Abstract

In this article, conflicts involving pharmacists and doctors are presented, especially those linked to the Inspectorate of Sanitation, in the city of Salvador in the last decade of the 19^th century, a topic that has not yet been addressed by the historiography. We seek to discuss how the regulation created during the imperial government to control healing practices in general and the work of pharmacists in particular, ended up limiting the work of the latter. Considering the regulations imposed on them by the health authorities to be unfair, for restricting their performance while favoring charlatans, several pharmacists fought to acquire autonomy in the face of what they considered the authoritarianism of doctors. Such conflicts reveal how much the establishment of medical science as hegemonic in the country was a turbulent process even between these supposedly allied professions. The beginning of the Republic, a context permeated by debates and transformations that occurred with the fall of the monarchy, the abolition of slavery and the initial difficulties for the establishment of power, was strongly marked by the presence of doctors, who worked together with military and judiciary to impose a new social organization. This medical presence was visible in the strong influence of racialized thinking that characterized public policies.

Key words:
Pharmacy; Salvador; Bahia; Health regulations; Sanitation

Introduction

Throughout the second half of the 19^th century, diverse healing practices coexisted with formal medicine in Brazilian towns and cities. Healers, witchdoctors, beatas, midwives, bleeders, apothecaries and numerous other actors without formal training were found together with scientific doctors in competition for treatments and for the attention of patients. The doctors, however, reacted to this situation. Some groups, associated with the faculty of medicine, fought arduously to improve the conditions for educational institutions and their practices, as well as seeking greater prestige and influence with government authorities and greater ability to combat the competition. In 1850, the Public Health Board was founded - transformed into the General Health Inspectorate in 1886 - with the aim, amongst other activities, of controlling epidemics and limiting the presence of forms of healing unregulated by medical faculties. However, even after they achieved more space with the political powers that be, the unofficial healing arts remained abundant and frequently enjoyed the trust of patients. Simultaneously, it was very difficult to implement the measures indicated by doctors in the Public Health Regulations²2 Sampaio GR. Nas trincheiras da cura: as diferentes medicinas no Rio de Janeiro imperial. Campinas: Editora da Unicamp; 2001..

The City of Bahia, as Salvador was known in the 19^th century, was no different. Despite having the oldest faculty of medicine in Brazil, whose nationally and internationally recognized professors actively participated in the political and social life of the city and country, the streets of the city center and outer suburbs were full of religious leaders who also treated the infirmities and maladies of the body and mind of their faithful. Fathers and mothers of the saint from religions of African origin were respected and loyally followed by mostly black workers, but also white ladies, businessmen, and individuals from politics and the police. However, simultaneously, they were combatted and denounced in newspaper articles and persecuted by the authorities and the police³3 Sampaio G, Albuquerque W. De que lado você samba: raça, política e ciência na Bahia do pós-abolição. Campinas: Editora da Unicamp; 2021.

4 Castillo LE, Parés LN. Marcelina da Silva e seu mundo: novos dados para uma historiografia do candomblé ketu. Afro-Ásia 2007; 36(2007):111-151.

5 Luhning A. Acabe com esse santo, Pedrito vem aí'. Mito e realidade da perseguição policial ao candomblé baiano entre 1920 e 1942". Revista USP 1995/1996; (28):194-220.

6 Pereira FLJ. Modernizar as cidades, civilizar os costumes: repressão a espíritas e candomblés na Bahia republicana (1920-1940) [dissertação]. Bahia: PPGH/UFBA; 2020.^-77 Parés LN. A formação do candomblé: história e ritual da nação jeje na Bahia. Campinas: Editora da Unicamp; 2020..

