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Pdf Maximiliano Rubín and the Context of Galdos's Medical Knowledge 97 MAXIMILIANO RUBÍN AND THE CONTEXT OF GALDÓS’S MEDICAL KNOWLEDGE Michael W. Stannard The Medical Context Galdós’s interest in doctors, medicine and abnormal mental states is well known and has been the subject of many studies.1 More than 50 doctors populate the pages of his fiction prompting Granjel to refer to a “colegio médico galdosiano” (167). Almost invariably these physicians are portrayed in a favorable light (García Lisbona, 105, note 3), epitomized particularly in the combination of scientific outlook and humane concern of Galdosian characters such as Augusto Miquis, Teodoro Golfín and Moreno Rubio. References to medications abound in the novels 2 while the medical sciences appear in a significant sample of Galdós’s journalistic articles more often than any other science.3 It is somewhat surprising, therefore, that Galdós’s knowledge of the medical sciences of his time should remain incompletely explored. It is the purpose of this paper to draw attention to the depth of Galdós’s understanding of the medical advances of his day, which still remains under-appreciated. Galdós wrote at a time of revolutionary changes in medicine. Gradually replacing the older vitalistic and humoral conceptions of disease, positivist medicine emanating especially from France identified anatomical abnormalities associated with many diseases (Laín Entralgo 273-308). Microscopical studies by Virchow and others from the 1840s onwards identified the cellular basis of disease. From the 1860s Pasteur and Koch showed the role of bacteria in infection while Lister found practical applications in his antiseptic, and later, aseptic techniques that revolutionized the scope and safety of surgery. In the decades of the 1870s and 1880s, when Galdós was writing many of his finest novels, dozens of disease-producing micro-organisms were identified.4 Prominent discoveries in human disease were the germs responsible for leprosy, tuberculosis, cholera, diphtheria, tetanus, anthrax and bacterial meningitis. These advances contributed to the high social esteem in which Madrid physicians were held in the 1880s, an admiration that Galdós shared.5 It might be asked how and where Galdós acquired his remarkably extensive knowledge of medicine. I know of no records of his research to indicate where he looked,6 but there are ample indications of likely sources. Firstly, he could be an indefatigable researcher when he wanted background information to give authenticity to his novels: financial speculation in Lo prohibido, the textile trade in Fortunata y Jacinta and women’s fashion in La de Bringas are good examples. Berkowitz describes how he would pursue individuals and sources of all kinds in search of the information he wanted ( Biblioteca 9-10); Leopoldo Alas notes the penetration with which he gathered information that he wanted.7 His special interest in medicine and doctors led him to cultivate the friendship of some of the leading Madrid physicians of his day. Foremost among these was his close, almost 40-year, friendship with Manuel Tolosa Latour (1857-1919) that is well 98 MICHAEL W. STANNARD documented, as are his letters soliciting and receiving from Tolosa detailed medical information.8 Tolosa Latour was Galdós’s probable contact with a remarkable group of physicians who played prominent roles in Madrid medicine in the last quarter of the Nineteenth Century, for he had been one of the disciples of the charismatic alienista José María Esquerdo who lectured in General Pathology as well as psychiatry in the newly liberated environment of medical education that followed the Gloriosa Revolución of 1868 (Eleizegui 29). Tolosa’s fellow students included the alienistas Jose María Escuder and Victoriano Garrido, the alienista-neuropsychologist Luís Simarro, the alienista-politician Jaime Vera, the criminal anthropologist Rafael Salillas and the medical journalist and campaigner Ángel Pulido (Ortega 65). In addition to this network, Galdós played host at home to other leading physicians like the surgeon Enrique Diego-Madrazo, who was one of those responsible for introducing Lister’s surgical techniques into Spain, and the professor of surgery at San Carlos, Alejandro San Martín, famous for introducing new surgical techniques and for his role in the adoption of inhalational anaesthesia (Marañón, 171).9 The 1880s saw much medical publishing in Spain with texts and encyclopedias translated from the French, English and German as well as works by Spanish authors. While knowledge of foreign languages and medical practice might be poor in the provinces (Seguin 458-59), the medical elites of Madrid and Barcelona were not only multilingual but also attended conferences abroad and obtained practical experience in major medical centers in France, England and Germany as a necessary part of their medical training. The medical books in what survives of Galdós’s library provide a sample of what Galdós had available to him (de la Nuez Caballero).10 Two volumes on nervous diseases by the