Sex, Death, and Atole at the Royal Indian Hospital

Mexico City, 18th Century

For the wounded, diseased, and ailing of Mexico City, just about anything was better than the Royal Indian Hospital. By the 18th century it had been around awhile. King Philip II had established the Indian Hospital in the 1560s in a haphazard attempt to demonstrate the Crown’s supposed “piety and love towards the Indians.”1 The colonial government, though, was not too interested in the institution; in fact, it appears that for a period in the 17th century, the hospital was entirely run by Amerindians.2 After that, however, it fell into neglect. By 1702, another King Philip (this one the fifth) declared it a “profound failure of charitable service” on the grounds that the Indians had discovered that “if they avoid the [Indian Hospital], they die less.”3

Not that Philip V was worried about dead Indians. But what was worrisome to colonial rulers was that they avoided the Indian Hospital and headed to the Hospital of the Holy Spirit, a hospital for Spaniards. This would not do: “This type of people must be kept separate from the Spaniards and mestizos, because of the nature of their ailments and their bad odor.”4

Race was a slippery word and idea in colonial Spanish America, and it referenced culture and faith much more than physiology. Nonetheless, Spanish colonists were unanimous that Indian bodies were inferior and depraved and could contaminate Spaniards in their midst.5

An architectural drawing of the interior hallway of a hospital with a large archway leading into a long hall with a tall, arched ceiling with doors along the sides.
Interior of the Indian Hospital’s chapel, 1744. (Vista interior de la iglesia del Hospital Real y General de los Indios de la ciudad de México, 1744, Mapas y Planos MP-MEXICO 151, Archivo General de Indias, Seville.)

King Philip V’s solution was to hand the hospital to the Holy Order of Saint Hippolyte. The Hippolytes already ran a host of hospitals across the colony. And more, the friars’ vows of poverty, charity and “unity through Holy zeal” seemed just what the Indian Hospital needed: fervent discipline to reverse the pattern of waste and neglect.

But it wasn’t.

The abuse continued. A 1730 inquiry by the Audiencia, the colony’s high court, revealed a litany of complaints. One former patient, Joseph Antonio Ramírez, reported that the friars assaulted him after he had complained about their routine tardiness. Ramírez stated emphatically that he “wouldn’t go back there for fear of the Fathers.” Joseph de Guadalupe and Andres Joseph, two “Indios ladinos,” complained of vomiting fits after having rotten meat thrown at them.6

Another patient testified that the friars hit him in the face with a loaf of bread. Others stated that they were fleeing because at the hospital the infirm were dying of hunger and never received any medicine. Patient Juan Esteban summed the situation up well: everything the friars do “is contrary to charity.”7

There was more. The friars were unpaid, of course, but they were also under-clothed, ill-fed, undersupplied, and forbidden from leaving the premises. So they took pleasure where pleasure could be had. In the 1730 inquiry, hospital staff and patients blew the whistle: “by day women come and visit them in their cells … and [the friars] sneak out through the garbage chute” or the graveyard to venture into the night, leaving the sick unattended. Sometimes women were seen in their cells “playing music with the friars.” The hospital’s porter added that the friars do not even sleep in the building, but stay out “until dawn, as is their custom.” One night, the doorman reported, a man came to the gate looking to beat to a pulp a friar who had propositioned his wife; an hour or so later the friar came back disguised in drag.8

These complaints (eventually) led to the Hippolytes’ dismissal. Nonetheless, the hospital was a nightmare, and patients’ chances of survival remained low. With strict rules to isolate patients from their usual milieu — that is, indigenous homes, customs, and diet — family was forbidden to visit. It was a site for the very poor to die alone.

An open book with yellowed pages and rows of handwritten log entries.
The Pharmacy log book of the Royal Indian Hospital, 1721. (Hospital Real de Naturales, “Libro de botica en que se asientan las medicinas que se traen para este Hospital Real de los Naturales.” (Mexico, 1721), 3v-4r, Colección Antigua 0643, Archivo Histórico del Instituto Nacional de Antropología e Historia, Mexico.)

