After the pandemic

Shortly after the Spanish flu pandemic, a book written in the first person came into the hands of readers, bringing a pungent testimony about the crisis that has befallen Brazilian society. Fear and perplexity filled the memories of the doctor Moncorvo Filho as he described the scenes he faced, when men and women of all ages and social classes rushed in despair to the hospitals with fever, vomiting in pain:

Loud roaring, screaming and moaning, I suddenly heard them leave the lobby and besides to my office. I run to see what it was. A human wave invaded the building of our headquarters: they were men, women and children, mostly ragged, compressing themselves to enter and wrap up themselves in all the rooms of our establishment. There were people from all social classes, white and colored individuals, old people, boys and children, carried by each other, some who wobble, squalid, burning with fever, others vomiting and finally some found already expiring on the public road [...] I, who was the only doctor present, because the other scientific professionals were unable to attend, as I said, the majority already affected by the Spanish flu, I felt ruined, and at first, I confess, before such tragic scenes, not knowing how to resolve the crucial situation, I had the urge to flee, to go far, where those macabre scenes were erased from my spirit and from my ears those piercing groans that ripped my soul. The fulfillment of duty, the love for humanity, sorry for the fate of so many people, some of whom, on their knees and folded hands, begged me for immediate help, made me reflect on the gravity of the moment. It was necessary to have all the presence of spirit and it became imperative to have a quickly plan to follow in the face of such a harsh eventuality (^{MONCORVO FILHO, 1924, p. 49}).

Thus, he registered the horrors he experienced in those days, in the midst of the difficulties faced by the government, doctors, scientists and, in particular, the Institute for the Protection and Assistance to Infancy (IPAI) – an organ created by him to take care of children, based on practices that he had been developing in his researches. The Spanish flu was, until then, “the greatest epidemic in history, a pandemic”. To measure the impact, it had on the world, Bertucci-Martins quantifies the number of the population affected.

While the First World War, of 1914-1918, killed approximately 8 million people, Spanish flu was fatal to more than 20 million human beings worldwide. Nothing has killed so much in such a short time. As for the total number of sick people: for a significant number of scholars, 600 million people would have suffered from the flu pandemic, but some assume that between 80 and 90% of the planet's population fell ill, which would add up to 1 billion people (^{BERTUCCI-MARTINS , 2003, p. 105-106}).

Published in 1924, by the Department of the Child in Brazil, in Rio de Janeiro, the book O Pandemônio de 1918 (The 1918 Pandemonium) brings in its subtitle Subsidy to the history of the flu epidemic that in 1918 devastated the territory of Brazil. Written a few years after the facts, the narrative brings the account of the experience permeated by historical information, making it possible to understand, in this discursive strategy, how doctors, scientists and public authorities in general faced epidemics in the world and in Brazil, and in particular, in view of the specificities of the Spanish flu that brought many difficulties to deal with it. In his first words, the reasons that led him to wait a few years to write and publish the book are clear.

Anyone who dares to write the following lines is still today, more than five long years have passed, under the weight of the anguishing impression that lacerated his soul in the frightful days of 1918. Only now, using my relative calm, I was able to gather in pages of sincere revelation what I was able to observe and note in the painful outbreak of the tremendous catastrophe that descended on our city and on the occasion of which I unwittingly had myself to assume a prominent role in the hard work provided to the population day and night. Being a witness to the most moving scenes, finding myself in the face of scenes capable of embarrassing the most stoic hearts, I intend, with the present and modest subsidy, to contribute in some way to the history of the great event that so pungent mourned our society. I purposely gave this book the title of 1918 Pandemonium, in order to characterize the cataclysm that was unleashed on us in this terrible year, because this word well expresses what we all saw and suffered then (^{MONCORVO FILHO, 1924, p. 9}).

From his testimony, it can be inferred that the event, in addition to marking Brazilian society as a whole, marked his own life. The doctor was a co-participant in the facts narrated there and assumed a prominent position in the fight against Spanish flu. This is someone who personally felt the pain of a collective tragedy, experienced intensely on the battlefront: a doctor from the Institute for the Protection and Assistance of Infancy who interfered in society, helping to deal with patients from Rio de Janeiro communities, thus showing, a conception of medicine that aimed, in addition to healing and care in general, to teach individuals the principles of hygiene and disease prevention.

