Physicians and statisticians : Two ways of creating demographic health statistics in Spain, 1841-1936

Continuity and Change

Volumn 12, Issue 2, 1997, Pages 247-264

  Rodríguez Ocaña, Esteban ^a   Bernabeu Mestre, Josep ^b  

^a UNIVERSITY OF GRANADA   (Spain)

^b UNIVERSITY OF ALICANTE   (Spain)

Author keywords

[No Author keywords available]

Indexed keywords

DEMOGRAPHIC HISTORY; DOCUMENTARY SOURCE; MEDICAL GEOGRAPHY; METHODOLOGY; NINETEENTH CENTURY; REGISTRATION SYSTEM; STATISTICAL DATA; TWENTIETH CENTURY;

SPAIN;

EID: 0031397935     PISSN: 02684160     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0268416097002920     Document Type: Review

References (75)

1. B. Nogueras and M. N. Pombo, 'Estadistica y censos en la España del siglo XIX: reseña de los nuevos tiempos', in D. Reher, B. Nogueras, and M. N. Pombo, España a la luz del censo de 1887 (Madrid, 1993), 10. And see J. Fontana, 'Prólogo', in A. Carreras ed., Estadisticas históricas de España, siglos XIX y XX (Madrid 1989), 7.
2. B. Nogueras and M. N. Pombo, 'Estadistica y censos en la España del siglo XIX: reseña de los nuevos tiempos', in D. Reher, B. Nogueras, and M. N. Pombo, España a la luz del censo de 1887 (Madrid, 1993), 10. And see J. Fontana, 'Prólogo', in A. Carreras ed., Estadisticas históricas de España, siglos XIX y XX (Madrid 1989), 7.
3. J. M. López Piñero, Los orígenes en Espańa de los estudios sobre Salud Pública (Madrid, 1989), 17-21.
4. The best local study thus far on the public health and burials is E. Santamaría and M. L. Dabrio, ' La Policia sanitaria mortuoria y su proceso de secularizatión en la Sevilla de la Illustratión (1750-1800)', Medicina e Historia 50 (1993).
5. Nogueras and Pombo, 'Estadística', 9.
6. Instrucción para el gobierno politico de las provincias (23 June 1813), made law 3 February 1823; the Royal Decree of 23 July 1835 (which became law on 19 January and 14 May 1836), and the Circular of 1 December 1837. These and other early pieces of legislation are summarized in 'Recopilación de las leyes, decretos, reales órdenes y circulares que se refieren al moviemento natural de la población', in Memoria sobre el movimiento de la población de España en los años 1858, 1859, 1860 y 1861 (Madrid, 1863), xv and ff.
7. Circular of 1 December 1837; see 'Recopilación de las leyes', xvii.
8. Royal Order 17 June 1863, reproduced in F. Abella, Manual administrativo de sanidad terrestre y marítima, 2nd edn (Madrid, 1879). It assigned the property of cemeteries exclusively to city councils, so that they came under municipal responsibility.
9. R. Revenga, 'Organización de la estadística en España. Apéndice 1', in J. Bertillon, Curso elemental de estadística administrativa (Madrid, 1907), 594-616.
10. 'Exposición', in Memoria (1863), viii-ix, citing problems such as 'the lack of administrative means [and] qualified personnel'; 'the difficulty in having the clergy under temporary subordination and participating in joint projects'; and difficulties in overcoming popular 'apathy and indifference'.
11. 'Until rigorous inscription is part of our popular tradition, statistical studies will be insufficient... because of the withholding of facts' ('Prólogo', in Movimiento de la Población de España en el decenio de 1861 a 1870 (Madrid, 1877), vi). The 'Recopilación de las leyes', xxiv, says: 'Since villages usually hide the truth, the central authorities should convince the municipal authorities that data given about births, marriages and deaths do not change the volume of taxable income; they allow the study of how the Spanish population reproduces, grows, develops and ends; and these social facts should be studied in depth for the Government to determine which measures to introduce for the benefit of humanity. ' (This and all subsequent translations are those of the authors of this article.)
12. Movimiento de la Población de España (Madrid, 1895), 11 and 25.
13. R. Maurell García, 'La mortalidad en Espana en 1900', Gaceta Médica de Granada 20 (1902), 505-12; 'Memoria', Boletin Demográfico Sanitaria (1905), ix; M. Pascua, 'Mortalidad española en el siglo XIX', Revista de Sanidad e Higiene Pública, 9/1 (1934), 577-79.