There were also practitioners of healing arts who declared themselves scientific, although they did not have a diploma from one of the faculties of medicine: “spiritists”, mediums, homeopaths and hydropaths, amongst others. Generally, they were white, educated men who presented themselves to the public with promises of cures for ailments, aches, illnesses and misfortune. During a period of innovation and belief in the promise of science, placing of hands was popular, as well as appeals to the supernatural⁸8 Rocha RR. Curas maravilhosas: curadores itinerantes no Brasil Republicano (1898-1905) [tese]. Salvador: Programa de Pós-Graduação em História da Universidade Federal da Bahia; 2020.. Academic doctors researched this mysterious world that so many of them were fascinated by. This was the case of Virgílio Damásio, an important republican leader, who wrote about electricity and its effects on diseases⁹9 Dicionário Histórico Biográfico da Primeira República (1889-1930). Virgílio Damásio. Rio de Janeiro: FGV/CPDOC, 2015. [acessado 2022 jan 14]. Disponível em: https://cpdoc.fgv.br/dicionario-primeira-republica; or the renowned psychiatrist Juliano Moreira who investigated, together with colleagues such as Alfredo Britto and Nina Rodrigues, trance, frequently applying hypnosis to try to discover the origins of this psychological phenomenon beyond religious explanations¹⁰10 Rodrigues N. O animismo fetichista dos negros baianos. Rio de Janeiro: Fundação Biblioteca Nacional; Ed. UFRJ; 2006.. The latter doctor also became famous for his studies of candomblé of nagô origin, including of the healing performed by its leaders - many of whom he admired, despite his assumed racism and ethnocentrism. Some years later, the doctor Adolfo Rabello Leite, also a pharmacist, presented his doctoral dissertation at the Bahian Faculty of Medicine considering the relationship between matter and spiritual phenomena¹¹11 Leite AR. Relação entre a matéria e os fenômenos espíritas [tese]. Bahia: Universidade Federal da Bahia; 1905.^,1212 Isaia AC. Bezerra de Menezes e Gonc¸alves de Magalha~es: muito ale´m do ce´rebro. Tentativas de enfrentamento ao materialismo cienti´fico do se´culo XIX. Revista Brasileira de Histo´ria 2020; 40(84):267-288..

The significant presence and force of these diverse healing practitioners, many of them connected to specific belief systems, but indiscriminately referred to as criminals and charlatans by the majority of academic doctors, created a veritable “anticharlatanism crusade” in the final decades of the 19^th century, intensifying at the start of the republican period. The establishment of the Public Health Inspectorate in 1886, institutionalized the persecution of unregistered medications even further. Its responsibilities included: Monitoring the practice of medicine and pharmacy, the study of epidemics, epizootics and common diseases, the study and provision of vaccines, health assistance, providing sanitation workers, and organizing of demographic-health statistics. It also sought to promote the organization and improvement of the Brazilian Pharmaceutical Code¹³13 Inspetoria de Higiene Pública. Dicionário da Administração Pública Brasileira/ Período Imperial/MAPA/AN. Inspetoria de Higiene Pública. [acessado 2022 jan 15]. Disponível em: http://mapa.an.gov.br/index.php/dicionario/administracao-imperial
http://mapa.an.gov.br/index.php/dicionar...

This represented a significant change in the way medications were produced, regulated and sold in Brazil. Further, it had a huge impact on the day-to-day practices of pharmacists who freely carried out their trade in diverse locations throughout Brazil. Frequently, they even adopted the title of doctor and counted on the support of patients from all walks of life, as well as from municipal authorities such as mayors and city councilors. In this article, I will present certain conflicts involving pharmacists and doctors, especially those connected with the Health Inspectorate, in the city of Salvador in the last decade of the 19^th century, a subject little investigated to date in the historiography¹⁴14 Pimenta TS, Costa EA. O exercício farmacêutico na Bahia da segunda metade do século XIX. História, Ciências, Saúde -Manguinhos 2008; .15(4):1013-1023.

15 Velloso VP. Assistência farmacêutica: discursos e práticas na capital do Império do Brasil (1850-1880). Varia História 2010; 26: 373-394.^-1616 Velloso V. Farmácia na Corte imperial (1851-1887): práticas e saberes[tese]. Rio de Janeiro: Casa de Oswaldo Cruz; 2007.. In the context of the sweeping changes taking place at the end of empire, with the definitive abolition of slavery and the start of the republic, the presence of doctors acting together with the military and judiciary at the start of the new government had an even greater significance. It showed the strong influence of racialized thinking that characterized public policy, and the exclusionary and authoritarian organization of society.

