Looking beyond the campaign to eradicate ancylostomiasis : the diary of the American physician

Between 1916 and 1923, the Federal District and 11 Brazilian states entered into cooperation agreements with the International Health Board of the Rockefeller Foundation to combat a rural endemic disease, namely ancylostomiasis. This paper presents the diary of Alan Gregg, one of the American physicians who worked in Brazil from 1919 to 1922. An interesting source to discuss issues relating to the history of public health in Brazil, in addition to information about the activities to combat ancylostomiasis developed by the Rockefeller Foundation in the country, the diary of the physician presents his impressions concerning nature, culture, politics and society in Brazil. In the diary excerpts presented here, however, aspects related to the professional activities performed by Gregg are prioritized.


Tt [19 de abril de 1919]
April 19 The sky behind us more and more golden, the mountains more and more a china blue, the see greener.… Very soon we could see a huge beak of gray granite, smooth and cold, nosing right up out of the sea at the mouth of the harbor, looked more like Sugar Loaf -Pao dAssucar -and so I knew Rio.… In the morning sun the Brazilian flag looked very much like a young tree, so very green and so very yellow.… Met Hackett at the dock and also Dr. Thomas Alves, a Government official in the Public Health Service who has been loaned to the Commission.The name Rockefeller is somewhat of a sesame here -I went through the customs with no examination.Then getting into the Commission's Ford we road up to the Hotel International one of the finest sites I have ever seen.Rio itself is rather exceptional, it has the formality and cleanliness of Paris, the hurry and lack of tradition of the U.S., all the warm open house subtrpical [sic] things I had never seen before, and something additional which needs watching before it appears in the literature.But there's no more question about it's beauty than that of Nancy Graves -it simply is the lovliest [sic] I have ever seen or imagined.… Met also Dr. Hydrick who did the H* [hookworm campaign] in the Camayan [sic] Islands, Trinidad and Tobago.A very nice Southerner, a man with brains enough to go to England as a Rhodes scholar and not waste his time studying books instead of Englishmen and their ideas.He took me over to Nicktheroy, across the harbor on the eastern side and there at the Hacketts we had a delicious warm swim and a pleasant dinner -waffles off an electric iron at the table and some beans much like home.I don't suppose there are many sunsets in the world more beautiful than the ones you see from Nicktheroy.

[20 de abril de 1919]
April 20th Dr. Pierce gave a luncheon today to the members of the Commission and their wives, where I met Dr. Darling and also Dr. Crowell and his wife.Darling is a tall, long-haired, open eyed man of ideas; he'd be at the head of a new religion if he were not at the head of the ranks in this new phase of medicine.He is aperson who loves vistas, medical and anthropological especially -and the way he talks of the Nordic race, the Mediterraneans etc., is most fascinating, because he knows a great deal about it.Smillie thinks he knows more about mosquitoes than all but two or three other men alive and I don't doubt it.The Crowells knew Don in the Philippines and have been most kind to me.He is at the Oswaldo Cruz Institute as the Pathologist.She seems rather the worse for her time in the Islands, and looks very tired.Dr. Chagas of the Institute was there also and I got along with him fairly well in French -it is going to be my salvation until I get some Portuguese.… From what Hackett says I shall go to Sao Paulo with Smillie and get familiar with various mosquitoes and worms and the simpler phases of the Portuguese tongue for a month or so, and then return to Rio with a chance to really get to work.I suspect that I will be sent to the state of Santa Catherina to do a H* [hookworm] survey and then perhaps to keep on there in charge of a few posts.The work here in Brazil is opening up with a most gratifying and tantalizing rapidity, for example there are eleven enormous counties that have requested surveys lately but we can't help them because we are so short of trained men.That is a month's crop of requests -and look at the size of Brazil!I see where I get what I came for -experience in health administration.

