Aurélio da Costa Ferreira’s “Moral Patch”: An Innovative Approach to the Treatment of Portuguese Soldiers in the First World War

Margarida Portela (HTC - NOVA/FCSH, CH - FLUL & CINAV - EN)

​

Presented at The Spring 2026 Military Welfare History Network Symposium ‘Healthcare, Disability, Non-State Actors and So Much More’

Date: Monday 2 February 2026 Venue: Online, via UCD Centre for War Studies

 

"The subject of this presentation is closely connected to my PhD research on the Portuguese Military Healthcare Service during the First World War. That research led me to encounter a number of physicians whose contributions have largely faded from historical memory, despite their relevance at the time. Aurélio da Costa Ferreira is one of them.

​

Portugal officially entered the Great War in 1916. Although a small nation, it faced the urgent need to care for soldiers injured and disabled during this conflict, due to a more modern and industrial warfare. Most of these men returned from the Western Front bearing severe physical and psychological injuries – while, in the African front, they would not even return home.. But, for those coming from France, their reception, treatment, and social reintegration posed serious challenges, particularly as the Portuguese medical service, both civil and military, was already overwhelmed by widespread disease, including tuberculosis and, later, in 1918, by the Spanish Flu.

​

Within this context, Portuguese physicians reflected on new ways to respond to war disability, expanding medical knowledge and seeking paths to rehabilitation and social reintegration. Among them, Aurélio da Costa Ferreira stands out as a pioneering yet largely forgotten figure, despite being one of the most prominent Portuguese doctors of his generation – and someone that updated himself constantly in matter such as psychiatry, psychotherapy, speech therapy, and medical responses to modern warfare.

​

But who was him and why do I think we should remember him? António Aurélio da Costa Ferreira was born in Funchal, the capital city of Portugal's Madeira archipelago, in the year 1879. And he died far from his homeland in Lourenço Marques, Mozambique, in 1922. He studied Philosophy and Medicine at the University of Coimbra and undertook postgraduate studies in France. A physician, educator, and intellectual of a remarkable extent, his work left a deep imprint on Portuguese society, education and welfare system.

​

Although today he is often remembered primarily for his pedagogical work, Costa Ferreira was intensely active in public life. As Director of Casa Pia de Lisboa, he promoted innovative educational models and expanded attention to children with special educational needs, emphasising rehabilitation and social integration.

​

In 1915, he founded the Medical and Pedagogical Institute in Santa Isabel, inspired by foreign experiences and dedicated to children with disabilities. This institution would soon prove crucial during the war, as it became a site where knowledge developed for educational purposes was redirected toward the care of war-disabled soldiers, at a time when Portuguese society remained largely reluctant to confront the consequences of this conflict.

​

We now know that Costa Ferreira was already engaged in debates on war disability by 1916. As Portugal prepared to send troops to France, he even warned the Ministry of War of the inevitable rise in the number of mutilated soldiers and the urgent need to address both their physical and psychological recovery. And, by offering his services to the state, he positioned himself at the centre of concerns that were shared by several other colleagues.

​

For that reason, in 1917, he was invited to participated in several inter-allied initiatives alongside Portuguese colleagues such as Alfredo Tovar de Lemos and José Pontes. These efforts were closely connected to developments in France, particularly the creation of the Office National des Anciens Combattants et Victimes de Guerre, which marked a turning point in European approaches to war disability.

​

The first major international forum was the Inter-Allied Conference on the Professional Re-education of Disabled Soldiers, held in Paris in May 1917. The Portuguese delegation took an active role, engaging with discussions on medical treatment, prosthetics, vocational guidance, pensions, and social reintegration — topics that aligned closely with Costa Ferreira’s own vision.

​

As a result of this involvement, Costa Ferreira was appointed Vice-President of the Executive Committee of this newly formed inter-allied organisation. And despite political instability in Portugal, due to the December 1917 coup from Sidónio Pais, he continued to participate in subsequent meetings, including the Second Inter-Allied Conference held in London in May 1918 – which ultimately led to the organisation of a major international meeting in Lisbon in 1919.

