Abstract
Recent accounting for disease in the aftermath of the Spanish Civil War has been contained within study of hunger in the early 1940s. Historians have cited the typhus epidemic which hit Spain between 1939 and 1945 as demonstrating a causal link between widespread semi-starvation and disease. Though important, the focus on hunger risks losing sight of other vital elements in the onset and transmission of typhus, however, as well as the way the epidemic's progress sheds light on population movement as central to the broader social history of the war and its aftermath.
By paying close attention to epidemiological records, this article argues that the direct causes of typhus and its vertiginous spread were primarily ideological and spatial. It shows first how the war's victors used the language of political and bacterial contagion to claim spuriously that the wartime Republic was responsible for the epidemic. It then demonstrates how the intense confinement on a huge scale of those linked to the Republic was at the root of the disease. Transmission depended on this mass imprisonment and on the increased circulation of families to support those in captivity. Finally, typhus influenced the social imagination of the Franco regime and its anxiety about hygiene, prisons, and control of the movement of the urban poor.
Typhus fever has long been associated with wartime conditions which produce mass displacement, increased population density, and poverty. The typhus bacteria – first identified experimentally in 1909 – is transmitted from person to person by body lice, which proliferate in overcrowded and unclean conditions, feeding on their human hosts. The link of typhus to conscripted armies and displaced civilians, as well as cramped factory conditions, slum housing, and prisons, underlies the association of typhus with the poor: the ‘dangerous classes’ of bourgeois imagination, ripe for denigration through symbols of dread related to vermin or ‘foreignness’. 1 Towards the end of the nineteenth century, bacteriology already had a scientific explanation for the spread of infectious disease, including typhus, but this progress only heightened the anxieties within affluent society about human transmission across the boundaries of social class and physical space. 2
This article examines the largely unexplored typhus epidemic which hit Spain in the aftermath of the civil war of 1936–1939. By combining political, socio-economic, epidemiological, and cultural dimensions, it aims to make connections between the war and immediate post-war periods and between two broad historiographical approaches which have conventionally posed separate sets of questions about disease in Spain in this era: the history of medicine, on the one hand, and histories of politics and the state, on the other. The advantage of a hybrid approach is illustrated by the first war-related outbreak of typhus in recently ‘liberated’ Madrid in 1939, which lasted from early April until September, producing 72 recorded cases, of which 19 per cent died. The wartime Francoist authorities had, in their own propaganda, already announced the presence of typhus among ‘the revolutionary masses’ of the Republican war zone, subsisting amid ‘wretchedness’ and ‘disorganization’. 3 They raised the spectre of the disease, associating it with ‘Asiatic Communism’, because it fitted the image of the enemy they were constructing and against which their ‘crusade’ was waged. 4 Some historical accounts have been ready to accept this constructed thesis that the ‘chaos’ and ‘dirt’ of the Republican zone meant that typhus must have been present because it appeared to be supported by selected sources. 5 But written impressions recorded in political documents are unreliable. Typhoid fever, a more common malady, was for instance very frequently mistaken for typhus in these accounts, in part because of linguistic confusion: typhoid has often been known as typhus abdominalis, in spite of its distinct bacterial origin. 6 Significantly, typhoid did not possess the ideological potential and ‘othering’ connotations commonly associated with typhus. Spanish medics could also produce less than reliable testimony as they were keen to ingratiate themselves with the wartime ‘liberators’ by portraying Republican health authorities as uniformly inept. In the aftermath, moreover, insurgent authorities refused to publish captured documents that testified to the Republic's substantial wartime achievements in public health. 7
The current article is based on documentation produced by international and Spanish medical officials and epidemiologists on the ground in both zones – government and insurgent – which demonstrates that no outbreak of typhus fever was identified in the Republican zone and only very few isolated cases occurred throughout wartime Spain. 8 It shows that typhus only materialized as a threat in the immediate aftermath of Madrid's occupation by Franco's forces at the end of March 1939 as the embryonic state's punitive form of demobilization, encompassing an organized mass incarceration of individuals identified with the Republic, was prioritized. This not only produced a huge prison population but triggered a large-scale and informal movement of people – often the poorest and most vulnerable – to avoid repression in their home villages and towns, or in search of shelter, employment or food, or to maintain contact with and sustain detained family members.
