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História, Ciências, Saúde-Manguinhos

Print version ISSN 0104-5970On-line version ISSN 1678-4758

Hist. cienc. saude-Manguinhos vol.16  supl.1 Rio de Janeiro July 2009 



Interpreting Brazil as afflicted by disease and by the spirit of routine: the repercussion of Arthur Neiva and Belisário Penna's medical report (1917-1935)*



Dominichi Miranda de Sá

Researcher at Casa de Oswaldo Cruz/Fundação Oswaldo Cruz. Av. Brasil, 4036/ 406. 20040-361 - Rio de Janeiro - RJ - Brazil.




The release of a report on the Instituto Oswaldo Cruz's 1912 scientific voyage to North and Northeast Brazil, led by physicians Arthur Neiva and Belisário Penna, debate that found its way to the pages of magazines of the letters and sciences. The report used the images of disease, geographic and cultural isolation, illiteracy, poverty, and a vocation for backwardness to portray the people living in interior Brazil. These images of the sertão were extensively criticized in the periodical A Informação Goiana, published by local doctors who refused to see the interior defined as 'sickly' and 'backwards'. The article analyzes the ways in which the Neiva-Penna report distinguished itself, becoming a reference for intellectual controversies surrounding the national question in Brazil.

Keywords: scientific voyages; sanitarism; sertão; nationalism; Brazil.



Scientific voyages have become an important focus of analysis in the social sciences and history in recent years.1 Scholars have endeavored to understand the ways in which intellectuals, physicians, scientists, and naturalists from the colonial period through the 20th century constructed the images of nature and people that helped shape the social imaginary about Brazil (Lima, 1999). In particular, reports, correspondence, field diaries, and books by foreign scientists and naturalists on 19th-century expeditions, along with documents and visual representations produced by Brazilian physicians and travelers at the turn of the 20th century, have served as essential sources in the investigation of such themes as family, food, clothing, housing, work, gender, domestic life, cultural, social, and economic contrasts, the European influence, the construction of nationality, civilization, modernization, and Brazilian development (Lima, 1999, 2007; Kury, 2001a, 2001b).

Of special note among these studies on the production of travelers are analyses of how Brazilian intellectuals have made use of reports from scientific voyages, particularly medical sanitary expeditions (Lima, 1999). In addition to contributing to the broader debate on the use of medical sources and travel narratives in interpretations of Brazil, such research has also reflected on relations between health, nation building, and the institutionalization of the social sciences in Brazil (Castro-Santos, 1987; Lima, 1999, 2003; Hochman, 1998; Lima, Hochman, 1996, 2004). The chief presupposition underlying these studies has been that medicine at the turn of the 20th century should not be understood solely as knowledge and scientific practice related to health care, but as a discourse on society and a program aimed at social reform (Lima, Hochman, 1996; Lima, 1999; Murard, Zylberman, 1985).

When we examine these scholarly works, we perceive that texts by 19th-century naturalists were devoted primarily to inventories of the natural world and detailed descriptions of collected specimens and of interactions between human beings and the environment (Kury, 2001a) and that at the turn of the 20th century, reports by Brazilian travelers emphasized the 'civilization' and modernization of Brazil, under the umbrella of 'national integration' (Lima, 1999).

This agenda was especially typical of reports born of exploration commissions and scientific voyages and expeditions organized by the Brazilian government, which were both expressions of Brazilian scientific production (Kury, 2001a) as well as essential prerequisites in carrying out the transportation and communication infrastructure projects and works meant to integrate the more distant points of the Brazilian territory (Lima, 1999).

The medical scientific voyages sponsored by the Instituto Oswaldo Cruz in the first half of the 20th century were part of this panorama. Particularly noteworthy was Arthur Neiva and Belisário Penna's 1912 expedition to North and Northeast Brazil, under assignment to the Inspetoria de Obras Contra as Secas [Inspectorate for Works Against Drought], an agency of the Ministério do Negócios da Indústria, Viação e Obras Públicas [Ministry of Industry, Roads, and Public Works] (Mivop).2 Of all the institute's expeditions, this had the greatest repercussion among Brazilian intellectuals, physicians, and politicians. The report used images of disease, geographic and cultural isolation, illiteracy, poverty, and a vocation for backwardness to paint the people of the sertão (Neiva, Penna, 1916).

Previous research on the topic has shown that publication of this report and the ensuing debate inspired the 1918 founding of the Liga Pró-Saneamento do Brasil [Pro-Sanitation League of Brazil], the movement to sanitize the sertões, the advocacy of rural preventive healthcare posts and sanitary education, and, above all, the campaign to federalize public health services in Brazil, whose greatest expression was the Departamento Nacional de Saúde Pública [National Department of Public Health], founded in December 1919 (Castro-Santos, 1985, 1987; Hochman, 1998; Lima, 1999, Lima, Hochman, 1996).

The report's repercussions, however, were not limited to the press or medical periodicals, nor to the promotion of public health policies at the time of its release. It was no flash in the pan. We can follow persistent references to the document for years on end in the journals of sciences and letters in the 1920s and 1930s, where the intellectual controversies surrounding Brazil's national question took up its main themes.

In this article, I analyze the release, reading, circulation, reception, and repercussion of the technical report on this journey requested by a federal body, then published as a scientific paper by an important medical journal of the day, and, in the following years, 'resignified' as a nationalist propaganda piece. How do we explain how this particular report stood out among so many others written at that same time?

To answer this question, I explore the 'adventure' of a text3, that is, the authors' production of the text but, above all, its erratic passage through the hands of different readers in different places and times. The various readings and innovative interpretations of the authors' original meaning of the text redound in an unexpected result: the Neiva-Penna report revived the discussion among politicians, physicians, and intellectuals of Planalto Central do Brasil, over the transfer of the federal capital to that area.


Scientific voyages and national integration

'National integration' was the federal government's chief watchword in the early years of the Republic. In essence, it was all about occupying and settling empty spaces and making them productive, particularly in the hinterlands (Maciel, 1998). The assignment was entrusted to the Mivop, which, through its agencies and departments, was supposed to "stimulate industry, help develop trade, build streets and open canals, regularize, improve, and maintain rivers, upgrade and equip maritime ports, expand and facilitate commu-nications, and broaden and popularize education."4

With an eye to incorporating the outlying areas of the interior, at the turn of the 20th century the Brazilian government gave top attention to works at ports and to the construction of railroads, while also organizing scientific voyages that were in themselves official projects to modernize and exploit the Brazilian territory's economic potential. The roots of this endeavor can be traced to the Empire, for example, in the form of the activities of the Comissão Científica de Exploração [Scientific Exploration Commission] (1856), the Comissão Geológica Imperial [Imperial Geological Commission] (1875), and the Comissão Geográfica e Geológica de São Paulo [Geographic and Geological Commission of São Paulo] (1886) (Figueirôa, 1997). But under the Republic, similar initiatives were not only stepped up but gained new expression. 'Incorporation' and 'scientific knowledge' of the territory - a partnership that not rarely included nosological surveys and efforts to fight disease in the locations targeted for occupation and settlement - became absolutely inseparable within the Mivop. Hence its ever closer working relations with research institutions like the Observatório Astronômico [Astronomic Observatory], the Museu Nacional [National Museum], and the Instituto Oswaldo Cruz.

