2024-03-31 15:25:00
Javier Segura del Pozo, health doctor
We continue our excursus on what healthcare was like in the century of the Enlightenment, focusing today Spain. THE medical teaching It was still limited to the wealthiest students and excluded for women and Jews. Surgical training was in the hands of the barber-surgeons’ guild. There were fewer than 4,000 doctors (concentrated in the cities and supervised by the Protomedicato) for a Spanish population of 11 million. Most of the population treated themselves and continued to go there healers, barbers and charlatans or they were looking for the miraculous effect of relics, saints or pilgrimages.
medical students
During the Modern Age, studying medicine meant choosing one of the most expensive careers. The students were mainly from rich layers made up of families of clergy, doctors and lawyers. A 1559 decree of Philip II limited teaching and teaching to universities, institutions or colleges within the boundaries of the Hispanic monarchy. In Spain and some German and Italian states, subjects were prohibited from enrolling in foreign institutions. They feared pernicious influences from the exchange of ideas between European students (come on, they destroyed the Erasmus program of the time). It was necessary to wait for a decree from Philip V in 1718 for scholarships to be created for the study abroadwith which new “useful knowledge and techniques” were acquired for the State project, in addition to the hiring of foreign professors to teach in Spain[1].
Scholars and Manteists in the Spanish university from the 16th to the 18th century: although university studies (especially medical ones) were reserved only for the wealthy classes, two categories of students were distinguished by their level of wealth or influence. The schoolchildren (on the left: clothing of a pupil of Santa Maria of Seville in the 16th century) who lived for a fee in the colleges founded next to the university, and which were distinguished by a garment called becaterm which was extended to the pension they enjoyed. AND the Manteists (right image) who wore the I’ll hold (cloak with collar) over the cassock. They lived in private homes and boarding houses and to survive they did various jobs, such as playing instruments and singing (center image) for locals and on request (origin of the prickly pear and prickly pears).
Two groups were excluded from this teaching: Jews and women. women They could not attend university, which prevented them from earning a medical degree. However, in the 16th century some women appear to have served surgical apprenticeships. However, according to Lindemann[2]the tradition of women in medicine was ancient, and some were familiar with the academic medical theories of their time. And there were midwives who published treatises to introduce the medical ideas of the time into obstetric practice, as we will see later.
Surgical training, however, took place in trade unions and not in universities (surgeon-barbers’ guilds) until the end of the 18th and 19th centuries. Doctors and surgeons-barbers They were distinct professions until the first decades of the nineteenth century. We must highlight the creation of the as a pioneering event Royal College of Surgery of Madrid in 1787, dedicated to the teaching of surgery outside the guild system, which included, as we will see later, the training of women as certified midwives. However, medical studies were prohibited for women until the first decade of the 20th century. On March 8 (a significant date) of 1910, the Royal Order of women’s free access to higher education was published, and in that decade the first Spanish doctors graduated, such as the Leonese pediatrician Nieves González Barrio.[3].
Healthcare in Spain in the Enlightenment
Second Perdiguero-Gil[4]the availability of skilled health care in the last third of the 18th century was markedly unequal in Spain, as in other European countries. There has been a concentration of highly qualified professionals in cities and large centers and an almost total abandonment of the rural population, which becomes even more important if we know that the latter represented 80-90% of the total population. He lived in conditions bordering on survival, after paying rent and taxes. Thus, when periodic subsistence crises occurred, dramatic limits were reached. At the end of the century, heThere were less than 4 thousand doctors for a peninsular population of 11 million and they were concentrated where there were patients able to pay their fees or there were institutions with common funds to contract medical services, such as the advicelos positions (their grain and financial reserves allowed them to contract health care for the rural population) or the farmers’ guilds (similar to similar urban brotherhoods).
Representation of a a doctor’s visit to the home of a wealthy family in the 18th century. He arrived on a seat of the sedan and carries bottles of medicine in his pockets and a syringe hidden under his arm. Liebig Trade Card c1910 (The art of healing 200 years ago. The doctor makes his visits). health care at home by doctors with academic training it was almost reserved for the wealthy classes and in urban areas. The social majority turned to other health workers (relatives, neighbors, healers, quacks, religious people) or were treated by doctors employed by charitable institutions, councils and unions in public charity hospitals.
However, still at the end of the 18th century, most of the population had to move “empirical” healers and healers. of all kinds, in addition to self-help or mutual help between neighbors. Professional practice continued to be controlled by the Protomedicatedor in the case of barber-surgeons by the subordinate court of Protobarberate and Protosurgeon. In short, the shortage of health workers with minimal academic training led the municipal authorities to allow the practice of professionals without a Protomedical license, who joined the numerous surgeons, barbers and bloodletters who practiced without needing to demonstrate the own training.