The most devastating wave of typhus peaked in Madrid in 1941, at the same time as epidemic outbreaks occurred in several areas of southern Spain and, a little later, in the north, reaching as far as Barcelona, where there were some 2400 recorded cases in 1942–1943 and 500 deaths. In Madrid, a thousand cases were reported in May 1941 and more than 6300 were recorded by August, producing almost a thousand deaths. By the end of 1941, the number of registered cases in Spain had more than doubled to some 15,000. Dr John Janney, a medical officer from the International Health Division (IHD) of the US Rockefeller Foundation (RF), noted that care in Madrid isolation hospitals, particularly the Hospital del Rey, had been ‘entirely inadequate’ and had contributed to the high mortality rate. 9 Panic was reported and people with the means had begun to depart the capital to the extent that the overloaded train system was collapsing. 10 With the war in Europe, international health officials on the ground feared typhus transmission from Spain to France, from where, amid the disruption of Nazi occupation, it might have spread eastwards (they argued) to rival the typhus pandemic of 1918 in the Balkans and Russia. 11 The Director General of Health, José Alberto Palanca, imagined a return to ‘medieval times’. 12 While opining privately that a ‘national catastrophe was inevitable’ because of the lack of means to combat the disease, publicly he blamed propaganda from foreign radio stations for ‘fabricating’ and exaggerating the danger. 13 Palanca knew that the civil war had disproportionately displaced people in the areas which had supported the Republic, and to him it seemed natural to see this ‘unstable mass’ as responsible for the epidemic: ‘the Reds had typhus during the war’ and, at the end of the war, ‘the Red population’ had sought sinuously to ‘melt into, infiltrate and hide itself’ within ‘the National population’. 14 He argued that this ‘infiltration’ was why the epidemic had struck only at this moment. 15
Between the beginning of the twentieth century and the civil war, typhus fever had made intermittent inroads in Spain, with significant loss of life in 1909 and, to a lesser degree, in 1919. During the relatively developmental years of the military dictatorship in the 1920s and the era of public health reform during the Second Republic in 1931–1936 cases were rare. 16 Epidemiologists expected typhus to appear with the conditions of mobilized conflict in 1936; and yet numbers remained low, with 11 cases in 1937 and 13 in 1938, even though rates of other diseases rose because of wartime damage to infrastructure (by air bombardment and shelling) and to neighbourhood public health provision. 17 Increasingly, health officials in the Francoist zone had to deal with large numbers of refugees who had initially fled ahead of Franco's armies, only then to be caught up by them as the military advance continued. These officials insisted on the absolute isolation ‘of all the sick or suspect [sospechosos] who come from epidemic regions’, by which they meant Republican areas, and thus all the refugees. 18 The term ‘suspect’ had two meanings since medical policing measures were being enacted simultaneously with the violent purge of political enemies. Civil governors responded to the situation first by mobilizing ‘friendly’ medical expertise and ‘healthy’ society to isolate those considered a threat. They also attempted to export the problem to other provinces.
Vaccines were being trialled in Europe and the US by 1936, but they were not yet reliable or widely available and Spain lacked resources to develop its own effective supplies. 19 In some Francoist areas efficacious imported vaccine was reserved exclusively for ‘the well-to-do’, as a Rockefeller Foundation epidemiologist observed. 20 Vaccinations in Francoist wartime prison camps were, in contrast, neglected by military authorities. From late 1939, civil governors became involved with the mass incarceration, described by the new regime as the ‘notorious growth’, of a prison population of ‘those who had participated in the monstrous Marxist rebellion’. 21 From this moment, governors, in collaboration with the Dirección General de Prisiones, were required to regulate health measures, including vaccinations of dubious quality against smallpox and typhus, in coordination with provincial health chiefs, as well as finding buildings to be used as temporary prisons, and controlling visits to them and managing food supplies. One of the projects conducted by Rockefeller officials in Spain was a laboratory-supported trial of vaccines in the prisons of Madrid in 1941. Lice infestation, they reported, was ‘universal’ in the city's gaols, all of them ‘heavily overcrowded with political prisoners’. 22 The Yeserías gaol was typical: it held 4000 inmates in 1941 who shared their space with ‘hundreds of brown rats’. 23 Prisoners constituted a large and captive sample for study, even if – problematically – visits meant they were not entirely isolated from the population under surveillance ‘on the outside’. 24
Three important questions arise from the narrative account of typhus in Spain given thus far. First, why did the pathogen not strike during the large-scale circulation of refugees in deprived conditions inside the Republican war zone during the period 1936–1939? Second, why did it appear later with Franco's victory? And third, why – after the initial surge in 1939 – did typhus return more virulently and spread widely two years later? The high incidence of disease in this period has been explained elsewhere by reference to the hunger of the early 1940s, which was so extreme as to be described as a famine in several regions in Spain. 25 Poverty and hunger certainly played a significant role in diminishing resistance to infections of all kinds. While typhus was contracted by a few more affluent individuals during the epidemic, the vast majority of the infected were poor. 26 Indeed, hunger was instrumentalized politically by the Francoist authorities, becoming a further element in the repression throughout the 1940s. 27 But hunger had also been a considerable problem in the wartime Republican zone because the refugee-inflated urban population stretched food supplies. And yet these wartime regions remained typhus-free.