14. R. Maurell García, 'La mortalidad en Espana en 1900', Gaceta Médica de Granada 20 (1902), 505-12; 'Memoria', Boletin Demográfico Sanitaria (1905), ix; M. Pascua, 'Mortalidad española en el siglo XIX', Revista de Sanidad e Higiene Pública, 9/1 (1934), 577-79.
15. R. Maurell García, 'La mortalidad en Espana en 1900', Gaceta Médica de Granada 20 (1902), 505-12; 'Memoria', Boletin Demográfico Sanitaria (1905), ix; M. Pascua, 'Mortalidad española en el siglo XIX', Revista de Sanidad e Higiene Pública, 9/1 (1934), 577-79.
16. E. Rodríguez Ocaña, 'The making of the Spanish Health Administration during the first third of the twentieth century', Quaderni Internationale di Storia della Medicina e la Sanità (Siena) 3 (1994), 49-65.
17. F. Méndez Alvaro, 'Algunas consideraciones sobre estadistica', El Siglo Médico 3 (1856), 593-4, and 'Estadística del cólera morbo', El Siglo Médico 4 (1857), 321-2. Francisco Méndez Alvaro and Pedro Felipe Monlau were the most prolific publicists when it came to public health during the middle third of the nineteenth century. See M. Granjel, Pedro Felipe Monlau y la higiene española del siglo XIX (Malaga, 1983); and J. L. Fresquet Febrer, Francisco Méndez Alvaro (1806-1883) y las ideas sanitarias del liberalismo moderado (Madrid, 1990).
18. F. Méndez Alvaro, 'Algunas consideraciones sobre estadistica', El Siglo Médico 3 (1856), 593-4, and 'Estadística del cólera morbo', El Siglo Médico 4 (1857), 321-2. Francisco Méndez Alvaro and Pedro Felipe Monlau were the most prolific publicists when it came to public health during the middle third of the nineteenth century. See M. Granjel, Pedro Felipe Monlau y la higiene española del siglo XIX (Malaga, 1983); and J. L. Fresquet Febrer, Francisco Méndez Alvaro (1806-1883) y las ideas sanitarias del liberalismo moderado (Madrid, 1990).
19. F. Méndez Alvaro, 'Algunas consideraciones sobre estadistica', El Siglo Médico 3 (1856), 593-4, and 'Estadística del cólera morbo', El Siglo Médico 4 (1857), 321-2. Francisco Méndez Alvaro and Pedro Felipe Monlau were the most prolific publicists when it came to public health during the middle third of the nineteenth century. See M. Granjel, Pedro Felipe Monlau y la higiene española del siglo XIX (Malaga, 1983); and J. L. Fresquet Febrer, Francisco Méndez Alvaro (1806-1883) y las ideas sanitarias del liberalismo moderado (Madrid, 1990).
20. F. Méndez Alvaro, 'Algunas consideraciones sobre estadistica', El Siglo Médico 3 (1856), 593-4, and 'Estadística del cólera morbo', El Siglo Médico 4 (1857), 321-2. Francisco Méndez Alvaro and Pedro Felipe Monlau were the most prolific publicists when it came to public health during the middle third of the nineteenth century. See M. Granjel, Pedro Felipe Monlau y la higiene española del siglo XIX (Malaga, 1983); and J. L. Fresquet Febrer, Francisco Méndez Alvaro (1806-1883) y las ideas sanitarias del liberalismo moderado (Madrid, 1990).
21. B.R., ' Importancia de la higiene y consequencias de su olvido. Comisiones permanentes de estadística', El Siglo Médico 4 (1857), 161-2.
22. F. Méndez Alvaro, 'El Registro Civil en España', El Siglo Médico 24 (1877), 131-4; 162-7; 194-9, and 242-7, esp. p. 196.
23. See P. F. Monlau, Elementos de higiene pública, 2nd edn (Madrid, 1862), 130: 'at last, we are on the right track and we should continue like that'. And see the third edition (Madrid, 1871), 736-8, for the quoted passage. See also the plan proposed by José Garófalo ('Breves indicaciones sobre un plan general de estadistica médica', El Siglo Médico 8 (1861), 163-5) as proof of the thoroughness desired by doctors worried about the difficulties of compiling useful statistics. He proposed the collection of data for each individual sick person including, among other aspects, town of origin, therapy prescribed, and outcome.
24. See P. F. Monlau, Elementos de higiene pública, 2nd edn (Madrid, 1862), 130: 'at last, we are on the right track and we should continue like that'. And see the third edition (Madrid, 1871), 736-8, for the quoted passage. See also the plan proposed by José Garófalo ('Breves indicaciones sobre un plan general de estadistica médica', El Siglo Médico 8 (1861), 163-5) as proof of the thoroughness desired by doctors worried about the difficulties of compiling useful statistics. He proposed the collection of data for each individual sick person including, among other aspects, town of origin, therapy prescribed, and outcome.
