Hospital Care in Brazil during the Hispanic Monarchy

During the period of the Hispanic Monarchy, the installation and structuring of a hospital assistance in Brazil was still very incipient. In its early years (1580s), there are few reports and information about hospital facilities or medical and surgical care. Most of these data are related to the Santas Casas de Misericórdia, some already installed since the first decades of the 16th century, which some historians call their “primitive facilities”[1].

The establishment of hospital units in Brazil and Portugal has an intrinsic connection with the creation of Misericordias (as their contemporaries called them, in the 16th and 17th centuries). These first institutions, whose headquarters (Lisbon) was founded in 1498, belong to a period of extreme importance to the history of Portugal, since it was only a few months before Vasco da Gama’s fleets arrived from India a few months before. After the first foundation, the process of installation of other “branches” and the fast expansion to overseas territories, highlight the importance that Misericordias had for the Portuguese Empire. In a little less than a century, there were already hundreds of Misericordias installed in continental territory and more than fifty in the overseas territories[2].

The first Holy House of Mercy, the one in Lisbon, was an institution protected by the Portuguese crown, and from his headquarter (or “mother house”) all the other counterparts (or “branches”) were being founded. Although they had a certain autonomy regarding their statutes and administration, which followed their own characteristics and adapted to local or regional particularities, the Compromisso da Confraria da Misericórdia, of the Holy House of Lisbon (1516), was the guiding document for all the others that would come afterwards[3].

Its foundation is part of a long term process that is intrinsically linked to a series of changes that took place in Portugal at the end of the 15th century (especially during the reign of D. Manuel) that aimed to organize and improve the assistance system. As Isabel dos Guimarães Sá states, the crown’s inictiatives in this period aimed at centralizing or standardizing the welfare system in Portugal, but also at removing the Church’s protagonism in this sector[4]. The great icons of this reordering of health care systems in Portugal were the Hospital de Todos-os-Santos (founded in 1492) and the Misericordia of Lisbon (1498)[5].

During the medieval period, most hospitals had been created from testamentary legacies, whose main concern was the salvation of the soul. This fact corroborates the participation and direction of hospitals in the hands of the Church. With the foundation of the Hospital de Todos-os-Santos and later creation of Misericordias, the Portuguese crown placed hospital management under its protection, and lay people started to administer them. Both institutions received numerous royal charities and privileges, which had a monopoly over the management of hospital care in Lisbon, and the same happened with the other Portuguese cities and overseas[6].

In Brazil, the first Misericordias accompanied, almost at the same time, the installation processes of the first colonial urban centers. Most of the documents related to the establishment of these institutions no longer exist, due to causes that range from deterioration due to organic causes (fungus, humidity, failure in the storage’s archives), administrative failures or destruction by external causes, such as the Dutch invasion in Bahia in 1624. From the available information about the foundation of the first Misericordias in Brazil, analyzed and interpreted by many researchers, point to the existence of fourteen institutions in the Portuguese America territory, during the period of the Hispanic Monarchy[7].

Some authors attribute the Misericordia of Santos as being the first in Brazil, which was founded in 1543. Instituted by Braz Cubas, soon after his return to Brazil (1540) “impressed with the hospitals he saw in the metropolis [Portugal] and with the Holy House there, he had the idea of establishing on the coast of São Paulo a house of medical assistance”[8]. Russel-Wood points out that Varnhagen, Southey and Serafim Leite were in agreement with this date of foundation, however he emphasizes that Serafim Leite doubted the existence of a hospital before 1549[9].

The year 1549 also marks the creation of Misericordia in the city of Salvador. Russel-Wood (1968) and Isabel dos Guimarães Sá (1997) dedicated much of their investigative work to the discussion and analysis of data, presented and interpreted by other authors, as well as how they supported their hypotheses[10]. The conclusions presented by Russel-Wood and Sá are in agreement with the date of 1549 for the foundation of this Misericordia, which would coincide with the installation of what would be the first urban center and the General-Government in the city of Salvador. With the arrival of Tomé de Sousa’s expedition to the city of Salvador, one of its first actions was the creation and installation of the first (and for a long time only) hospital in this locality[11].

