Medicine and the Spanish Civil War

Abstract

The very moving exhibition ‘Dreams and Nightmares’ mounted by the Imperial War Museum from November 2001 until April 2002 reminds us all too appositely of the horrors of warfare. The loss of life suffered as a consequence of the Spanish Civil War has been estimated as perhaps half a million1 and the scale of mutilation and disease attributable to it was colossal. If the First World War was the first major war in which casualties inflicted by direct military action outnumbered those caused by disease2, the Spanish Civil War may well have been the first in which civilian losses exceeded those of combatants. One of the very few redeeming features of warfare may be that it can stimulate progress in various aspects of medicine and surgery. Although medical historians have cast doubt on this belief3, the Spanish Civil War may offer some support for it. The uprising began with a military coup in which the Nationalist forces under General Francisco Franco soon gained control of sizeable areas of the country. The government (Republicans) responded by melding the militia columns into a popular army. Apart from the army medical branch, which almost entirely supported the insurgents from the outset4, the majority of doctors continued to practise their profession wherever they happened to be located at the outbreak of hostilities, without distinguishing between the loyalties of their patients. A few were executed early in the proceedings—by the rebels because they were thought to be Freemansons, or by one or other of the government factions because they were thought to be Catholics. Some were called up, some volunteered, some continued in civilian practice, but the distinction between military and civilian medicine became very blurred: front-line army mobile hospitals accepted sick and wounded civilians, and wounded soldiers were often evacuated back to rearguard civilian hospitals5,6,7. Doctors not in uniform often found that the town in which they were working would fall to the opposing side, but victimization of this group was surprisingly uncommon in a war in which reprisals were swift and bloody: this was largely because of the impartial stance of the profession and the need for medical expertise.