Historians of Latin America have only recently begun to revise the longstanding image of nineteenth-century Latin American physicians who faithfully (and passively) reproduced European medicine in their mainly tropical countries. Traditional historians in Latin America tended to debate how thoroughly European medicine was adopted. The more critical historians argued that Latin Americans were slow to embrace European medical models and thus remained sunken in backwardness.1 The more optimistic observers pointed to medical strides made in their nations, indicating a faithful local replication and understanding of the advances emanating from European and, to a lesser extent, U.S. centers.2 Whether they viewed the state of local medicine in more or less optimistic terms, both camps considered the source of medical knowledge to be primarily European.
This depiction was not entirely wrong. Brazil’s concerted efforts after the turn of the century to sanitize cities and backlands can be seen as evidence of how closely governments and medical authorities adhered to the highly successful methods used to eradicate disease in European colonies and the U.S. South. The Brazilian government’s desire to emulate those successes motivated it to support Oswaldo Cruz, director of public health between 1903 and 1909, in his efforts to eradicate bubonic plague, smallpox, and yellow fever from Rio de Janeiro and to set up an institute of tropical medicine, subsequently known as the Oswaldo Cruz Institute. During World War I, when European immigration to Brazil virtually stopped, Brazilian authorities addressed the health of Brazilians in the interior in an attempt to tap a vast potential source of labor. These efforts were extended in 1916, when the Rockefeller Foundation’s International Health Board (IHB) conducted disease-control programs in the Brazilian hinterland, targeting hookworm and later, yellow fever.
What is most significant about the historical accounts of these episodes is that they never express any sense that the participants were building on local Brazilian medical traditions, or even, in the case of the IHB, that they were aware of any such foundations on which to build. One of the most interesting critiques leveled at traditional medical historians is that they concentrated only on the outward movement of Western medicine from its metropolitan centers; they failed to ask how medicine practiced in faraway places subtly altered and adapted Western medicine to local milieux and, in turn, often influenced medical thinking in the metropolitan centers.3
In the case of Brazil, the irony in the portrayal of the early disease eradication attempts is that they actually had Brazilian antecedents. Some local doctors did view disease as one of the main factors retarding the country’s development and did try to grapple with some of those debilitating disorders. The simple yet radical notion Charles Stiles postulated in 1905 when he linked parasites and unhealthiness in the U.S. South, for example, had been noted by Otto Wucherer in Bahia in 1866.4 By the early decades of the twentieth century, however, these antecedents had become “hidden” in history. It is this hidden history that I wish to recover.5
Clearly, it can be argued that the efforts at disease control led by Oswaldo Cruz and the IHB represented a disjuncture with nineteenth-century antecedents of Brazilian medicine. The triumphs of bacteriology and the institutionalized growth of science in Western Europe and the United States dramatically changed medical science, greatly expanding its social role and political weight. What is less clear, however, is the widely accepted image promulgated by the actors at the time, and not a few historians subsequently, that the previous generations of Brazilian doctors belonged to some sort of “dark ages” of medicine. A close look at the neglected pre-Cruz era of Brazilian medicine reveals that it was neither as dark nor as wholly acquiescent as has been suggested.
This article aims to challenge the blanket notion that Latin American doctors were passively derivative by examining aspects of the research of a group of Bahian doctors known as the Escola Tropicalista Bahiana. Their case illustrates that there were physicians in Brazil, before the institutionalization of tropical medicine by the European colonial powers, who were actively engaged in an attempt to understand and define the idea of tropical disorders and to develop a distinctive Brazilian tradition in medicine.6 This was not only a quest for medical knowledge but an attempt to confront some of the problems of a new nation concerning whether its citizens could be healthy, whether the tropics were an inherently debilitating milieu, and whether “civilization” and progress were possible there.
Against the historical background of nineteenth-century Brazilian medicine, the Tropicalista school emerged as a dynamic force. Ultimately, however, it failed to establish a lasting tradition of tropical medicine, so that instead of being built on by later generations its work was eclipsed by European medical ideas. In an intellectual context, the Tropicalistas’ calls for the manipulation of the environment were ways of fending off the mounting pressure from European notions on degeneration. They were not altogether successful, as evidenced by the early work of Raimundo Nina Rodrigues, who moved from Tropicalista thinking to the wholesale adoption of European ideas regarding tropical peoples, ideas that were profoundly ominous for the future of Brazil.7
The Rise of the Tropicalista School
In Brazil, the attempt to develop a distinctive medicine of the tropics began in Salvador da Bahia in the 1860s. Between 1860 and 1890, the Bahian Tropicalista School of medicine, an informal group of about 30 Brazilian and a handful of foreign physicians, made discoveries concerning the hookworm, filariasis (the cause of elephantiasis and other conditions), and ainhum (a degenerative toe disorder); contributed to ongoing debates in parasitology as well as in beriberi, tuberculosis, leprosy, dracontiasis, and maculo; and helped reformulate the accepted patterns of Brazilian nosology, questioning whether Europeans really knew more about Brazilian health problems than Brazilians did.8
The three founding members of the Tropicalista school were Europeans who made their home in Brazil. Otto E. H. Wucherer (1820-1875) became the most renowned of the three foreigners. With his studies of Brazilian snakes and their poisons, his finding of the hookworm in Bahia, and his discovery of the embryonic filaria, Wucherer, more than any other of the Tropicalistas, forged the group’s identity, set its program of research, and made it visible in the European medical press.9 Of German-Portuguese descent, Wucherer spent his adolescent years in Brazil and then attended medical school at Tübingen, graduating in 1841.10 He worked at St. Bartholomew’s Hospital in London and also in Portugal before returning to Brazil in 1843. In 1847 he took up the position of physician to the German community in Salvador.
A second founder was John L. Paterson, a Scot (1820-1882). He graduated from the University of Aberdeen in 1841 and traveled to Brazil in his early 20s, encouraged by his older brother, Alexander, who had set up a practice with the British community in Salvador—a practice to which John succeeded unexpectedly in 1843, when his brother died.11 Paterson spent most of the rest of his life as a doctor in Brazil, although he made several extended visits to England and Scotland. In 1869, on one such visit, he worked with Joseph Lister in Edinburgh and was initiated into the method of antisepsis, which he then helped introduce into Bahia. Wucherer and Paterson came to the attention of the public authorities and the Bahian medical community during the 1849 yellow fever epidemic and the 1855 cholera epidemic. On both occasions, the foreigners were among the first doctors correctly to diagnose the epidemic disorders. Despite some acrimony from local physicians who challenged their diagnoses, they ultimately earned praise for their help and courage during the crises.
The third founding member of the Tropicalistas, José Francisco da Silva Lima (1826-1910), the son of a Portuguese merchant, was 14 when he moved with his family to Bahia.12 He graduated from the Bahian medical school in 1851. During his long career, he made several tours of European countries, visiting well-known medical centers, and like the other two foreign doctors, kept the local medical community informed about European medical advances. If Wucherer furnished the original research on which other Tropicalistas would build, Silva Lima provided the perseverance and continuity that led to their achievements. He was, for example, the driving force behind the longevity of the journal they started, the Gazeta Médica da Bahia, to which he contributed prolifically.
When these three men, together with a handful of others, declared in 1865 that they wanted to “clarify and develop the study of Brazilian medicine” and proposed to start by holding meetings to discuss their local cases and research, they were challenging a tradition in which medical ideas and practice were marked by conformity and replication of Western European, particularly French, medicine. The whole history of medical education in Brazil, as well as the path of career advancement in the profession, conspired to make physicians eschew originality and embrace inertia.
Medical teaching in Brazil began in 1808 when the Portuguese crown, fleeing Napoleon I, moved from Lisbon to Rio de Janeiro and inaugurated a period of far-reaching economic, social, and educational reforms as part of its attempt to upgrade Brazil’s status from peripheral colony to center of the Luso-Brazilian Empire. Agreeing that medicine was one of the fields that urgently required attention, João VI, at the instigation of his surgeon-general, José Correia Picanço, set up two chairs in the instruction of surgery and anatomy, and later two more in obstetrics and pharmacy, in Salvador and Rio de Janeiro.13
The teaching took place under the most precarious 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. In 1827 the crown, aware that Brazil’s newly independent status would require an improved infrastructure for education, reorganized and expanded the early courses into a school, with curriculum and faculty modeled after the medical schools in Paris and Montpellier.14
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.15 On the whole, however, centralization won out, as the early political experiments in state autonomy, particularly during the Regency (1831-1840), gave way to the increasingly centralized rule of Emperor Pedro II (1840-1889).16
Gradually the imperial government came to dominate all aspects of medical school life. It controlled the finances, nominated the directors, and, although professors were selected by competitive examination, was known to overrule the outcome of a competition and appoint its own candidate.17 A further source of regulation were the annual reports, written by a different professor each year and dealing with all aspects of school business, which were read to the faculty and forwarded to the central government.
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 who published preferred to do so in French publications. Ironically, the most original Brazilian medical work of the first half of the nineteenth century came from a French physician, Joseph Sigaud, a resident from 1825 to 1856, who wrote the first epidemiological study to focus on common Brazilian illnesses. His book, Du climat et des maladies du Brésil (1844), remained the most innovative medical work in Brazil until the advent of the Tropicalistas in the 1860s.18
As the century progressed, the numbers of graduating doctors increased dramatically and advancement in medicine became far more competitive.19 Thus Robert Dundas, a British doctor who resided in Bahia from 1819 to 1842, could report, on his return to England, that the “Brazilian physician, ... is characterized by a great liberality of feeling; is little disposed to jealousy, and altogether devoid of professional intrigue.’’20 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 largely on patronage; but as the numbers of graduates grew, competition for patronage was greater and the sought-after medical posts relatively fewer.21
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 social status and less as a scientific endeavor.22 Local grandees, when they could, preferred to send their sons to the law schools of Recife and São Paulo, from which the highest proportion of imperial civil servants was drawn. As the medical historian Cassiano Gomes asserts, “Medicine, at least in Bahia, 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.”23 In many cases, these men’s humble origin ensured their espousal of the most conservative values of society, as they sought to blend with the upper class and put a distance between themselves and their lower-class background.
In the medical school, such values led to a 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 to human anatomy.”24 It was unlikely, therefore, that the impetus for change would have come from within the Bahian medical establishment.
It was the Tropicalistas who, more than any other group of doctors in nineteenth-century Brazil, 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. At the same time, they were aware of the important medical strides being made in Europe. 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. The supporters they drew from among Bahian doctors included both established physicians attracted to the idea of original research and ambitious young doctors and students, such as Antônio Pacífico Pereira (1846-1922); his brother, Manuel Victorino Pereira (1853-1902); and Raimundo Nina Rodrigues (1862-1906), lured by the founders’ fruitful investigations and eager embrace of the newest developments, such as the use of microscopic examinations in clinical medicine.
The Tropicalistas’ critique of the Bahian medical establishment, of its outdated teaching methods and curriculum, and above all of Brazilian doctors’ lack of original investigation into Brazilian disorders appealed especially to these young doctors. They were setting out on their medical careers at a time of exciting and escalating changes in Western medicine and were bent on enhancing their own and their nation’s prestige through the promotion of scientific enterprise. Tropicalista demands for innovation in the way Brazilian physicians conceptualized disease in the tropics also appealed to many progressive doctors because they resonated with the broader demands of the intelligentsia, which, from the 1870s on, increasingly questioned the very foundations of imperial society.25
The birth of the Tropicalista school can be traced to Paterson’s suggestion that local doctors meet to discuss their own cases as well as the latest medical literature, a suggestion that led in 1866 to informal fortnightly meetings among about 14 physicians.26 The discussions focused on the cases most typical of the tropical milieu. To investigate these disorders, the physicians made full use of the most advanced tools of European medicine, such as medical statistics, new clinical methods based on measurement and applied physiology, the use of chemistry in analyzing bodily fluids, an increased understanding of hematology, a nascent parasitology, and above all, microscopy, which this group pioneered in Bahia.27 For their work they received no official support or funding, yet they managed to establish an institutional footing from which they became an important innovating force in Bahian, and ultimately Brazilian, medicine.
Two resources were central to their success. One was the Santa Casa de Misericórdia charity hospital; the other was the Gazeta Médica da Bahia, the journal they founded in 1866. In the Santa Casa hospital, which served mainly the poor of the city and its outskirts and also sailors, the Tropicalistas found a niche.28 Here, interested students observed and assisted on many cases, something they did not do at the medical school, which provided almost no practical training.29 Indeed, some of these students received their only practical instruction in the use of the microscope or the art of autopsy from the Tropicalistas.30 The Santa Casa also became a means to centralize the Tropicalistas’ otherwise isolated individual research efforts, and a place where like-minded doctors could experiment with new surgical methods and therapies which they either read about in the European and U.S. literature or, at times, acquired from local healers.31
If the hospital was the Tropicalistas’ venue for teaching and research, the Gazeta Médica da Bahia was their vehicle for publication and discourse. In an editorial in the first issue, the doctors enumerated five basic aims for the journal:
To pull together, as far as possible, the most active elements of the medical class so that, more united, and supportive of each other, we may attain higher public consideration; to disseminate the knowledge that the observations of all doctors, near or far, may impart; to keep abreast of the scientific developments of the most advanced countries; to study the questions which are of most interest to our own country ; to ensure the unity, dignity, and autonomy of our profession.32
Throughout the following decades, the Tropicalistas endeavored to live up to their original aims. They tried to forge a cadre of informed, united doctors who might augment the medical profession’s legitimacy and authority among Bahian patients. Their guiding principle, moreover, was always to focus on disorders relevant to the health of Brazilians. Therefore, they looked primarily at disorders they believed to be most common to warm climates, disorders caused by poor living conditions in Brazil, and disorders that may have resulted from the presence of African slavery.
In doing so, the Tropicalistas made their most original contributions to Brazilian medicine. Believing that the role of the physician was to help Brazilians understand and prevent disease in their midst, they argued that Brazilian physicians should not wait for Europeans to show them the way but instead, using the scientific methods the Europeans disseminated, must themselves decipher the problems of tropical diseases, problems that European doctors understood only superficially. They believed, furthermore, that they had much to teach the Europeans about such diseases. As Júlio Rodrigues de Moura, the lead speaker at the first Brazilian medical congress, held in 1888, put it, “I do not see another area of medicine in which we can so readily . . . discover, compare, and establish . . . theories that will make evident the value of our research.”33
Looking back in 1890, describing how the Gazeta Médica had survived for 24 years, Silva Lima stated that it was certainly not because of
the majority of our colleagues who were indifferent to [our efforts] and even disdainful [of them, For] they only hold as valuable and acceptable science that is imported from abroad, and they do not hesitate to proclaim our incapacity to cultivate [medical science] in our own country.34
Indeed, the Tropicalistas’ endeavor was as much to neutralize damning outside opinions of Brazil as to sway mainstream Brazilian thinking toward optimism.