Of special note among these republican initiatives were the Comissão Exploradora do Planalto Central do Brasil [Exploratory Commission on Brazil's Central Plateau], directed to moving the federal capital and headed by astronomer Louis Cruls between June 1892 and March 1893; the Comissão Construtora de Linhas Telegráficas [Strategic Telegraph Commission of Rio de Janeiro to Mato Grosso] (1891-1906) and of Mato Grosso to Amazonas (1907-1915); and the Instituto Oswaldo Cruz's medical scientific expeditions (Lima, 1999).

The Cruls Commission, as the first of these came to be known, was appointed under the republican administration of Floriano Peixoto, with the chief goal of demarcating the lands where the country's new capital was to be built, pursuant to the newly promulgated 1891 Republican Constitution. But the Commission did not restrict its activities to geographic demarcation of Brazil's future capital. It also conducted geological surveys and produced a 'medical diagnosis' of the entire Planalto Central (Rosas, 1996; Lima, 1999; Vergara, 2006). The diagnosis was particularly well elaborated on in attachment IV of the Commission's final report, written by doctor Antônio Azevedo Pimentel. Highlighting topics like topography, hydrography, geology, vegetation, climate, and endemic diseases, Pimentel advocated extending the settlement of Brazil from the coast into the sertão (grounded in observations of medical geography, that is, the analysis of the role of the environment in the emergence and distribution of disease); he argued that, contrary to popular belief, the lands of the interior were highly fertile and healthy.

An even more persuasive example of this partnership between science and territorial integration was the Comissão Construtora de Linhas Telegráficas, better known as the Rondon Commission, whose most famous activities gave birth to indigenist policies (Maciel, 1998; Biggio, 2000; Souza Lima, 1995). Covering a period of over twenty years, the voyages by members of the Brazilian Army's corps of engineers were also aimed at incorporating the interior into the country as a whole. The main purpose of these expeditions was to install and maintain telegraph lines and to demarcate and provide surveillance of Brazil's borders. But while they were hanging telegraph lines so the country's urban centers could communicate with the interior, the members of the commission, which included a number of naturalists, especially from the Museu Nacional, also engaged in scientific exploration of the territory, with a focus on reconnaissance of the country's geography. Carried out primarily on trips during 1907 through 1915, this work engendered some one hundred reports and was of major import in such diverse fields as cartography, botany, geology, zoology, anthropology, and the ethnography of indigenous and sertão peoples (Lima, Sá, 2006, 2008; Sá, Sá, Lima, 2008).

The scientific voyages sponsored by the Instituto Oswaldo Cruz took place in the 1910s, when the institution began working with the Mivop' Departamento de Agricultura, Comércio e Obras Públicas [Department of Agriculture, Commerce, and Public Works]. Expeditions into the interior were led by the institute's top physicians and scientists, who accompanied infrastructure works like railroad construction and the sanitary inspection of ports and of rubber extraction in the Amazon (Lima, 1999). This was the case, for example, of the earliest medical scientific voyages, which got underway in 1906 and were more modest in size; their goals were to reverse epidemic situations in limited areas. It was this year that Carlos Chagas was sent to São Paulo to end a malaria outbreak in the region where the Companhia Docas de Santos [Santos Port Company] was building a hydroelectric power plant. Soon after, still in 1906, Chagas worked alongside Arthur Neiva and Rocha Faria on a new anti-malaria campaign in Xerém, in the Baixada Fluminense area of Rio de Janeiro, where the Inspetoria Geral de Obras Públicas [General Inspectorate of Public Works] was building water reservoirs to supply the city. In 1907, Arthur Neiva was in São Paulo at the service of the Noroeste do Brasil Railroad, while Carlos Chagas and Belisário Penna went to Minas Gerais, where they too fought malaria, then hampering efforts to extend the Central do Brasil Railroad (Albuquerque et al., 1991; Lima, 1999; Kropf, 2006).

In 1910, Oswaldo Cruz was responsible for the sanitary inspection of works on the hydroelectric power plant being constructed by the Cia. Light and Power in Ribeirão das Lages, in Rio de Janeiro state; shortly thereafter, he and Belisário Penna headed to the Amazon at the invitation of the Madeira-Mamoré Railway Company (Cruz, 1910; Schweickardt, Lima, 2007).

Another voyage that manifested the strong bond between science and the territorial integration project was an expedition undertaken by Carlos Chagas, Pacheco Leão, and João Pedro de Albuquerque at the request of the Superintendência da Defesa da Borracha [Superintendency in Defense of Rubber]. From October 1912 to March 1913, these physicians surveyed the sanitary and living conditions at Brazil's principle rubber production centers, traveling the Solimões, Juruá, Purus, Acre, Iaco, Negro, and lower Branco rivers, among others. As expressed in the superintendency's orders, the expedition's central purpose was to conduct an epidemiological survey of the region to enable later exploitation of its natural resources (Albuquerque et al., 1991; Lima, 1999; Kropf, 2006; Schweickardt, Lima, 2007).

At that time the Instituto Oswaldo Cruz's scientific voyages were also in response to requests by the Inspetoria de Obras Contra as Secas, an agency of the Mivop, created in 1909 to survey the economic potential of Brazil's rivers, build dams, and survey the climatic, epidemiologic, and socioeconomic conditions of Northeast and Central-West Brazil (Santos, 2003). More specifically, members of the institute's expeditions conducted topographic reconnaissance and sanitary surveys of drought regions and drew up reports on the results of their trips.5

Such was the purpose of the scientific voyage to Piauí, Pernambuco, Bahia, and Goiás organized by Arthur Neiva and Belisário Penna in 1912. Like Carlos Chagas' expedition to the Amazon, Neiva and Penna's was additionally part of the national integration proposal (Lima, 1999). In their report, themes like ignorance of the true value of the Brazilian sertão and the incorporation of people living in the interior were likewise framed as key elements of the country's political and scientific agenda.


The account of the expedition into the interior

Consonant with the goals of the Inspetoria de Obras Contra as Secas, the expedition led by Arthur Neiva and Belisário Penna was meant to survey and map out a nosological picture of northern Bahia, southwestern Pernambuco, southern Piauí, and all Goiás. For seven months, from April to October 1912, the physicians studied the fauna, flora, geography, living conditions, and history of the places they traveled on donkey-back, with the aim of better understanding the incidence and distribution of certain diseases and proposing preventive measures to fight them. The overriding goal was to leverage the regions' productive potential and move towards modernization.6

Based on a wealth of examples sourced from the testimonies of the local inhabitants and over a hundred photographs, Neiva and Penna's report is a veritable ethnography of the lifestyle of people living in rural Brazil in the early 20th century (Lima, 1999, 2003). According to the report, sertanejos - inhabitants of the sertão - were backward, lazy, fatalistic, and feeble, not as a result of racial interbreeding (which was at the crux of the 19th-century debate on national identity), but because they suffered from completely avoidable diseases like ancylostomiasis, malaria, and Chagas disease, especially in what was then northern Goiás, now the state of Tocantins. In their sketch, disease was the greatest obstacle to progress in Brazil (Lima, Hochman, 1996).

The report leaves other strong characterizations: the people of the interior were diseased, forsaken and forgotten by the rest of Brazil; the sertão was huge, with a low population density; it was resistant to change; it would be hard to establish the minimum bases of nationality because there were no means of transportation and communication with the coast; illiteracy was presumed to be around 95%. Add to this the absence of public authority; poverty; apathy; the spirit of routine; a stubborn resistance to progress; a vocation for backwardness; primitivism; a veneration of dignified behavior, probity, and morality in the home; and a fervor for personal honor, but disregard for laws, accompanied by reliance on violence to settle conflicts (Neiva, Penna, 1916).

