864 Journal ofthe Royal Society ofMedicine Volume 72 November 1979 Spanish medicine in the Golden Age Robin Price MA ALA Wellcome Institutefor the History ofMedicine, 183 Euston Road, London NWJ 2BP The extent of the Golden Age of Spain varies according to the criteria used to measure it. In literature it may justly be said to extend from the early 16th century to the end of the reign of Philip IV in 1665; in medicine, from the beginning of the joint reigns. of the Catholic Monarchs, Isabella of Castile and Ferdinand of Aragon, in 1479 to the death of Philip II in 1598. These were tumultuous years for Spain and for the European world in general. For Spain particularly, the conquest ofGranada, the expulsion ofthe Jews, and the discovery ofAmerica in 1492, meant a confirmation of its role as conqueror, now wholly achieved within its own land, and an appetite for renewed conquest wherever else Spanish energies carried its peoples. Conquistadors passed to Mexico and Central America in the traditional sense, but conquistadors existed within Spain in the realm of the arts and architecture, and more particularly in the realms of medicine and surgery. The practice and development of these sciences during this period of released vigour constitute an enormous area of study, the complexities of which are considerable. Any attempt to include all this within the compass of one paper will necessarily be highly selective. Omissions and simplifications, therefore, must be attributed to an attempt to indicate in outline some of the major aspects of the period: medical licensing; education; the place ofreligion in the provision ofinstitutional health care; the practice of dissection, and the teaching of anatomy, surgery, physiology; the practice of representative areas of medicine; the place of classical tradition in medical theory and practice; and the transfer of medical knowledge and skill to the colonies. These categories are, of course, to a great extent interwoven and together form the remarkably rich fabric of Spanish medicine in the 16th century. By definition the official and literate medicine of the Spanish with which this paper deals excludes its opposite, the indigenous or folk medicine which, among the Moors in Valencia, probably among the peasants of the Iberian Peninsula, and certainly among the Indians of New Spain and Peru, enjoyed a high esteem. That of the Aztecs in particular was remarkably complex and undoubtedly efficacious; so much so, that at least one Aztec remedy passed into the European pharmacopoeias. Licensing and hence the practice of medicine were early regulated by a law of 1477 which first set up the Protomedicato as the medical licensing body. Throughout the 16th century regulations for the education of the practitioner and for his professional life were improved and amplified. Many new universities were created, in addition to the 13th century foundation of Salamanca; these were either of royal inspiration (Valencia, 1500), individual inspiration (Alcal'a, 1508), or city inspiration (Osuna, 1548). By 1619 there were no less than 32 universities in Spain, though Salamanca, with 7800 students and 70 professors in 1566, had declined by 1602 to 4000 students. Alcali, founded by the great cardinal Ximenes de Cisneros, Regent of Castile during Charles V's minority and inspirer of the celebrated Complutensian Polyglot text of the Bible, maintained a fairly constant level of 2000 students. By 1566 Alcala had managed to reform itself and its medical faculty satisfactorily. By these reforms, instead of continuing the founder's unworkable arrangement whereby two professors taught the two subjects ofthe Canon ofAvicenna, and Hippocrates and Galen, turn and turn about every two years, the School decided to appoint four professors in the major and minor chairs of Prima I Paper read to Section of the History of Medicine, 5 April 1978. Accepted 28 September 1978 0141-0768/79/110864--11/$01.00/0 ,.', 1979 The Royal Society of Medicine Journal ofthe Royal Society ofMedicine Volume 72 November 1979 865 and Visperas of medicine, a system which became general throughout the hispanic university world. The lectureship in the practice and theory of anatomy which had existed since c. 1563 was confirmed as a chair as a result of the same reforms; and the lectureship in surgery which had existed since c. 1519 became a chair in 1594. By law, the privilege of granting a degree in medicine lay with those universities which at the least possessed chairs of Prima, Visperas, Surgery and Anatomy. The Catholic Monarchs, in laws signed in 1480 and in 1496, had taken care to deny validity to degrees granted by Papal Bull, and these laws were confirmed by Charles V in 1523. In further laws of Philip II of 1563 physicians were obliged first to obtain their degree in Arts. They then took four courses in medicine followed by two years of practice before appearing before the Protomedicato (the licensing and examining body) to obtain licence to