Medicine, Government and Public Health in Philip IIs Spain: SharedInterests, 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 PressDOI: 10.1353/bhm.2012.0062

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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 aristocra-cies 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 for-ward 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 TerpstraUniversity 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, state-licensed 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 intro-duction 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 Pro-fession: Cooperation and Professionalization, and, the most innovative, ground-breaking chapter in the book, Poor Relief: Cooperation and Resistance. The work is based on extensive primary source research, carried out in royal chancel-lery, 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 flex-ible 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 medi-cal 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. His-torical 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 Apari-cio 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 pro-vide 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 adminis-tration of the state because such services were viewed as a matter of security that ultimately strengthened the state (pp. 17071).

Timothy D. WalkerUniversity 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 (978-0-7190-8546-8).

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 sick-ness 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 lan-guages 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 provi-sion 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