You can interact with the objects and images you will find here, and find out more information about them.
The founders of Fontilles used the term “sanatorium” to name their project because it explicitly expressed their intention to contribute to the search for a remedy to heal the sick, instate of limiting themselves to isolating and ensuring the patients’ bodily and spiritual care – as the medieval lazarets had done for centuries. As a result, in addition to medical assistance services such as a pharmacy, a nursing facility, and a clinic, Fontilles was also equipped, from the very beginning, with a laboratory. Securing a stable medical team proved to be more challenging. Except for the brief period when medical care was provided by the team of doctors and healthcare workers sent by the government of the Second Republic, under the direction of Pablo Montañés Escuer, the caregiving work was carried out for a long time by the Franciscan sisters. Much of the laboratory activity was also their responsibility. Additionally, specialists from neighboring towns periodically visited the sanatorium to conduct the necessary consultations. Mauro Guillén Comín, from Valencia, undertook the medical direction of the clinical departments and the laboratory remotely during the first third of the twentieth century, and so did Félix Contreras Dueñas, from Madrid, throughout the post-war period and the dictatorship, until the arrival of José Terencio de las Aguas, at the end of the 1960s. At this time, a stable team of specialists was formed thanks to the latter’s proximity and research projects.
The Puzzle. Voices and Images about Diagnosis and Treatments.
Mycobacterium leprae was identified as the leprosy pathogen at the end of the nineteenth century and the discovery changed the way in which the disease had been explained and treated until then. It ceased to be perceived as a visible disease visible in people’s bodies and became an invisible disease that could hide on people’s bodies long before any symptoms gave it away. The contagion thesis, which had long been disputed by those who defended its hereditary nature, reinforced the fear of leprosy and the rejection of those affected. Despite proving that it was one of the least contagious infectious diseases, the leprosy specialists who attended the first international leprosy congress in Berlin in 1897 concluded that isolation was the best prophylactic measure. And this served as an argument to create leprosy sanatoriums all around the world. The consensus on the bacterial aetiology of leprosy also changed the diagnostic techniques employed. This issue had been one of the great challenges of modern medicine, which had been unable to accurately distinguish leprosy from other diseases that shared similar clinical manifestations. In this case, the errors had very serious consequences for the people affected. Adding to the clinical methods based on skin lesion observation, microscopic methods made it possible to identify the presence of the pathogen in the body tissues where it nested. Despite these new diagnostic techniques, the differentiation of the types of leprosy and the causes of symptom disparity between one form and another long remained a subject of debate and classification proposals.
Mycobacterium leprae was never successfully cultured in vitro. Nor was it possible to artificially infect other animals, except the armadillo. The body of people affected by leprosy became, therefore, the only means available to study the effectiveness of the dozens of chemical and natural treatments tested throughout the twentieth century. Many of these treatments were tested in the Fontilles laboratory, as well as in those located in other sanatoriums around the world: from chaulmoogra oil, on which great hopes were placed, before the arrival of the first sulfones in the early 1940s, to the new drugs synthesised and tested in the following decades. In 1982, the World Health Organization (WHO) established the triple chemotherapy method (rifampicin, clofazimine and dapsone) that is still used today to treat leprosy. “We have opened many paths,” Maruja proudly claimed, recalling the not always recognized contribution that generations of people affected by leprosy had made to the understanding of this disease, offering their bodies in the hope that the newly tested drug would be the definitive one. The use of thalidomide to treat leprosy reactions was among the clinical investigations in which the Fontilles laboratory took part most actively. Under the medical direction of Félix Contreras, first, and José Terencio de las Aguas, later, clinical trials were performed on over 170 patients during the late 1960s, before being adopted as a standard treatment. Remittances of thalidomide supplied by the Dirección General de Sanidad and the German pharmaceutical company Grünenthal, or its Spanish subsidiary MEDINSA were used. The results were reported in the sanatorium’s publications and presented at international leprosy conferences and journals. This was the case of the large trial coordinated by the WHO, in which Fontilles participated along with other sanatoriums in India, Mali and Somalia.
Blood tests, a common practice in all clinical laboratories, had a special meaning in the Fontilles laboratory. They were used to control anaemia and other blood disorders caused by leprosy or by the side effects of sulfonic treatments. Colorimeters, devised throughout the twentieth century to determine haemoglobin concentration, or centrifuges, used to separate the blood components and to calculate their concentration using devices such as Marbel differential counter are some of the material testimonies of these techniques.
Blood transfusions were also widely used since the 1950s to compensate for anaemia and to relieve the dreaded lepra reactions: patients’ immune system responses, which constituted a serious obstacle to the application of new sulfonic treatments. Transfusions were also used in research on leprosy immunotherapy. Numerous trials were conducted to test the efficacy of transfusions from convalescent patients or patients with mild forms of leprosy to treat more severe forms. The transfuser devised and patented in the 1940s by Carlos Elosegui Sarasola and Ramón Arévalo García at the Spanish Institute of Haematology and Hemotherapy played a pivotal role, as it allowed transfusing blood indirectly without the presence of the donor.
Dozens of maps and graphs were drawn in Fontilles to show the origin of its inhabitants and the demographic changes of its population. The maps recalled the persistent endemic of leprosy in Andalusia, the Canary Islands, Galicia, and the Valencian provinces, where most of the Fontilles population came from. In the 1960s, when the Fontilles population was at its peak, a detailed statistical study was conducted on the state of health, sociocultural characteristics, and aptitude for work of the men and women residing in the sanatorium. The graphs showed the constant increase in admissions and decrease in deaths, especially from the 1940s onwards, when new sulfone treatments also made the first discharges possible. The colours illustrated a population made up of more men than women, mostly married persons who had left their families behind. The population progressively aged, as those who stayed became older and the departure of the younger ones became generalised. Illiteracy and poverty accompanied this population of former peasants and housewives, the only exception among which were workers or artisans. These graphs reveal nothing of all those other people who had the necessary means to pay for medical care and treatments without being isolated in sanatoriums. The maps and graphs were exhibited at medical congresses and international conferences on leprosy, where they served to show the health and social work conducted at Fontilles to the world. They also occupied the covers in full colour of up to seven issues of the Fontilles magazine and demonstrate the significance of the work conducted in Fontilles based on irrefutable data. This encouraged readers to continue providing their support through donations and alms.