Moncorvo Filho was part of the movement that ^{Oliveira (1990)} named “militant nationalism”, a nationalist perspective articulated around thinking about national salvation actions. In it, the intellectuals, regardless the social or professional origin to which they were linked, used their training and field of action to propose ways, aiming to overcome the problems that plagued Brazil. The doctor intended to face childhood problems such as the high rates of infant mortality in Brazil. These missionaries of progress sought to create an ideal that could be built from a new tradition, with the insertion of new practices that were aligned with those of European and North American countries.

Among those who preached progress, there were those who aligned themselves with the hygienist movement, which emerged in the second half of the 1910s. They understood that they could implement ideal hygiene practices in the country that could prevent diseases, reduce mortality and thus lead the country progressing. This perspective may have guided the physician Moncorvo Filho to put his experience on paper, in the hope that the history of that moment in Brazil could be studied in the future.

The historian who, in the future, seeks to describe the main epidemics that have plagued Brazil, with great difficulty, may have an idea of the formidable calamity that was the flu epidemic. And the statement is perfectly accurate, because by surprise it was the assault that filled with so many horrors those dark days, in which we lost the notion that we lived in an ultra-civilized country and surrounded by the wonderful comfort that we always enjoy. There, are the reasons that led me to write the present book (^{MONCORVO FILHO, 1924, p. 10}).

Thus, the struggle for life, close to the belief that it was necessary to overcome social ills, elevates the book to the condition of a historical document and autobiographical account of those who lived that period and acted in it. Far from being just full of data and names of diseases during the pandemic, the reader is faced with a reflective and emotional testimony. In many moments, Moncorvo Filho reveals how that moment became a significant memory for his personal and professional training, constituting an account of those who lived and acted decisively to contain the progress of the disease, insofar as he dedicated himself to caring, heal and teach hygiene practices to people to guard against.

The recognition of the vulnerability of the human being, perhaps, was also an important motivation for the writing of the book. Possibly, the author put the experience on paper to better understand that no place, even if “ultra-civilized and comfortable”, was exempt from being affected by something so overwhelming that it could change the course of people's lives, the economy and the social rules of conviviality. The loss of the notion of civilization, the result of the 1918 pandemic, could have been the motivation for writing the book.

Moncorvo Filho showed that the pandemic, in addition to affecting people with the disease, transformed the way in which Brazil and the world were constituted as a society. This loss of civilization notion was possibly what motivated the doctor to write the book. However, it is important to understand who this person was so that we can interpret the importance of the book in 1924, when it reaches the reader, and also the legacy the author left for the formulation of medical practices and hygienic precepts to the population.

A doctor in the fight against the pandemic

Who is this doctor who works to combat Spanish flu and leaves his testimony published in a book? For the interpretation of his performance, we assumed ^{Sirinelli's (2003)} notion of an intellectual person to examine his personal path, his sociability network, his political engagement in health and the way his generation faced that pandemic.

Carlos Arthur Moncorvo Filho was born in 1871, in Rio de Janeiro. In 1897 he completed his studies at the National Faculty of Medicine, despite having dreamed, when younger, of pursuing a military career. Influenced by his father, the doctor Carlos Arthur Moncorvo de Figueredo, changed his professional projects, and, also, after graduating, he also became concerned with the children's health. Coming from a family of doctors, like his father, since the beginning of his professional career, he was involved with social issues and, for that, he used his prestige to be able to intervene in the world around him and transform him.

The author of O Pandemônio de 1918 (The 1918 Pandemonium) stood out, according to ^{Freire and Leony (2011)}, in initiatives such as the Work of Cruz Verde (Green Cross), in 1920, with a focus on combating illiteracy, in the foundation of a popular child hygiene course, in 1915, and in the creation and participation in several scientific institutions. Of these, we can highlight the Scientific Society for the Protection of Children, the Eugenic Society of São Paulo and the Brazilian Society of Pediatrics.

Following his father's example, Moncorvo Filho has always shown interest in the social issue of the Brazilian people, with an expanded focus on childhood. He considered that the majority of children lived without basic notions of hygiene, which went in the opposite direction to all scientific and social notions that were expected for the development of a more dignified life. These positions made him a pioneer in Brazil in the creation and development of specific practices, that is, a project to intervene in society and guarantee a better quality of life for children.

The Institute for Protection and Assistance to Infancy, located in Rio de Janeiro, was the space in which he acted with greater prominence. There, he consolidated his principles of social medicine with a focus on childhood and achieved national and international prominence and respect. According to ^{Camara (2014)}, The Institute for Protection and Assistance to Infancy would be the maximum expression of the undertaking towards civilization and progress. This may give us clues as to why the fight against the pandemic would be the space Moncorvo Filho used to implement his ideas of progressive medicine, which he developed over time, a medical practice based on the intervention on individuals, as well as on the teaching of practices that would help them prevent diseases.