There was one bright spot, though. We do not usually associate the Spanish empire with tolerance and diversity: anti-idolatry campaigns and the infamous Holy Inquisition more easily come to mind. But a rare medical log from the Royal Indian Hospital paints a different, less dogmatic picture.9

The list of drugs at first seems prosaic for the day: rose water, Valencia pomade, endive emulsion, Water of the Queen of Hungary, Ointment of the Thirty. But then, a full third of the cures supplied at the Indian Hospital were atoles, that is, pre-Columbian herbal stews. Atoles of cacao and tobacco were used for purging the body of worms. Violet atole was probably administered for pleurisy.10

Some atoles were made of common medical plant materials, such as endive, mint, and almonds; others, however, remain shadowy and indiscernible, such as “golden atole” and “complete atole.”

Detail of a pharmacy log showing lines of handwritten entries.
Detail: Atoles in the Pharmacy log of the Royal Indian Hospital, 1721. (Hospital Real de Naturales, “Libro de botica en que se asientan las medicinas que se traen para este Hospital Real de los Naturales.” (Mexico, 1721), 3v-4r, Colección Antigua 0643, Archivo Histórico del Instituto Nacional de Antropología e Historia, Mexico.)

Atole had long been used in native medicine. In the 16th century, the Spanish physician Francisco Hernández noted that there were more types of medicinal atole around Mexico than he had the ability to record. Some of the most interesting he recorded included nochil atole, for invigorating the weak; michihuauh atole, for kidneys, the urinary tract and scabies; yolatolli, for those with too much blood; and yzquiatolli, for weak hearts or an overabundance of melancholy.11

The pre-Columbian recipes Hernández documented were not those in use at the Royal Indian Hospital. In fact, many of the ingredients (such as almonds and sesame) were brought to the Americas from Europe by the first conquistadors and missionaries. That is to say, the atoles at the Indian Hospital were syncretic medicines, mixing medical traditions from both sides of the Atlantic.12

Architectural floorplan of the Indian Hospital with a single large central area with a hall to the east and side-by-side rooms to the north, south, and west. More rooms line the building to the east of the central hall, with three in the far northeast side of the building for making atoles.
Plan of the first floor of the Indian Hospital, 1767. The green dots on the far eastern side indicate the rooms dedicated to making atoles. The blue dot north of them is the temascal. (Lorenzo Rodríguez, Plano inferior del Hospital Real de los Indios de Mexico, 1764, MP-Mexico, 225B, Archivo General de Indias, Seville.)

Nonetheless, women of native descent had authority over the atoles and the atolería (atole kitchen).13 In the 1764 plan of the hospital, we see that they worked next to another indigenous institution, a temascal (steam bath), which the hospital authorities acquiesced to when the patients once again fled the hospital to attain their preferred treatment with their families and neighbors.14

Perhaps it doesn’t seem like much. But by voting time and again with feet and mouths, these patients — the poorest of the poor of Mexico City — managed quite a lot. They first got the Hippolyte friars in and then later expelled, and perhaps more incredibly, in a political atmosphere that held native medical knowledge suspicious at best and heretical at worst, these infirm and their families won the treatment that they wanted and needed.

Historians of colonial medicine, especially in Latin America, have long pointed to patterns of “medical mestizaje.” Colonies were spaces of exchange and adaptation that neither the colonizer nor the colonized could escape. But what the Indian Hospital demonstrates is that syncretism was not a natural, destined, or gradual process. Rather, colonized people struggled and fought for it. Medical practice was situational, locally contingent, and unstable, and it was always political.