Identifying a “School” of Medicine
Among the Tropicalistas, Otto Wucherer, the key figure in the history of Brazilian filariasis and hookworm research, was the crucial link between advanced European medical ideas and local medical concerns. Most important was his relationship with the leading German parasitologists of the day. Even after he returned to Brazil in 1843, Wucherer kept in touch with many of them. Wilhelm Griesinger (1817-1868) asked Wucherer to contribute to his work in Egypt on schistosomiasis by looking for the schistosome parasite (bilharzia) in the bloody urine (haematuria) of patients in Brazil. In 1866, when Wucherer sought to comply with the request, he found a different, unidentified, embryonic parasite in the hemochylous urine of a patient; the parasite is known today as Wucheria bancrofti, the cause of filariasis.35 What had to be established was whether the threadworm was a cause or effect of hemochylous urine and, if a cause, what other symptoms were linked to it, what other fluids in the body contained it, how its life cycle was structured, and how it was transmitted. All of these questions subsequently engaged Wucherer and other Tropicalistas.36
Wucherer was slow to appropriate his findings and to spell out their full implications. He was cautious in attributing to the worm the role of causative agent of any particular disorder, and he never discussed the possible relationship between the filaria and elephantiasis.37 He took two years to write about his findings in the Gazeta Médica da Bahia38 His move to publish his research and initiate a whole cycle of investigations into the filaria attests to the encouragement he received from the Tropicalistas, who not only discussed his work but also urged him to write about it. As a group, therefore, the Tropicalistas gained the assertiveness to proclaim their contributions to a broader audience.
Once Wucherer had published, news of his discovery quickly reached the European medical press, and the Brazilians were seemingly left behind. In 1868 the French naval doctor A. Le Roy de Méricourt, a personal friend of Wucherer’s, quoted from his colleague’s writings, and two years later the French journal Archives de Médecine Navale published Wucherer’s findings. In 1876 the same journal gave a summary and commentary on subsequent Tropicalista work on the filaria. In England, Thomas Spencer Cobbold, the leading British parasitologist, informed the Linnean Society in London (on March 7, 1878) and a branch of the British Medical Association (in May 1872) of the discovery, and in Germany, it was communicated in the medical journal Deutsches Archiv für Klinische Medizin.39
Although the French first reported the findings in Europe, it was the British who moved most rapidly to the forefront of the investigation into the human parasite. As early as 1868 an Englishman, Dr. Timothy Lewis (1841-1886), working in India, duplicated Wucherer’s findings and presented proof of the link between elephantiasis and hemochyluria by locating the parasite in the urine and lymph of elephantiasis victims. In 1872 Lewis made a further breakthrough by finding the embryonic filaria worms in the blood of people suffering from chyluria, diarrhea, and elephantiasis.40
In 1876 Dr. Joseph Bancroft, in Australia, found the long-sought adult filaria, and suggested that an independent vector might be involved in its transmission and that the vector could be the mosquito.41 From 1875 to 1876, Dr. Patrick Manson, a British colonial physician based in China, was home on leave in England, where he learned about the developments concerning the filaria.42 Armed with this information, Manson, the “father of tropical medicine, returned to China and, in 1878, confirmed Bancroft’s hypothesis about transmission. Manson’s work led to the idea of a vector or intermediate host in the transmission of disease, a concept that is a cornerstone of modern tropical medicine.
How did the Tropicalistas react to the British achievements? Far from seeing themselves as passive recipients of the European findings, the Tropicalistas portrayed themselves as part of an international network of doctors working on tropical diseases.43 They sought to replicate and confirm the British findings, working to verify the identity of various microorganisms by exchanging specimens with European scientists and publishing comparative illustrations of helminths from Brazil and other parts of the world.44 They discussed hypotheses on the parasite’s life cycle and modes of transmission, helped trace the related disorders, and experimented with therapy.
Thus, for example, Manuel Victorino Pereira, Júlio de Moura, Felício dos Santos, and A. J. P. Silva Araújo replicated Bancroft’s work in Australia by finding the adult filaria in Brazil in 1877; Silva Araújo located the parasite in the scrotal tumor of an elephantiasis patient, where it had not been seen before.43 Silva Lima tried unsuccessfully to confirm Manson’s finding regarding the presence of the filaria in a mosquito’s stomach, a finding Silva Araújo finally replicated in 1878.46 Silva Araújo also confirmed the suspicion that filaria could lead to a variety of disorders by discovering filarias in a single patient who suffered from chyluria, scrotal elephantiasis, craw-craw, and erysipelas. He reported that electrotherapy was a particularly effective cure.47
In 1886 Pedro S. de Magalhães (a Bahian who had moved to Rio de Janeiro but remained a frequent contributor to the Tropicalista journal) found two adult specimens of the filaria in a patient’s heart. He searched for the filaria in water as a possible mode of transmission.48 In 1878 John L. Paterson and Thomas Hall—the latter, like Paterson, a British doctor resident in Bahia and very much a part of the Tropicalista group—tried to determine how much of Salvador’s population was infected with the parasite by testing some three hundred of their patients over a period of two months. They reported that more than 8 percent of the patients were infected and that, by race, blacks and mulattos had a higher incidence of infection than whites.49
Every advance made by Brazilians or doctors abroad was reported in the Tropicalistas’ journal, the Gazeta Médica da Bahia. The journal told a story about the Tropicalistas in which they emerged as an intricate part of an international cadre of doctors at the forefront of the investigation into a newly discovered parasite. That this was not an altogether false presentation can be seen by an article published by Bancroft in the Lancet regarding a patient with scleroderma in whose blood Bancroft had found the filaria. In the article he not only called on his British colleagues, Manson and Lewis, to carry out “further inquiries into the nature of this complaint,” but he also singled out for help “the practitioners of Brazil.”50
The Gazeta Médica portrayed each new filaria-related discovery as embedded in the broader context of the Brazilian contribution, with reference to the starting point, Wucherer. Although the journal reprinted all the important writings on the subject from around the world, its focus remained fixed. An 1880 editorial reminded readers that “in the [Gazeta Médica] are found all the conquests won [over filariasis] through the diligence of many observers in many countries, and not a few [of these conquests] have been due to the work of our own countrymen.”51
The editors avidly picked up European references to the Brazilian contributions. They reacted very quickly to threats to ignore Brazilian participation. In 1876, for example, Silva Lima annotated an article by the French naval doctor J. Crevaux on filariasis that Silva Lima believed was an important contribution to understanding the ailment. He asked the author to correct his facts about its discovery, however, giving priority to Wucherer rather than to Lewis.
The discovery of the filarías in urine is generally attributed to Dr. Lewis. As he has already justly received great honor for having discovered the filarias in blood, and the lymph of elephantoid tumors, it will not hurt him to acknowledge the priority of Wucherers discovery of the filaria in hemachylous urine, and that it was our humble journal that announced the important discovery.52
Silva Lima also complained that Cobbold did not give Wucherer his rightful due. In July 1877 Cobbold informed the Lancet about a communication he had received from Bancroft in Australia describing the latter’s discovery of the adult filaria and enclosing specimens for Cobbold’s inspection; but in his discussion of what was known about the helminth, Cobbold failed to mention Wucherer. When Silva Lima read the report, he protested the omission in an annoyed article in the Gazeta Medica. Wucherer, he stated, had been the first to reveal and fully describe the worm; and although others had since made important advances, it was grossly unfair that the efforts of “one of the most dedicated and patient contributors of science in Brazil” were being ignored.53
Silva Lima’s article, reproduced in the Archives de Médecine Navale, came to Cobbold s attention, and after an exchange of letters between them, Cobbold made amends at a meeting of the London Society of Pathology, establishing Wucherer as the discoverer of the filaria.54 In his 1879 book on parasites, Cobbold went further, describing not only Wucherer’s work but also that of Silva Araújo, Paterson, Júlio de Moura, Felício dos Santos, and Pedro S. de Magalhães, among others.55
Cobbold’s recognition of the Brazilian contribution, however, was the exception. On the whole, the British did not consider the Brazilian doctors’ work to be of any great import.56 Even when the Brazilian findings were clearly part of the whole body of filariasis research, the British medical press tended to report, appropriate, and then ignore the source of the information while keeping a complete record of the British contributions.57 Thus the detailed accounts of Patrick Manson’s work on filariasis written by his son-in-law, Philip H. Manson-Bahr, include no mention of Wucherer’s work; they credit Timothy Lewis with the early discoveries.58 Likewise, Manson’s colleague and rival, Ronald Ross, who wrote his own recollections of Manson’s work, mentioned Wucherer but noted that he had never read Wucherer’s writings.59 The Europeans were far less concerned about the origins of the discovery, perhaps because they were rapidly moving on to new ones; perhaps, too, they did not believe that Brazilians could make good medical researchers. The Brazilians, on the other hand, accentuated their role because they had so much at stake, both for the successful development of a distinct medicine and for European recognition of their efforts.
What was the significance for the Tropicalistas of portraying themselves as part of an active community of researchers? First, unraveling the mysteries of filariasis was clear evidence that this ubiquitous menace of the torrid zone was something that could be rationally understood, deciphered, and combated. Even though the high number of its victims was sobering, the doctors viewed the discovery of the parasite with some optimism. Their experiments with electrotherapy and high doses of purgatives, their energetic demands that the government intervene to improve public health, their analysis of the sources of the water the population consumed were as much attempts to resist the idea of the menacing tropics as to cure a disease.
Second, the story of the Brazilian role in probing filariasis was also a way of demonstrating that good science was possible in the tropics. This, in turn, was another means of resisting the stereotype of Latin American doctors as passive recipients of European knowledge. As Silva Lima put it,
Wucherers investigations shaped the course of further studies on this curious pathology. . . . the glory of concluding the work initiated by our collaborator belongs to the new generation. [Wucherer] showed us the way and he must be followed with perseverance so that the mysteries [of filariasis ] may be unraveled . . . [as well as those that] involve other, no less important questions of tropical pathology.60
The Tropicalistas portrayed themselves as being on the cutting edge of a new kind of medicine and as key actors in a process of reconceptualizing Brazil as a newly civilized and advanced nation, a nation able to socialize its people into “civilization,” partly by the intervention of its doctors.
A similar activist approach to tropical disease shows in another Tropicalista contribution to the nosology of Brazil: the discovery of the presence of hookworm. Tropical anemia, or “chlorosis,” was a long-established, amorphous ailment that symbolized the generalized way a tropical climate commonly attacked its victims. The Tropicalistas’ work on hookworm clearly illustrates how they rejected climatological determinism by challenging its “formless” approach and pinpointing a possible cause. It also shows how, while they moved toward specificity through the development of parasitology, they remained attached to broad environmental etiologies.
The story of hookworm disease in Brazil starts, again, with Wucherer. In 1865 Wucherer was called to the monastery of San Bento to attend to Delfino, a slave belonging to a plantation in Santo Amaro. Wucherer diagnosed the patient as suffering from an extreme case of a disorder commonly known in Brazil as cansanço or hipoemia intertropical, which shortly thereafter caused the patient’s death.61 An autopsy revealed numerous worms in the victim’s small intestine, which Wucherer identified as ancylostoma duodenale.62 The disorder Wucherer encountered has been identified as hookworm disease.63
By mid-1866, Wucherer had performed another six autopsies on similar cases, all of which revealed large clusters of the parasite. The Gazeta Médica da Bahia hailed the finding as an important breakthrough; Wucherer, it stated, had demonstrated that slaves and agricultural workers, the main victims of the disorder, contracted anemia from loss of blood because of the action of the parasites, a discovery that completely changed the understanding of the disorder’s pathology. As Wucherer noted, poor diet, alcoholic beverages, and unhygienic conditions could not account for the disorder as satisfactorily as the presence of the parasites.64 The key questions this time were the conditions in which the parasite thrived, whether these were related to climate, and how the worm was transmitted to the human host.65
Using the experiments of the German parasitologist Rudolph Leuckardt as his model, Wucherer grew larvae from eggs in soil and in water and compared their development to that of the Dochmius trigonocephalus parasite Leuckardt had observed. Wucherer learned that the ancylostoma grew well in damp earth, but he could not discover how the parasite might be conveyed into the stomach of a human host.66 Significantly, despite his experiments, Wucherer did not discard factors such as poor diet and lack of hygiene in the spread of the disease, holding that they weakened people and thereby predisposed them to the illness.67
If Wucherer, while moving toward a theory of medical specificity, was reluctant to relinquish those environmental factors, his young disciple Manuel Victorino Pereira took a bolder stand. Pereira’s research and writings show even more clearly the bundling of various disease etiologies to satisfy his own political aspirations for social reform. Of all the Tropicalistas, Victorino Pereira was the most politically engaged and the most active campaigner against slavery, an institution he despised as a measure of Brazil’s backwardness.
Thus, in reviewing Wucherers work on hipoemia intertropical, Victorino Pereira extolled Wucherers focus on the parasite and its behavior but also asserted that environmental factors determined the reproduction of the worm in the host and the chances of a particular individual becoming that host.68 Then he hurled a scathing attack at slavery. “Africans,” he held, “are undoubtedly the main victims of the disorder. It is not that the disorder is peculiar to their race but [that they fall victim] because of their servile condition.”69 After listing the abysmal social conditions likely to promote the spread of the worm, he declared,
The best preventive measure I know of . . . is to return to those miserable captives the liberty they were robbed of; and to hand over the prodigious fertility of our lands (matas), and the incalculable wealth of our mines to the robust arms of free labor.. . . “Hipoemia” is a disease of the poor, of the slaves, of the wretched.70
Victorino Pereira illustrates well the Tropicalistas’ attempt to retain the factor of environment as an influence on health. Certain environments—or institutions—operating in the tropics, tolerated by a lax and ignorant government, were conducive to sickliness in the population. The Tropicalistas juggled this older approach to disease and a new, “scientific” model, which shifted the focus of their scrutiny from the environment to the individual and specific disorders. It was the new aspect of their work that led to their international acclaim and, in turn, gave them a more forceful identity as a medical movement to be taken seriously back home. But in their critique of domestic problems, the Tropicalistas remained close to social medicine, viewing disease and social conditions as inextricably interwoven and calling on the government to be more active in removing conditions, such as slavery, that favored tropical virulence. Thus the Tropicalistas’ writings express a constant tension between the old and the new approaches and the doctors’ role in them.71
In Brazil, research into hookworm disease continued for decades and was debated long before North Americans took it up in 1917. By the 1890s, any well-informed Brazilian doctor understood a good deal about the life cycle of the worm, the course of transmission, and the consequences of infection.72 Armed with their findings, the Tropicalistas called on the government to provide more funds for investigations and to set up a health system more adequate to addressing Brazilians’ needs. Antônio Pacífico Pereira, a central Tropicalista figure, declared, “the sanitation of a city, we’ve said [before] and we repeat today, is a patriotic duty and the most urgent duty of the government of a city.”73
Nevertheless, at the turn of the century, hookworm seemed more to identify the Bahian Tropicalista School and its research than to signal a danger to Brazilians’ health and the nation’s economic development.74 As late as 1899, Pacífico Pereira complained bitterly that despite several attempts at government legislation, little had been done in the sanitation of Brazil: “It is the neglect or incompetence of those who direct and administer [the government] that cause this land to be classified by the foreign press among those countries that have been partly abandoned.”75 Indeed, the Brazilian government did not support hookworm eradication programs until 1917. It did so then as a result of the convergence of two trends: new definitions of national public health in Brazil and the internationalization of U.S. philanthropies, such as the Rockefeller Foundation, to promote worldwide public health.76
The record of these efforts shows that ultimately the Tropicalistas were written out of the story. Just as it was the British parasitologists who moved on to set up tropical medicine as a separate specialization, it was the Rockefeller Foundation and its International Health Board, rather than any domestic group of doctors like the Tropicalistas, that played a catalytic role in Brazilian hookworm eradication programs.77 The lingering question is why the IHB was successful in engaging the state and federal governments where the Tropicalistas failed.
