Julyan G. Peard is Associate Professor of Latin American History at San Francisco State University.

Race, Place, and Medicine

The Idea of the Tropics in Nineteenth-Century Brazilian MedicineBy Julyan G. Peard

Duke University Press

Copyright © 1999 Duke University Press
All right reserved.
ISBN: 978-0-8223-2376-1

Contents

Acknowledgments………………………………………………………………………..ixIntroduction…………………………………………………………………………..1Chapter One The Escola Tropicalista Bahiana: A Creative Response in Adversity…………………14Chapter Two The Politics of Disease………………………………………………………49Chapter Three Race, Climate, Medicine: Framing Tropical Disorders……………………………81Chapter Four Physicians and Women in Bahia………………………………………………..109Chapter Five Moving into Mainstream………………………………………………………138Conclusion…………………………………………………………………………….163Appendix 1…………………………………………………………………………….169Appendix 2…………………………………………………………………………….172Appendix 3…………………………………………………………………………….178Notes…………………………………………………………………………………181Primary Sources………………………………………………………………………..269Bibliography…………………………………………………………………………..273Index…………………………………………………………………………………305

Chapter One

The Escola Tropicalista Bahiana: A Creative Response in Adversity

* * *

When in 1865 in Salvador da Bahia some fourteen doctors started meeting regularly to discuss their local cases and original research, they initiated one of the few significant episodes of successful science in nineteenth-century Brazil and, indeed, in Latin America. The men met every two weeks at each others’ houses and, after a long day’s work, talked late into the night about unusual cases they had come across, medical articles that had caught their attention, the advances of parasitology and microscopy, and how it could all be applied to Brazil. They dreamed of producing original research that would “clarify and develop the study of Brazilian medicine.” This seemingly innocuous intention jolted the Brazilian medical establishment in which medical ideas and practice were marked by conformity and replication of Western European medicine, particularly French. The group, known retrospectively as the Escola Tropicalista Bahiana, proposed to develop a distinctive medicine of the tropics that although attuned to the newest European advances, adapted those advances to the particular concerns of Brazil, especially the Northeast. The regional specification was important because from its very inception the school challenged Rio de Janeiro’s medical hegemony. One of the group’s early problems was that, having no official framework within Salvador from which to operate, they had to carve out their own institutional base. They did this by using the main charity hospital as their “teaching” base, creating an influential medical journal, and, following the lead of three foreign founders with little insertion in the established patronage network, they struck out in new and original ways.

The Evolution of a Medical Community in Salvador

From its inception, medical education in Brazil was characterized by its adherence to French medical models, centralization, and the importance of patronage connections for advancement. Medical teaching in Brazil began in 1808 when the Portuguese Crown, fleeing Napoleon I, moved from Lisbon to Brazil. The arrival of King Joo VI in Brazil in 1808, accompanied by some fifteen thousand persons, under the protection of a squadron from the English fleet, inaugurated a period of fundamental change in Brazilian history. During his stay in Brazil, King Joo VI ushered in a number of momentous economic and social reforms as part of his attempt to upgrade the status of Brazil from peripheral colony to center of the Brazilian Empire. For example, all Brazilian ports were opened to foreign trade, thus undoing almost three centuries of mercantilist policy; prohibitions on manufacturing enterprises in Brazil were revoked; a Royal Committee of Commerce, Agriculture, Factories, and Navigation was appointed to encourage the expansion of these activities in Brazil; and the Bank of Brazil was established in Rio de Janeiro with branches in So Paulo and Salvador.

Equally important were the cultural changes introduced largely because the king recognized that, given the uncertainty of the outcome of events in Europe, the ruling elite would have to be trained on Brazilian soil rather than on Portuguese, as had been the custom. Thus printing presses became legal for the first time in Brazil and papers such as the Gazeta do Rio de Janeiro (1808) and the Idade d’Ouro do Brasil (1811) commenced publication. The first public library was established in 1810 in Rio de Janeiro with sixty thousand volumes. Realizing it needed to produce locally trained military and naval officers, engineers, and other experts, the government created a Naval Academy in 1808 and a Royal Military Academy in 1810, and organized courses in economics, agriculture, and industry in Salvador and Rio de Janeiro. The government quickly recognized, too, the need for schools of medicine to train Brazilians as doctors. The high death rate among soldiers in Brazilian hospitals had long been a source of denunciation by colonial authorities and some voices had long clamored for the creation of local medical schools. Now, these voices were joined by those of king and court who wanted to see health care practices in their newly adoptive country conform more closely to those in Portugal. In 1808, at the instigation of the surgeon-general, Jos Correia Picano, Joo VI set up two chairs in the instruction of surgery and anatomy, and later two more in obstetrics and pharmacy in Salvador and in Rio de Janeiro.

