Sanatoria of Madeira

Prince Frederico Carlos de Hohenlohe asked the Portuguese Government for permission to establish seaside and mountain sanatoria in Madeira for the treatment of consumptives. For this purpose he was to organise a company under Portuguese law, and our government would have the right to dispose of a certain number of places for the treatment of poor patients. Permission was granted by ministerial dispatch of 9 June 1903, after a favourable opinion had been obtained from the National Assistance for Consumptives (Assistência Nacional aos Tuberculosos). A commission of German experts came to Madeira to choose the sites for the sanatoria, and our government appointed the physician Dom António de Lencastre to accompany that commission to this island.

Once the opinions of that physician, of the Higher Council of Public Hygiene (Conselho Superior de Higiene Pública) and of the Crown Attorney-General’s Office (Procuradoria Geral da Coroa) had been heard, the concession he had requested was definitively granted to the Prince of Hohenlohe. It required a substantial deposit to guarantee fulfilment of the clauses of the contract, among which was the right of the concessionaire to carry out expropriations in the public interest and to import, free of customs duties, the materials needed to build the sanatoria.

The Sanatoria company, or enterprise, had as its agent on this island the late commander Manuel Gonçalves, an intelligent and enterprising man. Immediately after its organisation the company acquired the quintas (country estates) Santana, Vigia (‘lookout’) and Bianchi. In August 1904 it received from abroad the first materials for the installations it was about to build in the parish (freguesia) of Monte (‘hill’), where it soon employed some 300 workers, not counting the technical staff who had come from Germany.

For some years the business of the Sanatoria Company on this island ran smoothly, despite the campaign waged against it by some English residents, who feared that the Hohenlohe concession might harm their interests. However, when the Company, relying on the privileges it enjoyed, sought to expropriate the Quinta Pavão, belonging to a British subject who had bought it shortly before from an Austrian, serious complications at once arose. These forced our government to open negotiations not only with the concessionary Company but also with the cabinets in London and Berlin, which were likewise interested in the matter.

When it proved impossible to reach an agreement with the concessionary Company, our government offered it three options: arbitration by the tribunal at The Hague, the choice of other land for building the sanatoria, or rescission of the contract. The Company preferred the last proposal as the most feasible, and perhaps as the one that brought the greatest profits and advantages to those interested in the business in question.

By the law of 3 November 1909 the Government was authorised to rescind the concession granted to the Prince of Hohenlohe by the ministerial dispatches of 9 June 1903 and 4 January 1904, and to buy back the buildings, installations and all the rights belonging to the concessionaire, on payment of 4,425,000 marks and the corresponding interest at 5 per cent from 20 August 1908, the date on which negotiations were concluded. General Parreira had come to Madeira, commissioned by the Government, to value the properties of the Sanatoria Company.

The ministerial order (portaria) of 18 November 1909 gave full powers to the Viscount of Geral de Lima, Treasury Delegate (delegado do tesouro), to accept the buyback of the concession. Shortly afterwards the Company’s movable and immovable property passed into the possession of the State. Since then it has been in the charge of the head of the district Revenue Office (Repartição de Fazenda), who is responsible for doing whatever is necessary for its upkeep and proper administration (1921).

The Sanatoria Company found in the former queen, Empress Amélie, one of its most devoted protectors. The late King Carlos I, on receiving Professor Pannwitz, one of the members of the commission that had come to Madeira in 1904 to choose the sites for the buildings intended for consumptives, spoke words of admiration and encouragement for the Prince of Hohenlohe’s initiative.

The properties that passed into the Government’s possession on rescission of the contract were the Quinta Santana, where one of the buildings intended to receive patients stands, the Quinta Vigia, the Quinta Bianchi, the Quinta Amélia, the Quinta dos Reis e Palmeira, and the land at Marmeleiros (‘quince trees’), where the so-called sanatorium for the poor stands (1921). The State also received a quantity of water from the Arrebentão that had been acquired to supply the Company’s buildings, as well as all the furniture in those buildings. For all this property it paid the sum of 4,753,354 marks, of which 328,541 marks were interest due.

Converted into Portuguese money, these amounts show that the Company received from the State the sum of 1,159,864,025 réis (old Portuguese money of account; 1$000 = 1,000 réis, 1:000$000 = one conto = 1,000,000 réis), of which 1,079,700,000 réis was the value of the properties and 80,164,025 réis interest. At the time of the rescission the concessionaire was authorised to recover the deposit it had lodged to guarantee fulfilment of the clauses of the contract, which consisted of 725 bonds of the Portuguese foreign debt, each worth 20 pounds (1921).

