Approches historiques et enjeux contemporains
Edited By Patrick Fournier, Claude Grimmer and Marie Bolton
Les territoires ruraux font l’objet de préoccupations spécifiques en matière de santé : souvent considérés comme des « déserts médicaux », ils attirent de plus en plus l’attention des pouvoirs publics. La réalité est complexe et diversifiée en fonction de multiples paramètres. L’objet de cet ouvrage collectif est de comprendre les processus historiques qui ont contribué à façonner les relations entre les populations des campagnes, les soignants et les autorités de toutes natures. Différents éclairages permettent de comprendre les évolutions survenues depuis la Renaissance. À partir d’exemples principalement français et européens, mais aussi d’études de territoires colonisés et dominés, les auteurs s’interrogent sur les formes de la médicalisation à l’œuvre dans les campagnes : présence de médecins et d’autres personnels de soins, création de structures spécifiques, relations sanitaires entre villes et campagnes, apports des campagnes au savoir médical... En définitive, c’est la notion de territoire rural de santé qui est questionnée. Des ouvertures sur la situation contemporaine permettent de réfléchir à la pérennité des héritages et à l’ampleur des (r)évolutions en cours.
The countryside presents specific issues to consider when studying health care. Often termed "medical deserts," rural areas have increasingly become a focus of concern for public administrators. Multiple parameters demonstrate its complex and diversified reality. This collection seeks to understand the historical processes that have contributed to the development of relationships between rural populations, health care providers, and various authorities. A variety of perspectives illuminate the diverse changes that have occurred since the Renaissance. Through an examination of primarily French and European but also colonial examples, the authors investigate various forms of medicalization at work in rural areas: the presence of doctors and other health care providers, creation of specific health care structures, relationships between rural and urban areas in terms of health issues, contributions by country dwellers to medical knowledge, and so forth. The very notion of health care as specific to the countryside is questioned. The status of rural medicine and health care in present times is also addressed to reflect both on continuities with the past and the scope of changes to come.
Hiring Medical Practitioners during the Late Middle Ages and the Early Modern Period in Algemesí (Kingdom of Valencia, Crown of Aragon) (Carmel Ferragud)
Universitat de València
Institute for the History of Medicine and Science “López Piñero”
Abstract: This study analyzes the process by which Algemesí, a small village attached to the town of Alzira from the Moorish conquest in 1245 until its independence in 1574, attracted, hired, and negotiated with medical practitioners (doctors, barber-surgeons, and apothecaries) to provide health care to fellow town dwellers. It also examines the origin of these practitioners and their family ties with Algemesí, as well as their competence as advisors in times of epidemics or as expert witnesses in court. All in all, we see a rural world clearly concerned about health, considered to be a highly prized asset, and willing to invest part of its resources to ensure suitable medical care.
Résumé : La présente étude vise à analyser le processus par lequel Algemesí, un petit village appartenant à la ville d’Alzira de la conquête maure en 1245 jusqu’à son autonomie en 1574, attirait des praticiens médicaux (médecins, chirurgiens-barbiers et apothicaires) et les embauchait après négociation afin de dispenser des soins médicaux aux populations des localités voisines. Elle examine aussi l’origine de ces praticiens et leurs liens familiaux avec Algemesí, ainsi que leurs compétences en tant que conseillers en période d’épidémies ou lorsqu’ils sont appelés comme experts dans les tribunaux. En définitive, nous observons un monde rural fortement préoccupé par le sujet de la santé, considéré comme une priorité, et←43 | 44→ désireux d’investir une partie de ses ressources afin de s’assurer de disposer de soins médicaux appropriés.
Beginning in the middle of the 13th century, after the Christian conquest of the Muslim taifa kingdoms in Valencia, the territory composed of a large number of alqueries, from Arabic al-qàrya, the most common Moorish form of dwelling and farm, was organized by means of the share-out and settlement organized by King James I of the Crown of Aragon. This was the case south of the river Xúquer, in the region called La Ribera.
La Ribera was a large, low-lying region, measuring about forty kilometres long by thirty wide, and criss-crossed by the many meanders of the river Xúquer, the largest in the modern-day Valencian countryside. There were many towns and villages scattered about its flood plain. Ecological problems and its low volume of water these days make it hard for us to guess its true significance for the region’s economy in the past. The river characteristically had periods with very little water in it, followed by sudden rises in its level which frequently caused devastating floods. Nevertheless, its sediments and the control of its water levels with numerous hydraulic infrastructures since the 13th century had made rich agriculture possible.1
The region was split between an area under royal control, comprising the town of Alzira (one of the largest in the kingdom, represented at the parliament) and its territories, with about twenty dependent villages, or llocs, nine of which belonged to it directly, as well as a larger fiscal and jurisdictional district.2 Only a small core of the Muslim population remained in the town’s Moorish quarter, and it would gradually diminish with the subsequent conversion and then expulsion of the Moriscos in 1609.
Algemesí was one of the Muslim alqueries that became a Christian lloc.3 Three kilometres south of Alzira, Algemesí was one of the most dynamic settlements, with a population of 167 families. It had all the←44 | 45→ characteristics of a rural village with clear signs of the city’s influence. A varied group of craftsmen lived there, some of whom did not possess land, and others who combined their activity with tending small plots, or working as day-labourers. A large number of individuals migrated to Algemesí not only from other parts of the Kingdom of Valencia, but also from Castile, Biscay and Aragon. This increased the levels of poverty and marginalization in Algemesí. For most of them it was very difficult to start a new life far from their old homes, without properties, with the necessity of credits for establish themselves in their new town, buying food, house, or creating a workshop. They were at a disadvantage compared to the old neighbours.
