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Indian Hospitals and Government in the Colonial Andes

  • Gabriela Ramos (a1)


This article examines the reception of the early modern hospital among the indigenous people of the Andes under Spanish colonial rule. During the period covered by this study (sixteenth to mid-eighteenth centuries), the hospital was conceived primarily as a manifestation of the sovereign’s paternalistic concern for his subjects’ spiritual well being. Hospitals in the Spanish American colonies were organised along racial lines, and those catering to Indians were meant to complement the missionary endeavour. Besides establishing hospitals in the main urban centres, Spanish colonial legislation instituted hospitals for Indians in provincial towns and in small rural jurisdictions throughout the Peruvian viceroyalty. Indian hospitals often met with the suspicion and even hostility of their supposed beneficiaries, especially indigenous rulers. By conceptualising the Indian hospital as a tool of colonial government, this article investigates the reasons behind its negative reception, the work of adaptation that allowed a few of them to thrive, and the eventual failure of most of these institutions.

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1. de San Miguel, Garci Diez, Visita hecha a la provincia de Chucuito [Inspection of the Chucuito Province] (Lima: Casa de la Cultura, 1964), 100. For the history of the region during the colonial period, see Norman Meiklejohn, La iglesia y los lupaqa durante la colonia [The Church and the Lupaqa Under Colonial Rule] (Cuzco: Centro Bartolomé de las Casas, 1999). For an analysis of the inspection records, see John V. Murra, ‘Un reino aymara en 1567 [An Aymara Kingdom in 1567]’, in Formaciones económicas y políticas del mundo andino [The Economic Organization of the Inca State] (Lima: Instituto de Estudios Peruanos, 1975), 193–223.

2. Rosen, George, ‘The hospital: historical sociology of a community institution’, in Rosen, G. (ed.), From Medical Police to Social Medicine: Essays on the History of Healthcare (New York: Science History Publications, 1974), 274303. J. Henderson, P. Horden and A. Pastore (eds), The Impact of the Hospital 300–2000 (London: Peter Lang, 2007); Mary Lindemann, Medicine and Society in Early Modern Europe (Cambridge: Cambridge University Press, 1999); Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York and Oxford: Oxford University Press, 1999); Alejandra Piñeyrúa, ‘Caridad cristiana, asistencia social y poder político: las instituciones hospitalarias en España (siglos XIII al XIV) [Christian Charity. Social Assistance, and Political Power: Hospitals in Spain (13th to 14th Centuries)]’, in M. E. González de Fauve and P. de Forteza (eds), Ciencia, poder e ideología: el saber y el hacer en la evolución de la medicina española [Science, Power, and Ideology: Knowledge and Practise in the Evolution of Spanish Medicine] (Buenos Aires: Universidad de Buenos Aires, 2001), 61–107.

3. Horden, Peregrine, Hospitals and Healing from Antiquity to the Later Middle Ages (Ashgate: Variorum, 2008). See especially ‘A non-natural environment: medicine without doctors and the medieval european hospital’, 133–45.

4. Piñeyrúa, op. cit. (note 2); Miri Rubin, ‘Imagining medieval hospitals: considerations on the cultural meaning of institutional change’, in J. Barry and C. Jones (eds), Medicine and Charity Before the Welfare State (London: Routledge, 1991), 14–25; Juan Ignacio Carmona García, El sistema de hospitalidad pública en la Sevilla del Antiguo Régimen [The Public Hospital System in Ancien Régime Seville] (Seville: Diputación Provincial, 1978); Lindemann, op. cit. (note 2), 123–7.

5. Warren’s, Adam, Medicine and Politics in Colonial Peru: Population Growth and the Bourbon Reforms (Pittsburgh: University of Pittsburgh Press, 2010) provides in its first chapter an overview of the beginnings of colonial hospitals in Lima and the medical ideas professed by physicians under the Habsburgs. However, the actual timeframe of his study begins in the mid-eighteenth century (when this article ends) up to the mid-nineteenth century, long after Peru’s independence.

6. Arrizabalaga, Jon, ‘Poor relief in Counter-Reformation Castile: an overview’, in Grell, O.P. and Cunningham, A. (eds), Health Care and Poor Relief in Counter-Reformation Europe (London: Routledge, 1999), 1578.