In addition to doing scientific dissemination in newspapers, he mobilized himself to write in magazines for the same purpose. This corresponds to the perspective of ^{Sirinelli (2003)}, when he shows that intellectuals used different spaces of sociability, such as newspapers and magazines, seeking to maintain a field of dispute. In this way, Moncorvo Filho circulated his ideas so that others could join them. His action was not limited to assisting childhood, as he developed and disseminated an extensive scientific production. In newspapers of the period, such as O Paíz (The Country), or in magazines, such as Revista Nacional (National Magazine), Revista Fon-Fon (Fon-Fon Magazine), Revista ABC (ABC Magazine), or in his own authorship, such as Archivos de Assistência à Infância (Archives of Infancy Assistance). He disseminated scientific articles, bringing other intellectuals into the dialogue with whom he shared ideas. He was also engaged in the social agenda, proposing measures for childhood, publicizing work in the field of hygiene or commenting on the 1918 pandemic situation.

We highlight the publication in the Revista Nacional (National Magazine), of 1923, about the doctor's work in favor of childhood and the role of Institute for the Protection and Assistance of Infancy as institutional references for child care, which influenced other institutions in Brazil.

However, it is not enough to establish asylums and orphanages to house the children and hospitals where they find protection and treatment when sick. The action to be taken must go far beyond these limits. It must penetrate to the homes, where, by teaching everyone the knowledge of hygiene rules, mothers and heads of households are educated and oriented towards the observance of these norms, without which the struggle will always continue, that is why the roots from which evil springs will survive (Apud ^{GOLINELLI, 2017, p. 16735}).

He also founded the Department of the Child in Brazil in 1919, which would hold congresses, organize a Museum of Infancy and dialogue with the intellectuals around the theme of childhood, creating sociability networks and seeking, through them, to make their ideas and projects circulated in society. Thus, Moncorvo Filho can be seen as an intellectual committed to the transformation of society.

Assistance initiatives, such as those implemented by Moncorvo Filho, according to ^{Sanglard and Gil (2014)}, were one of several ways to alleviate poverty. According to these authors, such practices started through devotional brotherhoods and professional confraternities and, later, from secular or confessional philanthropic institutions. They were especially linked to childhood from the issue of infant mortality. These actions were aligned with a society that was undergoing political and social changes, forcing central and intellectual governments to seek ways to solve problems linked to poverty, especially the question of begging and those considered vagabonds, that is, the poor population that circulated in cities. The organization of assistance was, among others, one of the mechanisms put in place, as well as the maintenance of hospitals, among others. It was a moment when redemption through work was thought to lead the country to progress, as it would prevent the conversion of the poor into the miserable.

His performance had Rio de Janeiro city at the beginning of the 20th century as the scene of extensive urban and sanitary transformations that, in a way, contributed to the formulation of proposals inspired by European and North American models that would guarantee that Brazilian society would advance progress and civilization, as Câmara (2013) recalls. In this way, measures taken by philanthropic, private and assistance sectors, such as Institute for the Protection and Assistance of Infancy, were attempts to consolidate scientific and rational discourse, as well as its importance in reconfiguring the city, in the ways of life and in the behavior of the population.

According to ^{Bonato (2014)}, Moncorvo Filho recognized that there were many social problems that should be tackled by society and the authorities. It would be the way to eliminate all the evils that existed, such as hereditary diseases, alcoholism, syphilis, tuberculosis, among others, that caused the degeneration of the human being. Child protection emerged as central to the doctor's agenda, which aimed to intervene in the lives of children to prevent them from being affected by these evils. In their childhood protection projects, the agenda was to instruct families on hygienic and prophylactic care, from the teaching of childcare, home medicine and domestic education, with the aim of educating to civilize individuals.

The doctor was not restricted only to assist childhood, but to develop an extensive scientific production. In addition to the book under analysis, he published hundreds of works, many of them aimed at tuberculosis, parasitic diseases, yellow fever and infant mortality. Thus, we observe his care for a healthy childhood, a theme with which he was engaged in creating projects and in dialoguing with those who could share his ideas. Like other intellectuals who, in ^{Sirinelli's (2003)} perspective, are individuals politically engaged in the issues of his time, Moncorvo Filho used several spaces of sociability, seeking to maintain a field of dispute in order to circulate ideas and join others who associated with them. The book itself brings this perspective, by showing Moncorvo Filho's defense of the field of science, hygiene, childhood and politics. Childcare, scientific dissemination and implementation of innovative medical models of medical practice are unveiled during the 1918 pandemic, according to the narrative by Moncorvo Filho, as we will see hereinafter.

