História da saúde no Brasil

Brazil has one of the largest groups of scholars dedicated to the history of medicine and health. They have also organized, thanks to the Oswaldo Cruz Foundation (Fiocruz), a massive institution of social medicine and biology in Rio de Janeiro. In 1986, Fiocruz added a center for the history and memory of science and health, and over the last 30 years, it has grown an impressive graduate program and edited one of Brazil's best journals. Since 2013, more than 250 books have been published in its Health in Debate series. The three editors of História da saúde no Brasil are busy publishing research and leading scholarly activities in Brazil. Their new book demonstrates a wide range and depth of scholarship. We may accept their claim, put forth in the introduction, that this book offers “authors, references, and themes that display the current state of the history of health in Brazil” (p. 12). Let us add that it deserves attention well beyond Brazil.The book is organized into an introduction and 11 chapters written by 24 historians, 17 who affiliate with Fiocruz. Of the rest, nearly all teach at one of Brazil's federal universities, among them the most research-oriented and prestigious in the country. Most chapters are coauthored, again representing a remarkable degree of coordination uncommon among historians. The book moves from the colonial period to our twenty-first century but focuses on events after the empire (from 1889 on). A concentration on contemporary history is typical of Fiocruz-directed publications on health and science. The subjects covered are diverse: disease and cure in the colony (chapter 1), illnesses of slaves (chapter 2), medical training in the nineteenth and twentieth centuries (chapter 3), medical philanthropy (chapter 4), women and children's medicine (chapter 5), the rise of germ theory in biomedical research (chapter 6), the pandemics of influenza (1918) and HIV/AIDS (chapter 7), eugenics in the twentieth century (chapter 8), psychiatric institutions (chapter 9), public health between 1889 and 1945 (chapter 10), and health and sanitary reform from the dictatorship to the democratic era (chapter 11). The book has no conclusion, and a short introduction does less to pull these chapters together than to argue persuasively that the historiography of Brazilian health has been undergoing a renaissance. If the editors had attempted a synthesis, it would have needed to emphasize the influence of the sanitation and hygiene movements, medicalization, and the centralization of health institutions. The most common theoretical framework for the authors is inspired by Michel Foucault and Charles Rosenberg, who are perhaps the most important reference points for the cultural turn in health histories. Cultural history and political history continue to prompt research questions and methods, perhaps surprisingly in the face of a rapidly changing epidemiological reality like the devastation already inflicted on Brazil by the Zika virus and climate change.All the chapters are intended to be useful for their bibliographies and historiographical reviews. This kind of utility can come at the expense of engaging prose for anyone except experts. Several chapters are better able to balance captivating narrative and historiography, including Jaime Larry Benchimol's discussion of Domingos Freire, a scientist believed to have discovered the virus of yellow fever, and Vanderlei Sebastião de Souza and Robert Wegner's survey of Brazilian eugenics. Sometimes when the research of a historical theme like eugenics is published in a book that quickly becomes a classic by a prominent historian (for instance, Nancy Leys Stepan), few dare to follow that book's example. Souza and Wegner convincingly show, however, how little we know about Brazilian eugenics, especially immediately after World War II, when Brazil was better known for its harmonious race relations than for football. I also found Anny Jackeline Torres Silveira and Dilene Raimundo do Nascimento's comparison of the 1918 influenza and the contemporary HIV/AIDS pandemics creative. According to Rosenberg, we should understand disease within particular cultural frames, but these two pandemics, with their global ecological mechanisms, may equally and powerfully frame culture. All the chapters will be useful for researchers and should be necessary reading for graduate students embarking on a thesis on the history of contemporary Brazilian health and medicine.We must applaud the editors and authors for seeking to show “the current stage of a history of health [of Brazil] that comes from a multidisciplinary mold, is heir to multiple intellectual and political traditions, is diverse and polyphonic, is increasingly averse to theoretical and methodological dogmatisms, and is committed in her craft to understanding the intricate relationships among disease, health, and society” (p. 19). In future editions, I hope these prolific editors continue such commitments by balancing studies of the twentieth century with previous periods and cultural or political history with other approaches and by breaking down language barriers. Contemporary political and cultural history may both sell books but can fall out of alignment within a single volume. On the one hand, we may be asked to celebrate the pioneering men of the twentieth century who help mark our present progress over a diseased or ignorant past (including Oswaldo Cruz, João Carlos Teixeira Brandão, and Adolfo Lutz). On the other hand, old cultural beliefs (phlebotomy, miasmas, and witchcraft) make for good stories of a fantastic world of strange ancestors. Environment, economics, or demographics are mostly missing from the collection, and with them enormous ranges of historical methods, leaving us uncertain about a complex physical world of health determinants and outcomes. For example, until smallpox was eliminated by a vaccine (and a belief in that vaccine enforced by the state), it killed hundreds of thousands in Brazil regardless of whether the victim recognized it as a virus sent airborne by a cough, Christian sin, or the Yoruba spirit of disease, Babalú Ayé. Finally, while Brazil's South American neighbors, and especially Argentina, shared so many developments in their colonial and national histories of health, most of the chapters of this book include no Spanish sources. In these ways, we may better find the “intricate relationships among disease, health, and society” (p. 19)

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