typical of the facility for years. During the 1820s, the Colegio de la Independencia faced uncertain legal status, chronic financial shortfalls, and abrupt changes in administration, all of which compromised instructional quality. During the 1830s, the school functioned only intermittently and drastically reduced its course offerings due to uncertain sources of revenue, which led some to propose sweeping measures and solutions. For example, writing anonymously in 1833 in the newly restarted Mercurio Peruano to shed light on the medical reform movement’s fragmentation and ideological stagnation, one author stressed the need for change in an article entitled “No más protomedicato” (“No More Protomedicato”). He despaired that students in the Colegio de la Independencia learned about medicine only by reading in solitude, rather than through lectures and clinical practice. As a result of this distorted scholastic method, he suggested, “one must not get hopes up that a single student will leave the school who deserves the title of doctor, even though the youths may be of the greatest aptitude.”3 For this anonymous contributor to the Mercurio Peruano, however, reform and modernization could not be achieved by simply addressing revenue shortfalls, curricular issues, and internal problems at the Colegio de la Independencia . Signing his article “one who is interested in the public good” and invoking the language and goals of the medical reform movement, he suggested emphatically that “the teaching plan of the medical school requires a fundamental reform, for which it is necessary to begin by extinguishing the Protomedicato.”4 As a practical first step, he proposed replacwarren text i-290.4.indd 193 7/23/10 10:42 AM 194 Medical education and the end of Medical reforms ing the medical examiner’s tribunal with a junta of six or seven professors working under the name Facultad de Medicina (Faculty of Medicine). This arrangement, he argued, would transform and modernize medical teaching quickly and efficiently. The protomedicato, a medieval Spanish institution that licensed and regulated healers of different kinds, had obstructed the progress of medicine in...