Abstract

INTRODUCTION

The field of health care has undergone countless transformations in the 20 ^th century, when various specialties were instituted. These specialties were almost always taken as specific branches of knowledge that grew broader and deeper at rhythms and in directions which seem to be the result of a natural order of disease and/or health care technologies. At times, they are understood to be a technical division of scientific knowledge and their social, political, economic or corporate-professional motives remain hidden.

This mode of approaching history can be synthesized in the formulation of what Conti ⁴4 . Conti L. Estrutura social y medicina. In: Aloisi M, Berlinguer G, Conti L, Massuco-Costa A, Misiti R, Mondella F, et al. Medicina y Sociedad. Barcelona; 1972. p. 287-310. refers to as a doctors’ view of medicine: changing means but unchanging ends, as if the knowledge or equipment and other technology change over time, but the ultimate aim of medicine, to cure disease, does not change. Critics of the author, in contrast, highlight the mutability of these ends.

Taking Conti ⁴4 . Conti L. Estrutura social y medicina. In: Aloisi M, Berlinguer G, Conti L, Massuco-Costa A, Misiti R, Mondella F, et al. Medicina y Sociedad. Barcelona; 1972. p. 287-310. as reference, the aim of this study was to interpret and understand the historical changes that led to public health having new purposes for its practice and new fields of expertise, as part of the history of medical specialties in São Paulo between 1930 and 1940.

The article examines how the institutionalization of public health became involved with polar eugenic concepts that referred not only to the area of the biologist, such as strengthening the human race using medical and health measures, but also to the ideological notion of racial purity. In this particular involvement with eugenics, the religion of some doctors, represented by the Catholicism of the time, played an important role. If public health was an important State resource in constructing the nation’s prosperity, major scientific-political-ideological and cultural questions were present in its development as a specialty, even as part of the contribution of medicine in constructing the Estado Moderno – Modern State. ⁶6 . Freidson E. Profissão Médica: um estudo de sociologia do conhecimento aplicado. São Paulo: Editora da UNESP; 2008. ^{, 11}11 . Mota A, Schraiber LB. Mudanças corporativas e tecnológicas da medicina paulista, nos anos de 1930. Hist. Cienc Saude-Manguinhos . 2009;16(2):345-60. DOI:10.1590/S0104-59702009000200004.
https://doi.org/10.1590/S0104-5970200900...

Starr ¹⁷17 . Starr P. La transformación social de la Medicina en los Estados Unidos de América. México: Fondo de Cultura Económica; 1991. shows the distinction between the medical profession and other scientific professions due to the complexity of its image and expectations regarding the technological and scientific instruments of their work. This distinction is engendered in a complex field of actions and reactions, sometimes polarizing them against other professionals who “threaten” areas instituted by medicine, sometimes materializing as an “internal” struggle within the profession through confrontations between scientific, practical and political paradigms.

The doctor emerged as an organic intellectual, able to interact on two levels of the social structure: as an intellectual of a specific science and as a producer of symbols related to his profession. Historically, however, he has been circumscribed in an area of rifts, corporate reorganization and political and symbolic dissention. ¹1 . Bourdieu P. A economia das trocas simbólicas. 5. ed. São Paulo: Perspectiva; 2004. For medicine and its institutions, the period of 1930-1940 ushered in an era in which a new political order was at stake, de-structuring the power of the oligarchy and the elite, among them doctors. The reactions of the profession should be understood within this complex context, involving the historicity of the events interlaced with the internal technical and scientific dimensions of the profession itself.

This methodological approach allows us to grasp how doctors determined corporate, scientific and political redefinitions, as agents of medicine characterized by the extent of their intellectual and symbolic capital. Part of this movement resulted in the introduction of related eugenic concepts, considered to be scientifically based, into various discourses in the field of the population’s health. Catholicism occupied a surprising place in health, even having repercussions on the eugenic tenets that would be adopted.

