Book Review

As the name suggests, this work by João Martins e Silva, a retired Full Professor of the Faculty of Medicine of the University of Lisbon, and its former director, has as its main objective the detailed study – determinants, context, evolutionary process, responses, and consequences – of the bubonic plague epidemic that took place in the city of Porto in the last half of 1899. But, in fact, this work is much more than that. It is a detailed, well-documented, and informative account of the history of the great “pestilences” – the great threats to Public Health – from antiquity to the end of the 19th century, in search of manifestations of what is recognized as plague epidemics: a wave of people who become seriously ill in a community, with swellings in the lymph nodes, particularly in the groin, but also in the armpits – the “buboes” – preceded by the appearance of a substantial quantity of dead rats, in that same community (greatly simplifying). Hence, the characterization of the three historically identifiable plague pandemics was as follows: the “Plague of Justinian,” in the middle of the first millennium after Christ, the “Black Death,” in the 14th century, and the third that hit Europe in the 19th century. The Porto epidemic of 1899 was the last clear manifestation of this third pandemic in Europe. This is also the story of the genesis of the “microbiological theory of disease,” from the first microscopic observations of Antonie van Leeuwenhoek (1632–1723) to the microbiological work of Louis Pasteur (1822–1895) and his collaborators in France and the team of Robert Koch (1843–1910) in Germany. It is always fascinating to observe how difficult it was to overcome entrenched explanatory conceptions such as the miasmatic origin of a disease or the “spontaneous generation” (non-transmission) of pathogens. In this context, follows the identification of the plague bacillus by a collaborator of Pasteur, Alexandre Yersin (1863–1943), a Swiss doctor and researcher of French origin, when already living in Indochina, goes to Hong Kong, in the grip of the plague epidemic, and identifies Yersinia pestis (1894). And then came the vaccine and the anti-plague serum. Four years later, Paul-Louis Simond (1858–1947) discovered the transmission mechanism, from infected rats to humans, via fleas. Finally, there is Europe, Portugal, and Porto. A bipolar world: great progress in the sciences, arts, technology, new forms of communication and transport on the one hand, and, on the other, poverty, insalubrity, unemployment, often miserable living conditions, crass ignorance of much of the population, with the singular backwardness of the institutions of public administration, education, health, and government (“cemeterial city” as Ricardo Jorge called his city, due to its insalubrity and health indices lower than those of other cities of his time). The work articulately describes the main ingredients of the events concerning the plague epidemic in the city of Oporto in 1899. It does so in a systematic, detailed and extremely well-documented manner, illustrated by appropriately selected images (photographic and others). Of these ingredients, we will highlight the following here: • The identification of the microbiological agent causing bubonic plague had occurred about 5 years before the outbreak of the epidemic in Porto, while the predominant transmission process, from rat to flea and from flea to man, had been described the year before the start of this pandemic. Also, the tools and culture of translation, from scientific knowledge to medical practice, were much less effective than in our days (even though still imperfect). The result was skepticism and