Contents. Public Health in contemporary Spain

DYNAMIS Acta Hispanica ad Medicinae Scientiarumque Historiam Illustrandam Vol. 14  1994 Contents PUBLIC HEALTH IN CONTEMPORARY SPAIN (Guest Editor Rafael Huertas García-Alejo) Introduction (Spanish) RAFAEL HUERTAS GARCÍA-ALEJO   17 Regenerationism and Public Health. Angel Pulido's Two-Year Term as Head of the General Directorate of Health (1901-1902) (Spanish) DELFÍN GARCÍA GUERRA; VÍCTOR 2kLVAREZ ANTUNA  23 Summary 1.—Introduction. 2.—Outmoded health care and the regenerationist mood. 3.—The health care apostolate. 4.—The need for political renovation. Abstract The organization of public health services in Spain did not ignore the regenerationist movement, which became especially important after the loss of the colonies in 1898. The need to bring the country in line with the rest of Europe accentuated the conviction that health care in Spain was not up to the standards to be expected in a modern country. Against this background, Angel Pulido occupied his post in the General Directorate of Health from 1901 to 1902. His labors were characterized by three major features: the diagnosis of the precarious status of health in the country, which required urgent «regenerationist» measures comparable to those applied to other aspects of life in Spain; the importance of health education at all levels of society; and the need to combat the evils of the peculiar political game of his time, a key obstacle to the effective organization of public health services. Public Health Within the Framework of Local Administration: The Provincial Health Institute of Alicante (1924-1936) (Spanish) ENRIQUE PERDIGUERO GIL; JOSEP BERNABEU MESTRE; ELENA ROBLES GONZALEZ  43 Summary 1.—Provincial Institutes of Hygiene: Regulations 1921-1934. 1.1.—Regulations defining the Health Brigades. 1.2.—Creation of the Provincial Institutes of Hygiene. 1.3.—The Provincial Institutes of Hygiene within the context of health reforms during the Second Republic. 1.3.1.—The 1931 reforms: From County Council to Mancommunity. 1.3.2.—The 1934 reform: The health services law. 1.3.2.1.—Consolidation of mancommunity regimen. 1.3.2.2.—Technical, staff and administrative bylaws of the Provincial Institutes of Hygiene. 2.—Constitution of the Provincial Institute of Hygiene of Alicante. 2.1.—Organization of the Provincial Health Brigade of Alicante. 2.2.—Organization of the Provincial Institute of Hygiene of Alicante. 2.3.—Development of the Provincial Institute of Hygiene. 3.—The Provincial Institute of Hygiene within the framework. of the Mancommunity of Municipalities. 4.—The Provincial Institute of Hygiene of Alicante and the 1934 health services law. 5.—Conclusion. Abstract The development of the Provincial Institute of Hygiene of Alicante is described. In the first part the different national regulations that sanctioned the constitution and the successive reorganizations of the Provincial Institutes of Hygiene are reviewed. In the Second part, archival sources are used to reconstruct the life of the life of the Provincial Institute of Hygiene, from its predecessor, the Provincial Health Brigade, to the outbreak of the Civil War. We study both the first period, when administration of the Institute was dependent on the County Council, and the later period during the Second Republic, when it was run by a Municipal Mancommunity. Professionalization of Physicians and Health Campaigns in Twentieth-Century Spain (Spanish) ROSA MARÍA MEDINA DOMÉNECH; ESTEBAN RODRÍGUEZ OCANA  77 Summary 1.—Profession and specialization: Main sociological features. 2.—Definition of the market and incipient specialization. 2.1.—Contribution of the campaign against infant mortality to the consolidation of Pediatrics. 2.2.—Contribution of the anticancer campaign to the origin of the specialty in Radiotherapy. 3.—Technology and negotiation: Foundations of the monopoly. Abstract In this study we analyze the confluence of two processes that characterized the medical profession in Spain during the first third of the twentieth century. Health campaigns provided a formula for strengthening the interests of the professional collective by defining the demand for specific medical services, and consolidating the institutionalization of new areas of medicine, thus justifying their existence on a scientific basis. In addition, these health campaigns, to a great extent, based their propositions on the reputation of the specialist. We analyze two historical cases: the fight against infant mortality and the fight against cancer; the contributions of these two campaigns to the opening of a market for new specialist services, the role of technology, and processes of negotiation with other branches of medicine to guarantee a monopoly in providing treatment are examined. Prophylaxis Against Aging in Spain During the First Decades of the Twentieth Century (Spanish) ELVIRA ARQUIOLA  95 Summary Introdúction. 