Early modern medical history has experienced an explosion of interest in recent decades, but the specific study of the syphilis epidemic in Spain has not attracted the depth of analysis it has for other countries. Into this fertile field, Christian Berco has introduced a new perspective on the disease by looking beyond medical debates to focus on patients and their return to society after treatment in the Hospital de San Diego in Toledo, a hospital dedicated entirely to serving syphilitics. Berco’s primary sources are the admissions records for four thousand syphilitics between 1654 and 1665. He supplements these documents with copious research in notarial records to provide details about the material lives of hospital patients. Berco refers to his work as a sociocultural history, but it reads like a good microhistory about a particular institution at a specific time. The broader significance of the microhistory to the social impact of syphilis in Spain is obvious. Berco’s study is not faceless, as the author explores rather empathetically the lives of many individuals before, during, and after treatment for syphilis. Berco effectively synthesizes several aspects of material culture: clothes described in admissions records, property transactions, feminine make up, and specialized word usage adapted to hide or make fun of the condition. In this regard Berco demonstrates his mastery of Spanish literature and its innumerable references to the “French Disease.”

The author concludes that syphilis struck a cross-section of society, not simply those humanists blamed for the epidemic: vagrant urban beggars, prostitutes, and courtiers. The Hospital de San Diego only admitted those who could not afford home care, and unlike similar hospitals in other cities, it accepted individuals from beyond the city, who constituted the vast majority of its patients. Thus Berco quantifies that the disease wrought the same social misery to rural communities as it did to cities. While single men were unsurprisingly the largest group treated, nearly half of all patients were married, leading Berco into an interesting analysis of spousal returns to family and society. The author’s discussion of the high percentage of clerical patients, despite Tridentine reforms, is particularly revealing as it gets to the heart of a recurring theme of the work: the social reaction of a Christian society to patients suffering from a disease usually ascribed to sin. The debilitating effects of the disease and the excruciating mercury treatment left patients unable to work for considerable time, and quite a number would relapse in a year or so. Those who survived and avoided extreme poverty did so with the aid of family and public welfare institutions such as lotteries for orphans’ dowries. Of course, some family members took advantage of their disadvantaged relatives to enrich themselves. The book illustrates that practically anyone could fall on hard times in the early modern economy, and if syphilis entered the life cycle, the impact was often, but not always, devastating. Berco’s writing style is particularly commendable as it avoids medical jargon and the number numbness of overquantification. Despite the subject matter, it was a fun read suitable for advanced undergraduates and graduate students.

Given the sources available, Berco’s study is primarily focused on the “shame-faced” or deserving poor, the group humanists like Juan Luis Vives favored. The truly indigent would have no property to trace in notarial records, and the wealthy were not admitted to the hospital. Confraternities and godparentage are not mentioned as welfare aids, probably due to the lack of records. The only questionable assertion in this fine study was the author’s repeated comment (12, 130, 169) that contraction of syphilis was a death sentence. Syphilis is still somewhat mysterious, but nineteenth-, twentieth-, and twenty-first-century studies estimate the percentage of patients reaching latent late-stage syphilis to be under 50 percent, with several estimates below 30 percent. Whether or not it was a death sentence, Berco has shown how devastating the disease was to the social fabric of rural and urban communities.