​

Although Portuguese initiatives were positively assessed by foreign delegates, these efforts faced sustained resistance at home. Even so, Costa Ferreira continued his work, developing ideas that were both innovative and distinctly ahead of his time.

​

Crucially, he was the first Portuguese physician to conceptualise war disability as encompassing both physical and psychological dimensions. For him, the end of combat did not mark the culmination of a soldiers suffering. In response, he developed what he named «Penso Moral» or “Moral Dressing” and, in mid-1917, created a “Section for Mutilated War Soldiers” within his Medical and Pedagogical Institute — already known in all Lisbon simply as Saint Isabel Institute.

​

At Saint Isabel, Costa Ferreira established an integrated school-hospital model that combined medical care, rehabilitation, and social reintegration. Operating outside a strictly military framework, the institution complemented existing military systems of care, while continually addressing more specific challenges, posed by modern warfare – and, particularly, social and labour reintegration.

​

Admissions in Saint Isabel´s “Section for Mutilated War Soldiers” began in November 1917. Some soldiers were collected directly from the streets, where they survived by begging; others came from military barracks. Most arrived unconvinced with future treatments and resentful with society itself, fearing also renewed discipline and, once again, loss of autonomy. Costa Ferreira personally received each man, insisting that Saint Isabel was neither a barrack nor an asylum, but a civilian institution that worked in connection with other military institutions – and, therefore, completely focused on respecting individual autonomy.

​

Central to his approach was the practice of what I already referred, the “Moral Dressing,” implemented through individual conversations or employed by Costa Ferreira during small-group discussions. As José Pontes later described, these dialogues encouraged men to describe experiences and their injuries, producing emotional release and psychological support. So, this process functioned as a psycho-pedagogical examination that could lay the foundations for psychological reconstruction.

​

These practices align Costa Ferreira with a broader European movement later described as the “talking cure.” Influenced by thinkers such as Breuer, Freud, Rivers, and Ferenczi, he recognised the therapeutic value of structured listening, even if not framed explicitly within psychoanalytic theory.

​

This approach paved the way for functional treatment and vocational re-education. For most of his patients were young, ruralized, poor, deprived and uneducated, with injuries ranging from minor amputations to severe mutilations, including gas blindness and war neurosis. Care required attentive listening, medical supervision, physiotherapy, and practical training.

​

One innovative solution involved the use of “working hands,” prosthetic devices that enabled amputees to handle agricultural tools. Training was brief and practical, often conducted in the institute’s vegetable garden, for a more rapid reintegration. As a result, Saint Isabel became a highly dynamic institution, marked by constant admissions and discharges.

​

For more severe cases, the Institute acted as a transitional stage before soldiers were transferred to other institutions. However, all of them suffered from a chronic lack of funds and were destined to close in the end of the war. Saint Isabel itself ceased operations in July 1919, year that would mark the end of Costa Ferreira’s mission with maimed and disabled soldiers. By this time, this had become for him a most demanding undertaking. One that brought him both professional fulfilment and loads of personal, physical and mental damages.

​

But work had to continue. Costa Ferreira would not give up on others, mainly children. So, beyond his work with disabled soldiers, Costa Ferreira served on the Higher Council of Public Instruction, worked in Lisbon’s social assistance services, and sat as a deputy in the National Assembly. Even so, harm was already done and, in 1922, deeply frustrated by the limitations imposed on his work, he accepted a mission to Mozambique. Where, shortly after his arrival, at the age of 43, he took his own life.

​

Despite this tragic end, his legacy endured. In 1929, the Medical and Pedagogical Institute, located in Saint Isabel, was renamed in his honour, and his ideas continued to shape Portuguese approaches to disability, education, and social integration throughout the twentieth century.

​

(SLIDE 7) For that, we may say that Aurélio da Costa Ferreira anticipated in Portugal the international debates on war disability and rehabilitation, securing his place within the European medical-pedagogical landscape of those years. And that his work reminds us that the care for war-disabled soldiers was not only a medical challenge, but also a profoundly moral and social work that, nowadays, needs to be continued."

​​