INT36 DL
Final Project
12/10/21
Why did the Spaniards want to regulate healthcare in their empire abroad?: An Analysis of Public Health Initiatives in Bourbon Ruled Colonial Latin America
Although the Spanish Crown has stretched its powers as an absolute monarchy over its colonies in Latin America since it first began to create settlements overseas, the degree to which the Crown was actively involved in the governing, regulating, and maintaining of its colonies has varied greatly throughout time and transitions of power. This variance in levels of involvement in the New World is particularly evident when looking at the changes in how policies and reforms relating to topics like the establishment of hospitals and containment of epidemics have changed over time. When Habsburg ruled Spain experienced a shift in power as the Bourbons took the throne in 1700, Spain and its empire abroad underwent a series of greatly impactful reforms. These reforms focused on the empire’s growing desire to increase governmental control over its colonies in Latin America to strengthen their defenses and increase revenue. The third Bourbon monarch, Charles III, was responsible for extending the emphasis on centralization, gaining more profit, and strengthening the Spanish empire to the New World colonies, implementing policies that, as Fisher states, “exploited the wealth of Spanish America in a more systematic fashion than before”. (Fisher 185) One question that deserves more attention is what motivated the public health initiatives in colonial Latin America and how this changed during the Bourbon health reforms? Thinking specifically about Spain’s relationship with its colonies in modern day Argentina, Peru, Panama, Mexico, Ecuador, and Guatemala, this essay will argue that prior to the Bourbon reforms, the establishment of hospitals was mainly motivated by Christian ideas about accomplishing charity in order to achieve individual salvation, whereas after the shift to Bourbon power, motivations shifted to a newfound enlightenment era emphasis on the responsibility of the state to care for their less fortunate subjects, resulting in Spanish Crown becoming more involved in the establishment and reform of the healthcare system, and with that increasing their governmental control. This increased control and centralization is evident in Spain’s efforts to inoculate the Native Americans against European diseases, implement quarantine policies, establish new tax policies, and reform the financing of hospitals in Latin America.
Before the Spanish placed much of an emphasis on increasing control over their colonies, hospital institutions were still being established in the New World, which prompts the question: What motivated their establishment? By examining examples of the attitudes and beliefs that the Spanish who inhabited and colonized early colonial Latin America held and the institutions they established, it can be seen that much importance was given to the Christian value of charity. Prior to the 1700s, many Europeans viewed disease as a punishment from God, or “the work of the devil”, so hospitals were primarily established with the intention of providing care to those who were suffering, perfectly accomplishing the Christian goal of completing acts of charity in order to attain individual salvation to live an eternal life in heaven. (Newson 372) These institutions that helped to care for the sick were great evidence of the interconnectedness of medicine and religion at the time, as medical practices and beliefs often could not be separate from religious ones. (Newson 373) In 1574, an ordinance was issued by the Viceroy Toledo to establish a hospital in La Plata. (Ramos 191) The ordinance explains that one of the key purposes of this hospital was to instill the Christian practice of charity among the native populations, facilitating their conversion to Christianity. (Ramos 191) The Spanish viewed the native populations as lacking in compassion, and one of the main ways they hoped to “fix” this flaw in the Natives was through the establishment of hospitals like the one in La Plata. This hospital was to be run by local city leaders in Toledo and was funded by the community, making the establishment very distant from the Spanish Crown. The hospitals like this one in La Plata that were established throughout colonial America by local governments, as well as religious orders, served the dual purpose of acting as a colonizing system that worked to “civilize” and Christianize the “miserable” natives, and to provide care for the sick, which was important as European diseases struck Native Americans across the New World. While hospitals in the Spanish Colonies were initially created with the intention of accomplishing charity, as ideas about medicine and the roles of government changed as time progressed, hospitals did too.