Balance of the pandemic: history, challenges and initiatives

As an introduction, the book begins with “The first words”, where Moncorvo Filho justifies his writing. First, highlighting the importance of studying the period that he called “chaos” for Brazil. It also shows what it was like to act in that period, fighting the pandemic, presenting their desires, fears and uncertainties about what the future would be, not only for those affected by the disease, but for doctors, nurses and authorities, the latter often presented as incapable to deal with combating “Pandemonium”.

In the first chapter, “The flu in Brazil”, the doctor historically recovers the epidemics that affected Europe and Brazil. He comments on the flu epidemics in Italy, in 1328, and those in France, in 1387, 1403,1410,1414 and 1420. He notes that the flu devastated Europe in the 16th century, and in 1505, few European countries did not suffer serious consequences of high mortality with the flu. He also highlights the flu epidemics in 1515, 1543, 1555, 1675, 1691, 1693 and 1695 as the least important in Europe and the rest of the world.

Here, it is noticeable his analysis of epidemics and pandemics throughout history, showing the impact they caused, decimating the population and unbalancing civilization due to its high power of causing people to die all over the world. He cites an epidemic outbreak in 1850 that wiped out more than 600,000 people in Europe and everywhere, calling attention to the 8,000 deaths in the city of Rome alone. He also shows that, during the 18th and 19th centuries, in countries like Belgium, Denmark, Germany, France and Italy, several epidemic outbreaks of flu infected many people.

After the historical retrospective of flu epidemics that had been affecting the world, Moncorvo Filho turns to the emergence of epidemics in Brazil.

From the descriptions existing in these subsidies of the national medical literature, interesting data are shown in the spectacular and devastating blasts of the various epidemic outbreaks, keeping the relativity of situations, times and population, there is a lot of similarity with what happened in the pandemonium from 1918 (^{MONCORVO FILHO, 1924, p. 13-14}).

From there, Moncorvo Filho presents us with a perception of how the disease has manifested itself in our country over time. He shows that his objective is to give the dimension that mortality reached in 1918, allowing readers to study and understand the gravity of that moment in Brazilian history.

A history of epidemics in Brazil

Moncorvo Filho presented in his book an important study by Barão do Lavradio (Baron of Lavradio) that mapped the advance of epidemics in Brazil. He was a surgeon concerned with public health, a researcher of tropical diseases. In this way, he reveals how his intellectual professional career bears the marks of the “heritage of the elderly” as an “element of explicit or implicit reference” (^{SIRINELLI, 2003, p. 255}).

Moncorvo Filho highlighted Barão do Lavradio (Baron of Lavradio) for his studies on the catarrh epidemic in 1864 that lasted eight months, in addition to having studied flu epidemics in 1867 and those of 1889 and 1890. This same flu would have affected population in 1903, leaving 511 dead and, in 1904, 646 dead. In the year 1905, 530 were killed, with figures that evolved from 1906 to 1908. Between 1909 and 1918, the flu would still have caused 163 to 481 deaths per year. The doctor reported in the book how the flu epidemic spread in the country, living together with other diseases such as bubonic plague.

The spread and frequency of the flu among us, its increase on the occasion of the appearance of the bubonic plague in this capital, already in 1903, made us suppose its relations with this terrible disease and this presumption aroused many discussions about it. Thanks to the offensive and defensive hygiene measures put in place then, the plague was suppressed, but the deaf and insidious flu continued to affect all social strata, due to its constancy and its frequency, making doctors, and even the people, accustomed to it. it is something inherent to our environment, it is no longer strange and the colds are registered as common facts (unduly known by the people as constipations) (^{MONCORVO FILHO, 1924, p. 26}).

In addition to presenting the number of sick people Moncorvo Filho indicated that the hygienic practices he had been developing to educate the population had a satisfactory effect in containing the number of deaths from the disease. The doctor presents data not only of deaths, but of all those infected with flu, between 1904 and 1917, in the city of Rio de Janeiro, year by year, in an effort of quantification.

When working on the numbers between 1915 and 1919, including the number of deaths from the Spanish flu pandemic in Brazil, he pointed out that there was a total of 14,845 victims. Between October and November 1918, the most critical moment of the health crisis, 13,424 deaths were recorded, thus highlighting the serious disturbance that took place in the country after the first days of the flu, in 1918.

