Barberos, cirujanos y gente de mar: La sanidad naval y la profesion quirurgica en la Espana ilustrada (review)

Spanish medical institutions and professional roles changed greatly and often from 1712 to 1805, the period covered in Astrain Gallart’s book. Although the work is mostly devoted to naval surgeons, it provides an excellent guide to the modernization and professionalization of surgery in Spain, with the events that affected army, navy, and civilian surgeons in the eighteenth century. These developments reflect the interplay of the new Bourbon monarchy in Spain, with its efforts at the centralization of government structures and the improvement of the navy; the immobility of universities (“bastions of closed minds” [p. 118]) in regard to the training both of surgeons and of physicians who would incorporate anatomic knowledge into their expertise; the struggle of physicians to keep surgeons in a socially and professionally inferior position; and the efforts of the new academic surgeons to keep themselves separate from barbers and empirically trained practitioners. Astrain’s book is a particularly welcome guide to the frequent and contradictory rulings that kept separate, then merged, then separated again the professions of medicine, surgery, and pharmacy in Spain in the 1790s.

The changes throughout the century are examined in five major chapters: legislation regarding naval hygiene; the formation and functioning of a corps of naval surgeons; their theoretical and practical training; their working conditions and social standing; and their change from a guild orientation to being state-employed professionals. A brief epilogue and appropriately placed references throughout the book provide comparison with the events in other European countries. Astrain also furnishes choice examples to clarify the attitudes of the period and the methods through which surgeons subverted the physician-controlled educational system. To increase the “honor” of their profession in the eyes of society, naval surgeons were granted a naval uniform and authorized to share quarters with ship officers, while army surgeons were authorized to wear a sword. As was usual everywhere in this period, patronage and nepotism were never far from the promotions given to promising students and junior professionals. To get around the limitations on the surgical curriculum imposed by both tradition and physicians, the Cádiz College of Surgery gradually included more and more typical medical subjects, such as Hippocrates’ Aphorisms. Egregious examples of incompetence were pointedly used by proponents of the new surgical colleges, and Astrain quotes the case of the surgeon who was treating a woman’s badly burned hand, and pulled so hard that “the patient was left with one hand, and the operator with three” (p. 170).

The book’s division into chapters by subject matter, rather than chronological periods, illuminates the long-term trends in legislation, and social and professional developments. At the same time, this occasionally produces repetition, as well as the parceling of what could have been a chapter on the background to Spanish surgery before 1700. The book includes interesting black-and-white and color illustrations, but they serve merely as decoration: there is no reference to them in the text, and none but the first color illustration is identified. These minor limitations do not detract from the value of the book, however. Its conciseness, extensive international bibliography, and indexes of names and subjects make it a welcome and useful reference for students of medicine and surgery in eighteenth-century Spain.