25. Decrees and Circulars of 23 and 26 February, 22 May, and 2 and 3 June 1857.
26. F. Méndez Alvaro, 'Estadística sanitaria', El Siglo Médico 12 (1865), 333-4. 'Advertencia', in Boletin Mensual de Estadística Demográfico-sanitaria de la Penisula e Islas Adyacentes. Segundo semestre de 1879 (Madrid, 1880), unpaginated.
27. F. Méndez Alvaro, 'Estadística sanitaria', El Siglo Médico 12 (1865), 333-4. 'Advertencia', in Boletin Mensual de Estadística Demográfico-sanitaria de la Penisula e Islas Adyacentes. Segundo semestre de 1879 (Madrid, 1880), unpaginated.
28. E. Rodríguez Ocaña, 'Presencia de la estadística en los manuales españoles de higiene pública', in M. Valera, M. D. Egea, and M. D. Blázquez eds., Libro de Actas. VIII Congreso National de Historia de la Medicina, Murcia-Cartagena, diciembre 1986 (Murcia, 1988), 431-40.
29. Monlau, Elementes (1871), 737. Almost the same words were used by the International Health Board's delegate in Spain, Charles A. Bailey, commenting on the same problem in 1925.
30. F. Méndez Alvaro, 'El Registro Civil', El Siglo Médico 17 (1870), 405-9.
31. Monlau, Elementos (1871), 305.
32. From November 1872 in Madrid and May 1887 in Barcelona, a service for the examination of corpses was established, staffed by medical examiners: This was replaced in 1907 by a corps of physicians attached to the service, and extended to all cities with populations over 50,000 by Royal Orders of 4 August and 29 September 1918. In July 1925, all provincial capitals and cities with populations over 40,000 came under these directives. During the Republic, the Registry was suspended, but Franco's regime reopened it on 27 July 1939, appointing all staff directly from the Ministry of Justice.
33. Méndez Alvaro, 'El Registro Civil', 133-4.
34. Méndez Alvaro, 'El Registro Civil'. Other people were aware that these compilations were of little meaning to public health, but their proposals departed from the more ambitious medical claims of Méndez, simply suggesting the use of physicians to tabulate the data. Such was the case with Ruiz Jiménez, Observaciones (al censo de Madrid y estadística demográfica)', El Siglo Médico 26 (1879), 265-6.
35. Méndez Alvaro, 'El Registro Civil'. Other people were aware that these compilations were of little meaning to public health, but their proposals departed from the more ambitious medical claims of Méndez, simply suggesting the use of physicians to tabulate the data. Such was the case with Ruiz Jiménez, Observaciones (al censo de Madrid y estadística demográfica)', El Siglo Médico 26 (1879), 265-6.
36. Cited in R. Rodriguez Méndez, 'Estadística demográfica de Barcelona', Gaceta Médica Catalana 15 (1892), 481-5. On the founding of the Catalan organization, see 'Estadistica sanitaria de Barcelona y su provincia', Revista de Ciencias Médicas 5 (1879), 186-8.
37. Cited in R. Rodriguez Méndez, 'Estadística demográfica de Barcelona', Gaceta Médica Catalana 15 (1892), 481-5. On the founding of the Catalan organization, see 'Estadistica sanitaria de Barcelona y su provincia', Revista de Ciencias Médicas 5 (1879), 186-8.
38. E. Rodríguez Ocaña, 'La labor estad́stica de Luis Comenge (1854-1916) en el Instituto de Higiene Urbana de Barcelona', Dynamis 5-6 (1985-1886), 279-306.
39. Decree of Mayor's office, 26 November 1896, printed on 26 February 1897. Archivo histórico de la Villa (Madrid), 17-388-25. The year 1899 saw the first issue of the Anuario Estadístico Demográfico. Publication continued with data for 1900 as Estadística Demográfica del Ayuntamiento de Madrid.
40. The last issue of the Boletín was actually published in 1887 and provided data on the cholera epidemic in 1885.
41. In age groups of less than 1 year, between 1 and 5, between 5 and 10, between 10 and 20, between 20 and 40, between 40 and 60, and older than 60.
