NURSING EDUCATION AT THE BRAZILIAN NEW STATE ERA: THE CASE OF THE MEDALHA MILAGROSA SCHOOL

The aim of this study was to analyze how the creation of the Medalha Milagrosa Nursing School took place in 1945. This is a socio-historical study that uses an analytical strategy anchored in Pierre Bourdieu’s thought. Primary and secondary sources were used. As a result, the central role of the New State (Estado Novo) and its historically authoritarian interpenetration in the societal and economic spheres are discussed, as well as the process through which the field of forces and struggles was constructed by the players during the movement to create this school. In the organizational and bureaucratic field, disputes between the State, the Church, and the academic environment are observed. There is evidence related to the innovation that this school meant in the fields of health and education, as well as to actions taken by the players who created it according to the patterns of modern nursing. DESCRIPTORS: History of nursing. Academic institutions. State. ENSEÑANZA DE ENFERMERÍA EN LA ÉPOCA DEL ESTADO NOVO BRASILEÑO: EL CASO DE LA ESCUELA MEDALHA MILAGROSA RESUMEN: Este artículo objetiva analizar cómo se dio la creación de la Escuela de Enfermería Medalha Milagrosa, en 1945. Esto es un estudio socio-histórico que utiliza una estrategia de análisis anclada en el pensamiento de Pierre Bourdieu. Se utilizaron fuentes primarias y secundarias. Como resultado, se discute la figura central del Estado Novo y su interpenetración históricamente autoritaria en la esfera societal y económica, así como el proceso mediante el cual se establece el campo de fuerzas y de luchas construido por la acción de agentes en el movimiento para crear esta escuela. En el campo organizacional y burocrático, se observan disputas entre el Estado y la Iglesia y el ambiente académico. Hay evidencias relacionadas con la innovación que esta escuela significó en el campo de la salud y la educación, así como con la actuación de los agentes que la crearon según los moldes de la enfermería moderna. DESCRIPTORES: Historia de la enfermería. Instituciones académicas. Estado. http://dx.doi.org/10.1590/0104-07072016002570015


INTRODUCTION
Taking as the starting point the politicalinstitutional and organizational repercussions that arose from the New State (Estado Novo) practice and its despotic and infrastructural rule, the focus is on the creation of the Medalha Milagrosa Nursing School in 1945, at the end of President Vargas' first administration.
Using the reference to support this study, carried out in the light of a socio-historical process, the aim was to combine two mutually dependent strategies of analysis: one with an emphasis on the state-centric approach, which appoints the pivotal role of the State as the key mentor and articulator of social-economic development, leaving room for the interpretation of the meaning of historically authoritarian State interpenetration in Brazilian society. 1 The focus is on the arguments related to a strong State, which concentrates its power and succeeds in imposing its intervention on society. 2 In the New State, this also takes place with a focus put on education and the need for educational reform, which implementation suffered under the strong influence of the authoritarian regime led by Getúlio Vargas. 3he second strategy of analysis falls on the process that constitutes the field of forces and struggles brought up by the agents involved in the movement for creating and operating the Medalha Milagrosa Nursing School.The implications of such studies consist of trying to understand the social dynamics promoted by the agents that occupy a given space, guided by environmental interactions and actions depending on an organizational field under construction.
Therefore, the position that certain agents occupy in a given social space is taken into consideration, although it can be relative.The social space, in turn, has several dimensions formally construed and based on differentiation and distribution principles, which provides to the agents or group of agents the ability to be the force or power holders in this realm. 4he Medalha Milagrosa Nursing School case study shows the links between the political-institutional plan and the organizational as well.On one hand, it addresses the New State context; on the other hand, it tries to identify the new insights of the agents working in the institutional set-up of environments and power, especially in their ability to be holders, not only at the organizational level.] Reflection on the topic acknowledges that it refers to a strong and autonomous State, [7][8] which is the approach that almost always arises from studies conducted in countries marked by authoritarianism, such as Brazil.In developed capitalist countries, the lines of empirical research tend to concentrate on the State as the actor and the State as an institutional structure. 9 strong State, such as the New State, is the one that knows how to impose the rules of the political game with the society that it tries to rule, without necessarily using the coercive measures placed at its disposal, but by means of "incentives" and alternative resources to enhance its own positions and obtain approval in the social-environmental context. 10he analysis carried out here is substantiated in the light of the studied context, which identifies the increasing state autonomy necessary to deal with increasingly more complex societies and, at the same time, investigates the mechanisms that lead to the creation of institutions that will provide support for this structure in the process of development. 11his distinct point can be illustrated in two types of state power: despotic power and infrastructural power. 10These interrelated powers demonstrate the logistic and political mode of interpenetration of the State in the material base of the society, through the imposition of strategies restricted to the democratic game, such as the case of the New State.The greater the despotic power imposed infrastructurally by the State, in light of the social actors, the greater the dimension of its authoritarianism will be. 10Such degrees and variations lead to different political-institutional repercussions, which help us to understand how certain institutions were created, even in the face of repression, and how the cooperation of objective forces in action was obtained.Such issues are thoroughly examined, since they co-substantiate the study presented here.
