http://hpy.sagepub.com/ History of Psychiatry http://hpy.sagepub.com/content/9/34/201 The online version of this article can be found at: DOI: 10.1177/0957154X9800903404 1998 9: 201 History of Psychiatry Ricardo Campos and Tom Dening Alcoholism and medicine in Spain in the second half of the nineteenth century Published by: http://www.sagepublications.com can be found at: History of Psychiatry Additional services and information for http://hpy.sagepub.com/cgi/alerts Email Alerts: http://hpy.sagepub.com/subscriptions Subscriptions: http://www.sagepub.com/journalsReprints.nav Reprints: http://www.sagepub.com/journalsPermissions.nav Permissions: http://hpy.sagepub.com/content/9/34/201.refs.html Citations: What is This? - Jun 1, 1998 Version of Record >> by Pepe Portillo on June 22, 2014 hpy.sagepub.com Downloaded from by Pepe Portillo on June 22, 2014 hpy.sagepub.com Downloaded from
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http://hpy.sagepub.com/History of Psychiatry
http://hpy.sagepub.com/content/9/34/201The online version of this article can be found at:
DOI: 10.1177/0957154X9800903404
1998 9: 201History of PsychiatryRicardo Campos and Tom Dening
Alcoholism and medicine in Spain in the second half of the nineteenth century
Published by:
http://www.sagepublications.com
can be found at:History of PsychiatryAdditional services and information for
Alcoholism and medicine in Spain in thesecond half of the nineteenth century
RICARDO CAMPOS*
Edited byTOM DENING
1. Introduction
During the nineteenth century Spain participated in the social and medicalcondemnation of alcoholism which swept Europe and America.’ Alongsidethe formation of the liberal State, anti-alcohol publicity was disseminated bythe reforming elite to transmit the idea that the consumption of alcoholicdrinks was harmful to the individual’s health and dangerous in terms ofsocial order. Concern over the social effects of alcoholic drinks (increase incrime, madness, lack of discipline, absenteeism from work, etc.) stimulatedthose sectors of society interested in economic control and social discipline.In general, for this elite, the consumption of alcohol was incompatible withtheir ideals of social progress and rationalism. They saw alcoholic drinks as athreat to values such as austerity, success, savings, or the spirit of sacrifice;intoxication broke with the idea of self-control, letting loose the darkestinstincts of the human being.2The effects of industrialization much affected this anti-alcoholic reaction.
Technical innovations in the production of alcoholic drinks, improvedtransportation and increased commercialization of the industry,3 as well asthe growth of deprived urban and industrial centres had an immediate
impact upon the drinking habits of the population. Alarmed by this situation,many doctors, criminologists, academics, businessmen and town planners(and later, and with certain ideological nuances, workers’ leaders4) directedtheir efforts towards warning the Spanish population against the moral andsocial dangers of alcohol for both the individual and society.
* Work performed as part of the Proyecto de Investigación N° PB94-0060 financed by theDGCYT (Ministerio de Educación y Ciencia). Address for correspondence: Depto de Historia dela Ciencia, Centro de Estudios Históricos, Consejo Superior de Investigaciones Cientificas,C/Duque de Medinaceli, 6, 28014 Madrid, Spam.
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In general the publicists confidently regarded alcoholism as being a
manifestation of the savage and immoral lifestyle of the working classes.5 Inthis ideological framework we can consider the anti-alcohol campaign to bepart of a general normative strategy as regards the behaviour of these classes,whose ultimate objective was the eradication of its vices, the imposition ofdiscipline and containment within the framework of the new capitalist workorganization.6 6The participation of the doctors in this movement was important and was
characterized by its strong moral content. Although alcoholism had beendescribed as a branch of medicine by Magnus Huss in 1849, an idea furtherdeveloped by French psychiatry,’ Spanish doctors incorporated the pre-existent social image of the drunk into their scientific discussions. Althoughthis image was not exclusive to Spanish medicine, it became accentuated asthe doctors were more interested in publicizing the dangers of alcoholconsumption than in scientific investigation concerning its effects on thehuman organism. Thus, the anti-alcohol medical literature tended to simplifythe ideas, endlessly repeating a string of clich6s, which made alcoholismmore of a vice with terrible social consequences than an illness.8
8
In this way, Luis Men6ndez has signalled that the concept of alcoholism asan illness ’was part of a process of medical appropriation of a phenomenonconsidered, until then, as a vice, as disorder, as a social problem and verysecondarily as an illness. The medical concept of alcoholism was broughtabout from a series of social conducts which can be differentially classified asillness and social problem.&dquo; In the following pages we will analyse how andwhy Spanish doctors perceived alcoholism fundamentally as a social problemof moral origin and not as an illness.
