Do you know...

...who banned Coca-Cola from being sold in Portugal in the 1920's?

 
  If I was to name one person that perfectly epitomizes to spirit of the fight against pandemics in Portugal, I would not hesitate: Porto-born Ricardo Jorge. 

Yet, regardless of his decisive contributions to public health in the country, some of the Portuguese know him for a quirkier story of a long lasting ban of the most recognizable of sparkling drinks...! Let's put the gear in reverse and scroll down the timeline to learn a bit more about this remarkable man's actions.

estimated reading time:  10 min

Love it or hate it.

Coca-Cola.  

Presently the single largest producer of plastic in the world, 

Often accused of being part of the problem of child obesity and other health problems due to its sugar content.

Wikipedia contributors dedicate it a rather long entry, entitled 'Criticism of Coca-Cola' where many other factual allegations are listed.

Yet, in 2019, the brand's global revenue surpassed 37 Billion US dollars.
(that's no mistake there, that's a 'B,' as in billions!!!).

Despite all the apparent obstacles, we're talking about a company with a success story that is well over 120 years old.  

There was a time though when a small country in Europe - not the indomitable band of the Gauls - under the command of its public health delegate, by the name of Ricardo Jorge decided to ban its sale - a ban that spanned almost 50 years!

(Ok, now you're free to call him the Portuguese Asterix of public health :))

Back then, Ricardo Jorge argued that 'having cocaine in its composition would make it a narcotic and cause addiction" or "if that was false, then its trade name Coca-Cola would be false advertising". 

In any case, it should not be allowed to be sold in the country.

Ricardo Jorge's personal opinion about Coca-Cola?

Nobody knows.

In fact, the small percentage of Cocaine (alcohol was in it too!!) present in the original formula created by Pemberton in Atlanta, USA was no longer included in the 1920's list of ingredients.  Ricardo Jorge, who was a man of science with laboratorial expertise, could have simply tested the product. He chose not to.

​As it turns out, Ricardo's decision was but political - Portugal dictatorship was in its infancy but Ricardo was already on their side - such decision aimed to protect endemic products, such as wine - a key sector in the balance of trade - and some other beverages, produced by companies in Porto and Lisbon.

The Spanish flu - Ricardo Jorge's biggest challenge

In 1918 Portugal was an entirely different country: predominantly rural, only 10% of the 6 million Portuguese lived in big cities and another 10% had emigrated in the previous decade. Our participation in World War I aggravated hunger, food shortage, poverty, and social conflicts. 

It was a period of particular vulnerability marked by recurrent epidemic outbreaks such as exanthematous typhus and smallpox (both in 1918) , in addition to the high burden of endemic diseases such as tuberculosis. 

Furthermore, the most intense influenza pandemic wave coincided with a troubled political period during October to December 1918, when there were a military uprising and a general strike, which culminated in the assassination of the president of the Republic, Sidonio Pais in 1918.

  In spite of all these problems, there were coordinated interventions by public health authorities in trying to minimize the impact of the pandemic.

Ricardo Jorge, as director general of public health, defended some strict measures such as the suspension of fairs and pilgrimages and the closing of schools but he opposed to closing theaters, cinemas and also cafes, churches, public transport, markets, offices, warehouses, factories... He did not believe "that isolation in cities, or in hospitals, could contain a virus as violent as 1918's Influenza"(his own words) and ultimately didn't want to feed panic.

A major mistake, we know this now.

A few other mistakes were committed, some due to decisions based on his previous experience with the bubonic plague - with different contagion mechanisms (scroll down to see the next section) - some other due to insurmountable obstacles in implementing drastic measures in the short-term in a political torn country. 

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Uma publicação partilhada por SeePhillyRun (@seephillyrun) a 5 de Abr, 2020 às 3:02 PDT

Warning sign on a trolley car in Philadelphia, US.
Here in Portugal, about 10% of the population was lost to the Spanish flu but was definitely not the only country that had trouble dealing with 1918's pandemic: some estimates point to more than 50 millions lives lost to the virus in 2 years worldwide, more than double of those lost in WW1 during its 4 years.

The glory and fall of Ricardo Jorge in Porto

In June 1899 there were several cases of bubonic plague in Porto, which were diagnosed by the municipal doctor and director of the public disinfection facilities, Ricardo Jorge, in a poor neighborhood near the docks.

His response was according to the emergency of the situation: isolation of patients and affected areas, prevention and hygiene.

​​There was a reduction of train travel and passenger inspection and sanitary visits were made by health department doctors accompanied by the police.

In August the first official bulletin was published, with information on the transmission of the disease: 'The disease is caused by a microbe that can be found in swollen ganglions. Transmission is made through the skin, the nose and the mouth. According to Yersin, fleas are the main vehicles of contagion. There is a vaccine and treatment with the Yersin serum...'

 Ricardo Jorge, the health official in charge, was up to date with Yersin's and Shibasaburo's findings: after researching the plague in China, these physicians had isolated its bacillus in 1894 and produced a serum which was the only known prophylaxis and treatment available at the time. This serum was more effective if applied within the first few days of the disease. Immediately the world took notice and several foreign doctors came to Oporto to study the disease. 