The New State, which was in force from 1937 to 1945, under the command of Getúlio Vargas, typifies the arguments already mentioned, especially by its authoritarian and dictatorial nature, 11 exemplified by the granted Constitution that extinguished the political parties and dissolved the National Congress, 12 the State Assemblies, and the Municipal Chambers.
] Consequently, the new social order, in accordance with Fascist ideology, demanded a series of symbolic and political strategies for maintaining the new regime, at the same time that it reinforced the idea that liberal democracy was totally annihilated.
Getúlio Vargas' personal power was also consolidated through strategies aimed at personifying the myth with the help of the State.Therefore, in 1939 the Press and Propaganda Department (DIP) was launched to boost the worship of the State and the image of Getúlio Vargas, 14 which extended until his leaving power.Parades, manifestations, and radio shows were organized to carry out the celebrations, on the 19 th of April, of the dictator's birthday, in order to praise his personal qualities 4 and guarantee social dissemination by means of symbolic mechanisms of manipulation and coercion, 15 mediated by tacit recognition of authority.When the individual understands that those who exercise authority over him have the right to do so, this contributes to the addressee's recognition of the consecrated person as being the spokesperson authorized to speak on behalf of the group he controls.
During the New State intervention, education regarded as fundamental values the cult of nationality, discipline, morality, and work, among others.The pedagogic tenets, at that time, were considered completed and the educational ideal for labor was to "learn by doing". 16n the healthcare field, 17 public policy changes that took place in the first Vargas administration (1930-1945) were prominent as far as aspects of advancement, such as an infrastructural base with the creation of the Education and Public Health Ministry (MESP), in November of 1930, in response to the expectations of the First Republic sanitarian movement. 18ithout a doubt, this era left its mark as the period of public health in Brazil.In charge of the MESP (1934-1945), Gustavo Capanema centralized and professionalized the health care system and linked it to the Nationalist ideology of a strong and authoritarian State 17 as part of a reform process that he carried out.From 1937 the dictatorship regime was established.
It was only in 1947, however, that discussions on the public healthcare field were resumed with the Brazilian Hygiene Congress, which had been suspended since 1930.The last Brazilian Hygiene Congress had taken place in 1929, in Recife-PE, in its fifth edition.There was already a movement for the creation of a nursing school, affiliated with the Hospital do Centenário, which had not been implemented.In 1938, this hospital suffered an intervention.
Then, in 1945, the first school for "high standard nurses" was created, in conformity with the creation of Medalha Milagrosa Nursing School, link to Hospital Pedro II. 19t is worth investigating what it meant to the healthcare field to create a school in Recife-PE, at the end of the New State, comparable to the Escola de Enfernagen Anna Nery (EEAN).The latter was created in 1923 in the city of Rio de Janeiro.In 1945, it had already graduated its 20 th class and experienced the same reality of a dictatorial regime.The question, then, is: what were the repercussions of the New State on nursing education in Pernambuco, especially in the case of the Medalha Milagrosa Nursing School?
Capanema's Reform structured industrial education, reformed commercial education, and created the National Service of Industrial Training (SENAI), based on the Organic Laws of Education, 20 which had an impact on nursing.With the Constitution of 1937, the EEAN was included in the university system imposed at that time, and was incorporated into the Universidade do Brasil, currently the Universidade Federal do Rio de Janeiro (UFRJ).Its characterization as an institution of complementary education emerged with Law n. 452/1937, under the direction of the North American nurse Bertha Lucille Pullen. 21ater, in 1945, the EEAN came to be regarded as an education unit, through Decree-Law n. 8.393/1945, under the direction of Laís Netto dos Reys, who became the first director graduated at EEAN.
