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Financing Health Care in the Viceroyalty of Peru: The Hospitals of Lima in the Late Colonial Period

Published online by Cambridge University Press:  11 December 2015

David Cahill
David Cahill*
Affiliation:
Macquarie University, Sydney, Australia
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Extract

Perceptions of provision for health care in colonial Spanish America are invariably influenced by commonplaces familiar from the comparative history of pre-modern medicine. There is a danger that the reproduction of facile a priori judgements–such as lack of adequate provision, institutional underfunding, deficient nutrition, insanitary conditions, concomitant high mortality rates, and “Dickensian” institutions functioning as workhouses and death-traps for the poor–will distort our understanding of Spanish American health-care systems, such clichés being all too often simplistic, anachronistic, or culturally purblind. Moreover, the whole system, such as it was, may at first sight appear to have depended largely upon the desultory charity of some religious orders and a few pious individuals, with the royal exchequer occasionally rescuing financially-straitened institutions from the brink of bankruptcy and foreclosure. Like most such formulations, there is enough truth to this simplistic scenario for it to be a plausible enough portrait of health care not only in colonial Spanish America but in early modern Spain itself; indeed, of any pre-modern system of health provision. Some of these pejorative impressions–e.g., lack of adequate provision, underfunding–are hardy perennials that even today retain their currency in the wealthiest of welfare states, and are writ especially large in Third World countries. Then as now, such strictures, well-founded or not, are but part of the picture, and overlook considerable institutional achievements in making the best of available resources. Much of this criticism is of course susceptible to quantitative analysis, though statistical data on colonial health care are difficult to come by. As in so many spheres of colonial Spanish America, such figures as are available cluster in the second half of the eighteenth century, a product of the insatiable appetite of Bourbon ministers and bureaucrats for a quantitative dimension to policy-making.

Type
Research Article
Information
The Americas , Volume 52 , Issue 2 , October 1995 , pp. 123 - 154
Copyright
Copyright © Academy of American Franciscan History 1995

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References

* The research in Spain on which this paper is based was funded by the Economic and Social Research Council (United Kingdom) [project ref. G0O232117]. I am grateful to the two anonymous referees of The Americas for their helpful comments; responsibility for the final product, however, is mine alone.

1 Archivo General de Indias, Audiencia de Lima (hereafter AGI Lima), Leg.694, “Expediente promovido en cumplimiento de la Rl.Cédula de 23 de Agosto de 1786…”, 1788.

2 The precise meaning of these terms, and the financial processes which they described, are discussed in Bauer, Arnold J., “The Church in the Economy of Spanish America: Censos and Depósitos in the Eighteenth and Nineteenth Centuries”, Hispanic American Historical Review 63:4 (1983), 707–733.CrossRefGoogle Scholar

3 Van Deusen, Nancy, Dentro del cerco de los muros: el recogimiento en la época colonial (Lima, 1987), p.7.Google Scholar See also idem., “Los primeros recogimientos para doncellas mestizas en Lima y Cusco, 1550–1580”, Allpanchis XXII:35–36, (1990), 249–291. The whole gamut of health and social welfare institutions in the Hispanic world is the subject of Martz, Linda, Poverty and Welfare in Habsburg Spain (Cambridge, 1983).CrossRefGoogle Scholar

4 Fernández, Asunción Doctor, El Hospital Real y General de Nuestra Señora de Gracia de Zaragoza en el siglo XVIII (Zaragoza, 1987), p. 17,Google Scholar indicates that eighteenth-century Spain witnessed a contraction from 2,166 “hospitals” to 616 hospitals, 88 hospices, and 51 foundling homes, following a policy of concentration of health-care institutions instigated during the reign of Philip V.