2. The moral crusade of hygienism against alcoholism
The first treatises of Spanish hygiene were published in the middle of thenineteenth century. In accordance with their European colleagues, theSpanish hygienists championed a reformation of society based upon hygienicprinciples. Their observations of the living and working conditions of theworking classes brought to light the problems generated by the new industrialsociety, and were crucial in the condemnation of this state of affairs. Poverty,prostitution, insanitary housing, social illnesses and increased death rates
among the poor were questions studied by the hygienists, who were worriedby the potential social consequences.10 But their solutions, far from
combating the basis of this inequality, were directed at moralizing andeducating the working classes. This was because they considered that socialdivision and pauperism were inseparable from human nature and from socio-political organization. So Pedro Felipe Monlau (1808-1871)&dquo; was dogmaticin writing in 1845 that pauperism ’is a necessary condition of the samenature as man, as natural and social necessity is the inequality of conditions; 3
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and the inequality of conditions necessarily supposes indigence.’12 Moreover,despite the criticisms of the negative effects of industrialization, the hygienistsbelieved such effects to be inevitable and encouraged the governments andindividuals to correct them, moralizing the working classes with the aim ofrationalizing and disciplining their conduct, and in this way safeguardingsocial order.’3 In 1858, Joaquin Salarich (1816-1884)14 wrote regardingpossible solutions to the social problem:
The governments must not forget that the immense masses of workers,which are perfectly ruled and brought into line in their bills, are notabstract numbers which fall into line with every modification and
arrangement. They are numbers of meat and bone which make up animmense body through the veins of which flows depraved and ardentblood: the cancer of demoralization corrodes their innards; evil instinctsneutralize the beneficial results of the material advantages provided them.And it is that the most essential is forgotten, there is no self-moralization;they do not instil themselves with those religious beliefs which mustremove them from the depraved mire in which they live submerged; theydo not acquire understanding, which must bring them to realize thewretched state in which they vegetate; they do not educate themselves, sothat they may one day widen the restricted circle which confines themand binds them to their state of misery and idiocy. 15 S
Therefore, poverty and illness were the fruit of the nature of the worker andhis ignorance. The solution to this evil was moral doctrine: ’The worker ispoor, save him, help him. The worker is ignorant: instruct him, educate him.The worker has depraved instincts: moralize him’, wrote Pedro FelipeMonlau categorically. 16 From this ideological framework, it follows that theconsumption of alcoholic drinks was considered to be essentially a vice of theworkers, and that the hygienists were especially worried about its social andmoral consequences.
Joaquin Salarich, in his essay entitled Hygiene of the Weaver, following JeanBaptiste Descuret, included drunkenness among the passions of the worker. 17At no point did he use Huss’s term ’alcoholism’. Neither did Pedro FelipeMonlau who, in the second edition of his Elements of Public Hygiene dated1862, referred to it as drunkenness or intoxication, limiting himself to thedescription of the effects of ’that disgusting vice’ upon the increase in crimerate, madness or suicide.&dquo; Even as late as 1874, the founder of legalmedicine, Pedro Mata (1811-1877)/9 still used the term intoxication in thefifth edition of his Treatise of Legal Medicine and Surgery Theory and Practice,which, according to the cover, was an edition ’reformed and placed at thelevel of the most up to date knowledge’. 21From our research, it appears that the term alcoholism was first used in
1876, in the Practical Theoretical Study of Phrenopathology by Juan Gine yPartagas (1836-1903). 21 In this he dedicated a chapter to ’alcoholic madnessand alcoholism’, glorying in a wide knowledge of the recent French studies
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concerning the problem, although maintaining his critical distance from thedegenerationalist ideas of Valentin Magnan.22
All of this indicates the lack of knowledge shown by Spanish doctorsregarding the most innovative works on the subject of alcoholism during themid nineteenth century. It also shows that they did not regard theconsumption of alcoholic drinks as a pathology. Rather it was considered adeviation of behaviour, a product of ignorance and immorality.Thus Joaquin Salarich, deeply influenced by Louis Rene Villerme,
described intoxication as an everyday fact of life of the worker. He blamedvarious social and moral factors, such as the bad example received bychildren at home and in the factory, the bingeing and disorderly habits of theworker, the idleness of Sunday, the absenteeism of Monday, the proliferationof cafes and taverns, and the lack of moral and religious values. Thesefactors, by his judgement, were the principal causes of intoxication.23 Hisattitude towards the consumption of alcoholic drinks, in keeping with thebest hygienist traditions, was more sociological and moral than medical.What really interested him was to point out the moral aspects and the socialdisorder brought about by the consumption of alcohol:
This excess does not only oppose savings, the good education of thechildren and the happiness of the family but also submits to extremeindigence. Drunkenness makes the worker lazy, a gambler, complainingand turbulent; it degrades him and makes him aggressive; it destroys hisbetter habits; it scandalizes society and impels him towards crime.Drunkenness is the principal cause of fights, of many misdemeanours andof almost all disorder caused by the worker.24
It is interesting to emphasize that most hygienists considered the consumptionof alcohol to be the principal cause of the misery of the worker and not thecontrary, as suggested by other sectors, such as the worker movement. 25Thus Philip Hauser ( 1832-1925),26 in 1884, complained that the workingclasses, despite the economic crisis which was shaking the country, gatheredin their masses ’in the cafes, the taverns, the theatres and the bull-rings’. 21And in 1901, Jose Ubeda Correal wrote: ’we strongly believe that one doesnot drink due to one’s poverty, but rather poverty is frequently arrived at as aresult of drinking, and above all, of drinking to excess. 21 One year later thesame author tried to demonstrate that a worker’s salary was sufficient for hisneeds, if it were not for his degraded habits and love of drink:
On the working and economical conditions of the wife and the orderedand moralized habits of the husband: If he drinks, gambles and sees thetaverns as his habitual place of leisure, the budget does not provide evento get started. If, on the other hand, he is organized and a hard worker,and he does not mind dedicating his evenings to some form of
supplementary work, the possibility for which is frequently presented tothe intelligent and able worker, then the day’s wage or extra payment
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received for this work would supplement that which we can call thereserve funds of the family, increasing it and allowing all members of thefamily to fearlessly confront illness, accident or any misfortune whichwould suppose a period without work.29
However, in spite of the moral arguments, the doctors also took into accountthe social causes of alcoholism amongst workers. The alleged motives werediverse and were related to the hard living and working conditions which hadto be supported. The poor diet was regarded by some as the cause, turningto alcohol as a source of the energy denied to them by malnutrition. Becauseof this, some doctors recommended moderate use of wine as a tonic or as aform of nourishment, clearly distinguishing it from distilled drinks, whichwere considered to be extremely harmful.3° In 1901, a large survey, publishedin the cultural magazine La Lectura, presented the doctors’ opinions regardingthe consumption of wine with meals. Thirty-three doctors were in favour ofits use while thirty-five were against, claiming that any type of alcoholic drinkwas very harmful to the health.3’ Other writers thought that unsuitablehousing encouraged the poor to look to the tavern for the warmth andsociability which they lacked at home.32
However, the majority of the writings on alcoholism concerned themselvesonly with the stigmatization of the working class. Alcohol abuse was a fineexample of the negative qualities attributed to workers, allowing the creationof the stereotypical image of the worker across the whole country, whosecharacteristics were impertinence, social danger, physical and moral
decadence, idleness and absenteeism.33In addition, worker alcoholism had a public image which alarmed the
hygienists and social reformers. In effect, the worker drank in the tavern inthe company of his colleagues. From this point of view the tavern was aninsulted and vilified space as it represented transgression from the norms ofsocial conduct. What frightened them about the tavern was that itconstituted a privileged place for the social life of the working classes, wherethey satisfied their leisurely needs and organized themselves, subsequentlybecoming societies of resistance and political parties with socialist disposition.34
3. Alcoholism, a social plagueIn the last quarter of the nineteenth century Spanish doctors progressivelyabandoned the terms drunkenness and intoxication in favour of alcoholism.Better knowledge of recent studies concerning alcoholism forced them toadopt the new term. At the same time social hygiene was losing part of itsmoral emphasis to be replaced by a more technical approach.35 However,most medical texts maintained a strong moral attitude towards alcoholism,until well into the twentieth century.