7. Zorrilla, Elena Maza, Pobreza y asistencia social en España, siglos XVI al XX [Poverty and Social Assistance in Spain, 16th to 20th Centuries] (Valladolid: Universidad de Valladolid, 1987); Félix Santolaria Sierra, El gran debate sobre los pobres en el siglo XVI. Domingo de Soto y Juan de Robles 1545 [The Great Debate about the Poor in the 16th Century] (Barcelona: Ariel, 2003); José Antonio Maravall, Antiguos y modernos: visión de historia e idea de progreso hasta el renacimiento [Traditionalists and Modernists: Perceptions of History and the Idea of Progress up to the Renaissance] (Madrid: Sociedad de estudios y publicaciones, 1966); José Antonio Maravall, Utopía y reformismo en la España de los Austrias [Utopia and Reformism in Habsburg Spain] (Madrid: Siglo XXI, 1982); Bronislaw Geremek, Poverty: A History (Oxford: Blackwell, 1994).

8. Pullan, Brian, Rich and Poor in Renaissance Venice: The Social Institutions of a Catholic State, to 1620 (Oxford: Basil Blackwell, 1971); Brian Pullan, ‘Catholics and the Poor in Early Modern Europe’, Transactions of the Royal Historical Society, 26 (1976), 15–34; Rober Jütte, Poverty and Deviance in Early Modern Europe (Cambridge: Cambridge University Press, 1994).

9. Carmona García, op. cit. (note 4), 200–5; Linda Martz, Poverty and Welfare in Habsburg Spain: The Example of Toledo (Cambridge: Cambridge University Press, 1983); Teresa Huguet-Termes, ‘Madrid Hospitals in the Context of the Hapsburg Empire’, Medical History Supplement, 29 (2009), 64–85; Arrizabalaga, op. cit. (note 6).

10. Delgado Paulino, Castañeda, ‘La condición miserable del indio y sus privilegios [The Condition of the American Indian as Wretched and its Associated Privileges]’, Anuario de Estudios Americanos [Yearbook of American Studies], 28 (1971), 245335. In her study of poverty in eighteenth-century Ecuador, Cynthia Milton shows that the concept of poor without losing its moral connotation acquired a decidedly economic meaning. The Many Meanings of Poverty: Colonialism, Social Compacts, and Assistance in Eighteenth-Century Ecuador (Stanford: Stanford University Press, 2007) 92, 140.

11. Lohmann Villena, G. and Sarabia Viejo, M. J.  (eds), Francisco de Toledo: Disposiciones gubernativas para el virreinato del Perú 1575–1580 [Francisco de Toledo’s Regulations for the Government of the Viceroyalty of Peru 1575–1580], 2 vols (Seville: Escuela de Estudios Hispanoamericanos, 1986–9), Vol. 2: 95. For a similar description of the king’s paternal role in France, see Tim McHugh, Hospital Politics in Seventeenth-Century France: The Crown, Urban Elites and the Poor (Aldershot: Ashgate, 2007), 50.

12. Dean, Mitchell, ‘Pastoral power, police and reason of state’, in Dean, Mitchell (ed.), Governmentality: Power and Rule in Modern Society (Los Angeles: Sage Publications, 1999), 89116, 93.

13. Recopilación de leyes de los reinos de las Indias [Compilation of the Laws of the Kingdoms of the Indies], 4 vols (Madrid: Cultura Hispánica, 1973), Vol. 1: Título Cuarto, Ley Primera.

14. Carmona García, op. cit. (note 4), 25.

15. Guerra, Francisco, El hospital en Hispanoamérica y Filipinas [The Hospital in Spanish America and the Philippines] (Madrid: Ministerio de Sanidad y Consumo, 1994), 4309.

16. Jiménez, Manuel Olmedo, ‘El hospital de Santa Ana de Lima durante los siglos XVI y XVII [The Santa Ana Hospital of Lima during the 16th and 17th Centuries]’, in Actas del III Congreso Internacional sobre los Dominicos y el Nuevo Mundo (Madrid: Deimos, 1991) [Proceedings of the Third International Congress on the Dominicans and the New World], Gabriela Ramos, Death and Conversion in the Andes: Lima and Cuzco, 1532–1670 (Notre Dame, IN: University of Notre Dame Press, 2010), 102–3.

17. de Montesinos, Fernando, Anales del Perú [Annals of Peru], in Maúrtua, Víctor M. (ed.), 2 vols (Madrid: Imprenta de Gabriel L. y del Horno, 1906 [1642]), 1:234. Diego de Esquivel y Navia, Noticias cronológicas de la gran ciudad del Cuzco [News of the Great City of Cuzco Organized in Chronological Order], 2 vols (Lima: Fundación Augusto N. Wiesse, 1980), Vol. 1: 220.

