GOVERNMENT BY CHARITY: THE EMERGENCE OF THE EARLY MODERN HOSPITAL IN THE HISPANIC WORLD

Abstract

This dissertation examines the emergence of the early modern hospital as an institution in Spain and Spanish America, tracing its development through laws, intellectual debates, reform proposals, case studies, and its adaptation across both the Iberian Peninsula and the New World. While scholarship on poor relief has made valuable contributions, the institutional history of the hospital during this period remains largely overlooked. Existing studies have tended to focus instead on the regulation of mendicancy and vagrancy, the causes of poverty and epidemics, and the projection of modern welfare goals onto early institutions—often portraying them as tools for enforcing social discipline in response to the economic and ideological transformations of the sixteenth century. This study, however, demonstrates that hospitals did not arise from proto-modern economic or medical advancements that emerged in the short term, but rather from canon and civil law, evolving over time in response to enduring political and religious contexts. Originating in monasteries and sustained by private donations, hospitals evolved into autonomous and distinctive institutions under the leadership of the Spanish monarchy and the Church. They played a key role in the territorial expansion of the Iberian kingdoms throughout the Middle Ages and the Early Modern Period. Always endowed in perpetuity, hospitals were often established with specific provisions that defined their purpose as secular spaces where individuals could carry out charitable acts grounded in biblical ordinances. This legal and religious foundation gave them remarkable stability and resilience, along with the flexibility to support the organization of local communities by channeling resources, power, and authority. While the punishment of vagrancy, the regulation of mendicancy, and colonialism spurred legal innovation and intellectual debate, hospitals followed their own trajectories of reform and redefinition, shaped by the ongoing interplay of the monarchy, the Church, and local interests.