The hospital law of the Indies (Recopilación, libro I, título 4)
A 1541 order that hospitals be founded in every town of the Indies, Spanish and Indian alike, codified with twelve further laws into the título "De los Hospitales, y Cofradías". It fixes where a hospital may stand relative to the town, who audits it, which brotherhoods run it, and — in Peru — the head levy indigenous tributaries paid for their own hospitals. The law that governs that levy exists because the officials collecting it were taking it.
Why this wins its question: Colonial Spanish American hospitals are usually met one at a time, as founder anecdotes, or not at all. The law that made them a system is quotable and almost never quoted: a 1541 order to found hospitals in every town of Spaniards and of Indians, siting rules taken from the 1573 settlement ordinances, viceregal visitation, income for indigenous hospitals protected from being raided for seminaries, and a tomín levied on indigenous tributaries in Peru to pay for their own. Each is transcribed here from a digitised printing with the monarch, place and date the compilers put in the margin — including the clause in which the crown states that the officials collecting that levy were keeping it.
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 founding order is Recopilación libro I, título 4, ley j, whose margin reads "El Emperador D. Cárlos, y el Cardenal Gobernador en Fuensalida á 7 de Octubre de 1541". Headed "Que se funden Hospitales en todos los Pueblos de Españoles é Indios", it charges viceroys, audiencias and governors to provide with special care that in all the towns of Spaniards and of Indians of their provinces and jurisdictions "se funden Hospitales donde sean curados los pobres enfermos, y se exercite la caridad christiana".
Hospital siting was written into the town-planning ordinances. Ley ij, margin "D. Felipe II en la Ordenanza 122 de Poblaciones, en el Bosque de Segovia á 13 de Julio de 1573", directs that when any city, town or place is founded or settled, hospitals for the poor and for the sick of non-contagious diseases be placed beside the churches and by their cloister, and those for the sick of contagious diseases in raised ground and in such parts "que ningun viento dañoso pasando por los Hospitales, vaya á herir en las poblaciones".
Inspection was a standing duty of the highest colonial officers. Ley iij commands the viceroys of Peru and New Spain to visit the hospitals of Lima and Mexico sometimes in person and otherwise to have the oidores do it by turn, and to see what cure, service and hospitality is given the sick, the state of the building, the endowment, the alms and the form of their distribution; the ministers who assist best in that service are to be favoured, "para que les sea parte de premio".
Indigenous hospitals had ring-fenced income, and the ring fence records the leak. Ley iiij — Philip II at Tordesillas, 22 June 1592, and at Madrid, 12 February 1589 — orders that "de lo repartido á los Hospitales de Indios no se saque para los Seminarios, ni por esta razon se haga descuento alguno". A prohibition of that shape is evidence that the diversion was happening.
In Peru indigenous tributaries paid for their own hospitals by a head levy. Ley vij — Philip IV at Monzón, 8 March 1626, and at Madrid, 18 May 1640 — states that the Indians of Peru pay a tomín for their hospitality, which passes into the hands of the corregidores and alcaldes mayores of their towns, and that those living outside the cities suffer great want; viceroys, audiencias and governors are ordered to take account of the contribution with all possible care, and to keep the money and the sums found owing always ready, "para que se gaste en el beneficio y regalo de los Indios enfermos".
The same law is the crown's own record of the levy being stolen: if the authorities find that "los Corregidores y Alcaldes mayores se han aprovechado de este efecto", they are to proceed according to law, the provision against those who fail to pay in the chests in their charge being applied. The strongest evidence against a triumphalist reading of the hospital system is in the hospital legislation itself.
The oldest foundation the título carries is a bishop's, paid out of his own pocket. Ley x, margin "El Emperador D. Cárlos, y el Cardenal Gobernador á 29 de Noviembre de 1540", recites that fray Juan de Zumárraga, bishop of Mexico, seeing the extreme need the city then had of a hospital "donde se acogiesen los pobres enfermos y llagados del mal de las bubas", made it "á su costa" and asked the crown to take the patronage; the crown accepted, ordered it called the Hospital Real, had its royal arms set up in it, gave the administration to the bishops of that church, and required them to account for its administration and rents "sin que por ello hubiesen, ni llevasen interes alguno".
The título is a map of a working network rather than a single institution. It confirms the foundation and ordinances of the Hospital de Santa Ana of Lima, run by a brotherhood of its own (Philip III, San Lorenzo, 3 September 1616); confirms the ordinances of the Hospital de San Lázaro of Mexico City, which the Council of the Indies had approved in 1582 (Philip II, Lisbon, 11 June 1582); gives the administration of the hospital of Cartagena de las Indias, "donde se curan los pobres y Soldados del Presidio y Armadas", to the city's Regimiento (Philip IV, Madrid, 13 July 1647); and grants the anchorage duty of ships entering the port to the Hospital de San Lázaro of Cartagena (Philip IV, Madrid, 9 August 1651).
Two hospital orders are regulated by name. Leyes v and vj govern the Hermanos del Beato Juan de Dios, ley vj — Philip IV, Madrid, 4 January 1633 — recording that in some provinces bishops and their visitors were exacting fees from the brothers for accounting for goods, alms, testaments and gifts, and forbidding it; ley xij records that the form and order the Hermanos del Hospital de San Hipólito of Mexico City are to keep for the conservation, increase and good government of their house and the cure of the poor comes from a brief of Pope Paul V. The pages read do not say what the patients of San Hipólito suffered from.
What this source can and cannot support is worth stating plainly. The Recopilación is the law as codified: it shows what was ordered, by whom and when, and it shows the abuses the crown thought worth legislating against. It does not show how many hospitals were built, how they were staffed, or what became of the sick. Nothing here should be read as a count of institutions or of outcomes.