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Juliano Moreira and the Gazeta Medica da Bahia

Abstracts

Recent studies of Juliano Moreira have emphasized his work in Rio de Janeiro (1903-1933), but the main objective of this article is to describe his contribution to the Gazeta Medica da Bahia in the period before that (1893-1903). It describes the evolution of this magazine, which served as a vehicle for original research of the Bahian Tropicalist School It presents Moreira?s output in the Gazeta, in which he emerges as a student of dermatology, syphilology and parasitology, having identified cutaneous leishmaniasis for the first time in Brazil. At that time, he also consolidates his reputation as a professor in neuropsychiatry, conducting clinical studies in the field, analyzing treatment models and proposing changes in medical treatment. It highlights the importance of Moreira not only as a collaborator on the Gazeta during a decade, but also as an editor, as well as his role as chief editor (1901-1902).

history of psychiatry; medical press; leishmaniasis; Brazil


Estudos recentes sobre Juliano Moreira enfatizam sua obra no Rio de Janeiro (1903-1933), mas o objetivo central deste artigo é descrever sua contribuição na Gazeta Medica da Bahia, em período anterior (1893-1903). Descreve a trajetória dessa revista que serviu de veículo para as pesquisas originais da Escola Tropicalista Bahiana. Apresenta a produção de Moreira na Gazeta, em que ele surge como estudioso nas áreas de dermatologia, sifilografia e parasitologia, tendo identificado, pela primeira vez no Brasil, a leishmaniose cutâneo-mucosa. Nessa época ele também se afirma como professor em neuropsiquiatria, passando a realizar estudos clínicos na área, analisar modelos assistenciais e propor mudanças na assistência médica. Destaca a importância de Moreira não só como colaborador da Gazeta durante uma década, mas também como redator, bem como sua atuação como redator principal (1901-1902).

história da psiquiatria; imprensa médica; Gazeta Medica da Bahia; leishmaniose; Brasil


ANALYSIS

Juliano Moreira and the Gazeta Medica da Bahia* * This article is an integral part of the research conducted with the support of the First Projects Program (PPP) of the Fundação de Amparo à Pesquisa do Estado da Bahia (Fapesb).

Ronaldo Ribeiro JacobinaI; Ester Aida GelmanII

IProfessor of the Faculdade de Medicina/ Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Master's Degree in Environmental and Labor Health. Largo do Terreiro de Jesus - 40025-010 Salvador - BA - Brasil. jacobina@ufba.br

IIMaster's Degree in Teaching, Philosophy and History of the Sciences / Universidade Federal da Bahia. Av. Alm. Marques de Leão, 318/311. 40140-230 Salvador - BA - Brasil. gelmanester@yahoo.com.br

ABSTRACT

Recent studies of Juliano Moreira have emphasized his work in Rio de Janeiro (1903-1933), but the main objective of this article is to describe his contribution to the Gazeta Medica da Bahia in the period before that (1893-1903). It describes the evolution of this magazine, which served as a vehicle for original research of the Bahian Tropicalist School It presents Moreira?s output in the Gazeta, in which he emerges as a student of dermatology, syphilology and parasitology, having identified cutaneous leishmaniasis for the first time in Brazil. At that time, he also consolidates his reputation as a professor in neuropsychiatry, conducting clinical studies in the field, analyzing treatment models and proposing changes in medical treatment. It highlights the importance of Moreira not only as a collaborator on the Gazeta during a decade, but also as an editor, as well as his role as chief editor (1901-1902).

Keywords: history of psychiatry, medical press, leishmaniasis; Brazil.

The contribution of psychiatrist Juliano Moreira, who was born in Salvador in 1873 and died in the federal capital (Rio de Janeiro) in 1933, has recently been resurrected in studies such as those of Venâncio (Jul.-Dec. 2004), Oda (Dec. 2001), Oda and Dalgalarrondo (Dec. 2000), Vasconcelos (1998), Rocha, Pinto and Vieira (1998), Carvalhal (1997), Dalgalarrondo (1996) and publication of Vera Portocarrero's 1980 dissertation in book form (Portocarrero, 2002). In general, these studies emphasize the work and practice of this Bahian psychiatrist of African descendent during his period in Rio de Janeiro from 1903, when he assumed command of the Hospital Nacional de Alienados, to the start of the 1930s.

This article is part of a more comprehensive study, which intends to systematize the knowledge about his life, work and practices (medical and academic), from the preparation of his inaugural thesis for the Faculdade de Medicina da Bahia in 1891 to his transfer to the federal capital in 1903. The main objective is to describe the contribution of doctor and professor Juliano Moreira to the Gazeta Medica da Bahia, a magazine considered part of the history of Brazilian medicine's cultural patrimony, because it served as a vehicle for the original research of an 'association of physicians' that became known as the Bahian Tropicalist School (Coni, 1952).