Conflicts: pharmacy or apothecary?

In October 1889, the following declaration appeared in the Gazeta Médica da Bahia:

This text was published in October 1889 in the principal medical journal of Bahia, near the end of the empire, one month prior to the coup that implanted a republic in Brazil. With the title “Professional concerns”, the article looks at the appeals filed by two important pharmacists in Salvador, Euclides Emílio Pires Caldas and Manoel Hermelino Ribeiro, over “a year and a half ago”¹⁸18 "Euclides Emílio Pires Caldas" e "Manoel Hermelino Ribeiro" in Almanack Administrativo, Mercantil e Industrial da Bahia; 18 diez. del Corral FS, Souza MLA, Negrão OL. Do boticário ao farmacêutico: o ensino de farmácia na Bahia de 1815 a 1949. Salvador: EDUFBA; 2009.. They had requested a review by the provincial president of a decision by the Health Inspectorate of Bahia that they considered extremely unfair: the requirement that the pharmacists present, within 24 hours, a license to be able to maintain their well-established pharmacies in operation.

Already at the outset, the text states that despite the delay, the province had accepted the appeals in favor of the pharmacists, guaranteeing compensation for the error, as well as protection for all professionals from future questionable decisions by the Inspectorate. The author effusively praises his “eminent colleague, Councilor Almeida Couto”, then president of the province, who with his “just nature” had managed to “close the door” on future cases of a similar type that could arise due to the “erroneous interpretation of health regulations”, which the Inspectorate tended to make due to its notorious “lethargy and negligence”. Despite recognizing the importance of the supervision carried out by the agency, controlling the “unauthorized practice of pharmacy”, he affirmed that such errors were extremely bothersome to professional pharmacists, who had the “significant responsibility” of exercising their profession.

The immediate context underlying the dispute was the demand for the licenses at such short notice, together with other requirements that had been imposed on pharmacists over the years. The government had already created mechanisms to supervise the apothecaries and drug stores via the 1850 health decree, with the justification of improving the sanitation “of the capital and other settlements of the Empire”. This was done through visits by members of the Central Health Committee, which had the authority to fine and even close establishments that sold medications¹⁹19 Brasil. Decreto nº 598, De 14 de setembro de 1850. Coleção de Leis do Império do Brasil - 1850, p. 299. V.1 pt. I (Publicação Original). [acessado 2022 jan 20]. Disponível em: https://www.camara.leg.br/legislacao
https://www.camara.leg.br/legislacao... . The 1886 regulation, on the other hand, which had established the General Health Inspectorate, was more detailed, and quite specific in terms of regulations and monitoring of pharmaceutical enterprises, stipulating amongst other attributions, the registration of all pharmacists with the Inspectorate of their respective provinces, with the presentation of their titles. The “simultaneous practice of medicine and pharmacy” was also “expressly forbidden” even in cases where the doctor also had a pharmacy diploma - something that was fairly common during the Empire. Dr. Silva Lima for example, a renowned Bahian doctor, active in numerous medical societies, including the National Academy of Medicine, advertised both his clinic and pharmacy in the newspapers²⁰20 Edler FC. A Escola Tropicalista Baiana: um mito de origem da medicina tropical no Brasil. História, Ciências, Saúde-Manguinhos 2002; 9(2):527-568.. With the 1886 regulation, the association between “doctor and pharmacist to exploit the pharmaceutical trade” was prohibited. There was only one exception: in case the doctor worked in places where no pharmacy could be found, he could provide the necessary medications for the treatment of the patients, as long as they resided within three kilometers, at least, from the nearest pharmacy, and if the administration of the medication was urgent; without it being possible under any circumstance to have the right to operate a pharmacy for the general public²¹21 Brasil. Decreto nº 9.554, de 3 de fevereiro de 1886. Coleção de Leis do Império do Brasil, 1886; v.1. p. 57. [acessado 2022 jan 20]. Disponível em: https://www.camara.leg.br/legislacao
https://www.camara.leg.br/legislacao... .