Neiva and Penna also underscored the scarce number of doctors in vast areas of the Brazilian inland territory, which of course implied that most of those living in the sertão did not enjoy the services of healthcare providers - ergo the portrait of Brazil as a diseased, forsaken, and therefore backward country. They advocated increasing the number of doctors in these isolated areas, since the logical correlate to this lack of assistance was, they concluded, widespread reliance on so-called folk therapeutics (Neiva, Penna, 1916).

The report received great attention in Rio de Janeiro newspapers, particularly O País and Correio da Manhã, in 1917 and 1918; even back then, the bibliography suggests, it was an inescapable reference in the discussion of national identity (Castro-Santos, 1985, 1987; Hochman, 1998; Lima, 1999, 2002; Lima, Hochman, 1996, 2004). Because of the repercussions of its main themes, it has been identified as the point of origin of the nationalist campaign for rural sanitation and often associated with Brazilian writer Monteiro Lobato's character of Jeca Tatu, emblematic of the anemic, diseased man of the interior, unfit for agricultural labor, as well as with Mario de Andrade's satirical words on Brazil's sanitary situation, in his book Macunaíma: "Pouca saúde, muita saúva: os males do Brasil são" [Not much health, lots of ants: these are the woes of Brazil] (Lima, 2002; Lima, Hochman, 2004).

What was more significant, however, was the connection drawn between the report and the famous speech given by Miguel Pereira before the National Academy of Medicine in October 1916, in which he pressed home that the interior of Brazil was nothing but an "enormous hospital". Although Pereira made his speech before the report was published (Kropf, 2006, p.110), in the 1920s it came to be viewed more and more as an offspring of and heir to Neiva and Penna's diagnosis of the country. What is it that explains this 'chronological inversion', born from the document's circulation and impact - this process that transformed it from a mere technical report generally required by a Ministry into a product unto itself?

This question becomes doubly relevant if we bear in mind that although the report's most important, trenchant images were presented and received as a wholly novel interpretation of Brazil at that time (a fact that actually underpinned its persuasive power and its weight in garnering political and intellectual support), they were not actually new. I am referring not only to the famous, forceful images found in Euclides da Cunha's 1902 book Os sertões (tr. Rebellion in the backlands, 1944), images that were then associated with the report, such as that of "two Brazils," the polarity between sertão and seacoast, or the image of isolated sertanejos or their "exile within their own country". It is not precisely to these images that I am referring but more specifically to how the scientist Carlos Chagas had, since the early 1910s, repeatedly drawn links between rural endemic disease and the degeneration of Brazil or, better, how he emphasized that disease was the biggest roadblock to Brazilian progress (Kropf, 2006). I am also referring to the reports from Rondon Commission expeditions, which depicted sertanejos as 'diseased' (Diacon, 2006). Reports by members of the telegraph commission and press articles on these expeditions (particularly in Almanack Garnier and Jornal do Commercio) painted hinterland Brazil as unknown, unfamiliar, and forsaken - in short, as an isolated place that needed to be effectively incorporated into the rest of the country. Furthermore, many reports by 19th-century travelers to Brazil saw a connection between the so-called spirit of routine and sloth of people in the hinterland and their wretched existence. Saint-Hilaire, for example, makes frequent mention of work being done in completely unsystematic ways, solely for subsistence purposes (Barreiro, 2002).

Nor can the sociological character of the Neiva-Penna report (Castro Santos, 1985, 1987; Hochman, 1998; Lima, 1999, Lima, Hochman, 1996) be deemed original or taken as the sole explanation for the remarkable impact it had in Brazil's intellectual circles in the 1920s and 1930s. Analyses and lengthy ponderings on Brazilian social life during this period, with an emphasis on themes like family, work, food, customs, and housing, had been common in medical texts ever since the first half of the 19th century. This in fact prompted Gilberto Freyre, in an article published in O Jornal, to classify doctors as the "forgotten forerunners of sociological studies in Brazil" (Freyre, Jul. 21, 1942, cited in Lima, 2007).

Even earlier reports from the Instituto Oswaldo Cruz - for instance, Oswaldo Cruz's 1910 "Condições gerais sobre as condições sanitárias do rio Madeira" [General conditions on the sanitary conditions of the Madeira River] - contain sociological reflections on the living conditions in these regions (Schweickardt, Lima, 2007).

For all these reasons, the suggestion must be made that an entire set of factors accounts for the interpretive strength of this report and its endurance as a source for understanding Brazil's woes, one that made its impact felt on the works of Roquette-Pinto, Gilberto Freyre, Fernando de Azevedo, Florestan Fernandes, Antonio Candido, Emílio Willems, Samuel Pessoa, and others in the 1920s, 1930s, and 1940s (Lima, 1999, 2007). The fact was that there was nothing new about Neiva and Penna's negative representation of the sertão; however, the tendency - in a political context of strong nationalist feelings, like the height of World War I - was to understand the text as a whole new view of the interior and its inhabitants and as a great rediscovery of the country, comparable only to Euclides da Cunha's Os sertões. This was so much the case that a number of intellectuals asserted that the so-called 'true situation' experienced by sertanejos (i.e., disease, poverty, and abandonment) was made apparent only because the report was read and publicized.

Likewise significant in this regard is the date of the report's publication. It first appeared in Memórias do Instituto Oswaldo Cruz, with 1916 as the date of publication. However, that was not the year that this issue actually came out. There are scattered comments in other magazine articles stating that the report had been finalized in 1915, and that Arthur Neiva had been circulating copies of it since early 1917, although apparently it was never sent to the Ministry.7 Cover date aside, the issue of Memórias in question most likely was published only in 19188, when other magazines began citing and reviewing it.

This new information does not invalidate the usual interpretation that creation of the Liga Pró-Saneamento do Brasil [Pro-Sanitation League of Brazil] and the campaign for rural sanitation derived from circulation of the report. What is certain, however, as stated earlier, is that Neiva distributed copies to his peers, starting in Rio de Janeiro and São Paulo, and these were read and then released in newspapers like the Correio da Manhã and Correio Paulistano, through articles written by Gil Vidal and Afonso de Taunay, respectively, and also in the Revista do Brasil, with articles signed by Monteiro Lobato.

I would argue, as does Kropf (2006), that the report did not instigate Miguel Pereira's speech. I do submit that the reason for the report's tremendous repercussion can be traced to a combination of three things: the impact of Pereira's speech, juxtaposed with the nationalist context of WW I, and, above all, Neiva's endeavor to publicize the text by mailing it to major intellectuals and scientists of the day. The document is rich in its detailed research and records, but the mode of its original circulation was decisive in getting it into the hands of many men of letters, men who perhaps would not have read it even if it had been published in Memórias do Instituto Oswaldo Cruz in 1916.