The emphasis this work gives to Juliano Moreira's output in the Bahian period is due not only to the unfamiliarity with his output during that time (1891-1903), but also to the fact that during it this student in dermatology (including syphology) and parasitology made original discoveries and consolidated his reputation as a specialist in mental and nervous diseases, systematically conducting clinical and therapeutic studies, analyzing treatment models and proposing changes in medical and psychiatric treatment, as well as formulating proposals for legislation regarding the alienated in Brazil.

His role at the Gazeta Medica, although cited, is given little prominence by his biographers (Peixoto, 1933; Passos, 1975) and even less by current students of his work who, as we have highlighted, usually refer essentially to Juliano Moreira's intellectual output after his transfer to Rio de Janeiro.

This article is structured in two sections: in the first, we succinctly describe the evolution of the Gazeta Medica da Bahia, a medical magazine that has enjoyed a long life, one whose history, whenever possible, should be brought to the attention of new generations, especially in light of its recent rebirth; in the second part, we describe Juliano Moreira's role in the magazine, not only as a contributor, but also as an editor and even as editor-in-chief, which we consider to be an original historical discovery.

An Association of Physicians and the Gazeta Medica da Bahia

In 1865, a group of doctors decided to form an association in Salvador, Bahia, to "discuss scientific subjects". They agreed to meet in the evening twice a month. One of the founders of this "association of physicians", Doctor José Francisco da Silva Lima, wrote about this initial period two decades later, recalling that the meetings were held in the home of John Ligertwood Paterson, who authored the idea of creating this medical society, or in those of the other members, originally seven, but only six of whom actually participated in the sessions. John Paterson and Silva Lima, already mentioned, together with Otto Edward Henry Wucherer made up the most famous trio in tropical medicine in Bahia. They were all foreigners: Paterson was a Scot and the other two, Portuguese. Wucherer, born in Porto, had German paternal ancestry, a determining influence in his formation as a doctor. The other four were professors Antônio José Alves (surgery ) and Antônio Januário de Faria (clinical medicine) and doctors Manuel Maria Pires Caldas (surgeon) and Ludgero Rodrigues Ferreira (general practitioner). Ferreira never participated in the sessions, having become ill and dying shortly thereafter.

The subjects were diverse and often random, according to Silva Lima's testimony in his "Escritos médicos do dr. J.L. Paterson" ("Medical writings of Dr. J.L. Paterson") in 1886. In it, Silva Lima says: "there were no rules, programs or formulas for discussion, no reports or minutes; no one there had an obligation to do or say anything at any set time, in any set way on any set subject, but rather whenever, however and whatever he wished or was able to do" (cited in Fonseca, 1898, p.251; Pacífico Pereira, 1916, p.4).

The coordinator of the group, John Paterson, was highly regarded for having, in the face of opposition from doctors themselves, established, together with Wucherer, the diagnostic and contagious nature of the yellow fever and morbid cholera epidemics of 1849 and 1855, respectively.

It was in the bosom of this society - which other doctors joined, including foreigners such as Thomas W. Hall - that the 'progressive thought' of creating a medical periodical in Bahia was born. The author of the proposal was Professor Januário de Faria (Pacífico Pereira, 1916, p.253). The active members contributed to cover the expenses and on July 10, 1866, they published the first issue of the Gazeta Medica da Bahia. By the time it came out, Doctor Ludgero Ferreira and Professor Antônio José Alves (1818-1866) had already passed away.

Creation of the magazine was the logical consequence of their scientific meetings, since, although random in nature, they generated a need to record the experiences and ideas exchanged. The first pages of the inaugural issue of the Gazeta Medica da Bahia set forth its objectives in the Introduction. Although unsigned, the authorship has been attributed by some to the 'director', Virgílio Damásio, but, by the style, it clearly seems to us to have been written by Silva Lima, its true director and editor-in-chief (Figure 1)1 1 In his article on Silva Lima, Juliano Moreira (1918, p.1), before citing the objectives of the Gazeta Médica, clearly says: "Silva Lima, in his introductory article of the magazine...". It was the testimony of a disciple and friend. :

To concentrate, whenever possible, the active elements of the medical profession so that, further united and mutually reinforcing each other, they cooperate to add to its credit and public consideration; to disseminate all of the knowledge that their own observations or of others may reveal; to follow the progress of science in the more cultured countries; to study issues that most particularly interest our country; and to strive for the unity, dignity and independence of our profession (Introduction, 1866, p.3).