In the article published in the Gazeta Médica, a number of these points were mentioned. The author affirms that all pharmacists had to “obtain new licenses” to achieve the authorization to maintain their pharmacies in operation. Even if they already had licenses, they were obliged to obtain new ones, “under the unbelievable pretext of having to update their respective registrations”, affirmed the author of the Gazeta article. Some of them conceded and “fulfilled this formality, which seemed to everyone of utmost singularity”, stated the author of the text, showing that already in 1886, there was disquiet within the pharmaceutical community regarding the regulation. However, the final straw came in 1887, when the Inspectorate had “lost its friendly demeanor”, and adopting an “authoritarian manner”, addressed itself to the pharmacists “in an imperious tone through a public notice determining a 30-day deadline to present their licenses”.

For the pharmacists, many of these requirements were unjust, and it was inevitable that they generate resistance and criticism, although some resigned themselves and accepted the new requirements. On the other hand, the regulation included certain “guarantees and privileges” that benefitted “opportunistic laypeople”, who brazenly usurped the rights of serious professionals - leading to vehement opposition by many pharmacists in the press at different times.

The author refers here to the controversy surrounding the question of secret medications, which led to many disputes amongst health care professionals. He also highlights the huge list of substances that pharmacists were required to have on hand starting from 1886, based on the “well-known and unforgettable medication, instrument and labelling tables” that had become mandatory for all pharmacies, as a necessary condition for operating. From the point of view of the pharmacists, it was impossible for anyone to have all those substances readily available, due both to their exaggerated number and high price, which favored stores that operated without a license. According to the 1886 regulations, some “practitioners” could manage pharmacies in determined locations, if there was no “trained professional” available. However, with the difficulties imposed on responsible pharmacies, the understanding of the pharmacists was that many of them would cease to function, leaving the market open to such “lay opportunists”. Without the requirement to have such substances to hand, the stores that sold medications, unlicensed apothecaries, or even the unlicensed pharmacies (since many of them did not have licenses, but remained operating), ended up freely selling the most varied medications. These included those without approval from the Health Inspectorate, which were advertised daily in the newspapers - so called “secret medications”, so designated due to their formula not being publicly available. Given that they were “secret”, they could not be sold by registered pharmacies, and ended up being sold by untrained professionals or by establishments not registered with the Inspectorate. It was the case for example of the “Anti-Beberic Elixir and liniment”, from the “pharmacist Floriano Serpa”, or of “Quinoidine Duriez”, a secret French medicine prescribed for fevers, migraines and neuralgia, that was sold at the store of Galdino Fernandez da Silva, or even of the “infallible medicine” against erysipelas, smallpox and rheumatism, amongst many others that frequently appear in the newspapers (Figure 1).

The provincial government was generally in favor of the recommendations of the health agencies. After all, they were doctors coming from the same group, active in the faculty of medicine of Bahia, with clear common interests despite their internal disputes. For those representatives involved in public agencies, it was an attempt to improve the conditions for the faculty of medicine, and at the same time, to control and eradicate the wrongdoing of so called “charlatans”, who had managed to gain prestige with individuals from diverse social classes. Therefore, the restrictions were ever greater with each new regulation from the Public Health Body, especially following epidemics during which serious threats to the lives of urban citizens arose, as well as for the functioning of trade and port movement, so essential to the economy of Bahia.

However, in terms of the regulation of medications and the role of pharmacists, there was a significant impediment. Combatting the so-called swindlers, opportunists and charlatans, amongst the various labels that professionals trained in faculties attributed to their competition, was much more direct when dealing with African healers, or healers who appealed to the supernatural. Any healing activity by professionals not trained at a faculty of medicine of the empire or without a diploma validated by those institutions, was prohibited according to the public health regulations. In the case of those who produced medications, or worse still, those who sold them, it was much more difficult to regulate.

