Tuberculosis, also known as white plague, is a disease caused by the bacterium Mycobacterium tuberculosis or Koch's bacillus after its discoverer in 1882(1).
It developed widely in Europe from the 17th century onwards, favoured by poor living conditions: poor nutrition, overcrowding, substandard housing, etc.
It generally attacks the lungs and to a lesser extent the kidneys, brain and spine.
Not all people infected with TB bacteria become ill. There are patients with latent infections who can transmit the disease even if they do not have the disease(1).
The evolution of the disease is very silent from the beginning to the final stages, which meant that pulmonary tuberculosis patients, also known as consumptives, were not obliged to stay at home but alternated with everyone else until the last days of their lives. Their expectoration represented an active seed capable of sowing the disease everywhere when they coughed or spoke.(1)
Other less frequent means of transmission were from a tuberculous mother or wet nurse to her baby through breast milk or from the milk of a tuberculous cow to the population.
Treatments
Common treatments for TB until the end of the 19th century were varied and of little efficacy.
With the discovery of Koch's bacillus as the cause of the disease, specialised sanatoriums began to proliferate in Europe, located in high, sunny regions that were not very conducive to the chain of transmission of the micro-organism.
Another function of the anti-tuberculosis centres was to isolate patients, breaking the chain of transmission of the disease by offering a suitable climate, rest and diet to these patients. This, together with the progressive improvement of living conditions, meant that cases began to decline, many years before the first effective drugs appeared.
At the beginning of the 20th century, with the development of surgery, surgical treatments such as lung resections proliferated, but they were still palliative treatments.
In 1921, the anti-tuberculosis vaccine (BCG) was discovered, which represented a milestone in the fight against tuberculosis.
the fight against tuberculosis. In Gipuzkoa, vaccination campaigns began in 1930, starting with children in Donostia-San Sebastián and in the Fraisoro de Zizurkil Crèche by the doctor Jesús Alustiza, in which there were 256 children with their respective wet nurses.(2)
The first effective drugs against tuberculosis were streptomycin in 1944 and above all isoniazin in 1952.
Since then, the disease has been in clear regression and is still only a token case in the 21st century.
Anti-tuberculosis sanatoriums in Gipuzkoa
At the beginning of the 20th century, Gipuzkoa had a very high mortality rate due to tuberculosis. In 1914, the doctor Luis Alzua (3) reported to the Gipuzkoa Board of Trustees against tuberculosis that 13.10% of deaths in Gipuzkoa were caused by tuberculosis, a figure only exceeded by Vizcaya in the whole of Spain.
In 1899, the bulletin of the Real Sociedad Bascogada de Amigos del País stated that of the 961 deaths registered in Donostia-San Sebastián, 612 corresponded to adults and of these 128 were caused by tuberculosis, which represented 21% of adult deaths in the city.
In 1910, the so-called Jardín de Convalecientes (Convalescent Garden) was opened in Eibar for patients who had suffered from tuberculosis. It was founded by the doctor Niceto Muguruza(4).
The first anti-tuberculosis centre in Gipuzkoa was the Sanatorium Nuestra Señora de las Mercedes(5) opened in 1912 in Donostia-San Sebastián.
It was promoted by the doctor Emiliano Eizaguirre through the Municipal Anti-Tuberculosis Board and was located in Loyola. It had 40 beds exclusively for women and was inaugurated by King Alfonso XIII and Queen Victoria Eugenia.
For its economic maintenance, Emiliano Eizaguirre (6) established for the first time in the State the collection of the Fiesta de la Flor (7).
In the early 1930s it was transferred to the Junta de Beneficencia.
In 1913, Dr. Eizaguirre managed to create an anti-tuberculosis dispensary in the San Antonio Abad Civil Hospital (8) and in 1932 he created the Docker ward in the same hospital for children with tuberculosis primo-infection.
In 1928 he set up another in San Bartolomé Street in Donostia-San Sebastián. These were followed by hospitals in Eibar (founded by the doctor Ciriaco Aguirre) (9), Irún, Tolosa, Azpeitia and Bergara.
In 1933, the Andazarrate Anti-Tuberculosis Sanatorium(10) was opened on land in Asteasu. This new health centre was dedicated from its creation to the care of men and had 80 beds.
It was supported by 15 Mercedarian Sisters, who together with 3 doctors, 2 interns, 10 servants and 1 chaplain, made up the staff of the sanatorium.
The centre was supported in equal parts by the State, the Diputación and the local councils of the area.
In March 1956, the sanatorium was closed and the patients were transferred to the new Amara Hospital.
In 1934, the State took over the fight against tuberculosis and created an anti-tuberculosis dispensary in San Sebastian, directed by the doctor Salvador Bravo, and another in Eibar.