A question that no document clearly records was the criterion used for choosing the magazine's director. Instead of one of the five founding members, the person selected was Professor Virgílio Clímaco Damásio, from the legal medicine field. Professor Luiz Anselmo da Fonseca (1898, p.253) commented on the appointment as follows: 'Dr. Virgilio Damazio, now a federal senator, was placed in charge of the periodical and for many years illustrated the public teaching profession in this College".

Teixeira (2002), based on what Fonseca intimates, formulates a hypothesis for the choice of someone who was not among the founders and had contributed little to the Gazeta: "Perhaps it was his prestige as a professor of Medicine and one of the most prominent politicians of the times" (p.17).

We have verified, however, that in 1866 Professor Virgílio Damásio was a candidate for the public complementary sciences examination, having become a (university) professor only in 1876, with his prestige as an academic dating from the 1880s, especially after having studied abroad. Moreira (1913), in a conference on the sciences in Brazil, does not mention Damásio in connection with the Gazeta, a magazine that was also the subject of comments and prominence at the conference. He relates that the professor was one of those chosen by the College, in accordance with the legislation in effect at the time, to travel to Europe to familiarize himself with the latest in diverse fields of medicine. Following his trip, from 1883 to 1885, Professor Virgílio Damásio returned with "good ideas", highlighted by the suggestions contained in his report on the teaching of legal medicine (p.46). In the Jubilee edition of the Gazeta, Moreira (1918) clearly says in another article that Damásio's leadership was nominal, "because the real director of the Magazine was Silva Lima" (p.1). With respect to Damásio's political career, his prestige was subsequent to the creation of the Gazeta, but, having been president of the Republican Party, taking on an innovating proposition seems to us to be of a piece with his profile and practice, as well as being a person trusted by the founders.

An important addition to the group was a student, Antônio Pacífico Pereira, who in 1867, having just left 'the school benches', was chosen to succeed Virgílio Damásio as head of the Gazeta (Fonseca, 1898, p.253). Pacífico Pereira held the position from July 1867 to the middle of 1870, when the magazine was suspended, seeming to follow the destiny of so many other "unsuccessful attempts', as recorded on the first page of the Gazeta itself (Introduction, 1866, p.1), which mentioned that "publication of a periodical dedicated exclusively to the medical sciences has been tried two or three times in this province". At that time, Silva Lima, the person mainly responsible for the magazine, could no longer count on the participation of the young contributor, who had to prepare himself for the public examination to obtain a position in the Surgery Department in 1871 and shortly thereafter secured the right to study in Europe. The Gazeta resumed circulation in August 1871, under the command of Professor Demétrio Tourinho, and was again interrupted in July 1874, when the professor assumed command of the Asilo São João de Deus (Jacobina, 2001). It seemed the Gazeta was inexorably destined to disappear:

In a medium such as ours, characterized by the strong negative elements that enterprises like the Gazeta Medica da Bahia face, it would probably have continued to fluctuate between appearing and disappearing, ceasing altogether in the final extreme, at least for many years, having thus suffered the fate of analogous attempts that preceded or succeeded it (Fonseca, 1898, p.254).

At the start of 1876, Pacífico Pereira resumed command, maintaining the magazine with no further interruptions until 1920, when he fell ill, passing away in 1922 (Teixeira, 2002). He dedicated fifty years of his life, often at much personal and even financial sacrifice. Apart from the very beginning, when the members contributed to edit the first issues, the responsibility of the 'association of physicians', heralded on the cover of the Gazeta until 1883, was purely nominal (Fonseca, 1898, p.254). The annual deficits were borne by its most perennial director. As director and assiduous contributor for half a century, Pacífico Pereira was one of the two pillars that sustained this unique monument among Brazilian scientific publications.

The other pillar supporting the survival of a high quality magazine, published almost without interruption during the second half of the 19th century and the first decades of the 20th, was Silva Lima, primus inter pares, according to the testimony of Pacífico Pereira (1916, p.27, 29). He was the most versatile contributor and the editor-in-chief of the Gazeta Medica da Bahia from 1866 to 1910 (Table 1). This affirmation is based on both an observation made in a book that contains a cumulative index (Santana, Teixeira, 1984), as well as on the systematic reading of its numerous volumes, recently digitalized by Luciana Bastianelli and available on two CDs, and a book of selected articles (Bastianelli, 2002). Almost all of the first 38 volumes (from 1866 to 1906) contain an article by the Brazilian tropical doctor - not Brazilian by origin, as mentioned, but by choice since 1862 (Varela, Veloso, no date).