The so-called civil clinic tripled the hospital wards with a plethora of patients and in the outpatient consultations the movement grew visibly. However, mortality did not correspond to the large number of people attacked, especially from respiratory diseases. At that time, on September 10, the influenza epidemic in Dakar, the French port of Senegal, where Brazilian warships were anchored, and the ship that led to the Medical Mission headed by Deputy Dr. Nabuco de Gouveia, that headed for the theater of war. Then the biggest doubts hovered in the Brazilian spirit about the true diagnosis of this terrible entity that decimated mercilessly in Europe and was already beginning to be known among us as Spanish flu, as it is intended to differentiate it from the regular flu, by many called nostras (ours) and since long ago acclimated in our environment and with which doctors were so familiar (^{MONCORVO FILHO, 1924, p. 29-30}).

It is noteworthy how the Spanish flu spread quickly in Brazil. The country was not prepared to deal with the disease, which allowed the flu to proliferate, infecting large numbers of people. The movement of patients looking for hospitals brought the state medical apparatus to a collapse and also immobilized the government, impeding prevention and causing a calamity situation.

The spread of Spanish flu in Brazil

With the title “What was the Pandemonium”, the second chapter of the book is an account of those days when the Spanish flu pandemic curve advanced in Brazil. In addition to a historical account, it is, above all, a testimony of his own actions, of what he lived in that period, rich for analysis and reflection of the physician's perception of these facts.

In this chapter, Moncorvo Filho highlights the immediate performance of Dr. Carlos Seidl, an important hygienist and then director of public health. Elected a full member of the National Academy of Medicine in 1895, he was notable for developing studies for defensive prophylaxis in Rio de Janeiro, in addition to conducting studies on yellow fever and leprosy, which would make him an important sanitary practitioner. In the book A propósito da pandemia de 1918: fatos e argumentos irrespondíveis (On the 1918 pandemic: unanswerable facts and arguments), published in 1919, Carlos Seidl, in addition to narrating his personal experiences, presented his opinions and countered the criticisms he received at that time. In his book, Moncorvo Filho not only defends the person of the doctor, but also of his thinking, committed to a perspective of medical action then implemented by both, who preached the adoption of interventionist practices, aligning the doctor to an educational perspective.

According to ^{Goulart (2005)}, Carlos Seidl was a scapegoat used by the government to blame someone and defend himself against the inability to implement efficient measures to fight the epidemic. This also seems to be the perception of Moncorvo Filho, who devoted much of Chapter II of his book to defending the physician's performance.

It is, therefore, extremely evident that the Federal Health Director, in the orbit of his normal and regulatory functions, does not have the remembrance to carry out all the precise measures, in the conjuncture created by the invasion of the epidemic flu. And if this Director, wanting to give wings to an almost divine welfare, invading the duties of the Mayor, the Ministers of State and the President of the Republic, requested the preparation of all measures, for the eventualities, resulting from the sudden illness of 400,000 inhabitants of the city, of which at least 100,000 are without food and medication resources, depleted, organically miserable: if this Director of Public Health declared it was necessary, before the epidemic explosion, to transform schools into hospitals, order foodstuffs, monopolize medicines, organize ambulances, to send preparing enough funeral coffins, putting in cemeteries hundreds of men digging graves, in short, predicting everything that the events forced to do in a hurry, what would the government say, what would the fourth national power [the press] would say, so ready to criticize? (^{MONCORVO FILHO, 1924, p. 37}).

Moncorvo Filho's criticism concurrently with the defense of Carlos Seidl, shows the difficulty that the central government and local governments had to build a unit in the action to combat the pandemic. It also reinforces, in yet another moment, the government's inability to deal with the disease, showing that both the government, and the press, called the fourth national power, made very unjust criticisms. To measure how the pandemic hit in Rio de Janeiro, the doctor uses the State of São Paulo as a parameter, seen as advanced, equipped with adequate equipment, hygiene services and public assistance, which allowed a better fight against the disease. According to Moncorvo Filho, in the last quarter of 1918, 14,504 individuals had succumbed in Rio de Janeiro, more than double that of São Paulo, where the number of deaths had reached 6,861 people. According to Moncorvo Filho, however, the hygienist Carlos Seidl acted incisively, seeking funds even before the arrival of “Vapor Samara” (Samara Steamboat), coming from Dakar, which became the trigger for spreading the disease in the country, because it was not quarantined, which was to be confirmed sometime later.

^{Bertucci-Martins (2003)} points out that the São Paulo press, like the O Estado de S. Paulo (State of São Paulo newspaper), published several articles under the title “Councils to the people”, in which a series of prescriptions were published to clarify the population about hygienic care measures they should adopt to prevent infection and spread of the disease.

