“Of pearls and stars, he made the verse”: the literary career of the founders of Brazilian Neurology

ABSTRACT In the beginning of modern Neurology, between the 19 th and the 20 th centuries, neurologists often assumed simultaneous positions of intellectual prominence and gained significant cultural credentials. Not only observers and admirers of music, literature, and the fine arts, many neurologists and neuroscientists worldwide developed significant cultural careers. When studying the careers and lives of the founders of Brazilian Neurology, one finds only sparse information on their cultural activities, which are often relegated to side notes. Therefore, the author aims to focus on the literary output of some of the most important early Brazilian neurologists, who excelled in poetry or longer written forms and were eventually immortalized by the Academia Brasileira de Letras : Antônio Austregésilo, Aloysio de Castro, Deolindo Couto, and Miguel Couto, contextualizing their artistic production in their respective academic lives.


iNtroDUctioN
In the early days of modern Neurology, in the transition between the 19 th and the 20 th centuries, physicians and scientists often assumed positions of intellectual prominence. Not relegated to the confines of a hospital or laboratory, they soon became members of the cultural élite -not only as observers and admirers of music, literature, and the visual arts, but also as musicians, writers, poets, and artists themselves. This was due to their social and economic context: as educated and wealthier professionals, they had the cultural apparatus and economic means to be dedicated part-time to other, non-medical activities. Alexander Borodin became one of Russia's most celebrated composers 1 ; William Somerset Maugham, one of the most famous writers of his generation 2 ; Thomas Monro not only painted but also sponsored artists, including William Turner 3 . Neurology was no exception: Santiago Ramón y Cajal wrote short stories under the pseudonym "Doctor Bacteria" 4 ; Charles Foix wrote poetry and plays 5 . There is sparse literature focused on the artistic activities of the founders of Brazilian Neurology, often relegating these efforts to sidenotes. Therefore, the author focuses on the literary production of four of the most important early Brazilian neurologists: Antônio Austregésilo, Aloysio de Castro, Deolindo Couto, and Miguel Couto.

aNtÔNio aUstreGÉsilo roDriGUes liMa (1873-1960)
From Recife, Antônio Austregésilo ( Figure 1A) rose from an impoverished background to the position of "Father of Brazilian Neurology". While a student at the Colégio das Artes, in Recife, he fell under the spell of Tobias Barreto, father of the "Condorism", before moving to Rio de Janeiro. A student of Francisco de Castro, he first devoted his studies to alienism, writing a thesis on the clinical features of delusions. He progressively gravitated towards Neurology and eventually became its first professor at Universidade do Brasil, as the Universidade Federal do Rio de Janeiro was then called 6 . The Austregésilo-Esposel sign, described with his assistant Faustino Esposel (1888-1931), consolidated his position in the collective conscience of aspiring neurologists 7 .
Simultaneously, he developed a distinctive literary voice, influenced by Symbolism; still in medical school, he composed poetry, often published under the pseudonym Antônio Zilo. Essays and literary critics soon followed: his clique, "Os novos", severely criticized Realism, Romantism, and Parnasianism, and vigorously defended French Symbolists and Decadents, including Arthur Rimbaud, Paul Verlaine, and Stephane Mallarmé. He wrote essays on Medicine and other subjects, poetic prose (Manchas, from 1898) 8 , poetry, and a novel, Almas desgraçadas (1950) 9 ; furthermore, many of his speeches were collected 10 . He was elected to the Academia Brasileira de Letras in 1914, as the third holder of the 30 th chair 11 . However, his style was controversial, often considered convoluted, which led to snobbish comments by literary critics.

aloYsio De castro (1882-1959)
Son of Francisco de Castro (1857Castro ( -1901, the aforementioned professor of Medicine at Universidade do Brasil, Aloysio de Castro ( Figure 1B) studied under his father and graduated with honors with a thesis on gait disorders; he also inherited the taste for the letters, art, and music from his father. After a season in the great Parisian neurological hospitals, he launched an outstanding career culminating in a chair at the Academia Nacional de Medicina 6 . Due to his contributions to the development of the discipline in Brazil, he became acknowledged as the "Father of Brazilian Neurological Semiology" 12 .
Nevertheless, his artistic production, often overshadowed by his magnificent academic career, is also impressive: poet, composer, and music critic 1 , he eventually became the third immortal of the 5 th chair of the Academia Brasileira de Letras, inheriting the position from Oswaldo Cruz in 1919. The discipline in which he excelled the most was poetry; his works include Rimário (1926) 13 , Os carmes (1928) 14 , Tendresse (1932, in French) and Caminhos (1945) 15 . One easily notes his esthetic conservatism and penchant for older forms, such as the sonnet.

DeoliNDo aUGUsto NUNes coUto (1902-1980)
From Piauí, Deolindo Couto ( Figure 1C) also developed most of his career in Rio de Janeiro, becoming closely connected to the Universidade do Brasil, where he would establish in 1946 the institute of Neurology that today bears his name. One of the founders of the Academia Brasileira de Neurologia, he was patron and president of the institution as well, and eventually became dean of the university and president of the Academia Nacional de Medicina 6,16 . The sixth occupant of the 11 th chair of the Academia Brasileira de Letras, Couto, unlike the aforementioned physicians, didn't devote himself to poetry. Instead, his literary accomplishments lie in collected essays and speeches. Vultos e Idéias (1961) 17 , for instance, combines keen insights into the nature of Medicine and Neurology with biographical anecdotes 18 . Other late writings are biographical analyses of scientists and physicians, such as Afrânio Peixoto (1976) 19 and Clementino Fraga (1980).

MiGUel coUto (1865-1934)
Miguel Couto ( Figure 1D), from Rio de Janeiro, became notable as the successor of Francisco de Castro at the university 6 . His dedication to Neurology and vigorous defense of education 20 , excitedly supported in notable orations that led him to the 40 th chair of the Academia Brasileira de Letras as its third occupant, are fondly remembered 21 . Coincidentally, Couto became physician to Machado de Assis, who struggled with epilepsy; as a sign of respect to the magnitude of the writer, Couto never accepted pay for his services 22 .
The many names that built Brazilian Neurology have laid a solid literary foundation as well. From poetry to essays and autobiographical texts, many are the contributions to our letters given by those who, first and foremost, were physicians and scientists. As Aloysio de Castro wrote: [He, in hardened, polished marble, From gods animated the august effigy And to monuments gave the fair line, In brass that remembers times gone by. He, on the desk, laid the art that Patiently adjusts the stones, these golden fabrics Sewed, He, from the cup, the sculpted Reliefs resewed, this gracious Image in panels, in masterpieces, In colors delineated in the polished mold; But He, the supreme artist, He the excellent Forms carved, in inspiration diverse, Of pearls and stars, he made the verse.] (Ars Suprema, Rimários, 1926, translated by the author) 13