Mexico City's San Hipólito Hospital, established in 1567, was the first institution founded by Europeans to serve the mentally ill in the Western Hemisphere. Utilizing hospital archives, as well as Inquisition and criminal court records, Christina Ramos makes a strong case that the history of this institution and its residents can reframe our understanding of the medicalization of madness in the eighteenth century. In five succinct chapters, with an excellent introduction, brief conclusion, and useful tables and illustrations, this monograph is an important contribution to the field.
Like a number of other charitable institutions in New Spain, San Hipólito was endowed by a conquistador and run by a religious order, though its particular mission, to serve pobres dementes, set it apart. The first two chapters provide an overview of the hospital from its founding in the sixteenth century into the eighteenth century, when reform-minded officials attempted to revive a sclerotic institution to serve Bourbon-era ideals of public health and social order. With its physical plant neglected, its finances in disarray, and its founding order itself imperiled, ambitious initiatives from within and outside the order began renovation of the physical plant and internal operations, and altered the relationship between the hospital, its residents, and other institutions. Subsequent chapters analyze these years of change in detail, as the population of the hospital swelled and its resources were employed by both the Inquisition and criminal courts for their own ends.
Though these changes are fascinating and add to our understanding of the Bourbon Reform impulse, institutional history is not the author's primary goal or interest. Rather, the heart of the book lies in the author's analysis of the interplay between religious and medical thought and practice in the emergence of modern approaches to mental illness. As insanity could be used as a defense against both religious and secular crimes, courts adjudicating each type of accusation invested in developing means to study and assess the motivations and mental states of the accused. Though these efforts helped to open space for understanding of madness as a medical issue, this study demonstrates that there is not a simple dichotomy between science and religion; physicians’ testimonies did not become the primary determinants of outcomes at this time. By the 1760s, however, the testimony of physicians had become increasingly important in Inquisition trials, though ultimately it was still the inquisitors who decided whether someone had committed heresy or suffered from locura. A final determination in such cases could take years of observation of the accused in San Hipólito.
During the same era, secular authorities increasingly used San Hipólito as a place to manage those who could not be controlled otherwise. The presence of criminal inmates at San Hipólito was part of broader Bourbon-era social control initiatives. Feigned madness, followed by escape from the hospital, appeared to be a common outcome. San Hipólito's facilities and staff were simply not equipped to do what the state was asking them to do at this time.
Battered by the upheavals of the nineteenth century, San Hipólito was secularized during the Liberal Reform era, and it managed to survive until Mexico's first fully modern psychiatric facility opened in the early twentieth century. Even though the author summarizes events of post-independence history in the book's conclusion, these events are addressed only briefly, as they lie beyond the well-chosen focus of the study.
Among the book's strengths is the detailed exploration of a number of cases, including women and indigenous persons, from both the inquisition and criminal court records. The inclusion of illustrations drawn by one of the accused is particularly evocative of the challenges posed by these cases. The author's skillful synthesis of how this work addresses multiple scholarly debates will also be much appreciated by readers.