5 AGI, Audiencia del Cuzco, Leg. 12, “Relación…del Hospital de Naturales de la Ciudad de el Cuzco”, 3 June, 1816. Of related interest: Lastres, Juan B., ed., “Historia de la medicina en el Perú: La visita médica de las parroquias de la ciudad del Cuzco, siglo XVIII”, Revista del Archivo Nacional del Perú 20:1 (1956), 171–194; XX:2 398-416.Google Scholar

6 AGI Lima, Leg.694, informe of Administrador of the Hospital of Santa María de la Caridad, 10 May, 1787, in idem., “Expediente promovido en cumplimiento de la RI.Cédula de 23 de Agosto de 1786…”, 1788, records that small children of poor patients were often admitted with their mothers, and that the costs of their board and lodging were borne by the hospital.

7 AGI Lima, Leg. 908, “Relación diaria de la visita de esta Diocesis de Lima que hizo su Arzobispo Dn. Juan Domingo Gonzales de la Reguera…”, 1782–83.

8 Unanue, Joseph Hipólito, Guía política, eclesiástica y militar del Virreynato del Perú, para el año de 1793 Durand, José, ed. (Lima, 1985 [1793]), pp. 56–58, 200–218;Google Scholar the notation concerning the hospices of the Ocopa missionaries is on p. 210.

9 “Relación diaria…”, entry for October 3, 1782 (my translation).

10 Details of the foundation, construction, rebuilding, changes in function and clientele, etc., of the several Lima hospitals are drawn principally from Ballesteros, Jorge Bemales, Lima, la ciudad y sus monumentos (Sevilla, 1972);Google Scholar Relación y documentos de gobierno del Virrey del Perú, José A. Manso de Velasco, Conde de Superunda (1745–1761) Moreno, Alfredo, ed. Cebrián, (Madrid, 1983)Google Scholar; Relación y documentos de gobierno del Virrey del Perú, Agustín de Jáuregui y Aldecoa (1780–1784) (ed. Contreras, Remedios, Madrid, 1982).Google Scholar Deusen, Van, Dentro del cerco, pp. 26–28,Google Scholar provides a convenient chronology of foundations of the several types of female institutions. Further information on hospitals is contained in the archdiocesan visitation of 1782–83 (see note 7), while Unanue, Guía política, passim., provides dates for each hospital foundation, not always reliably.

11 Bernales, , Lima, pp. 287–88.Google Scholar Gabriel de Avilés y del Fierro (el Marqués de Avilés), Memoria de Gobierno, 1801–1806 (ed. Romero, Carlos Alberto, Lima, 1901), pp. 14–18,Google Scholar deals in some detail with this beaterio, called both “Amparadas” and “Recogidas.”

12 Superunda, Relación, pp. 259–266, for the effects of the earthquake. Manso de Velasco received his title only in 1748, but for consistency's sake I have referred to him throughout as Superunda.

13 Ibid.

14 Ibid. The wider context is provided by Villaroel, Oscar Febres, “La crisis agrícola del Perú en el último tercio del siglo XVIII”, Revista Histórica 28 (1964), 102–199;Google Scholar Pérez Cantó, María Pilar, Lima en el siglo XVIII: Estudio socioeconómico (Madrid, 1985), pp. 114–124;Google Scholar Ramos, Demetrio, Trigo Chileno, Navieros del Callao y hacendados limeños entre la crisis agrícola del siglo XVII y la comercial de la primera mitad del XVIII (Madrid, 1965)Google Scholar; Burga, Manuel, “El Perú central 1770–1860: Disparidades regionales y la primera crisis agrícola republicana” in Liehr, Reinhard, ed., América Latina en la época de Simón Bolívar. La formación de las economías nacionales y los intereses económicos Europeos 1800–1850 (Berlin, 1989), pp. 227–310.Google Scholar

15 Superunda, Relación, pp. 263–64 Quite how long this measure remained in effect is unclear.

16 Ibid., pp. 215–17, 415–16.

17 Jáuregui, , Relación, p. 159 (my translation).Google Scholar

18 Ibid.

19 Superunda, , Relación, pp. 217, 415Google Scholar; Aviles, , Memoria, p. 15,Google Scholar appears in an oblique reference to date this measure to 1759.