Undoubtedly the factors mentioned in the previous section determined the
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moral conception of the problem, but other influences need to be considered,such as the concept of social illness or the doctrine of degeneration.When the hygienists analysed the social causes of the illnesses they did it
in two ways. On the one hand, they emphasized deficient living and workingconditions as the principal element in the spread of diseases. Bad diet,insanitary housing and unhygienic working conditions were considered
important factors in this perspective. On the other hand, there was a vision ofillness with roots in hygienism and organizational sociology, for ’whosecultivators the terms illness or social pathology made reference to thealterations of economical, political or moral order of society’.36 In this way,the concept of social illness came closer to vice, to social plague, incorporatingmoral vision to the pathology. A typical example of this attitude would be thediscussion which Federico Rubio y Gali (1827-1902)37 read in the RoyalAcademy of Medicine in 1890 in which he exposed the necessity for thecreation of an ’essentially medical’ science which would be entrusted withthe identification and scientific correction of the defects of the social
organization. Such defects included social pathologies like alcoholism, alongwith smoking, begging, vagrancy, prostitution and criminality, in the sectionof ’individual vices consequential to the family and to society’. 31 In the samesense, Julidn Juderias in 1911 defended the suggestion that the objective ofhygiene was not only the study of and struggle against illness but also ’that ofthe regretful deviation of moral character; alcoholism, for example, of
terrifying consequences that in some way attacks the health, the physicalrobustness, and the development of the species’.39 And in 1919 AntonioAguado Marioni and Luis Huertas in their Cartilla Popular de MedicinaSocial, considered alcoholism to be the fruit of ’insufficient culture’,including it in an extensive list of social pathologies:
That treatment of spiritual light, illuminating little by little the minds, andunited with the necessary measures of protection will sweep from thecivilized countries this entire series of shameful social abscesses known asPAUPERISM, ILLITERACY, ALCOHOLISM, SYPHILIS and theirfatal consequences TUBERCULOSIS, PROSTITUTION, CRIME,DEGENERATION, MADNESS. 40
Alcoholism was seen by the doctors more as a cause of illness, as a morbidhabit, than as a pathology in itself. One clarifying aspect of this way ofthinking can be found in the attention given to it by doctors as a cause oftuberculosis. Arturo Builla Alegre warned ’that alcohol prepares the way forKoch’s bacillus, drink disturbs the stomach, digestion is badly affected,appetite is lost and starvation is soon to follow, fertile ground for the
propagation of the tubercule.’41 Thus Antonio Espina y Capo (1850-1930),42at the International Congress on Tuberculosis, held in Paris in October1905, warned that ’the close relationship between alcoholism and tuberculosisis an axiom.’43 Manuel Martin Salazar (1854-1936) attributed the high death
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rate due to tuberculosis in Andalucia and in the north of Spain to a ’cause ofsocial disorder’: alcoholism.44 For many hygienists, therefore, the anti-tuberculosis struggle was ’intimately connected with the anti-alcoholic
struggle,.45Alcoholism as a cause of illness and a factor in the degeneration of the
species led to fears about the potential economic harm to the nation.46Hospital costs, lost working days and losses due to industrial accidents werearguments that carried weight in the condemnation of alcoholism. For
example, Antonio Espina y Capo, at the Conference on Social Securitiesof 1917, distinguished between ’illnesses avoidable by means of failsafeprophylaxis, such as vareola and typhoid fever, illnesses which until now arewithout vaccine nor means by which to avoid them, and those born ofmorbid habits such as alcohol and tobacco.’4’ The latter, provoked ’by easilycorrected habits’, should be, if not excluded from health insurance, at leastweighted according to the increased risks of the drinkers becoming sick. Toput on a par ’the compensation given to an abstainee from alcohol andtobacco and that given to a hardened alcoholic or smoker’, would be ruinousfor a Society of Mutual Aid.48
4. The alcoholic, a degenerate
Following Benedict Auguste Morel’s theory of degeneration in 1857,49mental illness was regarded as strictly somatic, physically-mediated, hereditaryand incurable. Alcoholism and morbid heredity very soon became the mostimportant putative causes of degeneration and their importance in the
aetiology of madness was emphasized. The idea that alcoholism could behereditary or, likewise, the existence of an ’hereditary tendency to alcoholism’was, in effect, described and studied in minute detail by French degenera-tionalist authors such as Valentin Magnan or Paul Maurice Legrain, 51 whoseworks powerfully influenced the medical discussions concerning alcoholismin Spain in the 1890s.