Primary documental sources ⁵5 . Domingues O. Eugenia: seus propósitos, suas bases, seus meios. São Paulo: Companhia Editora Nacional; 1942. ^{, 15}15 . Rossister F. Guia prático de saúde. São Paulo: Casa Publicadora Brasileira; 1932. p.22-23. , ^aaAbreu HT. Os progressos da ciência e da igreja católica. Rio de Janeiro: Imprensa Médica; 1945. p.25-8. , ^bbBourroul C. In: Anais do Primeiro Congresso de Médicos Católicos; 1946; Fortaleza, BR. São Paulo: Indústria Gráfica Siqueira; 1947. p.21. , ^ccFontenelle JP. O trabalho de Saúde Pública no Brasil. 3o Congresso Brasileiro de Higiene; 1926 Nov 4-12; São Paulo, BR. São Paulo: Fiocruz; 1927. , ^ddMoreira R. In: Anais do Primeiro Congresso de Médicos Católicos; 1946; Fortaleza, BR. São Paulo: Indústria Gráfica Siqueira; 1947. p.217. , ^eeBechelli LM, Batista L. O problema da esterilização dos doentes de lepra. São Paulo; 1942. (Boletim de Higiene Mental, 5). , ^ffPacheco e Silva AC. Discurso de abertura. In: Anais do Primeiro Congresso Brasileiro de Eugenia; 1929; Rio de Janeiro, BR. São Paulo: Academia Nacional de Medicina; 1929. p.1-2. , ^ggPaula Souza GH. Os centros de saúde na organização sanitária do Estado de São Paulo. In: 3o Congresso Brasileiro de Hygiene; 1926 Nov 04 a 12, São Paulo, BR. São Paulo; 1927. p.59-86. , ^hhAguiar EC. Os preventórios de São Paulo. Folha da Noite, 1936 5;5:2. were used to analyze the establishment of public health as a specialty. In these sources, we sought traces of the social context of this knowledge and specific actions, the moment in time was also that in which the Brazilian Estado Moderno was constructed.

SPECIALIZED MEDICAL KNOWLEDGE IN HEALTH CARE, EUGENICS AND RELIGIOUS BELIEFS

From 1930 onwards, medicine was reorganized, privately owned surgeries practicing freely. A technological medicine, with increasingly technological based arrangements and with medical care gradually becoming more entrepreneurial, emerged ¹⁶16 . Schraiber LB. O médico e seu trabalho: limites da liberdade. São Paulo: Hucitec; 1993 . resulting in great internal tension within the profession. ¹¹11 . Mota A, Schraiber LB. Mudanças corporativas e tecnológicas da medicina paulista, nos anos de 1930. Hist. Cienc Saude-Manguinhos . 2009;16(2):345-60. DOI:10.1590/S0104-59702009000200004.
https://doi.org/10.1590/S0104-5970200900... In 1922, countless divergences between doctors were demonstrated in the National Practitioners Congress, albeit unified by the effort to exert ever greater control on medical professionals and the veto of the various medical and curative practices then in existence. ¹⁴14 . Pereira Neto AF. Ser médico no Brasil: o presente no passado. Rio de Janeiro: Editora Fiocruz; 2001.

This dispute was apparent in the curricula of the medical faculties: “by proposing the inclusion of this or that discipline in the medical curriculum, different sectors of the profession aimed to create space for their specialty to be recognized and valued”. ¹⁴14 . Pereira Neto AF. Ser médico no Brasil: o presente no passado. Rio de Janeiro: Editora Fiocruz; 2001. The requested actions took on a different tone with regards other occupations that rivalled the medical profession. How to deal with pharmacists, midwives, nurses, healers, spiritualists and their practices? “In each of these arenas, a different type of conflict took place, but with the same basic objective: to limit the field of these practices in order to ensure the sovereignty and authority of the doctor in the health care service market”. ¹⁴14 . Pereira Neto AF. Ser médico no Brasil: o presente no passado. Rio de Janeiro: Editora Fiocruz; 2001.

It was a contest between the diverse practices carried out by the hegemony of scientific and technological medicine, grounded in clinical pathology, which characterizes the Biomedicine system. Although some existing practices had been approached as Biomedicine “specialties” (such as homeopathy, today recognized as another medical system and not a Biomedicine specialty) ⁸8 . Luz MT. Medicina e racionalidades médicas: estudo comparativo da medicina ocidental contemporânea, homeopática, tradicional chinesa e ayurvédica. In:Canesqui AM. Ciências Sociais e Saúde para o Ensino Médico . São Paulo: Hucitec; 2000. p. 181-99. , in the above mentioned congress there were also disputes between schools of thought on treatment within Biomedicine itself.