The focus on hunger in explaining post-war sickness, though important, risks losing sight of other key elements in the spread and increase of contagious disease, as well as the way its course sheds light on the poorly understood but widespread population movement which was central to the broader social history of the war and its aftermath. When a leading Spanish epidemiologist, Manuel Mezquita López, summarized the typhus epidemic in the southern port of Málaga – one of the cities hardest hit in 1941 – he made the nutritional factor clear, but was also careful to explain precisely how hunger played a role within broader social dislocation: The association between hunger and typhus is owing not only to semi-starvation diminishing resistance to all infections, but also to the parallel anomalies and disturbances which are produced by prevailing and complex sociological mechanisms (the search for work and food, lack of clothing, soap, coal, etc.) which leads to a state of destitution and squalor that favours the propagation of lice and with it the spread of the sickness.
28
This glimpse of the bleak social landscape points us towards the political, economic, and social dimensions of the epidemic. The forced labour camps and gaols were at the heart of the construction of the Francoist state and the repressive moral economy by which it was ideologically buttressed. Mezquita had already been ‘purged’ by the Francoist health authorities, demoted for working in the Republican zone during the war, so he was careful not to risk further reprisal by suggesting that poverty was aimed punitively at the defeated. He also avoided mention of political prisoners, even though his work in Málaga made the connection between overcrowded prisons and typhus abundantly clear. The disease began, however, in the civil population among the displaced visiting families, described by another local prison doctor as a ‘parasitic social group which daily crowded the prison’, as they brought food and clothing for relatives. 29 The city had also drawn many more hungry and fearful migrants from the surrounding region, who were escaping the repressive environment of village life; these individuals were then constructed in Francoist discourse as ‘vagrant’, and frequently rounded up and placed in ‘preventive custody’ in already overcrowded prisons. 30 Transmission escalated in this way.
Paying attention to the methods of epidemiologists and the sources they leave allows an appreciation of how the direct causes of the typhus epidemic were primarily spatial: first, prolonged overcrowding of populations within confined spaces; and second, accelerated spread through the increased circulation of people, often escaping repression or seeking to support those in captivity. This society in motion was referred to by Palanca at the peak of the 1941 typhus wave as ‘the dance of the Spaniards’. 31 Homing in on the epidemic permits us to see how a dialectic was at play which went beyond questions of medical health: the key relation was between repressive control and popular responses to this control, as people sought to maximize their chances of survival by becoming migrants. 32
War Zones, Typhus, and the Language of Contagion
The wrenching dislocations imposed by Spain's war had been particularly acute in the Republican zone: first, because it was less well provisioned (the Republic held the populous big cities, while Franco rapidly controlled the major food-producing areas); and second, because Republican territory also shrank under constant military pressure. This produced the large-scale movement of civilians, initially under their own steam, from the south to Madrid. Precisely to avoid epidemics as a result of acute population density in the capital, the Republican authorities encouraged the dispersal of refugees through evacuation towards Catalonia and Valencia, which in turn became overcrowded. Epidemiologically-informed evacuation was supplemented by a coordinated Republican programme of public health, including publicity campaigns, development of fumigation technology, anti-crowding measures, vaccines, and the material aid and expertise of international charitable organizations. 33 As the Francoists occupied this or that town during the course of the war, they thus inherited a demographic situation in flux, controlling the consequences of which was delicately balanced. The occupiers, however, exacerbated the dangers by insisting on the rapid, comprehensive, political categorization of ‘the defeated’.
Their plans for a ‘liberated’ Madrid began to be put in place early, in October 1936, when the city's fall seemed imminent. 34 From the outset, internal security was placed alongside considerations of public health in measures that included the use of passes to control movement in and out of city, and plans for a census of neighbourhoods. 35 Public order also combined with hygiene and quarantine in the later plan of November 1937, with which Palanca was closely involved and which stated that ‘the function of security [was] not only repression but also the preventative work of sanitation and the cleansing of a society in which elements that elude mere formal surveillance remain floating around’. 36
Franco's own public pronouncements underlined the security–health link. His message relayed within the insurgent zone on 18 July 1938 contained a warning about the Republican enemy: ‘The health of the Fatherland, as with the health of bodies, requires the quarantine of those who come from plague-infested territory’.
37
Towards the end of the civil war (which ended formally on 1 April 1939), he further conflated the ‘suggestibility’ of the popular classes with the spread of a bacterial danger issuing from an internal enemy: It is not possible, without taking precautions, to return to social circulation, harmful, perverted, politically and morally poisoned elements, because their incorporation into the free and normal community of Spaniards would represent a danger of corruption and contagion for everyone.
