The pneumonic influenza in Portugal: risk and public health management in Portugal during the First Republic

The pneumonic influenza in Portugal: risk and public health management in Portugal during the First Republic

The influenza - or "Spanish influenza" - of 1918-19 was the greatest demographic disaster of the 20th century and, for some, the greatest in all human history. In spite of the data that exists regarding the number of deaths not being entirely reliable, we know that the Spanish influenza accounted for far more fatalities than the other major cause of deaths at the time - the First World War. In fact, estimates of the number of mortal victims point towards between 21 and 60 million.

The pneumonic influenza, as the influenza epidemic of 1918-1919 became known to us, arrived in Portugal at the end of May 1918. From July onwards it reached Lisbon and Porto, subsequently spreading throughout the entire national territory. The estimated mortalities attributed to the influenza in Portugal also vary, from more than 50 000 to more than 100 000 people, in line with the fatalities registered at a worldwide level. There is, nevertheless, consensus as to the demographic consequences of this epidemic: in fact, in Portugal, the pneumonic influenza was the single factor that caused the most deaths in the 20th century, exceeding by far the number of deaths in the colonial war and in the first world war.

In spite of its enormous relevance, the studies on this worldwide catastrophe are very few. In fact, following a first and almost contemporaneous phase of the outbreaks, in which many accounts of the epidemic were published, only at the end of the 70's was some systematic research begun. However, only in the 90's, and in particular with the conference held in Cape Town in 1998 to mark the 80 years of the epidemic, was there a renewed interest on this topic.

Similar trends were also observed in Portugal. There were a number of accounts and analyses of the pneumonic influenza at the time of its occurrence, among which the works of Ricardo Jorge (1919) and some PhD theses in medicine that elected the pandemic as a topic are noteworthy, followed by a long period of almost absolute silence. The interest in the phenomenon was reborn in some academic works, such as those of Cúcio Frada, Trindade and Girão.

However, the research produced on this occurrence is far from having exploited all of its virtues. The purpose of this work, based on the existing research, is to contribute towards the comprehensive study of the pandemic, namely with respect to public health management strategies. With this work we seek to not only understand, in multidimensional terms, a marked event in the history of Portuguese society, which involved the political and scientific fields, as well as several agencies related with public health. We also seek to use this case-study to reflect, based on what happened at the time, on the various dimensions - economic, social, cultural, political and scientific - of the problems of epidemics and on the pandemic risks which we face in the globalised universe of today, which continue to be a main concern of national and international public health agencies.

In fact, this pandemic presents many of the characteristics that some authors emphasize as typical of the society in which we currently live, a global "risk society". It was a global threat in the actual sense of the term, in that the influenza virus, like many current dangers, was not bound by countries, continents or species. It was a type of threat that challenged the health structures of the time that were not prepared to respond to this type of problem and that continues to elicit concern from the scientific community, which fears the possibility of a resurgence (idem). And it was probably a threat that, like current threats, was the object of contrasting interpretations, based upon the interactions between various social agents and different political forces.

The characteristics of the pandemic of 1918-1919 are therefore ideal to be studied in light of the current debates on new risks. A study in which the ideas, representations and controversies raised by the epidemic shall be analysed and compared with those surrounding similar current phenomena. The present situation, of a world that is far more unified than in the past, namely due to the migrations of the last few decades and the massification of air transport, keeps alive the fears of a resurgence of the pandemic.

In this sense, the objective of this project on the pneumonic influenza is to simultaneously analyse the phenomenon in its specific context and contribute towards a more extensive reflection on current pandemics and their public health consequences.

Estatuto: 
Proponent entity
Financed: 
No
Keywords: 

Risk, Health Policies, Social Representations

The influenza - or "Spanish influenza" - of 1918-19 was the greatest demographic disaster of the 20th century and, for some, the greatest in all human history. In spite of the data that exists regarding the number of deaths not being entirely reliable, we know that the Spanish influenza accounted for far more fatalities than the other major cause of deaths at the time - the First World War. In fact, estimates of the number of mortal victims point towards between 21 and 60 million.