The long journey of the Neiva-Penna report

In a tone of indictment, on Monday, October 23, 1916, the Correio da Manhã published the first of a series of articles that would continue almost without interruption until March of the following year. Its title was 'A eliminação do brasileiro' [The elimination of the Brazilian], and although it was not signed, it appeared as an editorial on the first page and so the author was likely Gil Vidal9, editor-in-chief of the Correio and responsible for most of the similar articles the newspaper would publish on the topic in the following months. This first text reported on the two speeches given by doctor Miguel Pereira in the previous weeks, at two different medical events, in which he criticized a statement by deputy Carlos Peixoto, who had said he was prepared to go "from mountain to mountain, awakening the dwellers of our sertão regions" to defend Brazil in the unfolding world conflict (Lima, Hochman, 1996; Hochman, 1998; Lima, 1999). Pereira argued that this would be an impossible task, since the interior of Brazil was nothing more than an "enormous hospital", inhabited by "a legion of diseased, useless" people. To back him up, the paper published the following text:

In the midst of the general apathy that leaves us indifferent to the destinies of our country and that keeps us from responding with regenerative energy, there are disorganized signs of anxiousness that make evident the apprehension prevailing within all spirits regarding the future of Brazil. ...

One must admit that it is curious to note that a few weeks ago, no one was in any way concerned about the danger that assails our nationality. ...

Today, now that the research of Carlos Chagas and Arthur Neiva, as thoroughgoing as it is brilliant, has made evident the Brazilian sertão just as it appears before the eyes of the scientist and physician, we can judge in what a predicament we would have been, had we transferred the site of the federal government to the Planalto Central, before accomplishing the immense task of sanitizing the incredibly vast Brazilian sertão. ...

The true conditions of this enormous area, which in our imaginations had been idealized as an Eden of fertility and wealth, were just the day before yesterday laid bare in a speech, as beautiful in form as it was valuable in substance, in which the illustrious professor Miguel Pereira hailed our eminent countryman Carlos Chagas as delegate of the medical community. Driving home the same point that had rung out in an address before the Faculty of Medicine, professor Miguel Pereira, during his toast on Saturday, painted, with a greater richness of details, the black picture of this Brazilian inferno. It is not a matter of endemic diseases localized in this or that area of the sertão, or scattered settlements that the illnesses smite; it is the entire country being vanquished by diseases, the imperialism of death and decay, unleashing its legions of parasites to destroy nationhood through the slow elimination of man.

To form an idea of the state of these forsaken populations, which are gradually being impoverished and eliminated, suffice it to say that the hideous Chagas disease alone has infected over one million Brazilians. ...

It is up to the president of the Republic to immediately forge an agreement between the Federal Government and the most directly interested states, so that we may commence the redemptive job of sanitizing the interior of our country, before we see Brazil disappear, through the gradual extinction of Brazilians.

Strictly speaking, the first text on the topic was signed by Gil Vidal and published in the same newspaper, on October 16, 1916, under the title "Desolador, mas verdadeiro" [Dismal but true]. It was basically a reprint of the first speeches by Miguel Pereira and deputy Peixoto, as if they were in dialogue. It was only after the aforementioned denunciatory text came out that the paper began publishing articles in an indignant tone - "O Brasil é um imenso hospital" [Brazil is an enormous hospital] (Nov. 10, 1916), "Sobre as condições de sanidade do sertanejo brasileiro" [On the sanitary conditions of the Brazilian sertanejo] (Nov. 22, 1916) - in addition to a series of daily texts by Belisário Penna entitled "Saneamento dos sertões" [Sanitation of the sertão] (Nov. 01, 17, 19, 20, 1916). The recurrence of the topic, the inflammatory tone of the newspaper texts, and Belisário Penna's protagonism of the sanitary campaign (Lima, Hochman, 1996; Hochman, 1998) increased more after the October 23 article lit the fuse of debate in the federal capital and, to a lesser extent, in São Paulo, but also in the 'diseased sertão'. By late 1916 the report on the 1912 voyage into the sertão, repeatedly cited by Penna as an illustration of Miguel Pereira's indictment, was serving as one of the most trenchant pieces of evidence that Brazil was truly an 'enormous hospital' and, most notably, as ammunition against those in the press and medical circles who accused Pereira of exaggerated pessimism and of supporting an unpatriotic campaign (Kropf, 2009). The report became obligatory reading and object of analysis, and Neiva saw to its distribution among scientists, physicians, and intellectuals.

A review of journals of letters and sciences then circulating in the federal capital - like Revista do Brasil, Braziléia, Brasil Ilustrado, Brasil Acadêmico, Brasil Social, Brasil Moderno, and Ilustração Brasileira10 - provides a clearer picture of the report's trajectory, that is, the growing number of references to it, its circulation in lettered circles, and the reformulation of its central themes. It was during this process of circulation and repercussion that, for example, the theme 'disease of the interior' stopped being solely a medical issue, acquiring a political nature as well (i.e., the urgent need to incorporate sertanejos) and, to a lesser degree, an economic one too, linked to the modernization of rural labor. The debate also expanded from the medical arena to embrace a cultural discussion about the tension between the traditional and modern lifestyles, which in turn was engaged in and, most importantly, honed by important intellectuals of the time (Lima, 1999).

Here it should be mentioned that the number of magazines in Rio de Janeiro was rising steadily in that period; alongside newspapers, they became the main vehicles for the day's cultural production and offered the best pay and best posts for intellectuals (Sá, 2006). It was during this period that the city's printers adopted technological improvements allowing them to increase output and introduce marked innovations in graphics, such as the use of color and photographs (Broca, 1975; Hallewell, 1985; Gomes, 1983).

In articles written for these magazines, physicians, scientists, and intellectuals like Monteiro Lobato, Catulo Cearense, Ronald de Carvalho, Roquette-Pinto, Afrânio Peixoto, Amadeu Amaral, José Maria Bello, Aloísio de Castro, Álvaro Ozório de Almeida, Juliano Moreira, Cardoso Fontes, Carlos Seidl, and Miguel Couto declared that Neiva and Penna had provided 'unprecedented' background information that would help to understand a part of the Brazilian population which had lived in neglect for centuries. It was therefore not surprising that a distinct society had developed in the sertão, with easily discernible traits, character, and mentality.

The earliest and most eloquent expressions to come out of São Paulo were the articles first published in the newspaper Correio Paulistano, in 1917, and later compiled into one text, in 1919, which was released in the Revista do Museu Paulista under the title "Uma grande jornada científica: a viagem de Neiva and Penna" [A great scientific undertaking: the journey of Neiva and Penna]. Its author, Afonso de Taunay, director of the Museu Paulista, said he was quite surprised to receive the originals of the unpublished report from his friend Arthur Neiva, conveying the results of a scientific voyage that, in his words, had traversed an area of Brazil as large as it was unknown. Calling the document the "standard of our day", Taunay listed his impressions of the "new things", as he put it, that Neiva and Penna had discovered about Brazil, particularly the fact that sertanejos were age-long victims of diseases and lived "isolated" from the rest of the country - not by geographic distance but because other Brazilians were completely unaware of their existence. He also emphasized that so little was known about the multitude of diseases in the sertão that Neiva and Penna had discovered completely new diseases, or "maladies of the sertão", as he defined them, citing as examples vexame and entalação (both now known to be clinical manifestations of Chagas disease; see Joffre Rezende, in this issue).11

In his text, Taunay makes frequent reference to the interest raised by the item "traditional therapeutics", since the report exposed the scarcity of resources which forced people of the sertão to rely on local flora as a means of combating disease. He was additionally struck by their reliance on healing prayer and on people with supernatural power. Quoting directly from the report - which Taunay took to be the gospel truth on the matter - he renews the narrative with arresting descriptions of the sertanejos who, in hopes of curing themselves of disease, would resort to biting the key to the sacristy, drinking the blood of a Guinea hen, or imbibing a mixture of alcohol, salt, pepper, garlic, kerosene, or tar from a pipe bowl, with lime added in. Re-writing the report in more direct language and making heavy use of more extreme examples of disease, poverty, and ignorance among the sertanejos, Taunay goes about defining the sertão as a place where both water and any notion of hygiene were in short supply, with humans and animals partaking of the same liquid; as the place where the 'caipira boçal' [uncultured yokel], wholly ignorant and unaware of his own problems and mistakes, was left in total neglect to destroy the earth "with his peculiar beliefs, fallacies, misunderstandings, and nonsense of all sort". The sertão, according to Taunay, comprised all those who were "isolated from civilization by distance [and] by government neglect, vegetating on arid lands, parasitic hosts to thousands of illnesses, poverty-stricken, and extremely ignorant" (Taunay, 1919, p.520).