As new enlightenment ideas surrounding scientific inquiry and new notions about charity and the responsibility of the state began to circulate Europe, they also started to influence policies and reforms in colonial Latin America. As this occurred, the motivations influencing hospitals and other institutions began to change. There existed a newfound understanding among leaders and officials that they had the power and the ability to do more than turn to solely religious rooted solutions for crises, like praying or blaming the epidemics on God and the native’s inherent “uncivilized” nature. (Cook, Lovell 181) While the motive of charity still existed, it morphed into a newfound enlightenment view of charity, one that meant local officials were responsible for those who were less fortunate in their region, making charity less about achieving Christian Salvation and more about giving local officials a new sense of importance and authority in governing the colonies. When the Bourbons came to power in the 18th Century, they sought to reform the system of hospitals that had been established prior on a more local and religious basis by expanding the existing medical institutions within a “centralized and more scientific context”. (Barbier & Craig 384) The main new motivation that the shift to Bourbon rule brought about was the drive to increase the “power and wealth” of the Crown and the Spanish Empire as a whole. (Cook & Lovell 182) In order to gain revenue and centralize power, the state needed to weaken the institution of the Church, which had been more involved previously in the establishment, funding, and maintaining of new world institutions like hospitals than the Spanish Crown had. This new motivation is evident in the reforms implemented as the Bourbons made their new goals and ideology apparent in their colonies. For example, inoculation campaigns to protect native populations against European diseases, while seeming like they could have stemmed from a humanistic goal of helping protect native lives, realistically stemmed from a Spanish economic goal to protect their colonial economy. (Ramirez Ch.4) These new economic and state centered motivations influenced many aspects of how the colonies in Latin America functioned, affecting tax policies, funding of hospitals, quarantine policies, and more, displaying the clear connection in how the shift in motivations resulted in a significant change in the governing and functioning of colonial Latin America.
As epidemic diseases struck Spain’s colonies in the New World, the native population was hit hard, as they lacked any immunity to these European viruses. One of the ways that Bourbon ruled Spain chose to address this disaster was through inoculation of the native populations. One of the key parts of the transition to Enlightenment medicine and thinking that occurred when the Bourbons took over was that the Spanish justified their forceful inoculation of their native subjects by claiming that it was their responsibility as the Crown to use their newly developed medical knowledge to save the natives from smallpox. While inoculation does serve the purpose of helping populations build up immunity to a disease they would otherwise be helpless to, during these epidemics, the Spanish were also greatly interested in increasing their involvement in and regulation of their colonial subjects by forcefully distributing these vaccinations. In order to effectively reach and inoculate as many natives as possible, Spanish officials had to form alliances with Native elites, increasing their connections to and involvement in more local levels of government that they had previously mostly left to function on their own. Using the 19th century smallpox epidemics that struck districts throughout Puebla, Mexico as an example, the process began with the Audiencia sending instructions to regional governors and provincial leaders on how to carry out inoculations, with Spanish military officers and local Indigenous elites then working together with the local parish priest to conduct a house to house inspection to determine who needed to receive inoculations and coercing those who were resistant into receiving the vaccine. (Ramirez Ch.4) While this was the process for towns that already existed, many native populations were still dispersed throughout an area rather than settled in a town, so in these cases, Spanish inoculation officers had to forcibly organize multiple native populations into one town so that they could be associated with a local parish. (Ramirez Ch.4) This not only helped with inoculation efforts, but also benefited the Spanish as they imposed new taxes on the natives. The connection between new enlightenment ideas and the inoculation campaign is evident in the 1780 Audiencia decree that granted permission to inoculate populations in Guatemala, the decree stating that this decision was “in accordance with the practice of all free and enlightened countries of the world”. (Ramirez Ch.4) As the Spanish Crown became more and more involved in Latin America as diseases brought disaster and chaos to the colonies, they continued to justify their forceful inoculation, surveillance, militarization, and coercion of the natives with the sentiment that they were protecting the “public good”. (Ramierez) Along with inoculation campaigns came a new practice of Census taking in the colonies, in which Spanish officials would check their records of who inoculation with local parish records, demonstrating another way that smallpox epidemics facilitated the spread of “colonial power and authority” to the affected regions. (Ramirez Ch.4)