20 AGI Lima, Leg. 694, “Plan comprensibo de los Enfermos Esclabos y Libres, que se han medizinado en estte Hospital de San Bartolomé…”, 8 May, 1787, in idem., “Expediente promovido en cumplimiento de la RI. Cédula de 23 de Agosto de 1786…”, 1788.

21 Ibid.

22 AGI Lima, Leg. 694, Conde de Portillo to Viceroy de Croix, 14 May, 1787 (with a “[Razón] de los Enfermos…”), in idem., “Expediente promovido en cumplimiento de la RI. Cédula de 23 de Agosto de 1786…”, 1788.

23 Unanue, , Guía Política, p. 57.Google Scholar

24 AGI Lima, Leg. 694, Portillo to Croix, 14 May, 1787 (with “Razón de los Enfermos…”), loc.cit.

25 See, e.g., Fernández, pp. 139–157 for a representative range of public subsidies and privileges.

26 AGI Lima, Leg. 694, informe of mayordomo of Real Hospital de San Andrés to Viceroy Jáuregui, 1782, with letter of mayordomo to Croix, 10 May, 1787, in idem., “Expediente promovido en cumplimiento de la RI. Cédula de 23 de Agosto de 1786…”, 1788. In 1790 (Table la), there were 49 “locos” housed in San Andrés.

27 Jáuregui, , Relación, p. 158.Google Scholar

28 Unanue, , Guía Política p. 57.Google Scholar

29 Jáuregui, , Relación, pp. 158–59;Google Scholar AGI Lima, Leg. 694, informe of mayordomo to Jáuregui, 1782; mayordomo of San Andrés to Croix, 10 May, 1787, loc.cit.

30 AGI Lima, Leg. 694, informe of mayordomo to Jáuregui, 1782, loc.cit.

31 Deusen, Van, Dentro del cerco, p.27 Google Scholar; Bernales, , Lima, p. 74.Google Scholar

32 Jáuregui, , Relación, p. 158.Google Scholar

33 Salas, Carmen Parrón, “Religiosidad y finanzas en el Consulado de Lima (1778–1821)”, Hispània Sacra 44:90, (1992), 587–650,Google Scholar is an exhaustive analysis of capital sums from religious (including hospital) and lay sources held by the Consulado. For the involvement of the Tobacco Monopoly, see AGI Lima, Leg. 1099, “Razón General de todos los Censos Ympuestos en estos Reynos del Perú, sobre la Real Hacienda, desde 8 de Agosto de 1781 hasta 30 de Octubre de 1783”, 27 January, 1784, indicating that 1,911,726 pesos of capital (”á censo redimible con el redito del 4 percent vajo la hipoteca de la Rl. Renta del Tavaco”) were held by the Consulado.

34 How long this endured is not clear; After 1780 the Consulado offered rates of 3 percent and 4 percent, and the tobacco estanco 4 percent.

35 AGI Lima, Leg. 694, informe of Administrador of La Caridad, 10 May, 1787, loc.cit.

36 Bernales, , Lima, p.75.Google Scholar

37 AGI Lima, Leg. 694, informe of mayordomo of San Lázaro, 9 May, 1787, in idem., “Expediente promovido en cumplimiento de la RI. Cédula de 23 de Agosto de 1786…”, 1788.

38 Aviles, , Memoria, pp. 22–23.Google Scholar For the introduction of the smallpox vaccine to Cuzco: Blanco, José María, Diario del viaje del Presidente Orbegoso al sur del Perú Luna, Félix Denegri, ed., (Lima, 1974 [1834–1835]) Vol.l, p. 265.Google Scholar

39 Martz, , Poverty and Welfare, pp. 54–57,Google Scholar notes that by the 1590s there were San Lázaros throughout Castile in the cities of Toledo, Burgos, Granada, Córdoba, Arévalo, Sevilla, Gijón (Oviedo), Zamora, and Segovia.

