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Continuation of the article of Prof. Juan O. Mesquida, Ph. D (Part 3)

Endowments of Respondentia

After 1656, the Misericordia hardly undertook direct charitable work and focused on running and supporting the Colegio de Santa Isabel and administering endowments. The earnings of those endowments went to support the Colegio and its Church, and to finance undertakings in the fields of religious practices, education or social assistance. Since the endowments of mortgage loans had not proven very dependable, after 1668, some donors opted for establishing endowments donating money for respondentias in the galleon trade or Asian maritime trade. A respondentia was a loan typical of maritime trade in which the creditor assumed the risks for the merchandise or the boat during the specified trip and the borrower assumed the obligation to pay back the capital and the agreed premium if the trip was successful. Interest rates in the galleon trade were rather high, reaching as high as 50% until the middle of the eighteenth century, but later went down to as low as 20%. Asian trade interest rates were much lower, between 25% and 10%. Respondentias in Manila were only loans to buy merchandise and not to finance the building of the ship.

These legacies had two additional conditions. First, only one half or one third of the seed capital was lent out, while the remaining money was kept in the store for safekeeping in case there are losses from the previous loans. Second, the donor of the endowment fixed a minimum capital that the Misericordia had to earn before giving any money for charity, These requirements meant that if there were losses, which were a common occurrence in the galleon trade, the beneficiaries of those legacies would get little or nothing at all.

Trader Diego Martinez Castellanos was the first to endow the Misericordia with the money for respondentias. He donated 3,920 pesos and wanted the Misericordia to keep fixed capital of 4,000 pesos before distributing any earnings among the assigned beneficiaries. Castellanos allocated the earnings of his legacy to support the Colegio de Santa Isabel and other expenses of the Brotherhood. The money would also be used to shoulder the retainers for the doctor and surgeon hired to visit the sick daily in the Hospital de la Misericordia and to attend to the sick in the Colegio de Santa Isabel, and to pay the medicines used in the both places.

The Misericordia accepted at least 59 endowments of respondentia from 1668 until 1810. Some of them included the Hospital of San Juan de Dios as one of the beneficiaries. By1701, four donors had assigned a total of 1,000 pesos for the sick in the Hospital. The endowment of Italian prelate Juan Bautista Sidoti in 1705 mentioned that the hospital had a new ward, and that the prelate earmarked three donations to pay the doctor, the surgeon, and the medicines of the sick in that ward, but he imposed the condition of admitting sick priests, foreigners, and Spanish residents “who because of misfortunate or poverty could not be cured at home.” A later endowment assigned 500 pesos to cover the treatment and support of Spanish Pobres vergonzantes in the Hospital. If all the endowments had performed well, the Hospital would have received as much as 3,290 pesos yearly, which was a very generous amount. However, the endowments did not always yield the expected results due to the frequent contingencies affecting the galleon trade, making the income of the Hospital erratic.

Even if the documentation about the earnings from the endowments is limited, there is enough material to show some periods when the Misericordia was able to provide some donations to the Hospital and other times there was hardly any dole-out. Returns were habitually good except when the galleon did not manage to leave port, sank or were captured by the British. Due to the provisions imposed by the donors of endowments, after every serious galleon mishap, the money of the endowment had to be re-invested and there was no dole-out for a number of years. Assuming that “no news is good news,” from 1670 to 1690 there is a great probability that the Hospital received small amounts from the Misericordia, but from 1692 to 1708, the funds of the endowments of respondentia sank so low that the Misericordia distributed hardly any money. A slow recovery of the funds followed until around 1722, and from then on, the situation became good for most of the years until 1742. For example, in 1741, the Hospital received the large amount of 2,829 pesos, although the allotment was not necessarily always so high. The capture of the galleon Covadonga in 1743 initiated another crisis. There was no income from the endowments until the 1750s and a full recovery happened only in 1760. However, two years later, the British invasion caused the collapse of the endowment funds, which would fully recover only in 1774, and from 1766 to 1786, the galleon trade functioned reasonably well and there were returns for the endowments of the Misericordia most of the years, even if the amounts were irregular. After 1787, new Spanish trading laws opened some ports to international trade, causing years of poor markets in Mexico, and as a consequence, the galleon only plied the route every other year. However, the amounts traded were larger than usual. Since then until 1823, the Misericordia gave returns of varying quantities to the Hospital following the intermittent pattern of the galleon trade, except for the period 1804-1808, when the Misericordia was forced to lend all the earnings to the government. Available information for the period 1809-1813 showcases the income of the Hospital from the endowments of respondentia of the Misericordia. During those five years, the Hospital received from the Misericordia only 2,789 and 1,190 pesos in 1809 and 1811, respectively.