18. While in France the monarchy did not receive this and other decrees from the Council of Trent, in Spain King Philip II accepted the decrees as state law. Thus the bishops’ authority over the hospitals went unquestioned. On Spain, see Carmona García, op. cit. (note 4), 69, and on France, see Jean Imbert, ‘Les prescriptions hospitalières du Concile de Trente et leur diffusion en France [The Rulings about Hospitals Issued by the Council of Trent and Their Propagation in France]’, Revue d’Histoire de l’Église de France [Journal of the History of the French Church], 42 (1956), 5–28.

19. Olmedo Jiménez, op. cit. (note 16), 585.

20. Pullan, Brian, Rich and Poor, op. cit. (note 8), 239; Juan de Matienzo, Gobierno del Perú [Government of Peru] (Lima: Institut Français d’Études Andines, 1967), 74.

21. Villena, Lohmann and Viejo, Sarabia, op. cit. (note 11), Vol. 1: 455–6.

22. Villena, Lohmann and Viejo, Sarabia, op. cit. (note 11), Vol. 2: 14–15, 17.

23. Matienzo, op. cit. (note 20), 79.

24. MacHugh, op. cit. (note 11), 21–2.

25. Studies on colonial hospitals in Peru focus on the city of Lima only. See for example Miguel Rabí Chara, Del hospital de Santa Ana (1549 a 1924) al hospital Nacional Arzobispo Loayza (1925 a 1999): 450 años de protección de la salud de las personas [From the Santa Ana Hospital (1549 to 1924) to the National Hospital Arzobispo Loayza (1925 to 1999): 450 Years Taking Care of People’s Health] (Lima: n.p., 1999).

26. de Ondegardo, Polo, ‘Los errores y supersticiones de los indios [The Errors and Superstitions of the Indians]’, Revista Histórica (Lima), 1 (1906), 207231, 209.

27. Matienzo, op. cit. (note 20), 18.

28. Villena, Lohmann and Viejo, Saravia, op. cit. (note 11), Vol. 1: 453.

29. Diez de San Miguel, op. cit., (note 1), 259.

30. In Mexico a portion of the Indian head tax, known as ‘medio real del hospital’, was used to support the hospitals. Josefina Muriel, Hospitales de la Nueva España [Hospitals of New Spain], 2 vols (México: Universidad Nacional Autónoma de México, 1990), Vol. 1: 138.

31. A few years later, viceroy Toledo stipulated that the profits generated by encomiendas without holders be assigned to the hospital of Santa Ana. However, these revenues were neither safe nor permanent. Lewis Hanke and Celso Rodríguez (eds), Los virreyes españoles en América durante el gobierno de la Casa de Austria [The Spanish Viceroys in America under the Habsburgs], 7 vols. Biblioteca de Autores Españoles [Spanish Authors Library] (Madrid: Atlas, 1978–80), Vol. 2: 66–7.

32. Archivo General de la Nación del Perú (from now on AGN), Derecho Indígena, Leg. 3, c.31. On epidemics in colonial Peru and their effects on the indigenous population, see Noble David Cook, Demographic Collapse: Indian Peru, 1520–1620 (Cambridge: Cambridge University Press, 1981).

33. AGN, Derecho Indígena, leg. 3, c.33.

34. Lastres, Juan B., ‘Una epidemia en el siglo XVI [An Epidemic in the 16th Century]’, Revista del Archivo Nacional del Perú [Journal of the National Archives of Peru], 19 (1955), 26777.

35. Villena, Lohman and Viejo, Sarabia, op. cit. (note 11), Vol. 2: 73–90.

36. The Real Tribunal del Protomedicato, a body in charge of supervising medics, was founded in 1568. Juan B. Lastres, Historia de la medicina peruana [History of Peruvian Medicine], 3 vols (Lima: Imprenta Santa María, 1951), Vol. 2: 57–8. See also John T. Lanning, The Royal Protomedicato: The Regulation of the Medical Professions in the Spanish Empire (Durham, N.C.: Duke University Press, 1985). Although documentation is scarce, it seems that indigenous healers were not uncommon among the empiricists working in the hospitals for Indians. Esquivel y Navia, op. cit. (note 17), Vol. 2: 48.

37. de Ayala, Manuel Josef, Diccionario de gobierno y legislación de Indias [Dictionary of Government and Legislation of the Indies], 13 vols (Madrid: Instituto de Cooperación Iberoamericana/Ediciones de Cultura Hispánica, 1989–96), Vol. 7: 144–5, explains the differences between the hospitals according to their source of support: royal patronage, taxes, private patronage, alms, and bequests.