Another striking facet of the text is Taunay's summary of the sertanejo's meager diet, often limited to flour. Since salt and coffee cost a fortune, they were rarely consumed. Under these circumstances, people appeased their hunger by using tobacco and, even more so, through excessive drinking. Residents of the sertão had few ways to illuminate their houses and only the most basic clothing. Children, for example, would walk about barefoot and naked. Added to all this were inadequate education, a non-operational mail service, an absence of any public lodgings like inns, early crime, and a nearly non-existent penal system, not rarely substituted by the stocks, castration, or murder. In closing, Taunay cites and endeavors to round out Neiva and Penna's proposed solutions, such as building rail lines and dams, providing health care, and fostering contact with the rest of the country so those living in the sertão would get a taste of progress while Brazilians on the coast would feel solidarity with them. He strongly urges people to read the report, because Neiva and Penna had uncovered new scientific facts and discovered new diseases of interest to scientists and doctors, while laying bare for all Brazilians 'unknown' aspects of their own country.

The Revista do Brasil, for example, published in São Paulo but enjoying a broad audience among Rio de Janeiro's men of letters - which in fact guaranteed its periodicity, longevity, and, most importantly, reputation as an outstanding forum for intellectual production and debate (Luca, 1999; Sá, 2006) - addressed the topic in a number of its departments, including Notes on Science, Men and National Matters, and the Monthly Review. Articles and speeches published in the daily papers were reproduced and commented on in the latter section of the magazine, where it is evident once again that the topic was the target of much attention in the Rio and São Paulo presses.

Starting in 1917, the report itself, with references to Neiva as its "distributor",12 was occasionally reviewed and analyzed in texts with rather suggestive titles, like "Os heróis do sertão" [The heroes of the sertão] (n.20, Aug. 1917, p.528-530), which compared Neiva and Penna to bandeirantes (colonial-era explorers), or "O saneamento do interior do país" [The sanitation of the interior of the country] (n.22, Oct. 1917, p.250-253), in which the author, A. Amaral, calls attention to the relations between rural labor and the more general topic of health. Besides Neiva and Penna, Amaral also cites doctor Miguel Pereira, for example, who, "thanks to the authors of the report", had been another to raise the cry about the tragedy of the sertanejo, an issue which he judged more critical and important than the world conflict then unfolding in Europe.

The topic continued to be debated in articles like "O Brasil esquecido" [The forgotten Brazil], by João Ribeiro (n.24, Dec. 1917, p.557-559). After reading Neiva and Penna, Ribeiro advocated the construction of roads into the sertão as a solution to Brazil's problems since, in his words, "they carry everything, even medicin". He went on:

I have read, for example, in this book [report] that almost everyone in an outlying municipality in the far corners of Piauí is illiterate: its inhabitants, without normal resources, without hygiene, without assistance, without schools, without trade paths, grow feeble, debilitated by goiter, fevers, hookworm, and nervous disorders, despite the excellent climate. However, this hapless population enjoys the providence of a deceitful, nefarious government that, shamelessly and by means of a state judge and four police soldiers, collects from them more than ONE HUNDRED contos de réis per year! ... One can certainly see that the hospital brings in some money.

The articles published in 1917 - one per month on average - tend to rewrite the report, expanding on its meanings and applying its ideas in new ways; in 1918, however, the articles average three a month and begin debating, correcting, or ratifying its proposed solutions, in a clear dialogue with the Liga Pró-Saneamento do Brasil.

The following two years (1918-1919) saw more articles, along with reviews of Belisário Penna's newly released Saneamento do Brasil (1918), a collection of his newspaper texts. With the report now published in Memórias do Instituto Oswaldo Cruz, the Revista do Brasil - to take one specific example - tended to discuss how to cure the diseases of the sertão, as well as how to potentially combat the sertanejo's 'spirit of routine', as we read in Mário Brant's "A valorização do brasileiro" [Valuing the Brazilian] (n.27, Mar. 1918, p.301-303). This discussion of the culture of a spirit of routine among sertanejos was likewise a topic in articles about the "gesticulations, and healing prayers, and physics, and powders ... from both-feet-on-the-ground therapeutics," as Monteiro Lobato put it in "O saneamento do Brasil" [The sanitation of Brazil] (n.27, Mar. 1918, p.303-305).

These publications reinforced certain images of life in the sertão as described in the report: it was a "procession of horrors" or "Dante's inferno"; the people of the interior lived in the hands of fate, and the only thing they knew of government was tax collection; the sertanejo was a "conservativ", burdened by a paralyzed psychological make-up, that is, overly attached to tradition and obstinately against progress, who would go about mumbling "é o jeito, é o jeito" [that's life, that's life] (n.39, Mar. 1919, p.314). The image of two Brazils persisted as well, as exemplified in José Maria Bello's "O problema do Brasil" [The problem of Brazil] (n.50, Feb. 1920, p.174-175). According to this article, more than disease and abandonment of the sertanejos, Brazil's big problem was the culture gap between the country's regions and their lifestyles, and so the absence of social ties should not be surprising. For Bello, while people in Rio and São Paulo enjoyed comfort and civilization, people in the interior were left to their own devices, living in degeneracy, neglect, backwardness, and melancholy. Renewing the image painted by Afrânio Peixoto in this same magazine - that the sertão began at the end of Rio's fashionable Avenida Central (Hochman, 1998) - Bello stated that just one half hour from the heart of Rio de Janeiro one no longer saw the polish of civilization but only the Dantesque inferno of people condemned by endemic disease, alcoholism, and illiteracy. In his words, outside the urban centers of Rio and São Paulo, one saw nothing but

[people with] anemia and hookworm, the wretched begging, drunks napping on the sidewalks and half-naked Negros who came to trade their quarter share of corn for a liter of firewater. Accursed Jeca Tatu! Trodden by nature, whose very luxuriance was hostile, forsaken by God and man, he knows nothing of life but animal sensations and facets of poverty. No longings, no ambition, excites his heart and inspires his soul; ignorance and, ensuing from it, vulgar superstition reduce the joy of his sensations to the poison of alcohol and the relations of the spirit to a childish belief in witchery and wandering souls. Comfort and human civilization lie five centuries away (n.50, Feb. 1920, p.175).

How, Bello asks, can this picture be from the same country and contemporary with Avenida Central, the Municipal Theater, the docks of Santos, the civilization of the coast, with its conferences, its justice, its gatherings in the Largo da Carioca, its academies, and all the "complicated workings of modern political societies"? According to his equation, the problem would be resolved not only through sanitation but above all through instruction, so that sertanejos would at last see themselves as an integral part of the soil on which they were born.