1.—Continuation of classic methods. 2.—Curing old age. 3.—Adaptation to old age. 4.—Development of social measures. 4.1.—Old age, a question of state. 4.2.—A new «fight against old age». Abstract This article analyzes the different attitudes toward the fight against old age held by medical professionals in Spain during the first half of the twentieth century. Three clearly differentiated stages are identifiable: «helping them to grow old», «curing old age», and «adapting to old age». The final stage saw the development of anthropological and social measures. Workers' Housing. One Aspect of the Temperance Movement in Spain During the Restoration (Spanish) RICARDO CAMPOS MARÍN  111 Summary 1.—Introduction. 2.—The temperance movement. 3.—The tavernless worker: Family and home. 3.1.—Type and location of workers' housing. 3.2.—The home-owning worker. 3.3.—The woman's mission and the role of the home in, the temperance movement. Abstract The Spanish Restoration saw the development of a pro-temperance literature, aimed at warning against the dangers of the excessive drinking, and demanding that the authorities apply measures to decrease the consumption of alcohol. One of the basic pillars of the temperance movement was the construction of housing for workers. The possibility of workers becoming owners of a healthy, comfortable home, and internalization of the bourgeois concept of the home, were fundamental influences on strategies to keep workers away from the taverns. Scientific Organization of Work and Medical Strategies for Occupational Hygiene in Spain (1922-1936) (Spanish) JOSÉ MARTÍNEZ PÉREZ   131 Summary 1.—Introduction. 2.—A new perspective on safety in the workplace. 3.—Prevention of accidents at the workplace and the Scientific Organization of Work. 4.—Consequences of the new strategy. 4.1.—The Scientific Organization of Work and the institutionalization of Occupational Medicine and Psychology. 4.2.—Prevention of accidents at the workplace and the decrease in labor unrest. 4.3.—The workers' new responsibility for their own safety. 5.—Conclusions. Abstract The present study attempts to explore the discourse with respect to occupational safety initially developed by the physicians and psychologists of the Madrid Institute for the Retraining of Invalids. We will try to show that this discourse comprised different elements that conferred upon it a wider scope than that of simple guidelines to prevent accidents in the workplace. With the incorporation of concepts such as professional education, orientation and selection, the discourse developed within a larger framework: that of the «rationalization» of economic and social life in Spain with the help of methods taken from the Scientific Organization of Work. To conclude, we describe some consequences of the application of some of the measures proposed for preventing accidents at the workplace. The Fight Against «Avoidable» Diseases and the 1918-1919 Influenza Epidemic in Spain (Spanish) ISABEL PORRAS GALLO  159 Summary 1.—Introduction. 2.—The prevention of «avoidable» diseases: Reasons in favor of the strategy chosen. 3.—Legislation for public prophylaxis against infectious diseases. 3.1.—Attempts to regulate public prophylaxis against «avoidable» diseases. 3.2.—Medical discourse for the prevention of «avoidable» diseases. 4.—A concept of prophylaxis against infectious diseases and its practical application. 5.—Conclusions. Abstract This study tries to examine a series of proposals for the prevention of «avoidable» diseases, which were presented in Parliament between 1914 and 1922. These proposals illustrate how Spanish physicians approached public prophylaxis against infectious diseases. The article also attempts to highlight how the 1918-1919 influenza pandemic may have affected the number and content of such proposals. Exanthematous Typhus During the Period Following the Spanish Civil War (1939-1943). Use of a Collective Disease to Legitimize the New State (Spanish) ISABEL JIMÉNEZ LUCENA  185 Summary 1.—Introduction. 2.—The New State and the public health situation. 3.—Use of the epidemic as a weapon to legitimize and reassert the ideology. 4.