In this way Rafael Cervera Barat (1828-1908),51 following the example ofLegrain, referred, in 1896, ’to the laws of heredity of alcoholism’ with theaim of demonstrating that ’the perversions of alcoholism accumulate fromone generation to the next until the family has been completelyextinguished. 5’ Through three generations, always following the informationsupplied by the French author, Rafael Cervera established and classified intothree groups (weakness of intelligence, moral insanity and the impulsives) aseries of mental abnormalities inherited through alcoholism. ’These
inheritors’, he explained, ’suffer from a vast number of disorders andabnormalities of the mind, whose multiple effects science has combined intoone word: mental degeneration. 51The acceptance of ’polymorphic heredity’, by means of which mental
patients could go from generation to generation changing and ever worsening
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until arriving at the extinction and disappearance of the lineage, wasgenerally accepted amongst those doctors who took on the study ofalcoholism after 1890. The deterioration was transmitted by means ofinheritance, increasing the degeneration of the descendants until the point atwhich these formed ’a true pathological museum where any class of moral,physical or intellectual monstrosity could be studied, above all when themother or father abuse spirituous drinks’.54
Such authors emphasized the influence that the intoxication of parents,during coitus, could have upon offspring. Although the doctors were agreedin showing the predominance of alcoholism amongst men and that,therefore, these were seen as being largely responsible for hereditarytransmission, female alcoholism was considered more dangerous due to itsconvergence with the paternal 55 and the risks it would entail for the foetus.56The frequency of abortions, of premature births due to the weakness of thefoetus, and the high rate of child mortality were some of the catastrophicconsequences of maternal alcoholism.5’ There was, therefore, a pejorativedifference when it came to the evaluation of male and female alcoholismwhich was exaggerated by the differing conceptions of the social roles of eachsex.58The Spanish medical texts concerning this subject emphasized the
supporting evidence from the French studies, and used these arguments asmuch to warn the medical profession as the general public about the seriousthreat of alcohol abuse to the survival of the species. The words of EduardoGarcia del Real exemplify this warning:
The descendants of alcoholics are not only inferior in quality, that is tosay, are not only worse, more sickly, physically and intellectually weaker,but are moreover fewer in number. After some generations descendancyexhausts itself. Alcohol harms and destroys, as with other functions, thosewhich are destined for reproduction and the conservation of the species.Intoxication may be a cause, at the same time exciting amorous impulsesand making acts of fertilisation more difficult. The impossibility ofcarrying out these acts is seen very early in alcoholized subjects.59
Along very similar lines Antonio Piga (1879-1952) and Antonio AguadoMarioni considered that alcoholism could transmit, through heredity, ’allclasses of alterations to the nervous system (...), the clumsy, layabouts, thevice-ridden, the selfish, epileptics, the morally insane, dipsomaniacs, thepathologically erotic, melancholics, imbeciles, idiots and criminals, are thosetypes frequently seen’. 60
It should be mentioned that most of these texts were written not bypsychiatrists but by doctors concerned with public health. Explanations forthis phenomenon are not easily arrived at but some clarifying ideas can beseen. Firstly, Spanish psychiatry, despite being largely somaticist,61 could noteasily accept degenerationalism, as the most celebrated psychiatrists were
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directors of private mental institutions and their scientific efforts weredirected towards demonstrating to their wealthy clientele that insanity wascurable.62 Degeneration connected with the incurability of .mental illnesscould not easily be admitted to by a psychiatrist in this situation, to do sowould have been to attack his own scientific and economic interests. At theend of the nineteenth century Spanish psychiatry remained faithful to moraltreatment and to the asylum as a therapeutic institution without even
glimpsing the social prophylaxis which could be performed outside its walls.In contrast, public psychiatry was overcrowded, limited to containment,without economic resources and staffed by almost untrained psychiatrists. Itwas, therefore, barely able, until well into the twentieth century, to cope withthe incarceration of thousands of impoverished insane, let alone to produceoriginal scientific works.63
Secondly, Spanish psychiatry did not develop specific scientific studies
concerning aetiology except for some studies which analysed disorders of thewill or its relation to madness and crime.64 Clear diagnosis of alcoholism didnot even exist, judging by the opinions of some psychiatrists, due to the poorsystems of classification of mental illnesses used in the mental hospitals.&dquo;Faced with these factors it was natural that alcoholism linked to degenerationhad its greatest impact upon doctors whose origins were in public hygiene.The theory of degeneration, as put forward by Benedict Auguste Morel,despite its subsequent reinterpretation in a more scientific tone by ValentinMagnan and Paul Maurice Legrain,66 contained a strong moral componentwhich fitted in perfectly with the hypotheses defended by the hygienists.Moreover, despite its biological determinism, degenerationalism showedspecial interest in the work of social prophylaxis towards alcoholism and inthe social consequences to which this gave rise, to such an extent that it wasconsidered the source of all social ills, in line with the ideas of the hygienists.
Thirdly, it should be taken into account that at the end of the nineteenthand the beginning of the twentieth centuries the subject of degenerationinvaded both social and political language. Spain’s loss in 1898 of Cuba andthe Philippines to the United States, the grave domestic political crisis andincreasing social unrest made degeneration the principal explanation for thecauses of corruption and decadence in Spain. An abundance of hygienic andpsychiatric literature was produced which regarded the revolutionarydisturbances and movements as the fruits of madness, alcoholism and
degeneration. Covered by the ’scientific’ alibi of degeneration, concepts suchas alcoholism, insanity, socialism and revolution were placed at the samelevel.6’
Moreover, from this scientific and ideological context there arose a
regenerationalist movement which advocated the institutional reformationand regeneration of the country through education and moralization.68Always concerned with social and political issues, public hygiene fitted
comfortably with the aims of regenerationalism,69 which gave the doctors the
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opportunity to take to the public stage and warn about the dangers which thedegeneration of the race posed for the country.
