Hookworm in rural Spain, 1910-1960: shifting paradigms around the Civil War.

BACKGROUND: In Spain, hookworm was first recognised as a miners' disease, becoming the goal of one of the most successful interventions in public health from 1912 to 1931. Hookworm also played a part in the growing interest in rural health problems that peaked during the Republican period (1931-6). The aim of this study was to compare the rationale and content of public health interventions against rural hookworm in Spain before the Civil War (1936-9) with those of interventions after the war. METHODS: Review of published and unpublished documents on hookworm produced by individual physicians and public health officials in the first half of the 20th century. RESULTS: Rural hookworm foci detected in pre-war years were explained in terms of the geographical and human environment and largely attributed to poor working and living conditions, prompting specific health campaigns. New rural foci were detected after the war, but this time the health administration did not intervene. Understanding of the disease changed, its impact on reproduction was highlighted and medical explanations pointed to the negative moral conditions of peasants rather than social issues. CONCLUSION: Civil War brought rupture and continuity to the public health domain. Although the Francoist health administration preserved similar organisation patterns, its practice was governed by different priorities. Moral and even religious positions provided a rationale for what had been previously explained in social and environmental terms. This approach, together with the perception of hookworm as evidence of backwardness, led to official neglect of the condition, which was still prevalent in some rural areas.

The birth of the anti-malaria campaign in Spain during the first 30 years of the 20th century: scientific and social aspects.

The relations between the scientific and the social domains in the particular case of malaria had developed at three levels. The first one operates around the transformation of malaria into an escapable disease and the combined efforts of parasitology and entomology are mixed with the growing development of the concept of social medicine. The second one deals with the rhythm and the content of the measures taken to fight the disease in each concerned country; in that case, very peculiar site-time coordinates ask precise questions. At the same level can be placed the differences in the campaigns led against malaria in colonies and in the mainland, differences that it would be misleading to approach on the sole side of social determinism. Finally the third level corresponds to the complexity of the relationships between the international and the local domains, as present from the birth of "Office International d'Hygiène de la Société des Nations" and the involvement of the Rockefeller Foundation where two strategic positions can be detected opposing people minoring problems and those seeking for eradication, who indeed were opponents at the level of the scientific direction, but also originate within the socio-professional boundary of the members of each group, respectively.

History of health, a valuable tool in public health.

The aim of this article is to highlight the importance of the history of public health for public health research and practice itself. After summarily reviewing the current great vitality of the history of collective health oriented initiatives, we explain three particular features of the historical vantage point in public health, namely the importance of the context, the relevance of a diachronic attitude and the critical perspective. In order to illustrate those three topics, we bring up examples taken from three centuries of fight against malaria, the so called "re-emerging diseases" and the 1918 influenza epidemic. The historical approach enriches our critical perception of the social effects of initiatives undertaken in the name of public health, shows the shortcomings of public health interventions based on single factors and asks for a wider time scope in the assessment of current problems. The use of a historical perspective to examine the plurality of determinants in any particular health condition will help to solve the longlasting debate on the primacy of individual versus population factors, which has been particularly intense in recent times.

[Professionalization of physicians and health campaigns in twentieth-century Spain]. / Profesionalización médica y campañas sanitarias en la España del siglo XX.

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.

[The crusade for health: sanitary campaigns of the first third of the 20th century in the construction of the culture of health]. / La cruzada por la salud. Las campañas sanitarias del primer tercio del siglo XX en la construcción de la cultura de la salud.

From the clarification of the origin and historical development of two of the most impressive health campaigns of the first third of the twentieth century, those against tuberculosis and to prevent infant mortality, an evaluation is sought from a long range view. Their contribution to the modern configuration of health as well as to the genesis of several regular traits of today's community and family medicine are pointed out.

[Space for the sick, space for physicians: hospital planning in Spain from the 18th to the 20 centuries]. / Lugar de enfermos, lugar de médicos. La consideración del hospital en la medicina española, siglos XVIII-XX.

The process of hospitals' evolution into the core of the spanish health system is studied both through a historiographical review and through primary sources. The resulting image is far from a straight one, and we assert that criticisms from the late Enlightenment, which do not preclude a previous age of bloom, prevailed during the first half of the nineteenth century, while the second half saw a contradictory reassessment of hospitals as professional health institutions.

[Morbidity and mortality from the cholera epidemic of 1833-1835 in Andalusia]. / Morbimortalidad del colera epidemico de 1833-35 en Andalucia.

PIP: The author examines the demographic impact of the Asiatic cholera epidemic from 1833 to 1835 in Andalusia, Spain, using archival medical reports. Data on mortality by region, sex, and age are included, and some worldwide comparisons among cities that experienced the 1830s epidemic are made.^ieng