The Failure to Establish a Lasting Tradition
The first part of the answer lies in the Tropicalistas’ marginal status in Brazil. One of the greatest obstacles the Tropicalistas faced in gaining recognition was that the region in which they worked was considered a provincial backwater.78 The medical community in Rio de Janeiro, the capital of the empire and the seat of royal patronage, had far greater prestige and privileges than its Bahian counterpart. Rio’s physicians benefited, for example, from Dom Pedro II’s personal interest in medical affairs. Fascinated by the development of nineteenth-century science, the emperor often attended sessions at Rio’s medical school and the Royal Academy of Medicine, where he was personally known to many of the doctors.
The advantage of proximity to the seat of power can be seen in the imbalanced dispensation of noble titles. Of the 49 noble titles Pedro I (1822-1831) and Pedro II (1840-1889) granted to doctors, 48 went to physicians in Rio de Janeiro and only one to a Bahian.79 Rio’s medical school also received more liberal financing than the Bahian school, as did its other medical institutions, such as the main medical journal, Annaes Brasilienses de Medicina, and the Museu Nacional, a center for scientific research. The justification given for this state of affairs was that Rio de Janeiro attracted the more brilliant minds.80
This relationship partly explains why, for example, Rio de Janeiro received Wucherers discovery of the hookworm parasite with skepticism. At the time, the leading expert on the disorder in Brazil was the court physician, José Martins de Cruz Jobim (1802-1878), who believed that the causal factors were tropical miasma and topography.81 Such was Cruz Jobim’s prestige that in 1867 the Imperial Academy of Medicine snubbed Wucherer by voting to reject his hypothesis that the hookworm caused hipoemia intertropical. Wucherer retorted scathingly that matters of science could not be settled by a vote.82
The medical community in Rio de Janeiro started to pay attention to the Tropicalistas only when their work gained recognition in European journals.83 Even then, however, the Tropicalistas lamented that the journal of the Imperial Academy of Medicine, the Annaes Brasilienses de Medicina, seldom acknowledged the work of the Gazeta Médica da Bahia84 Despite all the Tropicalistas’ demands for domestic support, in the end official medical circles in the capital largely ignored them. As a result, they never received any financial or other official backing for their efforts. For this reason, the Bahian doctors were unable truly to institutionalize their early ideal of medical research in the tropics so as to train a school of disciples and make a sustained contribution to tropical medicine.
A second reason for the Tropicalistas’ failure to establish a lasting tradition was the timing of their enterprise. As one historian of Brazilian science has noted, “in the few instances of research work being carried out in Brazil before 1900, such work was sporadic, isolated, ... or incapable of being self-sustaining.” 85 The Tropicalistas set out on their journey of medical discovery in the 1860s, when it was still possible for individual doctor-scientists to hope for recognition, even fame, from their activities as freelance clinicians and researchers. It was a period when “the biomedical sciences constituted a common or unspecialized scientific culture. It was easy to move from one subject to another, with considerable academic and geographical mobility. The whole approach was what we would now call interdisciplinary.”86
From the late 1870s on, however, spectacular biomedical advances proceeded so fast that two things changed. First, research now required far more than enthusiasm on the part of individual doctor-scientists. These decades saw a split between amateur and professional researchers, born of increasing specialization and the development of a stringent code of professional techniques and standards. A few European centers, such as the Pasteur Institute in France and others in Germany, became trendsetters in the science of bacteriology, which emerged at the forefront of the medical breakthroughs. These schools molded a whole generation of medical seientists, enabling them to compare the results of their research and to form a select professional elite.87
The flow of the new medical science was, to an even greater extent than before, from Europe outward. The development of parasitology and bacteriology in the laboratory, moreover, and later “the alliance between fieldwork and laboratory” required funding, coming mostly from governments.88 This led to the second crucial change in medicine after the last decades of the nineteenth century: governments were more willing to reconceptualize health as a national project worthy of investment. The change in thinking was directly linked to the coincidence of growing international economic competition and the triumphs of germ theory, especially regarding the disorders of the tropics.
Not only were the colonial powers ready to take on tropical disease, which they saw as one of the major obstacles to colonial development, by funding research; but the governments of independent tropical countries like Brazil also began to invest in solving these problems. By the 1890s, Brazil’s new republican government was forced to confront the issue of health as part of its efforts to replenish the labor force in a postslavery society. International capitalism presented huge new opportunities for Brazil to become one of the leading agro-export countries in Latin America. To provide the labor to attain that progress, the Brazilian elite looked both to encouraging more European immigrants and to improving the miserable living conditions of Brazilians in the backlands.89
National and local authorities therefore turned health into a question exceeding the traditional concerns for ports and port cities, and they sought to spread the net of public health to encompass all classes and populations, both urban and rural. In the process, they redefined doctors as crucial agents of improvement.90 By the time this heightened concern for “national efficiency” took hold, many of the Tropicalistas had died and others were aging. They had always worked from home laboratories and in informal groups. Although they had attracted younger doctors into their ranks, they had never trained a cadre of disciples single-mindedly pursuing a long-term research vision.91
A final reason for the eclipse of the Tropicalistas was the amazing success of Western medical science, which, from the 1880s on, swamped home-bred traditions like theirs.92 In addition, from the 1870s on, materialist philosophies such as positivism, social Darwinism, and “Germanism” had begun to take hold in Brazil.93 Brazilian social thought was growing increasingly complex, raiding foreign models for elements that could provide answers to Brazil’s particular problems and yoking them in a variety of ways to Brazilian nationalism.94
The Tropicalistas themselves were eclectic in the way they bundled new European medical ideas with older ones that had taken root locally. After the 1880s, however, one of the key problems in medicine —namely, the yawning gap between the increased understanding of disease and the lack of therapeutic advances to cure disease —appeared to be shrinking, as an unprecedented series of discoveries concerning bacteriology and vector-borne parasites made disease eradication and prevention seem possible.95 Unlike the Tropicalistas’ multifaceted etiological framework, which included biting social critiques and broad demands for environmental reforms to accelerate the melioration of the Brazilian people, a highly practical model of tropical medicine now emerged. By the turn of the century, the Brazilian government could target helminths, germs, and vectors and leave virtually untouched the underlying social relations of inequality, the source of much ill health in the tropics.96
Along with the triumphant thrust of the germ theory that dislocated nascent local traditions came other Western medical theories, such as those of innate criminality, proposed by the Italian psychiatrist Cesare Lombroso, and inheritance, proposed by the British scientist and eugenicist Francis Galton, theories that bolstered the story of European superiority to the detriment of other peoples.97 Brazilian doctors increasingly adopted these theories, for it was difficult to reject the immense authority of European medical science, with its unfolding cluster of brilliant discoveries. As Thomas Skidmore has noted for the Brazilian intelligentsia more broadly, “Brazilians were ill equipped intellectually to refute the supposedly scientific theories of race pouring out of Europe and North America” because their intellectual tradition was recent, insecure, and characterized by a sense of cultural inferiority.98
No wonder Brazilian doctors like Raimundo Nina Rodrigues were taken with Lombroso’s theories of criminology, for example, even though these theories had negative connotations for a country like Brazil. The Tropicalistas, however, while by no means untouched by the swelling title of new ideas, continued to select and adapt European ideas to their optimistic line of thinking. Thus a shift took place from the Tropicalistas’ malleability to Nina Rodrigues’ determinism over the question of the “degeneration” of Brazilians. This shift involved the rise of racial science, a “science” that formed the bedrock of Rodrigues’ ideas and that the Tropicalistas tried to hold at bay.99
Race, Climate, and Tropical Disorders
In their endeavor to understand disease in Brazil, the Tropicalistas rejected racial and climatological determinism and the idea that the inhabitants of the tropics degenerated irreversibly.100 The idea of the tropics as deleterious, particularly to Europeans, had developed in the European mind over centuries. The early European appraisal of the tropics, by contrast, saw it as a place of such abundance that it augured a new era in the relationship between humans and nature. In his study of British colonial Africa, Philip Curtin has shown how the shift toward a dread of the tropics was based partly on the real and very high mortality rate the region exacted of Europeans, who lacked the immunity that native peoples acquired mainly in childhood.101
James Goodyear has charted a similar opinion shift in Portugal regarding its colonial empire. In their writings, early Jesuit missionaries and doctors saw Brazil as a place of great salubrity.102 By the late eighteenth century, this favorable view had changed to a very negative conception of the torrid zone.103 Donald Cooper places the shift as late as the 1849 yellow fever epidemic, which took more than seven thousand lives in Salvador and Rio de Janeiro and was followed in 1855-56 by an even more deadly cholera epidemic.104
Whatever the timing of the shift, European doctors began to argue that Europeans could not expect to maintain their health in a hot country like Brazil. The change in attitude meant that Europeans who went to Brazil feared for their health, a fear that prevented large numbers of them from immigrating to that country, preferring the more temperate climates of North America and Argentina. A second consequence was that European doctors tended to believe that whites “degenerated,” morally and physically, in the Brazilian climate. Blacks, as natives of the tropics, were considered “degenerate”; the problem for Europeans was whether they would degenerate, too.105
By the mid-nineteenth century, the concept of the tropics had become an integral part of a U.S. and European debate on biological “degeneracy.” Some of the leading figures in the debate, such as the scientist Louis Agassiz and the writer and diplomat Arthur de Gobineau, had visited Brazil, and their ideas were well known to Brazilian physicians.106 The debate dealt with the questions of whether different racial characteristics correlated with distinctive intellectual qualities and whether cross-breeding of different races led inevitably to degeneration. The backdrop to this debate was the belief in a hierarchy of racial types in which some races, hailing from tropical climates, were posited as being more “degenerate” than others.107
In the original, monogenetic version of this scheme, drawn from the Scriptures, scientists assumed that all races belonged to the same species but that environmental factors had caused a “degeneration” away from a primordial form to the racial varieties of the world. The softer forms of the monogenetic version allowed a blurring of the different racial ranks because of the belief in the “infinite adaptability of man.”108 At the very moment that slavery in the New World was giving way under economic change and moral pressure, however, European and U.S. racial theory was crystallizing into “science,” with ever more negative consequences for non-Europeans and the denizens of tropical climates.109
By the mid-nineteenth century a new group, the polygenists, had abandoned the Scriptures and reformulated the older theory, arguing that different races were more like different species.110 Not all polygenists went to the extreme of applying this distinction to blacks and whites, but they argued that variations between the races had grown so numerous that, to all intents and purposes, the two could be treated as separate. The polygenists provided “evidence” for the biological and fixed differences among the various human species, including testimony from doctors in the United States who, ignorant of the processes of acquiring immunity in such illnesses as malaria and yellow fever, believed that blacks had to be medically treated differently from whites because of their physical and anatomical variations.111
The polygenist school argued that races fared best when they retained their purity and proper typological place; it retained intact the monogenetic scheme of the hierarchy of races, which placed whites at the pinnacle and blacks at the bottom. Racial science became now a “science of boundaries between groups and the degenerations which threatened when those boundaries were transgressed.”112
By the second half of the nineteenth century, the label tropical disorders had evolved from a more or less neutral and descriptive category of ailments to an idea fraught with complexity—imbued not only with Europeans’ fears and prejudices about their (often lethal) experience in hot climates, but also with an attempted justification of their long history of enslavement of peoples from tropical regions.113 The idea of tropical disorders now contained two very fatalistic connotations; it was the inevitable outcome of the combination of “airs, waters, and places,” which produced a pathological miasma; and the inevitable disease of the natives, which explained their supposed inferiority. According to this rationale, if African slaves were weak and lethargic it was because they came from a weak race and a debilitating climate, rather than because of the institution of slavery.114 But even if Africans were known to resist certain tropical disorders better than Europeans, this merely confirmed Europeans’ intellectual superiority, because the energy Africans needed to adapt to the rigors of the tropics made them intellectually less vigorous.115 The idea of tropical disorders, therefore, contained both climatological and racial variables that left little hope for the progress of the natives of tropical countries.
The implications of such theories for Brazil, with its tropical climate and one of the highest rates of miscegenation in the Americas, were devastating. Nowhere in Brazil, moreover, were the debates of racial science more pernicious than in Bahia. Not only was Salvador a largely black city; but because it attracted far less European immigration than Rio de Janeiro, much of its middle and upper social ranks were filled by mulattos.116 This was notably true for mulatto doctors, who were an accepted part of Bahian society. In 1848, for example, Tiburtino Moreira Prates noted in his medical school dissertation,
there are more than a hundred students in the medical school of this city [and] half of them are indisputably mulattos; of the others, we know that many are quadroons who have “passed”; of others, we are ignorant of their ancestry; those who are unquestionably of the Caucasian race do not number more than 20.117
This is the context in which the medical community in Brazil, and especially in Bahia, received European racial science. Racial science was digested here very differently from the way it was in Europe or the United States. If the medical community did not reject outright such European imputations, it is possible to see, at least in the Tropicalistas’ practice and theory, the use of subtle strategies of resistance to the unwelcome assessments of Brazil and Brazilians.
The theoretical underpinning of Tropicalista medical thinking—like that of doctors elsewhere—was the malleability of human beings. This conception of human nature provided the Tropicalistas with a “flexible, etiological model” that emphasized physicians’ need to direct their patients to retain, or regain, their health.118 The physician, for example, could recognize patients’ particular inherited predispositions and steer them in a safe direction by counseling them to avoid those environments (such as low-lying damp places, unventilated rooms, sudden climatic changes) and behaviors (inadequate diet, stress, overindulgence in sexual relations) most likely to lead to sickness.
In applying this conception to their endeavor of resisting the forecasts of doom for Brazil, the Tropicalistas clearly subscribed to the beliefs of the Lamarckian tradition, particularly the nineteenth-century version of neo-Lamarckianism (although they never self-consciously referred to themselves as Lamarckians). Neo-Lamarckianism emphasized the importance of adaptation to environmental factors such as diet, sanitation, and climate. It held that the adaptive or “acquired” characteristics that resulted were then passed on in the procreation of a new individual.119 As Silva Lima elaborated in 1890,
Natura non facit saltum, says the great naturalist, and the saying is true too for other processes . . . [such as] the achievement of the intellectual, moral, and social perfection of a people and its institutions. . . [However,] evolution in relation to intellectual culture, . . . [and] to scientific advances can be accelerated by human effort, and that effort, if persistent and well directed, can often achieve [a jump in a process that] . . . might otherwise have taken centuries.120
Neo-Lamarckianism, of course, could be made to fit the more pessimistic, moralistic thinking of those who felt helpless in the face of the growing army of wretched poor that seemed to be an inevitable part of industrialization in Europe.121 European observers often viewed the tropics in a similarly fatalistic manner.122 It was also possible, however, to appropriate neo-Lamarckianism for more optimistic ends; it allowed room for human intervention to manipulate the environment and thereby to improve human beings. This idea of the malleability of human beings, of “soft” hereditarianism, was particularly effective in Brazil, where hope existed that through the correct scientific, medical manipulation of the social environment, a “civilized” people could emerge.
