Medical Pluralism in the Iberian Kingdoms: The Control of Extra-academic Practitioners in Valencia

Over the last several decades, historians of medicine have grown increasingly interested in the coexistence of medical systems, a phenomenon known as medical pluralism. While medical pluralism is not at all uncommon in present-day societies, Robert Jutte remarks that it is relatively recently that medical historiography has shifted the emphasis from renowned doctors and orthodox practitioners to the more complex world of medical practice, to include all manner of healers involved in confronting illness. However, the study of this complex world—while indispensable to a full comprehension of the medical practices of any period—presents a number of challenges to traditional medical historiography. For example, the fact that practitioners of folk medicine, charismatic healers, and the like left behind relatively few documents means that we must turn to the systems of control to understand extra-official health practices (i.e. those practices that are neither regulated by nor included within legal frameworks). For this reason, a variety of new historiographical models have been developed, each with its own terms and concepts for the purposes of, on the one hand, properly interpreting and analysing medical pluralism historically and, on the other, methodologically resolving the problems this phenomenon presents, particularly the dichotomy between academic and non-academic medicine.1 These models make use of tools that previously pertained exclusively to social and political history in order to include not only academic medicine but also unregulated and unorthodox practices. In this way, these models help to account for all the options that existed for the treatment of sickness.2 In the case of early modern Spain, medical pluralism involves the coexistence of academic medicine—the Galenism taught in universities to physicians, surgeons and apothecaries through guild-based instruction—and other forms of medical practice. Studies undertaken to date3 demonstrate that alternatives to traditional Galenic therapies were present in all the territories of the Spanish monarchy, the same variety of notions concerning illness and healing practices identified elsewhere in early modern Europe.4 Thus, in order to understand the relationships among the different medical systems that coexist in a society during a certain historical moment, we must take into account not only academic medicine and its professionals, but also the society collectively.5 Part of this task is relatively easy; manuscript and printed sources are fairly abundant for the study of authorized health professions with regimented educational programmes, as the bibliographies of scholarship on these professions attest. As I have mentioned, however, this is not the case for extra-academic practices. Attempts to analyse large-scale tendencies related to illness and healing in a given society must therefore draw on a broad range of materials.6 In the best cases, I have information only about those practitioners who worked illegally, were found out, and then prosecuted. That is to say, the only information I possess concerns instances in which extra-official healing practices were actively repressed; the “other …” was made visible through political and professional control. This makes it necessary to study both the systems of control as well as the available health resources of a population. For this reason, our study—like those studies of other European regions—draws primarily on judicial documents related to court proceedings.7 But the importance of institutions that controlled and regulated the broad range of medical practices has sometimes been misunderstood. For example, while traditional historiography has tended to attribute the ubiquity of “empirical” healers and curanderos to a lack of physicians, surgeons, and educated pharmacists, it is now clear that this was not the case in the Iberian peninsula (although, as I discuss below, there was a shortage of physicians in Spain’s American colonies). Instead, the existence of a diverse offering of therapeutic options in sixteenth- and seventeenth-century Spain was due to cultural circumstances that should be studied from a historical perspective.8 Thus, one can now explain the presence of sanadores and empirics at court (especially that of Philip II), or in cosmopolitan cities such as Valladolid and Valencia that boasted not only universities but also a large number of physicians, without resorting to cliches, or references to superstition. On the other hand, the presence of a variety of different medical practices allows us to reject both the simplistic idea that the existence of institutions dedicated to the control of medical practice was attributable merely to the paternalistic concern of a monarch for his subjects, and the similarly limiting notion that these institutions represented nothing more than an attempt by the emergent bourgeoisie to claim new governmental powers or means of social control for itself. On the contrary, the prevalence of medical pluralism suggests that there was a real and pressing need to control the diverse and potentially chaotic world of medical practice.9