The establishment of quarantine policies as epidemics struck different regions across Latin America was another way that the shifts in ideology and policy during the Bourbon Era were evident in Spain’s colonies. As towns became infected, provincial alcaldes traveled to the afflicted towns to confirm an outbreak, usually categorizing it as smallpox, and then Spanish officials worked with Indigenous elites who knew the geography of the region to establish quarantine lines. (Ramirez Ch. 4) One specific example is when smallpox broke out in Chiapas in 1780 and the governor of the region met with Audiencia officials in order to formulate an organized, centralized response, in theme with Bourbon era policies, which included blocking off the roads that connected the western highlands to the pacific coast, preventing any human or animal from traveling past the blockades. (Ramirez Ch.4) When epidemics arrived in regions further away from colonial centers, such as when smallpox struck Jacaltenango in Guatemala, local priests were responsible for alerting the provincial and Audiencia authorities, acting as the link between their region and the larger colonial state. (Ramirez Ch.4) The President of the region would then send instructions for implementing quarantines to contain the outbreak. While the Presidents of the afflicted regions as well as the Audiencia officials were at the head of the quarantine efforts, the Indigenous elites also became involved, not only becoming allies, but often working as soldiers who patrolled the roads to enforce the quarantine policies. Although quarantine efforts were implemented on a town by town basis depending on where outbreaks occurred and the local topography, the way quarantine policies were established by Audiencia officials and enacted reflects Bourbon efforts of centralizing policy and overall governing of the colonies.
New tax policies were also a key part of the Bourbon reform of the Spanish colonies, many of them focusing on how the money that would fund the local hospitals would be collected. Looking to Panama as an example, there did not exist a formal leprosarium or hospital to treat those afflicted with leprosy for most of the 17th century. Because of the prevalence of leprosy throughout the region, the governor sought to establish one, and to do this imposed a special tax on pulperias to aid lepers. (Barbier & Craig 400) However, when the Viceroy got word of this in 1782, it struck down on this legislation in their continued efforts to centralize taxing legislation and dissolve the many local systems of taxing that individual districts and regions used to fund their local hospitals. (Barbier & Craig 400) Aside from just tax policies themselves, the amount of Crown-funding many hospitals received was also altered in an attempt to centralize the regulation of hospitals in the 18th century. The San Lazaro Hospital in Santo Domingo continued to receive less and less funding from charitable donations and other religious sources during the end of the 17th century, so when officials appealed to the Crown to seek financial relief, the Bourbon monarchy showed “great interest in sustaining their institutions”, and so the hospital began to receive more direct funding from the Crown. (Barbier & Craig 393) This was a trend prominent for many hospitals during the Bourbon era, however, it’s important to note that many were still underfunded and relied heavily on parish funding and donations. As the crown became more generous with funding hospitals in their colonies, they were actively increasing their control of these institutions and working to centralize the source from which the funding came. Hospitals themselves also underwent reform, becoming more specialized institutions than they had been previously. (Cahill 125) In the beginning of the 18th century, hospitals often served multiple purposes, acting as institutions providing poor relief, hostelries, colleges, and shelters for refuge all at the same time. (Cahill 125) With all of the new Enlightenment ideas circulating the New World in the 18th century, advances in medicine influenced hospitals to become more specialized in their functions, becoming more similar to what modern day society might call a “hospital”. In addition to these changes, the Crown also worked to reorganize the governmental systems from which many of these orders and reforms came with the creation of Intendancies, like was done in Rio de Plata in 1782. Intendancies, which were subdivisions of viceroyalties, were created to centralize the monarchy with military, financial, and judicial powers and put the power in the colonies in the hands of powerful officials, rather than dispersed among many lower tier officials. (Fisher 186)
As new motivations for public health initiatives arose, shaped by Enlightenment ideas and medicine from Europe, public health institutions and initiatives in the New World were morphed into Crown dominated colonial systems, in which the monarchy had more control than ever before. This new level of Crown control brought with it a conflict between the “reformist desires” of the Bourbons and the pre-existing ideas about how these institutions should be run and the Spanish Crown’s role in governing the colonies. (Barbier & Craig 394)
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