La accion medico-social contra el paludismo en la Espana metropolitana y colonial del siglo XX (review)

Malaria control in Spain during pre-DDT times deserves closer attention than it has received, for it followed a health-care development approach, in contrast to the more favored specific campaigns. In 1937 Lewis Hackett recognized that this provided the "general advantages arising out of well-organised medical assistance—healthy looking children, a lowered death rate, and the absence of falciparum. The trouble is malaria does not disappear."¹ Nevertheless Spain was one of the first European countries to enter the WHO registry of malaria eradication, in 1964.

Rodríguez Ocaña and his collaborators did a very broad investigation of rather dispersed documents to trace the development of malaria control through the troubled Spanish history of the first half of the twentieth century, showing how Gustavo Pittaluga, a disciple of Giovanni Battista Grassi, who had come to Spain in 1903, managed to organize malaria control on the lines of the Italian school, before the bonifica integrale dominated the field in Mussolini's time.

The first chapters describe the organizational and political steps. Malaria in Spain was not only rural but, in contrast to Italy or Holland, affected mainly poor areas far from the capital, owned by large landowners who were far better represented in Parliament than their exploited workers. Although there were early efforts to address local problems (Rio Tinto, Servicio Técnico de Paludismo in Cataluña, the Ebro delta, Alto Aragón), there is an obvious contrast between locust control, well established since the late nineteenth century, and that of malaria, not fully set up until the 1920s.

A period of social tension in 1917–20 created a general concern for health problems, and in order to show the social concerns of the monarchy, the first central antimalaria organization was created. It is interesting to follow the continuity of the technical orientation of the antimalarial efforts (guided throughout by Pittaluga and his school, particularly Sadí de Buen), through the changes from a liberal government to a dictatorship, a return to liberalism, a republic alternating between Left and Right, and a civil war. This continuity may have been due to the peripheral location of the problem and its recognized complexity, but above all to the scientific prestige of Pittaluga's school, the support of the Malaria Commission of the League of Nations (where both Pittaluga and de Buen were very active), and the backing of the Rockefeller Founadation. Even after the end of the war and the establishment of Franco's military dictatorship, the basic organization continued, facilitating the later introduction of DDT.

The basis of the antimalaria organization (chapter 3) was a network of dispensary-laboratories that provided free diagnosis, treatment, and follow-up, and various vector control measures adapted to the local epidemiology, including minor sanitation and technical advice to major engineering works. These dispensaries helped to set up the rural health system in the early 1930s, with the support of the Rockefeller Foundation.

One of the book's strengths is its inclusion of information about malaria control in the Spanish colonies, as well as in Spain itself. Activities in Spanish Morocco were dominated by the perceptions (often archaic) and power of the military, at war from 1921 to 1926 and later acting rather as an occupation army, mistrusting the local population. Although the civil government tried to follow an official policy of agricultural development incorporating some antimalaria activities, the lack of financial support, bureaucratic obstacles, the lack of civil-military collaboration, and the uncooperative attitudes of the colonization companies led to poor success. In Spanish Guinea, action was pushed by the interests of plantation owners and their demand for a labor...