We transcribe below two important documents that shed valuable light on the subject of this article:

From the Diário do Governo (‘Government Gazette’) of 29 October 1903: Directorate-General of Health and Public Welfare – 2nd Department. Informed by this knowledge, and after His Majesty’s Government had granted authorisation to build sanatoria there, the Prince of Hohenlohe organised a mission. Its medical side was represented by Professor Frankel of the Berlin Faculty, where his scientific authority is respected and enjoys the most glorious renown, and by Dr Pannwitz, secretary-general of the International Tuberculosis Bureau, who has so distinguished himself in directing various works in the fight against tuberculosis and in organising countless sanatoria. The mission’s aim was to choose sites on the island suitable for building sanatoria, some for those predisposed to tuberculosis, others for those infected with it. As the Prince wished a Portuguese physician to accompany the mission, Your Excellency’s generous goodwill saw fit to choose me, and it is with pleasure, and with the assurance of my gratitude, that I now report on my modest discharge of the honourable task I accepted.

We left on 2 September and returned to this capital on 7 October. We stayed on that island for ten very short days, and from our delightful excursions through that enchanting region, its villages, mountains and heights, we gathered the most pleasing impressions, though not without the light and shade that is the inescapable law of human contradictions.

From enjoying that matchless climate, and from the personal impression to which Sigismond Jaccoud – the great master of climatotherapy – attached such importance, and without so much as touching on the beauties to which artists surrender, seduced, we understood – I should say we felt – its incomparable physiology.

We felt its sedative effects, shown in the calm of the general circulation, the repose of the central nervous system and the lesser effort of inspiration, which bring patients the end of all excitement, the return of sleep, less coughing and a fuller satisfaction of the need to breathe. We felt too its tonic action, through the heightening of combustion within the organism and the quickening of the digestive functions, whose natural reward is better nutrition and a gain in weight.

The sad note, jarring in that glorious concert of nature, is the deplorable state of Madeira with regard to the very disease that people go there to cure.

And to one point I draw Your Excellency’s intelligent attention at once. Tuberculosis, like the splendid flora that has taken root there, has invaded the poor classes of the island, becoming there, as on the mainland, a popular disease. The mixing of sick and healthy in the hotels; the healthy succeeding the sick in their rooms without the slightest precaution or the most rudimentary disinfection; and the spread far beyond these centres of contagion, carried in dirty linen washed everywhere without prior treatment – these are serious causes of the propagation of tuberculosis. Its accomplices are the overwork (surmenage) of those who labour and the alcoholism of so many who deceive themselves with a momentary stimulation, vainly hoping to rebuild strength that only grows ever weaker.

It is this evil that must urgently be remedied. Certainly, the Prince of Hohenlohe’s enterprise meets one of the most essential requirements.

The immediate construction of sanatoria for rich and poor, run as closed establishments where the most meticulous disinfection is guaranteed, will surely transform the results that the immigration of consumptives has so far brought the island. The very grave drawback of the consumptive’s passage through the island disappears entirely, so that the benefit the patient seeks and obtains there brings it nothing but prosperity. In other words, building sanatoria prevents future invasions of Robert Koch’s bacillus. But what of the present evil? Part of it can be remedied by creating establishments for the poor; the rest will be met by enforcing the decree of 30 August 1902, which Your Excellency, with your lofty judgement, will know how to put into practice, providing Madeira with the equipment and staff indispensable for its defence. The law is certainly excellent, but ineffective and inapplicable without disinfection stations, etc., etc.

The work that the Prince of Hohenlohe intends to carry out is vast and complex. He wishes to make use of all the resources that the region offers.

Thus, on the coast he will set up cure hotels to treat the predisposed, the anaemic, the chlorotic, the lymphatic, the scrofulous, the exhausted and the neurasthenic. They will be equipped with all the modern apparatus that uses physical agents: heat, light, electricity, kinesitherapy and massage. He will build artificial beaches to complement thalassotherapy, etc.

In the mountains, below the fog zone, the general sanatoria for treating tuberculosis will be placed. Suitably wooded sites will be used, where large enclosed parks will be laid out for the patients’ enjoyment and for the open-air cure, which will be favoured by the nearness of superb pine woods.

