Introduction

1“Venereal disease” (Lat., morbus venereus, lues venerea) is the most widespread synonym for the “Great Pox” or “French disease” (lat. morbus Gallicus) –the latter being its most common name in early modern Europe, with the exception of France, where it was more well-known as grande vérole or just vérole¹. The adjective venereus/venerea stresses the direct relationship between the disease and the pleasures of Venus; in other words, its connection with individual sexual behaviour. The Latin noun lues was applied from antiquity to any condition that liquefied flesh, but it also emphasises the early modern perception of venereal disease as a contagious and calamitous scourge from both physical and emotional viewpoints.

2The outbreak of the Great Pox from 1495, first in Italy and then rapidly throughout the rest of Europe, soon became a first order social and health problem all over the Old World. Patients from all social groups were tortured by terrible pains in bones and joints, pustules and sores on the skin and mucous membranes. These symptoms made them look deformed and repulsive to the senses. In the beginning, the most extraordinarily various ideas about the nature and causes of the scourge circulated. Initially perceived as a new pestilence, its transmission was soon generally accepted as being by contagion, mostly through sexual contact, and its chronic and progressively invalidating condition recognised. Furthermore, the French pox raised serious moral and religious questions, and fuelled the stigmatisation of its victims in a similar way to that of lepers during the middle ages. In the face of the venereal disease, European communities developed a large number of public and private care initiatives involving processes of both social inclusion and exclusion.

3This article reviews, in the light of recent studies, the hospital care given to the sufferers from venereal disease in different European cities, particularly from Italy, France, Germany, Spain and Portugal, during the early modern times. I will examine the different patterns of care initiatives, the models of hospitals where they were provided, the nature of care practices, the actors in charge of them, and the sociological profile of the patients.

The earliest responses to the Great Pox (1495-1500)

4The earliest responses of the political authorities, both municipal and royal, to the French Pox were intended to protect and control those communities under their rule that were facing this new collective challenge. In the first moments, these responses mostly consisted of legal measures aiming to punish blasphemy, prostitution and other social practices perceived as immoral. Yet, other health care and poor relief responses were gradually being introduced as well. All this was consistent with changes in the perception of the condition, mostly brought about by its increasing familiarity, as well as by medical practitioners’ and lay people’s gradual awareness in the course of a few years that the new disease was not a pestilence but a contagion. Let us consider some illustrative examples of these earliest responses.

5The imperial edict proclaimed by Maximilian I on 7 August 1495 on the occasion of the Diet of Worms, is considered the earliest legal document where the French disease is referred to². The Holy Roman Emperor addressed it to the blasphemers, who were charged with all the calamities through which God was then punishing humankind. Among them it included “that new and very serious human disease just appeared in our times and unknown in the past which is popularly called ‘French Pox’”. Such a direct connection between the disease and blasphemy is by no means surprising, since the first perceptions of the new condition as a pestilence transmitted through the corrupted air, led contemporaries to assume the universal character of its effects. Nobody, in principle, could feel free from the risk of catching the disease and, therefore, nobody needed to be individually blamed for having caught it –deeply imbued as they were in a Jewish-Christian worldview.

6Thus, in this case and others of the same period, the great pox was framed and even legally dealt with in a similar way to other pestilences and calamities that appear to have been often surrounded by a millenarian halo because of the approximation of the year 1500. This was the case of the Ferrarese physician at the court of Duke Ercole d’Este, Coradino Gilino³. In about 1497 he claimed that “such extremely serious plague” was essentially God’s punishment for Italians’ and humankind’s many and serious sins, among which he emphasised the many wars in which they were involved, their increasing use of new lethal arms, and the invitation made by Christian Princes to the Turks to invade Italy:

We also see that the Supreme Creator, now angry with us because of our terrible crimes, is punishing us with this cruel scourge which has spread not only over Italy but also over the whole of Christendom. Everywhere the clamour of the trumpet is sounding, everywhere the turmoil of the armies is being heard; enormous numbers of weapons of war, bombarding devices, and war machines are being produced, and unbelievable iron weapons instead of stone balls are now being made. The Turks are being called into Italy. How many fires, how many sackings, how much slaughter of unfortunate mortals have we seen, and how many more and greater are we going to see! If only I were wrong! Therefore, let us say along with the Prophet, psalm VI: ‘O Lord, do not punish me when you are furious, do not afflict us when you feel angry’. This is, in my opinion, the cause of such an extremely serious plague⁴.