An exhaustive examination of sources can give some idea of the medical care network established in the region, especially in the royal jurisdiction, Alzira and its llocs, which became independent in the early modern period. However, I shall be paying particular attention to Algemesí. Its administrative situation, dependent upon Alzira from the 1238 conquest and colonization until its subsequent separation in 1608, forces us to consider two different periods in the organization of its system of medical care. This post-separation period ended at the same time as the foral period did, in 1714, when it was abolished by the Bourbon King Philip V. Medical practitioners in Valencia’s early modern centuries have not been the subject of an extensive research outside the capital. In this long-term analysis, I shall investigate the hiring strategies used in this region to attract professionals working in medicine –physicians, barber-surgeons and apothecaries– trained in the Galenic tradition, predominant in those centuries, along with their residence in towns and their relationships with the authorities. I shall avoid other significant forms of medical care such as empirical and magical approaches which require separate analysis that cannot be undertaken here.
Algemesí under the Jurisdiction of Alzira
After the conquest and settlement of the new kingdom, the need was felt for medical practitioners to look after the incomers who established their residence there. Doctors came along with the army, and in the Llibre del Repartiment (a record book in which the King’s scribes recorded promises of land grants) we see an early presence of several individuals working in medicine who received grants in La Ribera. From 1271 onwards, the king favoured some medical practitioners with various privileges, from←45 | 46→ land and house sites, to donations of money and tax exemptions.4 The king also made his wish very clear that medical practitioners should remain in the new kingdom. For this reason he imposed on them the condition of residence there and not alienating the properties for twenty years. It was becoming more and more usual for the king to have domestic or family doctors in his service in many cities in the kingdom and as the court was itinerant he needed to have the most prestigious professionals available wherever he went with his entire retinue, especially in the period of war with the Muslims. New settlers trained in medicine were arriving in the region. Most of them were humble barber-surgeons, but there were a few apothecaries. The Kingdom of Valencia did not remain oblivious to the general European context, especially in the Mediterranean area, where a way of understanding medicine based on Galenism and its particular model of healer had become highly prestigious.5
In order better to understand the organization of medical care in Valencia from the 14th century onwards, it is useful to look at the foral legislation, especially the heading De metges, or “Concerning doctors”, in the laws of 1329-1330. This legislation of King Alfonso III established the division of medical care with seven provisions. The examination system for medical practitioners was regulated along with its general conditions: municipal control, the appointment of examiners, the geographical scope of the measure, academic requirements, and fines in the event of non-compliance; the surgeon was obliged to write an expert report (dessospitació) when required to do so; doctors had to swear an oath not to attend to the seriously ill if these had not previously made their confession; the therapeutic indications had to be made with a prescription whose ingredients were specified in “common or vulgar” language, so that apothecaries could understand them; and finally, surgeons had to be←46 | 47→ examined, although they were not required to have studied at university. This control was also extended to barbers. This was a declaration of intent that could only be implemented very partially.6 The kings continued to regulate some aspects, in many cases avoiding the abuses and fraud committed by doctors and apothecaries with regard to their patients, but by the 15th century virtually all elements relative to the practice of medicine had been formalized, a situation what would remain until the suppression of these laws at the beginning of the 18th century.7
Most of the information we have concerning the 14th and 15th centuries comes from Alzira. During the whole of the 14th century there were hardly any medical practitioners working there. Some of the physicians we know of were foreigners, coming from places as far away as Avignon. The difficulties of finding people to practise in a town, which in the middle of the century, according to the municipal government (jurats (councillors) and prohoms (prominent citizens), was understaffed, forced the king to grant licenses to some Christians and Jews to work in the town without needing to be examined or to have paid the usual fee. It seems that by the turn of the century conditions for doctors, and some decided to go elsewhere.8
Most of the practitioners were barber-surgeons. Even the smallest, most remote location in the mountains usually had a barber among its residents, or someone who at least went to work there occasionally. Their job consisted of cutting hair and shaving beards, performing small surgical operations and treating external diseases. On their travels they were accompanied by a horse carrying everything they needed to do their work, for example in open-air markets. Muslims also worked as barbers.9
In addition to barbers, the most numerous medical practitioners were the apothecaries. The explanation for this is that their work was situated halfway between that of the merchant-shopkeeper and the artisan. As←47 | 48→ well as medicines, they made and sold a wide range of products, including for instance, wax for lighting, spices, sweets, paper, and gunpowder. Apothecaries were indispensable for supplying all these products. The least numerous professionals were the physicians, who were more prestigious and sometimes had received university training. These proportions did not change very much, although the numbers of apothecaries may have dwindled. Increasingly working as pharmacists, they gradually abandoned all the other occupations, which were taken over by other trades.10
The first contract with a doctor of medicine, Joan del Miracle, was signed on 18 June 1397. This doctor, a former resident of Valencia, was hired for six years. For the first time, an individual trained at the university and therefore with a solid educational background was going to offer his services in Alzira, for the not inconsiderable sum of eight hundred sous a year.11 The physician had to live in the town for the period of time stipulated and attend to its inhabitants and those of its contribució (jurisdictional and fiscal territory) whenever required to, as was customary in this kind of agreement. Since the end of the 13th century, in the municipalities of the Crown of Aragon, as well as those of a large part of the western Mediterranean, especially in the major Italian city-states, governors had become aware of the very important role played by medicine in maintaining their fellow citizens in a good state of health.12 They therefore hired not just physicians, but in some cases surgeons, apothecaries and blacksmith-horse doctors as well, to ensure free, high-quality medical care. This was yet another sign of the penetration of knowledge considered essential for keeping the population in good health. For many towns close to the capital of the kingdom, attracting medical personnel was by no means easy. The system of hiring doctors under contract (conducta) became institutionalized as a habitual formula for the rest of the Late Middle Ages in Alzira and in rural Valencia and Catalonia-Aragon (in the larger municipalities at least), and it would remain in place throughout the foral period.13←48 | 49→
Keeping the doctor inside the town boundaries, however, could be complicated. Everything depended on negotiations between the doctor and the town council, hinging on the physician’s wish to stay for as long as possible with a contract that would pay him the highest salary, even though this was merely a complement to whatever the clients were able to pay, as well as the needs of the municipality. These conditions were linked to the local economy, seriously affected by the crises caused by plagues, poor harvests, famine and war, which gradually reduced the population by half between 1400 and 1450, the presence or absence of epidemics, the time of year—summer—and the possible risk perceived. Other factors that determined the decision were the doctor’s reputation (if he was university trained), his experience, and membership in a long-established family, as he would thus know the makeup of its residents, and the local opinion of his medical skill, especially if he had already been hired before. Many doctors, particularly the younger ones, were itinerant and moved around in search of municipalities that would give them a stable life to whom they offered their services. On other occasions it was the municipal government that sent a representative to Valencia to sound out the market and negotiate hiring a new doctor.