The regulation stipulated that acting as a pharmacist without an official diploma was forbidden, but left numerous loopholes such that this could be circumvented. Additionally, limiting the sale of well-known medications, such as those coming from overseas, mainly from France, a global reference for medication production - in the 1886 regulation itself it was determined that pharmacists should adopt the French Pharmacopeia - was nearly impossible. In addition to being important for the medicine and pharmacy practiced in Brazil, France was a significant example for intellectuals, a symbol of civilization and scientific advancement for white, wealthy men from this side of the Atlantic. Undoubtedly, prohibiting the sale of “secret medications” was undesirable for the majority of owners of commercial establishments. Even though the trained pharmacists denied it, in the dispute between “professional pharmacy” in the sense of science and the art of producing medication, and “industrial pharmacy” meaning only the profitable trade, profits prevailed. The industry of miraculous pomades, magnificent syrups and other universal panaceas, such as can be found throughout Brás Cubas and similar stories, grew and multiplied in a country where science, limped along, losing lives to yellow fever, cholera, pustule fevers and bubonic plague; where austere white doctors with brilliant moustaches lost clients to black religious leaders such as the famous father of the saint Joaquim, of Saint Lazarus, who, with his prescriptions and powers, had stopped the arrival to Salvador of a cholera outbreak that had devastated southeast Brazil at the end of the eighteen-eighties²²22 Sampaio G, Albuquerque W. Santo Gonocô e pai ojú. In: Sampaio G, Albuquerque W. De que lado você samba: raça, política e ciência na Bahia do pós-abolição. Campinas: Editora da Unicamp; 2021. Cap.6.

Doctors and politics

The acceptance by the provincial authorities of the requests from pharmacists led to a declaration, in the manifesto published in the medical journal, in support of a well-known doctor - dr. Almeida Couto, then president of the province. Despite not always going against the decisions of the Inspectorate, after all, he was the province president who nominated the local hygiene agents, in that case he placed a limit on the inevitable advance of a still more aggressive public health policy, which made itself felt in the republican context. In October 1889, it was well known that the monarchy was coming to an end. On the 13^th of May 1888, slavery was finally abolished in Brazil, and the wealthy coffee producers and slave owners in general, reiterated their support of the decadent imperial government, riddled with political crises²³23 Grinberg K, Sales R. O Brasil Imperial (v.2). Rio de Janeiro: Civilização Brasileira; 2010..

At the same time, the influence of the doctors in politics was growing, with many of the renowned doctors from the faculty of medicine being avowed republicans. The more successful they were in implementing the various restrictions of the regulation, the more space they gained within the spheres of power. Therefore, it was interesting for the pharmacists to express their support for one of the last bastions of the imperial government amongst these doctors: dr. Almeida Couto. A respected and powerful political leader amongst the Bahian elite, four times lower house member, two times provincial president of Bahia, and once for the province of São Paulo, he was a member of the liberal party and defended the government of D. Pedro II until its final days. During those years of crisis for the empire, he withdrew politically from colleagues of the faculty, such as Virgílio Damásio and Manuel Vitorino Pereira and even his son in law and protégé, Raimundo Nina Rodrigues, who was part of the Bahia Health Inspectorate and continued in that role at the start of the republican government.

In July of that year, the faculty of medicine was readying itself for the arrival of Silvia Jardim, the republican leader who visited Salvador to present talks and argue for a change of government. Almeida Couto however, went elsewhere to receive the Count of d’Eu, husband of Princess Isabel, with official honors, who had also arrived to the city and intended to organize the third reign together with his political allies. Couto ended up being accused of attempting to persuade members of the black guard to attack Jardim. On the day of his arrival, en route to the faculty of medicine, the republican suffered an unpleasant situation while climbing Taboão hill. Stones were thrown at him and he was chased by capoeiras who shouted “death to Silva Jardim, long live the monarchy!” The episode became known as the “Taboão massacre”, and generated significant antipathy between faculty students and professor Almeida Couto, such that they cancelled the invitation already extended to him to be the paranymph of the graduation ceremony that year.

