53 / 105
53
A n a i s d o I HM T
peratures and soil emanations were widely perceived by
Western medicine as sources of “intermittent fevers”,
as well in the “Tropics” as in Europe. The change from
a malaria causation model based on “miasmatic” or “tel-
luric” elements to a parasitological model based on a
specific cause – a parasite transmitted to man through
the bite of an
Anopheles
mosquito – did not acquit flood-
ed or swampy lands; consequently it did not acquit
rice fields. As mosquitoes’ breeding sites, these lands
kept their insalubrious reputation. Until its disappear-
ance from Portugal, around 1960, malaria had always
been related to rice cultivation with rare exceptions.
From the 1930s, and particularly after the 1933 sur-
vey, rice fields became the scientifically legitimized axis
of malaria research and control actions in Portugal in
an effort undertaken by some doctors to follow inter-
national health trends, and strategies professed by the
League of Nations Health Organisation and its Malaria
Commission (League of Nations - Health Organisation
1927), as well as by the International Health Division of
the Rockefeller Foundation.
It should be noticed that rice fields were not unavoid-
ably malaria sites. In Spain, although these lands were
under the close scrutiny of sanitary authorities, they did
not represent the core of malaria’s ecological condi-
tions; irrigation development and land structure were
regarded as major environmental factors influencing
malaria distribution (see Perdiguero-Gil 2005). Randal
Packard (2007) also states that rice fields’ influence in
malaria numbers is closely related to agricultural tech-
niques (namely mechanisation and irrigation methods),
land exploitation models, living conditions, etc.The less
people needed to work on rice fields, the better hous-
ing and living conditions they had, the less rice fields
weighed on malaria numbers. But in Portugal, although
machinery was used in agriculture, rice cultivation re-
quired large number of seasonal workers, until the late
1950s. Some of them came from far away regions in the
north of the country, where work was harder to find
but where climatic and geographical conditions did not
favour malaria.These migrant workers were particular-
ly vulnerable to malaria when they arrived in the south-
ern rice fields. They had no resistance resulting from
previous infections and, especially until the late 1930s,
they slept in very rudimentary shelters, vulnerable to
mosquitoes' bites. Even when their shelters improved,
under legal regulation, they never offered complete
protection or sanitary conditions (Ministério do Inte-
rior – Direcção Geral de Saúde 1944).
Despite this complex set of ecological circumstances
embedded in political, economical and social factors,
malaria was not one of the major health problems in
Portugal during the first half of the 20th century. Ma-
laria has always affected mostly children, everywhere
in the world; it is still among them that it causes the
greater number of deaths. Until the 1970s Portugal had
high infant mortality rates (77,5 per thousand in 1960,
55,5 per thousand in 1970),
1
which were seen by Por-
tuguese doctors as a disgrace to the national reputation
and a pressing sign of much needed improvement in
health policies. But malaria was not one of the main
causes of children´s deaths.
However, sources suggest that some Portuguese doc-
tors may have seen this disease as a gateway into the
enhancement of state supported health services, by
applying for international technical and financial aid
(Saavedra 2014).The Malaria Committee of the League
of Nations Health Organisation had drawn up a set of
recommendations regarding malaria control, in the
late 1920s. These comprehended research, prevention
and treatment (League of Nations - Health Organisa-
tion 1927). Also, in 1931 the Health Organisation pro-
moted a conference about rural health making it one of
its priority subjects (Société des Nations - Organisation
d’Hygiène 1931).The Rockefeller Foundation´s Inter-
national Health Division was also very active in Europe
promoting public health, rural health, etc. and also had
malaria as one of its main foci (Farley 2004).Therefore,
malaria was a promising field for securing financial or
technical support to compensate poor national invest-
ment in health services and to encourage it.
Portuguese doctors may also have perceived a focus
on rural health as a way of attuning to the dictatorial
regime’s ideology, thus making their own cause more
appealing. The New State regime adopted the rural
world, its population and alleged “traditions” as core
symbols of its rhetoric about the “Portuguese national
identity” (Leal 2000; Melo 2001; Rosas 2001). In fact,
the Portuguese historian Fernando Rosas states that one
of the ideological myths of the regime “was the myth of
rurality”. According to it “Portugal was an essentially
and inevitably rural country, a traditional rurality taken
as a specific characteristic and virtue from which the
true qualities of the race sprang and in which the na-
tional being was seasoned. [...]Thence, land as the first
and the principal source of possible wealth, the path to
order and social harmony, the cradle of national virtues
(Rosas 2001, 1035).
Yet, the New State’s 1933 constitution established
Portugal as a corporatist republic (Lucena 1976; Ro-
sas e Brito 1996; Ferreira 2008), privileging private
initiative under state guidance; and the state’s control-
ling and dirigiste bent favoured the economy (Ferreira
2008), bypassing social and health issues. Investing on
1 -
https://www.pordata.pt/Portugal/Taxa+bruta+de+mortalidade+e+taxa+de+mortalidade+infantil-528-2950