The teaching took place in the most precarious of conditions, at the military hospitals in the two cities. At the end of four years a candidate could petition the surgeon-general for certification and on satisfying the requirements was recommended to receive a degree from the University of Coimbra in Portugal. By 1815 the Crown had upgraded the medical chairs in Rio de Janeiro and Salvador to medical-surgical colleges with a longer five-year curriculum, and more demanding entry requirements. In an attempt to replicate the European medical practice, the Crown aimed to create a sharp separation between the “empiricism” of barber-surgeons, midwives, and bleeders on the one hand, and the educated, theoretical understanding of formally trained doctors on the other.

In 1827 the Crown, aware that Brazil’s newly independent status would require an improved infrastructure for education, recommended further reorganization and expansion of the early courses into a school with a curriculum and faculty modeled after the medical schools in Paris and Montpellier. The changes were adopted in 1832 in the midst of the crisis of Pedro I’s abdication and the initiation of the liberal federalist experiment during the Regency (1831-40). Initially, therefore, institutions of higher education had a good deal of autonomy in the allocation of their resources, the election of their directors, and the recommendations for changes in the content of the curriculum. However, once the Regency gave way to the increasingly centralized rule of Emperor Pedro II (1840-89), school autonomy was ended. Indeed, the creation of medical education by governmental decree determined that medicine would become a more or less centralized enterprise, depending on the relative power of the royal bureaucracy and the strength of local challenges to that power. On the whole, this control stifled moves for innovation and reform.

Gradually the imperial government came to dominate all aspects of medical school life. An educational reform in 1854-the Bom Retiro law, named after the presiding prime minister-formally ended the autonomy of the medical schools. The stated purpose of the new law was to bring Brazilian medical teaching more into line with the latest developments in the leading medical schools in Europe. Thus it called for greater practical training, for better laboratory and clinical facilities, for maternity centers, for adequate autopsy facilities, and for botanical nurseries to carry out research into Brazilian plants with medical properties, all improvements that were virtually unaddressed for another thirty years. However, the underlying purpose of the law, that is, the attack on the autonomy of institutions of higher learning, was rigorously implemented. As a result, the imperial government controlled the finances of the schools, nominated the directors, and, although professors were selected by competitive examinations, was known to overrule the outcome of a competition and appoint its own candidate. Another source of regulation over the schools was the annual reports dealing with all aspects of the schools’ business, which were written by a different professor each year, read to the faculty congregation, and forwarded to the central government. In 1875 the government further tightened its control by deciding that adjuncts were no longer to compete for full chairs but to be appointed by government decree.

Throughout most of the nineteenth century, the medical schools continued to draw on the French example in shaping the curriculum, choosing examination topics for vacant faculty posts, selecting subjects for student dissertations, and deciding what to publish in Brazilian medical journals. Indeed, many Brazilian doctors preferred to publish in France and in French. Ironically, the most original Brazilian medical work in the first half of the nineteenth century came from a French physician, Joseph Sigaud, a resident of Brazil from 1825 to 1856, who wrote an epidemiological work focusing for the first time on illnesses most common in Brazil. His book, Du climat et des maladies du Bresil; ou statistique medicale de cet empire (1844), remained the most innovative medical approach in Brazil until the advent of the Tropicalistas in the 1860s.

As the century progressed, the numbers of graduating doctors increased dramatically and advancement in medicine became far more competitive. In the early decades of the new nation’s history, the number of physicians graduating per year in Rio de Janeiro and Salvador was sufficiently small so that the doctor/patient ratio was favorable to the physician. Thus Robert Dundas, a British doctor who resided in Salvador from 1819 to 1842, noted that the Brazilian physician “is characterized by a great liberality of feeling; is little disposed to jealousy, and altogether devoid of professional intrigue.” But this sort of comment contrasted starkly to the common complaint later in the century that some doctors unethically undercut others with discount rates. Moving from graduation into a successful career, a thriving practice, and a prestigious position on the medical faculty always depended on patronage, but as the numbers of graduates grew, competition for patronage was greater and the sought-after posts relatively fewer.

After midcentury, the higher number of doctors graduating from the two medical schools in Brazil not only created competition among the doctors within the two cities but also exacerbated the differences between the two medical communities. Increasingly, the rewards for physicians in Rio de Janeiro were much greater than in Salvador. This was in part because of the much larger European and Europeanized population that demanded the services of Western medicine. The array of medical institutions in Rio was also greater: the medical school had more students and thus there were more professors; a successful medical association formed in 1829, which became the Imperial Academy of Medicine in 1836; and the academy had its own journal, originally titled the Anais de Medicina do Rio de Janeiro. But undoubtedly the most important factor for the advancement of the individual physician in Rio de Janeiro, as well as for the status of the medical profession, was that Rio, as the capital of the Empire, was the seat of the court and of royal patronage. Thus, for example, in theory the medical school in Rio de Janeiro lost as much autonomy as the Bahian school under the centralizing tendencies of Dom Pedro II’s government. But, in fact, the school in Rio de Janeiro could compensate for this loss of autonomy much more successfully than the Bahian school simply because it had close connections with the high echelons of power. Rio benefited from the emperor’s personal interest in medical affairs. Fascinated by the development of nineteenth-century science, Pedro II often attended sessions at the Imperial Academy of Medicine, Rio medical school theses defenses, and graduation services. He was thus personally known to a number of doctors.