[3 de maio de 1919]
May 3 The last three days Smillie and I have been getting up at six and hurrying over to the Santa Casa de Misericordia a huge hospital run by the Catholic Sisters, to run through some clinical tests on the use of beta-naphtol as a remedy for hookworm.The patients are all uneducated Brazilians, in one of the eye wards, most of them having trachoma, and all of them well infected with H* (hookworm).It is simply a perfect little laboratory we work in, though the gift of as much as five milreis ($1.) would be so frightfully liberal an act that you'd be put in the papers for it instanter [sic].Where the money comes from to run the whole big place is problematical -except that the Catholic church is behind it.Were it not for the awful numbers of flies and the crowding of patients one on a high bed and one on the floor beneath him, the hospital would be quite presentable.The gardens around which the buildings lie cloistered are of course lovely.… And a dull droning noise fills the air, pouring out of the imposing chapel that stands in the center of the garden, -the prayers of the sick for relief from their ills.When one of our patients, Jose Boli, a pasty faced little defective with trachoma and an unqunchable [sic] grin, prayed this week it worked wonders and Jose is host no longer of 768 hungry H* [hookworm] worms and is fast convincing me that even if you don't prevent H* [hookworm] recurring in Brazil you can do an enormous lot of benefit to some pretty miserably ill men down here.

[8 de junho de 1919]
We came on the 6th and today is the 8th; yesterday went into a long day of wandering up and down the village [Rezende, Rio de Janeiro] street looking for special cases to treat today -an attempt to test the routine treatment for its efficiency in getting rid of H* [hookworm] infection and to try out the value of some more fresh chenopodium.I begin to see signs of people here being keen about the work in the receptions given you in the native huts, and in the voluntary requests for treatment from the people who have seen what it has done for their friends.The number of negroes here is much above what it is down in Sao Paulo, and the houses are even more sketchy than ever.… A letter from Hackett tonight confirms my impression which I wrote to you that I would go south to do a survey there.He says "We have two pieces of work to be done this year since the bugets [sic] expire on December 31st.These are the surveys of Santa Catherina and Parana.Since the work in Santa Catherina is to be followed by the immediate installation of an intensive post, it would be well to do Parana first.The trained personal from the Parana survey can then be taken to Santa Catherina, and later used as the nucleus of an intensive post.You will want to begin this work in July."Which when translated into terms of one U.S. syllable means that I am going into the coolest part of Brazil among more white people than anywhere else to do the work of finding out the extent of infection in a state and later going to do the same thing in even a cooler and more southern part of Brazil this later time among the great German section!… All the afternoon we have spent at the Santa Casa, watching a girl with severe symptoms of poisoning after her dosage this morning, and poor old Smillie whose wife died here in Brazil last fall in childbirth, has all the scene recalled to him every time he comes near to death.

[29 de junho de 1919]
Junho 29th As we finished an old negro sorcerer of some hundred years came wearily flatfooting [sic] up the road.We had asked out of curiosity for him to come to see us, for he is credited locally with the power to cast love and destruction spells.The old fellow was awed by too many strangely dressed men, not evidently in search of his aid seriously, and in his canninesshe [sic]  said "Oh no, Signors!If I could do such a thing as Magic it would have made me rich."Well, as a matter of fact it has kept him alive some hundred years here in this valley, with quite a humming trade in curses, especially in slavery days.As our administrator on the fazenda said "If the old man's magic were effective all the fazendeiros would have been dead long ago from the curses their slaves paid this old man to cast."When you can see the heavy iron manacles rusting in the barn, scarcely an object of interest as yet, -the manacles that bound slaves hands and feet together in a bunch for days at a time, in active use till 1888, you can realize we're just out of the pretty raw stage of life here.

