Sažetak | Razdoblje u kojem se u ovom radu pratila tuberkuloza u dubrovačkom društvu od 1825. do 1950. godine karakterizirano je velikim političkim i gospodarskim promjenama. To je razdoblje prije učinkovite antibiotske antituberkulozne terapije u kojem se ipak u nekim europskim zemljama već značajno uspijevalo smanjiti tuberkuloznu smrtnost. Istraživano razdoblje zahvaća 125 godina, za vrijeme kojih je Dubrovnik bio u sastavu Habsburške Monarhije (od 1867. pod nazivom Austro-Ugarska Monarhija), monarhističke Jugoslavije (Kraljevina SHS, Kraljevina Jugoslavija), kratko razdoblje Nezavisne Države Hrvatske i konačno Druge Jugoslavije. Dubrovačko društvo ranog 19. stoljeća zbog straha i osjećaja bespomoćnosti pred konstitucijsko-nasljeđenom ili mistično-vampirskom objašnjenju uzroka nastanka tuberkuloze nije poduzimalo neke posebne preventivne mjere. Držali su da se ne može boriti protiv nečega što je donekle sudbinski određeno. Otkriće bacila tuberkuloze 1882. godine dovelo je postupno do promjene stava i provedbe brojnih javnozdravstvenih mjera. Mjere su bile određene odlukama grada Dubrovnika prema zakonima država u kojima se Dubrovnik našao. Smrtnost od tuberkuloze doživljava svoj vrhunac tijekom 19. stoljeća da bi postupno padala početkom dvadesetog stoljeća a takva tendencija je nastavljena sve do pedesetih godina 20. stoljeća, s izuzecima ratnih razdoblja. Ona je i u Dubrovniku najviše pogađala najproduktivniji dio društva. Koliko su socijalne prilike dubrovačke sredine koja nije bila industrijska, a koliko mjere javnog zdravstva poduzete u tome razdoblju doprinijele padu smrtnosti, pitanje je ne samo dubrovačko nego i svjetsko. Dubrovnik u tome dugom razdoblju poboljšava loše higijenske prilike, kakve su vladale u 19. stoljeću i provodi niz drugih mjera usmjerenih na podizanje gospodarstva i životnog standarda. Tijekom 19. stoljeća liječenje se temeljilo na tradicionalnom liječenju prema humoralnom principu i biljnim pripravcima koji su olakšavali simptome bolesti. Poticaj za uvođenje novih pristupa liječenju tuberkuloze bilo je osnivanje nove dubrovačke bolnice, koja počinje s radom 1888. godine. U njoj se osniva isprva maleni paviljon za zarazne bolesti, nedovoljan za potrebe dubrovačkog stanovništva. Sve do nastanka novih zdravstvenih ustanova u kojima se moglo izolirati bolesnog pojedinca, najveći broj bolesnih liječio se u kućnim uvjetima i tako postajao izvor zaraze za zdrave ukućane. Nedostatak zdravstvene infrastrukture popravlja se u dvadesetim godinama 20. stoljeća, kada se utemeljuju antituberkulozni dispanzer, Dom zdravlja, "Morska kuća", Oporavilište za djecu na otoku Lokrumu i sanatorij "Tiha". Posebni odjel za plućne bolesti "Morska kuća" stvara preduvjete za provođenje izolacije, jedne od najvažnijih mjera borbe protiv tuberkuloze, dok se dio bolesnika upućivao u sanatorije širom Jugoslavije, a
najviše u Klenovnik, Golnik i Brezovicu. Pri gradnji "Morske kuće", sanatorija "Tiha" ili Oporavilišta na Lokrumu vide se utjecaji sanatorijumske arhitekture s velikim prozorima, sobama punim svjetla i zraka i zelenim okolišem. U društvu sveprisutna tuberkuloza ostavila je brojne tragove u umjetničkom stvaralaštvu, poglavito u književnosti, ali bez romantičarske faze tipične za europsku i svjetsku literaturu. Prisutnost tuberkuloze u društvu odražava se i u slikarstvu i kiparstvu, ali u prvoj polovici dvadesetog stoljeća.