In 1813, the Constitutional Assembly of Cadiz, Spain, suppressed the Manila galleon monopoly, and with the independence of Mexico in 1820, the trading route halted shortly after. In spite of the difficulties experienced in the last decades of the galleon trade, most borrowers of loans from the endowments did not perform well, so that between 1824 and 1855, the allotments were inconstant and irregular. Most of the earnings or even the capital, was used for the expenses of the Colegio de Santa Isabel. It was only after the government became active in the administration of the funds that the situation changed. Governor-General Antonio de Urbiztondo forced the Misericordia to buy shares in the newly-created Banco Español de Isabel II in 1851 and in 1854, a royal decree created two boards of directors that would administer the funds of the Misericordia and similar institutions. With the authorization of the Archbishop, the provisions of the donors of endowments of respondents were changed so that the money could be used for other types of loans. Income became more regular for the Hospital de San Juan de Dios, so that between 1855 and 1866, the Hospital received an average of 2,000 pesos in annual income from the Misericordia. In 1867, the government halted the distribution of revenues while conducting an inquiry on the finances of the Misericordia. As a consequence, the Hospital de San Juan de Dios received 12,824 pesos in arrears in 1879. By then, the Brotherhood of the Misericordia had been closed and its funds were efficiently managed by the government at a moment when the economy of the Philippines was improving, so that the Hospital kept on receiving yearly revenues from the endowment funds of respondentia. For example, in 1891 and 1892, the Hospital received1,806 and 2,954 pesos, respectively.

As the data from the different periods have shown, the donations that the Hospital de San Juan de Dios received from the Misericordia for more than two centuries were substantial but inconsistent. The Hospital had its own sources of income, although they were affected too, at least indirectly, by the ups and downs of the galleon trade that constituted the main economic activity of the City. Another source of income from the Misericordia to the Hospital was the endowments of mortgage loans which kept on producing some earnings, but the amounts were much smaller than those from respondentias.

Having to follow the provisions of the endowments of respondentia forced the Hospital de San Juan de Dios to admit other types of patients aside from the ones it was originally intended for, since it had to follow the wishes of the donors. By 1742, it had become habitual for the Hospital to admit priests, religious, pobres vergonzantes, policemen, retired army men, and foreign men, who were among those specified by Sidoti and other donors. Nevertheless, the hospital also treated destitute Filipinos and slaves. From 1730 to 1742, the Hospital served 8,000 sick people from among the lower social classes, most of them as outpatients.

Prioritizing Medical Attention

With the 1606 statutes, the Misericordia undertook the obligation to shoulder the expenses of hiring a doctor and a surgeon to look after the sick in the Hospital de la Misericordia. After the turnover of the Hospital to the Order of San Juan de Dios, the Misericordia committed to give a yearly retainer of 200 pesos so that the physician and surgeon of the hospital would look after the girls of the Colegio de Santa Isabel. Later on, some endowments assigned money to pay the retainers of the doctor and the surgeon.

There is evidence in 1740 that the Misericordia was paying the services of a physician for the Hospital. At that time, the facilities of the Colegio de Santa Isabel were overcrowded with 117 students and 8 servants, so that the Mesa had plans to expand the buildings. An epidemic of smallpox broke out in the Colegio in the first half of June, and the physician of the girls, Miguel de la Torre, blamed the spread on the narrow dormitories, and predicted wider contagion in the City if something was not done about it. The Mesa decided to advance the renovation and move out most of the girls while the construction work went on. Three years later, when the capture of the galleon Covadonga brought the whole city to an economic depression, the Misericordia stopped giving any returns to the beneficiaries of the endowments of respondentia, except to subsidize the Colegio de Santa Isabel and its Church, and to pay for the fees of the doctor and surgeon of the Hospital de San Juan de Dios who had to attend to the girls of Santa Isabel.

