Auscultation of an internee at the Bram Concentration Camp (Aude, France, 1939).
Image courtesy of: ESPAÑA. MINISTERIO DE EDUCACIÓN, CULTURA Y DEPORTE, Centro Documental de la Memoria Histórica. Archivo Centelles. Foto.9380
Written by Àlvar Martínez-Vidal and Xavier García-Ferrandis.
In concentration camps organised in France to intern refugees who had fled Spain at the end of the Civil War (February 1939), a number of clinical trials were performed by Catalan doctors in order to provide health assistance to their compatriots in the most rational way possible.
This short paper focuses on one of these human experiments, which combined health care, clinical supervision and scientific research. It was not the only clinical trial of this kind performed in such strange circumstances, but it was the most significant.
The humanitarian crisis provoked by the flood of refugees during the last weeks of the Spanish Civil War, along with policies of exclusion and control applied by French authorities during the first months of exile (since February 1939), has been the subject of a vast body of literature. However, the health crisis caused by the Retirada (exodus), and the later imprisonment in inhumane conditions of hundreds of thousands of people who had suffered the hardships of three years of war, has received much less attention.
A large number of health workers were among the Spanish refugees who crossed the French border, including hundreds of doctors, nurses, dentists, and other healthcare professionals. These people, who shared the fate of the Republican exiles, provided spontaneous care in difficult circumstances to the Spanish sick and wounded, both inside and outside the camps.
Initially, all medical personnel of the French Department of East Pyrenees, with the help of the Red Cross and the Women’s Union of France (UFF), was mobilised in order to carry out surveys and to vaccinate refugees against typhoid, diphtheria and smallpox. However, very soon medical supplies ran out and it was impossible for health authorities to maintain the sanitary cordon and to carry out medical inspections under proper conditions. In those circumstances, on 31 January 1939, the minister of Public Health, Marc Rucart, and the minister of Interior, Albert Sarraut, assessing the pros and cons, thought that the plan of concentrating more than one hundred thousand refugees in the Department could become a time bomb, which sooner or later could explode in epidemic form. Out of control, a pandemic could spread across France and weaken the country against its enemies; a France, let’s not forget, that shared borders with Nazi Germany, fascist Italy and with Franco’s Spain.
The Spanish refugees – women, children, elderly people and soldiers – ended up in improvised concentration camps on the beaches of the Roussillon surrounded by barbed-wire fences. These camps were hastily constructed on the sand which was surrounded by marshland. From the onset, the plan was for the interns to stay a short time, before being then transferred to their new destinations at other camps.
In this context, some of the medical doctors interned in those camps carried out not only health care activities, but also scientific research. In such miserable conditions, they performed clinical trials on the sick refugees. Unlike the atrocities committed by Nazi doctors in the death camps of the Third Reich, they carried out experiments on humans in order to maximise their clinical skills and scant resources for the benefit of their patients.
Joaquim Vinyes Espín was a young Catalan doctor interested in the effect of vitamins, which was one of the research fields in the Institute for Physiology of the Generalitat de Catalunya. Born in Barcelona in 1909, he graduated in 1934 at the Faculty of Medicine of the Autonomous University of Barcelona, and during the Civil War he was enlisted in the Republican army and reached the rank of captain. After the Retirada, he tried to leave France and go to America but failed to obtain a visa. He spent more than five years in the French camps, first in the camp of Saint-Cyprien (near Perpignan) and since February 1940 in the labour camp of La Ciotat (near Marseille).
The camp of Saint-Cyprien consisted of 650 rudimentary barracks divided into four ‘camps’ or sectors: one of which, with almost 400 barracks, was for soldiers, and another, with 35, for women. The general infirmary occupied three barracks of the administration sector. At the beginning, there was only one French doctor and two assistants; then, other doctors joined the medical staff of the camp.
During the first months of its existence, living conditions in the Camp of Saint-Cyprien were absolutely miserable, both with regard to the poor accommodation (wind, the cold, damp, crowded quarters) as well as the lack of food and drink. Hygienic conditions (lack of a sewage system, poor personal hygiene, clean clothing and shelter, etc.) were also deplorable. As a result, diseases associated with poverty and overcrowding broke out. These included parasites (scabies, lice, ringworm, etc.), deficiencies resulting from poor diets (malnutrition, avitaminosis), gastrointestinal infections, chronic respiratory diseases, acute conjunctivitis due to the sand and other conditions.
We know that, during his stay in the camp of Saint Cyprien, Vinyes Espín asked a pharmaceutical laboratory for free samples of vitamins; certainly, he got a great amount of them from the Société Parisienne d’Expansion Chimique (SPECIA), a company which produced Vitascorbol (ascorbic acid) and Bévitine (thiamine or Vitamin B1). He administrated them in an experimental way. Vinyes Espín treated his patients with one single vitamin, or in combination, so as to evaluate their effects on undernourished bodies suffering unknown clinical symptoms, such as shin pain, acute adrenal failure, polyneuritis, edema, etc.
Infirmary ‘medicine cabinet’, Bram Concentration Camp (Aude, France, 1939).
Image courtesy of: ESPAÑA. MINISTERIO DE EDUCACIÓN, CULTURA Y DEPORTE, Centro Documental de la Memoria Histórica. Archivo Centelles. Foto.3553
Vinyes Espín’s working hypothesis was that these syndromes were caused by malnutrition, specifically by a deficiency of Vitamin C, associated with other avitaminosis. He attempted to demonstrate that these clinical symptoms disappeared, or were mitigated, with the daily administration of a Vitamin C pill. The patients, as far as it can be ascertained, were Spanish refugees, but it is not known whether they were soldiers or civilians. The first clinical observation in the camp of St. Cyprian was done in April 1939 and the last one in January 1940. In regard to the means he used in order to explore the signs and symptoms of the patients, it is quite surprising the routine references to lab techniques to calculate the concentration in urine of some substances, like albumin, glucose, phosphates or Vitamin C.
As a final remark, a small number of refugee doctors, such as the Catalan Joaquim Vinyes Espín, carried out clinical trials during their stay in the internment camps of France. Vinyes Espín enjoyed a degree of professional autonomy, and with the support of a French pharmaceutical laboratory was allowed to access medical equipment and drugs. The purpose of these trials, rooted in the non-maleficence principle (primum non nocere), was to expand the knowledge of scarcely known diseases caused by malnutrition. Fortunately, he continued his studies on vitamins after World War Two; otherwise, little would be known about the contribution he made during his stay in the camps in Roussillon.
Àlvar Martínez-Vidal is a visiting scholar at the López Piñero Institute for the History of Medicine and Science, Universitat de Valencia and was previously a senior lecturer in this centre.
Xavier García-Ferrandis has a PhD from the University of Valencia and published L’assistència sanitària a la ciutat de València durant la Guerra Civil in 2015.