38. Madrid’s General Hospital possibly represented a model for the hospitals established in Spanish America. See Huguet-Termes, op. cit. (note 9), 76.

39. Lissón, Emilio, La Iglesia de España en el Perú [The Church of Spain in Peru], 5 vols (Sevilla: Católica Española, 1943–7), Vol. 3: 337, 359. The clergyman seems to imply that the Indians’ homes did not fulfil the criteria of ‘cleanliness’ necessary to administer the sacraments.

40. Ibid., Vol. 3: 334–5.

41. Lissón, op. cit. (note 39), Vol. 3: 349–72.

42. Lissón, op. cit. (note 39), Vol. 3: 451-2; Hanke and Rodríguez, op. cit. (note 31), Vol. 1: 234–5.

43. Benito, José Antonio  (ed.), Libro de visitas de Santo Toribio de Mogrovejo 1593–1605 [Records of Santo Toribio de Mogrovejo’s Pastoral Visitations 1593–1605] (Lima: Pontificia Universidad Católica del Perú, 2006), 367.

44. For example, the herds belonging to the rural parish of Huañec, Yauyos, are described as the property of two different kin groups (ayllus), Huañec and Llacuaz, respectively. Benito, ibid., 212. Historians of Africa and Europe have highlighted the importance of kin groups and of family structures for the study of poverty and social assistance. John Iliffe, The African Poor (Cambridge: Cambridge University Press, 1987), 8; Peregrine Horden, ‘Family history and hospital history in the middle ages’, in P. Horden (ed.), op. cit. (note 3), 146–282.

45. For example, the hospital of the rural parish of Los Reyes de Chinchaycocha, with a population of 2,100, was listed as ‘deserted’. Lissón, op. cit. (note 39), Vol. 5: 292.

46. This was the case of Huarmey, a town situated on Peru’s central coast. The records of archbishop Mogrovejo’s pastoral visitation listed a hospital and a parish church in poor condition, whereas the inspectors sent by archbishop Lobo Guerrero, Mogrovejo’s successor, noted that Huarmey had neither hospitals nor confraternities. Benito, op. cit. (note 43), 423–4; Lissón, op. cit. (note 39), Vol. 5: 263.

47. Lissón, op. cit. (note 39), Vol. 5: 271.

48. Lissón, op. cit. (note 39), Vol. 5: 282.

49. Lissón, op. cit. (note 39), Vol. 5: 303.

50. Diez de San Miguel, op. cit. (note 1), 118.

51. de la Espada, Marcos Jiménez, Relaciones Geográficas de Indias, Perú [Geographical Descriptions of the Indies, Peru], 3 vols (Madrid: Atlas, 1965), Vol. 1: 225, 234.

52. Lissón, op. cit. (note 39), Vol. 5: 268.

53. Jiménez de la Espada, op. cit. (note 51), Vol. 1: 158–9.

54. Jiménez de la Espada, op. cit. (note 51), Vol. 1: 172.

55. After visiting the province of Yauyos, the inspectors wrote, ‘the Indians never come to these hospitals’. Lissón, op. cit. (note 39), Vol. 5: 284.

56. ‘Relación de Chucuyto’ [Report on Chucuyto] by Pedro de Valencia, bishop of La Paz. British Library, Ms. AD13977, f. 519.

57. Diez de San Miguel, op. cit. (note 1); John Murra, op. cit. (note 1), 205.

58. Valencia’s observation that the barbers were Indians suggests that the surgeons were probably Spanish.

59. Valencia, op. cit. (note 56).

60. Diez de San Miguel, op. cit. (note 1), 220.

61. The Indians of the Anansaya kin group in Chucuito stated that, ‘it would be good to build a hospital in each town, but not establish one single hospital for the whole province because the patients won’t be able to make use of it’. Diez de San Miguel, op. cit. (note 1), 87.

62. Bishop Valencia accused the caciques of being rebellious, idolaters, and of antagonising the parish priests. Valencia, op. cit (note 56).