On the occasion of publication of the Gazeta's Jubilee edition, Juliano Moreira (1918) said that the real director had been Silva Lima, Damásio's leadership being nominal. He also said that the young Pacífico Pereira assisted him in the editing work, thereafter assuming the role of director at a very young age. Moreira emphasizes that the Gazeta had an impact from the very beginning, being noticed by medical publications in the Old World, so much so that, in its first year of existence, it received the support of the British Medical Journal, an important medical weekly of Great Britain's medical association.

The Gazeta ceased publication during Pacífico Pereira's illness in 1920 until his death. In 1922, Professor Aristides Novis, editor-in-chief from 1915 to 1919, took over the periodical, successfully maintaining regular publication until 1934, when the magazine virtually disappeared. The descendents of Professor Novis transferred the rights to the periodical to the Faculdade de Medicina (College of Medicine). Phoenix-like, the Gazeta reappeared in 1966, thanks to the initiative of Professor Aluisio Prata, who, with the collaboration of colleagues Zilton Andrade and Heonir Rocha, among others, maintained annual publication of the magazine until 1972, with a one off issue in 1976 (Sant'Anna, Teixeira, 1984). Recently, in June 2004, Professor José Tavares Neto, director of the Faculdade de Medicina da Bahia (Fameb-UFBA), took the initiative to resume publication of the magazine, which now appears semi-annually (Tavares-Neto, 2004, p.1).

The Gazeta's period of greatest prestige and historical significance extends from its creation in 1866 until the beginning of the 20th century. Prominent were the original works of Wucherer on ancylostomiasis (1866), filariosis (1868, 1869) and the classification of poisonous snakes (1867). Silva Lima's studies on beriberi (1866) and ainhum (1867) in original clinical research were also prominent. Paterson's contribution from 1866 to 1879 consisted of the precise descriptions of clinical cases. In addition to Pacífico Pereira's clinical and therapeutical observations, studies on beriberi and continuing the work of his mentor, Silva Lima, his reflections on medical teaching were also valuable, becoming a national reference on the subject. The writings of Nina Rodrigues on public health and legal medicine are also always remembered. Teixeira (2002), whose intention was not to provide a complete picture, but merely to record the names that marked the diverse phases of the Gazeta, cites, in addition to those mentioned, the following contributors: Manoel Vitorino, Almeida Couto, Silva Araújo, Gonçalo Moniz, Pirajá da Silva, Clementino Fraga, Oscar Freire, Martagão Gesteira, Aristides Novis, Prado Valadares and Armando Sampaio Tavares.

Other names may be forgotten, but in the studies on the topic, there is, without a doubt, one serious omission regarding the role he played during one of the magazine's phases, that covering the turn of the 19th to the 20th century: Juliano Moreira. Demonstrating his intellectual contribution to the pages of the Gazeta Medica da Bahia, as well as his role in editing the magazine for almost a decade, will be the main objective of this article's next section.

Juliano Moreira at the Gazeta: Contributor and Editor

Every academic must write an inaugural thesis to receive the title of Doctor in Medicine and Surgery. In 1891, Juliano Moreira took as the topic for his thesis the "Etiologia da sífilis maligna precoce" ("The etiology of precocious malignant syphilis"). In the prologue, the graduating student presented a characteristic of many of his writings, that of exercising criticism with refined irony: "In the sixth year of medical school, one must write a thesis to obtain the degree of doctor in medicine. I tried to analyze my situation and found it precarious...only that obligation remained, by virtue of which, I went to see, as the obedient citizen I make an effort to be, the thesis topics listed" (Moreira, 1891, f.V). He had hoped that the teaching reform instituted by the republican regime would eliminate the thesis requirement. Although this did not occur, Moreira considered that a small change in the academic requirement had at least assured him of greater freedom in choosing his topic.

In this truly inaugural study, for which he received the highest grade, Juliano showed his affinity for dermatological and syphilographical clinical work. Although his subject was malignant syphilis, he presented few references regarding the progressive general paralysis frequently found in tertiary syphilis. He was more concerned with refuting the thesis of climatic influence and, by denying this determinant, questioned the influence of race in the genesis and malignancy of syphilis as well. According to Afrânio Peixoto (1933, p.82), a disciple and friend, this work became almost an obligatory citation in studies of the subject and deserved the prominence given it by foreign specialists, such as Buret, a student of syphilis, in the Journal des Maladies Cutanées et Syphilitiques, and Professor Raymond, in the Annales de Dermatologie et Syphiligraphie.

