Medicine in Latin America

1. Development of Science
   1. Historians in Latin America view the source of medical knowledge as mainly European.
   2. Nineteenth century positivists laid the foundation for scientific thinking in Latin America.
      1. The general body of science has been transferred through diffusion form Europe and the United States. These ideas are spread by interaction and exposure and it is self-generating, once initiated. The actual acceptance and reception of this knowledge is shaped by the context for which it is presented and the relation of one's nation in keeping with mainstream 'science'. It is also shaped by the international perspective of the receiving nation.
      2. These scientific ideas are said to be grouped into two model types: active and passive. Arturo Ardao believes that "passive receptions are limited to assimilation of scientific ideas with ability to further diffuse them but without the ability to add creatively to the set of ideas in question. Active reception involves the capacity to carry the paradigm further in original research program."
   3. The developments in Brazilian science, technology, and higher education in the early 1900s can be seen to focus on two polar tendencies, one towards applied work and short-term practical results, the other more academic.
      1. The final decades of the 19th century and first decades of the twentieth can be considered the "Brazilian Enlightenment." There was intense contact with Europe, especially France, introducing Brazil to the concepts of evolution, biological and social Darwinism, positivism, and philosophical and political materialism.
      2. Brazil's political, cultural, and intellectual elites welcomed these ideas, each group accepting the aspect that suited it best.
         1. Positivism reigned in military circles, and the emperor was an enthusiastic propagator of new technologies.
   4. Positivism brought a vision that wasn't in sync with Brazil's own reality and it contradicted the manner by which scientific activities developed in Europe.
      1. "In France, positivism was accepted by only some of the evolutionist social philosophers; most natural scientists did not follow it at all. In the social sciences, positivism confronted new tendencies and theories, such as Marxism, spencerianism, and historicism." (Schwartzman Ch.4)
      2. Within the physical sciences, positivism conflicted with the theoretical lines followed in physics since Alessandro Volta and Luigi Galvani revealed the existence of non-Newtonian forces after the 18th century.
      3. Positivism also ran up against a barrier within mathematical sciences, where work had been influenced by the studies on non-Euclidean geometry carried out by Carl Gauss, Nicolay Lobachevsky, and Georg Bernhard Riemann by the end of the 19th century.
   5. It is against political decentralization, cultural borrowing, and practical urgencies that Brazilian science would enter 20th century.
      1. Organized scientific research in the mathematical and physical sciences began in Brazil within the Observatorio Imperial (Imperial Observatory) in Rio de Janeiro, formally created in 1827 but active only since 1845.
2. Creation of institutions
   1. Against the historical background of 19th century Brazilian medicine, the Tropicalista school emerged as a dynamic force. Ultimately, it failed to establish a lasting tradition of tropical medicine.
      1. Instead of being built on by later generations, the progress of the Tropicalista school was overshadowed by European medical ideas.
   2. When the founders of the Tropicalista school voiced 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.
   3. In the 1970s the Multinational genetics Project of the Organization of American States facilitated research in human genetics in a number of countries by standardizing biochemical techniques important in medical genetic research. This was the origin of the biochemical genetics program in the institute of Human Genetics of the University of San Andres medical school in Bolivia.
      1. "Eugenics, a socially constructed application of genetics, was, in part, the application of social Darwinian constructs in an attempt to preserve the predominance and 'racial purity' of whites, in countries where miscegenation was in evidence, and to encourage the immigration of socially favored groups in predominantly European countries. As in Europe, eugenics was an attempt to biologize social problems and propose 'scientific' solutions for them."
         1. In Europe eugenics found its scientific roots in Mendelian genetics.
      2. The new microbiology that resulted from the discoveries of Pasteur and Kock transformed medical research and public health everywhere starting in the 1880s. Latin Americans went to the Pasteur Institute in Paris soon after its founding (1885) to master the new techniques and theories.
   4. Religious positivism arrived in Brazil at full strength. The beginning of this period was marked by the creation of various institutions.
      1. The scientific institutions created in the first years of the Republic focused primarily on applying their results to meet what were perceived as Brazil's most pressing needs: exploring the country's natural resources, expanding agriculture, and ridding the nation's main ports and cities of disease.
   5. Success in applied science was one of the major causes of the crisis that pervaded most Brazilian scientific and technological institutions in the 1920s and 1930s and led first to the progressive concentration of competence in the state of Sao Paulo and later to the creation of Brazil's first higher education institutions with significant research functions.
      1. The North Americans were unused to the economy of scarcity and deprivation that reigned throughout Latin American laboratories. There, researchers were accustomed to make the best with what they had; resourcefulness in designing experiments was perhaps the key to the best Latin American science of the period.
      2. One group of physiologists performed high-quality research in the 1930s and 1940s. This was a distinctive group of high-altitude or environmental physiologists working in the Institute of Andean Biology founded by Carlos Monge in 1934.
         1. The work of Monge and Hurrado provided a model for centers of Andean biology and medicine established later, for example, the Institute of High-Altitude Pathology, in La Paz, Bolivia and the Veterinary Institute of Tropical and High-Altitude Research of the University of San Marcos (Lima), founded in 1985.
3. Education
   1. "The whole story 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."