practice. In 1588 Philip II further regulated the proofs of competence to be laid before the Protomedicato and again in greater detail in 1593. Similar proofs of competence for surgeons were the subject of regulations in 1528, 1563, 1588, and 1593. Special licences were authorized by Philip II in 1570 and 1578 for practitioners without university education, e.g. barbers, 'poulticers', urological specialists, couchers for cataract, and midwives. In 1559 a Real Provision was issued permitting, for the teaching and study of anatomy at Alcal'a, the dissection of the bodies of executed criminals or of those who died in the hospitals of Alcal'a. The first known dissection for this purpose in Spain had been performed in the late 15th century, with special permission from Rome, in the monastery- hospital of San Juan Bautista at the national shrine of Guadalupe; a shrine which later possessed no less than four hospitals, including one for women. It was at Guadalupe, most appropriately, that St John of God (1495-1550), successively traveller, soldier, shepherd, and merchant, had seen his vision of Our Lady holding out the naked child Jesus, and saying: 'Juan, see thou Jesus, so learn thou to clothe the poor'. Following the establishment of his first hospital for the sick poor in 1537 in Granada his movement went from strength to strength, and in 1572 his followers were organized by Pius V into a Congregation under the Augustinian Rule. By 1590 there were said to have been 600 Brothers Hospitaler in Italy, Spain, and the New World, possessing 79 hospitals containing more than 3000 beds. Other orders concerned in medical care were the Hermanos Minimos, usually known as the Obregones, founded in 1568 by Bemardino Obregon (1540-99), which spread to the Low Countries, Lisbon, and the colonies, and which directed the General Hospital of Madrid; and the Brothers of San Hip6lito of Mexico, founded in 1567 by Bernardino Alvarez (1514-84). While in the reformed and Protestant north of Europe hospitals of religious foundation were giving place to lay foundations, in Spain the number of hospitals founded through religious zeal was steadily increasing. On the whole they remained well run and useful until the end of the 18th century. The influence in Spain, during this and successive periods, of the Christian religion on hospitals and on institutional care cannot be over-emphasized. The practice of dissection and the teaching of anatomy, the foundation of medical science and the beginning of the new age of enquiry in medicine, was not regularly established in Spain until the creation in 1550 of the first Chair of Anatomy in the University of Valladolid, occupied briefly by Alonso Rodriguez de Guevara (b. 1522), who there taught anatomy and gave public dissections until he moved to Coimbra. His colleague at Valladolid, Juan Valverde de Hamusco, studied under Realdo Colombo at Padua and published his Historia de la composicion del cuerpo humano in Rome in 1556 (Figure 1), with its handsome illustrations by Gaspar Becerra. Though his work is based on the Vesalian model and follows the Vesalian division into seven books, even to using cruder and reduced versions, sometimes reversed and altered as to stance, of Vesalius' figures, his personal research corrected errors of detail and filled gaps left by Vesalius. By this text Spanish anatomical terms were now fixed as part ofthe medical language. As a recreation of the Vesalian approach, it is possibly the most distinguished early Spanish textbook ofanatomy; and in its own time it was sufficiently widely regarded throughout Europe to achieve publication in Italian editions (1560, 1586), in a Dutch edition (1568), and in Latin editions (Venice, 1589, 1607), that is, some 50 years of usefulness. 866 Journal ofthe Royal Society ofMedicine Volume 72 November 1979 Figure 1. Title-page ofthe first edition ofJuan Valverde de Hamusco, Historia de la composicion delcuerpo humano, Rome, 1556. (By courtesy of the Wellcome Trustees) The earlier writers such as the polymath Andres Laguna (1499-1560) in his Anatomia methodus seu de sectione humani corporis contemplatio (Paris, 1535), the first work on anatomy written by a Spaniard, adhered to traditional knowledge. Brnardino Montania de Monserrate (c.1480-c.1551), who in old age had himself carried to the lectures of Alonso Rodnrguez de Guevara at Valladolid, enjoys the distinction of having published his Libro de la anothomia del hombre (Valladolid, 1551), the first full anatomical text written in Spanish and the first Spanish anatomical text to include illustrations. It enjoyed European esteem, although it remains true to the Galenic tradition in spite of its appearance 8 years after the Vesalian Defabrica of 1543. In Valencia anatomy was taught by Luis Collado and Pedro Jimeno. The latter, formerly a disciple of Vesalius at Padua, published his version of the new understanding of the human body and the result of his own dissections in Dialogus de re medica (Valencia, 1549).