Júlio de Moura put the idea best when he noted, in an article on tuberculosis,
The Brazilian family . . . suffers from an organic weakness incorporated in successive generations. . . . Without . . . entering into a prolonged discussion of the acclimatization of Europeans in hot climates and . . . the question of advantages and disadvantages that result from . . . the cross between the invading races and the aboriginal, we must admit that the original trunk from which we descend . . . [has lost] a certain physical and moral vigor. It is quite possible that any Darwinist would find in us sadly visible symptoms of a hybrid race that connot progress.123
Moura continued hopefully, however,
These innate physical dispositions can be subject to fruitful modification. . . . These are elements of decadence that have no other origin than the most basic negligence and ignorance of. . . . the science of hygiene.124
The Tropicalistas resisted the detrimental labels imposed by climate and race by leaning toward the idea that most disorders were universal, but that the tropical heat and humidity exacerbated maladies in such a way as to make them distinctive.125 Exactly how heat and humidity affected disease and decay was what they intended to elucidate. In examining their writings on these themes, a useful starting point is the work of Antônio Pacífico Pereira, who straddled the old and new in medical concepts, partly to retain an optimistic approach to civilization in the tropics.
A recurring theme in Pereira s writings is the oxygenation of the blood.126 He believed that the lack of oxygen (anoxemia) could lead to such tropical ailments as beriberi; that it underlay most such ailments by acting as a principal “predisposing cause”; and that it was the key to explaining tropical decay. He worried that Brazilian physicians did not give this factor the importance it deserved.127 Pereira agreed with the German physician and hygienist Max von Pettenkofer that Europeans degenerated in the tropics because, in a hot and humid climate, the body never wholly threw off poisons to accomplish a thorough regeneration of the tissues.128 As Pereira noted, “In the climatological conditions in which we live, the influence and effects of vitiated air are much more . . . serious and long-lasting than in temperate climates.”129
Pereira, however, conveniently ignored the fatalism inherent in Petten-kofer’s theory. Instead, he expressed increasing concern about the practical steps to be taken to neutralize the dangers of poor oxygenation. In an influential 1878 article on the importance of hygiene in Brazilian schools, he presented these concerns in terms of proper ventilation and exercise, noting how schoolchildren were forced to sit still for long hours in crowded, hot, badly ventilated classrooms, their bodies unable to carry out the oxygenation needed for sturdy development.
In a modern society . . . education not only addresses the cultural, intellectual, and moral [development] of a child, but it must also address his physical development . . . Physical education must be the great, urgent, and vital question of this country, in which the race slowly languishes [as a result of] the climatic conditions and the level of organic activity gradually atrophies with each passing generation.130
Pereira then turned to practical considerations to combat the drawbacks of what he called a debilitating climate and a decadent race, making recommendations for the spatial layout of schools and the reduction of passive learning to ensure that correct oxygenation could take place. Thus, despite his flirtation with ideas damning to Brazil, Pacífico Pereira contradicted those ideas by never abandoning his faith in the possibility of manipulating the tropical environment to ensure progress in his homeland. It is significant that, in similar fashion, the other Tropicalistas accepted many of the European ideas about the tropics; but if they believed in degeneration, they emphasized regeneration.
In 1888 the second-generation Tropicalista Braz Amaral took up the theme that correct oxygenation would produce a better caliber of Brazilian. He argued that gymnastics was crucial to the development of people’s energies in the tropics and should be made an obligatory part of the school curriculum.
Upon this question depends the beauty of the race, the vigor of the worker, the productivity of the intellectual, the energy of the soldier, the development of industry, the advance of science, and the prosperity of our nation.131
As much as they rejected climatological determinism, the Tropicalistas rejected racial determinism; but they addressed European stereotypes of racial inferiority less openly than they did those of climate. It is possible, nevertheless, to get an indication of their thinking on this issue by looking at the writings from their clinical practice. These writings lead to the conclusion that the Tropicalistas refused to pick up the polygenist gauntlet of “different species.” Disease in the tropics, in their conception, had a good deal to do with poverty, malnutrition, lack of sanitation, and the conditions of slavery; in other words, with poor social conditions, which led to disease the same way such conditions did in the more temperate climates of Europe. Thus, in their clinical work, the Tropicalistas several times raised the question of the relation between race and a particular illness; but they never pursued this line of inquiry, or they deflected it to the social conditions of Africans and creoles.132
Wucherer and his disciples associated hookworm disease with Africans and creoles, for example, but argued that it was unhygienic living conditions that enabled the hookworm to thrive, and that those conditions, rather than race, were ultimately responsible for the disorder. Silva Lima, who first described ainhum, initially viewed the enforced barefootedness of African slaves as an important factor; but then he observed that libertos (freed slaves), who almost always wore shoes, also suffered from the disorder. Even though he found the problem only among Africans, he never argued that it was racially inherited. Instead, he professed to be mystified by the disorder.133
Another disorder Brazilian doctors thought to strike blacks more than whites was tetanus. But here again, the doctors refused to be satisfied with a purely racial etiology. R. da Cunha reported, for example, the case of a tetanus patient who died of the disorder, noting that the victim was black, which had “predisposed” him to the ailment. But da Cunha added that the victim was male; that he had a strong constitution; and that the city had recently suffered a cold spell, all of which were equally important variables.134
Similar reasoning can be seen in a review Wucherer published in 1867 of the work of the German physician and medical geographer Carl F. Heusinger, on geophagy.135 Heusinger argued that geophagy occurred in all climates and that it was found in European countries as well as tropical ones; he also asserted that Africans had a greater predisposition to it. Wucherer, while not wholly rejecting the first part of the hypothesis, found Heusinger’s evidence unreliable and therefore remained skeptical of his claims.136 But Wucherer roundly rejected the second part of Heusinger’s hypothesis, that Africans had a greater predisposition to geophagy, arguing that Heusinger had by no means proved his case. Only if all other factors, including living conditions, remained constant could racial predisposition be accepted as a definite cause.137
In the debate over whether the “pure-blooded Negro” was immune to yellow fever, an immunity some observers believed was lost when “hybridization” occurred, Wucherer sided with the skeptics. He noted that yellow fever occurred less and in milder form among Africans, but he believed that the difference was related to immunity conferred through acclimatization, not race.138
Wucherers position was typical of much of the Tropicalistas’ work. Indeed, they never used medical facts to advocate a separate medicine to deal with the “peculiarities” of blacks, as doctors did in the antebellum South and the West Indies.139 In Brazil, the racial and climatological explanations of “degeneration” were not the rivals Philip Curtin has suggested they were in the West Indian context.140 The blurring of racial lines through miscegenation and black social mobility, albeit limited, meant that whites could not comfortably dismiss notions of backwardness based on climate or racial categories. For this reason, the Tropicalistas’ writings are largely silent on the racial question. But they clearly would have agreed with one of their admirers, Luís Anselmo da Fonseca, a mulatto physician and professor at the Bahian medical school, who stated in 1887 that it was an error to seek the origins of Brazilian social, economic, and political evils in the “physiology of the Brazilian race” when the “lessons of history” showed that “people whom we today admire, when they were in a more primitive stage, were even less advanced socially than we are at present.”141
The Tropicalistas’ silence on race is best interpreted as ambivalence. Like many in the Brazilian upper class, they accepted the assumption of racial science that the white race was superior to all others; but they refused to accept the rigidity that was becoming one of its more prominent features. As members of the Brazilian intelligentsia, moreover, the Bahian physicians were part of the tradition that, in contrast to the United States, had “assimilated the savage races instead of trying to destroy them, thus preparing us to resist the devastating invasion of race prejudice.”142 Practically speaking, they worked alongside numerous mulattos like Fonseca, so that the reiteration of the inevitable inferiority and sterility of racially mixed people must have rung false.
It is tempting to speculate that the Tropicalistas clung to a nineteenth-century Brazilian etiquette regarding race. Emília Viotti da Costa has described this etiquette brilliantly. At its center was silence, made possible by the particular Brazilian social construction of race, in which biological, social, and cultural perceptions were so entangled that an individual’s biological race could cease to be the salient characteristic. In other words, it was possible for a person of African descent who had achieved the culture and social distinction of an upper-class white to “pass” as white.143
Such a framework would help explain why, although the Tropicalistas accepted European thinking about a hierarchy of races, they also adhered to older notions of fluidity and the belief that it was possible for “inferior” races to better themselves and move up in the hierarchy. As Braz Amaral, one of the younger Tropicalistas, stated in 1886,
Man improves himself by improving the milieu in which he lives, . . . by perfecting the conditions of his intimate life, . . . purifying his blood, by being provided with good schools, hygienic offices, by reducing the number of work hours . . ., by giving children good mothers, by eating good food. ... All of this is in the range of the doctor’s [work.]144
Another Bahian doctor argued, even more optimistically,
The racial mixture [in Brazil] will not prove an obstacle to progress but . . . will lead to a definite, national type with the aptitude and resistance needed to dominate a tropical milieu. Our civilization will certainly differ from the European one, because it will have evolved in a different environment, but by no means will that mean that it is inferior.145
By the 1880s and 1890s, however, as the waning of the empire and the rise of the republic made questions of national identity more urgent, Brazil also received a barrage of new currents of thought. Many Brazilians were moving away from the confident belief in the power of scientists like the Tropicalistas to manipulate the environment and improve the caliber of citizens toward a much greater pessimism about biological determinism.146
Beyond the Tropicalistas: The Response of Raimundo Nina Rodrigues
As a young physician in Bahia, Nina Rodrigues was much taken with the Tropicalista approach to medicine, seeing in it an alternative to what he viewed as the “sterile and banal medicine, of doubtful scientific value, coming from the Bahian medical school.”147 Eventually, however, Nina Rodrigues, a mulatto, began to transcend Tropicalista thinking on the question of whether susceptibility to disease was racially determined. Not only was racial inheritance a key variable in the predisposition to certain disorders, he came to believe, but Africans and racially mixed peoples were also more predisposed to criminality, had inferior powers of reason, and should not, therefore, be allowed to become full citizens of the nation.148
Raimundo Nina Rodrigues was born in a rural region of Maranhão and, like many Brazilians, was steeped in the culture of his family’s slaves from an early age. He grew up on the family estate, associating with the children of 60 slaves, learning to read with a slave woman known as Madrinha Mulata, listening to the stories about the quilombo of Pau-da-Estopa and the lepers of Anajatuba.149 He started his medical training in Bahia but in 1884 transferred to Rio de Janeiro and graduated there in 1887, returning to his native province to practice. In 1889 he moved to Salvador, where he practiced, taught at the medical school, and carried out the bulk of the anthropological work for which he later became famous.
Already known in Bahian medical circles and highly praised by Silva Lima for his work on leprosy in Maranhão, which the Gazeta Médica da Bahia published in 1887, Nina Rodrigues soon became active among the Tropicalistas. He worked beside them at the Santa Casa de Misericórdia; he joined the fledgling Sociedade Médica da Bahia, founded in 1888 by Silva Lima and Victorino Pereira; and, together with two other Tropicalistas, he organized the Third Brazilian Medical Congress, hosted in Bahia in 1890.150 Beginning in 1888, he published copiously in the Gazeta Médica da Bahia on subjects that were part of the Tropicalista agenda, such as beriberi, leprosy, the demand for statistical information on disorders that most afflicted Brazilians, and. the need to reform the Bahian health system. By the 1890s, Nina Rodrigues had become one of the principal contributors to the journal, and from 1890 to 1893 he was its editor in chief.
Links of marriage and friendship sealed his professional association with the Tropicalistas. He married the daughter of J. L. D’Almeida Couto, one of the Gazeta Médicas chief editors. His brother-in-law, Alfredo Tome de Britto, was a younger Tropicalista. He became close friends with Virgílio Clímaco Damásio, another Gazeta Médica editor and medical school professor, to whose chair in legal medicine Nina Rodrigues succeeded in 1891.
Because he is best known for his later, pioneering work in Afro-Brazilian ethnology and Brazilian legal medicine, Nina Rodrigues’ early writings have been largely ignored. Yet it is these writings, emerging from his clinical practice, that reveal Nina Rodrigues’ early preoccupation with the question of race, a preoccupation that would lead him more and more toward the determinism of nineteenth-century anthropology and racial science.151 In 1903 Nina Rodrigues recalled admiringly how the Tropicalistas had challenged the Bahian medical school’s sterile regurgitation of medical science “made for other races and for other countries.”152 He was undoubtedly drawn to the Tropicalista fold because he identified with their emphasis on the importance of original research in medicine. In fundamental ways, however, he transcended the Tropicalistas’ belief in the malleability of human nature through social environmentalism. Very early on, he began to ask questions about the relationship between race and pathology, a relationship the Tropicalistas had not left unpondered, but which they had always referred back to social factors.
Nina Rodrigues’ early explorations in this direction can best be illustrated by two articles he published in the Gazeta Médica da Bahia.153 The articles dealt with a study of leprosy in Maranhão, where he had worked with two other physicians collecting data. Leprosy was one of the disorders that had become a focus of concern in the years preceding the fall of the empire in 1889. It had acquired international visibility since the Norwegian researcher Gerhard H. A. Hansen had isolated the leprosy bacillus in 1873, even though his findings were disputed for a long time.154 The disease, more-over, was endemic to Brazil, particularly to certain geographical pockets in the north.155
In his first article, Nina Rodrigues stated that his clinical findings pointed to the importance of contagion in the disorder, although he said he had no positive knowledge about the “infectious agent” or the mode of transmission. Given the uncertainty of the precise cause of the disease, he argued, it was important to consider the factors in predisposition, among which were the familiar atmospheric ones —climate, humidity, sanitary conditions, and diet. Nina Rodrigues, however, went a step further than the Tropicalistas and mentioned the additional factor of racial susceptibility. Drawing eclectically on Darwin’s theory of natural selection and Lombroso’s concept of atavism, he asserted that susceptibility to leprosy was inherited.
According to scientific principles of natural selection, the fact that leprosy is caught by some individuals rather than others in exactly the same conditions, among members of the same family . . . [leads] us to believe that many times these individuals descend from a single genealogical branch which was, at some time, attacked by leprosy. The immunity [of some members] depends on the laws of alternative inheritance, or atavic inheritance.156
Nina Rodrigues, therefore, greatly weakened human agency as a factor in controlling the disease. While he still considered hygienic living important, he became far more interested in exploring the ramifications of inherited predisposition.157 Subsequently, he focused increasingly on this deterministic strand.
From the inheritance of the predisposition to leprosy in certain families, Nina Rodrigues moved to the predisposition of certain races. He insisted that racial pathology should be central to Brazilian medical investigations. Using a polygenist argument, he held that different human species, constituted by physical and chemical variations and molded by different lifestyles, must offer divergent predispositions to the same illness.158 The problem to be investigated, therefore, was the influence of race on Brazilian pathology. Nina Rodrigues lamented that very little medical work had been done in this direction in Brazil, and that what had been done offered no clear statement of which races and race crossings were involved.159 Devising such a statement, however, was no easy task, for it was extremely difficult to determine what racial parts went into the formation of people of mixed racial heritage, such as mulattos. Nevertheless, said Nina Rodrigues, it was not impossible. He provided a methodology for trying to disaggregate the term mestiços (by which he meant racially mixed people in general). Only with such a clarification would it be possible to elucidate how disorders were racially determined.