38
The Francoist insurgents’ occupation of the north coast by autumn 1937 (the Basque Country, Santander, and Asturias) was viewed as a dry run for imposing control over the big cities – Madrid, Barcelona, and Valencia. Republican defence of Santander was undermined from within by a rebellion of fifth columnists at the same time as 150,000 refugees arrived by road in late June from the now occupied Basque Country, with – according to Francoist health officials in Santander – ‘an appalling intensity’. 39 The city had been ‘inundated’, creating an unprecedented social mixing as population pressure temporarily broke down the usual urban stratification. 40 The subsequent order issued by the occupying military for ‘confinement to their homes’ of ‘the Republican population’ to prevent individuals from eluding political investigation led to fearful surges towards the quays to escape, thwarted for weeks because of Franco's blockade of the port. The repressive aims underlying the occupation thus compounded overcrowding and increased the epidemiological risks. The Republican authorities were nonetheless blamed for the situation by a Francoist health official: ‘Thus was the final Red evacuation [towards] Santander, without sanitary provision and in a state of complete savagery’, despite the fact that the health records in Santander showed only a handful of cases of measles among Republican migrants on the north coast between September 1936 and the ‘liberation’ in the summer of 1937, and no sign up to that point of typhus. 41
A similar priority of investigation and categorization informed the occupation of Madrid itself. The edict of the occupying military authorities on 30 March 1939 starkly declared: ‘the calmness of our triumph allows us to measure the guilt of our enemies precisely’. 42 There were to be no evacuations except to rapidly overflowing concentration camps. The urban space was divided into numbered militarized districts to facilitate political vigilance. From the testimonies of people arriving and leaving (fleeing repression, seeking anonymity, depending on the black market for basic necessities etc.), we know that this total control of movement proved impossible. Demographically, the peripheral, neglected, and overcrowded margins of Madrid (e.g., Carabanchel and Vallecas) grew vertiginously after the war's end was declared on 1 April 1939. These zones were long associated by social commentators with vice and ‘dirt’, and they were seen as ‘infectious spaces’. 43 In addition, there were a number of more socially mixed areas of the city, liminal zones, such as Chamberí, where wealthy and poor lived nervously cheek by jowl. 44
Already by early 1939, Franco's controlled press had announced that experimental vaccine programmes were being accelerated. This overstated what was feasible, but fuelled propaganda about ‘malign microbes’ which would be imported from previously Republican areas. 45 The first typhus victim in the city of Madrid became ill on 2 April 1939. This was the beginning of the initial post-war typhus epidemic, although the occupying authorities claimed that the first case arose in early March when the city remained ‘under Red domination’, following ‘thirty-two months of filth and hunger’. 46 After ‘liberation’, the city's Falangist mayor boasted that its state of health ‘could not be more excellent’, a situation he contrasted inaccurately with the Republic's record: ‘when we arrived we found a population overrun by misery and, as a consequence with real epidemics of typhus and cases of smallpox aggravated by a lack of the elementary means to combat these plagues’. 47 Censorship allowed the Franco government to propagate a simple narrative which explained the epidemic by reference to the physical convergence of the two wartime zones: ‘Red Spain’ and ‘healthy Spain’. The Republic, it was claimed, had already suffered an epidemic; this was ‘natural’ since its zone was proletarian, with all the ‘uncontrollable vices’ that this entailed, and its war effort was backed by ‘foreign’ forces disseminating ‘foreign ideas’. 48 The health services of the Republican wartime zone had in truth proved remarkably effective, however, although the outcome of the war determined that henceforward it would be those from Republican areas who suffered most from typhus.
A study of the cases in Madrid in 1939, undertaken by health officials acceptable to the new authorities, showed, in fact, that typhus had not resulted from insanitary conditions in the wartime city but was ‘imported’ by movement of a ‘dangerous’ population, infected with lice, leading to ‘inter-human contagion’. 49 The study confirmed implicitly that the Francoist policy of imprisoning evacuees in camps before dispatching them to their places of origin for political assessment exacerbated the spread of infection. The first victims were predominantly inward migrants, including those fleeing violent purges elsewhere. Typical of the odyssey of refugees was a 25 year-old woman who had fled Santander with its capture in 1937, first to Valencia, and thence to the poor district of Tetuán in the north of Madrid where typhus spiralled in 1941. 50 Equally, the parents of a 7 year-old boy who contracted typhus had come from an agricultural town in Ciudad Real where economic production had been collectivized by Republicans during the war. As soon as the Francoist authorities took over, corralling ‘the guilty’ began as part of a wave of state-enforced retribution. The family fled to the greater anonymity of Madrid and settled in outlying Vallecas. The boy became infected either during the intense confinement before leaving or on arrival in Vallecas, where typhus had taken hold when the local football ground was deployed as a concentration camp to hold hundreds of prisoners huddled together in freezing conditions. 51 Vallecas became a focus of typhus again in 1941 at a time when many male breadwinners there were either imprisoned or unemployed. By June 1941, John Janney reported, the local populace had ‘been starving for a long time’. 52 Migrants included families returning from wartime evacuation as well as soldiers (‘Red militiamen’) ordered to return to their place of origin for political investigation, even though many no longer had homes to return to in the capital. Other typhus victims in Vallecas and similar poor peripheral Madrid neighbourhoods in 1939 were migrants from the agrarian towns of the south-east, such as Murcia, where Francoist occupation and confinement was accompanied by desperate hunger. 53
These aspects of the grim social reality of the war's aftermath were ideologically constructed in Francoist publicity. The ‘evil customs’ of uncleanliness of migrants and the proletarian classes were ‘the sad inheritance of the Marxist period’.