After his graduation, Juliano Moreira accepted appointment by the medical commission to the Hygiene Inspectorship to provide assistance to indigents suffering from fevers and dysentery in the city of Bonfim and the surrounding areas, such as the village of Campo Formoso. Appointed on April 6, 1892, he left Salvador the following day, arriving at the recently emancipated city the next day. The report of this experience in public health was one of his first publications and the first signed with his full name 'Juliano Moreira' in the Gazeta Medica da Bahia. He entitled it "Endemo-epidemia da Jacobina (1891-1892)" ("The endemo-epidemic of Jacobina (1891-1892)") (Moreira, 1894) and justified referring to it as such because the area where the malaria epidemic raged was part of the district of Jacobina, it being common for the population to refer to the region affected, now belonging to the municipality of Bonfim, by its old name.

From the start of his professional life, the young doctor did not neglect his academic vocation. In 1893, he held the position of assistant in the discipline of psychiatry and nervous diseases under Professor Tillemont Fontes (Moreira, 1894, p.208). Soon after, he passed the public examination and was appointed on September 15, 1894 to the remunerated position of teaching assistant in surgical anatomy at the Faculdade de Medicina da Bahia (Noticiário, 1894, p.142).

Preparation for the examination for the teaching assistant position in anatomy also stimulated him in 1893 to write his first article published outside of Bahia, entitled "Músculo acrômio-clavicular" ("The acromio-clavicular muscle"), published in the magazine Brazil-Medico. That same year, we find reviews of six articles, from one English and five German magazines (Moreira, 1893), signed with the initials 'JM', the way he would sign an editorial (1901) and a review (1902a) some years later, upon becoming an editor and a contumacious contributor. By the style, topics and his domination of foreign languages, we can conclude that it was through reviews of medical magazines that he initiated his contribution to the Gazeta, one that lasted a decade (1893-1903).

The young Juliano had been a graduate for less than four years when he participated in the creation of the Sociedade de Medicina e Cirurgia da Bahia (SMCB) on November 18, 1894. Pacheco Mendes and Alfredo Brito were president and vice-president, respectively, of this association. We find no support for the Passos' thesis (1975, p.11) that Juliano had been the creator of this medical society. His position, in fact, was discreet, as director of the annals and a member of the Sectional Dermatology-Syphology Commission (SMCB, 1894). Six months after its creation, on April 6, 1895, the SMCB signed a contract with the Gazeta Medica to publish the Annals of the entity in the magazine (SMCB, 1895).

Working together with the creators of the Gazeta, Silva Lima and Pacífico Pereira, and intellectuals of the Faculdade de Medicina da Bahia, such as Nina Rodrigues, Alfredo Brito and Pacheco Mendes, enabled Juliano Moreira to contribute, on a regular basis, articles and discussions of the clinical cases recorded in the sessions of the medical association that he helped to found. This association experience, especially being articulated in a specialized publication, seems to us to have served as an inspiration for Juliano Moreira, since later in Rio de Janeiro, given his gregarious spirit, he led the creation of a number of scientific societies, participated in many others, some of which were not medical, and also created several scientific publication that always had a uniting purpose, even when they were not an official organ of any entity.

Analyzing the author's participation in the Gazeta Medica, as a whole (Appendix 1 and Table 2), one notes that in 1895 Juliano Moreira became an assiduous contributor, with the publication of some ten articles, syphilis being the main theme. Meanwhile, Juliano Moreira's most prominent research work in this period did not concern his main topic, syphilis, but another 'hot climate country' disease with cutaneous manifestations, the Biskra or endemic boil or, in more contemporary language, cutaneous or American tegumentary leishmaniasis (ATL). These studies became part of a fertile and original tradition at the Gazeta Medica, that of scientific studies of national interest on so-called tropical diseases, mainly infectious and parasitic, as were the previously mentioned works by Wucherer on ancylostomiasis and filariosis, and Silva Lima on beriberi and ainhum.

The Discovery of Leishmaniasis in Brazil

In the SCMB's December 30, 1894 session, the young dermatologist presented his work "Existe na Bahia o botão de Biskra?: estudo clínico" ("Does the Biskra boil exist in Bahia?: a clinical study"), published in the Gazeta Medica da Bahia in February 1895 (Moreira, 1895a, p.254-258), in which Moreira minutely described the clinical forms, based on numerous clinical cases, and affirmed for the first time the existence of the Biskra boil in Bahia and Brazil, also known as the Orient boil or ulcer and the endemic boil of hot countries (Moreira, 1895b). His observations refuted any age, gender or racial specificity of the disease: "I have observed the boil in people of all ages, men and women. No constitution or race (that inhabits this state) is proof to the "Bouton d'Orient" (Moreira, 1895a, p.255).