Another problem linked to racial hybridization and disease was the apparent contradiction that while indigenous Brazilians were immune to leprosy (as he wrongly believed), mixed-bloods were highly predisposed to it.160 In the end, Nina Rodrigues was unable to come up with any meaningful relationship between race and the predisposition to leprosy. Thus, he concluded that with the exception of Brazilian Indians (whom he did not number among his cases), all the races living in Brazil were liable to contract leprosy.161
In spite of this conclusion, the question of the relation of race and illness continued to intrigue him, and in a second article, published in 1890, he entered the sphere of racial anthropology, attempting to break down the racial “types” to be found among Brazilian mestizos.162 The search for pure African types among Brazilian mulattos set the boundaries for much of Nina Rodrigues’ later work. Drawing on the then current paradigms in European and U.S. racial science and anthropology, he argued that the inferiority of the African had been scientifically established. In the debate over whether hybridization invigorated the race or led to further degeneration, Nina Rodrigues sided with the latter camp. He had already, he thought, added further proof to this view by noting, in the case of leprosy, that Indians of mixed racial character lost the immunity of their “pure” ancestors.
By the 1890s, when he moved into the area of legal medicine, Nina Rodrigues’ ideas on the “inferior races” had been reinforced, so that in relation to crime and the law, he came to argue that “inferior peoples” should be granted “attenuated” responsibility. Those of mixed race should be ranked according to a hierarchy of greater and lesser degeneration and granted civic responsibility accordingly.163 Moreover, he warned, it would be a mistake to confuse the cultural value of a race with the laudable qualities of individuals of that race.
If we know black or colored men worthy of our esteem and respect, this does not negate the truth that until now blacks have been unable to build civilized nations.164
Some people, Nina Rodrigues continued, believed that the black race would eventually disappear through weakness, sickness, or infertility.165 But this belief, he stated, “is a manifest error. . . .Racial crossing does no more than retard the elimination of white blood,” but in no way would racial crossing lead to the disappearance of the black race in Brazil. Thus Nina Rodrigues, viewing the question of race mixture and the strong African presence in Brazil through the prism of European theories, was unabashedly pessimistic about the future of Brazil. Civilization in the tropics would be, at best, second-rate.
During the following decade, Nina Rodrigues continued to catalogue the regional and ethnic origins of the colored population in Bahia. He differentiated linguistic groups, investigated African religious cults, and collected African artwork, all of which made him unpopular among a group of professors at the medical school and earned him the nickname negreiro (slaver).166 Indeed, at the height of his seminal ethnographic work, Nina Rodrigues was bitterly opposed by the medical school. The biggest clash came in 1897, when the faculty voted to reject his Memória histórica, the annual report on the school’s activities, usually accepted as a matter of course.
Not only did Nina Rodrigues challenge the existing standard of teaching, but his research into race threatened the faculty’s own attempts to play down African influences in Brazilian culture and highlight European ones.167 It was well known, for example, that Nina Rodrigues attended such African rituals as candomblé as part of his research. Whether he was the only member of the intelligentsia to do so is unknown, but certainly he did not bother to hide his opinion that knowledge of such practices was an important aspect of scientific understanding. Indeed, he held that the study of Africans in Brazil should be central to the disciplines of both medicine and law. Thus he focused on a reality the Bahian intelligentsia preferred to ignore.
In contrast to Nina Rodrigues, the Tropicalistas kept silent on the question of race, and in this they were closer to traditional Bahian physicians. The irony of both positions is that the one seemingly more accommodating to race, that of the Tropicalistas, was as heavily imbued with ideas of white superiority and black inferiority as that of Nina Rodrigues. The Tropicalistas’ silence was a way of legitimating the status quo and the traditional manner of dealing with racial discrimination. While Nina Rodrigues’ ideas would seem more damaging to Brazilians, later historians, seeking to dignify the African contribution to Brazilian culture, were indebted to him for salvaging so much of Brazil’s African past, even though they rejected his ideas on the hierarchical ranking of races. Nina Rodrigues’ fascination with things African in Brazil, in the long run, laid the foundation for a whole new way of evaluating the African contribution to the Brazilian nation.168
The pre-Oswaldo Cruz era in Brazilian medicine should not be dismissed as one of merely passive and derivative medical science and practice. The Tropicalista school offers a clear example of nineteenth-century doctors attempting to rethink the idea of disease in the tropics. In so doing, they began a shift from thinking of the tropics as a region of physical and mental degeneration to the assertive view that through medical improvements, Brazil and its people could participate in the long march toward civilization. If for some European nations, as the British colonial secretary, Joseph Chamberlain, said in 1899, “the study of tropical diseases [was] a means of promoting imperial policy,” in Brazil the reframing of tropical disease and the pursuit of tropical medicine were primarily nationalistic ventures intended to redefine the country’s place in the world.169
In resisting the traditionally negative image of the tropics, the Tropicalistas remained well entrenched in nineteenth-century social medicine, viewing disease and social conditions as inextricably interwoven. This was true even when they were pioneering parasitology in Brazil and even when they became familiar with Pasteur’s bacteriology. For the Tropicalistas, sanitation, improved social conditions, education, and the abolition of slavery were the most effective ways of achieving a healthy population in a tropical milieu.
By the 1880s, the Tropicalistas had gained some of the acceptance beyond Bahia that they had sought. The original leaders matured from obscure clinicians in a tropical backwater to participants in an international debate and founders of a prestigious journal. Their movement helped to modernize Bahia’s medical school and medical establishment, and helped shift the interest of Brazilian doctors from purely European concerns to Brazilian problems. Yet the Tropicalistas failed to institutionalize separately so as to make a sustained contribution to medical science or to create new generations of disciples who would carry on their work. Their investigations provided none of the foundation on which Oswaldo Cruz and later generations of medical researchers would build.
There are many reasons why Oswaldo Cruz set up a successful research institution funded by the government and the Tropicalistas failed to do so.170 In the 1850s and 1860s, freelance doctor-scientists could hope for recognition, even fame, from their combined activities as clinicians and researchers. But by the 1880s and 1890s, rapid biomedical advances and debates over the organization, administration, and specialization of the new medicine had brought radical changes. The model for successful medicine in this era included funding and recognition by governments and official institutions, which the Tropicalistas, as provincial physicians, never fully received. Those like Nina Rodrigues, who continued to keep up with the latest medical trends, increasingly allowed the contours of medicine in Brazil to be established elsewhere.
By the turn of the century, to impose “civilization” on Brazilians, the country was importing racial determinism, criminal anthropology, and legal medicine—artifacts disguised as neutral scientific universality and developed by colonial nations for their own needs. By then, the Tropicalistas’ attempt to define the idea of the tropics and tropical disorders had been eclipsed by a tropical medicine and a racial determinism constructed by the colonial nations of the more developed world.
A Travel to Collections grant and a summer stipend from the National Endowment for the Humanities, and a San Francisco State University Affirmative Action Award funded the research for this article. The author would like to thank Nancy Leys Stepan and the two anonymous HAHR reviewers for their helpful comments on earlier versions of the manuscript.
E.g., Fernando de Azevedo, Brazilian Culture: An Introduction to the Study of Culture in Brazil, trans. William Rex Crawford (New York: Macmillan, 1950), 179-82, 423.
E.g., Antonio Caldas Coni, A escola tropicalista bahiana: Paterson, Wucherer, Silva Lima (Salvador: Typ. Beneditina, 1952).
Mark Harrison explores this theme in “Tropical Medicine in Nineteenth-Century India,” British Journal for the History of Science 25 (1992), 299-318; and esp. in the introduction to his Public Health in British India: Anglo-Indian Preventive Medicine, 1859-1924 (Cambridge: Cambridge Univ. Press, 1994). See also David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: Univ. of California Press, 1993). For a recent traditional view, see liana Lowy, “Yellow Fever in Rio de Janeiro and the Pasteur Institute Mission (1901-1905): The Transfer of Science to the Periphery,” Medical History 34 (1990), 144-63. On how to define Western medicine, see Arthur Kleinman, “What Is Specific to Western Medicine?” in Companion Encyclopedia of the History of Medicine, 2 vols., ed. W. F. Bynum and Roy Porter (London: Routledge, 1994), 1:15-23.
For the history of hookworm eradication in the U.S. South, see John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge: Harvard Univ. Press, 1981).
For a recent case study of a “buried” episode, see Jaime L. Benchimol, “Domingos José Freire e os primórdios da bacteriologia no Brasil, História, Ciências, Saúde, Manguinhos 2:1 (Mar.-Jun. 1995), 67-98.
Institutionalized tropical medicine means “a discipline with its own journals, institutions, qualifications, and an exclusive discourse [that] did not emerge until the last decade of the nineteenth century, and partly in response to metropolitan imperatives.” Harrison, “Tropical Medicine,” 299. The institutionalization was partly a result of Europeans’ deciding to rule their large, and in many cases recently acquired, colonies directly, which forced them to consider health problems in the tropics. The first school of tropical medicine was set up in Liverpool in 1899, followed by others in London, 1899; Hamburg, 1901; and Portugal and France, 1902. See Martin F. Shapiro, “Medicine in the Service of Colonialism: Medical Care in Portuguese Africa, 1885-1974” (Ph.D. diss., Univ. of California, Los Angeles, 1983), 19; Michael Worboys, “Tropical Diseases,” in Bynum and Porter, Companion Encyclopedia, 1:520; Arnold, “Medicine and Colonialism,” ibid., 1:1393-1435; D. J. Bradley, “Tropical Medicine,” in The Oxford Companion to Medicine, 2 vols., ed. John Walton et al. (Oxford: Oxford Univ. Press, 1986), 2:1394-95.
See Gilberto Freyre, “Nina Rodrigues recordado por um discípulo,” in Perfil de Euclydes e outros perfís (Rio de Janeiro: José Olympio, 1944), 211-18. For a study of Nina Rodrigues’ ideas, see Mariza Corrêa, “As ilusões da liberdade: a escola Nina Rodrigues e a antropologia no Brasil” (Ph.D. diss., Univ. de São Paulo, 1982); Dain Borges, “ ‘Puffy, Ugly, Slothful, and Inert’: Degeneration in Brazilian Social Thought, 1880-1940,” Journal of Latin American Studies 25 (May 1993), 239-41.
For a more complete description of the doctors and their backgrounds, see Coni, Escola tropicalista. A prosopographical analysis of the Tropicalistas suggests a core group of men, never numbering more than about 12 but surrounded by a larger circle of some two dozen identifiable supporters. See Julyan G. Peard, “The Tropicalista School of Medicine of Bahia, Brazil, 1860-1889” (Ph D. diss., Columbia Univ., 1990), 45-47: Madel T. Luz, Medicine e ordem política brasileira: políticas e instituções de saúde, 1850-1930 (Rio de Janeiro: Graal, 1982), 139-64. See also Carlos Oliveira, “Medicina e estado: origem e desenvolvimento da medicina social no Brasil. Bahia, 1866-1896” (Master’s thesis, Instituto de Medicina Social, Univ. do Estado de Rio de Janeiro, 1982).
For Wucherers herpetology work, see Otto Wucherer, “Sobre a mordedura das cobras venenosas e seu tratamento,” Gazeta Médica da Bahia (Salvador; hereafter GMB) 1 (1867), 229-31 241-43, and “Sobre o modo de conhecer as cobras venenosas do Brasil,” ibid., 193-96.
Renato Clark Bacellar, Brazil’s Contribution to Tropical Medicine (Rio de Janeiro: Gráfica Olímpica, 1963), 61-73. For a slightly different version of his early life, see the biographical article in União Médica 1 (1881), 178-79, 226-28. For the importance of the German community and its influence in Bahia, see Frederico G. Edelweiss, “A secular presença da Alemanha na Bahia,” Anaias do Arquivo do Estado da Bahia 39 (1970), 223-42. See also Gilberto Freyre, Nós e a Europa germânica: em tórno de alguns aspectos dos relações do Brasil com a cultura germânica no decorrer do século XIX (Rio de Janeiro: Grifo, 1971).
José Francisco da Silva Lima, “O Dr. Paterson, sua vida e sua morte: esboço biográfico,” GMB 18 (1887), 337-44. 385-94. 433-39. 481-92.
“O Dr. Silva Lima,” GMB 41 (1910), 337-57; “O jubileo do Dr. Silva Lima,” ibid. 33 (1901), 247-52.
Octavio Torres, Esbôço histórico dos acontecimentos mais importantes da vida da Faculdade de Medicina da Bahia, 1808-1946 (Salvador: Imprensa Vitória, 1952), 10-12; Lycurgo Santos Filho, História geral da medicina brasileira (São Paulo: Hucitec, 1991), 2:39-49. Before that time, Brazil had no community of doctors trained in Western medicine. Over three centuries of colonial history, no more than about one hundred European-trained physicians had served in Brazil, either as personal physicians to high-ranking civil servants or as part of the imperial bureaucracy. Most of the health care in colonial society was provided by religious orders and low-ranking barber-surgeons, apothecaries, midwives, and faith healers. See, e.g., James D. Goodyear, “Agents of Empire: Portuguese Doctors in Colonial Brazil and the Idea of Tropical Disease” (Ph.D. diss., Johns Hopkins Univ., 1982), esp. chap. 4, “Portuguese Physicians and Colonial Curers.” Such healers continued to provide much of the health care during the nineteenth century. See Santos Filho, História geral, 2:432-44; Dain Borges, The Family in Bahia, 1870-1945 (Stanford: Stanford Univ. Press, 1992), 94. For the early generation of doctors who set up medical institutions in the new nation, see Goodyear, “Agents of Empire,” 318-22.
The Paris Medical School, the most influential school in Western medicine during the first half of the nineteenth century, was where “the clinical approach based on bedside observations and postmortem findings” first emerged. See Guenter Risse, “History of Western Medicine from Hippocrates to Germ Theory,” in The Cambridge World History of Human Disease, ed. Kenneth F. Kiple (Cambridge: Cambridge Univ. Press, 1993), 17.
For an account of the shifts from and to centralization, see Roderick J. Barman, Brazil: The Forging of a Nation, 1798-1852 (Stanford: Stanford Univ. Press, 1988), 60-216; Emília Viotti da Costa, The Brazilian Empire: Myths and Histories (Chicago: Univ. of Chicago Press, 1985), 53-77 For a contemporary account from the medical point of view, see Manuel José de Araújo, “Breve noticia sobre a fundação e marcha do ensino médico na Bahia,” GMB 10 (1877), 506-14; “Reforma do ensino médico,” ibid. 14 (1882), 146-47.
The Regency was the period between Pedro I’s abdication in 1831 and the crowning of his son as Emperor Pedro II at age 14 in 1840.
E.g., in 1887 the minister of the empire invalidated the outcome of a competition for a faculty post in the Bahian medical school on the grounds that there was insufficient evidence to prove the candidate’s competence. He ordered a new competition to select another candidate. See CMB 18 (1887), 529-32.
Joseph-F.-X. Sigaud, Du climat et des maladies du Brésil: ou statistique médicale de cet empire (Paris: Fortin, Masson, 1844). Some other influential foreign doctors in the nineteenth century were T. J. H. Langaard, who wrote Diccionario de medicina (1865); Aristide Garnier, a Frenchman who lived in Rio de Janeiro and directed the journal of the Academy of Medicine, Annaes Brasilienses de Medicina; and the Englishman Jonattas Abbot, who taught and worked in Bahia from 1860 to 1878 and founded a small natural history museum at the Bahian medical school. None of these doctors ever generated a movement like that of the Tropicalistas.