42. 'Although it should be revised in the future, we think it will always be convenient to remain close to the terminology used in other countries, in order to facilitate comparative studies' ('Advertencia', in Boletín Mensual de Estadística Demográficosanitaria de la Península e Islas Adyacentes. Segundo semestre de 1879 (Madrid, 1880), unpaginated).
43. According to the introduction to the Royal Order of 8 October 1880 (Gaceta, 10 October), which set out the regulations which should govern the demographic health statistics service. However, we have no information about the actual collection processes.
44. R. Rodriguez Méndez, 'Revista de Higiene', Revista de Medicina y Cirugía 6 (1880), 273-4. With this in mind, data published in the Boletines from 1879 to 1884 are analysed in the research project DGICYT PM89-023: E. Balaguer Perigüell, et al. 'Análisis demográfico-sanitario: estudio de la evolución temporal y distribución geográfica de estructura de la mortalidad por causas de defunción', La transitión epidemiológica en España de 1879 a 1919 (University of Alacant, 1993).
45. R. Rodriguez Méndez, 'Revista de Higiene', Revista de Medicina y Cirugía 6 (1880), 273-4. With this in mind, data published in the Boletines from 1879 to 1884 are analysed in the research project DGICYT PM89-023: E. Balaguer Perigüell, et al. 'Análisis demográfico-sanitario: estudio de la evolución temporal y distribución geográfica de estructura de la mortalidad por causas de defunción', La transitión epidemiológica en España de 1879 a 1919 (University of Alacant, 1993).
46. R. Vazalde, 'Un intento laudable. Estadistica sanitaria', El Siglo Médico 26 (1879), 466-9.
47. Royal Order of 5 January 1885 (Gaceta, 23 January); 'Legislación de fecha atrasada. Sanidad terrestre', in Boletín de Sanidad, 1890, 158-60.
48. Grouped by ages up to 5 months, 5 months to 3 years, between 3 and 6, between 6 and 13, between 13 and 20, between 20 and 25, between 25 and 40, between 40 and 60, between 60 and 80, and older than 80.
49. Circular of 12 December 1899 (Gaceta, 16 December).
50. 'Memoria', in Boletín Demográfico Sanitaria, 1905, ix.
51. Ibid., x.
52. C. Calleja, 'Perfeccionamiento de la estadística médica', El Siglo Médico 48 (1901), 244-6.
53. 'Inspección General de Sanidad Exterior', Boletín Demográfico Sanitario, 1904, ler semestre, 1905. A Royal Order of 20 June 1904 ordered its publication and permitted the publication of subsequent ones.
54. Ibid., xii.
55. '...effective statistics that serve as a base when dealing with the country's public health. They should also serve as a faithful indicator of the measures taken by the authorities, to guide the hygienist and the governor when studying mortality... to discover all accidental or chronic ailments that corrode the life of a people, and to provide essential elements of judgement for the application of fruitful reforms'.
56. This publication also quantified the activities of laboratories, the public health provincial institutes, and harbour health stations, in addition to gathering diagnoses from hospitals, asylums, and other institutions.
57. Deaths in charitable institutions were only divided into two age groups : under age 5 and over age 5.
58. M. Pascua Martínez, 'Organization del Departamento de Estadísticas sanitarias y su utilizatión', in L. Nájera Angulo ed., Actas del Primer Congreso National de Sanidad (Madrid, 1934), Vol. III, 337-48.
59. 'Municipal health officers, who are at the same time town physicians, are not paid for gathering and forwarding data on infectious diseases, and thus forget their obligation; but the existing structure of the statistical service, established by the present Decree of Health, does not provide legal means by which to enforce compliance' (M. Martin Salazar, La Sanidad en España (Madrid, 1913), 61).
60. Angel Fernández Caro, 'Introduction', to Francisco G. Membrillera, El problema sanitaria de España (Barcelona, 1921), iii.
61. G. Banqueiro Gil, Introductión a la metodología estadística aplicada a las cuestiones sanitarias (Madrid, 1930), 120-1.
62. Before mid-year there was to be an annual summary of the previous data as well. Thus, in May 1927 the annual summary for 1926 was published (Boletín Técnico de la Directión General de Sanidad 2, 319-55); the one for 1927 was published in Volume 3, pp. 203-39; the one for 1928 in Volume 4, pp. 222-59; and the one for 1930 in Volume 5, pp. 138-75.
