From Body to Community: Venereal Disease and Society in Baroque Spain by Cristian Berco (review)

Cristian Berco could have titled his study of the pox in early modern Toledo Beyond the Hospital because his success exploring the lives of Toledans long before and well after their stay in the city's venereal disease hospital marks its most salient feature. Its foundation is a mid-seventeenth-century admissions register for the Hospital de Santiago. Although it only covers about a decade, Berco makes the most of it by reading it against Toledeo's wider notarial archives, fleshing out the lives of patients in wills, contracts, deeds, and rental agreements. It is not that this has never been done before, but Berco's book may represent the fullest application of this methodology to early modern medical history.

He begins by surveying rhetoric. Although Spanish writers deployed the pox to smear various targets, whether prostitutes, Jews, lowly paupers, or debauched nobles, Berco shows that the disease was too widespread to pin on a single group. The themes of sin, shame, and righteousness will be familiar to those who have studied the rhetorics of pox elsewhere. But there seems to be a uniquely Spanish flavour in this book, such as the importance attributed to baldness, a symptom that seems to have carried far more significance here than elsewhere. Chapter two offers a useful outline of medical ideas, emphasizing doctors' belief that the pox was curable, a positon with important ramifications. For example, it complicated the cases of patients returning for treatment a second time. Curability meant that theirs was not a recurrence of a stubborn disease but, rather, a new infection because they had resumed sin. Berco's creative speculation on what this may have meant for such patients provides a good example of the kind of inviting scholarship he weaves throughout the book, helping readers to imagine the range of possibilities suggested by his sources and humanizing the experiences of the long dead.

When Berco sketches the contours of the hospital's population, the fruits of his archival handiwork start to show. For example, we learn that many patients came from away. Less than a quarter hailed from Toledo itself, a factor that challenges the assumption that syphilis was essentially an urban disease; a lot of rural Spaniards caught the pox. But what potentially constitutes the most important finding concerns class. Berco makes good use of data that it is easy to imagine other scholars overlooking: records of patients' clothing. From expensive silks to bare rags, Berco employs the range of such garments as an evocative gauge of wealth (set prudently against information dug from wills and contracts) to show that Toledo's hospital patients were not uniformly poor as was so commonly the case elsewhere. Berco exploits these textiles further when exploring self-fashioning. The reputational impact of the French disease was particularly profound for female patients, who, he suggests, may have dressed their best to deflect speculation that they were lowly or, worse, prostitutes. Analysis of the patients' marital and economic prospects after hospitalization shows that while infection posed significant dilemmas, life went on. Some patients (typically men with property but almost never women), later succeeded in marrying and, with the help of kinship networks, it was not unusual for patients to resume their economic lives.

Berco deserves applause for this creative book. I only wish he would have pushed the analysis even further. At times, the evidence from Toledo stands in stark contrast to that of pox care elsewhere. The most obvious contrast lies in the apparent openness with which rich Spaniards applied to the hospital despite the fact that it meant announcing their infection publicly. To compare, rich syphilitics would not have been caught dead in a hospital in seventeenth-century London, where a vibrant medical marketplace offered them the means to purchase medical confidentiality via private care. Perhaps in the midst of economic depression and demographic decline, Toledo simply lacked enough physicians. Or, potentially more fascinating, could it be that the...