In the Captaincy of Espírito Santo, Misericordia was located in the newly created city of Victoria, being founded in 1551. As with the other cities mentioned above, these statements are also based on unconvincing data[12].

Following the existing Misericordias in the period of the Hispanic monarchy, the Misericordia of Rio de Janeiro presents a rather controversial foundation date. Some authors attribute its foundation to have occurred in the year 1553, but without citing documentation to prove it[13]. Others, however, attribute the existence of a Misericordia in the city of Rio de Janeiro to the year 1582, when the Spanish squadron of Diego Flores Valdez was rescued by priest José de Anchieta, with the help of some Misericordia’s brothers[14]. Russel-Wood mentions that Felix Ferreira, in his study about Misericordia of Rio de Janeiro, sustained the foundation of this institution before the arrival of Estácio de Sá in 1565, but he did not present arguments strong enough to base this affirmation[15].

The year 1560 is indicated as the year of the foundation of Misericordia de Olinda[16], whose evidence is uncertain and doubtful. In the same year also appears the creation of the Misericordia de Ilhéus[17].

At the end of 16th century, there are the Misericordias of São Paulo[18] e Porto Seguro, whose data is also in doubt[19]. The Misericordia of Paraiba, located in the village of Filipeia de Nossa Senhora das Neves may have been created in 1585[20].

In the 17th century, the Misericordia of Sergipe was founded in 1604, Itamaracá in 1611, Belém in 1619, and Igarassú in 1629[21]. The Misericordia of Maranhão is mentioned in a letter from the Jesuit priest Antônio Vieira, from the year 1653. In this letter he sustained the existence of this institution, however he also tried to encourage the Mesa of this MIsericordia to build a hospital[22].

Although the information about the exact dates of the foundations of these institutions in Portuguese America territory is debatable, most historians do not doubt their existence during the period of the Hispanic Monarchy. These authors, who study the creation and implantation of these institutions in overseas territory, argue that the Misericordias were created as the urban centers were stablished, thus extending the reach and action of these institutions on hospital assistance[23]. The request of privileges already granted to Misericordia of Lisbon, made by the membres of the Administrative Board, mirrored the intention to transplant the same rights to overseas territories. Almost always, the crown waited for the request of grants as a way to keep its participation in the management of the Misericordia assistance actions in the overseas counterparts[24].

The existing privileges were very diverse and the counterparts ended up requesting the ones that suited them best. At times, with the high costs of hospital expenses, the Misericordias were forced to request new aid from the crown, as a way to improve their conditions of care. In 1605, the administrator and brothers of the Misericordia of Olinda requested to be able to collect the tithes of chickens, other birds and animals, specifying that this grant was intended for the maintenance of the sick[25].

However, many times, what ended up occurring was the request to be granted the same privileges that the Misericordia of Lisbon had, as in the case of Misericordia of Bahia that requested to use the same privileges as Lisbon, which were granted on September 23rd 1622[26]. Previously, the Misericordia of Olinda had already requested the same right, which was granted on January 26th, 1606[27].

The historical moment where there was more need of the crown help to maintain the Misericordias hospitals was during the period of the Dutch attacks. In this period, the negative repercussions on the financial health of these institutions extended to all overseas domains of the Portuguese crown, but especially to the East and Brazil[28].

If information about the existing Misericordia foundations during the period of Hispanic Monarchy in Brazil is scarce, the information about the operation of these hospitals is even scarcer. Rare are the data about the professionals who worked in the existing hospitals. One of these examples is the surgeon Gaspar Ruiz Cuevas, of Spanish origin (Canary Islands), who worked at Misericordia of Olinda at least from 1590 to 1594[29].

The same data about the professionals and hospital of the Misericordias are also scarce for the beginning of the 17th century. Friar Vicente do Salvador described an event that happened in one of the battles, in 1624-25, when the Dutch attacked the city of Salvador. The Franciscan friar mentioned an expedition, commanded by Don Fadrique de Toledo y Osorio, which had attacked the main hospital post of the Dutch. The Dutch at this period were using the wards of the hospital of Misericordia of Salvador to treat their soldiers. In this assault, although the buildings of Misericordia resisted almost unscathed, part of the hospital wall and the door of the cathedral were damaged. In addition, two surgeons who were working at that time healing the war wounded died, as well as a wounded man, who was recovering, and had been shot again[30].