We know of several medical families that worked in the region for generations: the apothecaries Falcó (one of whom was married to a woman from Algemesí), Vendrell, Vidal and Sanç, and the barber-surgeons Blasco and Fontclara.14 Some individuals from these families and others, those with the deepest roots in the town, were part of the local elite of prominent citizens that governed it. Some of them were members of the general council and others held executive posts (jurats) and even the highest post, that of justícia. They also purchased the right to manage certain taxes, whereby they consolidated their economic power. Nevertheless, the presence of itinerant medical practitioners who became aveïnats, or new residents coming to the town with a request to live and pay taxes there, is notable.
From the enormous amount of archival data we may deduce that the number of medical practitioners per inhabitant grew considerably. This←49 | 50→ was due to the fact that while Alzira experienced gradual depopulation during the 15th century, similarly to those of other places in the Crown of Aragon, the number of healers rose.15
The llocs dependent on Alzira, without their own local administration, did not make do with receiving medical care from the town. They also obtained their own healers. This was the case with Algemesí. The earliest information about a medical practitioner in residence, the surgeon Joan Pasqual, dates from 1422. He asked to be examined before the tribunal of the city of Valencia.16 After his exam, the Algemesí native was considered competent and a notification was sent to the city’s civil justícia asking him to issue the relevant certificate of his credentials that would allow him to work anywhere in the Kingdom of Valencia. Barber-surgeons are mentioned in Algemesí up to and beyond the end of the 15th century: in 1485, Joan Carbó; from 1499 to 1503, Martí Goçalbo; and from 1500 to 1533, Pere de Morós.17
In short, it appears that during the Late Middle Ages Algemesí had a medical care service that was based on barber-surgeons. These were common in all the towns, urban and rural, in the Crown of Aragon. It was only possible to be seen by a doctor by going to Alzira, where the physician, hired since the end of the 15th century, was obliged to treat the inhabitants of the places belonging to it.
Nevertheless, the zeal with which the small elite of Algemesí kept an eye on the quality of medical care, and the affinity with the doctor who was hired, was clearly seen in 1519. The syndics, representatives of Algemesí, protested over the attitude of the jurats of Alzira who, without calling a general consultative council, as was mandatory according to the town’s ordinances, had hired a doctor without taking into account their opinion. They furthermore refused to allow the taxes of Algemesí to be paid to this doctor.18 In the early 16th century Algemesí was experiencing a demographic recovery, along with the rest of the region, after a sharp drop in the population throughout the 15th century.←50 | 51→
Separation from Alzira and the Hiring of Healthcare Personnel in Algemesí
Around the middle of the 16th century, municipalities that had belonged since the time of the Christian settlement to the town of Alzira or the nearby city of Xàtiva began to break away. Various reasons explain this process. First, there was economic growth, associated with the expansion of mulberry cultivation and the breeding of silkworms. This enriched the peasantry of the comarca and gave it a high degree of purchasing power. Signs of this wealth are very much in evidence. The area under cultivation grew considerably, and during the 16th century the area of irrigated land doubled in size. Between 1575 and 1590 Algemesí ’s tax revenue increased six-fold. Important building work was also undertaken, and in 1582 the new parish church of Sant Jaume Apòstol (Saint James the Apostle) was inaugurated. In 1615 and 1620 jurisdictional rights were acquired over the small lordships of Cotes and Pardines.19 Secondly, there was considerable population growth, palpable in the very notable increase in baptisms, which rose from 308 between 1540 and 1549 to 816 between 1580 and 1589, a trend that lasted until 1630.20 Finally, the consequences of the Revolt of the Brotherhoods (Germanies) have to be taken into account. This confrontation between the municipal authorities of Valencia and the nobility led to repression and the payment of heavy fines. Alzira, which had stood firm in the revolt, was punished with heavy taxes that were too onerous for it as well as for similarly small localities. The situation was propitious for Algemesí and other places dependent on Alzira seeking to break away from it, especially with the permanent demand for money from the king. In 1574, King Philip II granted the privilege that made Algemesí an universitat, that is, an autonomous administrative body, with certain rights and privileges, but above all, with its own territory and government. Some years later, in 1608, Philip III conferred upon Algemesí the title of “royal town”.21
The new municipalities had to seek out medical personnel, and contracts proliferated when medical needs and financial possibilities converged. A high price was paid to the king for these privileges of administrative independence, and from that moment onwards the newly autonomous←51 | 52→ local councils had to attend to an increasing number of municipal obligations. Hiring a doctor was not cheap and some heavily indebted towns could not afford one. However, quite a long time before they gained their autonomy, and even though they did not have a doctor on their books, they usually had medical practitioners, mainly barber-surgeons.
