Rosa Ballester, professor of history of science: “We know that decent housing or food is also important to improve health” | Science

Rosa Ballester Añón (Valencia, 77 years old) receives this newspaper at the Student Residence, a symbol, founded in 1910, of what could have been the renaissance of Spanish culture and science before the Civil War and the Franco regime. Emeritus Professor of the History of Science at the Miguel Hernández University of Alicante, Ballester says that “in the Renaissance Spain was clearly at the forefront of scientific and medical practice at the time”, but that it later experienced “clear phases of decline”. “At the beginning of the 19th century, the period of Fernando VII was bad for everything, including science and medicine, and later, during the period that we call the silver age of science and medicine, which saw its protagonists go through this residence, we experienced another fantastic period of Europeanization, of being back in tune with the rest of the countries around us”, he recounts. Later, in the years of the Franco dictatorship there was a regression and from the 70s and 80s it began to be at a level similar to that of many Western countries”, she sums up.

One of the stellar moments in the medical and scientific history of Spain, which Ballester has studied in depth, is the Royal Philanthropic Vaccine Expedition, led by the Spanish doctor Francisco Javier Balmis, in 1803. Then, the Spanish Crown wanted to bring a remedy for the spread of smallpox to its American territories, in order to maintain a population capable of paying taxes and improving the image of a distant institution that had a few years of domination over those lands left. To move the newly discovered vaccine by Edward Jenner, orphaned children, some as young as three years old, were used as a means of transportation for that medicine. As on other occasions when studying the past, some feats, even those carried out with the best of intentions, used methods that are intolerable today.

Ask. How does a historian see a scientific milestone that cured thousands of people, but also used homeless children to achieve it? How should these past events be judged?

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Response. It is the first international public health mission in the world and has saved thousands of people on three continents. The expedition is something very positive. There is no need to take away any kind of solemnity or importance from that fact. On the other hand, the assessment of the people who intervened there. Balmis is a very interesting character, with very firm authority and very clear ideas. Figures like Isabel Zendal, the director of the Casa de Expósitos [de la que salieron los niños que sirvieron de vehículo para la vacuna], is a heroine. But human beings have lights and shadows. As happened with the authorities in America, the viceroys, for example, the one in New Spain in Mexico did everything possible so that it did not work.

And then there is the key issue of children. You have to think about what it was like to be a foundling at the end of the 18th century and the beginning of the 19th century. Virtually everything is unknown about these children, they were very vulnerable, children up to three years old. But in order to carry out the vaccination chain, it was impossible to take cows, which was where the vaccine was grown. Now this, from an ethical point of view, would be unthinkable, and in fact, we know that children died. Isabel Zendal made Carlos IV promise that once the expedition was over the children would be accommodated, but we are not sure what happened to all of them in the end. We know that at least two of them died on the way and then, depending on where they ended up, they received a better or worse reception. None ever returned to Spain. Nor is Isabel Zendal or an illegitimate son of hers with whom she traveled.

P. At that time of the Balmis expedition, the causes of diseases began to be better known and it seems that we are going to be able to eradicate them all, with vaccines and other means. Medicine has many successes, but over time we have taken those successes for granted and there seems to be more skepticism about the possibilities of medicine to heal us. Do you think this change in perception is justified?

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R. When it is known that there is a cause and effect relationship between some microbes and infectious diseases, and vaccines and other therapeutic options appear, an idea of ​​unlimited progress arises. But then we see that there are advances, but also failures, because human biology is very complex and progress is not continuous. And the appearance of new technologies, which give access to information that previously only professionals had, and which is sometimes not interpreted correctly, can encourage this skepticism.

I believe that this skepticism exists and that we have to heal. On the one hand, with the good work of scientists and doctors, for their moral integrity and, for example, not saying that something is the discovery of the century or that we are going to change the way we treat a disease when the clinical trial It didn’t have the right features. And also with good information in the media. That people have access to this information, for their own well-being, and that it not be sold as a film of good guys and bad guys.

P. Throughout history, is ideology seen to affect the way medicine is practiced?

R. Yes, of course. Those values ​​matter. If you look at the 2030 Agenda, the idea of ​​health goes far beyond the idea of ​​giving drugs or performing surgeries. We know that to improve health, decent housing or food also matters, an idea of ​​the broader public health programs. Surgery, transplants, drug design or knowledge of the molecular dimension of pathologies are essential. But it is also necessary that we work on the environment, on social inequalities.

In general, I bet for a vision of equity and justice and for public systems, that everyone can benefit from scientific and medical advances, because it is something basic for human dignity. I believe that scientific research that works for everyone must be promoted, although that does not mean that the weight of foundations is not important. On a historical level we cannot forget, for example, the role of the Rockefeller Foundation.

“The design of drugs or knowledge of the molecular dimension of pathologies are fundamental. But it is also necessary that we work on the environment, on social inequalities”

P. How has women’s health medicine treatment changed throughout history?

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R. When scientific medicine was born, in the Western world, in classical Greece, women considered themselves biologically inferior to men by nature. She was vulnerable, she was about to fall ill. For example, menstruation is said to be a way for the female organism to expel humors, an excess of blood that is bad. While the man, especially in the period of youth, he is like perfection from the biological point of view. This has social implications of all kinds. Women did not enter universities, for example, in Medicine, until the end of the 19th century, and they could also study, but, at first, they could not practice.

As patients, there was a lot of unknown. For a long time there was an idea that the uterus was a kind of being with its own life that was in the abdominal cavity and that caused menopause or hot flashes to be interpreted as an ascent of the uterus, like an almost living animal that ascended and touched the diaphragm. With the expansion of the knowledge of anatomy, it is seen that the woman is not inferior, she is different from the man, especially in these aspects.

Then there have been other criticisms, which have come mainly from excessive medicalization, for example, childbirth or menopause. But neither should we idealize natural childbirth, because it has risks. Like everything in life, virtue can be in the golden mean.

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