Medicine, Government and Public Health in Philip IIs Spain: Shared

Interests, Competing Authorities (review)

Timothy D. Walker

Bulletin of the History of Medicine, Volume 86, Number 4, Winter 2012,

pp. 681-683 (Article)
Published by The Johns Hopkins University Press
DOI: 10.1353/bhm.2012.0062

For additional information about this article

http://muse.jhu.edu/journals/bhm/summary/v086/86.4.walker.html

Access provided by Harvard University (9 Oct 2013 12:46 GMT)

book reviews Bull. Hist. Med., 2012, 86 681

Gavitt aims in this volume to set charity into the context of state formation, not
simply in the form of institutions or bureaucracies, but also at the level of humanist
ideology and mercantilist economy. The humanist educational program shaped
an aristocratic class that could preserve its status only by removing women into
charitable and clerical institutions. These institutions for women played a central
role in the development of a status culture and in forms of social discipline. Yet
the underlying drive had less to do with the Foucauldian birth of prison or clinic
than with Eliass civilizing process and Pieter Spierenburgs domestic ideology.
Gavitt argues persuasively that [a]lthough one might see in [womens] refuges
. . . attempts at totalitarian social control, early modern states and their aristocracies in northern Italy thought of these institutions quite literally in more familiar
terms. Charity attempted to extend the discipline of the family to reach those
members of the family, primarily women and girls, whom strategies of so-called
family and lineage preservation had displaced (p. 243). This argument recalls
Gavitts discussion of merchant ideology in his earlier volume and carries it forward into the changed social dynamics of the early modern period. As such, the
study offers a valuable contextualization for institutions that are often discussed
only in terms of pious intentions and horrific results.
Nicholas Terpstra
University of Toronto

Michele L. Clouse. Medicine, Government and Public Health in Philip IIs Spain: Shared
Interests, Competing Authorities. Surrey, UK: Ashgate, 2011. xiv + 204 pp. $104.95
(978-1-4094-3794-9).
This book addresses a fundamental issue of the history of medicine, but one that
is relatively understudied: what was the role of the European monarchical state
in organizing medical care during the early modern period? Evolving crown
interest in fostering a system to improve citizens healththereby strengthening
demographic resources as a tool to promote national fortunesraises fascinating
questions (in English, John Tate Lanning and David Gentilecore have taken them
up, but few others). Michele L. Clouse approaches this subject with great ability
and detail in her new volume.
Clouses self-described scholarly interests focus on the intersection between
political, legal and social history in early modern Europe (dust jacket). As she
broaches the matter in the introduction, her goal was to to examine how medical
practice in sixteenth- and seventeenth-century Spain became a deliberate device
of the state authorities, manipulating it to help achieve national and imperial
ends. Furthermore, Clouse attempted to bridge the gap between institutional
and regulatory perspectives and actual medical practices in the marketplace
(pp. xii), thereby chronicling a broad context of contemporary medical
experience.