63. Before mid-year there was to be an annual summary of the previous data as well. Thus, in May 1927 the annual summary for 1926 was published (Boletín Técnico de la Directión General de Sanidad 2, 319-55); the one for 1927 was published in Volume 3, pp. 203-39; the one for 1928 in Volume 4, pp. 222-59; and the one for 1930 in Volume 5, pp. 138-75.
64. Before mid-year there was to be an annual summary of the previous data as well. Thus, in May 1927 the annual summary for 1926 was published (Boletín Técnico de la Directión General de Sanidad 2, 319-55); the one for 1927 was published in Volume 3, pp. 203-39; the one for 1928 in Volume 4, pp. 222-59; and the one for 1930 in Volume 5, pp. 138-75.
65. Before mid-year there was to be an annual summary of the previous data as well. Thus, in May 1927 the annual summary for 1926 was published (Boletín Técnico de la Directión General de Sanidad 2, 319-55); the one for 1927 was published in Volume 3, pp. 203-39; the one for 1928 in Volume 4, pp. 222-59; and the one for 1930 in Volume 5, pp. 138-75.
66. Particular attention was paid to typhoid fever, smallpox, measles, scarlet fever, whooping cough, diphtheria and croup, influenza, pulmonary tuberculosis, cancer and other malignancies, and puerperal septicaemia.
67. Rockefeller Archive Center, RF, 5, 1.2, 238, 3060, Bailey to Russell (letter), 9 March 1925. On the relationship with the Rockefeller Foundation see E. Rodriguez Ocaña, J. Bernabeu Mestre, and J. L. Barona, 'La Fundación Rockefeller y España, 1914-1936. Un acuerdo para la modernización científica y sanitaria', in VI Congreso de la Sociedad Española de Historia de las Ciencias y de las Técnicas. Segovia, septiembre 1996 (publication forthcoming).
68. Royal Order of 27 March 1930 (Gaceta, 29 March), 1971-2.
69. In the First National Health Congress (1934), a paper given by Pascua (cited in n. 47 above), the head of the Health Statistics Bureau of the Department of Public Health boasted that the Boletín Semanal had been published 'without interruption since 7 June 1930'.
70. Circular of 2 June 1931 (Gaceta, 7 June).
71. Circular of 3 May 1936 (Gaceta, 6 May). The last legal text on public health policy before the Civil War, Order of 15 February 1936 (Gaceta, 18 February, ratified 20 February), complained about the 'notorious and highly confirmed neglect' of basic health-care professionals in the process of gathering statistical data. In the supplement to Estadísticas Sanitarias no. 241 (1934), Pascua wrote: 'the obvious irregularities present in data from provincial Medical Officers used in this work (on typhoid fever morbidity) demand caution from those interested in this subject'. Quoted in A. Salvat Navarro, Tratado de Higiene (Barcelona, 1935), Vol. III, 783.
72. Circular of 3 May 1936 (Gaceta, 6 May). The last legal text on public health policy before the Civil War, Order of 15 February 1936 (Gaceta, 18 February, ratified 20 February), complained about the 'notorious and highly confirmed neglect' of basic health-care professionals in the process of gathering statistical data. In the supplement to Estadísticas Sanitarias no. 241 (1934), Pascua wrote: 'the obvious irregularities present in data from provincial Medical Officers used in this work (on typhoid fever morbidity) demand caution from those interested in this subject'. Quoted in A. Salvat Navarro, Tratado de Higiene (Barcelona, 1935), Vol. III, 783.
73. For example, the ones for 1933 (1934; Madrid, 41 pages) and for 1934 (1935; Madrid, 41 pages).
74. Order of 16 January 1936 (Gaceta, 21 January).
75. Mandatory declarations, grouped by cities with populations greater than 20,000 and by provinces, included data for births (live or dead), total deaths, deaths of children under 1 year of age, and the number of cases and deaths from 'EDO' - diseases requiring separate reporting. Cumulative data for the remaining towns and villages, grouped by province, were provided, as well as a distribution of deaths by cause (according to the abbreviated international classification of 1941) for the city of Madrid.