5. The individual responsibility of the alcoholic
The relative importance of vice and illness in the aetiology of alcoholism is animportant issue. Most Spanish doctors were agreed in the definition ofalcoholism as a process of intoxication originating from the voluntaryconsumption of alcoholic drinks. Jose Ubeda de Correal, reflecting this
mentality, stated that ’alcoholism is the result of the toxic action upon theorganism from habitual and exaggerated use of alcoholic liquids, whatevertheir nature or origin. ,70 The fact that the individual alcoholized himselfvoluntarily is fundamental in understanding why alcoholism as a medicalconcept should incorporate moral evaluations, and why the alcoholic wasconsidered degenerate rather than sick. His responsibility for the acquisitionof the illness was insistently stated by anti-alcoholic writers.One factor which delayed the adoption of the alcoholism concept was the
division of the clinical symptoms into two stages: acute and chronic alcoholism.
Magnus Huss observed and described the difference which existed betweenthe physical and psychic effects (symptoms) which alcohol produced in theorganism depending on the grade of intoxication, distinguishing between afirst phase of acute alcoholism, equivalent to drunkenness, and a secondphase of chronic alcoholism which constituted the true pathology. Theseideas were apparently well understood by Spanish doctors:
The generality of the writers of the material does not admit to more thantwo groups, which are really no more than two phases in the intoxicationproduced by acute intoxication, which occur with one excess and
disappear with it, and which constitute what common language wouldrefer to as drunkenness, and chronic intoxication which is produced as aconsequence of repeated excesses and which imprints upon the organismserious and lasting modifications.’1
Acute alcoholism was not therefore an illness but a short-lived alcoholicintoxication whose effects disappeared with the elimination of the alcoholfrom the organism. On the contrary, chronic alcoholism was a permanentintoxication which was moreover born of ’acquired necessity’ and its
development would be ’in relation to the harm it produced, and to a greateror lesser desire for spirituous drink’. 71 However, it was not always admittedthat chronic alcoholism was an illness. The fact that chronic alcoholism wasthe product of continuous ingestion of alcoholic drinks was for many writerssynonymous with vice, with habit, whilst acute alcoholism was no more thanan accident.
Faced with this state of affairs, in 1914 Pedro Artes published a leafletentitled Drunkards in which he tried to clarify the ambiguity which hid the
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concept of alcoholism and the semantic confusion of the term ’drunk’. In his
opinion, alcoholism was only considered as an illness ’if, as a consequence ofthe drinking habit, conditions of the central nervous system are acquiredsuch as delirium tremens and dipsomania’, despite the fact that ’theseconditions are only the morbid effects of alcoholism.’’3 The narrow marginsto which alcoholism-illness was reduced and the lack of medical attention
given to its studies ’as an efficient cause of these states’ explained why it wasconsidered not to be medical material but a ’vice whose correction fell to themoralists and legislators’.&dquo;
Unfortunately, these interesting words spoken by an unknown provincialdoctor did not have much impact upon his colleagues. Alcoholism continuedto be largely considered as a vice and the proposed solutions in order tocombat it were moral.
REFERENCES
1. Brian Harrison, Drink and the Victorians: The Temperance Question in England, 1815-1872
(Pittsburgh, Pa: University of Pittsburgh Press, 1971); Harry Gene Levine, Demon of the MiddleClass: Self Control, Liquor and the Ideology of Temperance in 19th Century America (Berkeley, CA:University of California Press, 1978); A. E. Dingle, The Campaign for Prohibition in Victorian
England: The United Kingdom Alliance, 1872-1895 (New Brunswick, NJ: Rutgers UniversityPress, 1980); James S. Roberts, Drink, Temperance and the Working Class in Nmeteenth-CenturyGermany (Boston: George Allen & Unwin, 1984); Didier Nourrison, Le Buveur du XIXème siècle
(Paris: Albin Michel, 1989).2. José Sierra Alvarez, El obrero soñado. Ensayo sobre el paternalismo industrial (Asturias, 1890-1917)
(Madrid: Siglo XXI,1990); Pedro Trinidad Fernández, La defensa de la sociedad. Cárcel ydelincuencia en España (siglos XVIII-XX) (Madrid, Alianza Editorial, 1991); Adrian Shubert,’Paternalismo y mineria. Práctica social de la Hullera Española’, Cuadernos del Norte, xxix(1982), 82-90; Ricardo Campos Marin, ’Alcoholismo y reformismo social en la España de laRestauración’, en Angel González de Pablo (Coordinador), Enfermedad, Clínica y Patología.Estudios sobre el origen y desarrollo de la Medicina Contemporánea (Madrid: Editorial Complutense,1992), 161-73.
3. Teresa Camero, Expansión vinícola y atraso agrano (1870-1900) (Madrid: Servicio dePublicaciones Agrarias, 1980); Nuria Puig Raposo, ’La modernización de la industria delalcohol en Tarragona, Ciudad Real, Navarra y Granada 1888-1953’, en V Congreso de laAsociación de Historia Económica (San Sebastián: Universidad del Pais Vasco, 1993).
4. About the role of working class movement in anti-alcoholic struggle see Ricardo Campos Marin’Herencia y medio social en el discurso antialcohólico del socialismo español (1886-1923)’, enRafael Huertas y Ricardo Campos (Coords), Medicina Social y clase obrera en España (Siglos XIXy XX) (Madrid: FIM, 1992), 67-91; Carlos Serrano, ’Le vin du prolétaire. Alcool et sociabilitéouvrière en Espagne à la fin du XIX siècle’, en Raphael Carrasco, Solidadités et sociabilités en
Espagne (XVI-XX siècles) (Besançon: Annales de l’Université de Besançon, 1991), 371-89.5. Fernando Alvarez-Uria, Miserables y locos. Medicina mental y Orden social en la España del sigloXIX (Barcelona: Tusquets, 1983); Pedro Trinidad Fernández, ’Trabajo y pobreza en la primeraindustrialización’, en Historia de la Acción Social Pública en España. Beneficencia y Previsión
(Madrid: Ministerio de Asuntos sociales 1990), 101-33.(6) José Sierra Alvarez, ’¿El minero borracho? Alcoholismo y disciplinas industriales en Asturias’,
Cuadernos del Norte, xxix, 58-63; Aida Terrón Bañuelos, ’El sentido de la educación popularcomo educación de las necesidades. (Las funciones de la escuela en la Asturias industrializada)’,en José Luis Guereña, Alejandro Tiana (eds), Clases populares, cultura, educación. Siglos XIX-XX.Coloquio hispano-francés (Casa de Velázquez, Madrid, 15-17 junio de 1987) (Madrid: Casa deVelázquez, 1989), 143-58.