Statistika smrtnosti od tuberkuloze tijekom 19. stoljeća nije bazirana na čvrstoj medicinskoj podlozi, ali postupno prema kraju stoljeća pokazuje sve više preciznih, a sve manje općenitih, simptomatskih dijagnoza. Zahvaljujući razvoju dubrovačke bolnice i privatnoj inicijativi liječnika prve polovice 20. stoljeća, dijagnostika postaje bolja i brža. I dok su u cijelom 19. stoljeću mjere zaštite od tuberkuloze bile skromne, osnutkom Antituberkuloznog dispanzera u Dubrovniku 1920. godine kao prvog antituberkuloznog dispanzera u Kraljevini Srba, Hrvata i Slovenaca dolazi do značajnog pomaka u društveno organiziranoj borbi protiv tuberkuloze. Utjecaj liječnika koji rade u dispanzeru sve se izrazitije očituje kroz njihov aktivni društveni pristup, borbu protiv stigme i mišljenja da svježi zrak dovodi do bolesti, poglavito brojnim napisima u novinama, plakatima i organiziranjem predavanja i tribina. U usporedbi s drugim europskim sredinama dubrovačko je društvo bilo neindustrijalizirano i orijentirano na poljodjelstvo, uz slabije finacijske temelje za aktivnije društvene mjere. Ipak i u Dubrovniku se poduzimaju konkretne aktivnosti, mjere asanacije stanova, organiziraju se "šumske" osnovne škole kao u Londonu, a osviješteno građanstvo gradi novu gimnaziju jer je stara bila leglo plućnih bolesti. Prave protivepidemijske mjere kao što su besežiranje sustavno su se počele primjenjivati nakon pedesetih godina 20. stoljeća, kada su i u Dubrovnik stigli specifični lijekovi. Međutim u Dubrovniku je smrtnost od tuberkuloze pala i prije uvođenja BCG cjepiva i farmakološke antituberkulozne terapije. Zasluga za to najviše pripada dispanzerskoj aktivnosti uspostavljenoj početkom 20. stoljeća, uz poboljšanje standarda, provedbu javnozdravstvenih higijenskih mjera, izolaciju bolesnih, poboljšanje uvjeta stanovanja, bolju prehranu i sigurniju dijagnostiku. |
Sažetak (engleski) | The period in which tuberculosis in Dubrovnik society was followed in this paper, in the period between 1825-1950, was characterised by great political and economic changes. It is the period before the efficient antibiotic anti-tuberculosis therapy when in some countries significant reduction in mortalitiy caused by tuberculosis was already present. At the beginning of the research period Dubrovnik was part of the Habsburg Monarchy (since 1867 under the name Austro-Hungarian Monarchy), followed by monarchist Yugoslavia, a short period of the Independent State of Croatia and, finally, the Second Yugoslavia. Dubrovnik 19th- century society was not taking any special precaution measures against tuberculosis, as the causes searched in constitutionally inherited body features or mystical-vampire causes spred the feeling of fear and helplessness. It was believed that something which was to some extent destined to be could not be fought. The discovery of tuberculosis bacillus in 1882 has gradually led to the change in the attitude and implementation of numerous public health measures. The measures were defined by the regulations of the city of Dubrovnik according to the laws of the states in which Dubrovnik was found at the time. The mortality rate of tuberculosis reached its peak during the 19th century, while at the beginning of the 20th century it was gradually dropping. This trend continued until the 1950s, with the exception of war times. In Dubrovnik too, the tuberculosis had the strongest effect on the most productive part of the society. The question of how social circumstances of Dubrovnik community, which was not industrial, as opposed to public health measures taken in that period, contributed to the drop in mortality, does not regard only Dubrovnik, but have global features, too. During that long period Dubrovnik improved its poor hygienic conditions inherited from the 19th century, and introduced different measures to foster economic and social development. During the 19th century the treatment from the previous century was continued without significant changes. It was based on humoral principle and herbal preparations which relieved the symptoms of the disease. However, foundation of the new hospital of Dubrovnik, opened in 1888, was an incentive for implementing new approaches to tuberculosis treatment. In the hospital a pavillion for contagious diseases was formed, small at first and insufficient for the needs of the inhabitants of Dubrovnik. Up until the building of new health institutions in which sick patients could be isolated the greatest number of patients were cured at home and therefore becoming a source of infection for healthy household members. The lack of health infrastrucure was improved in 1920s, when anti-tuberculosis dispensary, Health centre, ''Morska kuća'' (Sea House), Children recovery centre on the island of Lokrum and ''Tiha'' Sanatorium were founded. The special ward for pulmonary diseases ''Morska kuća'' created preconditions for isolation, one of the most important measures against tuberculosis, while a part of patients were directed to sanatoriums all around Yugoslavia, mostly in Klenovnik, Golnik and Brezovica. In building of ''Morska kuća'', ''Tiha'' sanatorium and the Recovery centre on Lokrum influence of sanatorium architecture can be seen, with big windows, rooms full of light and air, and with green environment. Omnipresent tuberculosis has left numerous traces in artistic creativity, especially in literature, but without the romantic phase, typical for European and world literature. A strong presence of tuberculosis in the society is mirrored in painting and sculpture in the first half of the twentieth century.
The tuberculosis mortality statistics during the 19th century was not based on firm medical ground. However, gradually, towards the end of the century, diagnosis were more and more precise and less and less general and symptomatic. Thanks to the development of the Hospital of Dubrovnik as well as private initiative of doctors, in the first half of the 20th century the diagnostics got better and faster. While the entire 19th century was modest in the protection measures against tuberculsis, with the foundation of Anti-tuberculosis dispensary in 1920, as the first one in the Kingdom of Serbs, Croats and Slovenes, a significant, socially organised fight against tuberculosis started. The influence of doctors working in the dispensary became more and more recognised through their active social approach, fight against stigmatization, against the opinion that fresh air causes the disease, especially through numerous newspaper headlines, posters and organised lectures and public discussions. The comparison of social activity of Dubrovnik society to other European communities points out crucial differences regarding its lack of industrialisation, highly agricultural environment, as well as poor financial basis for more active social measures. However, in Dubrovnik some concrete activities were undertaken, housing remediation measures, ''forest'' elementary schools were organised, like in London, while conscious citizens built new grammar school, because the old one was a source of pulmonary diseases.
Real anti-epidemic measures, like vaccination, have sistematically been taken since 1950s, when specific medications arrived in Dubrovnik. However, in Dubrovnik the tuberculosis mortality rate dropped even before the vaccine and specific anti-tuberculosis therapy were introduced. Credit for this, back at the beginning of the 20th century, mostly belongs to activity of dispensary, together with standard improvement, implementation of public health measures, isolation of the sick, improvement of housing conditions, as well as better diet and safer diagnostics. |