Presentation

Presentation

The articles in Dossiê História, Assistência e Saúde (The History, Assistance and Health Dossier) were original delivered as lectures at the International Seminar entitled State, Assistance and Philanthropy, held in Rio de Janeiro in November 2009¹. The main aim of this event was to promote debate on the current trends in the established historiography concerning the theme of assistance and encompassing a diversity of related perspectives and approaches.

It is praxis for historiography por – especially that which deals with the emergence of a public health system por – to treat debate on aid, assistance and health care as a dimension of the Welfare State and its relationship with traditional models of public and private assistance. Aligned with that perspective are studies related to the professionalization of assistance and care, seen as the new configuration of health care was propitious to the advent of certain professions (creating sanitarians, public health nurses, sanitary educators, social workers) and the redefinition of the spheres of activity of traditional health professionals. More recently, gender, ethnicity and so-called ‘life stages’ (infancy, youth and old age) have likewise become fundamental variables in our understanding of the modern forms of health care and social welfare.

The themes of assistance and the protection of physical (and spiritual) well-being are also essential topics in studies on the religious, scientific, professional and philosophical values that guide actions intended to promote forms, commitments and pacts of solidarity and mutual assistance among different groups and social classes. As a historically-situated cultural practice, assistance has created material and symbolic resources of its own that are now clearly visible in extraordinary situations, such as epidemics, natural disasters and war. At these times of social disorganization and anomie, social assistance practices become essential to the preservation of life.

Finally, the history of health care also suggests reflection on a special type of material culture that translates into installations and facilities (hospitals, asylums, clinics, homes) tailored to those specific ends, establishing a correlation between architecture and urbanism and the religious values, scientific knowledge or political ideologies that orient the care practices involved.

The articles selected for inclusion in the History, Assistance and Health Dossier are representative of the trends touched upon here in examining these themes from inventive and healthily heterodox approaches.

Laurinda Abreu proposes a new approach to the construction of the Portuguese welfare system between the 16^th and 18^th Centuries, which was orchestrated by the Portuguese Crown with the support of the local elites. In demonstrating how the Crown created a formal network of welfare institutions and services, the author widens the discussion on the responsibility of the modern Portuguese state to promote and professionalize health care, expanding on a remit traditionally restricted to the control of epidemics. Considering the local repercussions of the Portuguese welfare paradigm, the discussion proposed here serves as a point of reference in reading the articles in this dossier, which basically deal with the construction of the welfare network and the professionalization of health care.

The issue of the absence/presence of the State in the process of institutionalizing health care in the state of Rio Grande do Sul, broached with originality in an article by Beatriz Weber, leads to a different perspective on the organization of medical assistance in the early 20th Century, seen through the prism of competition between different types of "curative art". Inspired by the political precepts of positivism, the constitution of the Gaúcho Republic, promulgated in 1892, provided for freedom of practice in the field of the curative arts. The author’s argument leads to the conclusion that, in the specific case of Rio Grande do Sul, the organization of a health care system derived from the Gaucho physicians’ success in monopolizing these "curative arts" at the expense of the quacks, faith-healers and midwives. In this case, it should have been up to the State to ensure professional freedom in the field of health-care service provision.

Softening the hegemonic role of physicians in the provision of health care services, Verônica Pimenta Velloso explores the professional associative organization of chemists in Imperial Rio de Janeiro. The article draws attention to the role chemists played in rendering health services to the population, moving beyond apothecary to actually prescribing and even administering certain therapies (technically the preserve of trained physicians). This overlapping of the professional practices of chemists, doctors and other practitioners of "the curative arts" in providing health care services generated alliances and conflicts that required state intervention in the form of professional and sanitary legislation that guaranteed the chemists autonomy before the medical class and gravitas before the lay public.

Taking as its guiding thread an analysis of the professional and academic careers of Antonio Fernandes Figueira and Luiz Barbosa, Gisele Sanglard and Luiz Otávio Ferreira retrace the process of institutionalization of pediatrics and child care in Rio de Janeiro during the First Republic. Their analysis examines the association between these doctors and the Rio elite, revealing a whole network of personal, political and institutional ties that involved the issue of pediatric training at the Rio de Janeiro Medical Faculty and the creation of a child care network. For the authors, at the same time as these physicians legitimized their standing as specialists in childhood illnesses, the role of lay philanthropy in health care underwent a re-signification, with the construction of new posts for health attendance. Sanglard and Ferreira’s singular approach reveals the visceral association between the institutionalization of pediatrics and child care, albeit without ignoring the disputes and conflict that marked this process.

An article by Márcia Barros da Silva returns to the discussion of the local repercussions of the Portuguese welfare model in examining the health care provided at the Santa Casa de Misericórdia hospital in São Paulo in the late 19^th and early 20^th Century. Based on consistent analysis of data on the origin, gender and age-group of the sick treated there, the institutions by which they were referred, and the sources of the institution’s funding, the author identifies the inauguration of the new hospital in 1885 as a milestone in the way the population of São Paulo would receive medical care. Her text brings out the intertwining of the public and the private in the management and organization of clinical health care and relates it to urban transformations in the city and the reconfiguration of medical practice.

In covering diverse cultural contexts over a broad spectrum of time, the organization of this Dossier aims to raise questions on modern forms of assistance and social welfare whilst promoting the findings of research groups working with the history of health care and expanding debate on the theme. We invite you to join us. Have a good read!

Belo Horizonte, June, 2010.

Gisele Sanglard

Luiz Otávio Ferreira

Maria Martha de Luna Freire

Maria Renilda Nery Barreto

Tânia Salgado Pimenta

(Editors)

1

The

Seminário Internacional Estado, Assistência e Filantropia was held in Rio de Janeiro from November 16 to 19, 2009 and was supported by Capes and Faperj.

Publication Dates

• Publication in this collection
  31 Jan 2011
• Date of issue
  Dec 2010