Juliano Moreira: the black Brazilian who greatly influenced the modern school of Neurology in Brazil

Abstract Juliano Moreira was a black Brazilian physician, well recognized for his role in the foundation of scientific psychiatry in Brazil; however, little is known about his influences on modern Neurology. Our aim is to highlight Moreira’s importance in the field of Neurology and his role in the development of scientific and medical societies in Brazil. We describe his contributions from his doctoral thesis in 1891 to his 27-year tenure as the director of the National Hospice for the Insane. We also review Moreira’s role in the foundation of societies including the Brazilian Academy of Sciences and the first Brazilian journal dedicated to Neuropsychiatry, concluding that Moreira was one of the most important influential figures for the development of Neurology in Brazil. In addition to his influences on various medical fields, Moreira distinguished himself as an impactful citizen who fought against racist and xenophobic medical theories of his time.

study of syphilis which profoundly influenced his future medical interests. He graduated the following year at the age of 19, with a thesis on syphilis, refuting climate and racial factors as determinants of disease severity 3,4 .
The advances in Moreira's learning regarding mental illness resulted in his appointment as assistant chair of Clinical Psychiatric and Nervous Diseases. In 1896, Moreira competed for a position as substitute lecturer in the Nervous and Mental Illness Department of FAMEB. Perhaps the best way to elucidate the situation Moreira faced would be to quote the man himself: "I intend to conquer the seat of substitute for the chair which is why, recognizing myself devoid of the external gifts that attract the favors of chance, I will never be at ease during the exciting and sometimes spectacular procedures of a tender" 1,5 . At the age of 24, not only was Moreira approved for the position, but he secured first place, receiving the maximum score from the judges. In 1903, he took charge of the National Hospice for the Insane (NHI) in Rio de Janeiro, which he directed until 1930 2,6 .
Moreira is well recognized within the field of psychiatry in Brazil; however, his influence in modern Neurology is little discussed. Hence, our aim is to highlight Moreira's importance in the field of Neurology and his role in the development of scientific and medical societies in the country.
Moreira first demonstrated his inclination towards Neuropsychiatry in his doctoral thesis "Etiology of Early Malignant Syphilis" 3 . In this work, Moreira identified a gap in the study of syphilis related to the causes that made the disease more severe in some patients, and refuted the widespread theory that syphilis was more prone to transmission and malignancy in the tropics due to climate and racial factors 6 . On his 1896 thesis for the substitute lecturer position entitled "Arsenic Dyskinesia", Moreira described the neurological manifestations of arsenic poisoning 5 .
Moreira also contributed with his writings and role at Gazeta Médica da Bahia (GMB), one of Brazil's first scientific medical journals. From 1893, he published several articles on neurological consequences of syphilis and other nervous diseases 7 . Moreira became editor of GMB in 1896 and editor-inchief in 1901 7 .
From 1903 until 1930, Moreira was the director of the NHI, considered as the place where the practice of neurology began in Brazil 2,6,8 . During this period, the NHI underwent a series of renovations with the creation of new pavilions. Of note, Antônio Austregésilo, the regarded precursor of modern Brazilian neurology, was appointed in 1904 as the person in charge of one NHI pavilion 9 .
Another of Moreira's important contributions was the creation of the journal "Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins" in 1905; the first Brazilian publication specializing in Neuropsychiatry. Later, the journal changed its name to "Arquivos Brasileiros de Psiquiatria, Neurologia e Medicina Legal" following the foundation of the Brazilian Society of Neurology, Psychiatry, and Forensic Medicine in 1907 of which Moreira was the director until 1933 10 , and to "Arquivos Brasileiros de Neuriatria e Psiquiatria" in 1917 11 which during five decades had wide-ranging influences on Brazilian Neurology.
Moreira was one of the founders of the International League Against Epilepsy in Budapest in 1909 12  Despite all his medical contributions, Moreira struggled to be accepted as a black authority in a racist society in a time just 10 years after the abolition of black slavery in Brazil. In his doctoral thesis, Moreira rebutted the concept of race hierarchy and that native and black people were negative factors of miscegenation 4 , openly criticizing implicit racist theses on the inferiority of black people as being more vulnerable and severely affected by the disease 4 .
Some authors consider that the neuropsychiatric scientific movement was initiated in Brazil by Moreira, since  before him, miscegenation and heredity were considered to be the primary sources of most mental illness 13 . Moreira scientifically refuted xenophobic theories which stated that some mental and infectious diseases were climate-related, attempting to use those pathologies to prove a somewhat biological inferiority of non-white people 14 .

FiNal reMarKs
Moreira greatly influenced psychiatry and neurology in Brazil. Of note, Antônio Austregésilo worked under the direction of Moreira at NHI, participating in societies, academies and journals alongside him. Therefore, if not the founder of "Visit to the hospice whose director is a mulatto and a particularly virtuous person. With him, Brazilian lunch with lots of pepper and a German woman. Then, visit to ministers, thank God that most of them were absent...". We present the English translation of Einstein's diary entry regarding the meeting with Moreira on May 11, 1925. Source: ©The Hebrew University of Jerusalem, Israel. Digital image photographed by Ardon Bar Hama. The authors own the right to reproduce this material in the context of the present publication. scientific neuropsychiatry, he is certainly one of the most important influential figures for the establishment and development of Clinical Psychiatry and Neurology in Brazil.
We conclude by quoting this great black Brazilian's first speech as a substitute lecturer at the age of 24, when Moreira said, "In days of more light and humanity, the external fog will no longer come to the line of account. " We hope these days of more light might come soon.
acKNoWleDGMeNts First, we have to thank professor Ronaldo Ribeiro Jacobina for his kind and careful reading of this manuscript, providing important insights to the authors, and for the inspiration to write this historical note, greatly based on readings of Jacobina´s works on Moreira´s life. We also thanks professor Maria Luiza Saraiva-Pereira and professor Alan Alves Brito for the counseling in the proper usage of terms to tackle systemic racism in science in the final version of this manuscript. We should mention that the conception of this article could be seen as an example of serendipity. During a mentorship program in the beginning of the COVID-19 pandemic, a group of medical students and a lecturer of the medical school of Universidade Federal do Rio Grande do Sul, who coincidentally is a neurologist, were developing a storytelling activity about eminent Brazilian scientists from the past. During the activity, we "discovered" Juliano Moreira as a very important Brazilian scientist in ABC files (as we have discussed in the paper, Moreira was one of the founders and former president of this important scientific academy), and we were surprised about his contributions to the field of neuropsychiatry and neurology, and by the fact that none of us from a University in southern Brazil had ever heard about him and his role in neurology. Thereafter, our interest in Moreira´s work rose with time while reading his works and works about him. We discussed our idea for writing this paper with Ingrid Lorena da Silva Gomes, a young physician recently graduated from Universidade do Estado da Bahia, who was familiar with Moreira´s biography, and she joined us in the journey that culminated in the current paper.

sUPPleMeNtarY Material
The following material is available online for this article: S1. Search strategy for the historical note.