54
Epidemics threatened because of the personal habits of social groups which were ‘infected’ by ‘filth’, ‘neglect’ and ‘moral abandonment’, the product of ‘vulgar-Marxistoid permissiveness which inundates our lives’, creating ‘deplorable inter-social mixing’.
55
In July 1941, Janney, visiting some of the poorest families in Málaga, who lived in dark, poorly ventilated, and overcrowded communal lodging houses (corralones), each with up to 70 families, assessed the situation more rationally: For the most part, these living quarters are as clean as it is possible to have them considering the enormous handicaps under which these people are trying to live. In several instances we found the breadwinner of the family ill, and in others he was either imprisoned, dead, or out of work.
56
The controlled press placed ‘vigilance’ first, ‘in the name of the Patria’, by calling on ‘citizens’ to denounce ‘dirty persons’, beggars, and the homeless as a threatening ‘invasion of national territory’. 61 One of the first acts of the health authorities’ Junta de Epidemias (Epidemic Commission) was to institute a cleanliness campaign. Orders were issued to permit the police, and Falangists, to detain persons in an ‘unclean state’. 62 This ‘disinfection’ went together with typically fascist rituals of punishment, such as forced ingestion of purgatives (usually castor oil). Men thus targeted had their heads shaved and women had theirs doused in vinegar and their bodies scrubbed with soap blended from oil and petroleum, a method being employed in the Jewish ghetto of occupied Warsaw, as Palanca knew from his 1941 visit to Nazi Germany's ‘General Government’. 63 When the Francoist authorities resorted to head-shaving in Madrid and elsewhere in 1940–1941 to ‘purify’ migrant women, the recipients responded angrily because of the memory of these same techniques inflicted in their home villages as political punishment. Such was the hostility to these methods in working-class neighbourhoods that the authorities called instead for mobile gas apparatus to disinfect people. 64
Between 1942 and 1945, the typhus epidemic in Spain was gradually controlled, somewhat against expectations and partly as a result of largely unacknowledged international assistance which patched over the gaps left by Franco's purge of medical doctors and public health specialists associated with the Republic. At the end of the war, approximately 1000 officials and employees of the Madrid Health Department were brought before a Political Responsibilities court appointed by the Director General of Health, Palanca; at least 800 were similarly processed in Barcelona, many being suspended or forcibly relocated. 65 Palanca was a political conservative, elected for the Catholic CEDA in 1933, who had served in Spain's colonial army in North Africa. He was a friend of both General Emilio Mola, first head of the July 1936 military rebellion, and of General Severiano Martínez Anido, a notoriously repressive city governor in Barcelona after the First World War, who in 1937 Franco named as Chief of Internal Security, Public Order and Border Inspection. Palanca himself oversaw the purges in the medical profession, including the removal in 1939 of the clinical head of Madrid's centre for infectious diseases, at the Hospital del Rey. 66 Occasionally Palanca's intervention could ‘save’ an individual from prison, at the same time removing them from any position of professional responsibility, a process Palanca revealingly termed ‘quarantine’. 67 In general, the Francoist authorities set political priorities above epidemiology; locating blame for the epidemic with the wartime Republic and its ‘proletarian’ support base was part of this. Palanca explicitly denigrated what had indeed been effective public health policies in the Republican zone by conflating them with political ‘atrocities’. 68 In one play on words, he traduced these public health initiatives by associating them with the killing of alleged rebel supporters by Republican militias because the latter proclaimed this to be in the interests of ‘la Salud Pública’ (evoking the French revolutionary Comité de Salut Public). 69
Prisons, Population, and the Politics of Urban Space
During the civil war, Francoist forces captured in excess of 400,000 Republican combatants, according to a document produced by the Inspección de Campos de Concentración de Prisioneros in March 1939. Most of the captured ended up in some form of detention. The same document stated that some 180,000 were awaiting classification, although this may be an underestimation and did not mean that those already assessed had been released. 70 The detained were held across Spain in overcrowded camps which became nuclei of infection – barbed wire encampments, disused barracks, factories, sports stadia and bull rings. In the Valencia-Alicante area on the north-east coast, where Republican refugees had gathered in March 1939 awaiting evacuation boats that never arrived, there were some 14 concentration camps. 71 One of the most notorious was at Albatera (Alicante), soon overflowing with many thousands of prisoners – by the time it closed within the year, as many as 20,000 had passed through. Extra-judicial executions were frequent inside the camp and in its surrounds, but the main killers were hunger and disease. It was reported that in one month alone in Albatera, 72 prisoners died of hunger, and that a fever believed to be typhus was widespread, claiming victims even among the guards, themselves recruited from across Spain. So calamitous was the situation that the authorities shut the camp down in October and transferred its prisoners to other detention centres. 72