7It was also about 1495 when the earliest public initiatives in Europe of establishing institutions for looking after this new type of patient can be detected. The case of the Blatterhaus at Augsburg (1495), a hospital founded ex professo by the municipal authorities of this imperial city, is not only the earliest one in German lands, but also the most studied⁵. More generically, George Rosen (1958) has referred to the existence of different municipal measures concerning hospitalisation and treatment of sufferers from the French disease in other German cities like Würzburg (1496) and Freiburg (1497)⁶.

8Other European cities opted, however, for opening wards specifically intended for these patients within already established hospitals. This appears to have been the case, among others, of the Iberian cities of Seville, Valencia and Lisbon. In Seville, during the final years of the fifteenth century the Catholic Monarchs ordered their proto-physicians to take charge of the sufferers from the French disease at the Hospital de San Salvador, and to care for them with the medicines from its pharmacy⁷. The same might have also happened at the Valencia Hospital de Santa Lucía or de la Reina, originally a royal foundation under Franciscan management (1310), which had been refounded thanks to a rich Valencian burger in 1383, when its administration was transferred to the municipal council of Valencia⁸. Some years later, on the occasion of its incorporation into the newly created Valencia General Hospital (espital general) in 1512, it is reported that on Sunday 12 March that year the “men suffering from the mal de Sent Ment [i.e., French Pox] were brought in procession” from the Hospital de la Reina to the new General Hospital⁹.

9In Italy, the earliest private care initiatives for the poor suffering from the French disease were mostly channelled through religious confraternities¹⁰. The case of the Compagnia del Divino Amore is well documented. Founded in Genoa in 1496, this religious confraternity appears to have been, to some extent, the model that inspired other confraternities with similar aims –some of them under the same name– that proliferated in different Italian cities. They were organisations of pious men and women dedicated to the collection of funds to assist in the care of the victims of the new disease. They believed that the condition was a divine punishment and should therefore be treated through religious acts as well as such practical social initiatives that were permitted by God¹¹. According to its 1497 statutes, the Genoa Compagnia del Divino Amore aimed to “sow and plant in our hearts the divine love, that is charity” towards the poor¹².

10In 1497, the Genoa Compagnia created another confraternity, the Societatis Reductus Infirmorum Incurabilium, sub titulo Beate Marie, whose aim was to gather funds for the building of a new hospital. This Ridotto was a shelter specifically devoted to those categories of the poor who were excluded from general hospitals (like the Ospedale di Pammatone at Genoa), and to those for whom neither the lazzaretti or quarantine stations for maritime travellers nor the old leproseries were an alternative. In the statutes of the Ridotto (1499) its purpose was clearly specified: to treat “the wretched poor and with an incurable disease”, as they were unable to survive on their own and were abandoned by all because of their very serious and lasting illnesses. The phrase infirmi incurabiles, needless to say, was at the time almost a synonym for victims of the French disease. Those seeking to be admitted to the Ridotto had to be residents of Genoa and previously examined by its administrators and physician, in order to avoid fraud. In the request for official authorisation made to the City Governor in 1500 a dual purpose of the Ridotto was quite clear. On the one hand, it had to make sure that the incurable poor were cared for in both their physical and spiritual ailments, so that their souls could be saved from damnation; on the other, it had to clear the city streets and squares of the unpleasant image of these “incurables¹³”.

