The strategic location of the city —being part of the Way of Saint James, a seaport, and close to the Spanish-French border— led to a constant movement of people and facilitated the transmission of epidemics throughout history. (1)
The fact that the city had good socio-sanitary conditions for each historical period meant that the consequences of epidemics were more limited than in other surrounding places.
Endemic infectious diseases such as tuberculosis (particularly widespread in the Basque Country), HIV/AIDS, or newly emerged ones like COVID-19 are not discussed in this article.
Bubonic Plague
The bubonic plague, also known as the Black Death, is an infectious disease mainly transmitted by fleas of common rats.
It arrived in Donostia-San Sebastián from southern France via the Way of Saint James in the spring of 1348. The exact death toll is unknown, but the fact that vegetable gardens began to be used as cemeteries gives an idea of the crisis's scale. (2)
This outbreak lasted several years and was the deadliest, creating a socio-economic catastrophe from which it took a long time to recover.
Other reinfections occurred up to six times during the 14th century. The memory of these events endures to this day through chapels and altars dedicated to Saint Roch and Saint Sebastian, who were invoked as protective saints at a time when medicine could offer little more than isolating the sick. (3)
It was at the end of the 15th century that the recognizable plague doctor outfit was devised: a long waxed leather coat, gloves, a hat, and the iconic bird-beaked mask filled with aromatic herbs to counter the stench of the sick. (2)
The last outbreak occurred in the mid-16th century, triggering a period of collective hysteria similar to that experienced in other European cities. Many infected people were transferred to Santa Clara Island, where they were buried. (4)
The plague was virtually eradicated by 1720, leaving a death toll of 25% of the population in Europe.
The Black Death has inspired many literary and cinematic works, including Ingmar Bergman’s film The Seventh Seal.
Cholera
In the 19th century, cholera was the most deadly epidemic disease in Gipuzkoa, appearing in several outbreaks. (5)
In the autumn of 1834, cholera entered Donostia-San Sebastián via a ship from Bilbao. It remained in the city for two months, infecting 79 people, of whom 46 died. (6)
The population within the city walls was around 7,000, one-third of whom were soldiers and outsiders. The infection was less severe inside the walls thanks to the city's good hygienic and sanitary measures.
The danger was greater in Loyola (densely populated) and Igara (with marshes and stagnant water). The population outside the walls was about 6,000. (6)
The first case appeared on September 21 in the niece of a nobleman living in the city, whose duties involved frequent contact with seamen and inspecting passengers’ belongings. Although the girl survived, the nobleman's daughter died a week later and his wife on October 1.
Cholera spread from farmhouse to farmhouse via infected travelers and clothes, and, being resisted by the city walls, it established itself in the San Martín neighborhood, a poor area with barely 800 inhabitants and unsanitary housing. (7)
The Misericordia and the San Bartolomé convent were used as cholera hospitals. Among the first 18 deceased were a surgeon, two nurses, and a nun.
On December 22, 1834, a Te Deum was sung at the Church of Santa María to give thanks for the end of the epidemic.
Another outbreak occurred in 1855 after a 30-year hiatus. The peak of the epidemic lasted from late August to late September, and it was d over in December. Of the 8,207 severe cases diagnosed in Gipuzkoa, 4,393 died.
Cholera reemerged in 1884. Doctors Luis Alzua (8) and José Ramón de Sagastume (9) played key roles in treating and documenting this outbreak.
In that outbreak, 9 people died and 7 were cured in the urban area; in the outskirts, 41 died and 22 recovered. (10)
The higher number of deaths in rural areas was due to the victims being elderly or already ill. At the San Martín Hospital, 2 chaplains, 3 doctors, 2 surgeons, 5 nurses, and 7 Sisters of Charity died.
Spanish Flu
The Spanish flu was a pandemic that hit the city 1918 and 1920. It was the deadliest epidemic in Donostia-San Sebastián, as in many parts of the world.
The starting point was around Irún, an important hub for soldiers and workers.
From September onward, the city was affected, with over half of the 60,000 inhabitants falling ill in different waves. Around 1,000 people died. The mortality peak occurred in the autumn of 1918.
There were several recurrences until the last one in 1920, which had little statistical impact but did affect small children due to the simultaneous measles epidemic — a syndemic.