[20 de julho de 1919]
July 20th Hydrick told me an amusing thing about Elavo, the diener [sic] at Sao Paulo.Dr. Darling has made out some tables of figures comparing infant mortality with the amount of income.
Elavo, who is a wonderfully funny looking coon, very usefull [sic] but terrified of Darling looked at the tables with closest attention.He has been trying to get his courage up for six months to the point of asking for a raise in salary to help out with his new white wife of whom he is very proud.He came to Smillie and said "How is a man going to raise a child if that table is true?'100 milreis most of the children die, 75 milreis all the children die' -and he wont give me more than 70 milreis!How is that baby of mine going to get along in this hygiene job!" [10 de agosto de 1919] I keep my servants -and I have four here -all busy at the job of finding out how much of this queer little place has Hookworm.Out of 197 thusfar [sic] we have found four who havent Hookworm I say some fellers have all the Luck dont they?Yesterday with a hemoglobin book in my pocket and a guarda (male nurse) to do the difficult talking I started out on some house to house investigation which yielded me about 80 cases and was the most interesting and amusing work you can think of.The natives can barely read, live in the simplest sort of traditional existence and with swarthy skins, earrings, large straw hats, wooden bowls for the evenings grain, doublestringed [sic] bows called bodoques with which they throw stones and kill evenings roast as he sings in the tree, figas or little carved hands to keep off the evil eye, old muzzle-loading flint locks or cap rifles -and the very latest ideas in the treatment of their Hookworm provided with much amusement and pleasure and satisfaction by yours truly.… We all eat dinner in the Restaurant Itapema which is run by a big cheerful Italian who thought I was Rockefeller´s son and tried to charge us double prices.So I had to set aside half a morning and go and talk to him which was very amusing and excellent practice for me for I am coming to like dickering and palavras de negocios.

[21 de setembro de 1919]
September 21 1919 As we were talking I heard a queer thudding noise and looking out saw in the street on horse back a leper with most of his fingers…….They are allowed to come in to town twice a week and beg provided they dont get off their horses.I saw eight yesterday for this place is a veritable nest for leprosy.The ones in the colony are the bravest they chose to do what one told me was the only thing he could do for his family -keep away from it.and [sic] I say chose because there is no obligation to get away; it is in rich and powerful families here who will not allow any such law to be made or enforced.Just yesterday a girl was yanked out of the Escuola [sic] de Nossa Senhora De Belem next door -sick four [sic] months to the point where the doctors diagnosis was merely confirmatory -they all knew the child had leprosy.This is a country of perfect individualism and it has its virtues and its vices."What do the fazendeiros do with their money?"I asked yesterday at almoco [sic] of a young advocate."Loan it at 12% per month" was the reply and the rest confirmed him.