The magazine's texts generally echo the report in expressing "amazement" over the incredibly high rates of disease in the interior and the state of abandonment in which the sertanejos lived: "hopeless beggars" (n.52, Apr. 1920, p.365-366), "the marginalized, lamentable ruins of multiple, decimating endemic diseases, catalogued on nosological tables and held in disregard or criminal indifference by government leaders" (n.53, May 1920, p.87). This is also said about the report: "invaluable book that will stand as a landmark in this country owing to the large number of consequences it brought about. All of today's national initiatives stem from this unpretentious report, whose prime merit lies in telling the whole truth" (n.43, Aug. 1919, p.358-359). Or, further, "the most eloquent testimony to our backwardness, our laxness and ineptness, in everything that has to do with progress" (n.48, Dec. 1919, p.303-304).

In the 1920s, the topic continued to appear in texts like Luiz Araújo Correa de Brito's "Tradição e progresso" [Tradition and progress] (n.54, Jun. 1920), which discusses how Brazilians could, in the author's words, keep progress from being the enemy of tradition in Brazil. A similar discussion shows up in "Beatos e cangaceiros" [Holy men and social bandits], a review of Xavier de Oliveira's book of the same title. Relying on elements of the Neiva-Penna report, this book put forward that cangaço - a kind of social banditry typical of Brazil's sertão in the early twentieth century - could also be considered "a disease endemic to the sertão", attributable to the ignorance bogging down the sertanejos and to the absence of formal justice, further deepening what he called the "gap of centuries of civilization between those living on the coast and in the interior" of Brazil. Reliance on tradition and its "folk remedies", political ignorance, and resistance to progress continue to claim space in Luiz da Câmara Cascudo's "A humanidade de Jeca Tatu" [The humanity of Jeca Tatu] (n.57, Sep. 1920, p.84-85), where the author stresses that Jeca Tatu was far from a mere figment of Monteiro Lobato's imagination. He pointed out: "Jeca the conserver of long-time traditions, Jeca the nomad, mistrustful, setting fire to a forest to get rid of a bit of stubble, Jeca using the prodigious fertility of the land as a natural refuge for his slothful disease - he exists and is our contemporary".

The verdant nature seen by romantic literature, the region's climate, and the bovarism of coastal society were associated with the report too, as was immigration, systematically. Other repeated themes were so-called traditional therapeutics and the political manipulation of the placement of rural prevention posts, which, according to the authors of these magazine articles, would end up increasing the rural population's alleged resistance to government presence in more distant areas. Further tied to the report were the themes of education and instruction, regarding matters like recommendations on building latrines and open sewers and how to combat worm diseases more effectively.

The following years and issues of the magazine saw the inception of the debate about the relations between sanitation and rural labor, which soon detached itself from references to the report and gained autonomy as a discussion about the national question. Yet in the 1930s, the texts continued to use the report's hardest-hitting images, mentioned earlier, though without direct citation of the document and with decreased frequency (competing as they did with topics related to the Revolution of 1930 and the post-1937 Vargas dictatorship known as the Estado Novo). Disease is still recurrently associated with the world of labor, and references to the image of the two Brazils persist, with the coast at times defined as 'modern' and the sertão as 'backwards' or, at other times, the coast as foreignized, artificial, and Europeanized and the sertão, authentic and genuinely national. In addition, we find articles about Brazil's colonial heritage, nomadism, and the weak social bonds between sertanejos, along with the absence of points of identification between Brazilians. Likewise common were debates on government initiative and proposals of educational assistance that would, for instance, do away with "irrational, backward" land use and optimize work in the fields.13

As we can see, the articles that commented on, discussed, or re-appropriated the report's themes were nationalistic and propagandistic in tone. But it should be pointed out that a topic that was quite secondary in the text published by Memórias garnered much attention in its repercussions: the so-called 'two-feet-on-the-ground therapeutics', an image meant to sum up the spirit of routine, stark poverty, 'realism', and absence of health care for sertão dwellers. In these discussions, 'two-feet-on-the-ground therapeutics' became the quintessential term for describing, and chief means of overcoming, the sertanejo's "five centuries of backwardness" (an image found in the report) vis-à-vis the country's coastal dwellers.


The reaction of the 'diseased sertão' and the defense of Central Brazil

The instigative article published in Correio da Manhã on October 23, 1916, brought to the public eye the image of Brazil as an 'enormous hospital'. As we have seen, many doctors and intellectuals in Rio de Janeiro and São Paulo joined in the chorus. But in Goiás - one of the Brazilian states making up what was then called the diseased sertão, both geographically and symbolically - a single sentence from the same article simply inspired creation of the magazine A Informação Goiana (1917-1935), as per the statement made in the editorial to the first issue14, released on August 15, 1917: "Now that the research of Carlos Chagas and Arthur Neiva, as painstaking as it is brilliant, has revealed this Brazilian sertão as it appears in the eyes of this scientist and this physician, we can judge in what a predicament we would have found ourselves had we moved the site of the federal government to the Planalto Central before completing the colossal task of sanitizing the vast Brazilian sertão". The magazine, edited by physicians from Goiás and members of the military who had taken part in the Comissão Exploradora do Planalto Central do Brasil - the Cruls Commission mentioned earlier (1892-1893) - was founded as an instrument that would provide a systematic critique of the Neiva-Penna report and a defense of Central Brazil's healthiness - a "medical scientific conclusion" endorsed by members of the commission called to bear witness, in the pages of the periodical, against the idea of Brazil as an 'enormous hospital'.

Founded by two native sons of Goiás, Antonio Americano do Brasil, a physician educated in Rio de Janeiro, and Henrique Silva, a member of the military and of the Cruls Commission, the monthly magazine intended to publicize the "central-most and least known" state in Brazil.

With articles also contributed by Capistrano de Abreu and Miguel Calmon, A Informação Goiana addressed a number of topics, including the local economy and politics. Yet as the debate on sanitation of the sertão intensified in the federal capital, the medical tenor of its articles intensified as well. As mentioned above, one of the most hotly discussed topics was of course the Neiva-Penna report, contested in great depth. According to the magazine's editors and contributors, the two Manguinhos scientists were "the most tireless heralds in defaming the things of Goiás" ("Em favor de Goiás. Assunto sanitário", Aug. 1920, p.3). The magazine in fact presented itself as an initiative by "country doctors" ("O saneamento do hinterland", Aug. 1918, p.9) in their battle against "the official science of Manguinhos"- using the name by which the Instituto Oswaldo Cruz was then known ("A ciência oficial no Brasil", May 1918, p.131) - in an effort to revert the characterization of people from Goiás as "tripanogoianos", a reference to the scientific name of Chagas disease (American trypanosomiasis), or as "the most polished examples of the worthless Jeca-Tatus" ("Em favor de Goiás. Assunto sanitário", Aug. 1920, p.3).

Particularly in the 1920s issues, the Neiva-Penna report was heavily criticized and often associated with another scientific report mentioned earlier, written by doctor Antonio Azevedo Pimentel, a physician with the Cruls Commission, who in the late 19th century had guaranteed that Goiás was one of the healthiest regions in all Brazil. Doctor Pimentel himself and doctor Francisco Ayres da Silva, another physician from Goiás, were among the magazine's most steadfast contributors. They contended that the Planalto Central was an extremely wealthy region due to its ores, vegetation, cattle pastures, fish, and hot springs and also "extremely healthy", a place where, for instance, there were no signs of tuberculosis, Spanish flu, or paludism (malaria).