As for the dimension and internal divisions of the Misericordias hospitals, so is the information, which is infrequent. In one of the few reports, Gabriel Soares de Sousa (1584), mentioned what he had witnessed about the lack of financial resources of the Misericordia of the city of Salvador (very poor), whose hospital facilities were very small[31].

Despite the lack of constant resources and the financial overload, the Misericordias never gave up the preference granted by the Portuguese crown. They continued acting in all welfare prerogatives, even though, sometimes, their members questioned whether it was worthwhile to keep this monopoly or not. What the Board feared the most was that the Misericordia, abandoning the hospital assistance, would also lose all the other privileges and grants conquered[32].

The Misericordias were not the only ones to intervene in the health preservation of the population, and as far as this performance of other religious brotherhoods or orders as curing agents did not threaten their preference in the privileges granted, the Misericordias let these other institutions to act. Among all these institutions that operated in Brazil, the most important in relation to health care and assistance was the Society of Jesus. The entrance of the Jesuit order in Brazil was contemporary to the foundation of Misericordia in the city of Salvador, in 1549[33].

Although there is a large amount of documentation related to the activities of the Jesuits in Brazil during the 16th and 17th centuries, there is little information circumscribed to health issues. Serafim Leite mentions a reasonable number of brothers who worked as nurses, surgeons, barbers and apothecaries. As far as possible, there was always a group of brothers responsible for these activities in the colleges of the Society, both in Europe and in Brazil. As for the apothecaries, the medicines, during the 16th and 17th centuries, came from Portugal already prepared. However, with the increasing amount of piracy actions, which attacked ships with the intention of confiscating the prizes goods that were leaving or arriving in Brazil, this invariably influenced the Jesuit’s practices. As a way to protect themselves from the lack of these goods, the Jesuits always had some stock of medicines, which were made in their apothecaries[34].

As for hospital facilities, infirmaries were mandatory in al Jesuit Colleges and Residences, with the presence of nursing brothers who treated, preferably, members of the order. However, as some Colleges were located in areas with few resources and far from the small colonial urban centers of Brazil, they ended up exercising healing activities on people outside the order. As for the brothers who exercised healing activities, there were a few dozen brothers scattered throughout the Brazilian captaincies, most of them being nurses and surgeons. Often a brother who acted as a nurse or surgeon also practiced as an apothecary. In conflict situations, they also worked together with the Misericordias. At the time of the Dutch invasion in 1624, a “blood hospital” had been created at the College of Bahia, where some wounded were treated, especially soldiers. Similar attitudes also occurred in cases of epidemics and other situations in which the Misericordias lacked resources and professionals[35].

Even though there were great difficulties in the creation of hospital facilities, as well as the existence of health professionals, most historians seem to agree that, during the period of the Hispanic Monarchy, healing services were made available to the population living in Portuguese America, as well as to those who were passing through. On occasions of epidemics, wars or delay in the arrival of resources from Europe, gradually, solutions were found to solve the problems related to assistance, even if in a precarious way[36].

The brotherhoods played an important role in providing healing services, especially the Misericordias and the Society of Jesus. These institutions sought, whenever possible, to come closer to the model of their founding mothers. The Portuguese in Brazil, and other overseas territories, sought to fell as they did in their original lands, and having the same institutions they had in Europe helped make daily life less difficult. Many grants of privileges and bounties to the Misericordias were made during the period of the Hispanic Monarchy. The Spanish crown sought, whenever possible, to maintain the existing procedures and concessions. And it was in one of the periods of greater conflict, occasion of the Dutch invasion, that these aids were preponderant[37].


[1] A free translation of Santas Casas de Misericórdia is Holy Houses of Mercy. Campos (1943); Russel-Wood, 1968; Sá, 1997; Abreu, 2000; Paiva, 2002.