To all these “professionals” we had to add a legion of charlatans and healers of both sexes. Some of the latter were itinerant and specialized in the treatment of rabies or the evil eye, using a variety of ointments, creams, religious relics, spells and rituals, as well as in the correction of humps or hernias. A royal decree of 25 May 1785 attempted to control the practice, always suspected of heresy. In many cases these were people who also carried out other occupations and for whom healing was a way of putting a gift they possessed at the service of the community in exchange only for gifts considered more gratitude than payment for services, in a society where, according to in Perdiguero[5]community bonds were even stronger than the drive for individual profit.
An 18th century quack surgeon
In the Spain of the Enlightenment, religion It continued to be central to the population’s worldview, including that relating to ideas about their illnesses, which is why they often sought relief from their illnesses in saints, religious relics, hermitages, and pilgrimages. For this reason, popular ideas about health and illness were closer to that of healers than to that of professionals. And although these were available and accessible, they were not consulted from the beginning because they belonged to different social and cultural contexts. In any case, it is important to consider that the available healthcare alternatives have been taken into account eclectically by the majority of the population and that professional and secular medicine continued to be more complementary than competitive in the 18th century. A worsening of the disease could encourage ordinary people to consult a doctor as a last resort, despite the cost of his fees. Likewise, wealthy people did not exclude the possibility of consulting healers.[6].
A similar situation occurred in Portugal of the 18th century. According to Isabel Mendes, the majority of the population “treated themselves, consulted the midwife, listened to the quack or followed the cure prescribed by the healer. On the other hand, popular medicine and university medicine often coincided, and cases in which the same person turned to the doctor and the healer seeking solutions to their illnesses were not uncommon.[7]. The frequent demand for empirical healers in Portugal, despite there being some opposition from doctors, was explained by the limited number of available medical professionals, in addition to the limitations of their knowledge. They thus allowed themselves to take care of the numerous wounds caused in daily life by physical violence, or to effectively take care of insufficient hygiene or a poor diet.[8].
To complement the previous text, I leave you this 17-minute video edited by UNED in 2002, entitled «Getting sick in 18th century Madrid» which describes health care differentiated by level of wealth, the main charitable institutions existing in Madrid, the most widespread diseases and health problems, their relationship with the significant level of existing poverty and the institutional mechanisms to register and control the legion of urban poor .
[1] LINDEMAN, M. (2002). Medicine and society in modern Europe, 1500-1800. Madrid: Siglo XXI Editores, pp.113
[2] Ibidpp. 113-114
[3] ZAFRA ANTA MA, HERNÁNDEZ CLEMENTE JC, GARCÍA NIETO VM, MEDINO MUÑOZ J. (2022). “Biography of a pioneer pediatrician in Spain: Nieves González Barrio (1884-1961).” Pediatric Journal of Primary Care. 24, pp. 93-102.
[4] PERDIGUERO-GIL, E. (1992). “The popularization of medicine in the Spanish Enlightenment”. En: The popularization of medicine, 1650-1850, and. Roy Porter, London: Routledge, pp. 163-164.
[5] Ibidpp. 165-167.
[6] Ibidpp. 167-168.
[7] MENDES, I. (2002), “Popular medicine versus university medicine in the Portugal of John V (1706-1750)”, Dynamic, 22, pp. 210-221.
[8] IbidP. 215.
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The text provides a detailed overview of healthcare practices in 18th century Spain, with a focus on the socio-economic factors shaping medical attention and the various types of health practitioners available to the population. Key points include:
- Healthcare Access: Professional medical care was predominantly accessible to the wealthy and urban populations, whereas the majority relied on alternative healers, such as family members, neighbors, and quacks, as well as charitable medical institutions.
- Role of Healers: A significant portion of the population turned to “empirical” healers who often had no formal training. The lack of trained medical professionals led authorities to permit unlicensed practitioners to operate.
- Charlatans and Rituals: Alongside legitimate healers, many charlatans provided health services, often using folk remedies, religious relics, and rituals. Some of these practitioners were itinerant and catered to specific ailments or performed traditional practices.
- Cultural Context of Illness: Religion played a crucial role in people’s understanding of health and illness. Many sought relief through religious means, highlighting a cultural preference for traditional healing practices over formal medical care, which was viewed as distinct from their social and cultural contexts.
- Eclectic Approach: The population didn’t strictly adhere to one form of medicine; instead, they often adopted remedies from both traditional and professional practices. It was common for individuals to seek help from both doctors and healers, reflecting a blend of medical systems.
- Portugal’s Healthcare Similarity: A parallel situation existed in 18th century Portugal, where people relied on both traditional healers and medical professionals due to limited availability and knowledge in the medical field.
- Video Resource: The text mentions a video titled “Getting sick in 18th century Madrid,” which further explores healthcare disparities based on wealth, prevalent diseases, and the social conditions of the poor in urban areas.
the historical account underlines the complexities of healthcare knowledge, practice, and access in Spain during the Enlightenment, marked by a plurality of healing traditions and socio-economic barriers.