In addition to denying that the sertão of Goiás was an "enormous hospital," both doctors - along with the periodical's editors and other contributors - were of one voice in claiming that the region's main problem was the absence of transportation and communication with the rest of Brazil. In their view, Goiás suffered from troubles caused by its geographic situation and not a lack of sanitation.

That Memórias would publish the Neiva-Penna report in a way that seemed to suggest confirmation of a "scientific truth", following so much debate and controversies in newspapers and magazines, offended them especially and raised the temperature of the periodical's articles, as we can see in the two illustrative examples below, one of which refers to an article published in Correio da Manhã on October 23, 1916, and the other, to the 1918 publication of the report in Memórias, in which Oswaldo Cruz is identified as being responsible for the delay in the report's publication:

In December 1916, the Correio da Manhã stated that we would be in a fix if the capital of Brazil were some day to be located in the area of the Planalto Central, as determined by the legislative drafters of the Constitution.

And it was said that the scientific notables of Manguinhos had just discovered paludism, leishmaniosis, Chagas disease, and other dangerous illnesses there.

The Director of this magazine then took the opportunity to address a letter, that same day, to that morning newspaper, disagreeing in composed terms and stating that none of these physicians could have conducted research in this location nor in the 14,400km2 area chosen for the capital of Brazil.

After having published the letter, the editors of our sister paper asserted that the epistler was laboring under a false impression, for Drs. Arthur Neiva and Belisário Penna had been there with the Manguinhos Institute Commission.

In a new letter, our Director proved that these physicians had not been in the aforementioned locale and that they had manifested themselves in regard to its unhealthiness based solely on hearsay and in order to join the chorus of those who were raising an outcry about the sanitary state of the Brazilian hinterland [in English in the original].

The Correio resolved not to publish this evidence, because it was not in their interest to destroy the specious declarations made previously nor to refute the emissaries of Manguinhos ... who remained silent.

But the most sensational Scientific Voyage through the North of Bahia, southwest of Pernambuco, south of Piauí, and from north to south of Goiás, by Drs. Arthur Neiva and Belisário Penna, has just come out in the Memórias do Instituto Oswaldo Cruz, confirming once and for all that on their excursion these young scientists did not so much as glimpse the borders of the 14,400km2 area demarcated by the Cruls Commission for the future Federal District of the Republic! How then could these hasty travelers conduct scientific research of the place chosen for the future capital of the Union, given that this place is found in the center of said geographic area?

Remembering what guides us here, we are not moved by second intentions but rather so as not to forsake the commitment we assumed in the article which introduced this magazine: "to refute with precise facts and figures the unfair appraisals of the land of Goiás that have so often been noised abroad in books and in the press" ("A verdade sempre aparece", Feb. 1918, p. 80).

The much proclaimed writings on Central Brazil, published in recent days, and penned by certain travelers already lauded as young Brazilian scientists, wholly justify the title of these lines. ... These contradictory, implausible passages fill pages of the bold "Scientific Voyage". And thus the unforgettable sanitizer of Rio de Janeiro was correct in not allowing the work of Misters Arthur Neiva and Belisário Penna to appear in the "Memórias do Instituto Oswaldo Cruz." Our wise countryman consigned it to his desk drawer; and perhaps those closest to him may give his reasons" ("Viajores - mas superficiais observadores", Mar. 1918, p. 91).15

The report's publication in Memórias reignited indignation over the October 23, 1916, article in Correio da Manhã. In this process, the magazine's contributors not only challenged the report's general line of interpretation (the idea of a 'diseased sertão') but also made a point of listing alleged - and trifling - errors in Neiva and Penna's text. For example, they had supposedly assigned incorrect meanings to certain linguistic regionalisms; they had cited fish from regions of Goiás that they hadn't even visited, while at the same time omitting any mention of the obligatory vaca mocha, a very common breed of dairy cattle throughout the state, which they most certainly would have seen had they covered the region carefully. According to the magazine, the very quantity of "errors" (but the vaca mocha particularly) was a sign that Neiva and Penna had substantially exaggerated the conclusions of research in Goiás, a state about which they in point of fact knew little.

Out of these criticisms was born an absolutely non-stop, systematic campaign that stretched from 1919 to 1935, in which entire issues of the magazine first underscored the "region's isolation" and then resolutely defended moving the federal capital to the interior, to the Planalto Central, to Goiás, as already stipulated in the 1891 Constitution itself, a fact the editors repeatedly harped on and an idea they strongly advocated.

They guaranteed that once the capital had been established in Goiás - which was the "true heart" of Brazil, as the most central spot in the nation's territory, between Pará and Rio Grande do Sul - it would spread progress and civilization throughout the interior. They also guaranteed that in its fights to see the capital transferred, the magazine was "uncovering" and revealing the true riches of Goiás to other Brazilians, as the Rondon Commission had done in Mato Grosso some years earlier. While staunchly defending the transfer of the capital as a pro-sertão patriotic campaign (a campaign, according to them, which was actually more authentic and nationalistic than the public health movement they opposed), they prompted others to take up and continue the cause, including the periodicals O Sertão (1921), Correio Oficial (1911-1921), Goiás (1911-1922), Jornal de Goiás (1920-1921), O Lidador (1909-1917), Nova Era (1914-1919), A Imprensa (1914-1932), O Democrata (1923-1927), Voz do Povo (1927-1934), and Brasil Central (1937-1942), together with the Sociedade Goiana de Geografia e História [Goiás Geography and History Society], founded in 1921, and the Associação Universitária Goiana [Goiás University Association], created in 1932. In 1919 they also devised and submitted to the Senate draft laws in favor of moving the federal capital ("Um projeto apresentado no Senado", Dec. 1919, p.59) and to the commission of the Constituent Assembly as well, chaired by Afrânio de Mello Franco, then minister of Foreign Affairs ("O que se debata na comissão elaboradora da futura constituinte", Nov. 1932, p.31; "Em defesa da localização da nova metrópole no Planalto Central", Feb. 1933, p.53; "A mudança da capital da República: projeto de lei apresentado à Assembléia Constituinte", Nov. 1933, p.25). Additionally, they managed to put the topic into debate at the 6th Brazilian Geography Congress, held in Rio de Janeiro in 1920 ("Mudança da Capital da República. VI Congresso Brasileiro de Geografia", Feb. 1920, p.85).

Although the A Informação Goiana had to quit circulating because of financial reasons and the death of its key promoter, major Henrique Silva, its articles helped put the question of transferring the federal capital to the Goiás sertão back on the Brazilian political agenda (with this transfer in fact made in 1960, with the construction and inauguration of Brasilia). To illustrate this point, suffice it to say that works on the history of the debate in favor of moving the capital have depicted the magazine's editors and contributors as the "pioneers of Brasilia" (Vasconcelos, 1992).



Since the 1980s, important analytical studies in the social sciences have explored the ramifications of the rural sanitation campaign within public health policies and in the debate on national identity (Castro-Santos, 1985, 1987; Hochman, 1998; Lima, 1999, Lima, Hochman, 1996). The relevance of this topic to our understanding of the history of Brazil in the first half of the 20th century has been reinforced by research focusing primarily on the creation of public health institutions within an analysis of the process of nation- and state-building in Brazil, based on the hypothesis that from 1910 to 1960 the issue of health was central to the enforcement of public policies meant to extend citizenship and government authority in Brazil (Lima, Hochman, 1996).