The pneumonic influenza, as the influenza epidemic of 1918-1919 became known to us, arrived in Portugal at the end of May 1918. From July onwards it reached Lisbon and Porto, subsequently spreading throughout the entire national territory. The estimated mortalities attributed to the influenza in Portugal also vary, from more than 50 000 to more than 100 000 people, in line with the fatalities registered at a worldwide level. There is, nevertheless, consensus as to the demographic consequences of this epidemic: in fact, in Portugal, the pneumonic influenza was the single factor that caused the most deaths in the 20th century, exceeding by far the number of deaths in the colonial war and in the first world war.

In spite of its enormous relevance, the studies on this worldwide catastrophe are very few. In fact, following a first and almost contemporaneous phase of the outbreaks, in which many accounts of the epidemic were published, only at the end of the 70's was some systematic research begun. However, only in the 90's, and in particular with the conference held in Cape Town in 1998 to mark the 80 years of the epidemic, was there a renewed interest on this topic.

Similar trends were also observed in Portugal. There were a number of accounts and analyses of the pneumonic influenza at the time of its occurrence, among which the works of Ricardo Jorge (1919) and some PhD theses in medicine that elected the pandemic as a topic are noteworthy, followed by a long period of almost absolute silence. The interest in the phenomenon was reborn in some academic works, such as those of Cúcio Frada, Trindade and Girão.

However, the research produced on this occurrence is far from having exploited all of its virtues. The purpose of this work, based on the existing research, is to contribute towards the comprehensive study of the pandemic, namely with respect to public health management strategies. With this work we seek to not only understand, in multidimensional terms, a marked event in the history of Portuguese society, which involved the political and scientific fields, as well as several agencies related with public health. We also seek to use this case-study to reflect, based on what happened at the time, on the various dimensions - economic, social, cultural, political and scientific - of the problems of epidemics and on the pandemic risks which we face in the globalised universe of today, which continue to be a main concern of national and international public health agencies.

In fact, this pandemic presents many of the characteristics that some authors emphasize as typical of the society in which we currently live, a global "risk society". It was a global threat in the actual sense of the term, in that the influenza virus, like many current dangers, was not bound by countries, continents or species. It was a type of threat that challenged the health structures of the time that were not prepared to respond to this type of problem and that continues to elicit concern from the scientific community, which fears the possibility of a resurgence (idem). And it was probably a threat that, like current threats, was the object of contrasting interpretations, based upon the interactions between various social agents and different political forces.

The characteristics of the pandemic of 1918-1919 are therefore ideal to be studied in light of the current debates on new risks. A study in which the ideas, representations and controversies raised by the epidemic shall be analysed and compared with those surrounding similar current phenomena. The present situation, of a world that is far more unified than in the past, namely due to the migrations of the last few decades and the massification of air transport, keeps alive the fears of a resurgence of the pandemic.

In this sense, the objective of this project on the pneumonic influenza is to simultaneously analyse the phenomenon in its specific context and contribute towards a more extensive reflection on current pandemics and their public health consequences.