On the numbers of practicing doctors in Bahia and the doctor-patient ratio, see Peard, “Tropicalista School,” appendix 2, pp. 397-98. For numbers of graduates 1861-89, see ibid., table 1, p. 391. See also Roderick J. Barman and Jean Barman, “The Role of the Law Graduate in the Political Elite of Imperial Brazil,” Journal of Inter-American Studies and World Affairs 18:4 (Nov. 1976), 423-50; José Murilo de Carvalho, A construção da ordern: a elite política imperial (Rio de Janeiro: Campos, 1980); idem, “Political Elites and State Building: The Case of Nineteenth-Century Brazil,” Comparative Studies in Society and History 24 (July 1982), 378-99.
Robert Dundas, Sketches of Brazil; including new views on Tropical and European Fever. . . (London: John Churchill, 1852), 389. Emphasis in the original.
Roderick Barman discusses this in relation to law graduates. Brazil, 238. On the importance of patronage in nineteenth-century Brazil for success in almost any field, see da Costa, Brazilian Empire, 188-90, 196-97; Richard Graham, Patronage and Politics in Nineteenth-Century Brazil (Stanford: Stanford Univ. Press, 1990).
See Borges, Family in Bahia, 104-5; Nancy Leys Stepan, Beginnings of Brazilian Science: Oswaldo Cruz, Medical Research, and Policy, 1890-1920 (New York: Science History Publications, 1976), 50-51; Gilberto Freyre, The Mansions and the Shanties (Sobrados e mucambos): The Making of Modern Brazil, trans. and ed. Harriet de Onis (New York: Knopf, 1963), 391; Barman, Brazil, 238; Luís Couty, “O ensino superior no Brasil,” GMB 15 (1884), 521-32. Bahia offered far fewer opportunities for advancement than Rio de Janeiro, which in medicine alone had a larger principal medical school, in addition to other institutions, such as the Imperial Academy of Medicine and the Museu Nacional.
Ordival Cassiano Gomes, Manuel Victorino Pereira: médico e cirurgião (Rio de Janeiro: Livraria Agir, 1957), 29.
Gilberto Freyre, Order and Progress: Brazil from Monarchy to Republic, ed. and trans. Rod W. Horton (Berkeley: Univ. of California Press, 1986), 124.
Useful literature on the intellectual and political changes of the 1870s includes João Cruz Costa, A History of Ideas in Brazil: The Development of Philosophy in Brazil and the Evolution of National History, trans. Suzette Macedo (Berkeley: Univ. of California Press, 1964), 82-202; Antônio Cândido, Formação da literatura brasileira (momentos decisivos), 5th ed. (São Paulo: Itatiaia, 1975); Boris Fausto, “Society and Politics,” in Brazil: Empire and Republic, 1822-1930, ed. Leslie Bethell (Cambridge: Cambridge Univ. Press, 1989), 262; Jeffrey D. Needell, A Tropical Belle Epoque: Elite Culture and Society in Turn-of-the-Century Rio de Janeiro (Cambridge: Cambridge Univ. Press, 1987); E. Bradford Burns, A History of Brazil, 3d ed. (New York: Columbia Univ. Press, 1993), 165-71; Charles A. Hale, “Political and Social Ideas in Latin America, 1870-1930,” in The Cambridge History of Latin America, vol. 4, C. 1870-1930, ed. Leslie Bethell (Cambridge: Cambridge Univ. Press, 1986), 382-414. See also n. 94.
Silva Lima, “O Dr. Paterson,” 385.
Wucherer was responsible for introducing one of the earliest microscopes in Bahia. See Coni, Escola tropicalista, 39-40, n. 24, 25. See also Charles-Edward Amory Winslow, The Conquest of Epidemic Disease: A Chapter in the History of Ideas (Madison: Univ. of Wisconsin Press, 1980), 293; Brian Bracegirdle, “The Microscopical Tradition,” in Bynum and Porter, Companion Encyclopedia, 1:102-19; Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge: Cambridge Univ. Press, 1978), esp. chap. 4, “The Microscope and the Revelation of a Cellular Universe,” 69-90.
On the Santa Casa, see A. J. R. Russell-Wood, Fidalgos and Philanthropists: The Santa Casa de Misericórdia of Bahia, 1550-1755 (Berkeley: Univ. of California Press, 1968); Carlos Ott, A Santa Casa de Misericórdia da Cidade do Salvador (Rio de Janeiro: n.p., 1960); Peard, “Tropicalista School,” 48-53.
In the 1870s this was true of many medical schools in Europe and the United States. See Reiser, Medicine and the Reign of Technology, 81,
Coni, Escola tropicalista, 38-39.
The Tropicalistas’ interest in Brazilian pharmacopoeia and folk remedies deserves further study. For some of their writings on the subject, see Peard, “Tropicalista School,” 100, n. 116.
GMB 1 (1866), 1. Emphasis added. All translations from GMB are the author’s.
Primeiro Congresso Brasileiro de Medicina e Cirurgia do Rio de Janeiro (Rio de Janeiro: Imprensa Nacional, 1889), 4; GMB 2 (1868), 193.
José F. da Silva Lima, “Terceiro Congresso Brasileiro de Medicina e Cirurgia: discurso inaugural do Presidente Dr. Silva Lima,” GMB 22 (1890), 157.
Filariasis is an ancient disorder; the variety Wucherer studied was known to the Hindus, the Arabs, and the Europeans. The long threadworms block human lymph channels, causing a general constitutional weakening and often, immense swelling of the legs, arms, scrotum, and breasts. The French physician Jean-Nicolas Demarquay also discovered the embryonic filaria in 1863 in a patient who had spent time in Cuba. But when he showed the helminths to the expert, Dr. Casimir Davaine, the latter doubted their significance. Thus the discovery was forgotten until Wucherer renewed interest in the parasite.
For a good account of the early research into filariasis in Bahia, see José Francisco Silva Lima, “Nova fase na questão da natureza verminosa da chiluria; descoberta do representante adulto da filaria de Wucherer,” GMB 9 (1877), 387-96, 481-92; Pedro S. de Magalhães, “Descripção de uma especie de filarias encontradas no coração humano,” ibid. 19 (1887), 49-65, 109-30, 152-65, 200-11.
According to Thomas Spencer Cobbold, a relation between elephantiasis and hemochyluria had long been posited. See Parasites: A Treatise on the Enzotoa of Man and Animals. . . (London: J. and A. Churchill, 1879), 200. Silva Lima, however, stated that in Bahia it was rare to find both symptoms together. “Memória sobre a hematuria chilosa, ou gordurosa dos países quentes, pelo Dr. J. Crevaux, médico da marinha franceza, com anotações e comentarios,” GMB 8 (1876), 50.
Otto Wucherer, “Nota preliminar sobre vermes de uma espécie ainda não descrita, encontrados na urina de doentes de hematuria intertropical no Brazil,” GMB 3 (1868), 97-99; and “Sobre a hematuria no Brasil,” ibid. 4 (1869), 39-40, 49-50, 61-62, 73-74, 85-86.
See Thomas Spencer Cobbold, “The Life-history of the Filaria bancrofti, as explained by the Discoveries of Wucherer, Lewis, Bancroft, Manson, Sonsino, myself, and others;” Journal of the Linnean Society; Zoology 14 (1879), 356-70. For English translations of the key articles in the early unraveling of the filaria puzzle, see B. H. Kean et al., eds., Tropical Medicine and Parasitology: Classic Investigations, vol. 1 (Ithaca: Cornell Univ. Press, 1978), 374-405. See also Le Roy Méricourt, “De l’hematurie intertropicale observée au Brésil,” Archives de Médecine Navale (1870), 141; Deutsches Archiv für Klinische Medizin (Sept. 27, 1872), 379-400; Veterinarian (Jan. 1876); Paul Bourel-Roncière, “Résumé and Commentary on the Writings of Silva Lima, Silva Araujo, and Others,” Archives de Médecine Navale (Mar. 1878). For further references up to 1878, see Cobbold, Parasites, 202-5.
H. Harold Scott, A History of Tropical Medicine, 2 vols. (Baltimore: Williams and Wilkins, 1930), 1:159; Ronald Ross, Memories of Sir Patrick Manson (London: Harrison and Sons, 1930?), 9-10; Silva Lima, “Nova fase,” GMB 9 (1877), 389; Cobbold, Parasites, 184-85; Timothy Richards Lewis, “The Nematoid Haematozoa of Man,” Quarterly Journal of Microscopical Science 19 (1879), 245-59. Lewis called the parasite he found in human blood filaria sanguinis hominis.
Cobbold, Parasites, 190, 192; Ross, Memories, 15.
Manson’s biographers report that he found out about the filaria from reading Lewis’ work on the filaria sanguinis hominis at the British Museum. Indeed, they do not credit Wucherer with the discovery at all. See Philip H. Manson-Bahr and A. Alcock, The Life and Work of Sir Patrick Manson (London: Cassell, 1927). For more on Cobbold, see Douglas M. Haynes, “From the Periphery to the Center: Patrick Manson and the Development of Tropical Medicine as a Medical Specialty in Britain, 1870-1900” (Ph.D. diss., Univ. of California, Berkeley, 1992), 16-19.
One of the leading Tropicalistas, John L. Paterson, offered a typical assessment in 1878: “There are in the field [of filariasis research], as much in this country [Brazil] as in other countries, many zealous researchers, so that we can await confidently more definite answers than have been given up until the present.” GMB 10 (1878), 536.
In addition to Griesinger, Wucherer sent specimens to Cobbold and the parasitologists H. Weber and Rudolph Leuckardt. He also sent herpetology specimens to the British Museum and the London zoo. He corresponded with Méricourt of France; a young English naturalist, Mr. Reed; Dr. Cotting, a colleague of the researcher Louis Agassiz, who had visited Brazil; and Dr. John O’Neill, who practiced in West Africa and wrote on craw-craw. Silva Lima sent specimens to the Hunterian Museum in Britain and to various European doctors interested in tropical diseases. See GMB 8 (1876), 7-22, 97-111. The same issue reproduces graphics of microorganisms associated with filariasis and bilharzia.
GMB 9 (1877), 538; Lancet 1 (Mar. 30,1878), 464.
A. J. Silva Araújo, “A muricoça e as filarias wuchereria,” GMB 10 (1878), 382, 385-89.
Idem, Caso de chiluria, elefancia de escroto, escroto linfático, craw-craw e erisepela em un mesmo indivíduo; descobrimento da wuchereria filaria na linfa no escroto; tratamento pela electricidade com excelentes resultados,” GMB 9 (1877), 492-504; idem, “Do tratamento da elefancia pela electricidade,” 13 (1882), 350-55; Patrick Manson, “Filaria Sanguinis Hominis in relation to Elephantiasis, Chyluria, and Allied Diseases,” Lancet 1 (Mar. 30, 1878), 465.
Magalhães, “Descripção de uma especie de filarias,” 49-51; London Medical Record 15 (June 15, 1887), 273.
J. L. Paterson, “Fatos relativos à filariose,” GMB 10 (1878), 529-36. They also looked at the relevance of age and gender. See also ibid. 30 (1899), 457.
J. Bancroft, “Scleroderma in Relation to Filaria Sanguinis Hominis,” Lancet 1 (Feb. 1885), 380.
GMB 12 (1880), 49.
Silva Lima, “Memória sobre a hematuria chilosa,” 63.
Cobbold, Parasites, 186-87; Silva Lima, “Nova fase,” 395.
Silva Lima, Nova fase, 481; Cobbold, Parasites, 191. Cobbold’s letter was published in Lancet 1 (Jan. 12, 1878), 69; Silva Lima’s response in ibid. (Mar. 23, 1878), 440-41.
Cobbold, Parasites, 186-87. See also Cobbold’s obituary in GMB 18 (1886), 170-71.
E.g., in a paper presented on his behalf to the Medical Society of London in 1878, Cobbold acknowledged Brazilian contributions and then stated dryly, “Manson arrived independently at the same conclusion. Wucherer would, were he alive, be the last to claim priority to Lewis, Bancroft, and Manson in this matter [of the relationship between the filaria and elephantiasis].” Lancet (Mar. 30, 1878), 465. A review some years later of a Brazilian monograph on filariasis noted, “The major part of the pamphlet is occupied by an historical résumé of the whole subject of filarial disease in man, dating from Wucherer’s discovery in 1868 of the immature form of the haematochylous urine. ... We are glad to note that full credit is given to Manson for his laborious investigations, conducted, as they were, under conditions of great difficulty, and crowned by the really brilliant identification of the mosquito as the intermediary host.” London Medical Record (June 17, 1887), 273.
For European journals reprinting and discussing the Brazilians’ work, see the bibliography in Cobbold, Parasites, 202-5.
Manson-Bahr and Alcock, Life and Work of Sir Patrick Manson, 39-41. Manson’s article “Tropical Medicine and Hygiene,” Tropical Medicine and Hygiene 2 (July-Dee. 1917), 103-9, does, in passing, mention Wucherer and Demarquay.
Ross, Memories, 10.
GMB 8 (Mar. 1876), 111.
Also known in Brazil as opilação, the disorder was known in various parts of the world as cachexia africana, tropical chlorosis, mal d’estomac, and mal de coeur. Erwin H. Ackerknecht, History and Geography of the Most Important Diseases (New York: Hafner, 1965), 130.
Otto H. Wucherer, “Patologia interna sobre a moléstia vulgarmente denominada ‘opilação’ ou cansanço,’” GMB 1 (1866), 27-29, 39-41, 52-54, 63-64.
After malaria and tuberculosis, hookworm is believed to have been the most wide-spread disorder in hot climates until the advent of effective therapies and preventive measures. Thousands of worms attach themselves to a host’s small intestine, where they suck blood for nutrition, producing severe anemia in the host and sometimes causing the victim to have an urge to consume earth (geophagy).
GMB 3 (1868), 184.
See, e.g., Júlio Rodrigues de Moura, “Do hipoemia intertropical considerada como molestia verminosa, “GMB 5 (1871), 6-9; idem, “O Dr. Davaine e sua doutrina parasitária da hypoemia intertropical,” ibid. 14 (1882), 102-11; Manuel Victorino Pereira, “Ancylostoma duodenale. Chlorose de Egito—hypoemia intertropical,” ibid. 9 (1877), 19-31, 68-82.
Otto H. Wucherer, “Sobre o ancylostoma duodenale ou strongylus duodenalis Dubini,” GMB 3 (1869), 198-99.
Wucherer, “Patologia interna,” 64. Wucherer also argued that hipoemia intertropical was distinct from febre paludosa (malaria).
M. V. Pereira, “Ancylostoma duodenale,” 24, 71.
Ibid., 78, 81.