Some localities, especially the smallest, opted for formulas adapted to their situation. At the end of the 16th century in Castelló, which had broken away from Xàtiva in 1587, Doctor Castellano offered to go one day a week with his son, most likely his assistant, to provide remedies to anyone who saw him, as was customary in the town of Alzira. The doctor went on Tuesday, market day, to visit the sick, and this was announced to the people of the nearby villages. The apothecary responsible for making up the medicines prescribed by the doctor was also given a house in Castelló.22
From the middle of the 17th century onwards, conductas were habitual all over the region and the plague that affected the area between 1648 and 1651 was certainly one of the reasons.23 The aftermath of the plague was devastating, as shown by the complaints of authorities and local people. Governors died or abandoned the towns, taxes ceased to be collected, economic activity ground to a halt for want of manual labour, everything collapsed, there was a food shortage, and, in short, it was necessary to ask for loans to survive.24 The work of the doctors was regarded as essential in those circumstances, and many nearby municipalities within a few kilome←52 | 53→tres from Algemesí decided to hire them. In 1626 a surgeon was taken on in Alginet and a doctor in 1654, and permanent posts were also created for doctors in Guadassuar in 1656, Castelló in 1660, and l’Alcúdia in 1663.25
The case of Algemesí is paradigmatic. A study of the quinque libri of the parish of Saint James the Apostle and the municipal records (Manuals de Consells) indicates the presence, the permanence, and some aspects of the medical practitioners in this town during the early modern period. These elements were certainly shared with the other towns in La Ribera. Between the first recorded surgeon in 1566, Antoni Ferrando, and the medical personnel known in the 1620s, we have on record five surgeons and eight doctors of medicine.26 Miquel Jeroni Virués is the first known doctor of medicine in Algemesí, and, curiously, the one about whom we know the most: between 1570 and 1575 he acted as godfather in several baptisms, and in 1576 he presented a daughter born of his marriage to Isabel de Luna for baptism.27 Miquel Jeroni was the son of the highly prestigious doctor Alonso Virués. He was one of the doctors of Juan de Ribera, archbishop and viceroy of Valencia, and he also treated the prisoners in Valencia’s jail. He was born in Benicarló, in the north of the kingdom of Valencia, one of the places where the family lived.28 He was awarded his bachelor’s degree in medicine in October 1568, and his doctorate at an unknown later date. He must only have lived and worked as a doctor in Algemesí for a short while, as his other daughter was baptized in Valencia. Hopes for this doctor must logically have been high, and he did indeed inherit from his father the post of doctor to the archbishop of Valencia and to the prisoners in the municipal jail. Furthermore, in 1598 he was made an examiner of doctors. Several businesses are known, some with his father-in-law, the gentleman Miquel Joan Boïl, in notarial protocols of the city of Valencia, where he still had his residence in 1606. Virués←53 | 54→ is the author of about 20 literary works of a religious nature which extol medicine, particularly in opposition to the use of weapons.
Francesc Joan Torres and Antoni Joan Torres, whose ties of kinship are unknown to us, took their children to be baptized in 1597 and 1600.29 Their presence in the records is short-lived and we are unable to say anything about their work as doctors in Algemesí. The doctors Miquel López de Perona (1586) and Agustí Martí (1593 and 1595) also appear in the documents, acting as godfathers.30 It seems that these doctors were not residents and that they were asked to be godfathers because of their prestige. It is also possible that they spent very little time in the town because while they had some dealings with inhabitants of Algemesí, they never practised medicine there. The same was true of surgeons Jaume Fort, Miquel Àngel Carbó, Francesc Ros, Joan Lluc and Josep Martí.31 Excepting the latter, their presence was limited to one year, recorded between 1595 and 1609.
Things began to change in the new century, but very especially from 1620 onwards, not long after Algemesí’s process of independence had taken place. Between 1600 and 1613 Doctor Bernardí Granja appears recorded in the parish books. Married to Vicenta Muñoz, both of them acted on numerous (up to eight) occasions as godparents at baptisms, and they had four children.32 Granja is the first doctor to stay in the municipality for any length of time, but after him a succession of doctors appears. Tomàs Jordà (1620-1631), followed by Bernat Baró (1631-1647), Juan Alonso (1647-1652), Gabriel Plaça (1657-1701), Maties Cubells (1702-1704) and Pere Folqués (1694-1703). None of their contracts seem to have overlapped, except for the last two. This situation is clearly related to the beginning of the municipal government contracts established with doctors. In fact, we only have sporadic information about any other doctors, simply acting as a godfather.
The first municipal documentary register to be conserved begins in 1640, so we cannot be sure when the first contract with a doctor was←54 | 55→ signed. However, seeing his prolonged permanence in the municipality as a resident, it would be no surprise to learn that Tomàs Jordà was the first doctor hired.33 Nevertheless, the doctor for whom we have certain information was Doctor Bernat Baró. He was hired for a second year in June 1646 for a term of one year and for the same (unspecified) salary. This doctor had been living in Algemesí at least since 1633, and he was already married to Joana Àngela before he arrived in the town, as we have no record of either his marriage or the baptisms of their children. Following the habitual case with doctors he acted as a godfather at baptisms on numerous occasions.