It is in this context that the “specialty” appeared as the driving force behind policies in research, in clinical and health practice, reorganizing scientific, medical-care and prophylactic and health institutions. The more general type of professional was gradually overtaken by the specialist, more technical and specific, as a professional able to provide medical care in urban and rural centers and with new forms of social production in the health care area.

In Sao Paulo, the area of public health was institutionalized at the end of the 19 ^th century, but the transformations of the first decade of the 20 ^th century, be they on an urban level or new policies aimed at the interior of the state, led to the doctor Geraldo de Paula Souza becoming the director of the Health service in 1922, with the aim of establishing a public health model as proposed by the Rockefeller Foundation:

Paula Souza changed the prevailing technical-care model, valued the formation of a single general administratively decentralized and regionalized outpatient network and proposed a new type of service: the Health Center. ⁹9 . Mendes-Gonçalves RB. Tecnologia e organização social das práticas de saúde: características tecnológicas do processo de trabalho na Rede Estadual dos Centros de Saúde de São Paulo. São Paulo: Hucitec; 1994. Measures such as training health care educators and professionals specializing in hygiene and controlling parasites, local endemic disease and infant mortality were decisive to the further development of health and hygiene. ¹³13 . Mott ML, Byington MEB, Alves OSF. O gesto que salva: Pérola Byington e a Cruzada Pró-infância. São Paulo: Grifo Projetos Históricos e Editoriais; 2005. In the Third Brazilian Hygiene Congress, in 1926, Paula Sousa stated that the following aspects of public health were the State’s obligation:

If these measures in the field of health should have been put into practice, the absence of the “health doctor” as a key worker in the area and “specialized professional” was resented. From that moment, public health came to be conceived as a medical specialty, albeit in the hands of others. The public health specialty would be gradually and slowly established, making room for other branches of medicine to treat health education as part of their knowledge and actions. In the words of Paula Souza:

Constructing a “new nationality” and a “true Brazilian”, a central issue in establishing sanitarism as a specialty, can also be found in the interpretation of thinkers and social scientists. It involved different fields of knowledge and fed the racial and eugenic debate, which so strongly marked this period of history, in order to answer the question: who are we?

The discursive poles in the sociological and historical field had some aspects particular to Sao Paulo by defending a white and racially superior ‘paulista’ – citizen of Sao Paulo. Those of African descent, considered “inferior”, would be absent from the original formation of the paulista population, in the same way as some immigrants, considered “degenerate and invasive scum” would be restricted by the whitening and eugenic paulista project. Such discourse would be incorporated into the health thinking of the period.

During the 1 ^st Eugenics conference, held during the centenary celebrations of the Academia Nacional de Medicina , in Rio de Janeiro between July 1 and July 7, 1929, the doctor and psychiatrist Antonio Carlos Pacheco e Silva from Sao Paulo made a speech in which the basis of eugenics were treated as a paulista effort.

In his opinion, Sao Paulo concerned itself with improving the Brazilian race, stating “with the real pride of a paulista ”, that the first eugenic society had been founded in that state, it being

From a health point of view, by incorporating eugenics as a medical term, strategies were demarcated in the search for the ideal human, recognized in their individuality to be modified. It was said that not all had the same chance of rising above their state, which was deemed morbid and degenerate. Understood as a scientific technology, environmental eugenics, as well as the measures that aimed to restrict individuals, required long debates and ended in major subdivisions.

From obstetrics to surgery, from health practices to experience established by psychiatrists, all incorporated eugenics, albeit interpreted in diverse and even conflicting forms. This clash between “eugenics” had political, philosophical, religious and scientific ramifications, converging on two central aspects: those who understood that environmental actions were capable of equating to the production of a “good man” (positive or environmental eugenics, the public health definition) and those who regarded heredity and restriction as the only way to racial improvement (negative or restrictive eugenics). This scientific field is undermined by various readings and actions, which sought, in myths of origin and modernizing innovations, to bring to light human racial superiority.

