Summary The aim of this article is to explain the situation of the Spanish hospital system during the twentieth century and to analyse the reasons why the difficulties that a significant part of the Spanish population, resident in rural areas, had to access hospital services during the Franco dictatorship were perpetuated. The first section uses a conceptual perspective to discuss the repercussions that the new medical significance of the hospital had for the notion of 'rural hospital'. The second section examines the projects for hospital modernisation that appeared before the Spanish Civil War (1936–39) and highlights what impeded the consolidation of these pioneering experiences in the country. The following section analyses the hospital situation in Spain's rural world as well as the profound changes that occurred during the last decades of the dictatorship, just on the threshold of the health reform that was finally implemented in the democratic period.
The aim of this article is to explain the situation of the Spanish hospital system during the twentieth century and to analyse the reasons why the difficulties that a significant part of the Spanish population, resident in rural areas, had to access hospital services during the Franco dictatorship were perpetuated. The first section uses a conceptual perspective to discuss the repercussions that the new medical significance of the hospital had for the notion of 'rural hospital'. The second section examines the projects for hospital modernisation that appeared before the Spanish Civil War (1936–39) and highlights what impeded the consolidation of these pioneering experiences in the country. The following section analyses the hospital situation in Spain's rural world as well as the profound changes that occurred during the last decades of the dictatorship, just on the threshold of the health reform that was finally implemented in the democratic period.
Beginning at the end of the 18th century, the emergence of hospital medicine and, half a century later, the development of experimental medicine and health statistics, transformed the way medicine was taught. This new training model prioritized the "clinical view", to the detriment of the view on the social environment where professional practice was undertaken. Despite this subordination, on an international scale, social medicine and other social and health sciences continued to be important subjects in the medical curriculum. However, in Spain the presence of social and health sciences was scant. In this article, focused mainly on the early Franco regime, we intend to clarify the roots and reasons for this marginalization, such as the legal and administrative "regulations" of the Spanish university; academic and corporate resistance to incorporating interdisciplinary approaches; and a political and ideological context that delayed, until the Spanish Transition, the evolution of Spanish health towards the concept of "public health". To do this, we have divided the article into two parts. The first follows the evolution of medical training from the middle of the 19th century to 1938, while the second describes and analyses the reforms of medical curricula made between 1938 and 1959. ; Desde finales del siglo XVIII, la eclosión de una medicina hospitalaria y, medio siglo después, el desarrollo de la medicina experimental y de la estadística sanitaria transformaron la manera de enseñar la medicina. Este nuevo modelo de formación privilegió la «mirada clínica» en detrimento de la mirada sobre el medio social dónde se ejercía la práctica profesional. A pesar de esta subordinación, a escala internacional, la medicina social y las demás ciencias sociosanitarias continuaron siendo materias importantes en el currículum médico. En España, sin embargo, la presencia de ciencias sociosanitarias en las facultades de medicina fue muy escasa. En este artículo, centrado sobre todo en el primer franquismo, pretendemos esclarecer las raíces y las razones de esta marginalidad, tales como el reglamentismo» legal y administrativo de la universidad española; las resistencias académicas y corporativas a incorporar enfoques interdisciplinares; y un contexto político e ideológico que retrasó, hasta la Transición democrática, la evolución de la sanidad española hacia el concepto de «salud pública». Para ello dividimos el artículo en dos partes. En una primera se repasa la evolución de la formación médica desde mediados del siglo XIX hasta 1938, mientras que en la segunda se describen y analizan las principales reformas de los planes de estudio de medicina realizadas entre 1938 y 1959.