Moreira distinguished the endemic boil from the cutaneous lesions of syphilis, since most of the cases he received had been diagnosed by doctors as buboes (bouba brasiliana). In his opinion, however, "a good portion of the cases" fit within the Biskra boil diagnosis (Moreira, 1895a, p.257-258). It was, very probably, the first description of clinical cases of American tegumentary or cutaneous leishmaniasis in a Brazilian scientific publication.2 2 Altamirano-Enciso et al. (Sep.-Dec 2003, p.863) affirmed, mistakenly, that "professors Juliano Moreira and Antônio Austregésilo of the Bahian Tropicalist School, made a detailed description of clinical cases of ATL, although erroneously following the Breda and Sommer proposal of 'bouba brasiliana' (Moreira, 1895)" (our italics). The error was that of the Bahian doctors of the day, not Moreira, who correctly made the differential diagnosis that enabled his important discovery. Further to this article of Juliano Moreira (1895a), it must be clarified that there was no co-authorship with Antônio Austregésilo. Both had published a study on ainhum in 1908 in the Brazil-Medico (Moreira, Austregésilo, 1908).

Regarding the causes of the illness, the author said that the pathology appears both initially and secondarily (excoriations and other scabies type cutaneous diseases, etc.). It was also noteworthy that in conversations with his patients about their disease, he did not ignore the possible presence of an insect in the causal complex: "The bite of an insect - the muruim, has often been attributed by some of the sick as the start of the disease" (Moreira, 1895a, p.255). Finally, he informed that he had undertaken a series of inoculation trials and anatomo-pathological studies, but that these were still very incomplete, and promised to present them when they were finished (p.257).

It should be mentioned that the etiological agent of this disease, a protozoan, had been identified in 1893 by a Russian military surgeon, P.F. Borovsky, but the finding had a limited circulation, probably having been published only in Russian. Only in 1903 was the etiological agent considered to have been discovered, when James Homer Wright, of Baltimore (EUA), observed forms of protozoans in the cutaneous ulcer of an Armenian child with the Orient boil and he named it the Welcozona tropicum, later changed to Leishmania tropica (Cox, 2002, p.605). As for the agent of the visceral form, only in May of that same year did the Englishman William Leishman perform a liver biopsy on a soldier with Kala-azar in India and, in July, Donovan discovered the kala azar etiological agent. Ross named the genus Leishmania, and afterwards the name L. donovani was given to the visceral leishmaniasis agent (Altamirano-Enciso et al., Sep.-Dec. 2003). In 1911, Gaspar Vianna gave the Bauru ulcer agent (American tegumentary leishmaniasis) the name Leishmania brasiliensis. Only in 1921 was the role of phlebotomy established as the insect transmission vector (Cox, 2002, p.606).

From Contributor to Editor-in-Chief of the Gazeta

In 1896, Juliano Moreira took the exam to be a substitute professor in the nervous and mental diseases discipline's 12th section with a thesis on 'arsenical dyskinesia' and passed in 1st place with the highest grade possible. It was not by chance that he began to appear among the editors of the Gazeta Medica at that time, with Braz Amaral as manager/editor3 3 The position of managing editor was eliminated in 1901, only reappearing in 1915, with Aristides Novis. In 1922, with the death of Antônio Pacífico Pereira, Professor Novis assumed the position of director at the Gazeta. and Silva Lima the editor-in-chief (Table 1). The latter, as already mentioned, was one of Juliano Moreira's intellectual role models.

It is worth noting that there were two interruptions in Moreira's participation as a contributor to the Gazeta before his definitive transfer to Rio de Janeiro: the first, from February 1896 to November 1898, and the second, from October 1899 to December 1900, when he again traveled to Europe to participate in several medical congresses involving the two fields that still shared his attention, dermatology (and syphology) and neuropsychiatry.

In the middle of 1901, Juliano Moreira assumed the position of editor-in-chief, as attested to by his name heading the list of editors, occupying the position previously held by his mentor, Silva Lima, as well as by the elimination of the managing editor position (Figures 2, 3, 4) and, most notably, his signing of the text that opened volume 33 (Moreira, 1901, p.1-3), in which he announced the modifications that he intended to introduce in the magazine, which he effectively achieved in that volume, which ran from July 1901 to June 1902. The original articles section assumed primacy, especially contributions to the "true Brazilian nosology" (p.2), as the founders had done. The "general reviews" section followed, with "extratropical nosologies" and national and foreign reviews. Finally came the section for "teaching, hygiene and public medicine issues".




The expression of his leadership can also be verified in his multiple contributions to this volume (see Appendix 1, from item 25 to 32). He often wrote the first article, the reviews and the necrologies, assuming a role similar to that of Silva Lima when he appeared at the head of the list of contributors in the magazine's prior volumes.

