The main military medical… (Págs. 41-66) Joan Serrallonga The main military medical organisations in the rebel army, 1936-19391. Los organismos centrales de sanidad militar en el ejército sublevado, 1936-1939. Joan Serrallonga, Universitat Autònoma de Barcelona, España E-mail: [email protected] Abstract: For an accurate study of the 1936-1939 Spanish Civil War, it is important to analyze military health care. The reshuffle of the Military Me- dical Corps during the Republic reduced its staff and reinforced it. Medical Corps officers were divided after the military uprising of 1936. Rebels kept organic continuity, completely centralized around the Main Headquarters and the Board of Services. Healthcare network was rebuilt from military di- visions and invested with an attractive mobile structure. Medical troops were increased by urgent measures. The appointment of civil doctors and pharmacists was the most effective and lasting one. New military doctors would obtain good jobs in the first post war period. Keywords: Spanish Army, Military Medical Corps, Spanish Civil War, Mi- litary hospitals. Resumen: Para estudiar la Guerra Civil española de 1936-1939 resulta cru- cial evaluar la asistencia sanitaria militar. La remodelación del Cuerpo de Sanidad militar durante la República redujo los efectivos y ganó en firmeza. Al producirse la sublevación militar de 1936 los mandos de Sanidad Militar se dividieron. En línea de continuidad orgánica los sublevados centralizaron por completo este Cuerpo entorno a la Jefatura de Servicios y la Junta Fa- cultativa e implementaron urgentes medidas para conseguir efectivos. La asimilación de médicos y farmacéuticos civiles será la más efectiva y de mayor alcance. La red asistencial se construyó en base divisionaria y con una atrayente estructura móvil. En la inmediata posguerra la útil colocación situó a los asimilados. Palabras clave: Ejército español, Sanidad militar, Guerra Civil de 1936- 1939, Hospitales militares. 1 Recibido: 19/05/2015 Aceptado: 12/06/2015 Publicado: 25/06/2015 RUHM 7/ Vol 4/ 2015© ISSN: 2254-6111 41 The main military medical… (Págs. 41-66) Joan Serrallonga Introduction. he development of an efficient military health program is a determining factor in any campaign or war. Military manuals defined health services as “the conservation of hu- T man resources”. In this sense, one of the lessons drawn from World War I was the im- portance of a well-maintained and innovative system of military medicine. In the inter- war period, a strong drive was made to perfect procedures and strengthen the organiza- tion of military health services. Improvements included advances in surgery, surgical ambulances, nursing units, vaccines, the use of antiseptics to prevent gangrene, the crea- tion of front line hospitals, the replenishment of equipment and medicines, evacuation systems and, equally important, psychological assistance. These were essential elements in any armed conflict. And in the case of a ruthless civil war in which the civilian popu- lation became hostage to the fighters, the needs were even greater. Therefore, when ana- lyzing the Spanish Civil War of 1936-1939, establishing the role of military health care is fundamental. By the early 1930s, in contrast to the modern armies of Europe, the Spanish Ar- my had incorporated no distinctive equipment, strategies or tactics. Its ordnance was in such a ruinous state that often it was inoperative. The “art of war” was anything but innovative. Military training looked to the past. For over a century, organization of the Spanish Military Health Corps had been addressed only in the midst of colonial cam- paigns and was devoid of realistic budgets, lacking in planning and inferior to civilian health care. Reviews of the history of Spanish military medicine have revealed this sor- ry state of neglect. 2 It must even be said that reports were falsified to conceal its brutal failures. Among the population, the Corps medic came to mind only for his questionable role in authorizing exemptions from the obligatory military service. The popular view of military health care was formed during the blood-drenched Moroccan campaigns, and was to persist. Faced with inadequate equipment and lacking the necessary medicines, the valor and skill of surgeons and practitioners was the only training available in the North African battlefields. "Army medicine and, more particu- larly, surgery was dominated, between the end of the Great War and the outbreak of the Civil War, by the continuing struggle agains Maroccan insurgents... The army medical branch was highly respected, and its surgeons gained valuable experience in the Maroc- co campaings".3 But any military leader could see the need for more surgeons and for an overhaul of the