Unlike other epidemics that mostly affected children and the elderly, this flu mainly hit young adults aged 15–34, causing severe pneumonia. (2)
Dr. José Beguiristain (11), from the Manteo Hospital, played a key role in treating the epidemic alongside pediatrician Angel Elvira. (12)
Typhoid Fever
Typhoid fever is an ancient infectious disease, but it wasn’t until the mid-19th century that its germ was identified and the disease described.
September 1845 and February 1846, the city suffered a typhoid outbreak. Though other outbreaks surely occurred earlier, this was the first one clearly identified.
In 1902, 42 people died from typhoid fever in Donostia-San Sebastián. The source was in Artikutza, and it reached the city through the Añarbe River. For this reason, in 1919 the city council purchased the estate and shut down mines and livestock operations to protect the water supply. (13)
Dr. Juan José Celaya (14), of the San Antonio Abad Civil Hospital, played a vital role in implementing measures and treating the epidemic.
Smallpox
In the 18th century, smallpox was the most aggressive disease affecting the Gipuzkoan population. (1)
Numerous 18th-century manuscripts preserved in the Julio Urquijo collection library (15) reflect the concern and work of the territory’s physicians. Urquijo was a bibliophile and advocate of Basque culture who collected major works in the Basque language.
These documents include the observations of Dr. Josef de Luzuriaga (16) and report the application of Dr. Gati's method (inoculation of the disease) to 1,202 patients from towns like Azkoitia, Deba, Zestoa, Mutriku, Donostia, Azpeitia, and Bergara. The mortality rate was about 1 in 4.
The discovery of the smallpox vaccine in 1796 was a major milestone, although the disease was not fully eradicated until many years later.
A small outbreak still occurred in the city in 1900.
Yellow Fever
In 1814, just one year after the fire that devastated Donostia, a yellow fever epidemic ravaged the region. (17)
According to Dr. Vicente de Lardizabal (18), of the Royal Guipuzcoan Company of Caracas and member of the Society of Friends of the Country, all the city's pharmacies were destroyed in the fire, and their owners moved their businesses to nearby towns like Hernani and Pasaia. Donostia-San Sebastián faced the epidemic without even a pharmacy to supply medicine to those who could afford it.
Worse still, high demand and limited supply caused medicine prices to skyrocket, further hindering access.
Dr. Juan Montes, provincial commissioner for the disease, and Donostia’s chief physician Eugenio de Arruti (19), led the fight and documented their efforts extensively.
Another outbreak arrived in Donostia in 1823, coming from the port of Pasajes. (20)
Other Infectious Diseases
Several infectious diseases primarily affected children and, although they did not become epidemics, did create infection hotspots in the city.
In order of mortality: meningitis, measles, diphtheria, whooping cough, and poliomyelitis.
Improvements in sanitary conditions and widespread use of vaccines by pediatricians led to their near-eradication.
Referencias
(1) De la peste al covid. Koldo Mitxelena Kulturunea
(3) Largo, Gontzal. «Los porqués de San Sebastián». Diario Vasco.
(4) San Sebastián.
(5) Memoria sobre el cólera en Donostia. Sancho el Sabio Fundazioa. https://www.euskalmemoriadigitala.eus/handle/10357/1076?mode=full
(6) Sada, Javier. «Epidemias de cólera». Diario Vasco.
(7) Sada, Javier. «El cólera». Diario Vasco.
(8) «Alzua Orbegozo, Luis». Entziklopedia Auñamendi.
(9) «Sagartume, José Ramón». Entziklopedia Auñamendi.
(10) Hernaiz, Cristina. «Epidemia de cólera en el País Vasco. pp. 20». Euskal Herriko Univertsitatea.
(11) «Beguiristain y Gorriti, José». Auñamendi Entziklopedia
(12) «Elvira López, Angel». Biblioteca Complutense, Médicos Históricos.
(13) «Artikutza». Sitios históricos.
(14) «Celaya San Miguel, Juan José.». Biblioteca Complutense. Médicos Históricos.
(15) «Urquijo Ybarra, Julio». Auñamendi Entziklopedia
(16) «Ruiz de Luzuriaga, Ignacio María». Auñamendi Entziklopedia
(17) Rilova, Carlos. «Historia marítima». Diario Vasco. 2015.
(18) «Lardizabal, Vicente». Auñamendi Entziklopedia
(19) «Francisco Eugenio de Arruti Zabala». Auñamendi Entziklopedia
(20) «El impacto de la fiebre amarilla en Pasajes». Gaceta Sanitaria.