The aim of this article is to explain the situation of the Spanish hospital system during the twentieth century and to analyse the reasons why the difficulties that a significant part of the Spanish population, resident in rural areas, had to access hospital services during the Franco dictatorship were perpetuated. The first section uses a conceptual perspective to discuss the repercussions that the new medical significance of the hospital had for the notion of 'rural hospital'. The second section examines the projects for hospital modernisation that appeared before the Spanish Civil War (1936–39) and highlights what impeded the consolidation of these pioneering experiences in the country. The following section analyses the hospital situation in Spain's rural world as well as the profound changes that occurred during the last decades of the dictatorship, just on the threshold of the health reform that was finally implemented in the democratic period ; SI
The aim of this paper is to highlight how hospitals, in Catalonia since the late Middle Ages to the currently, adopted a governance model which resulted in the creation and preservation of hospitals or care institutions in virtually all municipalities, even in small, whose frame legal was the private or civil law. Firstly, we observed how individuals were motivated not only by philanthropy or charity, but also by a need to contribute something to the community after their death, to give back part of the assets the testators had accumulated during their lifetimes, as citizens who had benefited from their positions. Secondly, we observed that the small local private institutions merged with municipal hospitals, but that their assets were managed separately from those of the town. Third, as well as its care function, the hospital was also an economic agent that operated along similar lines to the Italian "Monte dei Paschi". It provided loans to working class citizens at a modest rate of interest. The meaning of the institution was found to be more complex than the simple provision of care services. It acquired a specific value in the identity of the community, it became one of the centers of debate in public life and it took on an economic and financial meaning that strengthened the construction of the citizens' collective identity. ; Los hospitales, en Cataluña, se inscribieron desde la Baja Edad Media hasta nuestros días dentro un modelo de gobierno específico que dio lugar a la creación y mantenimiento de una densa red de instituciones asistenciales en prácticamente todos los municipios, incluso en los más pequeños, cuyo marco legal fue el derecho privado o civil. Dicho modelo tiene sus fundamentos, en primer lugar, en la constatación de cómo los individuos legaban al hospital no sólo por la filantropía o caridad, sino también por la necesidad de aportar algo a la comunidad después de su muerte, en una suerte de consigna con el fin de devolver parte de los activos que los testadores habían acumulado durante su ...
Resumen: En el presente artículo se describe la evolución del sistema sanitario catalán utilizando, para ello, el desarrollo de un concepto cultural –el hospitalo-centrismo– clave para entender la hegemonía de la institución hospitalaria en los dispositivos de salud actuales. A tales efectos y utilizando dos perspectivas complementarias como son la historia antropológica y la antropología médica, el artículo analiza un case study a partir de tres ejemplos: la demanda de urgencias hospitalarias asociadas a una concepción cultural de lo que es "grave" y al embodiment de su eficacia por los ciudadanos; la necesidad del rol de asilo en las enfermedades crónicas o terminales; y la conversión del cuidado doméstico como "hospitalización doméstica" en el caso de la salud mental.
Palabras clave: hospital-centrismo, sistema sanitario, historia de hospitales, urgencias, cuidados crónicos, salud mental.
Abstract: This article describes the evolution of the Catalan Health System, using the development of a key cultural concept –hospital-centrism– to understand the hegemony of the hospital institution in the current health devices. To this purpose, and using two complementary perspectives such as anthropological history and medical anthropology, the article analyzes a case study from three examples: the demand for hospital emergencies related with a cultural conception of what is "severe", and with its effectiveness embodied by the citizens; the need of the asylum role in chronic or terminal diseases; and the transformation of domestic care to "domestic hospitalization" in mental health cases.
Keywords: hospital-centrism, health system, history of hospitals, emergencies, chronic care, mental health.
Resumen: En el presente artículo se describe la evolución del sistema sanitario catalán utilizando, para ello, el desarrollo de un concepto cultural –el hospitalo-centrismo– clave para entender la hegemonía de la institución hospitalaria en los dispositivos de salud actuales. A tales efectos y utilizando dos perspectivas complementarias como son la historia antropológica y la antropología médica, el artículo analiza un case study a partir de tres ejemplos: la demanda de urgencias hospitalarias asociadas a una concepción cultural de lo que es "grave" y al embodiment de su eficacia por los ciudadanos; la necesidad del rol de asilo en las enfermedades crónicas o terminales; y la conversión del cuidado doméstico como "hospitalización doméstica" en el caso de la salud mental. Palabras clave: hospital-centrismo, sistema sanitario, historia de hospitales, urgencias, cuidados crónicos, salud mental. Abstract: This article describes the evolution of the Catalan Health System, using the development of a key cultural concept –hospital-centrism– to understand the hegemony of the hospital institution in the current health devices. To this purpose, and using two complementary perspectives such as anthropological history and medical anthropology, the article analyzes a case study from three examples: the demand for hospital emergencies related with a cultural conception of what is "severe", and with its effectiveness embodied by the citizens; the need of the asylum role in chronic or terminal diseases; and the transformation of domestic care to "domestic hospitalization" in mental health cases. Keywords: hospital-centrism, health system, history of hospitals, emergencies, chronic care, mental health.
