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

Abstract

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.