Catalan, Armangué y Tuset, are to be found together with a translation from the English of volume II of the Bourroughs Wellcome Libro medico azul by Charles Christie, and a translation from the French of the fourth Spanish edition (eighth French edition) of Sigismond Jaccoud’s Tratado de patología interna with its dedication to Galdós by Tolosa Latour. A Spanish text dedicated to Galdós by the author, though uncut, is Diego-Madrazo’s Lecciones de Clínica quirúrgica. Heightened awareness of medicine was not only thrust upon the inhabitants of Madrid by the remarkable medical discoveries and the consequent changes in medical practice of the 1880s, but also by the dire state of the capital’s public health. Cities such as Paris, London, Birmingham and Manchester experienced explosive population growth in the preceding two thirds of the nineteenth century fed by migrants from rural districts in search of work. The population of Madrid increased from 398,000 in 1880 to 470,000 in 1890 and would reach 540,000 by 1900, an increase fed by migration from the land that more than offset the high mortality that particularly affected the young, who accounted for more than 40% of the deaths in the city while only responsible for 12% of the population (Goldman 158). Crowding of the poor in corrales on the Calle Toledo is described with documentary veracity by Galdós, in his Visita al cuarto estado in Fortunata y Jacinta,11 while the squalid conditions of under-the-roof dwellings of the casas de dormir and casas de vecindad of the notoriously ruinous barrios bajos of Inclusa, El Hospital and Latina (Bernaldo de Quirós and Llanas Aguilaniedo 123-132) provided an ideal environment for the spread of the typhus, cholera, diphtheria, tuberculosis, fevers and meningitis that Galdós describes.12 Attempts to prevent these diseases were not helped by lack of understanding of the mode of their transmission. The ancient miasmatic theory that disease was caused purely by bad smells MAXIMILIANO RUBÍN AND THE CONTEXT OF 99 GALDÓS’S MEDICAL KNOWLEDGE continued to be influential in Spain as in England until the end of the century, while Max von Pettenkofer’s variant telluric theory, in which epidemics were attributed to a pathological quality of certain soils,13 actually delayed implementation of measures to control the spread of water-borne diseases. Faced with such onslaughts of disease, community physicians tried to understand their origins and predisposing conditions with the best medical ideas they had to hand. They recognized the importance of poverty, dirt, overcrowding and malnutrition but were also impressed by the way in which diseases tended to run in families, which led them to suggest a causal, inherited predisposition. In Galdós’s time, it was widely accepted that the consequences of the physical and moral lives of parents would be passed on by heredity to their descendants, an idea associated with the theories of the French zoologist, Lamarck. This idea evolved into a wide-ranging theory of social ills in the work of the French aliéniste Benedict Morel (1809-1873) who propounded a theory of degeneration in 1857 to account for environment-related loss of primitive, biblical perfection.14 At the hands of his disciple Valentín Magnan, who was influenced by Darwin’s On the Origin of Species of 1859, the theory of degeneration acquired an evolutionary slant in which degeneration was attributed to regression to a supposedly more primitive and barbaric state (Huertas, “Magnan” 365). Social and medical thinkers of Galdós’s time brought this interpretive mind-set to the consideration of four great endemic diseases of modern city life, the so-called enfermedades sociales degenerativos, that appeared likely to undermine civilized society as they knew it (Hauser, “Siglo” 211-220). These conditions were tuberculosis, held to be largely familial and decimating all conditions within society; alcoholism, which became a fearsome social problem as a result of the recent development of industrial distillation and the widespread availability of cheap spirits (Hauser, “Siglo” 209-211); madness, attributed to heredity and the stresses of modern city life (Giné y Partagas, Freno-patología 217-237); and syphilis, attributed to the breakdown of morals and society associated with urban poverty and prostitution (García Viñas 153). The leading higienista, Hauser (1832-1925), in his surveys of the public health supported by improved population statistics, issued dire warnings. To him, these enfermedades seemed so universal and uncontrolled that they appeared to threaten Western society and even the human race itself.15 It is in this medical-scientific context that Galdós gave himself the task of portraying the middle class with all its strengths and weaknesses, but withal the class in whose energy, he believed early on, lay the future of Spanish society (Pérez Galdós, Observaciones 167). As a result, the created world of Galdós’s novels could not avoid portrayals of these enfermedades sociales degenerativas16 that menaced the world he depicted.
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