Stepan ¹⁸18 . Stepan N. A hora da eugenia: raça, gênero e nação na América Latina. Rio de Janeiro: Editora da Fiocruz; 2005. produced a pioneering thesis on eugenics in Latin America and highlighted national peculiarities. It refuted the predominant view in the US and Europe that the case of Latin America would be a mere copy and showed how a neo-Lamarckian vision of eugenics was the cornerstone in the specific application of this debate. France was the hub from which the most commonly adopted version of eugenics radiated, leading to health and preventative actions being the ideal choice in shaping the population ¹⁸18 . Stepan N. A hora da eugenia: raça, gênero e nação na América Latina. Rio de Janeiro: Editora da Fiocruz; 2005. (p. 14).

For this type of eugenics, based on factors influenced by sanitarism ³3 . Castro Santos LA. Poder, ideologias e saúde no Brasil da Primeira República: ensaios de sociologia histórica. In: Hochman G, Armus D, organizadores. Cuidar, controlar, curar: ensaios históricos sobre a saúde e doença na América latina e Caribe. Rio de Janeiro: Editora da Fiocruz; 2004. and by hygienist propaganda, ¹²12 . Mota A. Quem é bom já nasce feito: sanitarismo e eugenia no Brasil. Rio de Janeiro: DP&A; 2003. such actions can intervene in individuals’ physical and mental development. This discourse gained a privileged space in Education and Law. In public health, it was of fundamental importance in childhood health care and child care. It came to occupy a special place on the medical agenda, merging children’s health care with heredity and, thus, with national destiny itself. This focus on childhood also had repercussions on obstetrics, with infantilism colonizing the construction of maternal health care, one of the historical roots of later reproductive health, centered on pre-natal hygiene, aimed at women seen primarily in their role as mothers. ¹⁰10 . Mota A, Schraiber LB. Infância e saúde: perspectivas históricas. São Paulo: Hucitec; 2009.

Eugenic feuds found a Catholic presence involved in the business of the medical profession, especially at the moment in which sanitarism occupied a privileged position in the State’s health care policies. Translated through its normalizing habits and customs, as well as its preventative character and its eugenic stamp, this profile made room for many Catholic tenets to be discussed before the actions of the doctors. After lengthy disputes, specialization became increasingly more corporate and sanitarism gained increasing state power. Catholicism approached this debate, placing special importance on those that touched on issues deemed to be within its sphere of action, above all those that involved the family.

The commitment to introduce the dogmatic bases of the religion into medical specialties gained force within the profession. Human understanding of disease and death, so exercised in 19 ^th century medical reports, created the effect of reality in tales of suffering and invited reparative actions. Humanitarianism, even as narrated in the glacial language of medical science, ⁷7 . Laqueur TW. Corpos, detalhes e a narrativa humanitária In: Hunt L. A nova história cultural. São Paulo: Martins Fontes; 2001. p.239-78. gained new elevation in descriptions with a Christian slant.

Medical clergymen represented the Church within the profession even in this period of specialization. However, it was the lay doctors who were responsible for divulging its precepts as “Science”, recommending ways of “living well” based on hygienist (sanitarist) and “spiritually elevated” attitudes.

Scientific conquests need no longer be a cause of worry to Catholicism, as:

BETWEEN THE HEALTH OF THE SOUL AND THE ILLS OF THE BODY: EUGENICISTS IN CONFLICT

The relationship between Catholic thinking and eugenic sanitarism came to be based on the concept of the human body as a mold created by divine will and on belief in the value of healthy but, above all, spiritual, families:

“Family health” and its heritability were conceptualized as follows, in the words of the doctor Celestino Bourroul, from Sao Paulo, Chair of Tropical Medicine in the Faculty of Medicine, Universidade de São Paulo :

Environmental eugenics was taken as a health and hygiene tool, able to build a “new humanity” and a “new flock”. This would be its motto. Defending “one type” of eugenics was a way for Catholicism to take part in the debate, defending its prerogatives at the same time as it attacked the opposing camp, i.e., postulations advocating birth control through compulsory sterilization. This issue would involve part of health thinking.

Family would become a concern of restrictive eugenics, in the sense of guaranteeing good offspring for the nation, but with one important difference: restrictions to matrimony and, if possible, sterilization of those deemed to be degenerates. This more individualizing view, distancing itself from what would come to be public health with its collective perspective, provoked reactions from the defenders of eugenic sanitarism, especially with a Catholic bias. This occurred as it touched on an area that the Church defended as its own and had family health and breeding as its central axes.