From 1939 to 1940, most of Franco's political prisoner population was moved from camps or police detention to the teeming prisons, via processing by mass military trials. By June 1939, Valencia's main gaol, the Model Prison, which had 800 cells, already housed 8,000 prisoners. 73 In 1942, it still held some 5,000, with 3,500 more in the city's San Miguel de los Reyes prison. By the end of 1939, according to official figures, there were some 270,000 political prisoners in Spain, tens of thousands of whom were civilians who had merely fulfilled a public role at some level in the Republic. The pre-war average total for 1930–1934 had been 9,400. 74
The regime was aware of the threat of disease caused by overcrowding, but there remained 241,000 prisoners officially in May 1940. 75 The first prisoner pardons granted selectively by Franco in the early 1940s were an attempt to alleviate the danger of epidemic. But the decree law of April 1941 making provision for ‘parole’ (‘libertad condicional’) stipulated that those released be ‘banished’ to a location no less than 250 kilometres from the site of their ‘crime’ or their place of ‘habitual residence’, thus adding to the unprecedented human movement. 76 In this political context, establishing epidemiological cordons sanitaires was problematic as Palanca bowed to the state's imperative publicly to prioritize ‘political safety measures’ over ‘safe sanitation’. 77 Within a few days of occupation Barcelona's Model Prison was overflowing and disused factories had to be deployed: between 1939 and 1942, 35,000 prisoners passed through the city's gaol system. 78
Infection was also spread via forced labour brigades. Assigned to construct or reconstruct public infrastructure and buildings, including churches, these brigades were highly mobile. Members of one infected brigade were responsible for carrying typhus in the deep south of the country from Algeciras to Jeréz, and from there to Salamanca and Palencia in the centre-north, and ultimately to Tarragona and Gerona in the north-east. 79 One nucleus of typhus from which cases came to Madrid's hospital of infectious diseases was the labour detachment at Cuelgamuros, the site of Franco's monument to the war, the Valley of the Fallen, where work was begun in 1940 and large numbers of political prisoners were deployed who had frequently spent time in several other camps, prisons or labour detachments. 80 The scale of the labour brigades would be further increased by the hundreds of individuals sentenced for low-level black-market transactions over food, amid the hunger of 1941. 81
Although it may appear paradoxical, we can observe a causal relationship between state-driven confinement and actual population movement in this period. Across Spain, numerous types of traveller converged: those migrating in search of a place of safety, or enough to eat, or anonymity that might enable them to achieve paid work; or those leaving areas from which the authorities had already banished them, or those complying with the order to return to long-departed homes. 82
‘Judicial necessity’ – the Francoist goal to categorize on a mass scale and imprison ‘the guilty’ – thus encouraged what Palanca described as ‘excessive mobility’. 83 The motive of the order for those captured to return to their places of origin was to allow ‘local knowledge’ about the political backgrounds of individuals to be used as ‘evidence’. 84 The number of urban homeless – many of whom had already been held in makeshift camps – was also thereby increased. In Madrid, after the capital's fall in 1939, bomb sites were relied upon and temporary family shelters were improvised unofficially in the lice-ridden rebel trenches around the old city. 85 Not only were detainees being forcibly moved for categorization, moreover, but the already incarcerated were transported around between gaols. Basque and Cantabrian prisoners, for example, were sent to Cádiz gaols, where there were 729 recorded typhus cases in 1941 and 1294 in 1942, particularly in the main prison, El Puerto de Santa María, which held some 5,500 prisoners, five times its capacity. 86 International health officials reported that outbreaks of typhus in the north also occurred as a result of prisoner transfers in Navarre, the Basque Country, Palencia, and Asturias. 87 Transport was agonisingly slow in sealed wagons. 88 The railway infrastructure was overwhelmed. The Valladolid to Madrid service in mid-April 1939 was so packed that passengers had to walk ‘on the backs of seats or on the shoulders of the people’ and on the bundles on the floor, which included foodstuffs for small-scale selling on the black market. 89
The link between this population movement and politico-judicial ‘liquidation’ of the war was also closely connected with the Franco regime's political instrumentalization of hunger. The resulting near-starvation for so many was a major motivational force for migration, and therefore of spreading infection. By the autumn of 1940, the RF official, John Janney, noted that the defeated in the south were suffering ‘a long drawn-out slow starvation’. 90 An optimistic estimate of daily consumption for each child who could access food relief was just 400 calories; in Almería the masses of ‘child beggars’ were ‘like hungry dogs’. 91
