Luz Maria Hernandez Saenz. Learning to Heal: The Medical Profession in Colonial Mexico, 1767-1831. New York and Berlin: Peter Lang, 1997. x + 301 pp. $48.95 (cloth), ISBN 978-0-8204-3328-8.
Reviewed by Abel A. Alves (Ball State University)
Published on H-LatAm (December, 1997)
Luz Maria Hernandez Saenz has done a great service to Colonial Mexican studies by providing a survey of the late colonial medical profession that is situated in a cultural and social context. Using documents of the period 1767-1831, she is able to supersede the earlier factual recitations of an Aristides Moll or Josefina Muriel, while also recognizing the ground-breaking work of individuals like Guenter Risse, John T. Lanning, and Noemi Quezada in the social history of medicine and healing. If there is anything lacking in her survey, it is in her rather cursory approach to the issue of curanderismo, though, in all fairness, she does use the official licensing procedures of the Protomedicato as a touchstone, and no author can cover absolutely everything, thereby giving some credence to Hayden White's approach to history as a type of creative fiction.
The major strength of the book is its willingness to study the social and economic circumstances of medical professionals, as well as their training and performance. As such, Learning to Heal is a study in social stratification and the castas as well as being a study in the history of medicine. After pointing out that the latest medical discoveries of the Enlightenment era were available in New Spain, Hernandez Saenz is also quite correct in arguing that "Improper treatment was not always the product of the practitioner's obscurantism but a result of the still primitive state of medical knowledge and science in general ..." (p. 63). As a result, New Spain's officially licensed physicians and surgeons often enough went on the attack against unlicensed practitioners and curanderos not because they were consistently inferior, but because their lack of official license and the "impurity of their blood" stood as an affront to medical hierarchy. Likewise, with an examining and licensing institution like the Protomedicato (i.e., one dominated by criollos) peninsulares and non-Spanish foreigners commonly felt the animosity of professionals jealously guarding their privileged status:
The great majority of medicos were criollos for whom a medical career offered ample opportunity for social advancement, prestige and a respectable income. Thus, they resented intruders and foreigners and were reluctant to grant them licenses. The most conspicuous examples of criollo control and exclusivity were found in the medical faculty where Mexican physicians successfully defended their monopoly on academia and therefore on the Protomedicato. Officially, ultimate control of the various branches of the medical profession remained firmly in their hands (p. 63).
And this had its implications for nurses, pharmacists, midwives, and bloodletters as well as for physicians, cirujanos latinos, and cirujanos romancistas. However, the artisanal status of many of these professionals led the licensing medical establishment to be somewhat more lenient with them than with those who directly infringed upon the incomes and prestige of the university-trained physician, and, in so many ways, the true theme of the Hernandez Saenz book is one of "incomes and prestige."
For the most part, licensed physicians stood above the fray and treated the rich of the cities with little or no competition, but they still sought to diversify their investments. From 1799 to 1803, Dr. Jose Ignacio Garcia Jove, president of the Protomedicato, collected a total of 3,528 pesos in licensing fees and other emoluments, as well as maintaining a private practice and serving various religious orders (p. 49). In so many ways, he was as much the entrepreneur as pharmacists who opened multiple shops and employed unlicensed oficiales to increase their "turnover." Likewise, a certified phlebotomist and surgeon like Juan Antonio Xarillo "boasted the titles of surgeon of the Hospital of San Juan de Dios, substitute surgeon of the Real Carcel de Corte, and surgeon of the Inquisition prison" (p. 195). He also attended the Archbishop and his family and other members of the Church hierarchy. Further down the hierarchical ladder, "Jose de San Ciprian, a licensed barber and undoubtedly an ambitious young man, was the owner of two offices ..." (p. 197). In Mexico City, where the most ambitious of health professionals operated, the competition was pronounced and the rewards significant, but rewards were doled out according to station. Thus, "The contempt of the elitist Protomedicato for the lower ranking practitioners under its jurisdiction manifested itself both in neglect and criticism. Neglect translated into both lack of enforcement of the phlebotomists' racial and training requirements and in toleration of the illegal practice of midwifery and phlebotomy" (p. 180).
Still, impetus for some social mobility existed in colonial Mexico, and surgeons could benefit from the Enlightenment's emphasis on practical experience. Though a Mexican Escuela de Cirugia was founded, its licensing procedure allowed for more latitude than the standard applied to physicians. Thus, Jose Mariano Orozco y Toledo, who graduated in 1804, was both born out of wedlock and born the son of a mestiza. At least seven, or almost eight percent, of the surgeons who graduated between 1804 and 1821 were born out of wedlock. Though limpieza de sangre statutes were not as strictly enforced here as at the zenith of the colonial medical hierarchy, only Antonio Almorin officially joined Orozco y Toledo as a cirujano latino with Indian ancestry, "and not until 1830 did the examination documents record the Bachiller Jose Maria Velasco as the son of indios tributarios" (p. 90). This "leniency," in turn, was not extended to mulatos, and a Cuban mulato named Jose Vazquez Silva was flatly denied admission in 1788. Hernandez Saenz, therefore, clearly writes a book where the general trends and complexities of casta are a major issue. Her readership should not be limited to those solely interested in the history of medicine, and the history of medicine is enriched by her research.
On a final note, it must be said that the book does suffer from a small number of editorial blunders and that the reader must struggle through the page-flipping required of chapter endnotes. Hernandez Saenz's readership must remember that this is more a function of cost-saving exigencies in this turbulent era in the history of publishing than it is a deliberate affront to the reader. Likewise, it is hoped that this Peter Lang book, of use to undergraduates and those unfamiliar with late colonial medical history, will make it to many library shelves that might exclusively focus on the latest offerings from Stanford, California, and New Mexico. This work nicely complements a primary source like Jose Ignacio Bartolache's Mercurio Volante in that it serves as a useful method of introduction to a very rich and comprehensive topic in colonial Mexican history.
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Abel A. Alves. Review of Saenz, Luz Maria Hernandez, Learning to Heal: The Medical Profession in Colonial Mexico, 1767-1831.
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