By this period, the council’s sensitivity with regard to health and medical care was beyond doubt.34 When in July 1647 there was no doctor in Algemesí (the last mention of Baró is on 23 April 1647) steps were taken to procure a new practitioner. The jurat en cap, the leader of the local council, claiming that the town had been without a doctor for too long, went to Valencia, where he had obtained the services of Juan Alonso, a veteran doctor who was prepared to move to Algemesí for two years, for a salary of 200 pounds. To pay this, a tax was introduced that even clergymen had to pay. Any resident who refused to pay this tax would not be obliged to, but if he wanted to be treated, the doctor was informed that he would have to charge a fee of ten Castilian reales per visit.35 At that time Algemesí was experiencing an economic crisis, which could also be felt in the fall in the marriages as well as the birth rate. A report of 1639 referred to harvests decreasing by 33 % as the consequence of a series of floods, rising salaries (also associated with the expulsion of the Moriscos in 1609), the decline of the silk trade, the town’s heavy indebtedness caused by the payments owing to the king, as well as the expenses incurred in the passage of armies or in various lawsuits pursued against Alzira.36 This may be why not everybody was obliged to pay the tax required to hire the doctor. In any case, the usual formula that would be used from the start to provide the doctor’s salary would be a special tax called the tacha del doctor en medicina. To collect it, as voted for by the councillors, a collector was appointed by the highest municipal authority. He collected the tax on the basis of a list that he was given, and he undertook to pay the doctor on the agreed dates.←55 | 56→
The next doctor to be hired was Vicent Joan Corbí, born in Ontinyent, a town about 44 kilometres south of Algemesí. The date is unknown, although we do know that he had moved by 1656. It was then mentioned in the municipal council that at that time (late October) in in the neighbouring town of Guadassuar there was a trustworthy doctor called Gabriel Plaça who proposed moving to Algemesí for the sum of 250 pounds.37 The council decided to hire him. Algemesí’s relationship with Doctor Plaça lasted, it would seem, virtually until his death in 1702.38 His contract was renewed every four years, and he was paid a salary of 250 pounds a year, and exempted from paying taxes (franch de la mòlta, sisa del vi, soldats i altres peches de la vila).39 Despite the considerable rise in salary, authorities must have deemed necessary to have a trusted doctor. The contracts with Plaça were drawn up at a time of economic prosperity, when Algemesí was recovering from the serious economic and demographic crisis that reached its highest point in the middle of the 17th century. The traumatic experience of a series of various catastrophes during the first half of the century was by then being overcome. Nonetheless, problems arising due to the situation made it necessary in 1681 to increase the clergy’s contribution to the tacha from 12 to 20 pounds, alleging economic difficulties and the rise in the number of clergymen (18) in Algemesí.40 Nonetheless, in 1682 Plaça’s salary was reduced by 20 pounds, due to the town’s financial difficulties.41
In 1702 Doctor Maties Cubells was hired for a period of two years on a salary of 150 pounds. However, the following year Pere Folqués was also hired and each doctor was to receive 150 pounds. With this the municipality obtained the services of two doctors for just 50 pounds more than they had paid Plaça for many years.42 We can claim that by the early years of the 18th century Algemesí’s contingent of healers was quite a lot larger than it had been in the 16th century: two doctors, two surgeons, four barbers and one apothecary.←56 | 57→
Surgeons, Midwives and Apothecaries
Everything seems to indicate that in the early modern period the barber-surgeons continued to provide medical care for the majority of the people of the region, as they had done since the Middle Ages. In some small localities, in return for a salary, they were hired for a specific period and stayed to look after the local people free of charge, cutting hair and shaving, providing medicines and bleeding them. Algemesí, on the other hand, always attracted enough barber-surgeons without the need for contracts.
Many of the surgeons who appear in the records were married and baptized their children in Algemesí. Some seem to be the sons of local people, or come from places nearby in the kingdom of Valencia, to judge by their surnames, but many others had quite often came from elsewhere to settle there. This was very common with surgeons who put down roots in Algemesí for the longest periods of time. They arrived while they were still young and got married and apparently began their careers there. Some examples are the surgeon Jacinto Huarte (the son of a merchant from Zaragoza) who was married three times in Algemesí: in 1628 to Esperança Domingo, daughter of the notary of Algemesí; in 1639 to Elisabet Anna Puigverd; and before 1654 to Úrsula Esteve. He had a child with each of them.43 In 1665, Pedro Medina, from Logroño in Castile, married Paula Pastor, widow of Victoriano Borrell, an inhabitant of Algemesí.44 On 8 July 1671 Pedro Beortegui, born in Pamplona in the kingdom of Navarre, married Jacinta Borrell and they had four children.45 This surgeon died a violent death in 1684, according to the sacrament book.46
Women were frequently pregnant and they were always assisted in childbirth by midwives.47 Many children were baptized in the parish, after first being baptized at birth by the midwife due to the high rate of infant mortality.48 In this respect, a very important role was also played by←57 | 58→ midwives, whose job was to attend to women giving birth and to so-called women’s ailments. The name of the midwife who brought the baptized child into the world appears in many baptism registers. In Algemesí we know that in 1657 it was established that all women in labour had to hand over a sum of money to the midwife every time they called her.49
Apothecaries, indispensable for the supply of medicines and many other products, were also present in Algemesí in the last quarter of the century. Àlex d’Aguirre was an apothecary born in the city of Valencia who settled in Algemesí in about 1580. Around that time another apothecary, Jaume Marc, was also living in the town.50 In the first decade of the 17th century Miquel Armengol and Joan Armengol were recorded, but only as godfathers; therefore, similarly to what I said about doctors, they almost certainly did not live in Algemesí.51 Such a paltry number seems to be the reason why Algemesí hired an apothecary. The man chosen was Joan Ximeno. Nevertheless, by 1669 he had closed his workshop due to the requirements of the apothecaries’ association of Valencia: two years’ practice in an apothecary shop in the city before setting up on his own. The municipality, after exploring several avenues, then had to reach an agreement with another apothecary named Josep Colomer, a resident of Sueca, a nearby town.52 Years later, in 1683, the son of Joan Ximeno asked to be paid a salary of 20 pounds and exempted from taxes if he reopened his father’s apothecary shop. Algemesí hired him on the condition that he provided medicine to the poor of the parish and the hospital free of charge. He made another offer of 12 pounds’ salary tax exempt but with payment from the poor and the hospital, in reply to which the authorities agreed to exempt him from all taxes but not to pay him a salary.53 The←58 | 59→ appointment in 1687 of the apothecary Francisco Emo, from Nules, in the north of the kingdom, was very different. The jurats took him on for a salary of 30 pounds a year for a period of six years, with the obligation to give medicines to the hospital and to the poor free of charge. He was also given a house and exempted from paying taxes, and he was given help to move there.54 The problems they had had with the Ximeno family, who most probably left in the end, must have made the authorities of Algemesí lose faith in them. On the other hand they pinned all their hopes on the new apothecary.