[2] Sá, 1997.

[3] O Compromisso da Confraria da Misericordia (1516). Santa Casa da Misericordia de Lisboa; Sá, 1997; Abreu, 2000.

[4] Sá, 1997.

[5] The process of foundation of the Hospital de Todos-os-Santos, whose main constructions took place between the years 1492 and 1504, was part of a broad project already started in other European countries (especially in Italy, in the city of Florence) that aimed to organize the existing health system, changing the numerous small and scattered medieval constructions for the installation of large hospitals. Prior to D. Manuel’s initiatives, D. João II, in 1479, had asked Pope Sixtus IV for permission to merge the small medieval hospitals and to found a large hospital in Lisbon, a model that would later be followed by the cities of Coimbra, Évora and Braga. These small hospitals (around forty-three in Lisbon and its surroundings) incorporated the Hospital de Todos-os-Santos (Sá, 1997).

[6] Russel-Wood, 1968; Sá, 1997; Abreu, 2000; Paiva, 2002.

[7] Campos, 1943; Russel-Wood, 1968; Paiva, 2002.

[8] Campos, 1943: 216.

[9] Russel-Wood, 1968, a partir de Vargnhagen, F. A. (1854-7). História geral do Brasil. Rio de Janeiro, vol. 1; Southey, R. (1810-19). History of Brazil. Londres, vol. 3; Campos, E. S. (1943). Santa Casa da Misericórdia de Santos. São Paulo; e Leite, S. S.J. (1938-50). História da Companhia de Jesus no Brasil. Rio de Janeiro-Lisboa, vol. 1. Besides the date of foundation, these authors maintain that a letter of confirmation was issued in 1551 (Russel-Wood, 1968: 39-40).

[10] For example, Varnhagen (1877) e Campos (1943); (Russel-Wood, 1968; Sá, 1997).

[11] Russel-Wood, 1968; Sá, 1997.

[12] Russel-Wood based his afirmations on Lycurgo Santos Filho (1947), História da medicina no Brasil. São Paulo, vol. 1 (Russel-Wood, 1968: 40).

[13] Paiva, 2002.

[14] Campos, 1943; Russel-Wood, 1968; Gandelman, 2001; Paiva, 2002, a partir de Khoury, Y. A. (2004). Guia dos Arquivos das Santas Casas de Misericórdia do Brasil: fundadas entre 1500 e 1900. São Paulo: CEDIC: Imprensa Oficial do Estado de São Paulo. Vol. 2.

[15] Russel-Wood, 1968: 40.

[16] Campos, 1943.

[17] Russel-Wood, 1968.

[18] Campos, 1943; Russel-Wood, 1968.

[19] The only evidence for this statement is a letter, from a much later period. In a letter of 1718, Dom João V guaranteed financial help to complete the works on the church and hospital of Misericordia. He claimed in this correspondence that it was “the first and oldest there was, and would were in that Brazil” (Russel-Wood (1968: 40) quoting Carlos Ott (1960), A Santa Casa de Misericordia da cidade do Salvador.

[20] According to Abreu and Paiva, in Guia dos Arquivos das Santas Casas de Misericórdia do Brasil, it is stated that the foundation of this Misericordia came from the action of Duarte Gomes da Silveira, who had gone to this territory with the objective of achieving a peace treaty with the Potiguaras Indians. These data, according Abreu and Paiva, should be carefully analyzed, however, they inform that the same Guide, soon after, mentions the arrival, in 1595, of an inquisitorial visitation that confirms the existence of this institution (Paiva, 2002). Russel-Wood mentions the year 1604 as the year of the foundation of this Misericordia, together with that of Sergipe (Russel-Wood, 1968).

[21] Campo, 1943; Russel-Wood, 1968. Abreu and Paiva question Russel-Wood’s statement regarding the foundation of the Misericordia of Igarassú in 1629, since he does not cite any source to support this data. However, soon after, they point out that by the rigor of his investigative work one can trust this information, albeit with reservations. According to these authors, there is no other information about this institution, and they state that, if it existed, they doubt that it resisted after the Dutch attacks (Paiva, 2002: 271). Abreu and Paiva, from de Guia dos Arquivos das Santas Casas de Misericórdia do Brasil, point to the Misericordia of São Luis do Maranhão the date of 1622, with a letter of December 3 (Paiva, 2002: 270).