The analyses from the 1980s and 1990s cited in these pages showed where the potential lay for intellectual and political mobilization and support for the rural sanitation movement. This article has endeavored to deepen the discussion by investigating some of the criticisms and opposition triggered by the debate, as well as the ways in which the regional, political, and cultural themes attached to the discussion of disease as a metaphor of national identity continued their interplay for so long. In addition to my intent to help understand the presence of themes from this report in texts by Florestan Fernandes, Emílio Willems, Antonio Candido, and others in the 1940s and 1950s (Lima, 1999), I have explored how the controversies and dialogues published in the day's magazines influenced this long-running interpretation of Brazil's dilemmas. I have argued that this interpretation was only so enduring because the related debates were nourished by medical magazines but also and even primarily, for two decades, by magazines in the letters and sciences.

Furthermore, to reinforce an argument that has been criticized in the historiography of the sciences in Brazil, I have endeavored to show how the so-called pre-scientific scholars - that is, Brazilian essayists and minor authors whose intellectual production preceded the foundation of the country's universities - in fact played a major role in shaping and spreading the ideas consecrated in the 1930s and 1940s. Because Brazilian institutions were still fledgling at the time, a good part of their production as well as the promotion and dissemination of their ideas occurred through the press, above all magazines (Sá, 2006). In this regard, we must remember the era's printing problems and slow distribution of books, which lent the periodical press a marked intellectual importance, with its broader and faster circulation and more affordable products.

Based on this examination of these works and initiatives, I would argue that the discussions raised by the Neiva-Penna report, especially those regarding traditional therapeutics, laid the ground for the 1920s and 1930s intellectual discussions to reinforce aspects of the Brazilian social environment and political institutions and, further, for the analyses of the 1940s and 1950s to gain a sharp anthropological tenor, with an emphasis on issues of social heritage and culture (Lima, 1999). Within this framework, 'disease' and 'spirit of routine' became recurrent intellectual interpretations and representations of Brazil. Evincing the power of these ideas, we have seen how Goiás mobilized in opposition to them, engaging in a campaign to have the federal capital transferred to the Planalto Central. More than 'health', their demand was for 'change', and their conviction, that once the sertão had become the federal capital, it would go down in the history of Brazil.



* This article is the product of research undertaken as part of the project Uma Viagem, um Novo Brasil: o Relatório Científico de Arthur Neiva e Belisário Penna e sua Repercussão na Produção Intelectual Brasileira (1916-1940) [A Journey, a New Brazil: Arthur Neiva and Belisário Penna's Scientific Report and its Repercussions in Brazilian Intellectual Production (1916-1940)], conducted at the Graduate Program in the History of the Sciences and Health, Casa de Oswaldo Cruz, Fundação Oswaldo Cruz, during 2005-2008 with a Prodoc/Capes graduate fellowship. Capes' financial assistance made it possible to hire Ludmila Gama, Tamara Rangel, and Samara Mancebo, who collected and organized information for the study. PIBIC-CNPq fellow Ingrid Casazza surveyed data and researched the magazine Informação Goiana. I would like to thank all my colleagues with the project Brasil Imenso Hospital, with which this research has ties, for the fruitful exchange of ideas, especially Nísia Trindade Lima, Simone Kropf, and Gilberto Hochman. I also extend my thanks to the anonymous peer reviewers who offered suggestions that were almost entirely incorporated into the final version of the text.

1 This interest is evidenced not only in books and academic theses but likewise by the publication of special issues dedicated to the theme of voyages in important periodicals and by the many symposia and exhibits on the relations between science, field diaries, and representations of Brazil, including, for example: Viagens e Viajantes, Revista Brasileira de História, v.22, n.44, 2002; Ciência e Viagens, História, Ciências, Saúde - Manguinhos, v.8, supl., 2001; the colloquium Science, Civilization, and Empire in the Tropics, sponsored by the Museu de Astronomia and the Universidade do Estado do Rio de Janeiro, in 2000; and the exhibit The Science of Travelers: Nature, Population, and Health in 500 Years of Interpretations of Brazil, sponsored by the Casa de Oswaldo Cruz/Fiocruz, also in 2000.

2 A free translation is provided in this article of the quoted titles and others that appear in different languages.

3 This is Roger Chartier's image (1998). I owe this indication to one of the anonymous peer reviewers of this article.

4 Report of the Ministério dos Negócios da Indústria, Viação e Obras Públicas, 1892-1893. Available at: Accessed on: Mar. 26, 2008.

5 Report of the Inspetoria de Obras Contra as Secas. Ministério de Viação e Obras Públicas, 1911-1912. Available at: Accessed on June 21, 2007.

6 Report of the Inspetoria de Obras Contra as Secas. Ministério de Viação e Obras Públicas, 1911-1912, op.cit.

7 Ministry documentation, in the hands of the National Archive, contains no copy of the report nor any mention of its being sent to the Inspetoria de Obras Contra as Secas. Nor do ministerial reports make any reference to the report's submission. For information indicating that the text of the report was finalized in 1915, see the article by Simone Petraglia Kropf in this issue.

8 Simone Kropf's research on Chagas disease (2006) shows that in the latter half of the 1910s the scientific interpretation of what were then called rural endemic diseases was under dispute. Especially important in this debate was the symptomological profile of Chagas disease, which its discoverer had defined in rather broad strokes; even the mentally ill and those with goiter were seen as suffering from Chagas disease. The target of attacks and subject of many medical scientific clashes (involving both Brazilian and Argentinean physicians and scientists), this clinical profile transformed Chagas disease into the great 'scourge of the sertão' back then. Kropf suggests that this scientific dispute may have delayed publication of the report, since Chagas was to present two articles defending himself from his critics in the same issue of Memórias. Nevertheless, it should be pointed out that publication delays were not unusual in early twentieth-century periodicals. The annals and bulletins of Brazil's National Academy of Medicine, for instance, often came out late.

9 Gil Vidal - pen name of Leão Veloso Filho - was the paper's first editor-in-chief (Leal, n.d.).

10 Space limitations prevent me from commenting on all magazines researched. I chose to explore the longest-running periodical of that time, Revista do Brasil, where the debates could be followed through a number of consecutive issues. This publication served as a kind of 'case study' in this article, since my proposal was to assess and demonstrate the ways in which the themes of the Neiva-Penna report moved beyond medical circles to be discussed by intellectuals from different backgrounds. Further on this topic, see Luca, 1999.

11 Further on this topic, see Nísia Trindade Lima's article in this issue.

12 Of special note among these texts: "Notas à margem do relatório do dr. Arthur Neiva sobre o Norte" (Revista do Brasil, n.37, Jan. 1919, p.59-71; n.38, Feb. 1919, p.196-201; n.39, Mar. 1919, p.311-314; n.40, Apr. 1919, p.462-465; n.41, May 1919, p.65-69; n.42, Jun. 1919, p.169-176; n.48, Dec. 1919, p.301-309), which affirms Neiva's importance as an 'independent advertiser' of the report, even after its publication in Memórias. Given the themes mentioned or cited in these notes and other magazine articles, we presume that the version distributed by Neiva was identical or very similar to that published in Memórias.

13 These debates appear in issues 67, 69, 71, 74, 82, 83, 85, 87, 89, 93, 94, and 102 of Revista do Brasil.

14 The magazine was located by reading Magalhães, 2004.

15 As we know, the report was in fact published in Memórias, and we have no research information that would allow us to speculate about Oswaldo Cruz' alleged interference to delay publication.



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Submitted for publication on April 2008.
Approved for publication on July 2008.



Translation by Diane Grosklaus Whitty

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