Historia de la enfermería de salud pública en España (1860-1977) (review)

Josep Bernabeu Mestre and Encarna Gascón Pérez. Historia de la enfermería de salud pública en España (1860-1977). Alicante, Spain: Universidad de Alicante, 1999. 103 pp. Tables. Ptas. 1,057; e6.35 (paperbound, 84-7908-513-4).

This "History of Public Health Nursing in Spain" by Josep Bernabeu and Encarna Gascón offers a concise account of the route through which the profession of visiting nurse developed, briefly flourished, and then withered in Spain from the early twentieth century to 1977. This was not a lineal development; even as late as 1953 a pamphlet decried that in Spain "the word nurse is not given its correct meaning" (p. 83). Indeed, the readers would have been well served by a subject index and a definition of what the authors mean by public health nursing, so that the story might be more easily followed. As occurred with physicians and surgeons in the first half of the nineteenth century, in twentieth-century Spain the course of studies and the professional title of nurse suffered multiple reconceptualizations. Therefore, before addressing their subject, the authors describe the first comprehensive proposal for "visitors to the poor" (by Concepción Arenal, 1860) and the laws from 1888 to 1935 governing educational curricula for what were then considered auxiliary health professionals (dentists, minor surgeons [practicantes], midwives, and psychiatric nurses).

The first nursing school was founded in 1896, but the title of nurse was not recognized by law until 1915. The National School of Child Health Promotion (puericultura) and the National School of Hygiene (sanidad), founded in 1923 and 1924, respectively, were the first institutions to train nurses for home visits in an educational and preventive mode, focused on such subjects as the care of privies, the nutritional value and preparation of meals, and prenatal and infant care. Little testimony seems to be available on how the graduates of these institutions carried out their work, and the authors rely, for an approximate description, mostly on laws and proposals for professional improvement. The establishment of a School of Visiting Public Health Nurses was one of the projects of the Spanish Republic (1931-39) for improving the health of the working class and the indigent. The Rockefeller Foundation provided funds from 1931 to 1936 for the construction of a building and scholarships for fourteen future faculty members, who took courses at Western Reserve University (Cleveland) and worked at the Harlem (New York City) Nursing and Health Service. Six of them also participated in a course for nursing supervisors at Columbia University's Teachers College (New York City). In Spain, brief courses were offered from 1933 to 1935 to prepare visiting nurses while the school was being established, but due to the outbreak of civil war in 1936, the institution was never inaugurated. Catalonia's wartime School of Nurses (Escola d'Infermeres) provided specialty training for visiting nurses until it was closed at the end of the war (1939).

Under Francoism (1939-75), public health nursing was redefined in 1942 through the National School of Sanitary Instructors (focused on child health and tuberculosis prevention and treatment) and the Social Visiting Nurse Corps of the Falange (the regime's only legal party). In the following three decades, the government opted for personnel reductions among sanitary instructors and child health assistants, and favored a professional model for nurses that emphasized curative, rather than preventive, health-care tasks. In 1953, the profession of nursing was eliminated, and the title of Sanitary Technical Assistant (known as "ATS" by its initials in Spanish) was introduced as an amalgamation of the licensures for nurses, practicantes, and midwives. It was not until 1977 that ATS schools were converted into university-level nursing schools. Public health nursing remained, up to that time, a marginal activity within the health affairs of Spain. The book closes without mentioning...