682 book reviews Bull. Hist. Med., 2012, 86

The books subtitle, Shared Interests, Competing Authorities, speaks to the core
questions posed by the author, as she explores the rival centers and dispersed
foci of medical knowledge (skillfully drawing distinctions and parallels between
popular empirically trained healers and conventional university-trained, statelicensed physicians and surgeons), while examining how monarchical authorities,
in formulating a national medical policy, sought to harness the benefits of both
types of practitioners for the good of the state.
The architecture of the volume is straightforward. Following the general introduction that lays out the problem and reviews the relevant historiography, the five
subsequent chapters address issues of Protecting the Public Health: Tribunal del
Protomedicato, Medical Education at the University, Emperics, Surgeons and
Experiential Medicine: Patronage and Legitimization, The Apothecarys Profession: Cooperation and Professionalization, and, the most innovative, groundbreaking chapter in the book, Poor Relief: Cooperation and Resistance. The
work is based on extensive primary source research, carried out in royal chancellery, parliamentary, and provincial archives across Spain, in Madrid, Valladolid,
and Salamanca.
Clouse offers illuminating discussion of the chronic professional competition
between conventional practitioners and the decidedly popular healing methods
of unlicensed empirics, male and female, whose less expensive though often
valid medical care served the majority of Spanish subjects. The creation of a flexible state regulatory framework, with an examining board administered by the
Protomedicato, designed to draw in and legitimize socially valuable empirics
while excluding mere quacks and charlatans, was a great innovation of Philip IIs
reign, and a triumph of pragmatic domestic administration. The junta headed
by the Protomedicato, a committee of medical experts convened on an ad hoc
basis to assess new medical practices or remedies, offered extra-university medical practitioners a means by which they could gain professional legitimacy and
reap financial rewards. The juntas role in validating certain medical techniques
and innovations derived from the marketplace also reinforced the professional
superiority of a medical elite responsible for policing the world of medicine in
early modern Spain (pp. 8687).
Clouses thoughtful, balanced, and insightful analysis is highly engaging. Historical vignettes illustrate the larger argument of the book, while allowing insight
to the medical context of the time and the cosmology of medical practitioners
(be they popular or conventionally trained) in Philip IIs Spainas with the
example of the life and celebrated remedya miraculous oilof healer Aparicio de Zubia (pp. 7784). A particular strength of the book is the consideration
of female healers and their interactions with the medical licensing authorities.
Midwives offered obstetrical or gynecological care and often provided other
healing services. Initially, the tribunal of the Protomedicato was not supposed to
license female healers, but over time it developed a pragmatic policy of licensing
women, upon demonstrating their skills to the tribunals satisfaction (pp. 8889).
A remarkable picture emerges: the surprising degree to which the Spanish
crown took an interest in the health of the common population. The monarchy,

book reviews Bull. Hist. Med., 2012, 86 683

perceiving this policy as a natural part of its social responsibility, sought to provide conditions for the good health of its subjects. Thus the crown, cooperating
with regional and municipal authorities, supplied financial support for health
measures; set up an administrative body to certify physicians, surgeons, and other
healers; monitored medical education; and intervened in the time of epidemics.
Accessible and effective medical care was part and parcel of the crowns administration of the state because such services were viewed as a matter of security that
ultimately strengthened the state (pp. 17071).
Timothy D. Walker
University of Massachusetts Dartmouth

Alun Withey. Physick and the Family: Health, Medicine, and Care in Wales, 16001750.
Manchester, UK: Manchester University Press, 2011. xii + 240 pp. Ill. $95.00 (9780-7190-8546-8).
This stimulating book sets out to offer a good regional medical history of Wales
in an important period of transition (p. x). It also suggests what to do with the
history of medicine in Wales (p. 3) by considering a wide range of sources, in
both English and Welsh, from probate inventories and account books, to diaries
and poems. The three sections deal with notions of disease in Welsh society from
the later Middle Ages down to the later eighteenth century; medical knowledge,
and the circulation of new ideas in both Welsh and English; and concepts of sickness and caring in a Welsh social setting. There is a robust discussion of writing
the history of a country lacking state institutions of its own, and in which two languages competed for primacy of esteem. Withey sees Wales as a country pulling
simultaneously in two directions, between the rural traditions, medical legends
and folklore, oral culture, and localism (p. 202) of its past, on one hand, and on
the other the advances of print culture (first in English, then in Welsh), the provision of medical supplies and services by apothecaries and doctors, and the caring
provisions made by the poor law, local communities, and even small hospitals.
The effect of these advances was that [f]or a small, relatively sparsely populated
and reputedly insular country, Wales was remarkably open for business (p. ix).
Though the emphasis of the book is on the later part of the period, when
change was so extensive that some topics (surgery and midwifery) have had to
be excluded, important suggestions are also made about the sixteenth century.
Discussing The Welsh Body, Withey undermines notions of a backward and
remote culture by showing how medieval learning transmitted in Latin fused
with folk concepts and representations of the body in Welsh poetry to provide a
distinctive conception of bodily health. This then served as a receptive vehicle
for the absorption of new ideas percolating into Wales from Europe through the