Hospitals for Indians in the colonial Andes (1548-1666)
The Peruvian viceroyalty built hospitals reserved for indigenous people from 1548, and paid for them with a levy on indigenous tribute, the tomin de hospital - so the charity came from the pockets of the poor it was for. An inspection in 1619 found hospitals in 74 of 152 places visited and 63 of those 74 deserted. The people they were built for called them the house of the dead, and the version that worked was the one indigenous authorities ran themselves.
Why this wins its question: Two accounts of this subject circulate in English and both are useless. One says the Spanish crown built hospitals for indigenous people across the Andes, and stops; the other says colonial hospitals were instruments of control, and stops. The scholarship supports a third account that is more specific than either and is set out here with its figures: a datable provincial network from 1548, endowed by a named levy on indigenous tribute so that the poor funded their own charity; an internal inspection in 1619 that found hospitals in 74 of 152 places and 63 of those 74 empty; a documented reason for the emptiness in the words of the people concerned, that the hospital was the house of the dead and that at home they could eat their fill and there were fewer lice; a variant in Chucuito that worked because it was built on pre-Hispanic provisioning, three circuit surgeons and an Indian barber in each of seven towns; indigenous authorities claiming the mayordomia by 1629 on the explicit argument that Spaniards and clerics were robbing the poor; two named cases of exactly that robbery; and the crown abolishing the levy in 1666 while corregidores kept collecting it. Achievement, cost, motive and refusal are each a sourced claim, and none of them is an inference.
Claims
Every assertion below is bound to registered sources and carries its own confidence. Weight them; do not treat the page as uniformly authoritative.
The network is datable and it starts early. The Indian hospital of Lima was begun at the initiative of its archbishop in 1548; those of the principal viceregal cities - Trujillo in 1551, Piura in 1553, Cuzco and Huamanga in 1556 - were created by order of their town councils. Viceroy Toledo's inspection tours from 1569 prompted foundations at Potosi, La Plata, La Paz and Huancavelica. This is a provincial system, not one showpiece in a capital.
The funding mechanism is the part worth knowing and it cuts both ways. Toledo ordered that a portion of indigenous tribute, known as the tomin de hospital, be earmarked to support the Indian hospitals. Where European hospitals lived on alms and bequests from the rich, this one was endowed from a levy on the people it treated: the resources to maintain the hospitals came from the communities themselves. It is simultaneously a standing fiscal commitment to indigenous health care and a charge laid on indigenous tributaries to pay for it.
The system's own audit records its failure with unusual precision. Of the 152 places visited in the 1619 archiepiscopal inspection under Lobo Guerrero - a figure that includes some towns where Spaniards and Africans also lived - fifty-seven had no hospital, and in twenty-one the inspectors left no clear indication of whether one existed, though probably none did. Of the seventy-four remaining villages that did have a hospital, in sixty-three cases the inspectors indicated that these were deserted or that the inhabitants did not want to make use of them.
The refusal was informed and was stated in the sources. From the time of Jeronimo de Loayza, first archbishop of Lima, it was known that Indians would not enter the hospital because of the fear it instilled in them; they referred to it as "the house of the dead". Questioned in 1567, the curacas of Chucuito replied that there was no need for a hospital, and said they preferred to stay in their homes, where they could eat their fill, and which were not so full of lice. The objection was to diet, hygiene and isolation, and on the evidence of the 1619 tally it was correct.
Where the model was adapted rather than imposed, it functioned. In Chucuito in 1619 each of the seven towns of the province had a hospital in a house equipped for the purpose; in addition to the tomin, and partly following the pre-Hispanic model of provisioning from the resources of the province, the hospitals were allotted the maize harvests that came from the distant lowlands of Moquegua and Larecaja. Three surgeons were charged with attending the inhabitants of the seven towns, and in each town there was an Indian barber. The working unit was a supply system and a circuit of visits, not a building patients were expected to enter.
Indigenous authorities did not merely receive the institution; they claimed it. Petitioning the archbishop in 1629, the Indian leaders of Yauyos maintained that since the time of Archbishop Loayza it had been customary for the hospitals to have Indian mayordomos, and asserted that if they were given charge there would be no Spaniards and clerics despoiling the poor of their property. By that decade some curacas considered the administration of the hospitals an integral duty of their office - the same men whose predecessors had said in 1567 that no hospital was needed.
The despoiling the Yauyos petition names is documented, not rhetorical. During the smallpox epidemic that struck the viceroyalty in 1588-9 the viceroy directed that money be taken from the community funds of the Lima diocese as a loan to the hospital of Santa Ana; contributions totalling 2,000 pesos were collected, a significant sum given the penury the epidemic must have caused among the native population. The doctor Marco Antonio Gentil later sued for unpaid salary and the judgment held that the Indians had to pay the fees he claimed. At Marca in Huaylas the hospital facilities were seized and ruined by the mayordomos of a powerful rancher and landowner of the province, who used them to house livestock and warehouse wool.
The end of the system is recorded in the crown's own wording. By a royal order issued in 1666 the tomin was amended and removed on the ground that "the hospitals have died out and come to an end in the Indian reducciones" - and it was acknowledged that in some provinces the corregidores went on collecting it after the hospitals it paid for had ceased to exist.
The justifying doctrine is part of the record and is not flattering. Indians were legally classified as miserables, a status that made them wards entitled to protection precisely because they were held incapable of governing themselves, and Toledo's ordinances of 1574 justified the hospitals as vehicles for teaching Christian charity to a people the viceroy characterised as having no charitable instincts of their own. This framing was read on the first pass through the article and was not re-verified sentence by sentence on the second, so the confidence is lowered accordingly; what is firm is that the miserables category and the Toledan justification are both present in the source.