[22] Abreu and Paiva, from de Guia dos Arquivos das Santas Casas de Misericórdia do Brasil, point to the Misericordia of São Luis do Maranhão the date of 1622, with a letter of December 3 (Paiva, 2002: 270).

[23] Sá, 1997; Abreu, 2000; Paiva, 2002.

[24] Sá, 1997; Paiva, 2002.

[25] At this time, they reported that the high famine that existed and the expenses exceeded the resources they had available. And that having the prisons been created in the captaincies of Pernambuco, Paraíba, Rio Grande and other states, the amount of sick people had increased (Requerimento do provedor e irmãos da Misericordia de Olinda dirigido a D. Filipe II, pedindo-lhe para arrecadarem os dízimos dos frangos e mais aves, cabritos, cordeiros, leitões e ovos, para a manutenção dos enfermos da dita instituição), before October 7th, 1605 (Paiva, 2002).

[26] Alvará régio autorizando a Misericórdia da cidade do Salvador da Baía de Todos os Santos a usar dos privilégios concedidos à Misericordia de Lisboa, 22 de setembro de 1622.

[27] Alvará régio autorizando a Misericórdia de Olinda a usar os privilégios concedidos à Misericordia de Lisboa, 22 de janeiro de 1606.

[28] Paiva, 2002: 24.

[29] The mentions of this Spanish surgeon, who worked at the Misericordia of Olinda, are based on inquisitorial documentation. In 1593, this surgeon was called to testify in one of several complaits against the merchant João Nunes in Olinda. A stonemason by the name of Pedro Silva had testified against the merchant in 1593, and died on July 24 at the Misericordia hospital. Gaspar Ruiz (or Roiz) Cuevas was the surgeon who had attended this stonemason (Mello, 1996: 63-64).

[30] Frei Vicente do Salvador, 2010.

[31] Gabriel Soares de Sousa, 1879.

[32] Russel-Wood, 1968; Sá, 1997; Abreu, 2000.

[33] Russel-Wood, 1968; Sá, 1997; Abreu, 2000.

[34] Leite, 1953.

[35] Leite, 1953.

[36] Sá, 1997; Abreu, 2000; Paiva, 2002.

[37] Leite, 1953.

DOCUMENTAL REFERENCES

O Compromisso da Confraria da Misericórdia (1516). Santa Casa da Misericórdia de Lisboa. Lisboa per Valetym fernandez e Harmam de cãpos. Recuperado em https://purl.pt/27090/1/index.html#/1/html

Alvará régio autorizando a Misericórdia de Olinda a usar os privilégios concedidos à Misericórdia de Lisboa. ANTT, Arquivo Nacional da Torre do Tombo, Chancelaria de D. Filipe II, Doações, liv. 17, fl. 118v.

Alvará de D. Filipe II para que a Misericórdia de Itamaracá, no Brasil, possa gozar dos privilégios da Misericórdia de Lisboa. ANTT, Arquivo Nacional da Torre do Tombo, Chancelaria de D. Filipe II, Doações, liv. 21, fl. 171.

Alvará régio autorizando a Misericórdia da cidade do Salvador da Baía de Todos os Santos a usar dos privilégios concedidos à Misericórdia de Lisboa. ANTT, Arquivo Nacional da Torre do Tombo, Chancelaria de D. Filipe II, Privilégios, liv. 3, fl. 39.

Requerimento do provedor e irmãos da Misericórdia de Olinda dirigido a D. Filipe II, pedindo-lhe para arrecadarem os dízimos dos frangos e mais aves, cabritos, cordeiros, leitões e ovos, para manutenção dos enfermos da dita instituição. AHU, Arquivo Histórico Ultramarino, AHU-ACL_CU__015, cx. 1, doc. 24.