Conclusion: Best Care with Doctors
During the Middle Ages a medical care system developed in the Kingdom of Valencia that was the origin of practices that were maintained for centuries, until the loss of the furs in 1707. The degree of sophistication that the practice of rational medicine, based on Galenism, had reached by the closing stages of the Middle Ages is striking. Its level of penetration in society, the great recognition it received from all members of the population as well as the authorities, merely corroborates the great concern for something as highly valued as health and recovery from illness and injury. These were objectives that were constant priorities of the public authorities.
Following the model introduced in Alzira, many municipalities that emerged in the 16th century hired their own healers. This was the case with Algemesí. In this way they managed to combat common diseases and temporary epidemics. But they could also rely on healers’ expert opinions to take the necessary steps when faced with an outbreak of the plague or to advise judges.55
It is neither possible nor correct to establish a clear dividing line between what happened in the rural and urban worlds in reference to the practice of medicine.56 The degree of the penetration of urban health customs in the←59 | 60→ countryside of La Ribera is evident, particularly in places like Algemesí. Likewise, the presence of originally rural practices continued in towns. For a young doctor, surgeon, or apothecary, the group of towns enjoying economic and demographic growth that had recently obtained their autonomy in La Ribera must have been a great attraction. It was a good chance to begin a career for some doctors. For others, already veterans in their profession, their experience was exactly what made them attractive and some doctors who had been trained at universities, or who came from large cities, sometimes quite far away, ended up in Algemesí. Some stayed there all their lives, like Plaça, while others moved on after a few years in search of new contracts, as was customary in the Hispanic kingdoms.57 The authorities began to take steps to replace their practitioner as soon as there was a risk of being left without doctors or apothecaries. Whether in neighbouring places, or in Valencia, they found the appropriate resources. They negotiated salaries and conditions, even when sometimes they were too expensive for them to support. The contracts signed were variable in length, but they ensured the local people’s medical care, after paying the corresponding tax, of course. All in all, we see a rural world clearly concerned about health, a highly prized asset, and willing to invest part of its resources to ensure for itself suitable medical care.←60 | 61→
* This article was made possible by the financial support of the Spanish Ministry of the Economy and Competitiveness (FFI2014–53050-C5–3-P [2015–18]), as well as European Union ERD funds. My thanks for the helpful comments and contributions made by Vicent Niclòs and Josep Antoni Domingo. Translation was provided by Andrew Stacey.
1 Tomàs Peris Albentosa, Història de la Ribera. De vespres de les Germanies fins a la crisi de l’Antic Règim [segles XVI-XVIII], 6 vols., t. 1, L’escenari i els protagonistes (Alzira: Bromera, 2001), 19-64, 93-120.
2 Antoni Furió, El camperolat valencià en l’Edat Mitjana. Demografia i economia rural (segles xiii-xvi), Valencia, Universitat de València, doctoral thesis, 1986, 4 vol., t. I, 94-107.
3 On Algemesí during the Middle Ages, see A. Furió, El camperolat valencià, op. cit., 463-464, 468. Salvador Vercher Lletí, L’abastiment municipal de cereals i de carns a la vila d’Alzira i el seu terme (1370-1415): una contribució a les relacions ciutat-camp en la Ribera del Xúquer, Valencia, Universitat de València, doctoral thesis, 2017, 37, 42, 44-45, 55, 85, 102, 105, 135-145.
4 Carmel Ferragud, “Els practicants de la medicina en la creació del regne de València (1238-1300)”, in Actes d’Història de la Ciència i de la Tècnica, 2 (2) (2009), 61-85 (64-65); Medicina per a un nou regne. El paper de la medicina i els seus practicants en la construcció del regne de València, s. XIII (Alzira: Bromera, 2009), 96-99.
5 Numerous studies exist for different European states and territories. For example, and as a magnificent overview, see Nancy Siraisi, Medieval and Early Renaissance Medicine: an Introduction to Knowledge and Practice (Chicago-London: The University of Chicago Press, 1990). With regard to the territories of the Crown of Aragon and the Kingdom of Valencia, see Carmel Ferragud, Medicina i promoció social, Corona d’Aragó, 1350-1410 (Madrid: CSIC, 2005); Michael R. McVaugh, Medicine Before the Plague. Practitioners and Their Patients in the Crown of Aragon, 128-1345 (Cambridge: Cambridge University Press, 1993); Lluís Garcia Ballester, La medicina a la València medieval. Medicina i societat en un país medieval mediterrani (Valencia: Alfons el Magnànim, 1989).
6 Luis García Ballester, Michael R. McVaugh and Agustín Rubio Vela, Medical Licensing and Learning in Fourteenth-Century Valencia, Transactions of the American Philosophical Society, vol. 79, part 6, Philadelphia, 1989, 1-10.
7 María Luz López Terrada, “El control del ejercicio médico en la Valencia foral: las corporaciones locales frente al poder real”, in Facultades y Grados. X Congreso Internacional de Historia de las universidades hispánicas (Valencia, November 2007), vol. II (Valencia: Universitat de València, 2010), 15-34.
8 Carmel Ferragud, “Medicina i societat a Alzira durant la Baixa Edat Mitjana”, in Actes de la X Assemblea d’Història de la Ribera. Riuades i inundacions a la Ribera del Xúquer en la perspectiva histórica (Antella: Ajuntament d’Antella, 2005), 89-102.
9 Carmel Ferragud, “Barbers in the Process of Medicalization in the Crown of Aragon During the Late Middle Ages”, in Flocel Sabaté (ed.), Medieval Urban Identity: Health, Economy and Regulation (Newcastle: Cambridge Scholars, 2015), 143-165.