40 AGI Lima, Leg. 694, informe of mayordomo of San Lázaro, loc.cit.

41 Jáuregui, , Relación, p. 156 Google Scholar; Martz, , Poverty and Welfare, pp. 38–44,Google Scholar provides information on the foundation and early history of the order. For the post-independence vicissitudes of the religious orders: Tibesar, Antonine, “The Suppression of the Religious Orders in Peru, 1826–1830”, The Americas, 39:2 (1982), 205–240 Google Scholar; Urteaga, Horacio Villanueva, Gamarra y la iniciación republicana en el Cuzco (Lima, 1981), pp. 93–114, 185–196Google Scholar; Blanco, , Diario, Vol.1, pp. 263–4,Google Scholar and Jordán, Pilar García, Iglesia y poder en el Perú contemporáneo 1821–1919 (Cuzco, 1991).Google Scholar

42 Bernales, , Lima, pp. 215–16.Google Scholar

43 AGI Lima, Leg. 694, “Razón individual de los Hospitales que la Religión de San Juan de Dios tiene…”, 8 May, 1787, in idem., “Expediente promovido en cumplimiento de la R1.Cédula de 23 de Agosto de 1786…”, 1788.

44 Ibid. Though in the 1782–83 episcopal visitation, the Archbishop of Lima states that Santa Ana was one of a group of hospitals “servidos por seglares”: see “Relación diaria…”, 1782–83, entry for 6 October, 1782.

45 Unanue, pp. 234, 244 for Cuzco; pp. 257, 264 for Arequipa; pp. 287, 294–95 for Huamanga. That concerning the archdiocese of Lima is at pp. 186, 206–07, while the data for the diocese of Trujillo is at pp. 274, 278. In all cases, Unanue's tithe figures are for 1774–1779, which suggests that the income levels he provides in the 1793 Guía política (pp.56–58) may also date from the 1770s. Certainly, the differences with those provided by the mayordomos of the respective hospitals are in some cases marked: e.g., Unanue provides an annual income for San Bartolomé of 4,300 pesos, while its mayordomo reported (Table 2) an average income of 19,603 pesos for the quinquennium 1782–86.

46 See, in addition to the works cited in footnote 14, Fisher, John, Government and Society in Colonial Peru: The Intendant System 1784–1814 (London, 1970),Google Scholar especially Chapters 5–6, pp. 100–135; idem., Mines, Silver and Miners, Silver in Colonial Peru, 1776–1824 (Liverpool, 1977);Google Scholar idem., Commercial Relations between Spain and Spanish America in the Era of Free Trade (Liverpool, 1985); Nicolini, Javier Tord and Lazo, Carlos, Hacienda, comercio, fiscalidad y luchas sociales (Perú colonial) (Lima, 1981);Google Scholar Quiroz, Alfonso W., “Reassessing the Role of Credit in Late-Colonial Peru: Censos, Escrituras, and Imposiciones”, Hispanic American Historical Review, 74:2 (1994), 193–230.CrossRefGoogle Scholar Galindo, Alberto Flores, Aristocracia y Plebe: Lima, 1760–1830 (Lima, 1984);Google Scholar idem., “Aristocracia en vilo: Los merca deres de Lima en el siglo XVIII” in Jacobsen, Nils and Puhle, Hans-Jürgen, The Economies of Mexico and Peru during the Late-Colonial Period, 1760–1810 (Berlin, 1986), pp. 252–280;Google Scholar Haitin, Marcel, “Urban Market and Agrarian Hinterland: Lima in the Late-Colonial Period” in idem., pp. 281–298;Google Scholar while Jacobsen, Nils, “Commerce in Late Colonial Peru and Mexico: A Comment and Some Comparative Suggestions” in idem., 299–315,Google Scholar critically assesses the historiography and conflicting interpretations of the late-colonial Peruvian economy, with special reference to Lima and its hinterland.