The Reigning Epidemic

ADVICE TO THE PEOPLE (Extracted by the “State” from the Health Service official communiqué, already published)

Avoid crowding, especially at night.

Do not make visits.

Take hygienic care with your nose and throat: inhalations of mentholated Vaseline, gargling with water and salt, with iodized water, with citric acid, tannins and infusions containing tannins, such as guava leaves and others.

Take, as a preventive measure, any quinine salt in the doses of 25 to 50 centigrams per day, preferably at mealtimes.

Avoid any fatigue or physical excess.

The patient, at the first symptoms, should go to bed, because rest helps healing and keeps complications and contagion.

You should not receive any visitors at all.

Avoiding the causes of cooling is necessary both for the healthy, as well as for the sick and convalescent.

Elderly people should apply all these precautions even more rigorously (^{BERTUCCI-MARTINS, 2003, p. 110-111}).

On the other hand, Moncorvo Filho emphasizes that the press in Rio was constantly putting pressure on the authorities demanding strong measures. According to the doctor, many of the government officials did not believe in the strength of the flu, even comparing it to bubonic plague and cholera, both with less lethal power, which may have hindered more emphatic action by national authorities.

The newspapers lived full of these reprehensible mockery to the authorities, moved by dread and despair in the face of the most horrible epidemics that have plagued our beloved land and then did not spare hostilities towards the men of the government who, in fact, without having the most rudimentary equipment for stifle any violent incursion of epidemic disease, without the most elementary organization of Public Assistance, in spite of the cries of an old date from all the press in the country, from men of heart and from all of us, doctors and hygienists, they could do nothing at those times of pain and anguish for Brazil from the cruel pandemonium of 1918 (^{MONCORVO FILHO, 1924, p. 32}).

Despite highlighting that, in addition to the press, he and other doctors and hygienists also called for more action in the face of the flu pandemic. What would come, according to the author, would leave many unable to act to remedy the consequences of that disease. This is because, according to the doctor, the “prominent weather disturbances” of the Spanish flu could not have been predicted by anyone, nor the profound “organic and social misery” that would cause the death of a large part of the national population.

The 1918 Spanish flu pandemic, in his view, would have surpassed all calculations and that, therefore, no city could cope satisfactorily with its advance. With this understanding, Moncorvo Filho countered the numerous criticisms that were made to the federal health director, who would resign and be replaced by Carlos Chagas.

In face of this fact, it is neither logical nor sensible to demand that any city, however advanced, be equipped, in its public and private assistance services, to effectively deal with the colossal morbidity of almost half of its population, in a few hours affected by an illness whose deeply depressing influence of the nervous system is the dominant and characteristic note (^{MONCORVO FILHO, 1924, p. 35}).

The Institute for the Protection and Assistance of Infancy in Rio de Janeiro, where the doctor worked and was the coordinator, also did not escape the consequences caused by the Spanish flu, affecting students, midwives and nurses who, according to Moncorvo Filho, fell one by one because of the disease, which made him seek help among the lay population to combat the pandemic.

With the scarce staff that, as was said, I had, already using some of the people, harvested even among those who treated the most seriously patients, I transformed the common facilities of the Institute into a First Aid Station, filling the largest rooms with all the tables and beds we had. Despite an almost absolute deficiency of resources, the goodwill, the relative calm in the way of acting, the enormous activity developed and the ardent desire to serve all those people who burned with fever, some in rave, others falling affected by the collapse, others still succumbed by the collapse, others still succumbed under the most serious bizarre modalities of a terrible disease, supplied many of our shortcomings and, after the first moments of intense turmoil in the spirit, that dantes que spectacle generated in me, I managed to organize all services, although overloaded with work superior to my strength in the face of the crowd squeezing itself in every corner of our institution (^{MONCORVO FILHO, 1924, p. 50}).

The doctor's first action was to summon companions, and even street people, to help guide patients. Then, he acted so that the Institute became a first aid station, prepared to serve the population. This made it possible to assist a large contingent of patients who would be greater if they did not use such a measure, as the disease progressed very quickly. The government and the private sector also organized first aid posts, as revealed in the following chapters when the author addressed the “dismantling of our public assistance. Aid stations organized by the Government, the City Hall and private individuals.”

Educational measures in the face of the pandemic

The first aid posts were created with the objective of contributing to the fight against the pandemic at a time when the public authorities were unable to deal with the progress of the disease. About this, the doctor Moncorvo Filho made several considerations regarding the conditions that favored the proliferation of the disease among the poorest population in our country.