10 Carles Vela, “Defining Apothecary in the Mediaeval Crown of Aragon”, in Flocel Sabaté (ed.), Medieval Urban Identity, op. cit., 127-142.
11 C. Ferragud, “Medicina i societat”, op. cit., 98-99. The great majority of medical practitioners were trained in a system of open, artisanal apprenticeship with a master, and this included Muslims and Jews.
12 Marilyn Nicoud, “Formes et enjeux d’une médicalisation médiévale : réflexions sur les cités italiennes (xiiie-xve siècles) ”, Genèses, 82 (2011/1): 7-30.
13 I have copied all the municipal documentation of the 15th century, which has enabled me to study in depth the town’s medical care system and conclude that the hiring of physicians was constant throughout the century. On medical care in the countryside in the Crown of Aragon in general and contracts with healers in particular, see Carmel Ferragud, “La médecine en milieu rural dans la Couronne d’Aragon au Moyen Âge”, Études Roussillonnaises, 26 (2013-2014), 15-22 (19-20).
14 Carmel Ferragud, “Els practicants de la medicina a Alzira durant la Baixa Edat Mitjana (1355-1465): activitat econòmica, política i social”, in Salvador Comes and Raül Añó (eds.), Associacionisme i moviment obrer a la Ribera de Xúquer [Actes de la XIV Assemblea d’Història de la Ribera] (Alginet: Ajuntament d’Alginet-Diputació de València-Cooperativa Elèctrica d’Alginet, 2017), 45-60.
15 C. Ferragud, “Els practicants de la medicina”, op. cit.
16 Mercedes Gallent Marco, “Profesionalización y control del personal médico en el siglo xv: la licencia para ejercer del cirujano Johan Pasqual de Algemesí”, Saitabi, 33 (1983): 97-104.
17 Arxiu del Reial Col·legi Seminari del Corpus Christi o del Patriarca de València [henceforth ACCPV], No. 26550 (19 Jan 1485); A. Furió, El camperolat, op. cit., t. 4, 1245 and 1247.
18 ACCPV, No. 11506, fols 40r-v (15 May 1519).
19 Josep A. Domingo, Terra i treballs. L’agricultura d’Algemesí sota l’Antic Règim (Valencia: Saó/Ajuntament d’Algemesí, 1998), 14-16.
20 Ibid., 40.
21 Josep E. Estrela Garcia, Els privilegis de la independència d’Algemesí (segles xvi-xvii). Estudi i edició lingüística (Valencia: Saó/Ajuntament d’Algemesí, 1999), 21-26.
22 José Martí Soro, Historia de Villanueva de Castellón, Valencia, Ajuntament de Villanueva de Castellón, 1987, 180. In the 16th century, there was a great variety of conductas in Catalan municipalities with all kinds of healers, concerning the type of agreements depending on the services to be performed, the period of health care, sometimes two days a week, or payment in coin or in kind. Manuel Camps Clemente, Manuel Camps Surroca and C. Aler, “Algunes conductes del segle xvi a Catalunya”, Gimbernat, 9 (1988): 57-73. In general, on medicine in Valencia in the early modern period, see José Mª López Piñero (ed.), Historia de la medicina valenciana, 3 vols., t. 1 (Valencia: Vicent Garcia Editor, 1988), 71-162 and t. 2, 1989, 9-75. José María López Piñero and Víctor Navarro, Història de la ciència al País Valencià (Valencia: Alfons el Magnànim, 1995), 134-196.
23 On this plague epidemic, which had devastating effects on the Hispanic kingdoms, for Valencia see Mercedes Vilar Devis, “Las pestes del siglo xvii en Valencia. Su incidencia y repercusión en el Hospital General (1600-1700)”, Estudis, 18 (1993): 119-146.
24 J. Martí Soro, Història de Villanueva, op. cit., 172. In Algemesí it was forbidden to purchase silk from anywhere liable to be suffering contagion, the penalty being a fine and the burning of the silk. Arxiu Municipal d’Algemesí [henceforth AMAlg], Manuals de Consells [henceforth MC], H-48/2, fol. 190v (21 Jun 1648). The tax farmers, damaged by the closure of the town due to the risk of contagion, asked for compensation. AMA, MC, H-48/2, fol. 180r (9 Feb 1648).
25 Tomàs Peris Albentosa, Història de la Ribera. De vespres de les Germanies fins a la crisi de l’Antic Règim [segles xvi-xviii], 6 vols., t. 4, La cultura popular (Alzira: Bromera, 2005), 161.
26 He baptized his son Joan Antoni. Arxiu de la Parròquia de Sant Jaume Apòstol d’Algemesí [henceforth APSJA], Llibre de baptismes i confirmacions [henceforth LBC], 1565-1587, fol. 15 (30 Oct 1566).
27 APSJA, LBC, 1565-1587, fol. 14r (29 Jun 1570). He was the son of Alonso Virués also a doctor of medicine, a resident of the city of Valencia. APSJA, LBC, 1565-1587, fols 89r-v (15 Nov 1575), fol. 97v (14 Oct 1576). At the baptism of his daughter the godparents were the doctor of theology Francisco Virués and Jerònima Viruesa, a maiden, Jeroni Virués’s brother and sister. They were known for their literary writings, as was another brother called Cristóbal, a soldier.
28 For the biographies of Alonso and Jeroni Virués see Rafael Martínez Seguí, Sesión apologética dedicada al doctor Jerónimo Virués (Valencia: Imprenta de Manuel Alufre, 1897).
29 Francesc was married to one Àngela, and Antoni to Beatriu Àngela; they had a daughter and a son, respectively. APSJA, Llibre de baptismes [LB], 1588-1613, fol. 71v (3 Sep 1597), Ibid., fol. 95 (11 Aug 1600). They and their wives also acted as godparents.
