Hospitals

by

Heather Vrana

• LAST REVIEWED: 21 April 2021
• LAST MODIFIED: 21 April 2021
• DOI: 10.1093/obo/9780199766581-0250

Introduction

Contemporary readers likely have a narrow view of hospitals. But prior to the 19th century, hospitals were used for many purposes: to provide charity for the needy, shelter wounded soldiers, house homeless community members, inoculate against disease, learn and teach anatomy, and heal the sick and wounded. Hospitals were nearly indistinguishable from hospices, where citizens who could prove their need could receive shelter and food. These hospitals were charged with dealing with epidemics, demographic collapse, war wounds, birth (and sometimes baptism), death, and all of the other bodily expressions of colonization, occupation, and expansion. Of course, buildings or other spaces for healing preceded European colonizers. While a few of the books discussed below provide a glimpse of pre-Columbian hospitals, this is an ample area for exploration. Early colonial hospitals were built alongside churches, buildings of state, trade houses, and houses for the wealthy. The boundary between medical and religious knowledge was blurred. Practitioners were diverse: the very indigenous and African healers who were censured by the Inquisition were also relied upon. Universities, like Guatemala’s Universidad de San Carlos (founded in 1676), offered medicine as a course of study. The Enlightenment “arrived” unevenly in Latin America. Generally, the number of hospitals grew, as did the number of the regulations concerning them. Owing to imperial anxieties, as well as epidemics and medical innovation, medicine (and hospitals) became more a part of colonial life. Enlightenment hospitals were teaching and research institutions, too. With independence, medical science became a tool of liberal state building, as it had previously been of colonial administration. Liberal governments wrested responsibility for care of the sick and the needy from religious orders. Positivism and eugenics became the drivers of much hospital work. Clinics for the degenerate and other threats to the nation promised rehabilitation. Diagnoses and specializations proliferated. Then, a number of welfare states emerged throughout the region, sometimes in response to popular demand. Some hospitals sat in uneasy balance between positivism and the welfare state. Hospitals were also laden sites in the Cold War. Mid-20th-century revolutions were fought with health care among guerrillas’ demands. Some revolutionary states managed to fulfill their promises of accessible community health care. Around the 1980s, state welfare gave way to privatization. While this has continued, proponents of community and preventive health care have won crucial victories in many places. Hospital historiography sits at the intersection of many fields. Historians of science, technology, medicine, public health, charity, nationalism, social movements, and political repression all have a stake in hospital history. Many of these fields have produced extensive bodies of knowledge, even conferences and journals dedicated to their study. But this is not the case for hospitals. Of course, the boom in scholarship on history of medicine and Science and Technology Studies (STS) has provided still more texts featuring hospitals in nuanced ways. In fact, many different types of historians consult hospital records in the course of their research. So, on the one hand, hospital history is everywhere; on the other, it is obscure.

General Overviews

The most accessible overview of history of medicine that addresses hospitals is Cueto and Palmer 2015. In fact, few synthetic overviews have been written on the subject, although edited volumes and comparative studies abound. Stepan 1991 and Abel 1996 are very useful as starting points. Though focused on eugenics and modern public health policy rather than history of medicine or hospitals, in particular, both provide a broad thematic introduction to the topic. Stepan 1991 and Quevedo and Gutiérrez 2009 consider Latin America as a region. Birn and Necochea López 2011 provides an overview of scholarship in the early 2000s.

• Abel, Christopher. Health, Hygiene, and Sanitation in Latin America, 1870–1950. London: Institute of Latin American Studies, University of London, 1996.

  This paper lays out in broad terms and familiar themes the genesis of “modern public health policy” from the late 19th century through the Cold War. Eugenics, the Rockefeller Foundation, and tropical disease epidemiology are discussed. Although broad, this essay provides a thoughtful analysis of foreign capital, labor, and health-care infrastructure (including hospitals) in sections on the Panama Canal and Rio de Janeiro.

• Birn, Anne-Emanuelle, and Raúl Necochea López. “Footprints on the Future: Looking Forward to the History of Health and Medicine in Latin America in the Twenty-First Century.” In Special Issue: Science and Medicine. Hispanic American Historical Review 91.3 (August 2011): 503–527.

  DOI: 10.1215/00182168-1300164

  This essay is from a special issue of the Hispanic American Historical Review on Science and Medicine in recognition of the work of Nancy Stepan. It surveys the state of the field to highlight likely future avenues for research, including thematic foci like race, women’s health, religion, and social medicine and theoretical lenses from postcolonial and Cold War studies. Footnotes provide a valuable bibliography of dissertations, books, and articles. Useful for situating histories of hospitals within broader currents of the history of health and medicine.

• Cueto, Marcos, and Steven Palmer. Medicine and Public Health in Latin America: A History. Cambridge, UK: Cambridge University Press, 2015.

  This book is a highly readable and authoritative summary of the sociocultural history of medicine (including hospitals) with an emphasis on public health covering about five hundred years from pre-Columbian era to contemporary epidemiology. Though the text does not reflect original archival research unavailable elsewhere, the authors incorporate invaluable insights from the field’s 21st-century renaissance. This book is a great introduction to the field for beginners and non-academic audiences.

• Quevedo, Emilio, and Francisco Gutiérrez. “Scientific Medicine and Public Health in Nineteenth-Century Latin America.” In Science in Latin America: A History. Edited by Juan José Saldaña, 163–195. Austin: University of Texas Press, 2009.

  This book covers a tremendous amount of ground in the history of science in Latin America. It considers whether the region may be understood to have a distinctive scientific culture and ultimately argues that scientific ideas from Europe were adopted and adapted in the region. Several chapters address medicine, but chapter 6 best addresses hospitals as laboratories of scientific medicine.

• Stepan, Nancy. The Hour of Eugenics: Race, Gender, and Nation in Latin America. Ithaca, NY: Cornell University Press, 1991.

  This foundational book addresses eugenics as a scientific and social movement and emphasizes Mexico, Brazil, and Argentina. It argues that Latin American eugenics were different than European eugenics, thus challenging the center/periphery model of diffusion of scientific knowledge. It explores how eugenic thinking shaped everyday life and mainstream politics; reveals how reformers from places that other eugenicists regarded as backward were involved in eugenics. Hospitals appear as sites of expertise.