service. Following the terrible disaster of 1921, medical Colonel Silvano Escribano, a hygienist, had denounced that military health care in the Riff War was cha- otic and raised the death toll. The general reforms undertaken by the Second Republic corrected some calamities. Ranks were established for medical practitioners and techni- cians, with viable budgets. But these military doctors were tied to the powerful physi- cians who controlled the country's health apparatus with an iron hand. In fact, due to the 2 Josep M. Massons Esplugas (1913-2012), famous surgeon in the Republican Military Health Corps and in the International Brigades during the Spanish Civil War, published at his expense the course book Historia de la Sanidad militar española, Barcelona, Pomarés Corredor, 1994, 4 vols. 3 Nicholas CONI: Medicine and warfare: Spain, 1936-1939, London, Routledge, 2007, pp. 8-10. RUHM 7/ Vol 4/ 2015© ISSN: 2254-6111 42 The main military medical… (Págs. 41-66) Joan Serrallonga constant lack of personnel and their meager salaries, the Military Health Corps had nev- er emerged from under their wing. With the military uprising of July 1936, management of military medicine be- came different on the two sides. Here, we are dealing with the rebel faction, in which the scarcity of competent and specialized personnel soon became evident. Enlistment mechanisms used throughout the war failed to contemplate the skills of the conscripts, only replacement numbers. 4 Incorporations from the Carlist ranks, the Falange or the Red Cross were equally insufficient. A different matter was the control of hospitals by religious congregations. Furthermore, as the rebels were unrepresented in international organizations, help from these quarters was scarce. The victors' historiography has ex- plained the service, but their account is incorrect. In reality, military doctors failed to control the medical service and were incapable of assuring continuous care. Therefore, the role of civilian doctors was key. The incorporation of civilian physicians and pharmacists made up for the scant military staff. As a result, the civilian population in Nationalist Spain suffered partial neglect. Rebel leaders demanded all categories of medical personnel, specially sur- geons. It was hardly an easy task to organize a health service that covered the whole front line and handled the evacuation to rearguard hospitals. The establishment of a network of medical centers proved to be key to winning the war, as much for technical reasons as for troop morale. Civilian doctors, already purged, ran the set-up under light military supervision. As in the case of other cliques, the thick web of interests of physi- cians within the state apparatus prevailed. After the war, those who controlled civilian medicine returned advantageously to the center of power, made use of clientelism and viciously purged whoever had remained faithful to the Republic. In general, the Civil War represented a total halt to the modernizations undertaken by the Republic and cre- ated a breach of such colossal dimensions that it could no longer be closed. 1. Military Health Corps troops before the uprising. After the announcement of the military reform by Azaña, on 25th April 1931, there was a significant reduction in the number of troops in the Spanish army. Although some officers, much of them still feeling pessimistic after colonial losses, withdrew to avoid taking the oath of allegiance to the Republic, in fact the majority did so to obtain the attractive extraordinary retirement facilitated by the reform. The Military Medical Corps reduced by the same proportion, thereby putting an end to the unprecedented ac- cumulation of officers. It has been stressed that it is virtually impossible to ascertain the number of military members who had asked for early retirement, but this affirmation should be clarified. Alpert, with some difficulties, quantified the reduction for the ma- jority of the forces: ‘Of a total in 1931 of 20,576 commanding officers and officers, including those from the paid reserve forces, but not the disability corps, the 1932 forc- 4 James MATTHEWS: Reluctant Warriors. Republican Popular Army and Nationalist Army in the Spa- nish Civil War, 1936-1939, Oxford, Oxford UP, 2012, pp. 37-42, data in Table 2 (p. 38). Michael AL- PERT: “Soldiers, Politics and War”, in Paul PRESTON (ed.), Revolution and War in Spain, 1931-1939, New York, Methuen, 1984, pp. 202-224. RUHM 7/ Vol 4/ 2015© ISSN: 2254-6111 43 The main military medical… (Págs. 41-66) Joan Serrallonga es dropped to 12,373, with the active and reserve ones merged The difference was, therefore, 8,203 commanding officers and officers’. Puell, following the staff registers, raises the figure to 8,328.5 With Diego Durán Hidalgo