Michele Clouse has just published a book on Medicine, Government and Public Health in Philip II’s Spain (book presentation)
“Good Advice and Better Medicine: The Role of Court Physicians in Shaping Early Modern Spanish Medical Practices and Professions
The extension of the Spanish crown’s authority into the world of medicine was facilitated by the centralization of medical matters under a singular, nominal head of medicine – the protomédico (chief medical officer). The protomédico served as a public health officer, advising on royal policies handed down to the municipalities. Through the Tribunal del Protomedicato the crown made its presence felt in almost every arena of the medical market: regulating and licensing a diverse body of medical practitioners, reforming medical education in the universities, standardizing medical practice through print culture, defining the professional boundaries of certain medical fields, and patronizing medical innovation whether it derived from the university or the marketplace. Holding this important office was a university-trained physician, chosen by the Spanish monarch from among the court physicians and his médico de cámara. Like a modern surgeon general, the chief medical officer served an advisory role to the crown on matters of public health policy and enforced appropriate standards of practice within the medical community through licensure, examination, and inspection. Moreover, the protomédico symbolized both the crown’s commitment to protecting and improving the health of the populace and its continued presence in the local marketplace in the early modern political world of overlapping and expanding jurisdictions and interests. Municipal and royal authorities saw a clear need to restore order and provide for the welfare of the body politic through the appropriate distribution and availability of scant resources whether fiscal, material, or medical; the protomédico served as one measure to achieve those goals of effective governance.
The court physicians, from whom the protomédicos were chosen, participated in discussions about public health measures and shaped medical reform policy alongside representatives of the Cortes, ecclesiastical, and municipal officials. All parties generally agreed that protecting the public health meant implementing more effective and standardized examination and licensing requirements for all medical practitioners. That the medical profession was ripe for more regulation and control was a given: who wielded that influence was a point of discussion and negotiation and court physicians used their influence with the king and other courtiers alike to effect change in the medical profession.
The history of the protomédico and the Tribunal del Protomedicato as an extension of royal authority in Spain and expansion of the early modern state has received significant scholarly attention in recent years. Less understood, however, is the influence the protomédico wielded more directly on the medical world. The extent of these court physicians’ influence over medical matters is revealed in the careers of Luis Mercado, Cristóbal Pérez de Herrera, and Olivares, among others. The professional activities of these three men highlight the nature and extent of the court physician’s influence on Spanish medical practices and public health policies more generally. Mercado used his position and influence at court to successfully convince Philip II to overhaul medical training for physicians and surgeons in the Castilian universities. He produced a series of medical texts on physic, surgery, and ancillary practices of bone-setting that set the standards for examination and licensing requirements throughout Spain in the late sixteenth century. Pérez de Herrera used his medical skills to address the public health threat of poverty as he examined the sick and disabled littering the streets of Madrid. Olivares exercised the office of chief medical examiner like no other protomédico before him and oversaw not only the examination and licensing of a diverse group of practitioners in the marketplace, but also advised the king on the safety and benefit of new medical techniques and medicines introduced from the marketplace. It certainly is no coincidence that these men attended to the health of the king as well as the kingdom. In addition to care for the body, the Spanish court physicians “exercised good judgment and gave good advice” The crown relied on these medical professionals at the apex of the profession and with their privileged university training to serve as experts and offer wise counsel on medical matters as well as to police the profession.
 Harold Cook, “Good Advice and Little Medicine: The Professional Authority of Early Modern English Physicians,” Journal of British Studies 33 (January 1994): 4–7.