One of the rare detailed financial statements of the expenses of the Misericordia, covering the period 1750-1754, shows that the Mesa gave priority to paying the retainers of the doctors and surgeons of the Hospital attending to the girls, although due to the hard financial conditions, the money was sometimes delayed. By then, the retainer’s fees were higher, thus, the doctor received 300 pesos and the surgeon got 175 pesos. Dr. Eduardo Wogan (most likely the Spanish spelling of English Waugan) got his retainer for 1751 on the following year. The doctor for 1753 and 1754, Dr. Jose Teodoro Garcia, received his retainer on time, and so did the surgeon for those five years, Gregorio Pedraza. The Misericordia also allotted 400 pesos for the medicines of the Hospital, even though the money was not always enough. The guardian of the Mesa in charge of the pharmacy services had to advance part of the money, as it happened in 1751 when Juan Gonzalez de la Sierra, a member of the city council then, advanced 151 pesos to complete the 400 and got his money back two years later. Besides, the same financial report records small alms to the Hospital, like 50 pesos given in 1751 and 1752, which may have come from earnings of endowments.

Similar concerns for the retainers of the doctors of the Hospital giving it priority over other expenses happened in 1871, when the Government had taken over the funds of the Misericordia and was trying to organize the accounting of the endowments of the Misericordia. All payments from the endowments were suspended but Governor-General Rafael Izquierdo ordered paying the retainer of the new doctor of the Hospital de San Juan de Dios, Dr. Quintin Meynet, and the back fees of the previous doctor, D. Jose O. Navarro, to his widow.

Conclusion

The founding of the Hospital de la Misericordia was the final step in early Spanish Manila of a process to ensure hospital attention in Manila for the underprivileged social classes of the City and around it. By treating the slaves and servants of the Spaniards and the destitute Spanish and mestizo women, the Hospital filled up a gap, continuing the work started by Fr. Fernandez and answering the concerns of the acting governor-general then. Contemporary information described how hospitals in Manila used not only Western medical knowledge, but also local and Chinese medical and medicinal practices.

Adopting the organizational set-up and activities of Portuguese Misericordias provided a clear plan of social assistance to the one in Manila. The Misericordia of Manila replicated most of the experiences inherited, like the work of the stewards visiting the needy, hiring the services of a doctor and a surgeon, or providing alms for health recovery periods. Early documentation attests to the implementation of the Portuguese model and the involvement of the Misericordia in the medical service of the City during times of crisis and in the supervision of its Hospital.

At first, the Misericordia managed to support the Hospital by means of donations and alms, but very early on, the Misericordia started receiving endowments, whose money was to be lent for mortgage loans, creating more stable revenue sources. Even if the formula worked for a few decades, prolonged demographic and economic crises, especially after the 1645 earthquake, and the concentration of efforts in supporting the Colegio de Santa Isabel, geared the Misericordia to turn over the Hospital to the Order of San Juan de Dios in 1656. Even after the transfer, the Misericordia retained a commitment to support the Hospital partially in exchange for continuous medical assistance to the girls of the Colegio de Santa Isabel. The change helped improve the material facilities of the Hospital.

Even if the Misericordia had diminished its obligations toward the Hospital, some of the members of the Brotherhood and others wished to help support the Hospital with further endowments, entrusting their administration to the Misericordia. Most of the new endowments were intended for use as loans in the maritime trade, especially in the galleon trade. Due to the many contingencies of the galleon trade in the eighteenth century and the changes experienced by the economy of the Philippines in the next century, income from endowments was erratic, with alternating times of bounty and scarcity. The Hospital profited from the endowments but it could not fully rely on them to meet all its expenses. As a consequence of the provisions of the endowments, the Hospital became a general hospital that admitted many types of sick people. In spite of the economic difficulties experienced by Manila and the Misericordia through the centuries, available information reveals that the Misericordia paid special attention to ensuring the retainers of the doctor and surgeon of the Hospital, who in turn had the obligation to attend to the girls of the Colegio de Santa Isabel.

As a whole, the Misericordia can be credited with making medical care available to some disadvantaged sectors of the population of Manila and later on in providing generous, even if inconsistent, income to the Hospital de San Juan de Dios and the doctors servicing the Hospital.

The early service of the Misericordia, the work of the Brothers of the Order of San Juan de Dios, and the presence of doctors and surgeons in Manila leave many unanswered questions about the medical training of those people as well as the quality of the service offered in the Hospital, opening new areas for further research in the broad field of medical history.