In 1952, the Amara Hospital began its activity with a capacity for 300 patients. The Provincial Council ceded the site to the Patronato Nacional Antituberculoso (PNA), which intended to house the existing anti-tuberculosis sanatoriums in Gipuzkoa in a single centre.
Thus, patients from the Nuestra Señora de las Mercedes women's sanatorium in Loyola and children from the Doker children's ward at the San Antonio Abad Hospital in Gros were transferred to the new hospital. In 1955, patients from the men's sanatorium in Andazarrate were admitted.
A double medical management was established with doctors José Luis Martínez de Salinas (Andazarrate) and Bartolomé Martínez De La Pera (Nuestra Señora de las Mercedes).
In 1974 it was renamed the Hospital de enfermedades del Tórax-Amara-San Sebastián.(11)
Throughout the 20th century there were some private and monographic clinics (dedicated only to tuberculosis) such as the San José clinic (founded in 1922 by the doctor Emiliano Eizaguirre), or the Villa Luz (created in 1948 by the doctors Salvador Bravo and José Labayen).
Epilogue
Tuberculosis caused a great deal of personal and economic devastation in Gipuzkoa the 19th century and the first half of the 20th century.With the appearance of effective antibiotics, widespread vaccination and the improvement in the living conditions of the population, tuberculosis ceased to be a major health problem in society from the mid-20th century onwards.
The doctor Emiliano Eizaguirre was a leading figure in the fight against tuberculosis, creating a network of sanatoriums throughout the province and the anti-tuberculosis booklet for the population. He established the flower festival to raise funds, and created a school of physiology in Donostia-San Sebastián where several generations of physiologists were trained.(12)
We must remember many doctors, nurses, carers, nuns, etc. who contracted the disease in the exercise of their duties in contact with the sick. An example of this is Toribio Albea, a doctor at the Fraisoro Crèche who died prematurely of the disease in 1920.
The Lorraine Cross was the symbol of the fight against tuberculosis and one of them is still preserved at 61 Prim Street in Donostia-San Sebastián, carved into the stone at the back, reminding us of the past of tuberculosis in history.(13)
References
(1) Tuberculosis en Gipuzkoa. Revista Bascongada. Begiratu: https://w390w.gipuzkoa.net/WAS/CORP/DBKVisorBibliotecaWEB/visor.do?ver&amicus=178878&amicusArt=321163
(2) Casa Cuna de Fraisoro. Entziklopedia Auñamendi. Begiratu: https://aunamendi.eusko-ikaskuntza.eus/en/casa-cuna-de-fraisoro/ar-157140/
(3) Alzua Orbeozo, Luis. Entziklopedia Auñamendi. Begiratu: https://aunamendi.eusko-ikaskuntza.eus/es/alzua-orbegozo-luis/ar-9345/
(4) Muguruza Larriña, Niceto. Entziklopedia Auñamendi. Begiratu: https://aunamendi.eusko-ikaskuntza.eus/en/muguruza-larrina-niceto/ar-82734/
(5) Sanatorio Nuestra señora de las Mercedes. Gipuzkoako Sendagileen Elkargoa. Begiratu: https://www.comgi.eus/es_sanatorio_nuestra_senora_de_las_mercedes.aspx
(6) Eizaguirre Marquínez, Emiliano. Entziklopedia Auñamendi. Begiratu: https://aunamendi.eusko-ikaskuntza.eus/es/eizaguirre-marquinez-emiliano/ar-37548/
(7) Fiesta de la Flor. Gipuzkoako Sendagileen Elkargoa. Begiratu: https://www.comgi.eus/es_fiesta_de_la_flor.aspx
(8) Hospital Civil San Antonio Abad. Entziklopedia Auñamendi. Begiratu: https://aunamendi.eusko-ikaskuntza.eus/eu/hospital-de-san-antonio-abad/ar-59937/
(9) Aguirre, Ciriaco. Entziklopedia Auñamendi. Begiratu: https://aunamendi.eusko-ikaskuntza.eus/es/aguirre-ciriaco/ar-24138/
(10) Sanatorio antituberculoso de Andazarrate. Gipuzkoako Sendagileen. Begiratu: https://www.comgi.eus/es_sanatorio_de_andazarrate.aspx
(11) Hospital de Amara. Gipuzkoako Sendagileen Elkargoa. Begiratu: https://www.comgi.eus/es_hospital_de_enfermedades_del_torax.aspx
(12) Lucha antituberculosa. Gipuzkoako Sendagileen Elkargoa. Begiratu: https://www.comgi.eus/es_lucha_antituberculosa.aspx
(13) Cruz de Lorena. Enfermería Avanza. Begiratu: http://enfeps.blogspot.com/2011/09/la-cruz-de-lorena-y-eldispensario.html