In view of the contextualization of the subject, and according to issues raised by the study, the objective, following the political-institutional and organizational repercussions generated by New State's policies and its despotic and infrastructural power, is to analyze how the creation of the Medalha Milagrosa Nursing School took place in 1945.

METHOD
This is a social-historical study that found in Pierre Bourdieu's thought the theoretical framework for analysis and interpretation, with the notion of field and symbolic power.The field structure and key positions are defined by the type of capital and the rules of the game, 4 while the field of power takes place in the space of force relations among different types of capital.] To apply the comparative method in the human sciences framework consists of searching for, in order to explain them, the similarities and the differences that present two series of an analogous nature, drawn from distinct social spheres.For Marc Bloch, the comparison still performs important functions, such as to research and explain specific and general aspects of each phenomenon and to help gain an understanding of the "causes" and "origins" of the phenomena. 24he data of this study were collected from August 2011 to July 2012.Primary sources were used, such as written documents, the Constitution, laws, decrees, reports, and newspapers from the archives of the Center for Research and Documentation of Brazilian Contemporary History, Fundação Getúlio Vargas, EEAN, UFRJ, the Fundação Joaquim Nabuco, and the Escola de Enfermagem Nossa Senhora das Graças of Universidade de Pernambuco; the secondary sources refer to Brazilian historiography from Vargas's Era and to nursing education.
The data were analyzed after collecting and organizing the primary sources, carried out by comparing the similarities and differences of the social phenomena to be investigated.For interpretation we used the theory of social capital, by Pierre Bourdieu, which can be taken as what the agents do every time, 4 constituting a movement similar to the order of things in the field.
To better understand the field and its analysis, attention is drawn to the strategy of a state-centered view, which configures the field of forces and struggles related to the studied phenomenon.
The results enable the visualization of the agents -a term used by Bourdieu -in the field, their symbolic fights, the strategies adopted in the field, and how they organize themselves, thus favoring the infrastructural base in health and education that had an impact on nursing education.
Regarding ethical aspects, although the study did not involve human beings, it was approved by the Ethics Research Committee Centro de Saúde Amaury de Medeiros in 2005, because it is linked to a project on the early days of professional nursing that took place from 1922 to 1945.

RESULTS AND DISCUSSION
Placing the case of Medalha Milagrosa School into the New State context, it is extremely important to describe how it was established and what it stood for in the field of health care and education, amid the process of its movement towards creation.On the one hand, the roles that the State and the Church played in this process made the social functions known and, later, legitimated.
In this context, the EEAN places itself as the "official standard school", because the other schools in the country are equipped according to it * .As for the Medalha Milagrosa School, it received its federal certification in 1949, four years after its creation.

The Medalha Milagrosa Nursing School: brief history
Nursing education in Pernambuco had its origin at Hospital Pedro II, where the first childbirth class was given, in 1880, for female and male nurses.It was at Hospital Pedro II that isolated forms of school organization took place, although it was not yet considered a field of nursing, which was consolidated decades later.
This innovative spirit found the right place on August 1, 1945, when Medalha Milagrosa Nursing School held its first classes, with the presence of the members of Santa Casa de Misericórdia and civil, academic, ecclesiastical, and clinical-surgical authorities.
The Medalha Milagrosa Nursing School found its headquarters at Hospital Pedro II under the direction of the São Vicente de Paulo Sponsors Association, with Sister Chabas as the Mother Superior and graduated Sister Ana Maria Sarmento as the instructor. 25The admission examination of the first class took place on July 10, 1945, when the examination board met, formed by Sister Rodrigues, the president; Sister Marques, first examiner; Sister Josefa Madureira, second examiner; and Sister Chabas, the director.
From the admission examination, 11 students were approved, after written and oral exams, on the same day as the abovementioned inaugural class, 25  ing School activities, in which the Minutes of the creation were attended by Dr. Fernando Simões Barbosa.Previously, it must be emphasized, he also participated in the movement for the creation of a school for nurses, linked to a reference hospital, jointly with Benedictine Pedro Roeser, without achieving success.
In the case of the Medalha Milagrosa School, everything indicates that Fernando Simões Barbosa was not only involved with its creation, but also joined the order of professors.Moreover, as an agent in the healthcare and education fields, it is known that he was the founder of a nursing school, the reason why this process was enriched with his symbolic capital, through his prestige and social status.