Hospital care of the sufferers from the venereal diseases in early-modern Europe

11As already noted, initially most university medical practitioners perceived the French pox as one more epidemic among the many that ravaged Europe. However, for some other practitioners, contagion, through individual contact of various forms, including sexual contact, was the most frequent cause. This was the case of the papal physician Gaspar Torrella, who first expressed these views in the medical treatise on the new disease he published in Rome in 1497¹⁴. Furthermore, in a new work on the French pox, which come out three years later (1500), Torrella appeared to be clearly inclined to the belief that venereal contagion was predominant, and that the social group of prostitutes was the main source of this condition and played a key role in its dissemination. His new work was written following the Platonic format of a dialogue between “people” (vulgus) and the “physician” (medicus). When the former asked the latter whether this disease could be eradicated, the “physician” replied in the affirmative by indicating that this aim could be achieved if affected prostitutes were kept under control (Torrella 1500, signat. d4v). Torrella ended the Dialogus by reporting an innovative proposal in more detail though he complained that no political authority had taken it on despite his insistence:

But… I finish this work praising God omnipotent and the very glorious Holy Mary, after which, none, neither the pope, the emperor, the kings, other princes and lords, have dictated provision at all [about the French disease]; despite the fact that this would be quite easy if in cities, as I have often suggested, matrons were chosen to investigate the disease by asking prostitutes about it, and had the authority, with the help of the secular authorities, to separate those who were found sick from those who kept healthy, and to confine the former in some house or hospital until they were cured by physicians assigned to this aim. This cruel and contagious disease could thus be eradicated¹⁵.

12Therefore, by 1500 a papal physician thought that a total eradication of the French disease was feasible, by identifying ill prostitutes and confining them in places where they would be treated by physicians contracted ad hoc until they recovered their health –an aim Torrella considered by no means impossible. However, by exclusively targeting public prostitutes who worked at the city brothel for the measures to eradicate the French disease, he turned them into a social scapegoat. He stigmatised them, not only by reason of their gender¹⁶, but also because of their social condition as marginalised women. For others like those at the public baths and private bordelages, and those working on their own as residents and visitors –e.g., the innumerable “courtesans” at the Roman and other European princely courts where the new disease also spread rapidly– appear not to have been included in his strictures. Certainly, Torrella’s choice was conditioned by moral and religious influences and social prejudices. Remarkably, however, the control measures he suggested consisted of public health actions; that is, he offered an allegedly definitive solution to a serious social problem by way of its medicalisation.

13Soon after Torrella had written these lines, new initiatives intended to provide a health care response were promoted in different parts of Italy. On the one hand, the political authorities of the communities began to establish a number of specific measures of public health and social control against the new disease. For example, they contracted medical and surgical practitioners to specifically care for the franciosati –apparently along the lines of the late medieval “plague doctors”– or opened new, especially dedicated wards in general hospitals. On the other hand, some religious confraternities, rather like the initiatives of the Genoa Compagnia del Divino Amore, began, with the support of the political authorities, to collect funds to erect hospitals specifically devoted to taking in the infected poor, who by then were increasingly begging in the city streets and squares.

14The cases of Ferrara, Bologna and Milan allow us to illustrate some of these responses from 1500 onwards. In Ferrara, then the capital of the dukedom of Este, two types of the above-mentioned initiatives can be documented. In May 1501, the city contracted the practitioner Ferrante da S. Domenico “to operate on many and diverse diseases, above all on the disease of those who have been infected through lower parts” (ad ciroicondum pluries et varios morbos, et maxime morbum eorum qui sunt infecti a partibus inferioribus); and four years later (1505), a medical practitioner resident at Ferrara was engaged by the Duke of Este as a “specialist” in the French disease (Zan Jacomo da Padoa, medico del mal franzoso). On the other hand, in 1499 a Compagnia di San Giobbe was established in Ferrara, dedicated to the biblical patriarch who had become the patron saint of the French disease. In March 1502, Duke Ercole gave the Compagnia the patent to collect funds all over the dukedom in order to erect a hospital to look after the victims of the disease and pay for their care. This patent was ratified by his son Alfonso d’Este in 1505, soon after becoming the new duke, although there is little evidence that the planned hospital was in action before 1525¹⁷.