The name of Juliano Moreira headlined the list of editors of the Gazeta Medica until June 1906, when Gonçalo Muniz assumed the role of editor-in-chief, which he had exercised de facto ever since the doctor was transferred to Rio de Janeiro in 1903. Most probably as an homage conferred by his contemporaries and former students, Moreira's name was maintained among the magazine's contributors until the 1914-1915 volume (Table 2), even though his last contribution to the Gazeta was his congress report published in July 1903.

On the Need to Establish Laboratories in Brazilian Hospitals

A work in Juliano Moreira's final period at the Gazeta Medica da Bahia deserves special mention due to its importance in the history of Bahian and Brazilian medicine. In April 1902, he published an article in which he defended the need to create laboratories in the country's hospitals (Moreira, 1902c, p.439-450). So obvious today, at that time it was a lucid manifestation of someone who, aware of the medical and sanitary practices in the major centers of Europe, especially Germany, brought an innovative and urgent proposal for health services in Brazil, chiefly those related to teaching.

Given the advances of scientific medicine during the last quarter of the 19th century, in particular in the final decade, the creation of a pathological anatomy service affiliated with a bacteriological laboratory and another for biochemistry ("clinical biochemistry"") in Brazilian hospitals was urgent, especially in those where medical teaching was practiced, such as the Santa Casa de Misericórdia, both in Bahia and Rio de Janeiro. Moreira (1902c, p.447-449) described how each of these services should be: location, personnel, equipment, etc. He enumerated the results of studies that utilized necropsy data and field research in the pathologies of metabolism and clinical bacteriology obtained using a microscope, a sure guide to the etiological differentiation of diseases (p.443), fundamental to orienting therapeutics. He lamented that many of these studies had not been conducted in Brazil and questioned the application of the results obtained elsewhere 'to our environment': "Who knows? A priori it is presumptuous to conclude" (p.443).

Juliano Moreira (1902c) affirmed that he had traveled throughout Brazil from north to south and had found only one hospital with a laboratory, in São Paulo (p.444). He affirmed that all hospitals, even those not affiliated with medical colleges, should be equipped to cooperate in the development of medical science, and that doctors should be trained and have the material necessary available to conduct scientific investigations (p.444). Teaching without clinical research, using the old methods, would be a crime of lese-science. One sentence stands out for its lucidity and style: "Only really worthy of the name of master is he who has become an authority through having known how to charge the unknown and broken lances in the conquest of truth" (p.445). For advances in his country - "heading the pages of the old Gazeta Medica" -, he demanded concrete measures from the Santa Casa and the leadership of the Faculdade de Medicina. He lamented, meanwhile, that students, "who boast so much about the solidarity of their members", have not joined together to demand teaching on scientific bases (p.446) .

His proposal was based on his visits to hospitals in the various countries to which he had traveled. In an ironic tone, he observed that it was not only the externalities he went to see, but also the useful elements available to doctors and the sick (Moreira, 1902c, p.446). He concluded that a hospital institution would only fulfill its social function if "it had machinery for scientific work" installed, its doctors were competent and responsible in their daily work and its administration, capable and confident. Finally, at this SMCB conference, subsequently published in the magazine, he returned to speak as the magazine's spokesman: "The Gazeta Medica expects of the Colleges of Medicine of the Country and the Casas de Misericórdia of Rio and Bahia reform of the clinical studies in the official teaching centers" (p.449). This would result in the installation of laboratories in hospitals throughout the country (p.449-450).

A decade later, Juliano Moreira (1913, p.46-47) would recall this article when commenting that laboratories had emerged throughout Brazil, even in autonomous research centers such as the Instituto de Patologia Experimental in Manguinhos. After the death of his mentor, Peixoto (1933) commented that that conference, published in the Gazeta Medica da Bahia and copied in several other scientific publications, had resulted in the creation of various services in hospitals in Brazil. The Faculdade de Medicina da Bahia, for example, created its Instituto de Clínicas, a set of laboratories that provided diagnostic support to the various services (p.83). Another example of the influence of Juliano Moreira and that article in particular: Professor Aristides Novis, director of the Hospício São João de Deus, subsequently renamed the Hospital Juliano Moreira, used this conference and the respective article as a reference to demand and obtain from the state government the creation of a clinical analysis laboratory for that mental institution (Jacobina, 2001).