All charity was, in theory, to be channelled through the state's welfare organization, Auxilio Social. In Málaga, where the rate of diseases such as smallpox had seen an alarming rise since 1939, Auxilio Social fed 32,000 people in October 1940, and the same number, many of them ‘Reds, escaping or visiting imprisoned relatives’, were similarly dependent on feeding stations in Granada until supplies ran so low that 18,000 were sent back ‘to the [former] Red zone’, along the coast ‘from which they had fled when the Nationals [Francoists] took it over’. 92 One of the first surges in post-war typhus occurred in Granada, in the town of Guadix, in February 1940, infecting 300 prisoners held in an abandoned sugar factory; the rate of fatality was 20 per cent. 93 The disease quickly spread to the provincial capital and within weeks there had been 150 recorded cases. Janney was informed there were 5500 prisoners in Granada in October 1940, ten times the Provincial Prison's capacity. The authorities insisted they were in control. Palanca stated publicly that the Granada outbreak was ‘of no importance’ and ‘not worth worrying about’. 94 At the same time, other migrants left Granada for Seville, believing conditions would be better there. But typhus was duly identified in Seville, first in a homeless shelter. 95 The evidence shows therefore that when Madrid's health chief related how the capital ‘was virtually cordoned off to prevent the entry of beggars’, he was in fact referring to economic migrants. The term ‘beggar’ was used by authorities to imply a lifestyle choice, but large numbers of the desperate poor were malnourished migrants, not locals, who arrived en masse, by train, having travelled long distances. 96 When ‘Reds’ and ‘egotists’ gave directly to those in need – by-passing Auxilio Social – they acted politically, not dispensing charity to ‘beggars’ but demonstrating solidarity amongst ‘the defeated’, contrary to the state-publicized ‘consensus’ against former Republicans. 97
The overarching Francoist drive was to confine, but local authorities were not above seeking to remove ‘problem groups’: in Córdoba, for example, unemployed labourers were given train tickets to head north to Valencia as long as they promised not to return. Once arrived they had little option but to occupy war-ravaged houses in the working-class districts of Grao and Nazaret where the typhus outbreak in the city subsequently began and fears grew of contagion across the divide between ‘the defeated’ and ‘the victors’. 98 Valencia's provincial head of health stated that the number of people on the move caused ‘a flood of infestations’ which affected primarily the indigent population but could penetrate ‘other social spheres’. 99 Inattentive to the dire epidemiological reality, the authorities alleged that the lower classes benefitted from ancestral immunity to typhus – just as they could also ‘contract’ Communism without personally coming to harm: the middle classes, however, possessed no such immunity. 100
The anguished search for work disproportionately affected women because the war and repression had deprived so many family economies of male breadwinners, through death or incarceration. While women were imprisoned by the Franco regime, female prisoners, overall, were a small minority of the detained population. Women's experience of prison was mostly through the intense one of being the wives, daughters or mothers of imprisoned ‘Reds’. Many battled to keep their families alive by illegal black-market selling of food items beyond the control of corrupt state price-fixing. These survival practices in turn generated a dramatic rise in women's detention, which coincided with the height of food shortages in 1941. 101 Many women had left their homes to be close to imprisoned, under-nourished family members who they kept alive by delivering small parcels of food and clothing to the gaol. A doctor in Zaragoza observed to a foreign visitor in October 1940 that among the 5,000 individuals in the city receiving food from Auxilio Social, were many refugees, ‘mostly the wives of red soldiers who are either dead or in prison’. 102 Auxilio's feeding stations drew in the families of prisoners and ‘those condemned for Marxist crimes’. Intelligence reports demonstrate, in fact, that state welfare was in part a way of keeping watch over the families of ‘Reds’, including those in prison. 103 In Madrid, welfare assistance was made dependent in April 1941 on the production of a certificate of delousing and, as ‘a hygienic precaution’, the authorities suspended family visits to children being housed and fed in Auxilio Social facilities. 104 The desperate search for a wage also saw the number of domestic servants increase markedly. The authorities tracked the occupational movements of servants, issuing warnings that ‘respectable society’ should be vigilant with domestics because they might import lice, just as earlier they had been harbingers of the revolutionary violence of the war. 105
There was relatively less hunger in the Falangist and conservative strongholds of the towns of central Spain than in the south or in working-class districts of the largest cities. Even so, large towns of the centre-north saw inward migration: in Burgos, the secretary of Catholic Action, which shared responsibility for public welfare, explained this influx by reference to the prison: The prison is [a] problem because it attracts a considerable number of families of convicts, particularly during the years of the judicial settlement of the civil war. All or almost all of these families have been aided by our institutions (certainly without bearing much fruit) and now, perhaps scared of returning to their own regions where they committed their crimes, have been settled here compounding our suffering.