15The case of Bologna, however, illustrates only the second type of response. In 1500, a group of citizens re-founded – newly dedicated to San Giobbe – the confraternity of Santa Maria dei Guarini as well as the hospital it managed. Both of them were devoted henceforth to care for the poor suffering from the French disease (mal franciosati) who had been rejected by the other city hospitals¹⁸.

16In contrast, Milan, the capital of the Great Dukedom of the same name, exemplifies the first kind of response. By 1500, a section of its Spedale Maggiore had been devoted to the “disease of the pustules, which has been recently discovered in the human nature” (la egritudine de b[r]osole, nouvament scoperta de la natura humana). At the same time, the old Hospital del Brolo, founded in the twelfth century, had become a “specialised” centre for brossolosi¹⁹.

17Between 1515 and 1530, hospitals for incurables began to proliferate all over Italy: Rome (1515), Naples (1519), Florence (1521), Brescia (1521), Venice (1522), Ferrara (1525) and Padua (1526). Yet, the model followed in other Italian cities like Vicenza or Verona was that of specialised wards for this group of patients within hospitals that were also devoted to other health care and poor relief activities. The size of “incurable” hospitals fluctuated considerably: while there were 600 patients at Naples in 1535, and 350‑450 at Venice during the period 1565-1588, there were only 24 inmates at Pavia during the biennium 1584‑1585²⁰.

18More than just a product of direct intervention by the public powers, these hospitals came into existence because of an alliance between the Church and diverse independent lay initiatives in which urban elites were notably involved. In fact, the Companies of Divine Love, which historians have related to the beginnings of the movement of Catholic Reform and the sixteenth-century “new philanthropy”, played a crucial role in all these cities, as promoters of both kinds of responses that were later channelled through new religious orders and congregations²¹. Among the orders particularly involved in these initiatives were the following three: first, the Jesuits, whose founder Ignatius of Loyola (1491-1556) turned the Venice incurable hospital into his headquarters after the mid-1520s; secondly, the Capuchins, whose order spread from the Ospedale di San Giacomo degli Incurabili of Rome after 1528, and was critically involved in the incurable hospitals of Naples and Genoa; and, thirdly, the Ministri degli Infirmi, an order founded by Camillo de Lellis in 1582 that soon spread from San Giacomo of Rome to other incurable hospitals first in Italy and from the seventeenth century to Spain, Portugal and Latin America. These orders had a dual function with regard to the hospitals: they played an indispensable role in sensitising people to the appropriateness of this kind of institutional solution to the problem of the incurabili, and at the same time, they were responsible for the actual care of the hospitalised victims of the condition²².

19The redemptive arms of this new philanthropy opened to accept socially marginalised groups like prostitutes and the wretched whose disease had deformed their bodies and disabled them. They combined the aim of moral rehabilitation of those who had fallen into sin, with that of protecting individuals who were vulnerable because of their weakness or innocence in the face of the risk of exploitation by the wicked. Thus, many incurable hospitals were associated with tasks to protect women’s honour and to rescue both fallen women and young women at risk. For these two groups specific institutions of confinement were created, under the premise of the existence of close links between prostitution and venereal disease²³. For instance, in the case of Venice, recently studied by Laura J. McGough, there were two major asylums for women, namely that of Le Convertite (1534) or the hospice devoted to save prostitutes and other women sexually “contaminated”, and that of Le Zitelle (1558) or conservatory, the mission of which was to protect Venetian girls from condemnation in the case that their beauty might have led them to sin²⁴.