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7. About the reception of Huss’s ideas in France, see Henri Bernard, ’Alcoolisme et antial-coholisme en France au XIXe siècle (autour de Magnus Huss)’. Histoire économie et société
(Rhes), vi (1984), 609-28.8. Ricardo Campos Marín y Rafael Huertas, ’El alcoholismo como enfermedad social en la España
de la Restauración: problemas de definición’, Dynamis, xi (1991), 263-86; Ricardo CamposMarín, Alcoholismo y Sociedad: Un Análisis de la ideología antialcohólica en España (1850-1923)(Madrid: Facultad de Geografía e Historia. Universidad Complutense de Madrid. Unpublisheddoctoral thesis, 1994).
9. Eduardo L. Menéndez, ’Saber "médico" y saber "popular": el modelo médico hegemónico y sufunción ideológica en el proceso de alcoholización’, Estudios de Sociología de El Colegio de México,iii (8), (1985), 263-96, p. 264.
10. José Manuel López Piñero, Luis Garcia Ballester y Pedro Faus Sevilla, Medicina y sociedad en laEspaña del siglo XIX (Madrid, 1964); Esteban Rodriguez Ocaña, La constitución de la Medicinasocial como disciplina en España (1882-1923) (Madrid: Ministerio de Sanidad y Consumo,1987); Esteban Rodriguez Ocaña, ’Paz, trabajo, higiene. Los enunciados acerca de la higieneindustrial en la España del siglo XIX’, in Rafael Huertas y Ricardo Campos, Medicina Social yclase obrera en España. (Siglos XIX y XX) (Madrid: FIM, 1992, Vol. II), 383-406.
11. Pedro Felipe Monlau, doctor and philosopher, was one of the most important Spanishhygienists of the nineteenth century. Among his written works, those which stand out concernpublic hygiene, matrimonial hygiene and industrial hygiene, each with a large readership.Moreover he was the founder, in 1858, of El Monitor de la Salud (The Health Monitor), the firstSpanish journal dedicated to sanitary education.
12. Pedro Felipe Monlau, ’Remedios del pauperismo. Memoria para optar al premio ofrecido por laSociedad Económica Matritense el 1 de Mayo de 1845’ in Estudios de Historia Social, 10-11 (1979), 374-85, p. 376.
13. Trinidad, ’Trabajo y pobreza en la primera industrialización’, 101-33.14. Joaquín Salarich performed his professional role as the doctor in the Catalonian village of Vich.
He published several short works concerning matters of hygiene, demography and sociologywhich are contained amongst those highlighted by Higiene del Tejedor (Hygiene of the Weaver).
15. Joaquín Salarich, Higiene del Tejedor. O sean, medios físicos y morales para evitar las enfermedades yprocurar el bienestar de los obreros ocupados en hilar y tejer el algodón (Vich: Soler Hermanos 1858),in Antoni Jutglar, Condiciones de vida y trabajo obrero en España a mediados del siglo XIX (Barcelona:Anthropos, 1984.), 285-6.
16. Pedro Felipe Monlau, Elementos de higiene pública (Barcelona: P. Riera, 1847), 171.17. Salarich, Higiene del Tejedor, 256.18. Pedro Felipe Monlau, Elementos de higiene pública o arte de conservar la salud de los pueblos
(Madrid: Segunda edición, Vol. I, Carlos Bailly-Bailliere, 1862), 898-911.19. Pedro Mata Fontanet is considered to be the founder of legal medicine in Spain and of the
psychiatric school of Madrid. Likewise, he is considered to have introduced into Spain thesomatic psychiatric ideas put forward by French psychiatry.
20. Pedro Mata, Tratado de Medicina y Cirugía Legal teórica y práctica seguido de un compendio detoxicología. Quinta edición corregida, reformada, puesta al nivel de los conocimientos más modernos yarreglada a la legislación vigente (Madrid: Carlos Bailly-Bailliere, 1874).
21. Juan Giné y Partagás is considered to have been the founder of the Spanish school of psychiatryand the most important specialist in these matters of the nineteenth century. Defender ofsomaticism, since 1864 he directed the Manicomio de Nueva Belén (Nueva Belén Mental
Hospital) in Barcelona. In 1881 he founded the Revista Frenopática Barcelonesa (BarcelonaPhrenopatic Journal), the first Spanish psychiatric journal. Amongst his publications mentionshould be made of his essay on phrenopathology (1876), and an important essay of hygienepublished in 1871.
22. Juan Giné y Partagás, Tratado teórico-práctico de freno-patología o estudio de las enfermedadesmentales fundado en la clinica y en la fisiología de los centros nerviosos (Madrid: Moya y Plaza1876).
23. Salarich, Higiene del Tejedor, 194.24. Ibid.25. About the controversy over the relationship between misery and alcoholism, see Campos
Marín, ’Alcoholismo y reformismo social en España’, 161-73; Campos Marin, ’Herencia ymedio social en el discurso antialcohólico del socialismo español’, 67-91.