Objectivos: 
<p>- Contribute towards a systemization of the information on the outbreak of the pneumonic influenza in Portugal, within the demographic, economic, social, political and cultural context of the time;</p><p>- Understand how this phenomenon, new in many respects, that challenged the existing knowledge and structures of the time, is represented by the different groups and social agents; </p><p>- Analyse the public health strategies used at the time for managing the epidemiologic risk, in light of the political, scientific and religious controversies at that time;</p><p>- Compare the reactions to this pandemic in a society still predominantly agricultural, dominated by illiteracy, where the religious vision of the world remains influential in spite of its competition with the scientific explanation, with the reactions to epidemic outbreaks with similar characteristics in the current "risk society", which tends to be urban, educated and, in a large part of the world, permeated by the prestige of the scientific discourse.</p>
State of the art: 
Apesar da enorme relev&acirc;ncia da influenza de 1918-19 ? com estimativas que apontam para um n&uacute;mero de mortes entre os 21 e os 60 milh&otilde;es (Crosby 1993; Diamond 1998; Heller 1998; Porter 2003; Philips &amp; Killingray 2003), os estudos sobre esta cat&aacute;strofe mundial s&atilde;o em n&uacute;mero bastante reduzido. De facto, ap&oacute;s uma primeira fase quase contempor&acirc;nea dos surtos, em que se publicaram muitos relatos da epidemia, apenas no final dos anos 70 come&ccedil;a a haver alguma investiga&ccedil;&atilde;o sistem&aacute;tica (Philips &amp; Killingray, 2003). Em Portugal passa-se o mesmo. Encontramos um conjunto de obras de relato e an&aacute;lise da gripe pneum&oacute;nica na altura da sua ocorr&ecirc;ncia, das quais se destacam os trabalhos de Ricardo Jorge (1919), seguindo-se depois um longo per&iacute;odo de sil&ecirc;ncio quase absoluto (Sampaio 1958). O interesse pelo fen&oacute;meno renasce em alguns trabalhos acad&eacute;micos, como os de Frada (1989, 1998 Trindade (1998) e Gir&atilde;o (2002). <br />Com a sua realiza&ccedil;&atilde;o deste trabalho procuramos, por um lado, compreender em termos multidimensionais um acontecimento marcante da hist&oacute;ria da sociedade portuguesa; por outro, utilizar este estudo de caso para reflectir, &agrave; luz do que aconteceu nessa altura, sobre os riscos de pandemia com que nos confrontamos no universo globalizado dos nossos dias. <br />Refer&ecirc;ncias bibliogr&aacute;ficas <br /><br />Crosby, Alfred W. (1993). Influenza. In K. F. Kipple (Ed.) The Cambridge World History of Human Disease, (pp. 807-811). Cambridge: Cambridge University Press. <br />Diamond, Jared (1998). Guns, Germs and Steel. Londres: Vintage. <br />Frada, J. J. C&uacute;cio (1998). A Pneum&oacute;nica de 1918 em Portugal Continental. Estudo socioecon&oacute;mico e epidemiol&oacute;gico, com particular an&aacute;lise do concelho de Leiria. Tese de doutoramento apresentada na Faculdade de Medicina da Universidade de Lisboa. <br />Frada, J. J. L&uacute;cio (1989). Lisboa e a pneum&oacute;nica de 1918, numa perspectiva m&eacute;dica, econ&oacute;mica e social. Provas de Aptid&atilde;o Pedag&oacute;gica e Capacidade Cient&iacute;fica apresentadas na Faculdade de Medicina da Universidade de Lisboa. <br />Frada, J. J. L&uacute;cio (2000). A Pneum&oacute;nica de 1918 em Portugal Continental. Estudo socioecon&oacute;mico e epidemiol&oacute;gico, com particular an&aacute;lise do concelho de Leiria. Revista da Faculdade de Medicina de Lisboa, S&eacute;rie III, volume 5(2), 127-132. <br />Gir&atilde;o, P. J. M. (2002). A gripe pneum&oacute;nica no Algarve (1918). Tese de Mestrado em Hist&oacute;ria Regional e Local apresentada na Universidade Nova de Lisboa. <br />Heller, P.B. (1998). 1918-1919 Influenza Epidemic Strikes. In J. Powell (Ed.), Cronology of European History (vol 2, pp. 1329-1331). Chicago: Fitzroy Deorborn Publishers. <br />Jorge, R. (1919). La Grippe. Rapport pr&eacute;liminaire pr&eacute;sent&eacute; &agrave; la Comission Sanitaire des Pays Alli&eacute;s dans la session e Mars 1919. Lisboa : Imprensa Nacional. <br />Kilbourne, E. (2003). A virologist?s perspective on the 1918-19 pandemic. In H. Philips, &amp; D. Killingray, (Eds). The Spanish Influenza Pandemic of 1918-19: New perspectives (pp. 29-38). London: Routledge. <br />Philips, H., &amp; Killingray, D. (2003). Introduction. In H. Philips, &amp; D. Killingray, (Eds). The Spanish Influenza Pandemic of 1918-19: New perspectives (pp. 1-25). London: Routledge. <br />Porter, R. (2003). Blood and Guts: A Short History of Medicine. London: Penguin Books. <br />Sampaio, A. (1958). Subs&iacute;dios para o estudo da epidemiologia da gripe. Lisboa. <br />Trindade L. (1998). A epidemia de gripe pneum&oacute;nica: a morte anunciada. Hist&oacute;ria, XX(8), 36-45.
Luisa Lima
Paula Castro
Coordenador ICS 
Start Date: 
01/04/2005
End Date: 
01/12/2007
Duração: 
32 meses
Closed