ABSTRACT
Although practising clinicians are inclined to be somewhat dismissive of administrators and managers of medical services, whether medically qualified or not, there is no doubt that the outcomes achieved by the health care professions are profoundly dependent on the quality of their organisation. Two examples familiar in present-day health care systems will suffice. The first is the mortality rate of acute myocardial infarction (“heart attack”), which is directly proportional to the time lapse between the onset of symptoms and attention from qualified paramedic or coronary care unit staff. Second, patients are dying in all the developed countries because adequate systems are not yet in place to maximise the yield of suitable donor organs for kidney, liver, or heart transplantation. Warfare places both civilian and military medical care under enormous strain, in terms of both the quantity and type of casualties and diseases encountered, and the medical services have to expand and adapt in an attempt to meet the challenge. The Spanish Civil War was a conflict in which the organisation of both military and civil medical facilities experienced a very rapid phase in its evolution from that developed in the Europe of World War I to that about to be tested by the nations involved in its sequel. It is true that the Moroccan campaigns of the 1920s had served to concentrate Spanish minds on certain principles such as the necessity for prompt surgery and the consequent desirability of locating the surgeon near the front, rather than transporting the casualty back to the rear (Gómez Ulla y Lea 1981: 35–41). Military medicine in particular was initially extremely deficient in manpower, especially on the government side since most of the army medical service had forsaken it for the rebels (Granjel 1986 a: 92). The shortages encountered by the rebels were, at first, those of equipment and supplies, with the principal industrial centres having remained in the government’s hands (Bescós Torres 1987).
