Tropical medicine in Brazil
Oswaldo Cruz Foundation – by Simone Petraglia Kropf
In the closing years of the 19th century, Patrick Manson announced that special education on tropical diseases was urgently required; given new knowledge about vector-borne parasites, this was presented as the most effective way of tackling the diseases that afflicted Britain’s colonies. The theme of tropical diseases assumed a political dimension in Brazil too. There was, in this case, no colonial enterprise: Brazil had achieved political independence in 1822 and become a Republic in 1889. Tropical medicine in Brazil was accorded a different political role – it was expected to help the creation of ‘a civilisation in the tropics’.
The dominance of microbiology and theories of vector-based disease transmission had diminished belief in the primacy of climatic and environmental factors as a cause of ill-health. However, the necessity for – and the usefulness of – creating a special discipline of tropical medicine within the faculties of medicine in Brazil was questioned.
During the first decades of the 20th century, the issue divided Brazilian medicine almost down the middle. Some argued that tropical medicine – since it provided new scientific knowledge on the parasitic causes of diseases and about the ways they were transmitted – was the best means of fighting diseases that affected the country, such as yellow fever, malaria and ancylostomiasis. Researchers at the Oswaldo Cruz Institute were in the forefront of this school of thought; indeed, their base was soon to achieve international recognition as a centre for research and education in tropical medicine. The discovery in 1909 by Carlos Chagas, a researcher at the Institute, of the American trypanosomiasis (Chagas’ disease, caused by the protozoan Trypanosoma cruzi and transmitted by a bloodsucking insect popularly known in Brazil as barbeiro) was praised as an emblem of Brazilian competence in the new field of tropical medicine. In 1926, Chagas presented the opening lecture in tropical medicine at the Faculty of Medicine in Rio de Janeiro. Mentioning the work of Europeans involved in fighting tropical diseases in Africa for colonial interests, he emphasised that in Brazil the study of tropical pathology should be committed to the advancement of the nation itself. Chagas argued that the specialism was important not only for keeping step with international advances in medical knowledge, but also as an instrument of sanitary and social reform in the country.
At the same time, tropical medicine had many critics in Brazil. Afrânio Peixoto, the Chair of Hygiene at Rio’s Faculty of Medicine, was a notable example. He argued that tropical medicine reinforced the prejudices associated with climatic determinism and old stereotypes created by Europeans who “defamed” the “torrid” countries as insalubrious lands unsuited to civilisation. Peixoto declared that there were no tropical diseases since there were no climatic diseases; for him, there were only “avoidable diseases” and Brazilian medicine had secure means of combating them.
Both visions shared common ground, in the shape of a belief in the ability of medicine to fight the impact of climate and the spread of diseases, and thereby assist national progress. Differences in attitude were rooted in the conflicts associated with the institutionalisation of medical sciences in Brazil during the first half of the 20th century. On the one hand, tropical medicine proved to be a means of affirming the usefulness of the research institutes such as the Oswaldo Cruz Institute, which were presented as the ‘true’ spaces for experimental and/ or scientific medicine. Ranged in the other camp were those who presented hygiene as a discipline with 19th-century roots within the Faculty of Medicine and argued that this institution was also a space for science, and not merely a space for theoretical teaching. These disputes were expressed further in political struggles to acquire key positions within Brazilian public health structures (Chagas and Peixoto competed for the coveted position of Director of the National Department of Public Health, with Chagas acquiring the post in 1920).
Brazilian tropical medicine was much more than a discipline that was forged and consolidated by developments in the international arena; the specialism developed in very particular ways in the country. Tropical medicine’s advance was, after all, not linked to imperialist goals and ambitions in Brazil. Instead, it benefited from local medical and political impulses, most notably the republican modernisation project that called for wide-ranging sanitary and social reform.
Currently described as ‘diseases of poverty’ or ‘neglected diseases’, tropical diseases – their impact and management – continue to be a rich subject of study not least as they provide rich insights into the complex relations between science, health and society.
Simone Petraglia Kropf is a Researcher and Professor in the Postgraduate Programme in the History of Sciences and Health, Oswaldo Cruz Foundation.