 On August 24th, a sanitary cord was established around the city, enforced by the military (2.500 men!). It lasted until the Christmas eve of 1899, with the strong opposition of economic elites, who saw their business paralise because products could not circulate.

​A general meeting with a large number of businessmen took place in the Merchants Association building (Palacio da Bolsa) that same month.

(see this older post for a virtual visit of Palacio da Bolsa)

Nevertheless, Ricardo Jorge was aware that the challenge was not in the well educated groups of society, but the working classes, who lived in the filth and in poor housing conditions, where fleas and rats were abundant. And he knew that the most important action was to remove people from these nasty circumstances.

In the dramatic words of Ricardo Jorge, the city of Oporto was a 'graveyard', where the so-called  'islands' - crowded neighborhoods where factory workers lived - were a factor of disease proliferation.

Sanitary practices were imposed. They included compulsory baths for any suspect of being sick (he ordered the construction of public baths) and even burning down the houses considered to be infected beyond salvation. In fact, these sanitary measures worked, and mortality was low: 326 cases of which only 111 deaths. 

Public reaction, however, condemned these actions: common people did not believe there was an epidemic at all and mobs reacted with extreme violence. Many doctors were assaulted with stones, especially Ricardo Jorge, who was responsible for their enforcement.

 Even though Ricardo Jorge was praised by the entire medical community, including the international, most citizens in Porto turned against him.

The mayor of Porto himself considered the isolation of the city as an interference of central government in local business and presented his resignation during that period.


Ricardo Jorge ended up resigning as well, for the lack of support regarding his health policies and moved to Lisbon, where he continued his career as one of the most important hygienists in Portugal, with worldwide recognition.

In Porto, the fight was won and the bubonic plague was considered extinct only seven months after the first cases, in January 1900.

---

Seen in the city

(Google streetview link)

This granite pyramid marks the place where a small flag was hoisted, which alerted navigators to the limit of docking for ships in times of plague, so that an inspection on board could be performed. Despite the dark past it represents, this landmark is located in a viewpoint with a beautiful view of the Douro and Gaia. The street received the toponym 'bandeirinha da saude' - the flag of health.

(Google street view link)

At the top of that same street is a public bathhouse in support of the homeless community, which is part of the public hygiene program started by Ricardo Jorge in 1899.

One century later - about the current situation

There's nothing too relevant I want to say about the current panorama. We're getting enough and trustworthy information from the public health authorities.

It's still early and uncertain when and how we can go back to running in a group in the city. 

The tourism industry was hit hard and there's no light at the end of the tunnel yet regarding when normal (or 'new normal') activities can possibly be resumed.

There's however many sectors that have not stopped and are lending a hand.

One fine example:

 The fighting force against the COVID-19 virus pandemic in the country has recently been reinforced by wine producers such as Symington or the Portuense Super Bock beer company, that started producing hand sanitizer gel from the alcohol taken from their produce.

​The gel is being donated to local Hospitals.

Unfortunately one cannot fight viruses by drinking wine, beer - or any other alcoholic drink, as a matter of fact - otherwise the virus would probably not affect Portugal :) :)

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Symington is donating 10,000 litres of Antiseptic Alcohol Solution to various hospitals in the north of Portugal’s. Produced to full medical specification by the Symington lodge team, first deliveries started today.

Uma publicação partilhada por Paul Symington (@paul.symington) a 2 de Abr, 2020 às 7:49 PDT

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Uma publicação partilhada por Super Bock (@superbock) a 21 de Mar, 2020 às 6:42 PDT

Some of the true heroes

A group of runners that included 9 doctors and one nurse: early last year, in this bespoke running tour,  we shared the story of Ricardo Jorge and some other interesting (including fun) stories about public health in Porto, unaware that one year later we'd be fighting a major pandemic and they would be in the frontlines....! 

Team of medical doctors posing with Ricardo Jorge (front row & center) during the outbreak of Bubonic plague in Porto, in 1899.

  While the health workers all around the world seem to have entered this sort of ultra-distance marathon (without having registered for it!), working in the frontline of national health services, a large percentage of the population is now stuck at home - something that doesn't actually require training but seemed a lot nicer when no one was forced do it...! 

This blog post was therefore an humble and simple tribute to all those 'in combat' right now, nurses, medical doctors but also cleaning staff, firefighters...!

Here in Porto, from Santa Catarina to Cedofeita: closed doors, drawn curtains... A deep and silent void fills the streets, much deeper then that we were used to seeing at 7AM on our sunrise tours. Empty of people, of sounds, even smells. 

Credits:  Agora Porto - public agency for sports and cultural activities

On a lighter note

I see strict quarantine being recommended in most countries. However in some, Portugal included, people are allowed to go for a short run outside. Nevertheless, different people find different ways to cope with social distancing :)

Keep sound and keep fit everyone! See you one day soon, in Porto for a run!

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