  1. A lack of sources results in some uncertainty about the date of the hospital’s actual founding. Consejo Real de Indios, “Capítulo Ciento y veynte y seys de la prouision que se despachò para nueuos descubrimientos y poblaciones, en treze de Iulio de sesenta y tres, en que manda se funden y hagan hospitales quese curen los enfermos pobres ansi Indios, como Españoles, 1563,” in Cedulario Indiano, ed. Diego de Encinas, vol. 1, 4 vols. (Madrid: Ediciones Cultura Hispánica, 1945), 219. Return to text.
  2. “Cuentas de cargo y data, Reales Ordenes, correspondencia y autos del Hospital Real de Naturales” (Valladolid & Mexico, 1639), IV Hospitales 1141-004, Archivo General de la Nación, Mexico. Return to text.
  3. “Real cédula en que a instancias de los religiosos de San Hipólito pasa a ellos la administración del Hospital Real” (Valladolid, April 8, 1701), Hospital Real de Naturales vol. 101, exp. 38, Archivo Histórico del Instituto Nacional de Antropología e Historia, Mexico. Return to text.
  4. “Real cédula.” Return to text.
  5. R. Douglas Cope, The Limits of Racial Domination: Plebeian Society in Colonial Mexico City, 1660–1720 (Madison: University of Wisconsin Press, 1994); María Elena Martínez, Genealogical Fictions: Limpieza de Sangre, Religion, and Gender in Colonial Mexico (Palo Alto: Stanford University Press, 2008). Return to text.
  6. “Indio ladino” was a derogatory epithet to indicate Indians who were spoke Spanish and had “lost” their own culture. Return to text.
  7. “Expediente de las pesquisa secreta y proceso informatorio sobre la asistencia a los enfermos, por los capellanes” (Mexico, 1730), 243r-264v, Hospital Real de Naturales vol. 86, exp. 5, Archivo Histórico del Instituto Nacional de Antropología e Historia, Mexico. Return to text.
  8. “Expediente de la pesquisa.” Return to text.
  9. Hospital Real de Naturales, “Libro de botica en que se asientan las medicinas que se traen para este Hospital Real de los Naturales” (Mexico, 1721), Colección Antigua 0643, Archivo Histórico del Instituto Nacional de Antropología e Historia, Mexico. Return to text.
  10. “Pleurisy” was a common diagnosis in the early modern world for many syndromes that would now go by other names. See Adrien Wilson, “On the History of Disease-Concepts: The Case of Pleurisy,” History of Science 38, no. 3 (October 1, 2000): 271–318. Return to text.
  11. Francisco Hernández, Quatro libros. De la naturaleza, y virtudes de las plantas, y animales, que estan receuidos en el vso de medicina en la Nueua España, y el methodo, y coreccion , y preparacion que para administrarlas (Mexico: Diego López Daualos, 1615). Return to text.
  12. The conquest of central Mexico brought together many medical cultures from Spain, Mesoamerica, Africa, and the Philippines, and the entirety of the colonial period evinces myriad forms of exchange and syncretism which emerged and faded, waxed and waned depending on many local conditions. There is an extensive academic literature on this phenomenon. The place to begin is G. Aguirre Beltrán, Medicina y magia: el proceso de aculturación en la estructura colonial (México, D.F: Instituto Nacional Indigenista, 1963). Return to text.
  13. It is possible as well that some of the many types of balms, water-based concoctions, and cordials distributed in the hospital were prepared in the atolería, especially considering the repeated complaints of insufficient provisions from the contracted pharmacist. The historical record, however, is not complete enough to fully arrive at a firm conclusion. Joseph Cárdenas, “Libro de cargo y data” (Mexico, 1750), 19r, Colección Antigua 0499, Archivo Histórico del Instituto Nacional de Antropología e Historia, Mexico. Return to text.
  14. Antonio de Arroyo, “Petición de Don Antonio Arroyo sobre que se le conceda fabricar un placer y un temascal para el uso de los enfermos y la agua suficiente para el gasto del Hospital” (México, February 23, 1763), Hospital Real de Naturales vol. 101, exp. 46, Archivo Histórico del Instituto Nacional de Antropología e Historia, Mexico. Return to text.

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