Un reto para la sociedad madrileña: La epidemia de gripe de 1918-19 (review)

María Isabel Porras Gallo. Un reto para la sociedad madrileña: La epidemia de gripe de 1918-19. Madrid en el Tiempo. Madrid: Editorial Complutense, 1997. 158 pp. Ill. Ptas. 1,950.00.

This concise, elegantly presented monograph tells the story of the so-called Spanish flu pandemic of 1918-19 from the optic of Madrid society. Though, as the author shows, influenza morbidity and mortality were much higher in other regions of Spain, Madrid's experience merits careful study as the alleged epicenter of the pandemic and as the fulcrum of debates within Spain over the responsibility for controlling the outbreak: local and regional administrations versus the national government, scientific versus political authorities, and the press versus them all.

Porras Gallo takes six snapshots of the epidemic and the responses to it. First, she briefly assesses social conditions and politico-sanitary organization on the eve of the influenza outbreak, pointing to legislative inadequacies, enforcement problems, and a confusion of roles regarding disease notification, treatment, and isolation of early cases. She then examines the epidemic trajectory and demographic cost of the epidemic, arguing that Madrid (unlike some other settings) did not experience increases in influenza and other respiratory disease mortality prior to 1918--making the May outbreak all the more explosive. The book offers a detailed study of the waves of influenza mortality and concomitant rises in a wide range of ailments, along with differential mortality distribution by age group, sex, and neighborhood; unfortunately, the author asserts but does not explore the disruptive social and economic consequences of this elevated mortality.

The last three chapters of the book are devoted to the political, professional, and popular (press) responses to the epidemic. Due to bureaucratic lethargy, most control measures were passed only after the first epidemic had subsided, and political authorities were still unprepared for subsequent outbreaks in the fall of 1918 and the early months of 1919. Extra funds for hospitals were appropriated slowly and proposals for sanitary centralization materialized late, leaving "tranquilizing the population" (p. 90) as the principal initiative of the national government. ¹ For their part, medical and public health authorities were at once baffled and divided on the causes of the influenza outbreak, but they united in calling for the creation of a Ministry of Public Health. Here Porras Gallo is at her most perceptive, demonstrating that this strategy at once diffused physician responsibility for the epidemic and fulfilled a longtime dream of doctors to create a central public health authority.

The author's exploration of the reaction of Madrid's population--"the great protagonist" (p. 17) of the 1918-19 epidemic--is less lucid. In seeking to track the public's reactions to protective and curative measures and their demands on medical professionals and the government, she relies exclusively on newspaper sources, which she takes as an "approximation of the expression of popular sentiment" (p. 118). The likely paucity of firsthand accounts by nurses, patients, and families does not absolve the author's responsibility to systematically analyze the newspapers in terms of their ownership, readership, and various relationships with political authorities, elites, labor groups, and medical professionals. Without a better understanding of whom Madrid comprised (and how the press interacted with these publics) it is difficult to follow the population's shifts back and forth among fear, hysteria, skepticism, and faith in medical science and government officials.

Madrid's newspapers play a perhaps unanticipated role in making this book interesting to audiences beyond peninsular specialists. Though Porras Gallo lends little attention to the misleading naming of the influenza pandemic as Spanish, she shows that it was Madrid journalists' aggressive coverage of the outbreak in May 1918 that pressed Spanish authorities to send two cables to London to report on the epidemic. As a nonparty to World War I, Spain was not subject...