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26. Philip Hauser, a doctor of Hungarian origin and Spanish nationality, dedicated himselfprincipally to the study of medico-social questions, publishing two important works concerningSeville (1884) and Madrid (1902), in which he analysed the medico-social situation of bothcities. In the same way he won the Breant Prize of the Academy of Sciences of Paris in 1889and the Pettenkoffer Prize of Munich in 1899, both for works concerning cholera.
27. Philip Hauser, ’El pauperismo en Andalucia y singularmente en Sevilla’, Revista de España, n382 (1884), 198.
28. José Ubeda y Correal, El alcoholismo: sus efectos en el individuo y en su descendencia; su influenciadesmoralizadora en la sociedad y en la familia. Consejos para combatirlo y desterrarlo (Madrid:Imprenta de Administración Militar, 1901), 95.
29. José Ubeda y Correal, El presupuesto de una familia obrera (Madrid: Publicaciones de laDirección General de Sanidad, 1902), 53.
30. In reference to this see Juan Giné y Partagás, Curso elemental de Higiene privada y pública, Tomoprimero. Higiene Privada (Barcelona: Imprenta de Narciso Ramirez y Compañía, SegundaEdición 1871), 214-16.
31. ’El uso moderado del vino en las comidas’, La Lectura, xxi (1901), 759-68; 894-908.32. Ricardo Campos Marin, ’Casas para obreros. Un aspecto de la lucha antialcohólica en España
durante la Restauración’, Dynamis, xiv (1994), 111-30.33. Menéndez, ’Saber "médico", "saber popular"’, 263-96; Sierra Alvarez, ’¿El minero borracho?
Alcoholismo y disciplinas industriales en Asturias,’ 58-63.34. Amaro Del Rosal, ’La taberna como centro de discusión politica en Asturias 1914-1920’,
Cuadernos del Norte, xiv (1982), 79-84; in the review Estudios de Histona Social, 50-51, III-IV(1989) there are several papers about this subject: Jacques Maurice, ’Propuestas para unahistoria de la sociabilidad en la España contemporánea’, 133-43; Michel Ralle, ’La sociabilidadobrera en la sociedad de la Restauración (1875-1910)’, 161-99; Juan Luis Guereña, ’Unaaproximación a la sociabilidad popular: el caso de Asturias bajo la Restauración (1875-1900),’201-22; Jorge Uría, ’La taberna en Astunas a principios del siglo XX. Notas para su estudio.’Historia Contemporánea, v (1991), 53-72. Serrano, ’Le vin du prolétaire’, 377-89.
35. Rodriguez Ocaña, Paz, Trabajo e higiene, 386.36. Esteban Rodriguez Ocaña, ’El concepto social de enfermedad’, in Agustin Albarracín (Coord),
Historia de la enfermedad (Madrid: Saned 1987), 341-9, p.345.37. Federico Rubio Gali is considered to be the most important Spanish surgeon of the last quarter
of the nineteenth century. He completed his scientific training in England, working in 1860 as asurgeon alongside William Ferguson, and in Paris where, in 1864, he completed his surgicaltraining at the service of the Velpeau and Broca hospitals. In Spain he promoted the renovationof the medical institutions. In 1880 he created the Institute of Operational Therapy in thePrincesa Hospital of Madrid, formed by important surgeons and, in 1896, founded the firstmodem school of nurses.
38. Fedérico Rubio y Gali, ’Sociopatologia. Discursos leidos en la solemne sesión inagural del año1890 de la Real Academia de Medicina de Madrid’, Memorias de la Real Academia de Medicinade Madrid, x (5) (1890), 25-49, p.37.
39. Julián Juderías, La Higiene y su influencia en la legislación (Madrid: AIPLT, 1911), 14-15.40. Antonio Aguado Marioni y Luis Huerta, Cartilla Popular de Medicina Social (Madrid: Instituto
de Medicina social, 1919), 12-13.41. Arturo Builla Alegre, ’Cuestiones de Higiene Social’, Boletín de la Institución Libre de Enseñanza,
xxx (1906), 283.42. Antonio Espina y Capo centred his professional activities on heart and lung diseases, especially
in the study of tuberculosis. In 1889 he promoted the creation in Spain of an association whosepurpose it was to work against this disease. He was also the first Spanish doctor to useradioscopy and radiography on a regular basis.
43. Antonio Espina y Capo, ’Alcohol y tuberculosis. Comunicación hecha al Congreso Internacionalde la Tuberculosis celebrado en Paris en octubre de 1905’, Revista de Medicina y CirugíaPrácticas, lxx (1906), 129-40, p. 129.
44. Manuel Martin Salazar, La sanidad en España. Discurso leída ante la Real Academia de Medicina(Madrid: Imprenta del Colegio Nacional de Sordomudos y de Ciegos, 1913), 115.
45. Manuel Mer y Güel, Alcoholisme: trastorns que produeix y manera d’evitarlo. Discurs original legitper son autor en la Sesió Pública Inagural que l’Academia d’Higiene de Catalunya va a celebrarla vetlla del 17 de janer de 1908 (Barcelona: Academia d’Higiene de Catalunya, 1910), 13.
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46. In reference to this see: Pedro Sangro y Ros de Olano, Estudio sobre el alcoholismo y males queocasiona al individuo, a la familia y a la sociedad (Madrid: Garcia Rico, 1904), 39; Ubeda yCorreal, El alcoholismo, 96; Quintin López Gómez, El alcoholismo. Sus efectos y medios paraevitarlo (Madrid: Impr. J. Sastre y Cia, 1910), 33.
47. Antonio Espina y Capo, ’El seguro de la invalidez’, en Conferencia de seguros sociales celebrada enMadrid en los dias 24 al 31 de octubre de 1917 (Madrid: Imprenta de los Sobrinos de la Sucesorade M. Minuesa de los Rios, 1917), 10.
