Hookworm in rural Spain, 1910–1960: shifting paradigms around the Civil War

Background: In Spain, hookworm was first recognised as a miners’ disease, becoming the goal of one of the most successful interventions in public health from 1912 to 1931. Hookworm also played a part in the growing interest in rural health problems that peaked during the Republican period (1931–6). The aim of this study was to compare the rationale and content of public health interventions against rural hookworm in Spain before the Civil War (1936–9) with those of interventions after the war. Methods: Review of published and unpublished documents on hookworm produced by individual physicians and public health officials in the first half of the 20th century. Results: Rural hookworm foci detected in pre-war years were explained in terms of the geographical and human environment and largely attributed to poor working and living conditions, prompting specific health campaigns. New rural foci were detected after the war, but this time the health administration did not intervene. Understanding of the disease changed, its impact on reproduction was highlighted and medical explanations pointed to the negative moral conditions of peasants rather than social issues. Conclusion: Civil War brought rupture and continuity to the public health domain. Although the Francoist health administration preserved similar organisation patterns, its practice was governed by different priorities. Moral and even religious positions provided a rationale for what had been previously explained in social and environmental terms. This approach, together with the perception of hookworm as evidence of backwardness, led to official neglect of the condition, which was still prevalent in some rural areas.