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The professional recognition and sanitary reforms that physicians sought from the political powers throughout the constitutional era of the reign of Alfonso XIII were a continuation of those from the XIXth century. One of the most important demands was that rural physicians should answer directly to the State, especially with reference to salaries, rather than to municipal authorities generally held by caciques. There were constant problems between them. This work presents the case of the physician from El Pobo, Alfredo Alegre, whose conviction put health professionals, students and most of society on the warpath, joining their demands to a petition for pardon. This tragic story, apart from showing the importance of the daily press as a source, highlights the difficulties offered by professional practice in rural areas submerged in the past and the inability of politicians to resolve problems during one of the most hectic periods of our history.

Introduction: Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as "trencar lenfit" (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness., Objectives: To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital., Patients and Method: The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months., Results: Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 +/- 15.9 versus. 55.5 +/- 17.7 years +/- SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression)., Conclusion: The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. "Experts" in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs.

The consumption of medicinal herbs is one of the most important topics in alternative and complementary medicine. The widespread use of these substances among the general population gives rise to the possibility of therapeutic or toxic effects in patients seeking conventional medical assistance. To determine the frequency of medicinal herb use, the species consumed and the profile of medicinal herb consumers among patients with gastrointestinal disorders, patients attending the gastroenterology outpatient clinic of the Francesc de Borja district hospital (Gandía, Spain) over a 5-month period were interviewed and 539 valid questionnaires were obtained. A total of 34.7% of the interviewees had taken medicinal herbs at some time and 26.9% had used them in the last year. Self-prescription was reported by 67.1%. Medicinal herbs were mainly obtained in the pharmacy or herbalist's (74.7%). The results of medicinal herb therapy were considered good or excellent by 80.3% of the interviewees, average by 18.6% and poor by 1.1%. In the univariate analysis, medicinal herb consumption was positively associated with female sex (p < 0.001), a university education (p < 0.05), consumption of psychotropic drugs (p < 0.005), use of trencar l'enfit (TE, a common practice of magic medicine in Valencia) (p < 0.001), functional gastrointestinal disorders (p < 0.005) and a diagnosis of lower gastrointestinal disorder (p < 0.01). In the multivariate analysis, the variables that remained statistically significant were female sex (p < 0.005), university education (p < 0.01), use of TE and a diagnosis of lower gastrointestinal disorder. Fifty-seven botanical varieties were used. The most frequent varieties were Santolina chamaecyparissus (18.8%), Tilia platyphyllos (6.5%), Thymus vulgaris (6%), Equisetum ramosissimum (4.7%), Mentha pulegium (4.4%) and Valeriana officinalis (4.4%). The results show that consumption of medicinal herbs is frequent among patients attending the gastroenterology outpatient clinic of a district hospital. The probable profile of those showing maximum consumption is: female sex, university education, lower gastrointestinal disorder, functional gastrointestinal disorder, psychotropic drug consumption and use of TE.

The purpose of this paper is to show that the writings of 16th century Spanish surgeons-doctors contain considerable information about everyday surgical practice. These usually neglected data may bring us to a better understanding of the development of this aspect of medical practice. Surgical writings analysed here are by Daza Chacon, Juan Fragoso, Juan Calvo, and Pedro Arias de Benavides.