The clash between areas of medical-eugenic rationality and medical-Catholicism in Sao Paulo were examples of the tension that enveloped the eugenic project for shaping the Brazilian race. Antonio Carlos Pacheco e Silva, an ardent defender of restrictive and compulsory eugenic methods, including sterilization, gave evidence of the dispute surrounding that issue in his speech to the Constituent Assembly of 1934. In his opinion, the Church could not be opposed to restrictive eugenics, as sterilizing individuals was something that had occurred in the past. He recalled Matthew’s Gospel, chapter XIX, verse 12, which says:

Going still further, he gave the primacy in castrations to the Catholic Church, stating that “Pope Benedict XIV authorized the eliminations of certain organs from the boys who sang in the Sistine Chapel, enabling them to keep their soprano voices” ^eeBechelli LM, Batista L. O problema da esterilização dos doentes de lepra. São Paulo; 1942. (Boletim de Higiene Mental, 5). (p. 107).

In his book, Eugenia , Octavio Domingues, geneticist and professor in the Escola de Agricultura Luiz de Queiroz , attempted to persuade Catholics with arguments on the theories of genetic improvement and on presenting the best strains of humanity. He claimed to have identified an ideal eugenic type, listing scientific figures and saints as its representatives. According to him, a eugenically shaped man would be:

In response, he received a letter from Alceu da Silveira, a representative of the Catholic Church, which he published in his book. In the letter, Silveira accused him of a false alliance with religion, stressing the Pope’s words on the meaning of life, but, at the end, giving examples of eugenic activities of which Catholicism did not approve, such as pre-nuptial testing, sterilization and birth control:

Those doctors who defended medicine under Catholic precepts denounced the sterilization of so-called “lepers” proposed by the restrictive eugenicists. The paulista journal Viver! published a response in favor of advocates of eugenic sanitarism. The leprosy specialist Enéias de Carvalho Aguiar, who would become the first superintendent of the Hospital das Clínicas , Sao Paulo, in 1944, presented work that proved:

Thus the Asylo de Santa Terezinha and the Preventório de Jacareí asylums collected more than 300 children born to leprosy suffers and kept them separate from their parents from birth. Carvalho Aguiar observes: “To laymen, and even to non-specialist doctors, this assertion seems bold, but what we do is based on experience and on facts” ^hhAguiar EC. Os preventórios de São Paulo. Folha da Noite, 1936 5;5:2. (p. 2).

FINAL CONSIDERATIONS

The quest to understand the outlines that shaped health care practices leads us to positions that were historically presented and defended. Eugenics had ample space for its dissemination in various spheres, mainly involving the medical profession. There was a mixture of discourses from different fields of knowledge: on the issues of eugenics, religious beliefs influenced the way that eugenics was composed together with health and medicine itself.

For medicine and for sanitarism, these other types of knowledge and even nonscientific beliefs offered specific purposes of intervention in the health and disease of the “Brazilian people.” Thus, in a way specific to the socio-historical context of the years 1930-1940, medical practice and health clothed themselves in a specific historicity as regards their objectives such as social practices: the health and healing products to be achieved through their technical and scientific interventions were effectively redefined in the process of building specialties in medicine and public health.

Guided and influenced by factors influenced by sanitarism, eugenics believed that its actions would be capable of intervening in physically and mentally shaping individuals. In the medical field it was based mainly on children’s health care, merging health with heredity and with national destinies themselves. This started a process of incorporating dimensions of normality or pathology into national life and the lives of citizens, extending into various spheres of social construction and, in particular, the family. Catholic doctors were important spokespeople in this process.

The state of Sao Paulo laid claim to the privilege of a superior race already adjusted to new times, able to put Brazil on the track of progress. However, the arrival of migrants and immigrants who disembarked in a systematic and uncontrolled manner brought a new issue: it opened another space for the discourse of restriction of those who might “pollute the race of giants” made, according to the paulista version of their origins, from among the “Indian races “ and “daring Portuguese” when they planted their roots here. But this new issue fell to the following decades, posing a challenge to health control within specialized knowledge.

References

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