Nas trincheiras da cura: As diferentes medicinas no Rio de Janeiro Imperial

Human beings fall sick; sometimes they recover, but at times they die. Human intervention — whether psychological, surgical, or pharmaceutical — seeks to prevent death and promote recovery. Such intervention is uncertain and sometimes even counterproductive. This reality explains why, in the Western world, the practice of healing (what we term medicine) is so contested and so intolerant. Competing schools claim exclusive effectiveness for their therapeutics, seek to gain a monopoly of healing, and denounce rivals as charlatans and butchers. Dominant schools make training laborious, exclusive, and costly, as are the charges for medical care. Such tactics are self-defeating. Alternative therapeutics flourish because they are less expensive and because, historically, orthodox medicine has so often been crude and ineffective. The very illicitness of alternative medicines and the boldness of their claims make them the more alluring. (Just the other morning I saw in the window of an alternative healing center a notice: “We believe in miracles.”)Gabriel dos Reis Sampaio’s Nas trincheiras da cura studies orthodox and alternative therapeutics as they battled each other in Rio de Janeiro during the final decade of the imperial regime. As the title indicates, it was a trench war — intense, exhausting, destructive — that, in the last analysis, achieved very little. Despite the efforts of the orthodox doctors, seconded by the press and aided by the local health and police authorities, the curandeiros, the alternative healers, were not eliminated, nor were their activities long disrupted. The attempts of the local authorities to regulate and so control health practitioners may, as the author claims (p. 118), have intensified in the final years of the Empire, but the cases she cites do not suggest much effectiveness in their actions. Similarly, the press denounced the curandeiros as “barbarous” but was quite as capable of excoriating orthodox doctors for their failures and pretensions. Finally, the medical profession itself devoted as much time and energy to internal feuds as to attacks on alternative healers.In her introduction (perhaps the most effective part of the book), the author explains that the first chapter will study the inefficacy of orthodox medicine; the second, the disillusionment of the ordinary population with orthodox remedies and their resort to alternative therapeutics; and the third, the treatment by health authorities of the whole range of unlicensed (but not necessarily alternative) healers. The actual text does not follow the schema at all closely. Each chapter contains a little of everything. Part of the difficulty is that the work, a revision of a master’s thesis, does not display the conceptual rigor the topic requires. The text contains too many case studies narrated at length and too many summaries of the opinions and findings of experts the author has consulted.Compounding the problem of conceptual focus is the author’s inadequate understanding of the historical context. She does grasp the identification of scientific medicine with “civilization” in the minds of the Brazilian elite — an identification promoted, as she points out (p. 24), by the Sociedade de Medicina founded in 1829, later the Academia Imperial de Medicina. What she does not appreciate is that the key figures in these two entities had been trained at the Faculté de Medicine at Paris. French medicine was accepted into the twentieth century as the epitome of the “civilization” to which Brazil aspired. In 1922, the Brazilian government endowed a chair in the Paris Faculté de Medicine in recognition of this debt. Similarly, the author observes that “throughout the Second Reign, Brazilian intellectuals who were doctors strove to obtain greater prestige and influence with the authorities of the Imperial government” (p. 111). Here, too, she does not appreciate that such doctors were the imperial authorities. Witness José Martins da Cruz Jobim and Luís Carlos da Fonseca, both of them MDs of the Paris faculty, professors of the Rio Medical School, senators, doctors at court, and so close associates of Emperor Pedro II.Also absent from the work is any grasp of the broader international context necessary for an effective analysis of orthodox medicine in Brazil. Take, for example, the issue of state “licensing,” and so control, of healers. In Great Britain, the Medical Council and its register was not established until 1858. In the United States, orthodox medicine lost in the early republic all privileged status in relation to alternative therapeutics and did not regain it until the Flexner Report of 1910. The discussion of licensing and state control in chapter 3 would gain both depth and power if reference were made to these trends outside of Brazil.These criticisms should not deter anyone from reading the book. Gabriel dos Reis Sampaio has produced a work written in an engaging style and showing considerable intelligence. The author is to be commended for calling our attention to an important subject.

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