—Final considerations. Abstract By analyzing how the early Francoist regime in Spain used certain aspects of the epidemic of exanthematous typhus during the period from 1939 to 1943, this article explores how health policies may legitimize sociopolitical systems by validating ideas and actions that affect many aspects of society. The typhus epidemic and the actions it gave rise to were used as points of reference to support each of the doctrines of legitimization, within the overall ideological framework that the victors of the Civil War intended to establish. Their objective was to consolidate their power and challenge recusants to the New State. Illness and Social Insurance in Spain During the Early Francoist Regime (1936-1951). The Ill-Fated Compulsory Tuberculosis Insurance Program (Spanish) JORGE MOLERO MESA  199 Summary 1.—Introduction. 2.—The Francoist regime's campaign against tuberculosis: a clear strategy. 3.—The Falangist Party and the campaign against tuberculosis. 3.1.—The National Foundation Against Tuberculosis. 3.2.—The Compulsory Tuberculosis Insurance program. 4.—The sharing of power: The Directorate of Health versus the Social Insurances Institute. 5.—The Foundation and the Compulsory Health Insurance program: An impossible collaboration. 5.1.—Final restructuring of the Foundation. 5.2.—Duplicity of the health services. Abstract The campaign against tuberculosis was one of the main health tasks undertaken by the Francoist regime from the beginning of the Civil War. At the same time, the project to introduce compulsory insurance against tuberculosis was initiated, based on the Italian model of social insurance. This article analyzes the circumstances that impeded the implementation of the insurance program. One determining factor was the division of power among the different factions of the Francoist regime, which led to the introduction of compulsory health insurance by the Falangist Party. Relevant features concerning the organization and goals of the anti-tuberculosis campaign in Spain from 1936 to 1951 are also described. ARTICLES Sebastiano Dall'Aquila (c. 1440-c. 1510) and the «Disputation of Ferrara» Concerning Syphilis (1497) (Spanish) JON ARRIZABALAGA   227 Summary 1.—Introduction. 2.—Biographical note. 3.—Dall'Aquila and the «Disputation of Ferrara». Abstract This article aims to better illuminate the professional activities and intellectual personality of the Italian physician Sebastiano dall'Aquila Sebastianus Aquilanus (c. 1440-c. 1510) by assembling and reinterpreting several references to him from a number of both printed and manuscript sources that have had limited circulation among historians of medicine. The results of the inquiry are presented. In the first part the major features of his biography are outlined. The second one deals with his participation in the so-called «disputation of Ferrara», a notorious medical debate on the «French disease» (morbus gallicus) that took place in this northern Italian city in 1497, the details of which are described in greater detail. As a result, both the «Ferrara debate» and the figure of Sebastiano dall'Aquila attain a rather different historical significance. The Medical World of Juan Gil de Zamora's Historia Naturalis (ca. 1275- 1296 (Spanish) Luis GARCÍA BALLESTER; AVELINO DOMÍNGUEZ  249 Summary 1.—Introduction. 2.—Authors and medical writings: their diffusion in the Kingdom of Castille. 2.1.—Salernitan texts and Avicenna's Canon. 2.2.—Gilbertus de Aquila (Angelicus) and his Compendium medicine. 2.3.—Antidotaries. 2.4.—Hippocratic and Galenic writings. 2.5.—The other side of the coin: the antinaturalist reaction. Abstract The article describes the authors and works which were quoted by the Franciscan Juan Gil de Zamora in his Historia naturalis, a scientific encyclopaedia written between c. 1275 and before 1296, probably in the Franciscan monastery of Zamora (Kingdom of Castille). Juan Gil made wide use of the Avicenna's Canon, Gilbertus de Aquila (Anglicus)'s Compendium medicine, and Salernitan medical literature. His work contributed to the diffusion of these medical authors and works throughout the Christian intellectual milieu of late medieval Castille. This diffusion was not without problems. The Mirage of Free Practice. Regulation of Medical Care in Nineteenth- Century Spain (Spanish) JOSÉ VALENZUELA CANDELARIO  269 Summary Introduction. 1.—Foundations of the professional debate. Models of health care in the Enlightenment. 2.—The liberal alternative model: public charity organization and free practice. 3.—Liberal reform. 3.1.—Planning health care reforms: A many-sided debate. 3.2.—Toward a dual model of medical care: Medicine for the rich, and medicine for the poor. 3.3.—The debate over legal technicalities: The regulation of health care. 3.4.—The progressive alternative: The six-year reform. 4.