Processo de João Nunes. Olinda, Pernambuco, 20 de agosto de 1594. ANTT, Arquivo Nacional da Torre do Tombo, Tribunal do Santo Ofício, Inquisição de Lisboa, proc. 88.

BIBLIOGRAPHY

Abreu, L. (2000). O papel das Misericórdias dos “lugares de além-mar” na formação do Império português. Laurinda Abreu. História, Ciências, Saúde, vol. VIII (3). Recuperado em https://www.researchgate.net/publication/26368418_O_papel_das_Misericordias_dos_’lugares_de_alem-mar’_na_formacao_do_Imperio_portugues

Campos, E. S. (1943). Santa Casa de Misericórdia da Bahia. Origem e aspectos de seu funcionamento. Ernesto de Souza Campos. Revista do Instituto Geográfico e Histórico da Bahia. N. 69. Recuperado em https://www.ighb.org.br/_files/ugd/4f3af0_881ea04f00ea4d0aa065a491dc613b89.pdf

Gandelman, L. M. (2001). A Santa Casa da Misericórdia do Rio de Janeiro nos séculos XVI a XIX. História, Ciências, Saúde, vol. VIII (3). Recuperado em https://www.scielo.br/j/hcsm/a/CX5BXnKtBYtVvCXVrZjZMzP/?lang=pt

Leite, S., S. J. (1953). Artes e ofícios dos jesuítas no Brasil (1549-1760). Lisboa: Edições Brotéria; Rio de Janeiro: Livros de Portugal. Recuperado em https://ia903404.us.archive.org/23/items/arteseoficiosdos00leit/arteseoficiosdos00leit.pdf

Mello, J. A. G. de (1996). Gente da Nação. Cristãos-novos e judeus em Pernambuco 1542-1654. 2ª edição. Recife: Fundação Joaquim Nabuco, Editora Massangana.

Paiva, J. P. (2002). Portugaliae Monumenta Misericordiarum. Ed. lit. Centro de Estudos de História Religiosa da Faculdade de Teologia – Universidade Católica Portuguesa; coord. ientífico José Pedro Paiva. Laurinda Abreu e José Pedro Paiva, coordenadores do Vol. 5. Lisboa: União das Misericórdias Portuguesas. Recuperado em https://www.academia.edu/35494259/ABREU_L_PAIVA_J_P_dir_cient_Portugaliae_Monumenta_Misericordiarum_vol_5

Russel-Wood. J. R. (1968). Fidalgos and Philanthropists. The Santa Casa da Misericordia of Bahia, 1550-1755. Londres/Melbourne/Toronto: MacMillan. Recuperado em https://digital.bbm.usp.br/handle/bbm/963

Sá, I. G (1997). Quando o rico se faz pobre: Misericórdias, caridade e poder no Império português. Lisboa: Comissão Nacional para as Comemorações dos Descobrimentos Portugueses. Recuperado em http://repositorium.sdum.uminho.pt/handle/1822/4311

Salvador, Frei Vicente (2010). História do Brasil. Edição revista por Capistrano de Abreu. Brasília: Senado Federal. Recuperado em https://www2.senado.leg.br/bdsf/bitstream/handle/id/575110/000970367_Historia_Brasil.pdf?sequence=1&isAllowed=y

Sousa, G. S. de (1879). Tratado descritivo do Brasil em 1587. Rio de Janeiro: Typographia de João Ignacio da Silva. Recuperado em https://digital.bbm.usp.br/handle/bbm/4792

Varnhagen, F. A. de (1877). História geral do Brazil. Volumes 1 e 2. Rio de Janeiro: em casa de E. e H. Laemmert. Recuperado em https://digital.bbm.usp.br/handle/bbm/4825

Author:

Zeli Teresinha Company (Universidad de Salamanca)

How to quote this entry:

Zeli Teresinha Company. “Hospital Care in Brazil during the Hispanic Monarchy“. In: BRASILHIS Dictionary: Biographic and Thematic Dictionary of Brazil in the Spanish Monarch (1580-1640). Available in: https://brasilhisdictionary.usal.es/en/asistencia-hospitalaria-3/. Date of access: 13/04/2024.

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