20Similar processes could be also detected outside Italy. I will give some examples from France, Germany, Spain and Portugal. In Strasbourg, after a temporary shelter for indigent patients paid for by the city was set in 1496 or early 1497, a proper hospital for sufferers from the vérole was built between 1502 and 1504, the maintenance of which was at the expense of the city Parliament and Senate as much as of the alms of the local bourgeoisie. For almost three centuries this Blatterhaus or Domus pustulatorum fulfilled its role of hospital for venereal patients²⁵. In Paris, after visiting the wards of its Hôtel-Dieu on 23rd February 1508, the delegate surgeons, fearing that religious women and other hospital residents might become infected with the French disease, agreed that sufferers would not be admitted to that hospital, but transferred to two houses intended for this purpose, one for men in the district of Saint-Germain-des-Prés, and another for women in that of Saint-Honoré²⁶. Two years later (30 July 1510), the Hospital de Saint-Anastase (also known as that of Saint-Gervais) spent four Parisian denarii in buying straw to equip its stable “for putting some poor suffering from the French disease to bed because none dared to put them to bed with the others” (pour coucher aucuns povres malades de Napples à cause qu’on ne les osoit coucher avec les autres)²⁷.

21In the case of Germany, let me just refer to the case of Augsburg, where the house for caring for sufferers from the French disease (Blatterhaus) established by the city council of Augsburg in 1495, was supplemented by two Holzhäuser which the Fugger Catholic bankers founded in 1523-1524 and 1572 with the purpose of assuring “personal salvation and […] continuity of the Catholic faith in an increasingly Protestant environment²⁸”. And in contrast to the fate of the remaining city institutions for health care and poor relief which, once the Reformation was introduced in Augsburg in 1537, were reorganised and passed to the control of the city council, the high socio-political status of the Fuggers allowed them to maintain their control of the management of both Holzäuser²⁹.

22As for Spain, the cases of the Valencia General Hospital (espital general) and of the Toledo Hospital de Santiago may be representative of the two above-mentioned models. While I will leave for the next section the former, I will briefly refer here to the latter. The Hospital de Santiago at Toledo –the Spanish imperial capital until 1561 when the court moved to Madrid– has been recently studied by Cristian Berco from the perspective of a patient-centred history of disease. Originally belonging to the military Order of Santiago, it was turned, at the initiative of the Catholic Monarchs, into a pox hospital in 1500, eventually becoming one of the largest health care institutions “specializing” in the pox in the early modern Iberian Peninsula. Berco’s study deals with the meaning of venereal disease from the perspective of its sufferers in seventeenth-century Spain, mostly through the hospital’s admissions book between 1654 and 1665. He not only paid attention to pox patients’ suffering during hospitalization, but also tracked their everyday life before and after, in relation to their familial, communal, and institutional anchors³⁰.

23Finally, the Real Hospital de Todos os Santos (Royal Hospital of All the Souls, HTS) allows me to illustrate the Portuguese case. Promoted by the Portuguese king Joao II (1477-1495), the Real Hospital was built in Lisbon between 1492 (15 May) and around 1500. It started functioning at the beginning of the sixteenth century and its first Regimento was approved in 1504. In this Regimento a “house of the bubas” (casa das boubas) is referred to as a separate building where the sufferers from this condition were specifically cared for. Visiting and treating them was one of the multiple tasks that the HTS’s medical practitioner (fisico) should undertake³¹. However, neither of the two surgeons (either the resident or the external), nor their assistants, was assigned any specific function concerning the inmates at the casa das boubas; and, in fact, the earliest archival news of the existence of a “master of the bubas” (mestre de boubas) dates from 1539: it refers to the surgeon Braz Tenreyro receiving his appointment in October 1538. Before then, the responsibility of caring for the inmates in this section appears to have been assigned to one of the four “chief male nurses” (emfermeiros mayores) of the HTS, and one of these enfermeiros pequenos was also assigned to the casa das boubas³².

Hospital treatment of venereal disease: the cases of Rome and Valencia

24The cases of the Ospedale di San Giacomo degli Incurabili in Rome, and the Hospital General of Valencia are particularly expressive examples of the treatment of the French disease in two institutions that were representative of the two major organisational models of hospital care for sufferers in early modern Europe.

