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

Adam Warren's book on politics and medical reform in late colonial Peru makes a valuable addition to a growing corpus of Anglophone literature on the history of science and medicine in colonial Latin America. This tradition arguably began with John Tate Lanning's ambitious The Royal Protomedicato (1985) and has continued in recent years with works on medicine, public health, and charity in New Spain and on medicine and natural history in Peru and New Granada. Using a rich array of archival documents from Peru and Spain, Warren is able to trace the impact of Bourbon reforms on medicine and public health, areas of colonial history that have received relatively little attention compared to the traditional focus on administrative, economic, and clerical (often anti-clerical) reform. Warren also departs from the traditional reform literature by pointing to the fact that some of the reforms were ultimately unsuccessful, largely due to the complications that peninsular efforts aimed at spreading "useful knowledge" faced in local colonial contexts. Indeed, Medicine and Politics in Colonial Peru is careful to highlight the localized character of Bourbon reforms—not only in the local effects of imperial orders, but also in the way that local creole elites embraced, rejected, or modified these orders to suit their needs or agendas. In this way, Warren is able to show repeatedly the politicized identity of creole elite doctors and the active role they took in implementing (or not) Bourbon reforms, an argument that adds an important dimension to the literature on creole patriotism.

The book is organized into a series of vignettes, written in an engaging style, that highlight the debates engendered by particular medical reforms. Warren does not present these reforms as faits accomplis, but rather explores in depth the local conditions and power struggles that complicated their implementation. These include struggles between colonial government officials and local medical practitioners, both secular and religious, over the control and regulation of medical knowledge and practice, the administration of smallpox vaccine, the operations of Lima's leper hospital and a proposed cure for leprosy, reform of funerary and burial practices, and the proposed curriculum for the newly established School of Medicine and Surgery of San Fernando in Lima. The reforms demonstrate, on the one hand, Bourbon efforts to invoke the modernizing, secularizing discourse of science coming out of the Enlightenment. Although these efforts did have some significant effects, the reforms also engendered significant discord that would ultimately serve to solidify the basis of creole identity and resistance to imperial authority. The many conflicts of interest between religious and lay medical practitioners also show the high degree of integration of religious and secular authorities in the medical establishment that was typical of early modern Catholic societies, but whose importance is often underestimated in a largely Protestant historiographic tradition.

Warren's work thus adds important new dimensions to our knowledge of medical practice in the late colony. What is left to do now is to build a larger narrative of medicine and science in colonial Latin America and the Spanish Atlantic that synthesizes the findings of the new literature in the field. Along similar lines, Warren himself advises that "historians would do well to adopt . . . comparative approaches that look beyond a single regional case of social reforms within a trans-Atlantic framework" (p. 226). The trick is, however, to do so without sacrificing the exploration of the richness and variety of local contexts, something that Warren does so well in this book.