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Conclusion: From Pathological Fears to Pathological Bodies
The study of epidemics in the past can shed light on present responses and practices and illuminate broader historical questions. This analysis of typhus in Spain has offered a new perspective on the politics of the civil war era, the socio-demographic effects of the conflict's course and outcome, and the nature and effectiveness of the Franco state, especially its retributive policy of incarceration. Focused on the pivotal moment between war in Spain and eruption of global conflict, this analysis also delineates a key juncture in the history of epidemiology by exploring the modern environmental variables of control and categorization of population movement; fumigation and vaccination; and the ideological shaping of concepts of social and physical distancing. In showing how a significant aspect of the history of medicine can be used to understand wider developments, it has addressed other related historiographies and cognate disciplines. In attending to depictions and treatment of a displaced population as ‘unstable’ (‘dangerous classes’ and ‘revolutionary masses’), it connects with studies of the ‘massified’ body in the past – the discourse, language and metaphors produced around it, its relation to urban space, its movement and its confinement, as well as its potential for provoking emotional reaction. It does so, however, not merely by discussing disease in general as a symbol and idiom of internal threat, but by grounding the analysis in a concrete historical example of a specific medical condition, its aetiology and attendant myths.
Francoist reconstruction, beginning in conquered territories during the conflict and becoming more uniform from 1939, aimed at a repressive return to a rigid social and political hierarchy and tight control of public space to contain multiple threats associated with ‘the defeated’ and the poor. But the state's repressive policies themselves further stimulated the mobility of those very groups, a mobility which wartime conditions had initiated. Deploying epidemiological sources to explore the waves of typhus between 1939 and 1945 allows us to see the significance of migration, because epidemiology depends on quantifying, explaining, and controlling population movement. Amid political executions, mass imprisonment, hunger, homelessness, and intense economic exploitation, the embryonic Franco dictatorship's response to epidemic disease, as well as the language used to describe it, became inseparable from the authorities’ often contradictory policies for controlling movement within social space. Throughout Spain, repression in the form of incarceration and forced labour flowed across the boundaries of the overcrowded prisons, from those politically detained inside to their families and comrades under surveillance in confined public space ‘outside’. Franco's police state understood the close links between these spaces when it threatened reprisals against prisoners for political protest graffiti appearing in public places outside the gaols. 109
For the state reconstituted after 1939, typhus represented a generalized threat from below to social classes deemed to be more stable. Ideas shared amongst ‘the respectable’ about hygiene, purity, and cleanliness were part of a reclamation of the pre-war social order and helped re-establish a ‘tolerable’ spatial distance between social classes. In Madrid, the Easter public devotions of 1941 – which customarily mixed the social classes – were suspended, and only concerts of sacred music for the segregated and paying middle classes, and the military parade marking Franco's victory, went ahead. 110 By 1943, the worst of the epidemic was over, though there were still relatively contained outbreaks. In April 1944, 60 cases appeared in Valladolid, which was reported to be ‘full of beggars’, against whom ‘insufficient measures’ had been taken. Such was the concern that cancellation of the Holy Week processions was considered, but it was decided that this would create panic by undermining the image of normality the regime sought to project towards its own social base. Rapid isolation and discrete vaccination carried out in Valladolid by a newly formed ‘epidemiological brigade’ meant that the number of infected was limited to ‘no more than 110’, but there was public alarm because individuals ‘of social standing’ were among the relatively few who died. 111
José Palanca's claim that the ‘chaos’ and ‘contagion’ of the wartime Republican zone had been the origin of the typhus epidemic was false. His explanation nonetheless reveals the underlying ideological assumption: the wartime and post-war multitude was volatile and shifting, not only in the sense that it was physically on the move, but because it was also cunning and calculating, psychologically unquiet and restless. Once typhus had erupted, the masses needed to be ‘tranquilized with truth’ 112 (the regime's truth) because they were inherently irrational and manipulable. Palanca's ‘evidence’ was that during the civil war they had ‘been swayed (en masse) towards murder’. 113 During the epidemic, it thus became more evident than ever that the bodies of ‘workers’ and ‘the defeated’ symbolized the deep-seated anxieties of the Francoist victors, fears intensified by the recent war, which had seen challenges to the pre-existing social and political order. Once typhus emerged it was, therefore, imperative to denounce ‘the unclean’, ‘for the well-being of the Patria’. 114
Typhus, like any disease, has no meaning in itself: it is a micro-organism and only acquires meaning and significance from its human context, ‘from the ways in which it infiltrates the lives of people, from the reactions it provokes, and from the manner in which it gives expression to cultural and political values’. 115 The typhus epidemic in Spain only became a reality once the stakes in the civil war of 1936–1939 had been won and lost. It then became a prism through which the Franco regime, bolstered by its social and intellectual support base, could construct and attempt to control ‘the enemy within’.