“…to be Cured of a Fever”: Guatemala, the San Juan Hospital’s Women’s Ward, and a World of Fevers, 1781–5
Ricardo Castellón, Lea-Marie Trigilia, and Stefanie Gänger
On 22 March 1781, María Paz, identified as a married, about thirty-year-old mulata – a term then referring mostly to persons of (part-) African descent1 –, was admitted to the newly founded San Juan Hospital in Guatemala ‘to be cured of a fever (fiebre)’. María Paz was one of 104 sufferers admitted to the hospital’s women’s ward on account of a ‘fever’ between January 1781 and December 1785, a five-year span over which the logbooks, recording the sufferers’ personal details, are exceptionally complete.2 Fever was the second-most common cause of admission to the hospital for women in the period, the most important being gálico, with 137 cases, a term that referred to a ‘constitutional’, or chronic venereal condition at the time. Fever would soon surpass venereal ailments, however. During the two decades between 1788 and 1808, fevers became the most important cause of admission to the hospital for men and women, according to the data compiled by Lynda de Forest Craig: taken together, fever and tabardillo (‘typhus fever’) would account for the majority of admittances, with other ailments like diarrhoea, gálico, dropsy (hidrópica), injuries – apparently often resulting from (domestic) violence –, ‘old age’, or tumours far behind in number.3 Even between January 1781 and December 1785, when fever was not yet the primary cause of admission among the inmates of the women’s ward, it was already the most common cause of death. Around 40% of the ward’s fever patients – most of them women of colour – succumbed within days, nine on average. Amongst them was María Paz, who passed away two days after her admission to the hospital on 24 March 1781.
![Entrance of María Paz in the register of the San Juan Women's Hospital of Guatemala, reading: “Mulata 42 // María Paz approximately 30 [years old], originally from San Sebastían, married to Luis de Paz, never met her parents, came to be cured of a fever on the 22nd [of March] // Died on the 24th [of March] N. 5”](https://backend.hist.uni-heidelberg.de/sites/default/files/styles/img_free_aspect_0005/public/2025-06/blog3_0.png?itok=NCkUjon9)
The San Juan logbooks are one of many archival records of interest to the FEVER project, in which we study not only accounts of the sensory experience of fever, or ideas about its causation, but also the astounding prevalence of the disease in this period’s medical records, its relevance to persons like María Paz.
The San Juan logbooks are revealing in this regard. For one thing, the diagnosis’s salience in them is of a piece with the data historians have retrieved for other parts of the Iberian, British and French empires. From Scottish hospital admissions,4 parish registers in south-east England,5 to military statistics in the British and French Caribbean,6 many records speak to the fact that fevers constituted a prevalent disease category and cause of death in the period. Admittedly, like other medical records, these logbooks likely only convey a partial, perhaps even lopsided, view of past medical demography, that ought not to deceive us; sufferers of smallpox in and around the Guatemalan capital, for instance, were mostly registered and treated in separate facilities.7 What they do allow us to better comprehend is why so many physicians at the time spared were persuaded that fevers were ubiquitous, and fatal. Fevers were “the most frequent of all diseases,” as the Scottish physician-author William Buchan cautioned his readership;8 or as his Spanish counterpart Joseph Masdevall wrote, fevers killed “more persons than all other ailments combined”.9
Arguably, much of the diagnosis’ prevalence is owing to the term’s sheer capaciousness. By the 1780s, in Guatemala and elsewhere, ‘fever’ was referred to by medical professionals and lay persons as a generic illness, marked by a plethora of signs or symptoms: an altered pulse and heartbeat, a ‘general debility’ or malaise, pain in the head, delirium, heat and shivering and chills.10 Physicians distinguished dozens or even hundreds of genera, or kinds of fever,11 ranging from bilious, remittent, typhus, childbed or scarlet fevers to jail, yellow, hectic, or adynamic fevers, each defined by a distinct temporality, symptom, or place of occurrence. To Guatemalans of the period, the term would have encompassed ‘measle-ish (sarampionsas) fevers’, in which the sick were covered with spots; tertian fevers, so-called because febrile accessions recurred on the third day; or, indeed, tabardillo, a Spanish-language medical term for a ‘continued’, or ‘typhus fever’, which Guatemalans also referred to as pestilential, ‘furious’, contagious, ‘acute’ or malignant fever.12 Indeed, late-colonial Guatemala saw several outbreaks of tabardillo which particularly affected urban and Maya communities.13 While the pervasiveness of the diagnosis, ‘fever’, around 1800 owed much to the disease category’s epistemic scope in Guatemala and elsewhere, however, it was not merely an artefact of the period’s classificatory schemes. In many ways, the growing protagonism of fevers was also a reflection of the period’s changing epidemiological landscape: the waning of other, more striking epidemic diseases – the plague and, with the advent of the vaccine, smallpox –,14 but also the rise of ‘new’ or particularly virulent fevers, including ‘typhus’.15