   2. Popular and intellectual diffusion was a certainty due to the notoriety of Freud and Einstein. But more profound reception depended on the presence of professional groups with appropriate training. Both psychologists and physicists were in short supply in Latin America countries in the 1920s. Thus the reception of psychoanalysis by psychiatrists is in some sense parallel to that of relativity by engineers. Psychiatrists in the Latin world, although trained in a wholly somatic approach to mental illness, had traditionally adopted a eclectic stance with regard to medical theory and this pronounced eclecticism strongly colored the reception of Freud in the period before the establishment of 'orthodox' psychoanalytical groups in the 1940s and 1950s.
   3. Minas Gerais was a place where students could begin their education and even get in touch with people and institutions trying to uphold the standards of scientific work that were being developed in Sao Paulo and Rio de Janeiro.
      1. More often than not, their academic and research institutions worked mostly as a selecting and breeding ground for the country's central cities.
4. Development of Medicine
   1. Brazil's efforts after the turn of the century to sanitize cities and backlands can be seen as evidence of how governments and medical authorities adhered to the highly successful methods used to eradicate disease in European colonies and the US South.
      1. "In the case of Brazil, the irony in the portrayal of the early disease eradication attempts is that they actually had Brazilian antecedents. By the early decades of the 20th century, however, these antecedents had become 'hidden' in history."
   2. 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.
      1. Gradually the imperial government came to dominate all aspects of medical school life.
   3. Throughout most of the 19th 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.
      1. As foreigners, the Tropicalists were excluded from the existing network of patronage so crucial to the advancement of medical careers.
      2. It was the Tropicalists who, more than any other group of doctors in 19th century Brazil, who first critiqued Brazilian medical teaching and practice.
   4. One of the values that Latin American scientists seem to have acquired is to associate high prestige with publication in 'mainstream' journals, to the detriment of regional scientific publications. Indeed the struggle to have a journal recognized as 'mainstream' is a phenomenon of international politics that impacts upon Latin American science.
   5. During the Second Empire and the first decade of the Republic, Brazilian medicine was mostly clinical and sanitary. Nineteenth-century diagnostic and therapeutic resources were scant. The efforts of hygienists--the epidemiologists of their time--were focused on correlating certain diseases with soil, climate, and other environmental conditions. Physicians were consulted and gave opinions about the physical organization of cities, the opening of roads, the landfill marshes, the construction of sewers, and the basic regulations for private residences, schools, hospitals, and lodgings.
      1. Modern bacteriological research and sanitary medicine started in Sao Paulo, in part, because of impetus provided by educational, scientific, and technological initiatives in that state in the first years of the Republic.
      2. The first initiative was the creation of Sao Paulo's Instituto Vacinogenicao (Vaccine Institute) in 1892, which was to produce vaccines to protect the nation against repeated epidemics of smallpox.
   6. The law that eventually established the institute also provided for the organization of three different laboratories: one for clinical analyses, one for bacteriology, and a third for pharmaceutical research. Only the second of these became a reality.
      1. In 1894 and 1895 the institute responded rapidly and efficiently to cholera epidemics. The Instiuto Bacteriologico, and Lutz in particular, were to gain special fame with the public health campaigns aimed at wiping out yellow fever and the bubonic plague
      2. From its initial role as a factory of serum and vaccines, the institute rapidly broadened into a center for bacteriological research and personnel training and a gathering place for a new generation of medical doctors in tune with the medical revolution started by Pasteur.
      3. Originally entrusted solely with the manufacture of serum and vaccines, the institute assumed the character of a research center. Under its new statutes it enjoyed "total autonomy in its technical and scientific investigations" and could ask the government to send any of its staff members to various places to study relevant scientific questions.
   7. House-by-house vaccination as an approach to public health moved a state in the direction of a proactive role, though the class bias in imposing this form of medicalization was clear. This approach to public health was dependent on discrimination against the lower class, denying them rights to the privacy and freedom from state intrusion which elites so vigorously defended.
   8. Historians of Mexican medicine all stress the role of Spanish republican researchers in training students and founding distinctive research 'schools' in various specialties.
5. Physicians
   1. 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.
      1. 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 and whether "civilization" and progress were possible there.
   2. 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 of European disseminated, must themselves decipher the problems of tropical diseases, problems that European doctors understood only superficially.
   3. Through the Universidad, the state exercised control over entrance into the medical profession, improving the status of physicians through selectivity. However, the impact of this control was limited. These physicians of state-organized education did not guarantee loyalty to the state.
   4. Doctor recommendations contained an element of social control over the behavior and morality of lower classes. Public health measures such as this facilitated the imposition of a liberal social and timework ethic in the working classes.
      1. Rios thus sought to extend medical expertise into the engineering and administration of public education.
      2. Dr. Bourgeois seems to have realized the practical limitations of disseminating hygienic methods through the press, observing that not all potential victims could or did read published recommendations.
   5. Public health policy represented the growth of bureaucratic regulation of society as the central government attempted to assert its authority over local and regional interests more completely.
      1. The regulation of medical professionals by the state linked professionalization and bureaucratization. The Chilean case revealed increasing intrusions of state personnel into the social realm, justified by the public good, and enforced through the state's police powers.
      2. The justifications of these policies reveal both the deep roots of a powerful Executive in 19th century Chilean politics, and the early linkage drawn between the 'scientific discourses' of medical professionals and the bureaucratic centralization of state power.

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