Rosa Ballester, professor of history of science: ‘We know that decent housing or food is also important for improving health’ | Science

Rosa Ballester Añón (Valencia, 77 years old) receives this newspaper in 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 the scientific and medical practice of 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, science and medicine included, and later, during the period we call the silver age of science and medicine, which saw its protagonists go through this residence, we experienced another fantastic period of Europeanization, back in tune with the rest of the countries around us”, he says. Subsequently, in the years of Franco’s 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 summarizes.

One of the stellar moments in the medical and scientific history of Spain, which Ballester has studied extensively, is the Royal Philanthropic Vaccine Expedition, led by the Spanish physician Francisco Javier Balmis, in 1803. At the time, the Spanish Crown wanted to bring a remedy to the spread of smallpox in its American territories, in order to maintain a population capable of paying taxes and improve the image of a distant institution that had left a few years of dominion over those lands. To move Edward Jenner’s newly discovered vaccine, orphaned children, some as young as three years old, were used as a means of transportation for that medicine. As at other times in the study of the past, some enterprises, even those carried out with the best intentions, have used methods that are intolerable today.

To 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?

Reply. It is the world’s first international public health mission and has saved thousands of people on three continents. Shipping is something very positive. There is no need to take any kind of solemnity or importance away from this fact. On the other, the evaluation of the people who attended. Balmis is a very interesting character, with very firm authority and very clear ideas. Characters such as Isabel Zendal, director of the Casa de Expósitos [de la que salieron los niños que sirvieron de vehículo para la vacuna], is a heroine. But humans have lights and shadows. As happened with the authorities in America, the viceroys, for example, that of New Spain in Mexico did everything possible to make it not work.

And then there’s the key issue of children. You have to think about what it was like to be a foundling in the late 18th century and early 19th century. Virtually everything is unknown about these children, they were very vulnerable, children up to three years old. But to carry on the vaccination chain it was impossible to take cows, which was the place 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 settled, but we’re not sure what happened to all of them in the end. We know that at least two of them died on the street and then, depending on where they ended up, received a better or worse reception. No one ever returned to Spain. Nor is Isabel Zendal or an illegitimate child of hers that she traveled with.

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

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 is born. But then we see that there is progress, but also failures, because human biology is very complex and progress is not continuous. And the emergence 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 do it to heal. On the one hand, with the good work of scientists and doctors, for their moral integrity and, for example, by not saying that something is the discovery of the century or that we will change the way we treat a disease when clinical trials did not have the characteristics right. And also with good information in the media. That people have access to this information, for their own well-being, and that it is not sold as a movie of good guys and bad guys.

P. Throughout history, has ideology influenced 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 ​​administering medicines or performing surgery. We know that decent housing or food, an idea of ​​broader public health programs, also counts for improving health. Surgery, transplants, drug design or knowledge of the molecular dimension of pathologies are essential. But it is also necessary to 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 fundamental for human dignity. I believe that scientific research that is good for everyone should be promoted, even if this does not mean that the weight of foundations is not important. Historically we cannot forget, for example, the role of the Rockefeller Foundation.

“Drug design or knowledge of the molecular dimension of diseases are essential. But it is also necessary to work on the environment, on social inequalities”

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

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 into disease. For example, it is said that menstruation is a way for the female body to expel fluids, an excess of blood that hurts. While man, especially in his youth, is like perfection from a biological point of view. This has all sorts of social implications. Women did not enter universities, for example, in Medicine, until the late 19th century, and they could also study, but, at first, they could not practice.

As patients, there were many unknowns. For a long time it was thought that the uterus was a kind of living being of its own that was located in the abdominal cavity and that caused menopause or hot flashes to be interpreted as an ascent of the uterus, like a nearly living animal that saliva and touched the diaphragm. With the expansion of knowledge of anatomy, it is seen that women are not inferior, they are different from men, especially in these aspects.

Then there were other criticisms, which mainly came from excessive medicalization, such as childbirth or menopause. But we shouldn’t idealize natural childbirth either, because it carries risks. Like everything in life, virtue can be in the happy medium.

You can follow MATTER in Facebook, Chirping And Instagramtip here to receive our weekly newsletter.