30 (Perona) APSJA, LBC, 1565-1587, fol. 190 (22 Feb 1586); (Martí) APSJA, LB, 1588-1613 (5 May 1593, 11 Aug 1594, 3 Feb 1595).
31 (Fort is a godfather at a baptism) APSJA, LBC, 1565-1587, fol. 59r (2 Mar 1572); (Carbó, from Cullera, is a godfather at a baptism) fol. 110r (18-12-1577); (Lluc has his daughter baptized) APSJA, LB, 1588-1613, fol. 19 rº (9 May 1590), (Martí has a son baptized) fol. 57 (5 Oct 1595); (Ros acts as a witness in a document) ACCV, No. 24890 (8 Mar 1574).
32 APSJA, LBC, 1565-1587, fols 114, 153, 156, 158, 171, 173, 174, 204, 221, 231.
33 Married to Caterina Morla, he had two children. APSJA, LB 4, fol. 56 (27-11-1620), fol. 69v (12 Aug 1622).
34 AMAlg, MC, H-48/2, fol. 142r (17 Jun 1646).
35 AMAlg, MC, H-48/2, fol. 167r-v.
36 J. A. Domingo, Terra i treballs, op. cit., 43-44.
37 Guadassuar had also managed to break away from Alzira, in a process similar to that of Algemesí. The competition between neighbouring municipalities to hire doctors is also evident in our case. AMAlg, MC, H-48/1, fol. 229r (29 Oct 1656).
38 Doctor Plaça’s daughter, Clementina, married the doctor of medicine Bartomeu Joan Montoliu. Montoliu, who did not practise in Algemesí, was buried on 10 Sep 1692. APSJA, Llibre de mortuoris, 1680-1702, fol. 282r.
39 AMAlg, MC, H-47/1, fols 44v-45v, 180r and 341r-v.
40 AMAlg, MC, H-46/1, fol. 90 (17 Aug 1681).
41 AMAlg, MC, H-46/1, fol. 163 (1 Nov 1682).
42 AMAlg, MC, H-47/1, fol. 183 (10 Feb 1703).
43 APSJA, Quinque libri [henceforth QL], 1625-1660, fols 59, 152, 218, 332v-333r, 389v, 394v.
44 APSJA, QL, 1661-1702 (17 Dec 1665).
45 APSJA, QL, 1661-1702, (married), fol. 315; (baptism) fols 84v, 102r, 147v, 233v. Curiously, when she was widowed, Jacinta married another barber from Navarre, born in Puente de la Reyna, named Cristóbal Sagarundo. Ibid., fol. 350v (8 Feb 1686). Pedro and Jacinta were tobacco importers. ACCPV, No. 17305 (25 Feb 1678). His son of the same name, also a surgeon, was married and had a son in Algemesí.
46 APSJA, Llibre de defuncions, 1558-1702, fol. 220 (2 Dec 1684).
47 Jacques Gélis, History of Childbirth (Cornwall: Polity Press, 1991), 103-111, 150-165.
48 In the case of one of the daughters of the surgeon Beortegui, of note is the fact that the midwife baptized her with another name, and that a small symptomatic malformation showed up: she was one finger short (y a denou de dits). It had been commonplace since medieval times for midwives to be able to baptize newborn babies if there was a danger of death, with the aim of ensuring observation of the sacraments. See, for example, Inmaculada Carmona-González and María Soledad Saiz-Puente, “El bautismo de urgencia. Función tradicional de las matronas”, Matronas. Profesión, 10(4) (2009): 14-19.
49 AMAlg, MC, 1650-1660, fol. 261 (15 Jul 1657).
50 Aguirre acted as a godfather on several occasions between 1582 and 1586, which is indicative of how established he was in the town. APSJA, LB, 1585-1587, fols 169, 176, 177, 186, 187, 189. About Marc see APSJA, LB, 1585-1587, fol. 162 (23 Jun 1583).
51 APSJA, LB, 1588-1613, fol. 144 (17 Jul 1605), fol. 160 (19 Feb 1607), fol. 161 (12 Mar 1607).
52 AMAlg, MC, H-47/1, fol. 350 (13 Oct 1669); fols 363v-364r (30 Nov 1669). Ximeno had been living in Algemesí since 1615. He was married to Maria Folqués and had three daughters, and he acted as a godfather on several occasions.
53 AMAlg, MC, H-46/1, fol. 208 (10 Aug 1683), fol. 354 (22 Ap 1686).
54 AMAlg, MC, H-46/1, fol. 389v (1 Jul 1687).
55 Carmel Ferragud and Mariluz López Terrada, “La intervenció dels experts en medicina en els tribunals de justícia moderns. Els casos d’Alzira i Albalat en els segles xvi i xvii”, in Salvador Vercher (ed.), Actes de l’XI Assemblea d’Història de la Ribera (Corbera, 10, 11 i 12 de novembre de 2006): volum miscel•lani (Corbera: Ajuntament de Corbera, 2008), 241-254. Vicente L. Salavert, “Los médicos frente a las epidemias en la Valencia del siglo XVI”, Estudios sobre la profesión médica en la sociedad valenciana, 1329-1898 (Valencia: Ajuntament de València, 1998), 161-194.
56 C. Ferragud, “La médecine”, op. cit.
57 Although chronologically later, the conclusions are similar in the case of Catalonia and Castile. Alfons Zarzoso i Orellana, L’exercici de la medicina a la Catalunya de la Il•lustració (Manresa: PHACS, 2006), 60-84. Miguel Ángel Sánchez García, Los profesionales sanitarios en la Castilla rural del Antiguo Régimen. Ejercicio profesional y análisis sociológico y familiar en las tierras de Albacete, Doctoral thesis by the Universidad de Castilla-La Mancha, Albacete, 2012.