25In 1515, the Compagnia del Divino Amore of Rome re-founded the hospital of San Giacomo in Augusta as that of San Giacomo degli Incurabili. The support of the Pope Leo X to this enterprise was crucial, not only in reinforcing the new hospital project, but also in helping the confraternity to secure sufficient financial aid to expand their mission in other Italian cities during the following years³³. According to the papal bull Salvatoris Nostri Domini Iesu Christi, the re-founded hospital provided specific care for the male and female poor who were ill from diverse genres of incurable diseases, among them the French disease, while the victims of epidemic diseases and leprosy as well as those of curable diseases were excluded³⁴. In this bull, it was observed that “for a number of years a large number of the sick poor, all infected with various kinds of incurable diseases, have come together from many parts of the world in this city, the motherland common to all the faithful”. Since it was impossible for them to “gain entrance without difficulty to the hospitals of the city because such people were a multitude, and their diseases offended the eye and the nose”, they were “obliged for the whole day to look for food throughout the city, sometimes dragging themselves along on little trolleys and vehicles, giving offence to themselves and blocking the way to those whom they encounter³⁵”.

26In the course of the sixteenth century, the Ospedale di S. Giacomo of Roma passed from 123 male and 82 female inmates during the first ten months of 1530 to 620 men per year (until 1559), 1,442 men and 335 women in 1569, and 2,208 patients in 1581. Apparently, this increase of inmates was related to the popularity of the guaiacum-based treatment³⁶. This product of American origin rapidly spread all over Europe from the second decade of the sixteenth century³⁷. Before the introduction of guaiacum into the Old World, the new disease had been treated by means of ointments and other medicines, the composition of which included mercury. This remedy was much used during the Middle Ages to treat all kinds of skin diseases, and continued to be used for the French disease during the sixteenth century and later. According to the humoral views pertaining to the Hippocratic-Galenic tradition which was the dominant doctrine in medieval and renaissance university medicine, both remedies were instrumental to the purpose of stimulating the evacuation through diverse ways (including salivation in the case of mercury) of the altered humours allegedly causing the French disease, as well as to that of cleaning up the patients’ skin and mucous membranes. These remedies were normally applied in heated spaces in order to increase sweating, on the assumption that this phenomenon accelerated the elimination of the morbid matter.

27The guaiacum wood was crushed and boiled, and the three resulting substances were administered in three different ways. First, the scum was applied, once it had been reduced, to the skin and mucus lesions; secondly, the concentrated solution was ingested at regular intervals as the main ingredient of this treatment; and thirdly, a diluted solution resulting from boiling up the guaiacum wood again with more water, was given along with meals. The treatment with guaiacum was administered only during certain months of the year, although the timetable at different hospitals fluctuated between two or three spring months in Bologna and Rome, the spring and autumn months in Padua and Venice, and more than eight months in Florence³⁸.

28The treatment was given under the prescription of health practitioners, who at the Roman hospital of San Giacomo degli Incurabili included a physician and a surgeon who visited the patients every day. Most patients in this and other similar hospitals inside and outside Italy came from the poorest social strata. However, it appears that they were poorer in Rome than in other Italian cities, largely because its special position as the capital of Christendom made it attractive to beggars from all over Italy, and even other countries in Europe³⁹. The increase in the number of patients at San Giacomo, particularly during the second half of the sixteenth century, might also be related to a sequence of natural crises, drought, and epidemic diseases affecting Rome⁴⁰.

29On the other hand, in 1512, three years before the hospital of San Giacomo degli Incurabili was established in Rome, the municipality of Valencia founded the General Hospital (espital general) as a result of a consolidating process which had begun during the last quarter of the fifteenth century and involved the four main city hospitals (dels ignoscents, de Santa Llúcia o de la Reina, d’En Clapers, and de Sant Llàtzer). The new hospital included specific rooms for patients with fevers (febres), madness (orats), sufferers from the French disease (there better-known as mal de sement or siment), wounded (nafrats) and abandoned infants (borts), in addition to a separate annexe for lepers. All the wards, except those for the nafrats and borts, had separate wards for men and women⁴¹.