63. On health care in rural Spain under the Ancien Régime see Luis Alfonso Alcarazo García. La asistencia sanitaria pública en el Aragón rural entre 1673–1750. Las conducciones sanitarias de Barbastro [Public Health Assistance in Rural Aragon from 1673 to 1750. The Contracts to Provide Health Services in Barbastro] (Zaragoza: Institución Fernando El Católico, 2010); Luis S. Granjel, La medicina española renacentista [Spanish Medicine in the Renaissance] (Salamanca: Universidad de Salamanca, 1980); Anastasio Rojo Vega, Enfermos y sanadores en la Castilla del siglo XVI [Patients and Healers in Sixteenth-Century Castile] (Valladolid: Universidad de Valladolid, 1993). On the diverse forms of social assistance and health care in Europe, see Peregrine Horden, ‘Household care and informal networks: comparisons and continuities from antiquity to the present’, in P. Horden and R. Smith (eds), The Locus of Care: Families, Communities, Institutions and the Provision of Welfare Since Antiquity (London: Routledge, 1998), 21–67.

64. Since the late sixteenth century representatives of the Indians submitted requests to decrease the amount of contributions paid to the Church. This is why fifty years later the colonial government tried to reduce the contributions already included in the tithes. The Church fiercely opposed this initiative. Hanke and Rodríguez, op. cit. (note 31), Vol. 4: 122–3.

65. Cahill, David P., ‘Financing Health Care in the Viceroyalty of Peru: The Hospitals of Lima in the Late Colonial Period’, The Americas, 52, 2 (1995), 12354.

66. Lissón, op. cit. (note 39), Vol. 5: 308.

67. Archivo Arzobispal de Lima (from now on AAL), Hospitales, leg. 1, exp. 1. Archbishop Mogrovejo’s inspection records document the presence in the region of a Garci Barba, head of a powerful family that owned land, ranches, and a sugar cane plantation. Benito, op. cit. (note 43), 19, 29, 376–9.

68. This was the bank owned by Juan de la Cueva, a noted financial institution in the seventeenth century. AAL, Hospitales, leg. 2, exp. 2.

69. The curacas stated during the investigation on this case that ‘the parish priests usually take for themselves the property and livestock belonging to the hospitals’. AAL, Hospitales, leg. 2, exp. 8.

70. AAL, Hospitales, leg. 1, exp. 9.

71. AAL, leg. 2, exp.13, 1629.

72. On the question of church jurisdiction over rural hospitals, see Juan Bautista Lassègue, ‘La fundación progresiva de un convento-hospital en Parinacochas, diócesis del Cuzco, 1567–1586. Apuntes de lectura e hipótesis de estudio [The Gradual Founding of a Convent-Hospital in Parinacochas, Cuzco Diocese, 1567–1586: Some Notes and a Hypothesis]’, Revista Andina [Andean Review], 4 (1984), 487–512.

73. AAL, Hospitales, leg. 2, exp. 25, 1660.

74. Hanke and Rodríguez, op. cit. (note 31), Vol. 5: 208.

75. The religious order of the Bethlehemites, devoted to the care of the poor, was founded in Guatemala in the seventeenth century and rapidly spread throughout Spanish America. There are few historical studies about the Bethlehemites. See for example Carlos Mayo, Los betlemitas en Buenos Aires: convento, economía y sociedad, 1748–1822 [The Bethlehemites in Buenos Aires: Convent, Economy, and Society, 1748–1822] (Sevilla: Excelentísima Diputación de Sevilla, 1991). There is no historical study about the order of San Juan de Dios in the Andes. For Mexico, see Solange Alberro, Apuntes para la historia de la Orden Hospitalaria de San Juan de Dios en la Nueva España-México, 1604–2004 [Notes for the History of the Hospital Order of Saint John of God in New Spain-Mexico, 1604–2004] (México: El Colegio de México, 2005).

76. AGN, Derecho Indígena, leg. 17, c.291, 1756.

77. AGN, Derecho Indígena, leg. 23, c. 396, 1781.

78. AGN, Derecho Indígena, leg. 24, c. 442, 1790.

79. Matraya y Ricci, Juan Joseph, Catálogo cronológico de las pragmáticas, cédulas, decretos, órdenes y resoluciones reales generales emanados después de la Recopilación de las Leyes de Indias [A Catalogue Organized in Chronological Order of the Laws and other Regulations Produced after the Compilation of the Laws of the Indies] (Buenos Aires: Instituto de Investigaciones de Historia del Derecho, 1978), 259.

80. Cahill, op. cit. (note 65).

81. AGN; Derecho Indígena, leg. 16, c. 278, 1748.

82. The trial records contain statements given by curacas, other indigenous authorities, and parish priests confirming that social assistance in Chucuito was provided as described.

I would like to thank Medical History’s anonymous referees for their suggestions. Anne Pushkal translated this article from Spanish. Any errors and omissions are entirely my own.


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Indian Hospitals and Government in the Colonial Andes

  • Gabriela Ramos (a1)


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