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Adam Warren - Medicine and Politics in Colonial Peru: Population Growth and the Bourbon Reforms

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    Medicine and Politics in Colonial Peru: Population Growth and the Bourbon Reforms
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By the end of the eighteenth century, Peru had witnessed the decline of its once-thriving silver industry, and it had barely begun to recover from massive population losses due to smallpox and other diseases. At the time, it was widely believed that economic salvation was contingent upon increasing the labor force and maintaining as many healthy workers as possible. In Medicine and Politics in Colonial Peru,Adam Warrenpresents a groundbreaking study of the primacy placed on medical care to generate population growth during this era.

The Bourbon reforms of the eighteenth century shaped many of the political, economic, and social interests of Spain and its colonies. In Peru, local elites saw the reforms as an opportunity to positively transform society and its conceptions of medicine and medical institutions in the name of the Crown. Creole physicians in particular, took advantage of Bourbon reforms to wrest control of medical treatment away from the Catholic Church, establish their own medical expertise, and create a new, secular medical culture. They asserted their new influence by treating smallpox and leprosy, by reforming medical education, and by introducing hygienic routines into local funeral rites, among other practices.

Later, during the early years of independence, government officials began to usurp the power of physicians and shifted control of medical care back to the church. Creole doctors, without the support of the empire, lost much of their influence, and medical reforms ground to a halt. As Warrens study reveals, despite falling in and out of political favor, Bourbon reforms and creole physicians were instrumental to the founding of modern medicine in Peru, and their influence can still be felt today.