The Church played an important role as institutional agent due to its position in the fields of health care and education, with the attendance of Archbishop of Olinda and Recife, Dom Miguel de Lima Valverde, who presided over the Medalha Milagrosa Nursing School's inaugural session, and affixed the first signature on the Minutes of the creation on August 1, 1945.On that day, the Medalha Milagrosa Nursing School organizing commission also met, with the presence of Dr. Barros Lima, then the Hospital Assistance Department Director; representatives of the Santa Casa de Misericórdia Administrative Board of Recife; professors of the Medical School; and members of the middle class of Recife.The medical class was represented by Prof. Homero Marques, who made the opening speeches and highlighted the medical-social importance of the creation of this school. 25rom an operational point of view, the classes at Medalha Milagrosa Nursing School started taking place on a regular basis, offering technical, theoretical, and practical duties more efficiently, with students receiving essential learning in nursing techniques and sterilization, surgical equipment, operating room protocols, and patient management in general.
Compared to EEAN, the Medalha Milagrosa Nursing School adopted similar rituals, such as: the nursing cap ceremony and the use of lamps during graduation, which occurred a posteriori.Over the years, the teaching had been built according to a professional identity already in place, which contributed to the formation of an emerging field at the time, thus allowing the possibility of sharing beliefs and values.The cognitive and normative bases were present in this process of forming nursing professionals.
The analysis shows that the Medalha Milagrosa Nursing School, since the beginning, has consistent-ly applied the values and norms of the educational field identified with the agents that stood out in the organizational field of pre-training for nursing, 5,19 a topic that will be discussed in the next section, taking into account that the configuration for the school organization itself was linked to the Medical School, indicating the presence of the academic world, as well as the current hospital model.
Although the Church had exerted a strong influence as the school's sponsoring agent, suffice it to say that Hospital Pedro II, where it was established, was maintained by Santa Casa de Misericórdia and received public subsidies from the State 19 since the beginning of the 20 th century.Therefore, its role in the studied context should be mentioned, with infrastructural bases prior to the school creation, which was born through political and educational alliances that deserve attention.

Health and Education Organizational Field: the role of the State and the Church
The Medalha Milagrosa Nursing School, can be considered the first professional nursing school in Pernambuco, which provides an opportunity to focus on the background of its institutionalization. [26][27] The Church, played a key role in this process, bringing in a French nurse, in 1943, to manage Hospital Pedro II; she observed the nursing practice conditions provided to the patients and noted the need to create a nursing school.The nurse, Sister Germaine Chabas, belonged to Order of São Vicente de Paulo, whose Sisters of Charity were already working in Hospital Pedro II.
In Pernambuco long before, in 1922, the Hospital do Centenário Sponsoring Association was launched, bringing together philanthropic and mobilization actions for a model hospital, which would have a favorable institutional environment for the struggle to create a nursing school.
The Hospital do Centenário was inaugurated in 1925, with State subsidies and under the influence of the medical class, designed to assist the population and improve medical education.][21][22][23][24][25][26][27][28] More than a decade later, already under the New State, trying to promote reform in the State health care service, the expropriation of Hospital do Centenário took place, wherein state power was imposed, 8 with the intention of providing service to the State Public Service Welfare Institute, intended for its members.This action went against the medical class, which had just allowed the arrival of nurses to manage the Hospital do Centenário and, with their innovative ideas, managed to obtain support from the society.
Although this happened during the New State, there are elements that indicate repercussions in nursing, which suffered the influence of this dispute, and finally managed to revive when the power play in its favor was reversed by the Church.The counterpoint of this analysis lies in the action of the agents responsible for the creation of the Medalha Milagrosa Nursing School.
The Medalha Milagrosa Nursing School started operating without direct official help from the government, and it was up to the Church to provide the predominant symbolic capital in this power play.On the other hand, as the institutional agent, the State played the controlling role, with its norms and values shared by the agents, and this was consolidated through leveling, without coercion, but through adherence and identification along the lines of a standard school, fulfilled by maintaining the rituals.Although no longer official, however, the schools at that time had to fulfill the requirements of the standard school, keeping the cap and badges rituals, among other symbols.Then, the Medalha Milagrosa Nursing School was recognized by decree n. 27.281 of September 30, 1949, already under the name Nossa Senhora das Graças Nursing School, after the Dutra administration passed Law n. 775 on August 6, 1949, that ruled on the standards of nursing education in the country.
During this period, even with Getúlio Vargas no longer in power, it is possible to point to some small-scale political-institutional and bureaucratic repercussions presented in the movement for the creation and struggle of the agents in the healthcare and educational field.