In collective housing, in serious condition, many of its residents fell almost overwhelmed by the terrible disease. The population was quite rightly alarmed and on October 10 all public services were already significantly out of touch with their staff, away from their duties due to illness, with a very high number of guides drawn by the Police Stations for the admission of people with flu in the Hospital of Mercy. The miserable and beggars, as always, were the first to fall victim to the devastating disease and in whom the most serious illness was immediately installed. The paralysis of the usual life of the city began: the entertainment houses were closed, rather due to their affected staff, making it impossible to carry out the shows and sessions, than even by means of prophylaxis. Municipal schools and private schools also closed their doors. Commercial establishments, especially hotels, bars and taverns, where the frequency was then almost nil, were gradually ceasing to function because simultaneously all the employees were surprised by the terrifying Spanish flu (^{MONCORVO FILHO, 1924, p. 52}).

The disease, in his interpretation, left the control of the public power when it began to reach the poorest, such as beggars, the miserable and the low-income population in general, forcing the adoption of measures, such as closing local businesses, paralyzing cultural activities, schoolchildren and any and all activities that generate crowds of people. This has led not only the Institute for the Protection and Assistance of Infancy, but hospitals and police stations, for example, to act as spaces for the reception of patients and, thus, help them in the process of care and cure. The hospitals were overcrowded, as were the morgues, which led employees to work day and night: “In the various morgues there were a few dozen unburied corpses. There, people work day and night to bury those who pay, but the indigent wait for their turn to come” (^{MONCORVO FILHO, 1924, p. 54}).

Moncorvo Filho mentions the preparation of a medication used by him at the health center he founded at Institute for the Protection and Assistance of Infancy and helped care for 10,000 patients, of whom 945 died. Caravanas do Bem (Goodwill Caravans) were created to operate in low income areas as Morro do Salgueiro, Morro da Cruz, Morro do Telégrafo, Estação da Mangueira, Engenho de Dentro, Encantado de Cascadura, Porto de Maria Angu, Ramos and elsewhere. Professionals – mostly doctors and nurses – and volunteers took medicine and helped fight the disease, teaching hygiene practices to the population that did not have access to this type of scientific education, reinforcing, therefore, a posture already thought and practiced in his action as a doctor at the Institute for the Protection and Assistance of Infancy.

Of the various cases reported in the book, we highlight two. The first deals with 19-year-old Laurentina Cordeiro, who suffered from the flu and, after fainting in the street of weakness, was taken to Santa Casa hospital, where she was wrapped in a sheet to be buried. On September 25, 1918, she woke up in the coffin before being taken to the Cajú cemetery. With the help of doctors, she returned to the hospital and was cured of the disease. However, according to Moncorvo Filho, it became a haunt in Santa Casa hospital, where they believed she had died and returned to haunt the local professionals.

Another, more emblematic case is that of a family in Catumbi neighborhood, which experienced difficulties in burying their beloved ones who had died a few days earlier affected by the pandemic.

A poor family from Catumbi neighborhood, which unfortunately had lost two beloved ones more than four days earlier, keeps the corpses at home because they have already exhausted all their means. In a double despair for the wickedness that consisted of keeping those bodies unburied and for the high state of bodies decomposition in which they were already stinking out of rottenness the whole neighborhood, the head of that family was studying a way to solve the case. Then the door of the house remained waiting for one of the many trucks that crossed the street at all times, piled up, carrying on the corpses of the victims of Pandemonium and, when passing one of them, he stopped it and, on his knees, impelled the driver of the vehicle to take the corpses that had been involuntarily in his home for so long to the cemetery. After the heated discussion, the man in the truck said that he had strict orders not to receive any more bodies and that the vehicle was full; the head of the family insisted and they were sorry for the situation of those poor people, he proposed, and it was accepted, to exchange two fresh corpses for that one whose rottenness was unbearable, allowing time for their possible handling (MONCORVO FILHO, 1925, p. 66).

The highlights given by Moncorvo Filho to these cases express his understanding that the bankruptcy of the government made it difficult to efficiently fight the pandemic, specifically with regard to the poorest population.

Lessons from the pandemic: the legacy of a testimony

The book O Pandemônio de 1918 (The 1918 Pandemonium), written by the doctor Moncorvo Filho, brings an account of the Spanish flu in Brazil, interspersed with studies on influenza epidemics, numbers, statistics and life stories of persons who, abandoned to their fate amid the precarious conditions of life, became victims of the pandemic. It also addresses the deficiencies of the health system, the lack of protection of those professionals who dealt more closely with the infected, the unpreparedness of society itself and the absence of a sanitary structure that would allow putting into practice the hygienic precepts that the author advocated for all.

