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LAS ENFERMEDADES MÁS FRECUENTES A PRINCIPIOS DEL SIGLO XIX
DR. ENRIQUE DE LA FIGUERA VON WICHMANN
Presidente del Colegio Oficial de Médicos de Zaragoza
Introducción.- La población española en 1800 era de 11,5 millones de personas y se caracterizaba por una alta tasa de natalidad y morbilidad. La Guerra de la Independencia fue precedida de una crisis demográfica. Es de destacar la ausencia de censos fiables, siendo los registros parroquiales la fuente más aproximada a la realidad. Las causas de muerte también son difíciles de determinar por la escasa e imprecisa información de los registros de defunción: la mayoría constan por causas mal definidas: afección, mal, irritación, dolor de pecho, tos, pulmonía y ataque al cerebro…
Las epidemias y el hambre en los años de 1803-1805 ocasionaron una mortalidad igual o superior a la producida durante el periodo bélico de la guerra de la Independencia española que tuvo lugar entre los años 1808-1814. Una vez iniciada la contienda, las puntas de muerte se concentraron entre 1809 (400.000 muertos) y 1812, con un impacto desigual en las diferentes regiones españolas. 1812 fue conocido como «el año del hambre» y se calcula en 100.000 el número de fallecidos en ese año. Porcentualmente y en relación a la población existente, la guerra de la Independencia resultó la más letal de todas las guerras españolas contemporáneas.
La alta mortalidad se debía a las consecuencias de la contienda: junto a las víctimas directas de la guerra (afectó más a la población civil que a los combatientes), hizo aparición la hambruna y las epidemias infecciosas.
La peste, último conato en Mallorca (1820) dejó paso al paludismo y a las epidemias de tifus exantemático, fiebre amarilla, cólera; y a brotes de sarampión, viruela, gripe, escarlatina y difteria («garrotillo»).
En el fondo del problema subyacía el subdesarrollo económico, el bajo nivel de vida (problemas de alimentación, ropa, vivienda, mala higiene y pésima salubridad pública); y de suma importancia fue un insuficiente y tardío progreso médico-sanitario. La esperanza de vida entre 1860 y 1887 era de 29 años, enormemente inferior a la media Europea.
La asistencia sanitaria era privada, estando los hospitales encargados de la atención a los pobres. Las medidas sanitarias eran adoptadas por el Estado según los acontecimientos y no tenían carácter estable. Los Ayuntamientos (alcaldes y jefes políticos) tenían competencias en salubridad, caracterizándose por sus decisiones autónomas y descoordinadas junto a la ineficacia crónica de la medicina, farmacia, veterinaria y las limitaciones técnicas de la cirugía.
Las enfermedades infecciosas eran las más frecuentes y mortales a principios del siglo XIX. La guerra propiciaba un medio idóneo para su desarrollo de forma epidémica.
En la expansión de estas epidemias tenía un papel decisivo el escaso nivel de vida de una población básicamente agrícola, de auto subsistencia, con bajo nivel cultural e higiénico, escasez de médicos y escasa demanda de sus servicios por una población que consideraba la mortalidad como un parámetro natural e ineludible en muchos casos (Pérez Moreda, 1980).
Dependientes de las condiciones de vida, las enfermedades infecciosas se presentaban, en el siglo XIX, como enfermedades sociales típicas. La inexistencia, o ineficacia, de la actuación pública que ayude a combatirlas, contribuye a reforzar el carácter discriminador que las distingue.
La infección hacía estragos entre las clases bajas y solía respetar a los núcleos privilegiados (Nadal, 1988).
La Fiebre Amarilla (Plaga Americana o vómito negro) era transmitida por el mosquito Aedes Aegypti.es una enfermedad de ciudades portuarias y de las riberas de los ríos navegables, y por tanto de aparición muy localizada: hubo brotes en Cádiz (1800), Cartagena, Málaga (1800-1804), Granada (1804), Sevilla, Alicante, Valencia, Barcelona (1821-1870), Palma de Mallorca (1870). Las más devastadoras fueron las declaradas en las primeras décadas del siglo.