30Before new infirmaries for the mal de sement were built in 1587, Valencia General Hospital had four sections for this group of patients, namely two wards or quadres de mal de sement (one for men with 31 beds, and another for women with 24 beds) and two smaller wards or goletes de les buves (one for men of 15 beds and another for women with 26 beds) where mercury ointments were applied. The treatment also included other drugs such as purgatives and stimulants for sweating, which were intended to foster the elimination of the morbid matter, and surgical interventions on the different lesions of skin and mucous membranes⁴².

31When the wards were enlarged, the hospital administrators and health practitioners established a separation of patients in different wards according to their predominant symptoms (plagues and dolors), with the purpose of avoiding contagion, and to their different social status. The goletes, where ointments (unsions), baths (banys) and sweatings (suors) were performed every year between March and September, were also enlarged at the end of the sixteenth century. At the same time the period of admission was shortened in order to deal with an ever increasing influx of patients⁴³. This feature seems to have been related to the increase in the number of sufferers from the French disease in all Europe, as much as to the prestige of the mercury treatments given at that hospital⁴⁴.

32A physician, a surgeon (aided from 1530 by two apprentices or joves cirurgians) and a pharmacist were, without distinction, in charge of all the inmates at the Valencia General Hospital. Besides, between 1512 and 1580 a single man was in charge of the wards of febres, mal de sement and nafrats (hospitaler dels pobres malalts), and a male nurse (enfermer) helped the hospitaler in each of these three wards. However, the male nurse specifically in charge of the French disease ward (enfermer del mal de siment de homes), who was paid between six and ten pounds every year, had no equivalent in the ward for women, who were looked after by pious women with no salary except occasionally. From 1580 the enfermer del mal de sement became the “father of the French disease” (pare del sement), and a parallel figure of the mare del sement also came into being. Both had to live with their families within the hospital and received an annual salary of ten pounds (fifteen pounds in 1597) for the care of the patients, being in charge and taking care of the hospital furniture and equipment in each chamber, and managing the other employees in the wards. Among them there was, after 1559, the enfermer de la goleta, who was in charge of administrating the mercury ointments⁴⁵.

33All the patients in the care of the Valencia General Hospital went there of their own free will with the exception of the prostitutes from the local public brothel, who were obliged to go into the hospital as soon as they showed any symptom of the mal de sement, and could not work because of their illness. They were expelled from the city if they did not comply with these instructions. Furthermore, from the earlier testimony of Antonio de Lalaing (1460-1540) –the lord of Montigny travelling across Spain from 1501 to 1506 along with his master and future king Philip I of Castille, and visiting Valencia in October 1502–, it seems that Torrella’s advice soon began to be followed by the authorities of Valencia city: by then two physicians paid by the municipality were allegedly in charge of inspecting the prostitutes at the public brothel every week; and those suffering from “pustules or other secret diseases” were moved away and accommodated by the city councillors in “a place to look after them at the former’s expenses”, while those who were foreign were “sent away, wherever they want⁴⁶”. However, the earliest documented appointment of a sanitary inspector dates from 1548, almost half a century later, when the city council designated “mestre Pedro”, surgeon of the General Hospital, for the examination of the prostitutes from the local brothel to make sure that they were healthy⁴⁷. Finally, in 1584 the Valencia municipal authorities paid sixteen pounds per year to the surgeon designated for this job, and he was required to examine the prostitutes every week. The several orders that were dictated throughout the second half of the sixteenth century (1562, 1589, 1598) appear to have been intended not only to control the spread of the French disease but also to protect prostitutes from their procurers’ abuse. The progressive toughening of these regulations throughout the period suggests that the level of compliance was open to improvement⁴⁸.

Concluding remarks

34In this overview, I have examined the guidelines of early modern medical and social responses to the great pox in Mediterranean Europe, and analysed the different patterns of hospital care of venereal disease patients in Italy, France, Germany, Spain and Portugal. A significant part of the authorities’ response consisted of attempts to stop the spread of venereal disease by targeting female prostitutes confined in public brothels. These policies may well have reflected simultaneously misogyny, social discrimination for the poor, and cultural ambivalence toward the significance of venereal disease and its sufferers.