For good discussions on the relation between disease, squalor, destitution, and the rise of the bacteriological theory, see John M. Eyler, “The Sick Poor and the State: Arthur Newsholme on Poverty, Disease, and Responsibility,” and Elizabeth Fee, “Henry E. Sigerist: His Interpretations of the History of Disease and the Future of Medicine,” in Framing Disease: Studies in Cultural History, ed. Charles E. Rosenberg and Janet Golden (New Brunswick: Rutgers Univ. Press, 1991), 275-96, 297-318; Nancy Tomes, “The Private Side of Health: Sanitary Science, Domestic Hygiene, and the Germ Theory, 1870-1900,” in Bulletin of the History of Medicine 64:4 (Winter 1990), 503-39; Margaret Pelling, “Contagion/Germ Theory/Specificity,” in Bynum and Porter, Companion Encyclopedia, 1:309-34; Warwick Anderson, “Excremental Colonialism: Public Health and the Poetics of Pollution,” Critical Inquiry 21:3 (Spring 1995), 641-69. Fee also deals with the practical implications of the different approaches to studying diseases in “Sin versus Science: Venereal Disease in Twentieth-Century Baltimore,” in AIDS: The Burdens of History, ed. Fee and Daniel M. Fox (Berkeley: Univ. of California Press, 1988), 121-46.
See Adolpho Lutz, “Ancylostoma duodenale e ancylostomiase,” GMB 19 (1888), 487-89, 541–44. 20 (1889), 60-65, 113-24, 157-66, 315-22, 410-14, 451-56, 516-24, 555-59, 21 (1889), 58-61,132-39, 158-64.
A. P. Pereira, “Projecto d’esgotos na Bahia,” GMB 36 (1904), 193. See also idem, “Aos médicos deputados: reformas necessárias à legislação sanitaria e ao ensino médico,” ibid. 9 (1877), 1-6, 49-56, 96-105, 145-51, 193-99, 337-46; idem, “Origem das epidemias de febre amarela na Bahia, ibid. 30 (1899), 483-86. See also Silva Lima’s calls for mosquito eradication after learning mosquitoes were involved in transmitting filariasis. “Sobre alguns casos de lymfangite filariosa,” GMB 30 (1899), 507-8.
In a 1906 article, Oswaldo Ferreira Barbosa asserted, “We, tropical people, are not anemic; tropical anemia is a myth that exists only in the imagination of those who created it.” “Anemia tropical,” GMB 37 (1906), 295.
A. P. Pereira, “A higiene na Bahia,” GMB 30 (1899), 438.
See Marcos Cueto, ed., Missionaries of Science: The Rockefeller Foundation in Latin America (Bloomington: Indiana Univ. Press, 1994).
See Steven C. Williams, “Nationalism and Public Health: The Convergence of Rockefeller Foundation Technique and Brazilian Federal Authority During the Time of Yellow Fever, 1925-1930,” in Cueto, Missionaries of Science, 28; Steven C. Williams, “The International Health Board and Changing Urban/Rural Relations in Brazil,” Research Reports from the Rockefeller Archive Center (Spring 1990), 14. Mark Harrison argues that a similar obfuscation of the role of the Indian Medical Service occurred in India after 1860. “Tropical Medicine,” 301.
Doctors in Bahia complained constantly about the preferential treatment meted out to the medical school and health care institutions in Rio de Janeiro. See, e.g., A. P. Pereira, “Pareçer da comissão da Faculdade de Medicina da Bahia sobre o projeto para a criação de uma Universidade da Corte,” in “Memória histórica dos acontecimentos mais notaveis do anno 1882 no Faculdade de Medicina da Bahia,” Brazil, Ministro do Imperio, Relatórios Ministerais, Época do Imperio, Annex B (1883). Complaints about regional favoritism were echoed in other fields, such as agriculture. See Gerald Michael Greenfield, “The Great Drought and Elite Discourse in Imperial Brazil,” HAHR 72:3 (Aug. 1992), 384.
Lycurgo Santos Filho, História da medicina no Brasil, 2 vols. (São Paulo: Brasiliense, 1947), 2:376-78. The Bahian physician was Lima Gordilho, named Barão de Itapõa in 1872.
Santos Filho himself accepts the argument. See ibid., 1:272-73. Barman observes, “Because of the superior economic, social, and cultural opportunities it offered, Rio de Janeiro city acted as a magnet, attracting from the provinces anyone of talent, thus reinforcing its hegemony over the nation.” Brazil, 219.
Goodyear notes, “Cruz Jobim was willing to entertain the thought that climate and disease were so inexorably linked that incidence of a certain ailment characterized a climate, rather than a climate ordaining the presence of certain diseases.” “Agents of Empire,” 323-34, esp. 327. Cruz Jobim’s view of the disorder was noted by August Hirsch in his Handbook of Geographical and Historical Pathology (Erlangen: Verlag von Ferdinand Enke, 1859-62), but not in the later edition of the book. On the concept of miasma, see Caroline Hannaway, “Environment and Miasmata,” in Bynum and Porter, Companion Encyclopedia 1:292-308; and Vivian Nutton, “The Seeds of Disease: An Explanation of Contagion and Infection from the Greeks to the Renaissance,” Medical History 27 (1983), 1-34.
Otto H. Wucherer, “Ancylostomas duodenaes,” GMB 2 (1867), 151.
E.g., journals in Rio de Janeiro such as União Médica and Brasil Médico, both founded in 1881, began to publish their work. União Médica explicitly mentioned the Bahian journal as its model. See editorial, União Médica 1 (1881), 1-5.
As late as 1887, a writer in GMB lamented, “Even though we are in the 18th year of publication, we don’t know if the court medical community [ahí na corte] is aware of the existence of the Gazeta Médica da Bahia.” GMB 18 (1887), 378. In 1898 Silva Lima, writing on the 32d anniversary of the journal’s founding, stated somewhat bitterly that the journal undoubtedly would continue its “patriotic and humanist mission,” but only because of the sacrifices of a few physicians; for the journal had always lacked full moral and material support from the Brazilian medical class as a whole. “A Gazeta Médica e o seutrigesimo segundo aniversário,” GMB 30 (1898), 1-6. Most of that class resided in Rio de Janeiro, although Silva Lima was undoubtedly also castigating Bahian doctors.
Stepan, Beginnings of Brazilian Science, 159.
Michael Worboys, “The Emergence and Early Development of Parasitology,” in Parasitology: A Global Perspective, ed. Kenneth S. Warren and John Z. Bowers (New York: Springer-Verlag, 1983), 4.
Lowy, “Yellow Fever,” 145. See also Worboys, “Emergence and Early Development,” 6-11; John Farley, “Parasites and the Germ Theory of Disease,” Milbank Quarterly 67:1 (1989), 50-68.
Lowy, “Yellow Fever,” 162.
On the idea of encouraging European immigration, a topic that has been well researched, see Fausto, “Society and Politics,” 262; Needed, Tropical Belle Epoque, 32-33; Stepan, Beginnings of Brazilian Science, 84-85; Thomas H. Holloway, Immigrants on the Land: Coffee and Society in São Paulo, 1886-1934 (Chapel Hill: Univ. of North Carolina Press, 1980); George Reid Andrews, Blacks and Whites in São Paulo, Brazil, 1888-1988 (Madison: Univ. of Wisconsin Press, 1991), 85-88. For the notion of improving the national population, less well researched, see Greenfield, “Great Drought,” 375-400, esp. 383-85, 398-99. See also Belisario Penna, O saneamento do Brasil (Rio de Janeiro: Typ. Revista dos Tribunaes, 1918); Luís Antônio de Castro-Santos, “Power, Ideology, and Public Health in Brazil, 1889-1930” (Ph.D. diss., Harvard Univ., 1987); Nísia Trinidade Lima and Gilberto Hochman, “Descobrindo a nação, construindo o estado: o movimento pela reforma da saúde pública no Brasil da Primeira República” (Paper presented to the Latin American Studies Association, Washington, D.C., Sept. 1995). On millenarian rural resistance to the intrusion of urban modernization, see Todd A. Diacon, Millenarian Vision, Capitalist Reality: Brazil’s Contestado Rebellion, 1912-1916 (Durham: Duke Univ. Press, 1991); Ralph Della Cava, Miracle at Joaseiro (New York: Columbia Univ. Press, 1970); Robert M. Levine, ‘“Mud Hut Jerusalem’: Canudos Revisited,” HAHR 68:3 (Aug. 1988), 525-72.
Robin L. Anderson, “Public Health and Public Healthiness: São Paulo, Brazil, 1876-1893,” Journal of the History of Medicine and Allied Sciences 41:3 (1986), 293-307. See also Stepan, Beginnings of Brazilian Science, 118-20. For examples of doctors’ increasing role, see “O leite em São Paulo,” in Annaes Paulistas de Medicina e Cirurgia 4:1 (Jan. 1915), 1-5; and Carlos Meyer, “As aguas de abastecimento de São Paulo: sua qualidade, febre tifóide, disenteria amebiana,” ibid. 4:6 (July 1915), 136-41.
See Stepan, Beginnings of Brazilian Science, 104-56.
This was also true of the local traditions in other regions. For India, see Harrison, Public Health in British India, 4-5, who emphasizes the convergence of British medicine and local Indian responses.
On “Germanism,” see Cruz Costa, History of Ideas, 186-93.
Thomas E. Skidmore, Black into White: Race and Nationality in Brazilian Thought (New York: Oxford Univ. Press, 1974); idem, “Racial Ideas and Social Policy in Brazil, 1870-1940,” in The Idea of Race in Latin America, 1870-1940, ed. Richard Graham (Austin: Univ. of Texas Press, 1990), 7-36; Jeffrey D. Needell, “History, Race, and the State in the Thought of Oliveira Viana,” HAHR 75:1 (Feb. 1995), 1-30; idem, Tropical Belle Epoque, 1-7; da Costa, Brazilian Empire, 190-233; Cruz Costa, History of Ideas, 82-202; Ivan Lins, História do positivismo no Brasil, 2d ed. (São Paulo: Nacional, 1967).
Some of the successes of this period were filariasis, discovered by Patrick Manson in 1879; the malaria parasite, by Laveran, 1880; Vibrio cholera by Koch, 1883; plague bacillus by Kitasato and Yersin, 1894; the malarial life cycle by Grassi and Ross, 1897; trypanosomiasis by Bruce, 1896-1902, and Chagas, 1908; and leishmaniasis by several researchers, 1900-1911. See Worboys, “Emergence and Early Development,” 7. On the history of therapeutics, see Morris J. Vogel and Charles E. Rosenberg, eds., The Therapeutic Revolution: Essays in the Social History of American Medicine (Philadelphia: Univ. of Pennsylvania Press, 1979); W. F. Bynum and Vivian Nutton, eds., Essays in the History of Therapeutics, Clio Medica: A Series of Primers on the History of Medicine, vol. 22 (Amsterdam: Rodopi, 1991).
E.g., in the case of hookworm, the IHB gave three doses of oil of chenodium to cure the disorder and recommended the wearing of shoes and the building of latrines as a means of prevention.
Nancy Leys Stepan, The Hour of Eugenics: Race, Gender, and Nation in Latin America (Ithaca: Cornell Univ. Press, 1991), 35-54.
Skidmore, “Racial Ideas,” 12.
The term race is used here in the sense Nina Rodrigues envisaged it: as a tangible, biological fact that, if only he could investigate it fully, could be broken up into different pure types. On the definition of race, Peter Winn has written succinctly, “Race [is a] human invention . . . shaped and reshaped over time and space.” Americas: The Changing Face of Latin America and the Caribbean (Berkeley: Univ. of California Press, 1992), 306.
For a good introduction to the idea of degeneration in the nineteenth century, see J. Edward Chamberlin and Sander L. Gilman, eds., Degeneration: The Dark Side of Progress (New York: Columbia Univ. Press, 1985), esp. the essay by Eric T. Carlson, “Medicine and Degeneration: Theory and Praxis,” 121-43. For a discussion of the idea of degeneration in Brazil, see Borges, “Puffy, Ugly, Slothful,” 239-41.
Philip D. Curtin, The Image of Africa: British Ideas and Action, 1780-1850 (Madison: Univ. of Wisconsin Press, 1964), 58-87. On the dread of the tropics in the second half of the nineteenth century, see Dane Kennedy, “The Perils of the Midday Sun: Climatic Anxieties in the Colonial Tropics,” in Imperialism and the Natural World, ed. John M. MacKenzie (Manchester: Manchester Univ. Press, 1990), 118-40.
See Goodyear, “Agents of Empire,” esp. chap. 2, “Brazil: ‘Terrestial Paradise’?”
Donald B. Cooper, “Brazil’s Long Fight Against Epidemic Disease, 1849-1917, with Special Emphasis on Yellow Fever,” Bulletin of the New York Academy of Medicine 51:5 (1975), 672-96. For a discussion of yellow fever in blacks and whites, see Kenneth F. Kiple and Virginia Himmelsteib King, Another Dimension to the Black Diaspora: Diet, Disease, and Racism (Cambridge: Cambridge Univ. Press, 1981), 29-49.
European concerns about the whites’ degeneration in the tropics are well illustrated by a questionnaire from a group of French doctors to the Bahian Medical Society. The questions included, “Was the Bahian climate unhealthy? Do foreigners living there have a shorter life span than [people living] in the great European cities? Are Europeans more subject to contracting disease than the natives of the region? Is the European’s fertility changed by climate, food, or work conditions?” GMB 20 (1888), 45-48. Goodyear notes that even in the colonial era, some people worried about how Brazil’s climate could “undermine the social morality of the colony,” inducing idleness and moral lapse. “Agents of Empire,” 273-75. See also Stepan, Hour of Eugenics, 44-46; idem, “Biological Degeneration: Races and Proper Places,” in Chamberlin and Gilman, Degeneration, 97-120. See also Harrison, “Tropical Medicine,” 306.
Skidmore, Black into White, 29-30. See also Moema Parente Augel, Visitantes estrangeiros na Bahia oitocentista (São Paulo: Cultrix, 1980), 214. For contemporary views, see Prof, and Mrs. Louis Agassiz, A Journey in Brazil (Boston: Ticknor and Fields, 1868), 529-32; and medical students’ dissertations; e.g., Guarino Aloysio Ferreira Freire, “Qual o papel que desempenha a civilisação?” (Faculdade de Medicina da Bahia, 1888).
For literature on racial science, see Nancy Stepan, The Idea of Race in Science: Great Britain, 1800-1960 (London: MacMillan, 1982); George M. Fredrickson, The Black Image in the White Mind: The Debate on Afro-American Character and Destiny, 1817-1914 (New York: Harper and Row, 1971); William Ragan Stanton, The Leopard’s Spots: Scientific Attitudes Toward Race in America, 1815-59 (Chicago: Univ. of Chicago Press, 1960); George W. Stocking, Jr., “The Persistence of Polygenist Thought in Post-Darwinian Anthropology,” in Race, Culture, and Evolution: Essays in the History of Anthropology (New York: Free Press, 1968); Stephen Jay Gould, The Mismeasure of Man (New York: W. W. Norton, 1981). For Brazilian literature on the idea of race, see Artur Ramos, O negro na civilização brasileira (Rio de Janeiro: Casa de Estudante no Brasil, 1956); José Honório Rodrigues, Brazil and Africa (Berkeley: Univ. of California Press, 1965); Sílvio Romero, História da literatura brasileira (Rio de Janeiro: Garnier, 1888); Celia Maria Marinho de Azevedo, Onda negra, medo branco: o negro imaginario das elites, século XIX (Rio de Janeiro: Paz e Terra, 1987); Lilia Moritz Schwarcz, O espectáculo das raças: cientistas, instituicões e questâo racial no Brasil 1870-1330 (São Paulo: Companhia das Letras, 1993).