If Almeida Couto’s political positions alienated him from important colleagues at the faculty of medicine, leading him to also withdraw from the group that made up the health inspectorate, in agreeing with the appeals from important pharmacists such as Euclides Emílio Pires Caldas and Manoel Hermelino Ribeiro, he also indicated a notable political position. It ensured the support of the whole pharmaceutical profession via this act, seeking important allies during the final days of the imperial government. As the most important authority of the province and ally of the emperor, Almeida Couto was well aware of the republican threat which hung in the air. Interacting with colleagues from the faculty of medicine, he knew intimately the force of the republicans around him. Maybe for this reason, he sought to oppose a controversial measure from the doctors who worked at the inspectorate at such a critical juncture. The greater the power their adversaries achieved, the stronger they would be in an eventual republican government, which was growing closer with each passing day. Seeking to weaken his political opponents, Almeida Couto also courted the strong popular support that the pharmacists always enjoyed in the Bahia Health agency, due to providing various medications without a prescription, attending the sick in moments of despair and affliction, and frequently, assisting a population that suffered and had difficulty obtaining care from doctors who were both expensive and frequently ineffective in their treatments.

Almeida Couto was a popular politician. A regular at the Saint John Theater, in his youth, he was an important member of the abolitionist society - The Dois de Julho Abolitionist Society. When he died, there was great commotion: the streets of the city center were occupied by citizens from all walks of life, coming together to say goodbye to the old provincial president. It was 1895 and the republic was already arriving, full of doctors. The disputes that occurred between them and his colleagues at the end of the empire did not show a great impact. Soon at the start of the new government, Almeida Couto was elected state senator. In 1893, six years after having sided with the pharmacists mentioned here, he became quartermaster of Salvador. Whether it was a coincidence or not (probably not), his return to politics occurred after his enemies, doctors Virgílio Damásio and Manuel Vitorino left state office, the first governors of Bahia during the republican period. Almeida Couto, first of all, was an important and respected doctor, and the support that he enjoyed with the Bahian populations would have affected his being chosen by the governor Severino Vieira as the most important authority of the state capital.

The Republic of the doctors against the empire of the apothecaries

With the arrival of the republic, it became clear that the doctors were strengthening their position in the political game, while the pharmacists were increasingly on the defensive. Since 1887, when the Inspectorate established more demanding deadlines and requirements for licenses, it became more difficult for pharmacists to carry out their activities and to keep their establishments running, especially those who could not count on powerful friends. On the other hand, the government health agencies that were mainly doctors, such as the General Council of Public Health, of 1892, consisting of Silva Lima, Nina Rodrigues, Antônio Pacífico Pereira, Jacome Baggi, Eduardo Gordilho Costa, Alfredo Alvim, Lidio Mesquita and only one pharmacist (not by chance, the same Euclides Pires Caldas, supported by Almeida Couto, who had strongly allied himself with the doctors, different to the majority of his colleagues), showed that the “pharmacy profession” and medicine, were not “allied professions” as the author of the previously mentioned text published in Gazeta Médica had stated, or at least, not so allied. To the contrary, pharmacists would increasingly be reduced to only providing the medications that doctors prescribed, preparing prescriptions that they had indicated, and never treating patients as they had freely done prior to the existence of the Central Health Board. Or even after the creation of the Board, in numerous locations, when they took care of women in labor, prescribed medications for fevers, and received the diverse patients who sought them out. The doctors felt that it was necessary to impose medical control, so that science could prosper, the country could develop, diseases could be overcome, and its citizens could leave behind the colonial backwardness and the religious and cultural traditions strongly connected to Africa, the origin of the greater part of the Brazilian population.