La Zaragoza de los Sitios en 1808-1809 sufrió también una epidemia devastadora de Tifus exantemático (tabardillo pintado, fiebre de los campamentos), con tal cantidad de víctimas que fue la auténtica causa de la rendición de la ciudad. La enfermedad se atribuyó a la aglomeración de militares defensores, al gran número de cadáveres del Primer Sitio que se quedaron sin enterrar debidamente y al aire viciado. En cuanto a la población civil afectada, la causa era achacada inicialmente por los médicos a la poquedad de ánimo, porquería y miseria. De los 32.000 soldados más 12.000 voluntarios iniciales, el 19 de febrero de 1809 quedaron 2.822 defensores útiles, constatando la muerte de 10.200 soldados y voluntarios, y un sinfín de víctimas civiles.
El Cólera (Cólera morbo) a lo largo del siglo XIX asoló, procedente de la India, a extensas zonas de Europa y América. Penetró en España por el puerto de Vigo. En 1833 se declaró la primera epidemia en nuestro país. Hubo a lo largo del siglo cinco brotes, afectando al Centro/Norte y Valencia (1854-1855). Ocasionó 600.000 muertos.
La Difteria (Garrotillo) afectaba a todas las edades pero era más frecuente en la infancia. Se caracteriza por la aparición de falsas membranas (pseudomembranas) que se forman principalmente en las superficies mucosas de las vías respiratorias y digestivas superiores, pudiendo producir obstrucción respiratoria, ocasionando incluso la muerte por asfixia, parecido al método de ejecución de reos conocido como «garrote vil», de ahí su nombre popular del garrotillo y ésta enfermedad ocasionaba, por asfixia, el fallecimiento de la cuarta parte de los nacidos.
Entre 1879 y 1885 provocó 80.879 muertes.
En el último tercio del siglo XIX se produjeron varias epidemias de Sarampión. Causaba una gran mortalidad infantil; a lo largo del siglo provocó 80.629 fallecimientos.
La Tuberculosis (tisis, consunción, escrófula, mal de Pott, plaga blanca) es la enfermedad infecciosa más prevalente en el mundo. Causada por diversas especies del género Mycobacterium Tuberculosis. No fue hasta 1882 cuando Koch descubrió el bacilo causante de la enfermedad. A finales del siglo XVIII y comienzos del XIX afectaba más a los jóvenes siendo vista la muerte en el Romanticismo como una liberación; y el suicidio o el abandono total hasta contraer la Tisis constituía una meta admitida y deseada. A lo largo del siglo XIX permanecía vigente la doctrina anti contagionista.
La Viruela era una enfermedad altamente contagiosa causada por el virus variola. Desde tiempos milenarios afectó a la humanidad en forma de epidemias. Se contagia por contacto directo del enfermo, sus fluidos y la ropa. Tenía una mortalidad del 30%. El último caso conocido en el mundo fue en 1977. La OMS la declaró extinguida en 1979.
El Paludismo (malaria) enfermedad producida por parásitos del género Plasmodium y transmitida por mosquitos hembra del género Anopheles. Actualmente se producen 200 millones de casos anuales en todo el mundo. En España afectaba a la cuenca de Llobregat, Delta del Ebro, Levante, Andalucía, Extremadura y las dos Castillas; respetaba el Norte de España. Actualmente se detectan casos importados. Está en fase de experimentación final una vacuna eficaz.
La Escarlatina (calentura escarlata) es producida por el Estreptococo-hemolítico del grupo A. Predomina en todas las regiones con climas templados y en los meses de invierno y primavera. Afectaba con mucha frecuencia a la población infantil.
Una forma especialmente agresiva y virulenta de la enfermedad se volvió epidémica en Inglaterra y otros países europeos en el siglo XIX, donde la tasa de mortalidad fue inusualmente alta. Tenía una incidencia muy alta, con una elevada tasa de mortalidad, antes de la aparición de los antibióticos a mediados del siglo XX.
268 replies on “LAS EFERMEDADES EN ESPAÑA DURANTE EL S. XIX”
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