Importantly, the San Juan admission records open a rare window into a social segment that medical historians frequently know little about. Like most other Spanish American religious hospitals, San Juan de Dios was not just a place of healing, but one of charity sheltering those who were poor, sick, or dying.16 While it was not restricted to one ethnic group – or calidad, to use the period’s concept17 – most of the female ward’s inmates were women of colour. Between 1781 and 1785, more than half of the sufferers admitted to the ward were registered as mulatas, 34% were described as ‘Indian’, only 5% as Spaniards, and the small remainder as Black, enslaved, and mestizo women. This ethnic distribution reflects in part late-eighteenth century Guatemalan demography, and in part the fact that Spanish women would often have been taken care of at home. Compared with the general admissions, the fever figures suggest that Indias were slightly more likely to be afflicted: 50% of the fever patients were Indian women, 42% of them mulatas. That disproportion might well reflect a reality – contemporaries often observed that some diseases affected the Maya population disproportionately18 – but it might also be explained by that same conjecture, which likely biased diagnoses. At any rate, it reveals that the period’s medical discourse on African-descended persons’ relative invulnerability to fever was erroneous.19 Women like María Paz were by no means invulnerable to fever. On the contrary, as historians have shown, Indians and non-Indians in Guatemala around 1800 had a similarly limited life-expectancy and susceptibility to disease.20
The deeper we dig into the records, the better we can ascertain the contours of these women’s sufferings. One perhaps surprising observation is that those women overcome by fevers who would eventually be released – as cured or well enough to be discharged – normally remained in the hospital for extended periods of time: they stayed 28 days on average, anything from three days, to 35, 40, 45, 57, 61 or 72 days, to – the most remarkable cases – 133 days, that is, nearly five months, and 219 days, that is, seven months.21 This is particularly striking given the material cost to the hospital and the shortage of beds, provisions, and linen in it that the administrative period’s reports repeatedly stress.22 Likely, however, neither the hospital physicians nor servants would have been astonished to find that fevers lasted long, or had lengthy sequelae: it would seem that healers and sufferers of the late 1700s were well aware that one could expect some kinds of fevers to last months, be complicated with other ailments, or become ‘chronic’.23 Records like the San Juan papers not only give away that these women might have hoped to recover in the hospital – some 60% of the afflicted did survive the ordeal, after all; they also suggest that several were suffering from a fever or its sequelae for an extended period of time, staying – living – in the hospital for months. As such, the records are also one of many sources that allow us to revise our understanding of fever as an acute, deadly ailment one would naturally have expected to end quickly, either in recovery or death. To women like María Cornelia Bazon, the 34-year-old, unmarried (soltera) mestiza who stayed in San Juan Hospital for five months, for instance, it was precisely the reverse case: a disease that lingered, an obstinate, tedious ill that would not quit the sufferer for a long time.24
![Libro 2º en Q.e se Assientan las Mugeres Q.e Entran  Curarse en este S.To Hosp.l a Cargo del R[do] Prior Fr. Mariano Bacelo, Empieza en 1[o] de Enero de 1787, 1781, Archivo General de Centroamérica [AGCA], Expediente 12180.](https://backend.hist.uni-heidelberg.de/sites/default/files/styles/img_free_aspect_0005/public/2025-06/blog3.png?itok=8sTGn6Pj)
Acknowledgements and Division of Labour
The 1781-1785 logbooks are currently located in the Archivo General de Centroamérica, where Ricardo Castellón collected them for the ERC project. Lea-Marie Trigilia, a student assistant for the project, transcribed the records and crafted a dataset, producing the above-cited statistics. Stefanie Gänger wrote a draft of this blog based on these results, to which Lea, Ricardo and Yijie Huang contributed comments, corrections, and additions.
References
[1] Ricardo Castellón: Secretos de Familia. Las familias y su movilidad en El Salvador colonial. Siglo XVIII, San Salvador 2019, 62-63.
[2] 104 were admitted with fever (calentura, fiebre), three with tabardillo, or typhus fever: Libro 2º en Q.e se Assientan las Mugeres Q.e Entran  Curarse en este S.To Hosp.l a Cargo del R[do] Prior Fr. Mariano Bacelo, Empieza en 1[o] de Enero de 1787, 1781, Archivo General de Centroamérica [AGCA], Expediente 12180. Even though the preserved records span the years 1781–1808, we have limited our own statistical analysis to the first five years; from the year 1786 onwards, the records are fragmentary and the resulting data less robust.