Throughout the second rule, and even at the end of the empire, there were many pharmacists who did not accept the regulations, pay the taxes, or obtain the licenses. Their complaints and lack of satisfaction were noticeable in the newspapers, protesting against the fines, new taxes and snap inspections. Additionally, the secret medications continued to be very popular with the general public, and were freely advertised. Some important doctors, such as Dr. Silva Lima, a member of the Public Health Council for the state, continued to advertise their pharmacies in the newspapers. The denouncement of “privileges” for some, that appeared in the already mentioned newspaper was possibly due to this. Even so, the pressure from the doctors who worked at the inspectorate to police the pharmacies grew, as their influence at the beginning of the republican period also grew. Nina Rodrigues, a member of the Health Council, and exponent of legalized medicine in Brazil, who argued in favor of scientific racism throughout the country, had recognized the importance of a pharmacist who at times acted as a doctor for those with leprosy years prior, in a study carried out in Maranhão. It was the case of Mr. Theodoro J. D’Abreu Sobrinho, who “with remarkable humanity not only acted as a doctor but also provided medication”²⁴24 Nina Rodrigues R. Contribuição para o estudo da lepra no estado do Maranhão (1888). Gazeta Médica da Bahia 1888; em setembro e novembro de 1888.. In the 1890s, he was implacable with his colleagues in the implementation of new health regulations in Bahia, increasingly restricting the possibilities for action of pharmacists.

The exceptional case that occurred in 1877, when the provincial president sided with the pharmacists against the Inspectorate, was cited by pharmacists in 1893 who requested the right to keep their establishments operating. They took care to only cite Manoel Hermelino Ribeiro, and not Euclides Pires Caldas now a member of the Health Council. The Council, however, did not give in: they continued to deny the request to be able to keep the old license, obtained during the imperial period, and even revoked the licenses of those pharmacists who had laboratories and pharmacies still functioning²⁵25 Parecer aprovado na comissão de 5/02/1893, publicado na Gazeta Médica da Bahia na edição 27, de 1895..

The doctors who worked at the inspectorate continued to gain force at the start of the Republic, stridently defending the federalism instituted by the 1891 Federal Constitution. From this bedrock, the states and municipalities had to decide about questions related to numerous local issues, such as health. When they evaluated requests that were approved in Rio de Janeiro, the council members always affirmed its importance, showing that only licenses and authorizations given by the state would respected.

Over time, the health authorities encountered new problems for implementing health measures. One of these was overlapping legislation, suggested with the Sanitation Code, which created difficulties for punishing crimes defined in the Penal Code, such as charlatanism, of which numerous pharmacists had been accused²⁶26 Batista R, Silva MELN. A atuação de Antônio Luis Cavalcanti de Albuquerque de Barros Barreto na Reforma Sanitária da Bahia (1924-1930). Revista Brasileira de História 2021; 40(84):313-337.^,2727 Santos CA. Medidas sanitárias de que a Bahia precisa': as delegacias de saúde e a reforma sanitária em Salvador (1921-1930)". Revista de História e Estudos Culturais 2021; 18(2):269-299.. The era of defenders of Lombroso such as Nina Rodrigues with his persecution of mestiços healing practices and Pacífico Pereira, the author of long texts against charlatanism, was already in the past. It was an era during which, despite the generalized persecution, there was also much discussion regarding the freedom to practice medicine and the healing arts, undertaken by the first republicans who were adepts of positivism²⁸28 Weber BT. Identidade e corporação médica no sul do Brasil na primeira metade do século XX. Varia História 2010; 26(44):421-435.. What remained, however, was the repression, combatting of difference, and violence, encountering new ways of reinforcing itself, mainly against poor, black workers. The persecution of diverse practitioners of the healing arts assumed new forms, just as new prohibitions emerged²⁹29 Souza JEL. Sonhos da diamba, controles do cotidiano: uma história da criminalização da maconha no Brasil republicano. Salvador: EDUFBA; 2015. 30. Saad L. Fumo de negro: a criminalização da maconha no pós-abolição. Salvador: EDUFBA; 2019., in a process marked by the perpetuation of the racism, authoritarianism and violent public policy continuous throughout the history of our brief republic.

Acknowledgments

To Beatriz Jesus Rocha dos Santos and Anderson Souza Costa, undergraduate students (PIBIC/UFBA), who worked in this research.

References

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