Reference to the psychiatric hospital that received his name as an homage from Bahians leads us to a conclusion. His contribution in the specific field of psychiatry, an area which made him famous, to the pages of the Gazeta Medica was small. Small, but it existed. His report on the progress made by Franco da Rocha in the asylum colony in Juqueri, São Paulo stands out (Moreira, 1902b). In this article, despite praising the idea of an asylum colony, Juliano formulated thinking that is very contemporary in the mental health field: "I can hardly measure my lack of sympathy for the construction of asylums in such large pavilions for so many sick people, or for those in which all of the pavilions are equal, thus resulting in a certain monotony" (p.406).

Final Considerations

A panoramic vision of Juliano Moreira's work based on the various contributions published in the Gazeta Medica da Bahia (Appendix 1 and Table 3), enables us to verify that he did not have a "logical destiny" as a psychiatrist, a specialty in which he became nationally and even internationally known. He was a versatile and creative intellectual on many levels. Apart from his presence in the medical press, we see the multiple facets of Juliano Moreira revealed in his work that was published in the Gazeta:

- That of the tropical doctor who describes his fight against malaria in the interior of Bahia and later writes a critical review of the role of mosquitoes in the transmission of that pathology. This facet was also revealed by his critical reviews on beriberi and sleeping sickness, and, principally, his works on the endemic boil, both in medical geography and original clinical studies, when he described for the first time cutaneous leishmaniasis in Brazil, a theme that provides a bridge to another facet of the author;

- That of the dermatologist and syphologist who studied a urticaria having a medicinal origin, then farcinosis, a zoonosis with cutaneous manifestations, and, primarily, syphilis from a variety of aspects, such as tabetic pharyngitis, typhus, syphilitic pneumonias and the relationship between saturnism and senility;

- That of the neurologist and diligent psychiatrist of epilepsy, of myoclonia in hysterical and non-hysterical individuals; the psychiatrist also appears in another field of study, that of treating the alienated;

- That of the sanitarian, not only as a hygienist in combating and recording his struggle against the malaria epidemic, but also as a diligent formulator in health planning and administration, attested to by his participation in the reform proposal for the Asilo São João de Deus, his analysis regarding the asylum colony in Juqueri (São Paulo) and, especially, his defense of the creation of anatomo-pathological services and laboratories in Brazilian hospitals; and

- The facet of the historian of medicine and the sciences in general, analyzing the contributions of Brazilian scientists such as Francisco de Castro, Oscar Bulhões and Alfredo Kanthack and foreign ones such as Pasteur, Virchow, Von Ziemssem, Kaposi, Ludwig, Thiersch, Vogt and Bento de Souza, as well as synthesizing and disseminating the most relevant works presented in the national and international congresses of that era.

His comprehensive knowledge and creativity deserved a comment from his closest and most loyal disciple, Afrânio Peixoto (1933, p.82): "He had in him something praiseworthy as a doctor, tropicalist, dermatologist, syphologist, alienist, psychologist, naturalist and historian of medicine". The naturalist and psychologist would develop after his transfer to Rio de Janeiro in 1903, but they were interests awakened in his work in his native land. The other facets identified by Peixoto had already been witnessed in the pages of the Gazeta, including one that he had not noticed, that of sanitarian (or hygienist, to use the term in use at that time).

NOTES

REFERENCES

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  • *
    This article is an integral part of the research conducted with the support of the First Projects Program (PPP) of the Fundação de Amparo à Pesquisa do Estado da Bahia (Fapesb).
  • 1
    In his article on Silva Lima, Juliano Moreira (1918, p.1), before citing the objectives of the
    Gazeta Médica, clearly says: "Silva Lima, in his introductory article of the magazine...". It was the testimony of a disciple and friend.
  • 2
    Altamirano-Enciso et al. (Sep.-Dec 2003, p.863) affirmed, mistakenly, that "professors Juliano Moreira and Antônio Austregésilo of the Bahian Tropicalist School, made a detailed description of clinical cases of ATL,
    although erroneously following the Breda and Sommer proposal of 'bouba brasiliana' (Moreira, 1895)" (our italics). The error was that of the Bahian doctors of the day, not Moreira, who correctly made the differential diagnosis that enabled his important discovery. Further to this article of Juliano Moreira (1895a), it must be clarified that there was no co-authorship with Antônio Austregésilo. Both had published a study on ainhum in 1908 in the
    Brazil-Medico (Moreira, Austregésilo, 1908).
  • 3
    The position of managing editor was eliminated in 1901, only reappearing in 1915, with Aristides Novis. In 1922, with the death of Antônio Pacífico Pereira, Professor Novis assumed the position of director at the
    Gazeta.
  • Publication Dates

    • Publication in this collection
      15 Jan 2009
    • Date of issue
      Dec 2008

    History

    • Accepted
      May 2006
    • Received
      Dec 2005
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