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Pitt Latin American Series John Charles Chasteen and Catherine M Conaghan - photo 1
Pitt Latin American Series
John Charles Chasteen and
Catherine M. Conaghan,
Editors
Published by the University of Pittsburgh Press, Pittsburgh, Pa., 15260
Copyright 2010, University of Pittsburgh Press
All rights reserved
Manufactured in the United States of America
Printed on acid-free paper
10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Warren, Adam, Ph.D.
Medicine and politics in colonial Peru : population growth and the Bourbon reforms / Adam Warren.
p. cm. (Pitt Latin American series)
Includes bibliographical references and index.
ISBN-13: 978-0-8229-6111-6 (pbk. : alk. paper)
ISBN-10: 0-8229-6111-3 (pbk. : alk. paper)
1. MedicinePeruHistory18th century. 2. MedicinePeruHistory19th century. 3. Public healthPeruHistory18th century. 4. Public healthPeruHistory19th century. 5. PeruPopulation policyHistory18th century. 6. PeruPopulation policyHistory19th century. 7. VaccinationPeruHistory18th century. 8. VaccinationPeruHistory19th century. 9. SpainColoniesAmericaAdministrationHistory18th century. 10. SpainColoniesAmericaAdministrationHistory19th century. I. Title.
R482.P4W37 2010
362.10985dc22
2010020949
ISBN-13: 978-0-8229-7387-4 (electronic)
For my parents, and for Scot
ACKNOWLEDGMENTS
In writing this book I have been keenly aware of my reliance on the intellectual guidance, friendship, and generosity of others. I am particularly grateful to Christine Hnefeldt and Eric Van Young, who pushed me to become more intellectually rigorous as a historian and provided endless encouragement on earlier versions of this project. Likewise, Dain Borges, Suzanne Brenner, Nancy Caciola, and Marta Hanson all offered incisive feedback that led me to rethink my original questions and the significance of my findings.
The Department of History and the Center for Iberian and Latin American Studies at the University of California, San Diego, funded initial research for this project. Support from various sources at the University of Washington enabled me to travel abroad to do extensive additional research and released me from teaching for several quarters to devote myself to writing. A Junior Faculty Development Award financed research in Lima in summer 2005, while the UW History Department's Keller Fund enabled me to visit the Archivo General de Indias, Seville, in September 2006. The UW's Royalty Research Fund allowed me to return to Lima in 2008, and support from the UW History Department's Hanauer Fund financed the fees for illustrations and the drawing of maps. The Royalty Research Fund and a faculty research fellowship from the UW's Simpson Center for the Humanities released me from teaching for two academic quarters so that I could revise the manuscript.
Beyond this institutional support, I have benefited tremendously from the vibrant intellectual community at the University of Washington. I am especially grateful to my junior faculty writing group, including Elena Campbell, Purnima Dhavan, Shaun Lpez, Noam Pianko, Florian Schwarz, . I also invited feedback from the History Department's History Research Group, and I benefited immeasurably from the advice and help of Dauril Alden, Jordanna Bailkin, Charles Bergquist, Stephanie Camp, Kent Guy, Sandra Joshel, Linda Nash, Vicente Rafael, Ileana Rodrguez-Silva, Ben Schmidt, Sarah Stein, Lynn Thomas, Simon Werrett, and Glennys Young. I have also benefited from the valuable support of faculty in the Latin American Studies Program.
Intellectual communities beyond the University of Washington also strengthened this work. Two roundtable discussions of my work, led by Claudia Agostoni and Ana Mara Carrillo at the Universidad Nacional Autnoma de Mxico, challenged me to think about cultural historical approaches to the history of medicine in new ways. Participation in a colloquium at the Colegio Mdico del Per on the Peruvian doctor Hiplito Unanue taught me to appreciate the role of biography in medical histories. I am grateful to Oswaldo Salaverry for inviting me to that event. A colloquium on artisan surgeons at the Wellcome Trust prompted me to pay more attention to Lima's diverse surgeons, barbers, and cutters, as well as the problematic categories used to describe them. Beyond these presentations, I have benefited from the friendship, collaboration, and advice of Carlos Aguirre, Warwick Anderson, Ann Blum, Charles Briggs, Mark Carey, Too Coello, Marcos Cueto, Martha Few, Margaret Garber, Rosalva Loreto Lpez, Jorge Lossio, Cathy McClive, Heather McCrea, Zoila Mendoza, Rachel O'Toole, Alexandra Puerto, Guenter Risse, E. Elena Songster, Gabriela Soto Laveaga, Zeb Tortorici, Charles Walker, Eddie Wright-Ros, and Caroline Yezer.
This book would not have been possible, of course, without the assistance of many archivists, librarians, and staff in Peru, Spain, Britain, and the United States. I am especially grateful to Peru's archivists, whose efforts to preserve materials under difficult conditions are truly heroic. Laura Gutirrez Arbul and Melecio Tineo Morn's encyclopedic knowledge of the Archivo Arzobispal de Lima (and other archives) proved invaluable. Without the help of the interlibrary loan staff at the UW and the assistance of librarians Linda DiBiase and Theresa Mudrock, completing research for many of this book's chapters would have been impossible. The staff at the UW's History Department also provided helpful knowledge, friendship, and encouragement.
Working with the editors and staff at University of Pittsburgh Press has been a true delight. I am grateful to Joshua Shanholtzer for moving me through the publishing process quickly and efficiently and for coordinating particularly useful reports from two anonymous reviewers. Bill Nelson made beautiful maps that are included in this book, and Jos Ragas helped me acquire images from Peru.
Research for this project was made all the more enjoyable by friends in Peru, who made Lima feel like a second home. Vctor Colina Vega welcomed me into his apartment on numerous occasions, and his mother makes the best arroz con leche I have ever tasted. Soledad Marroqun's wild sense of humor, great taste in food, and extensive knowledge of wine and pisco made weekend lunches a delightful experience and a blurry memory. I still miss her late husband Guillermo. Lus Uztegui has been a loyal friend over the years, as has Adela Lpez. Conversations with friends from the Instituto de Estudios PeruanosAlex Girn, Raquel Retegui, Hildegardi Venero, and Johanna Yancarialways seem to start up right where they left off. My former housemates, Anglica and Rossio Motta, always made me feel like part of their family.
I owe a special debt of gratitude to my parents, who not only inspired me as scholars in their own right but also enthusiastically read an entire draft of the book manuscript and provided helpful suggestions. My sister and brother-in-law reminded me repeatedly that a larger world exists beyond academia and the book-writing process, as did Audrey Stanley and countless friends in Santa Cruz, San Diego, and Seattle. It would be hard to summarize all the ways my partner, Scot Orriss, has supported me since I first met him in Seattle in 2005. I don't think I could have finished this project without his love and nurturing, for which I will always be grateful.
Introduction
IN HIS FIRST MAJOR PUBLICATION, a work of rudimentary demographic analysis, a young doctor in Lima by the name of Jos Gregorio Paredes undertook a novel task. In 1807, just three years after receiving a medical degree at Lima's University of San Marcos, Paredes attempted to predict how a promising new medical practice might transform the size and health of the city's population. He concerned himself specifically with the widespread distribution and application of Edward Jenner's smallpox vaccine, which had been discovered in England eleven years earlier and had recently been made available to doctors in Peru. Drawing on parish and hospital records and combining them with census figures and information on infant mortality gathered from Lima's foundling home, Paredes used statistical methods to determine the population that would exist at the end of an indicated time period, assuming the prophylactic effect of the vaccine is successful. In making this calculation, he also sought to compare his findings to what might happen if the colony's doctors either neglected to employ the procedure or employed it incorrectly, prolonging the cruel tyranny of smallpox that had ravaged Peru's inhabitants for centuries. Prominent creole (American-born Spanish) physicians, who were the majority of physicians in Lima and often held positions of authority, had declared that they would use medicine to extend life expectancy, bring about population growth, and facilitate the colony's regeneration.
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