The high altitudes will be reserved for more special indications, no doubt including the summer treatment of some forms of tuberculosis.

On the advice of the medical mission, as soon as the company begins its work two meteorological stations will be set up, one on the Arieiro at 1,700 metres and another on the Paul da Serra (‘upland marsh’) at 1,500 metres, to judge reliably the winter weather conditions. The existing data, above all those presented by Mr João Tierno on the Paul, and the limited use made of the Arieiro for a few patients, admirable though they are, are not enough to form a scientific opinion.

To take advantage of the Atlantic climate, the medical mission designated a strip of the coast of Funchal bay, and in the parish (freguesia) of Monte it chose several sites, both for the sanatoria for the rich and for those for the poor, meeting the requirements of shelter and the other conditions that such establishments demand.

The first sanatorium for the poor, to be built immediately, will have forty beds in two pavilions, one for men and the other for women.

In closing, I must inform Your Excellency that the Government’s delegate owes as much gratitude for the distinguished manner in which he was received by the Prince of Hohenlohe and the whole mission, as all of us who have now visited A Ilha da Madeira (‘The Island of Madeira’) owe to the traditional courtesy with which the Portuguese authorities treated us.

God keep Your Excellency. To His Most Illustrious and Most Excellent Lordship the Minister of the Kingdom and President of the Council of Ministers. – Lisbon, 30 October 1903. – Dom António Maria de Lencastre.

From the Diário do Governo of 25 January 1914: ‘Until 12 noon on 27 February next, sealed tenders will be received at the Directorate-General of Public Finance, in the Ministry of Finance, for the lease, in a single lot, of the national properties specified below:

Tenders must be accompanied by a document proving that a provisional deposit of 10,000 escudos (the Portuguese currency from 1911: 1 escudo = 100 centavos = 1,000 réis) has been made at the Caixa Geral dos Depósitos, in cash or in public debt securities; on the definitive award of the contract this will be raised to the sum corresponding to two years’ rent. In addition to the certification of the bidder’s signature, tenders must state the bidder’s profession and residence, and likewise those of the guarantor or guarantors offered, who must be Portuguese citizens with property or assets in Portugal.

The said properties go to auction unfurnished and will return to the possession of the National Treasury (Fazenda Nacional) at the end of the contract, with all improvements made to them, without any right of retention or compensation for the tenant. The tenant is obliged to insure them in favour of the National Treasury against the risk of fire, and to compensate it for any damage not due to the normal use of the properties.

The monopoly lease (contracto) confers no exemptions of any kind, nor does it release the holder from compliance with the laws of the country, including tax and criminal law.

The building materials the State holds there do not form part of this monopoly lease, and the concessionaire is therefore obliged to keep them safe on the properties until the government disposes of them directly or at public auction.

On the said 27th, at twelve noon, in the Ministry of Finance, in the office of the Director-General of Public Finance, the Attorney General of the Republic and the Director-General of Customs will meet with him. Having examined the tenders submitted, they will draw up a ranking of them according to the rent and the other advantages offered, assessed as a whole. The government will award the concession to the most advantageous, while reserving the right to accept none if none suits it. If parliamentary approval is required for the definitive award of the contract, the government will submit the appropriate bill within 10 days.

• 3rd Department of the Directorate-General of Public Finance, 24 January 1914.’

The Head of Department, Augusto Correia da Silva Melo. After the failure of the company organised by the Prince of Hohenlohe, the task of building a sanatorium in Madeira passed to the ‘Assistência Nacional aos Tuberculosos’ (National Tuberculosis Assistance). The sanatorium would still not be a happy and eloquent reality had it not been for the benevolent efforts of Dr João Francisco de Almada, to whom this remarkable undertaking is chiefly owed, together with other indispensable improvements that are most closely bound up with it. Anyone wishing for detailed knowledge of the subject, which we cannot set out at length here, should read the interesting pamphlet A Obra da A. N. T. na Madeira by the distinguished writer Feliciano Soares, and the book Dr. João Francisco de Almada, produced under the chief editorship of the same writer. Its publication was due to the initiative of the present author, co-author of the Elucidário Madeirense.

The sanatorium was built on the former Quinta Santana, and its formal inauguration took place in 1941. It was given the name ‘Sanatório Doutor João Francisco de Almada’ as a most deserved tribute to the illustrious physician, who had died in this city on 14 June 1942.