Stepan, “Biological Degeneration,” 98; Skidmore, Black into White, 48-49.
Skidmore, Black into White, 49.
See Robert J. C. Young, Colonial Desire: Hybridity in Theory, Culture, and Race (London: Routledge, 1995), 11.
Todd L. Savitt, Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia (Urbana: Univ. of Illinois Press, 1978), 8; idem, “Black Health on the Plantation: Master, Slaves, and Physician,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, 2d ed. rev., ed. Judith Walzer Leavitt and Ronald L. Numbers (Madison: Univ. of Wisconsin Press, 1985), 315, 318; Curtin, Image of Africa, 84.
Stepan, “Biological Degeneration,” 115.
For background on the intertwining of medicine and racial science in Latin America, see Stepan, Hour of Eugenics, 41-46.
See, e.g., John S. Haller, Jr., “The Physician versus the Negro: Medical and Anthropological Concepts of Race in the Late Nineteenth Century,” Bulletin of the History of Medicine 44 (1970), 154-67; idem, and Robin M. Haller, The Physician and Sexuality in Victorian America (Urbana: Univ. of Illinois Press, 1974), 47-87. Some prominent doctors in colonial Brazil blamed slavery for exacerbating ill health. Goodyear, “Agents of Empire,” 275-77.
Curtin notes that some European observers considered blacks better suited to the tropics because they could throw off poisons (phlogiston) produced in the heat through greater perspiration. “But they paid a price for this physical adjustment... a weaker power of mind plus an extreme tendency to indolence. Therefore, no high civilization had ever occurred, nor was one possible, in any part of the tropical world.” Image of Africa, 67. See also Stepan, “Biological Degeneration,” 99; Todd L. Savitt, “Slave Health and Southern Distinctiveness,” in Disease and Distinctiveness in the American South, ed. Savitt and James Harvey Young (Knoxville: Univ. of Tennessee Press, 1988), 132. See also Mark Harrison, “ ‘The Tender Frame of Man’: Disease, Climate, and Racial Difference in India and the West Indies, 1760-1860,” Bulletin of the History of Meducine 70 (1996), 68-93; Warwick Anderson, “Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900-1920,” ibid., 94-118. Other commentators held that the tropical sun had a degenerative effect on the brain. Haynes, “From the Periphery to the Center,” 76-77.
In 1807, the total population was 51,112, of which 20 percent was mulatto, 52 percent black, and 28 percent white. In 1872, of a total of 108,139, over 44 percent was mulatto, over 18 percent black, and 35 percent white. Kátia M. de Queirós Mattoso, Bahia, século XIX: uma provincia no império (Rio de Janeiro: Nova Fronteira, 1992), 146; Donald Pierson, Negroes in Brazil: A Study of Race Contact in Bahia (Carbondale: Southern Illinois Univ. Press, 1942), 126-30; Thales de Azevedo, Povoamento da Cidade de Salvador (Salvador: Itapua, 1969), 235.
Tiburtino Moreira Prates, “Identidade da espécie humana,” quoted by Freyre, Mansions and Shanties, 398.
The phrase is from Charles E. Rosenberg, “The Bitter Fruit: Heredity, Disease, and Social Thought,” in No Other Gods: On Science and American Social Thought (Baltimore: Johns Hopkins Univ. Press, 1976), 33.
On neo-Lamarckianism, see Peter J. Bowler, The Eclipse of Darwinism: Anti-Darwinian Evolution Theories in the Decades Around 1900 (Baltimore: Johns Hopkins Univ. Press, 1983), 58-117; George W. Stocking, Jr., “Lamarckianism in American Social Science: 1890-1915,” Journal of the History of Ideas 23:2 (Apr.-June 1962), 239-56; Edward J. Pfeifer, “The Genesis of American Neo-Lamarckism,” Isis 56:2 (1965), 156-67.
Silva Lima, “Terceiro Congresso,” 151, 152.
Bowler, Eclipse of Darwinism, 66. Indeed, the Tropicalistas worried about the degeneration that had been allowed to occur in Brazil. Their task was to check and reverse this process.
E.g., Brazil presented a “painful contrast between the grandeur of the external world and the littleness of the internal. . .And the mind, cowed by this unequal struggle, has not only been unable to advance, but without foreign aid, it would undoubtedly have receded.” Henry Thomas Buckle, quoted in Skidmore, Black into White, 28-29. See also Borges, “Puffy, Ugly, Slothful,” 235.
Júlio de Moura, “Apontamentos para servirem de base ao estudo das estações climatéricas brasileiras mas aconselhadas para 0 tractamento da tísica pulmonar,” União Médica 1 (1881), 603-4, 606-7.
Ibid. 2 (1882), 9-10.
For an interesting discussion of the universal-distinctive notion, see Worboys, “Tropical Diseases,” 512-36; Bradley, “Tropical Medicine,” 1393-99.
For an older, related idea, see Curtins discussion of “phlogiston,” Image of Africa, 66-67. Pacífico Pereira was guided by recent studies on temperature control in the body, such as those of Max von Pettenkofer (1818-1901), Carl Frederick Wilhelm Ludwig (1816-1895), Ernst Felix Immanuel Hoppe-Seyler (1825-1895), and Carl von Voit (1831-1908).
A. P. Pereira, “Estudo sobre a etiologia e natureza de beriberi,” GMB 12 (1881), 533-36.
A. P. Pereira, “Higiene das escolas,” GMB 10 (1878), esp. 246. Freyre mistakenly attributes the article to Antônio’s brother, Victorino. Order and Progress, 126, n. 1.
A. P, Pereira, “Hygiene das escolas,” 193-94.
Braz H. Amaral, “A gymnasia nas escolas,” GMB 21 (1889), 157-58.
Creoles here refers to the children of Africans born in Brazil.
Ainhum was “a disease peculiar to the African race” because it was contracted in Africa and brought over in the slave trade. After the trade ended in 1850, the disorder began to die out, so that by the 1880s he saw very few cases. José Francisco de Silva Lima, “Um caso excepcional de ainhum,” GMB 15 (1884), 469. Going barefoot exacerbated the ailment because, in the last stages, the small toe would drop off, usually as the result of “accidental injury or gangrene.” Idem, “Estudo sobre o ‘Ainhum,’ moléstia ainda não descrita, peculiar à raça etiópica e afetando os dedos mínimo dos pes,” GMB 1 (1867), 146-51, 172-76; idem, “Noticia sobre o ainhum,” ibid. 12 (1881), 341-60. On slaves going barefoot, see Augel, Visitantes, 205; Freyre, Mansions and Shanties, 193.
R. da Cunha, “Caso de tétano traumático,” GMB 7 (1872), 35-40. For a discussion of the various ailments probably included under the umbrella of tétano traumático, also known as the mal de sete dias, see Mary C. Karasch, Slave Life in Rio de Janeiro, 1808-1850 (Princeton: Princeton Univ. Press, 1987), 153-54; Santos Filho, História gerat, 2:239-40.
Otto H. Wucherer, “A chamada geophagia ou chlorose tropical, ou antes chlorose (oriunda) de malária, considerada como moléstia de todos os climas,” GMB 2 (1867), 30-33, 40-43.
Hirsch, Handhook of Geographical and Historical Pathology, 1:344-46.
Savitt, Medicine and Slavery, 7-8, 47; idem, “Slave Health,” esp. 120-33. For an exploration of the idea of southern medical distinctiveness that does not focus on slave disorders, see John Harley Warner, “The Idea of Medical Distinctiveness: Medical Knowledge and Practice in the Old South,” in Science and Medicine in the Old South, ed. Ronald L. Numbers and Todd L. Savitt (Baton Rouge: Louisiana State Univ. Press, 1989), 179-205.
Curtin, Image of Africa, 66.
Quoted in Freyre, Order and Progress, 185.
José de Patrocinio, 1887, quoted in Skidmore, Black into White, 24. Examples of mulatto professionals other than doctors were the musician Emerico Lobo de Mesquite, the writers Joquím Maria Machado de Assis and Gonçalves Dias, the jurist Tobias Barreto, the archbishop Dom Silveiro Gomes Pimenta, the engineer Andre Pereira Rebouças, and the lawyer Luís Gonzaga de Pinto Gama.
Da Costa, Brazilian Empire, 241-42. Silence is, of course, difficult to document, and da Costa’s sources for her insight are few. On the question of who was black in the Brazilian context, see Carl N. Degler, Neither Black nor White: Slavery and Race Relations in Brazil and the United States (Madison: Univ. of Wisconsin Press, 1986), 93-138; Skidmore, “Racial Ideas,” 9. For a useful discussion about perceptions of race and color, see Winthrop R. Wright, Café con Leche: Race, Class, and National Image in Venezuela (Austin: Univ. of Texas Press, 1993), 1-10.
Braz H. Amaral, from the commencement speech to the Class of 1886, Bahian School of Medicine, quoted in GMB 18 (1886), 315-27.
Theodoro Sampaio, “Discurso,” Revista do Instituto Geográfico e Histórico da Bahia 18-20:37, 38, 39 (1911-13), 132
Brazil was not alone in this heightened national concern. See, e.g., Benedict Anderson, Imagined Communities: Reflections on the Origin and Spread of Nationalism, rev. and extd. ed. (London: Verso, 1991); E. J. Hobsbawm, Nations and Nationalism Since 1780: Programme, Myth, Reality (Cambridge: Cambridge Univ. Press, 1990). For more local reasons for the increased interest in foreign models as solutions to Brazilian problems, see Skidmore, “Racial Ideas,” 10-11.
Raimundo Nina Rodrigues, “Memória histórica sobre o ano letivo de 1896,” GMB, Edição especial comemorativo da inauguração do novo período da faculdade da medicina da Universidade Federal da Bahia (Oct. 1976), 14.
Nina Rodrigues’ publications relating to race include O animismo fetichista dos negros bahianos, 1896 (São Paulo: Nacional, 1935); As raças humanas e a responsabilidade penal no Brasil, 1894 (Salvador: Livraria Progresso, 1957); and the posthumous Os africanos no Brasil, 1932 (3d ed., São Paulo: Nacional, 1945). Lamartine de Andrade Lima states that Nina Rodrigues was a Sephardic Jew. Roteiro de Nina Rodrigues, Ensaios/Pesquisas 2, pamphlet (Salvador: Centros de Estudos Afro-Orientais, Universidade Federal da Bahia, Apr. 1980).
Andrade Lima, “Roteiro de Nina Rodrigues,” 2.
”Sociedade de Medicina da Bahia,” GMB 21 (1889), 45-46; “Terceiro Congresso Brasileiro de Medicina e Cirurgia,” ibid., 146.
Nina Rodrigues’ early writings include “Um caso de surdez verbal com parafasia,” GMB 20 (1889), 551-55; “O beriberi e as polinevritis: diagnóstico diferencial,” ibid. 21 (1890), 550-56, 22 (1890), 9-14, 66-72, 108-13, 150-54, 164-68, 211-18.
Quoted by Coni, Escola tropicalista, 76.
Raimundo Nina Rodrigues, “Contribução para o estudo da lepra na provincia do Maranhão,” GMB 20 (1888), 105-13, 205-11, 301-14,358-68,404-9, 21 (1889), 121-32, 225-34, 255-65, 21 (1890), 445-55; “Os mestiços brasileiros,” ibid. 21 (1890), 401-7, 497-503.
Ackerknecht, History and Geography, 110.
The Tropicalistas carried out several major studies on leprosy at this time. See, e.g., A. P. Pereira, “Contágio da lepra. Investigações histológicas e bacteriológicas que demonstran sua natureza parasitária,” GMB 19 (1888), 527-41, 20 (1888), 1-10, 51-60, 99-104, 149-56, 245-53. J. L. Magalhães, who was not a Tropicalista although he published in their journal, also studied the disease. “A morféa no Brasil especialmente na província de São Paulo,” ibid. 15 (1884), 358-65, 497-506, 557-69.
Nina Rodrigues, “Contribução para o estudo da lepra,” 313-14. For Lombroso’s concept of atavism, see Gould, Mismeasure of Man, 122-45, On the introduction of Darwin’s ideas in Brazil, see Peard, “Tropicalista School,” 332-36; Therezinha Alves Ferreira Collichio, Miranda Azevedo e darwinismo no Brasil (Belo Horizonte: Itatiaia, 1988); Afranio Coutinho, An Introduction to Literature in Brazil, trans. Gregory Rabassa (New York: Columbia Univ. Press, 1969), 163-69; Roque Spencer Maciel de Barros, A lllustração hrasileira e a idea de universidade (São Paulo: Univ. de São Paulo, 1959).
Nina Rodrigues, “Contribução para o estudo da lepra,” 404-9.
Nina Rodrigues quoted the French professor Charles Jacques Bouchard in support of this. Ibid., 359.
Two exceptions, he noted, were the work of Erico Coelho on puerperal fever in black women and that of Justo Jansen Ferreira, his own colleague at the Rio de Janeiro school, who had written a dissertation on “Labor and Its Consequences in the Black Species.” Nina Rodrigues, “Contribução para o estudo da lepra,” 360. Others who touched on the topic were Teixera Brandão, “Influencia das raças sobre a alienação mental,” GMB 19 (1888), 571; José Cardoso Moura Brazil, “Estudo do campo visial nas raças diversas do Brasil,” ibid., 572.
Nina Rodrigues, “Os mestiços brasileiros,” 405; “Contribução para o estudo da lepra,” 107.
Idem, “Contribução para o estudo da lepra,” 365.
Idem, “Os mestiços brasileiros,” 497-503. His categories were branco, negro, mulatto, mameluco, caboclo, cafuso, and pardo. For a discussion of the theory of racial types, see Young, Colonial Desire, 13-15.
Nina Rodrigues, As raças humanas, 3d ed. (São Paulo: Nacional, 1938), 215-17. See also Skidmore, Black into White, 59; Dain Borges, “Medical Ideas, Class, and Race in Brazil, 1830-1930” (Paper presented to the Latin American Studies Association, Albuquerque, Apr. 1985), 13-
Nina Rodrigues, Os africanos no Brasil, 20.
Ibid., 25, n. 4.
Andrade Lima, “Roteiro de Nina Rodrigues,” 5; Skidmore, Black into White, 58.
See Nina Rodrigues, “Memória histórica,” 7-30.
See Roger Bastide, The African Religions of Brazil: Toward a Sociology of the Interpenetration of Civilizations, trans. Helen Sebba (Baltimore: Johns Hopkins Univ. Press, 1978); Edison Carneiro, Candomblés de Bahia (Rio de Janeiro: Grupo Coquetel, n.d.). See also the case of eugenics in Brazil in Nancy Leys Stepan, “Eugenesia, genética y salud pública: el movimiento eugenésico brasileño y mundial,” Quipu 2:3 (Sept.-Dec. 1985), 351-84; idem, Hour of Eugenics, 44-54.
Quoted by Michael Worboys, “Science and British Colonial Imperialism, 1895-1940” (Ph.D. diss., Univ. of Sussex, 1979), 94.
Stepan deals with the reasons for Cruz’s success in Beginnings of Brazilian Science, 105-28.