[12 de novembro de 1919]
November 12 1919 Cresciuma Imagine to yourself a rather ruinous Hasty Pudding theatre in a very poor state of repair with many banks of school desks scattered through it, my camp bed in one corner and a bunch of Italian women with crying babies wandering through and around it, a fat little officious Brazilian doctor making physical examinations and a gang of thunderstruck Italians watching me write and saying "Ora!Ora!" at each move of this personal machine.A commission of railroad employees are gasping "Nossa Senhora!" at the sight of such huge worms as the microscope shows them, and the flies are acting as the only common denominator of the crowd.We are working in a deserted church and the motto that is painted on the rough boards is "Adeamus cum fiducia ad thronum Dei."With some little fiducia (if I must admit it) I went up to one of the few coal mines of Brazil this morning and examined about a hundred miners -but it did not have the appearande [sic] of the throne of God -rather the tower of Babel, Polish, German, Portuguese, Spanish and Italian being the languages necessary to success.… An interesting chap I met here last night is a Rumanian engineer who this time last year was a prisoner in Germany.He was shot through the belly in 1917 and got well cheerfully and apparently without much bother, to get it again five times in the legs.He thought that I was a German and I thought the same thing of him so naturally we were very peased [sic] to find that stature and blue eyes and a red mustache can mean other things in Brazil.He is in great doubt about the future of Europe and is one of the few minds I have yet encountered who sets a sufficiently large value on the Bolchevist [sic] movement.… Youve no idea what an easy social existence there is here.There is no repression along our lines.One of my guardas referred to his amour proper as his character and I am inclined to agree with him as I think it over, for there is no such thing as self control, nor any idea of state service or the common good.Work begins and ends when it pleases among the natives, and they simply dont know what application to work as an affair of the will is or can be.My guardas are no end proud of the fact that they are not as the others and are I think really grateful for the discipline they have received.… All Italian peasants at present eight years here but not yet speaking Brazilian.I can understand the immigrant problem better now that I have been one.
[19 de janeiro de 1920] Lages January 19 1920 I am on the job of finding out the extent of infection in a region here in a region about the size of the state of Colorado and half of New Mexico -travelling these last six months constantly, stopping only a week in each place and then after about five to eight hundred people have been examined clearing out for another place.Naturally the experience has shown me a good deal I never thought of before, and in this sort of a job meeting usually with the boa vontade of the people I am in a position to see and be told things that an ordinary stranger doesnt get to see.After this survey is through with we shall establish posts for the intensive treatment of the infected in the worst places, and by treating the people to a cure show them what they could be having in the way of health, and with this extraordinary lever inculcate the primary ideas of sanitation into them.The curious thing about it really is that the scheme works -they are profitting [sic] by it and adopting slowly the ideas of hygiene.And when you reflect that it was only in 1859 that the courts of Parliament in London had to close during the summer so horrible was the stench from the Thames from poorly disposed waste, or that the connection of sewres [sic] with the municipal drains of Paris was prohibited by law up till 1880 -perhaps the beginnings of sanitation here do not seem so insignificant.… Brazil is a mediaeval country with the constitution of the U.S. (practically) shoved down over it like a silk hat upon the head of a Roman plebe.It gives rise to incongruities -especially when the transportation is still so ineffective that one region differs enormously from the other in almost every way.The Brazilian is one of the most easily governed men in my experience.In an enormeous [sic] jam of people in Rio you can always move easily by say "Com licenca!" [sic] -and they always give way.They cannot resist persistent and gentle pressure -it wearsa [sic] them out completely!They never will refuse anything done slowly and quietly.My employees when I give them a a [sic] choice as to where they would like to work look quite pained and one began gently to tell my [sic] the custom in Brazil was that the obligation of the employee was to do whatsoever the parao [sic] wished -and not to choose his service at all! Imagine being lectured in a modern state on the obligations of the employee!But easy as these people are to lead like children, they have had no experience and with their system of family life and schools never get the chance to know the technique of government of others.Governments here are strong on just the same principle that little boys armies keep their unity -many titles and everybody happy -yes, a touch of impersonal "good of the service" and the opposition feels a sudden accession of strnght [sic] and you are back where you were if not even further back.Looking back upon the U.S. at this distance our national interest no longer seems to be liberty -more it is production that we care about.The men who menace liberty are excused if they are producers.Here Liberty still flourishes and I have never seen so high a per cent of people who can and do do [sic] just what they like.And incidentalyy [sic] a production do desperately inconvenienced by that same Freedom.… The per cent of infection here will not be over 13% where on the other side of the mountains down on the lovely palmy [sic] tropical littoral we have seen no place that had less than 88%.Several 96 and above.And very very sick people.The practice of a similar form of belief to Christian science is very common here.The Curandheiros or benzoadors can manage a disease very well at a distance, and the Catholic priests are not far behind.A curandheiro cures but a benzoador or blesser can avoid such things as the evil eye, cattle pests, flights of grasshoppers and frost.I know a priest who sold little calico flags at five mil a piece -value here about $5 -to keep the grasshoppers off.They did not work very well -but he said he had splendid silk flags at 50 mil that would work wonders!This being more money than a caboclo sees ever at one time -naturally it could not be denied that these big flags are good.I know an intelligent American woman -even as the Eddy followers are intelligent -who here employs a blesser for her ranch and believes in him.She has seen the cockroaches in droves swept out of the house after his prayers and she is no questioner of HOW it is done -she wants the results.Instead of people being angry at such stupidity twould [sic] be better for medicine to learn what happens and simply show if possible that with a phsical [sic] cause it works better to have a physical remedy.Instead of flying into a passion with the people who have found spiritismo [sic] to work as well as anything else.For if we are right the thing to do is to prove it.
[1 de fevereiro de 1920] Florianopolis February 1 1920 I wish Jim would come down here and see what a wonderful social position the negroes and mulattoes have here.I never realised [sic] how neatly subjugated they are in the U.S. until I see them expansively embracing some blonde here in the R.R. station or at a public meeting.If I were a coon with any education I'd come to Brazil -they gain more than they lose by leaving the U&S [sic].Portuguese is easy to pick up, and the educated coon here is just the same as a white.One of my boys is completely forgetful of color -he never remembers to put it down on the census card, and all the rest too draw almost no line at all.The trouble is that the black race has no more wanderlust than an ebony newell-post [sic] and they never will get up and do something really new.