48. Ibid., 11-12.49. Benedict August Morel, Traité des dégénérescences physiques, intellectuelles et morales de l’espèce
humaine et des causes qui produisent ces variétés maladives (Paris: J. B. Baillière, 1857).50. Valentin Magnan, De l’alcoolisme, des diverses formes du délire alcoolique et de leur traitement (Paris:
Baillière, 1874); Valentin Magnan, Leçons sur la dipsomanie (Paris: Sainte Anne, 1882); PaulMaurice Legrain, Dégénérescence sociale et alcoolisme (Paris: George Carré Edit, 1891).
51. Rafael Cervera Barat could be considered as the founder of Spanish ophthalmology. In 1887 hewas named director of the Ophthalmological Institute of Madrid.
52. Rafael Cervera Barat, Alcoholismo y civilización (Valencia: Imp. de A. Cortés 1896), 22.53. Ibid., 23.54. Antonio Muñoz Ruiz de Pasanis, Alcoholismo. Su influencia en la degeneración de la raza latina
(Madrid, Ginés Carrión, 1906), 41-2.55. Cervera, Alcoholismo y civilización, 39-40, Manuel Villegas Montesinos, El peligro alcohólico (Córdoba:
Imp de la Escalilla de Caballería, 1911), 54.56. Eduardo Garcia del Real, Los peligros del alcohol (Madrid: Espasa Calpe, 1915), 159.57. Antonio Piga; Antonio Aguado Marioni, Las bebidas alcohóhcas. El alcoholismo (Barcelona:
Manuales Soler, 1904), 152-3.58. Ricardo Campos Marin, ’La instrumentalización de la mujer por la Medicina Social en España
a principio de siglo: su papel en la lucha antialcohólica’, Asclepio, xlii (2) (1990), 161-74; CamposMarin, ’Casas para obreros’,123-9.
59. Garcia del Real, Los peligros del alcohol, 176-760. Piga; Aguado Marioni, Las bebidas alcohólicas, 142-3.61. Rafael Huertas y José Martinez Pérez, ’Disease and crime in Spanish positivist psychiatry’,
History of Psychiatry, vi (1993), 459-81.62. José Maria Comelles, La Razón y la Sinrazón. Asistencia psiquiátrica y desarrollo del Estado en la
España Contemporánea (Barcelona: PPU, 1988); Rafael Huertas, Organización sanitaria y crisissocial en España. La discusión sobre el modelo de servicios sanitarios públicos en el primer tercio del sigloXX (Madrid: FIM, 1994), 91-8; Rafael Huertas, ’La psiquiatría española del siglo XIX.Primeros intentos de institucionalización’, en I Congreso de la Sociedad de Historia de la
psiquiatría. Un siglo de psiquiatría en España (Madrid: Extra Editorial, 1995), 21-40; RicardoCampos, ’Higiene mental y reforma de la asistencia psiquiátrica en España (1900-1931)’,Documentos de Psiquiatría Comunitaria, vii (1995), 199-217.
63. Julián Espinosa Iborra, La asistencia psiquiátrica en la España del siglo XIX (Valencia: Cátedra eInstituto de Historia de la Medicina, 1966); Comelles, La Razón y la Sinrazón, 42-9; RicardoCampos Marin, ’Psiquiatría e higiene social en la España de la Restauración’, I Congreso de laSociedad de Historia y Filosofia de la Psiquiatría. Un siglo de psiquiatría en España (Madrid: ExtraEditorial, 1995), 53-66.
64. Timoteo Sanz Gómez, ’Locura alcohólica. Curación’, El Siglo Médico, xlii (1895) 25-42; JoséGaliana, ’Locuras tóxicas e infecciosas’, El Siglo Médico, 1 (1903). 378-80; J. F. Ferrer, ’Profilaxissocial contra el alcoholismo’, Revista Frenopática Española, lxxi (1908), 327-31; AntonioSánchez Herrero, ’Demencia de origen alcohólico’, El Siglo Médico, lx (1913), 341-2.
65. Ots Esquerdo, V. (1893), ’Locura alcohólica’, El Siglo Médico, x1, n 2065, 470-88, p.470.66. Valentin Magnan; Paul Maurice Legrain, Les dégénérés. État mental et syndromes épisodiques
(Paris: Rueff et Cie, 1895).67. Luis Maristany, El gabinete del doctor Lombroso (Delincuencia y fin de siglo en Espana) (Barcelona:
Anagrama, 1973); Alvarez-Uria, Miserables y locos; Andrés Galera, Ciencia y delincuencia. Eldetermmismo antropológico en la España del siglo XIX (Madrid: CSIC, 1991); Ricardo Campos,’El alcoholismo como enfermedad social’; Ricardo Campos Marin, ’La sociedad enferma:higiene y moral en España en la segunda mitad del siglo XIX y principios del XX’, Hispania,lv/3, núm. 191 (1995), 1093-112.
68. Manuel Tuñón de Lara, Medio siglo de cultura española (1885-1936) (Madrid: Tecnos, 1973);
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José Carlos Mainer, La doma de la quimera. Ensayos sobre nacionalismo y cultura en España(Barcelona: Universidad Autónoma de Barcelona, 1988).
69. Esther López Keller, ’Hacia la quiebra de la mentalidad liberal: las resistencias al cambio’, enHistoria de la acción social pública en España (Madrid: Ministerio de Asuntos Sociales, 1990),137-60; Delfin Garcia Guerra y Víctor Alvarez Antuña, ’Regeneracionismo y Salud Pública. Elbienio de Angel Pulido al frente de la Dirección General de Sanidad (1901-1902)’, Dynamis,xiv (1994), 23-41.
70. Ubeda Correal, El alcoholismo, 15.71. Ubeda Correal, El alcoholismo, 21.72. Muñoz Ruiz de Pasanis, El alcoholismo, 62.73. Pedro Artés, Borrachos, Etiología, Sintomas, Diagnóstico, Pronóstico y Tratamiento (Alicante,
Papeleria, Libreria, y Tipografia San José, 1914), 8.74. Ibid.
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