The formation of a professional nursing organizational field in Recife underwent changes related to the expansion that occurred with the inclusion of one more school, this time on the part of the Dutra administration with Decree n. 1.702 on June 25,  1947, which created the Nursing School of the State of Pernambuco, designed for technical-professional nursing education, with the aim of preparing "high standard nurses" for public health and hospital care services. 19ith this move, the State took over nursing education, and this school was inaugurated in the Hospital do Centenário only in 1950, linked to the Medical School, in a different time from the Nossa Senhora das Graças Nursing School, whose origin was associated with the initiatives of the Church in the healthcare and educational field.
Under the poor conditions that the school found itself in its efforts to meet societal demands, it was up to the Church, through Santa Casa de Misericórdia, to donate a lot in the open area of Hospital Pedro II for the school.This occurred due to the great deal of interest by the Church and the enrollment demands, when it became clear in the historical speech of what was expected that this exemplary undertaking would bring, keeping in mind the construction of a building.:2 There is the prediction of building a scientific capital on the part of the Medalha Milagrosa Nursing School, whose origin deserves comparison with the legacy of Florence Nightingale, identified with modern high-standard nursing.This, in turn, was implemented by Ethel Parsons during Carlos Chagas' sanitary reform, which sparked the arrival of a group of North American nurses, members of the Parsons' Mission, in the city of Rio de Janeiro in 1921.

FINAL CONSIDERATIONS
This study addresses the advent of nursing education in Pernambuco, in the context of the creation of the Medalha Milagrosa Nursing School, at the end of Vargas' first administration, with emphasis on the health and educational field.The results enable us to say that its creation was, at the time, a groundbreaking movement that evoked earlier institutions as basic references so that the work of the agents involved could succeed.
There is evidence related to the innovation that this school represented, observed in the formation of a nursing field, still under construction, that allowed relating it to the symbolic aspects of the agents in the given context, starting with the findings on the force behind modern nursing at the time.
The analysis raises political-institutional and organizational questions resulting from the New State actions; however, it respects the fact that the creation of the Medalha Milagrosa Nursing School took place when the dictatorial government of Getúlio Vargas was coming to an end, by the end of 1945.The observed movement requires the addition of the repercussions resulting from actions and deeds demanded by the Dutra administration, which took over from the Vargas administration, indicating a more democratic transition that started to be unleashed in the country.
The data suggest the role played by a strong State, but one that represents itself from the infrastructural standpoint, with a special focus on the subsidies that not only the Medalha Milagrosa Nursing School received, but also those provided to other institutions that work in the same field of formation.This fact should not be overlooked in the analysis of the social dynamics in which the interventions of the agents who occupy the spaces that allow maneuvers in different directions occur, affecting disputes or forming alliances in order to advance towards its purposes.
The analysis strategy, focused on the institutional configuration of the environments and power necessary for creating the Medalha Milagrosa Nursing School demonstrates an admiration for the legacy virtues of professional formation of nurses, based on the best they had to offer, on what they had to create, and on the high standard in the educational field, including the reproduction of symbolic rituals of legitimation; thus, it is not surprising that the new school was able to raise social support and earning praise since its early days, indicating evidence of the generation of scientific capital that grew from cognitive and normative bases, which are materially visible through the accomplishments that arise from the analysis: classes; examining boards; entrance admissions; enrollments; and turnout of people interested in enrolling.
In the studied events, observations were made regarding the representations of the members of the Church, physicians, and professors moving favorably towards the expansion of the field in Pernambuco, with the emergence of another educational institution, the Nursing School of the State of Pernambuco, which also must be taken into account.
The Church, in turn, played such an important role that it exceeded the strength of the State itself, because it was under its auspices that the Medalha Milagrosa Nursing School came into existence, and it is not an exaggeration to say that the symbolic capital upon which it was built and which predominated in the educational and healthcare field comes from its power to carry forward the accomplishments of the agents who nurtured their dreams yet to come true.
Will the Church be able to rely on philanthropic allies from the medical class linked to Hospital Pedro II, and at least the Order São Vicente de Paulo, which supports the formation of teaching staff in technical and managerial functions, without which the Medalha Milagrosa Nursing School operation would be at risk?Finally, it is asserted that this set of forces, with which such agents articulate, provides support to the kind of repercussions that had a major influence in nursing education, suggesting that this was the path taken by the agents who acted for the formation of an emerging field at the time, when it was possible to envision the sharing of values that would underpin the infrastructure basis required by Medalha Milagrosa Nursing School at the end of 1945.