Carmen Barona Vilar, Las políticas de salud: la sanidad valenciana entre 1855 y 1936, Universitat de València, 2006, pp. 292, illus., €16.65 (paperback 84-370-6331-0).

Abstract

This book is a substantial part of the PhD thesis defended by its author in 2002 at the same university which now publishes it, under the slightly different although more accurate title of Health organisation in the province of Valencia, as the emphasis is put more on the legal and institutional framework of government activities concerning the protection of health and the care of the sick poor. This means that Barona's sights are concentrated on the evolving shape of institutions (i.e., organic structure and administration, finance, personnel, targeted public) over time; the doctrines and strategies that directed them stay somewhat out of focus. In three chapters, she reviews the crucial legal turning points and the development of this part of state administration, follows the fate of the primary levels of health administration at the capital city and the provincial level, and studies the organization of medical care through poor law strategies. The book is thoroughly systematized, law by law and institution by institution, evolving over time. If the first chapter and the first section of the second chapter, dealing respectively with the review of national developments and the formation of a public health service in the city of Valencia, stand as able surveys of existing knowledge, this is not the case for the following one and two-thirds chapters. These, which include a study of the provincial health services, as well as the organization of care by charities, step empirically into hitherto unexplored ground, based on an assiduous exploitation of provincial archives. Barona gives a detailed picture of the inner fabric of the main official institutions built for the defence and promotion of health and the care of the sick. Diverse authors (Josep Bernabeu, Jorge Molero, Enrique Perdiguero, Ramon Castejon, and myself, among others) have explored the development of public health services at the state level or have followed most of the different initiatives deployed within the agenda of social medicine in the first forty years of the last century, but this is the first complete essay that deals with the whole group of health activities, personnel and institutions of a single provincial health institute. An obvious shortcoming for the modern history of public health in Spain is the lack of archival resources. It must not be forgotten that, for example, the building that housed the National Health Department stood at the front line during the siege of Madrid in the Civil War; and most provincial Health Institutes do not keep documents prior to the late 1970s, as an inquiry showed in 1989 (‘Archivos administrativos contemporaneos’, Dynamis, 1989, 9: 79–90). On the other hand, the provincial archives of the Diputaciones, the Spanish provincial organs of government, are much richer, and well cared for. Barona has quarried the Diputacion de Valencia's archives to obtain an interesting ore. To my knowledge, this is the first case study to produce an integrated picture of all official health strategies, preventive and curative, and within the broader scope of the poor-law schemes at the provincial level for the given period. One of the reasons why the University of Valencia stands as a stronghold of the academic history of medicine in Spain, under the inspiring leadership of Professor Jose Maria Lopez Pinero, now retired, has to do with the robust way in which the Department developed links with its social environment. The series of interdisciplinary workshops on regional health (mainly promoted by Josep L Barona, supervisor of the thesis that led to this book) and the production of a number of excellent studies dealing with local history give full expression of this. This book and the original dissertation spring from and nicely contribute to such a programme.