—Epilogue: The Restoration period. The local physicians' corporative movement. 5.—Conclusion. Abstract This article examines the organization of extrahospitalary medical care in Spain during the Nineteenth Century. We have attempted to use contemporary sources (newspapers, medical monographs, parliamentary records) within the background of the establishment of liberal politics in Spain. Our central hypothesis was that medical practice has to be considered a helping profession, to which free private practice was associated in an opportunistic manner. Faced with the mirage of «market ” deregulation, foreseen even by the professional élite, regulation by the state and corporative pressures framed the public system of health care, and favored consolidation of the profession. Successive reforms in the regulation of medical practice reflected the marked antagonism between city and country. The resulting hybrid model made public practice compatible with private practice by physicians on the state 's payroll. DOCUMENTS An Unpublished Letter by Ignacio María Ruiz de Luzuriaga (1763-1822) on the Spread of Vaccination in Spain (1801) (Spanish) GUILLERMO OLAGÜE DE ROS; MIKEL ASTRAIN GALLART  305 Summary 1.—Introduction. 2.—Transcription of Ruiz de Luzuriaga's manuscript, dated c. December 1801 in Madrid. Abstract With this document we provide an initial study of the introduction of vaccination against smallpox in Spain. Despite the great number of studies on the topic, there is need for complementary research to examine in detail how, when, and with what means vaccination was introduced in and spread throughout the country. Doctor Ignacio María Ruiz Luzuriaga (1763-1822), a leading character in this process, was an ardent proponent of vaccination, and vaccinator to the Court. Although he published nothing on the topic, he left behind several manuscripts, including reports and letters, that are held at the National Academy of Medicine in Madrid. We present one such letter, dated approximately in December, 1801, in which the writer gives an overview of the spread of vaccination and its proponents. Despite the inflated role Luzuriaga claims for himself, the text offers new information, and in particular, raises a number of questions (such as that regarding professional competition, the lack of a central vaccination committee, the role of enlightened bureaucrats, and communications with France during this period) which have yet to be examined in depth by Spanish medical historians. THESES ON THE HISTORY OF MEDICINE AND SCIENCE PRESENTED IN SPANISH UNIVERSITIES, 1991-1993 SECTION COORDINATED BY ALFREDO MENÉNDEZ NAVARRO  339 ANNOUNCEMENTS  355 NEWS  361 BOOK REVIEWS Bibliografia Histórica sobre la Ciencia y la Técnica en Esparsa (1988-1991). Asclepio, 41; 42; 43; 44. ALFREDO MENÉNDEZ NAVARRO  369 Actas 11 Congreso de la Asociación de Demografia Histórica (1991), Beitia ediciones de Historia. PEDRO MARSET CAMPOS y JOSÉ MIGUEL SÁEZ GÓMEZ  372 Roselyne Rey (1993). Histoire de la douleur/History of pain, Éditions La Découverte. FERNANDO SALMÓN  376 Cristina Segura Grairlo (ed.) (1993) La voz del silencio  Historia de las mujeres: Compromiso y método, Laya/Asociación Cultural Al-Mudayna. TERESA ORTIZ GÓMEZ  377 Vivina Asensi Artiga (1992). Murcia: sanidad municipal (1474-1504), Universidad de Murcia. VICENTE L. SALAVERT  379 Hilary Marland (ed.) (1993). The art of midwifery. Early modern midwives in Europe, Routledge. ROSA BALLESTER At:ióN  380 Ignacio González Tascón (1992). Ingeniería espariola en Ultramar, siglos XVIXIX, Cehopu/Tabapres. ANTONIO LAFUENTE  382 Elvira Arquiola; Luis Montiel (1993). La corona de las ciencias naturales. La medicina en el transito del siglo XVIII al XIX, C.S.I.C. ROSA BALLESTER A ' NÓN  385 D. v. Engelhardt (1991). Medizin in der Literatur der Neuzeit (Bd. Darstellung und Deutung), Guido Pressler Verlag. Luis MONTIEL  386 Patrice Pinell (1992). Naissance d'un fléau. Histoire de la lutte contre le cancer en France (1890-1940), Éditions Métailié. ROSA  MEDINA DOMÉNECH  388 Alfred I. Tauber; Leon Chernyak (1991). Metchnikoff and the Origins of Immunology: From Metaphor to Theory, Oxford University Press. JAVIER MAZANA CASANOVA  391 Paolo Sorcinelli (1992) La follia della guerra. Storie del maniconio negli anni quaranta, Franco Angeli; Gli italiani e il cibo. Appetiti, digiuni e rinunce dalla realtà contadina alla società del benessere, C.L.U.E.B. JOSEP LLUIS BARONA  394 Robert N. Proctor (1991). Value-Free Science? Purity and Power in Modern Knowledge, Harvard University Press. FRANCISCO JAVIER RODRÍGUEZ ALCAZAR  396 LIST OF CONTRIBUTORS  401 INSTRUCTIONS FOR AUTHORS  405