The outcome of the Rio medical community’s proximity to the seat of power can be clearly seen in the more liberal financing of the Rio de Janeiro school and main medical institutions. It was also evident in the unbalanced dispensation of noble titles for the two medical communities. Of the forty-nine noble titles Pedro I and II granted doctors, only one was given to a Bahian physician. The whole theater of royalty in Rio de Janeiro also gave the capital’s medical community a glitter and sophistication that, as the century wore on, contrasted more and more with the provincial, backwater nature of the Bahian one. Whereas early in the century numerous Bahian physicians had managed to become nationally prominent, by mid-century the Bahian medical community played second fiddle to that of the capital. The justification was that Rio de Janeiro attracted more brilliant minds. Ambitious Bahian physicians who could do so moved to the capital to pursue their careers. Those who remained behind began to air their grievances.

It is understandable, therefore, that those who managed to position themselves well in the system had little incentive to rock the boat by fostering change. This may have been especially true at the Bahian medical school, where a medical education was often prized primarily as a means of entering the ranks of power and less as a scientific endeavor. Local grandees, when they could, preferred to send their sons to the law schools of Recife and So Paulo, from which the highest proportion of imperial civil servants was drawn. As the medical historian Cassiano Gomes asserts: “Medicine, at least in Salvador, was the profession of poor people, of the sons of merchants with small amounts of capital, or even the sons of workers, of the petty bourgeoisie; herein lies the great social function of the school.” Numerous examples in Salvador bear this out. Antnio Pacfico Pereira and his brother Victorino were of humble Portuguese immigrant stock, as were Jos Francisco da Silva Lima and Manoel Joaquim Saraiva. Pedro Severiano de Magalhes began his studies at the orphanage school of So Joaquim. All of these men became prominent as doctors, as civil servants, or as politicians.

The Bahian medical school, like the other institutions of higher learning in Brazil, was also a vehicle for the rising social status of the mulatto. The fact that the government provided scholarships for poor students to enter the professions, regardless of color, was one of the underpinnings of the elite’s complacent belief that in Brazil, in contrast to the United States, there was no “Negro problem.” Brazilians noted with pride, and foreigners recorded in amazement, the many prominent mulatto Brazilian intellectuals and professionals in the Empire. This was true of medical graduates and faculty in Salvador. The professor Lino Coutinho, for example, was of a poor, mulatto background, and Domingos Carlos da Silva, Luis Anselmo de Fonseca, and Raimundo Nina Rodrigues, students and later teachers at the medical school, were mulatto. The values of most young men entering the medical school, therefore, led to the passive acceptance of medical education as a general, philosophical training rather than as a functional and practical profession. As Gilberto Freyre has noted, the value system of culture and knowledge in the Bahian medical school, certainly until the last decade of the Empire, subordinated the “scientific study [of medicine] to the study of classical literature, oratory, rhetoric, elegance, and purity in speaking and writing, to debate over questions more grammatical than physiological, and to dissecting problems closer to the pathology of literary style than human anatomy.” It was unlikely, therefore, that the impetus for change would have come from within the Bahian medical establishment.

The Tropicalistas, more than any other group of doctors in nineteenth-century Salvador, first articulated a critique of Brazilian medical teaching and practice. As foreigners, the founding Tropicalistas were excluded from the existing network of patronage so crucial to the advancement of medical careers; none of them, for example, ever taught at the Bahian medical school. The fact that they were on the periphery of imperial power and patronage allowed them more room to develop questioning and sometimes controversial ideas than if they had been in the capital city, close to official medicine, where such an autonomous group would have faced serious obstacles. At the same time, they were aware of the important medical strides being made in Europe and were especially interested in German advances. Clearly, for these men, audacity, daring, and original investigation would pay far greater dividends in possible fame and personal satisfaction than adherence to the local Western tradition of medicine, which, they saw, was failing to move into the new era of scientific medicine. They pushed, therefore, to make full use of the research arsenal of European medicine such as, for example, medical statistics, new clinical methods based on measurement and applied physiology, the application of chemistry in analyzing bodily fluids, an increased understanding of hematology, animal experimentation, and, most important, microscopy, which they pioneered in Salvador and through which they began to question hallowed theories about the etiology of Brazilian ailments. Above all, they insisted on looking at disorders of primary interest to Brazil.

(Continues…)

Excerpted from Race, Place, and Medicineby Julyan G. Peard Copyright © 1999 by Duke University Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.