[3] According to the statistics compiled by Linda de Forest Craig, who examined the hospital’s libro de enfermos from 1788 to 1808, there were 396 cases of fever (in addition to fevers the scribes ascribed to constipations, inflammations, or stomach pains), 164 for tabardillo, 202 cases of gálico, 102 of dropsy, 159 for fríos and 38 tumors, to cite a few examples. For the full statistics, see Lynda de Forest Craig: Patients and Disease in an Enlightenment Hospital San Juan de Dios in Guatemala City, 1788–1808, Ottawa 1987, 171–7. On the importance of (domestic) violence against women in the 1793, 1797 and 1800 records, see Sylvia Sellers-García: "A Hidden Plague: Violence and Public Health in Colonial Guatemala City", The Medieval History Journal 25 (1), 2022, 7–31.
[4] Guenter B. Risse: Hospital Life in Enlightenment Scotland, Cambridge 1986, 131.
[5] Mary J. Dobson: Contours of Death and Disease in Early Modern England, Cambridge 1997, 329.
[6] Philip D. Curtin: Death by Migration. Europe's Encounter with the Tropical World in the Nineteenth Century, Cambridge 1989, Table 1.6, 33.
[7] de Forest Craig: Patients and Disease, 132.
[8] William Buchan: Domestic Medicine: Or, a Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, London 1790, v; 140.
[9] Joseph Masdevall: Relación de las Epidemias de Calenturas Pútridas y Malignas, que en Estos Últimos Años se Han Padecido en el Principado de Cataluña; y Principalmente de la que se Descubrió el año pasado de 1783 en la Ciudad de Lérida, Llano de Urgel y otros muchos Corregimientos y Partidos, con el Método Felíz, Pronto y Seguro de Curar Semejantes Enfermedades, Barcelona 1786, 10.
[10] Volker Hess: Der Wohltemperierte Mensch. Wissenschaft und Alltag des Fiebermessens (1850-1900), Frankfurt/New York 2000, 31f.
[11] Ibid.: 19, 26, 34.
[12] Martha Few: For All of Humanity. Mesoamerican and Colonial Medicine in Enlightenment Guatemala, Tucson 2015, 51, 64. For other synonyms for tabardillo, see also Representación hecha por el N.A. (Noble Ayuntamiento) de la Ciudad de Guatemala para que se Aprueve por este Superior Govierno la Rezeta Dada por el D.R Dn. Manuel de Abalos P.A la Cura De los Emfermos Q.e Adolesen en Guatemala, 1774, Archivo General de Centroamérica [AGCA], Expediente 5916.
[13] On typhus epidemics in the area, see Few: For All of Humanity, 62.
[14] Christopher Hamlin: More Than Hot. A Short History of Fever, Baltimore 2014, 89. For that argument in relation to Spain, see Armando Alberola Romá and David Bernabé Gil: "Tercianas y Calenturas en tierras Meridionales Valencianas: una Aproximación a la Realidad médica y social del siglo XVIII", Revista de Historia Moderna 17, 1999, 96.
[15] Hamlin: More Than Hot, 92.
[16] On colonial hospitals, see, for instance, Gabriela Ramos: “Indian Hospitals and Government in the Colonial Andes,” Medical History 57, 2013, 30; Marcos Cueto and Steven Palmer: Medicine and Public Health in Latin America, Cambridge 2015.
[17] Ibid.: 30; de Forest Craig: Patients and Disease, 113.
[18] Few: For All of Humanity, 52.
[19] For that racist assumption, see, for instance, Henry Clutterbuck: An Inquiry into the Seat and nature of Fever; …Deducible from the Phenomena, Causes, and Consequences of the Disease, the Effects of Remedies, and the Appearances of Dissection. In Two Parts. Part the First. Containing the General Doctrine of Fever, London 1807, 92-93.
[20] Castellón: Secretos, 392-3.
[21] Libro 2º en Q.e se Assientan las Mugeres Q.e Entran  Curarse en este S.To Hosp.l, 1781-1785, AGCA, Expediente 12180.
[22] Indian women sufferers were apparently often lain on ‘duffel pillows (petate almohada)’ rather than proper beds. See the reports signed by Dr Dn Basilio Villarraglia Benegas and Joseph Pimentel. In: Informes Pedidos por Sr. D.R D.N Basilio Villanueva  Efecto de Conocer la Ropa que Existia en las Enfermerias y Roperia del .l Hospital de S.N Juan de Dios, 1768, AGCA, Expediente 5906.
[23] For accounts of fevers that lasted months, years or a lifetime; fevers involving a protracted convalescence; fevers that gave way to other ailments; and fevers that left sufferers with longer-term damage to their health, see Stefanie Gänger: “Not Perfectly Recovered. On ‘Obstinacy’, Chronicity, and the ‘Sequelae’ of Fever”, chapter in preparation.
[24] The woman entered on 13 October 1781 (due to “fríos” and “calenturas”) and was allowed to leave on 20 May 1782.
