Cristian Berco. From Body to Community: Venereal Disease and Society in Baroque Spain. Toronto: University of Toronto Press, 2015. 288 pp. $48.75 (cloth), ISBN 978-1-4426-4962-0.
Reviewed by Mona O'Brien (University of Glasgow)
Published on H-Histsex (August, 2016)
Commissioned by Katherine Harvey (Birkbeck, University of London)
No matter what illness a person may have, their identity cannot be reduced to their diagnosis alone. Victims’ social and familial relationships, economic roles, and positions in civic life, such as participation in religious groups, add layers of complexity. Furthermore, rather than passively accepting illness, individuals interact with their condition, seeking to control its impact on their identity and place within their society. In From Body to Community Cristian Berco explores the identities of victims of the Great Pox (syphilis) in seventeenth-century Spain and how this disease affected their physical and social lives.
Berco focuses on the patients of Toldeo’s Hospital de Santiago, relying on a single surviving admissions book (which covers approximately four thousand patients for the years 1654-65) as his central source. Additionally, similar to many previous studies of the pox, such as Claude Quétel’s History of Syphilis (1990), From Body to Community also draws on medical and literary texts. Such documents provide broader insights into contemporary medical-scientific and cultural understandings of the disease and its victims. However, Berco is also innovative in his use of sources, turning to notarial records such as dowries and rental agreements to trace the lives of some of the hospital’s patients. Unearthing the experiences of the sick, particularly those from lower social strata, has long represented a challenge in the histories of medicine and disease. In this work Berco’s careful research into Toledo’s records follows the lives of the poxed, discovering changes in employment, social position, and marital status. Berco’s methods are important for future studies of the pox and other diseases. Effectively, he shows how notarial records can “help further contextualize and problematize the experience of illness, especially chronic illness, as eminently social and not just somatic” (p. 169).
The book is divided into eight chapters which explore, quantitatively and qualitatively, the identities and lives of the poxed within the hospital and wider social contexts. From the outset it is evident that although united by a common diagnosis, the poxed formed a diverse group, cutting across sex and social strata, and coming from Toledo and beyond.
The introduction and chapter 1 investigate gender roles and the social status of pox victims. Berco draws on contemporary poetry and literature to illustrate how the popular imagination left women with very few cultural models of respectability to which they could turn, for example, the wronged virgin. Indeed, even these models were not secure because of the association of the pox with female promiscuity and prostitution. Men encountered more ambiguous attitudes. On one hand the disease was seen as a medal of honor, demonstrating successful sexual conquest and thus masculinity. On the other hand, infection could also be viewed as an indicator of moral deficiency, a perspective which may have become more influential during the Counter-Reformation. Overall, however, it appears that men’s reputations had a greater chance of surviving infection. Yet gender was not the only determinant. Social status also played a crucial role. The poorer the victim, Berco observes, the more unforgiving society was likely to be, with poor, unmarried women facing the greatest stigma.
In the first chapter Berco introduces a theme which reappears throughout the book, namely, how the poxed used clothes and other physical strategies to project respectable identities. Here Berco focuses on how men and women attempted to disguise the baldness that accompanied the disease. He also explores women’s cosmetic strategies, showing that the border between beauty and symptoms of venereal infection was strangely blurred. For example, plucked eyebrows were fashionable, yet recalled the hair loss caused by the pox. The ambiguous meanings of these fashionable appearances made it difficult to “pin the pox” onto its female victims, especially those from higher social strata, providing them with a valuable means of maintaining their positions in their communities (p. 37).
Chapter 2 “focuses on medical assumptions about the French disease from the perspective of the potential early modern patient” (p. 40). Berco surveys beliefs surrounding the treatment and transmission of the pox. Certainly this chapter provides an insight into the theories which could have influenced patients’ portrayals of their identities, for instance the nonvenereal theories of contagion (the belief the pox could be spread by casual contact, for example by sharing food and clothes), that likely appealed to those who were meant to be chaste. However, a lack of records from the poxed themselves means that their perspectives on these theories remain largely unknowable.