More than portraying what was the Spanish flu pandemic in 1918, that is, how the disease arose, advanced and spread in our country, the book draws attention because it is not a simple account of a distant observer, who takes knowledge of a disease, or of a person who bends over to study what happened. It is a testimony of someone who saw, lived and reflected on the arrival of a new disease, the existing ignorance about its spread and cure.

Ahead of the fight, particularly at the Institute for the Protection and Assistance of Infancy, he witnessed suffering, lost collaborators, recruited volunteers, acted in the healing of patients in an interventional way, curing patients, prescribing and publicizing hygienic practices to minimize the spread of the disease and prevent deaths.

A time elapsed between the pandemic and the writing of the book, so Moncorvo Filho had time to better reflect on the difficulties faced even to account of the dead persons in the face of the lack of reliability of the data available to them. Despite all efforts to articulate hygiene, education and medicine, there was no precise number of all those affected.

The mess of the 1918 Pandemonium did not allow us to have a perfect statistic of the mortality caused by the Spanish flu in its anxious days, despite the herculean and praiseworthy efforts of the Official Demography department. It is vaguely known that the total obituary in October and November of that dreadful year accounted for 16,996 deaths (^{MONCORVO FILHO, 1924, p. 87-88}).

The doctor comments that there was a possible underreporting of the disease when pointing out that it may have killed many more people than the records of that period. However, committed to the development of the nation's progress, it is perceptible the way in which, together with other intellectuals, he was dedicated to overcoming the spread of the disease.

From everything I have commented, it is concluded that we found, in contrast to what has been done in all literate countries, in the most deplorable state in terms of Public Assistance, continuing to this day under the same conditions only with complains of everyone: the press, doctors, hygienists and men of heart, always crying out against our disdain from such point of view (^{MONCORVO FILHO, 1924, p. 24}).

Like other doctors of his time, Moncorvo Filho acted to cure, educate and overcome the Spanish flu, when he arrived in Brazil and, especially, in Rio de Janeiro. With his progressive thinking, he understood that it was necessary to unify the country, overcoming, therefore, the criticisms made to the scientific authorities in facing the pandemic.

In addition to showing the difficulties faced by him and the Institute for the Protection and Assistance of Infancy in combating the high rate of deaths, it is evident that he used intervention practices aimed at the population, especially the most needy, educating for hygiene and childcare practices, but also to curb the then growing pandemic that had victimized many people. His action in combating Spanish flu was also based, to a great extent, on the practices he had already been implementing at Institute for the Protection and Assistance of Infancy for some years, when he thought and practiced a medicine that, at the same time, healed and educated individuals so that they could take care of themselves and, thus, contribute to the development of the nation.

These practices were guided by a medical perspective that Moncorvo Filho has developed since the creation of Institute for the Protection and Assistance of Infancy, in 1899. Practices that gained visibility as they circulated in other spaces, such as associations, scientific entities, newspapers and magazines, seeking sympathizers for ideas about childhood, science, hygiene, politics and education. This process points to the concept of an intellectual person, developed by ^{Sirinelli (2003)}, as one who works in various spaces, creates bonds and makes his ideas circulate and gain followers. This is clear in the book O Pandemônio de 1918 (The 1918 Pandemonium), since, besides bringing reflections that help us to think about the Spanish flu in Brazil, Moncorvo Filho also made an emphatic defense of the persons with whom he had ties and also participated in this process as Carlos Seidl, strongly criticized during the pandemic, but who had his defense.

The book prompt current reflections. In it, Moncorvo Filho showed that the pandemic transformed the way in which Brazil and the world were constituted as a society and, in this sense, is a legacy for our days as it helps us to broaden the understanding of the health actions relevance as a permanent challenge. Also, it does not allow us to forget that the spread of diseases such as epidemics / pandemics has social causes, which touches on us the perception and the sense of life in society, where prevention and management measures can only be successful in collective actions.

Regarding the Spanish flu pandemic, Moncorvo Filho recorded how he acted, in the midst of the difficulties and possibilities he faced, taking on the political task of intervening in favor of life of the poorest and those who would have less protection from the public authorities. The publication of the book indicates his concern to leave his testimony not only of the emergence of the Spanish flu pandemic, but of the way in which different persons of his generation engaged in the task of preventing contagion and the spread of the disease to prevent death, seeking interfere in sanitary measures, denouncing political decisions and the lack of structure in the public service. All these actions necessarily passed, in his understanding, through education.