Chapter 3 is one of the highlights of this book. Opening with detailed descriptions of six patients, Berco emphasizes the diversity of the hospital’s population. Patients were of both genders, married and unmarried, and came from highly varied economic and social positions. The analysis then focuses on patient gender and geographical origins. This includes a discussion of why non-Toledanos comprised the largest geographical group in the institution, encompassing factors such as economic migration, privacy, and deficiencies in healthcare in rural areas. Berco also shows that there was a high proportion of patients of the middling sort. This is particularly noteworthy because the hospital’s rules designated it for the treatment of the poor alone. Why did those wealthy enough to afford private care at home enter this institution? Berco points to a dearth of qualified medical practitioners as well as the hospital’s positive reputation as the factors that dictated this decision. This chapter, along with the book as a whole, provides a valuable contribution to histories of the institutional treatment of the pox and early modern Spanish health care.
Returning to the theme of appearance and identity, chapter 4 investigates the clothes that patients wore on arrival at the hospital. Berco provides a nuanced exploration of how garments and the textiles from which they were made reflected anxieties surrounding reputation, particularly in the case of female patients. Whereas previous studies have often focused on civic, religious, and medical interpretations of poxed women, Berco’s use of hospital records lends insight into how these women projected their identities and attempted to offset damages to their reputations.
Chapter 5 looks at the spiritual and physical treatment received in the hospital, and how gender and an individual’s unique constitution could influence the forms of both treatments. The discussion of the physical cures at the hospital, which included carefully personalized diets, serves as a good illustration of the individualistic nature of early modern medicine.
Chapter 6 analyzes patterns of marriage and sexuality among pox patients. In the period covered by the admissions book, 84.5 percent of the patients were single males, making them the largest group in the hospital (p. 108). Regarding the female patients, more married women entered the hospital, but the quantitative difference with unwed women was very slight. To explain this predominance of the unwed, Berco examines the contemporary cultural ideals of premarital sex. After their time at the hospital the majority of single patients, as far as Berco has been able to trace them, did not marry. Why did so many remain single? Berco does not provide a definite answer and the poxed did not leave a record of why they made this choice. However, Berco’s suggestions (including the economic strains that accompanied marriage and an increasing belief in the virtue of celibacy) remind us that the pox may not have been the only factor that influenced their decision.
Chapters 7 and 8 explore the effects of the disease on the victims’ ability to work and their relationships with their families and communities. Often the pox and its treatment significantly weakened patients’ employability. Furthermore, the moral stigma attached to the pox could damage family relationships. However, by tracing a sample of hospital patients through notarial records, including wills and rental agreements, Berco shows the variability of pox-patient experiences. While some were shunned, others could rely on their own economic assets or received support from family, friends, and colleagues. Recently the assumption of a disease-hate relationship that has prevailed through many studies of epidemic and pandemic disease has begun to be challenged. By showing the huge variation in responses to pox victims Berco’s work makes an important contribution to this debate, further destabilizing simplistic traditional assumptions about negative responses to disease, and the pox in particular.
Chapter 8 investigates an issue that is at times left unaddressed in historical studies of disease. Contemporary popular culture attempted to group the poxed into a “definable moral space” (p. 164). However, Berco shows that although some of the patients suffered socially and economically, many successfully resumed their lives and remained integrated in their wider communities. Once removed from the physical confines of the hospital, the poxed no longer represented a separate community. Furthermore, Berco has found little surviving evidence of relationships that may have been forged in the hospital. This provides an important reminder to historians of the distance between contemporary popular interpretations and ideals, and the actual lived experience of a disease’s victims.
The pox was not necessarily a permanent factor dominating an individual’s identity. This is possibly due in part to the nature of the disease, which can enter a dormant phase where it seems to have disappeared. Also significant, as Berco demonstrates, is the power of the other aspects of a person’s identity, such as their social status. Perhaps an alternative title of this book might have been From Bodies to Communities. What emerges most clearly from Berco’s analysis is the striking diversity in pox patients’ identities and experiences, alongside a strong sense of the huge variations in familial and social responses to disease. Absent from the book is a comprehensive comparison with previous studies of Italian Incurabili, German Blatterhausen, and the English foul wards. Such a comparison would arguably provide wider understandings of early modern institutions for treating the pox, and the attitudes they demonstrated. Nonetheless, Berco’s study provides an important contribution for any future comparative work. Finally, beyond his specific insights, scholars should benefit from and extend Berco’s innovative use of sources, particularly notarial records, to explore disease histories.
. See, for example, Samuel Cohn, “Pandemics: Waves of Disease, Waves of Hate from the Plague of Athens to A.I.D.S,” Historical Research 85, no. 230 (2012): 535-555.
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Mona O'Brien. Review of Berco, Cristian, From Body to Community: Venereal Disease and Society in Baroque Spain.
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