Abstract
This paper investigates continuities and changes in the definition of sickle cell disease in 1950s Brazil, taking into account that diseases have a history and are recognized as such according to the knowledge and perceptions available in a certain historical period and specific location. In the post-war era, new diagnostic tools, inheritance theories and, in particular, discussions on the concepts of race and racial relations, both nationally and internationally, were changing previous racialist and racist views. Nonetheless, the Brazilian medical interpretations of sickle cell disease continued to racialize it and even use deep-rooted racist formulations to explain its symptoms or the existence of the disease. It is argued that the celebration of racial mixture and racial democracy might have concealed racist presumptions biasing the study of sickle cell disease. Although race as a biological concept gradually gave way to other genetic expressions, in Brazilian medical papers on sickle cell disease, race continued to influence the interpretation of the disease, along with the persistence of concepts of heredity through blood mixture.
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Notes
It is important to stress that this paper deals with medical and social views from Western society in urban areas and, therefore, ancient knowledge on this disease will not be examined here.
Consequently there were three different opinions: first, one mostly held by foreign scientists and physicians, that there was a debilitating tropical anemia; second, the one that asserted the existence of a kind of anemia proper to tropical regions, but not a debilitating one; and third, one that denied any alteration of blood components due to racial mixture or tropical climate (Edler 2011).
Oswaldo Gonçalves Cruz (1872–1917) is the most important medical scientist of Brazilian history, as Louis Pasteur is to France and Robert Koch to Germany, and therefore he has risen to a quasi-mythical status in many of the historical accounts of his life and the history of medical sciences in Brazil. After acquiring his medical degree in Rio de Janeiro, Oswaldo Cruz enrolled in the microbiology course and worked at the Institut Pasteur between 1897 and 1899. After receiving international recognition for controlling yellow fever in Brazil, he received more national support to conduct other sanitary campaigns; he built a physical, political and intellectual structure in order to practice independent science in the tropics. For more details, see: https://portal.fiocruz.br/trajetoria-do-medico-dedicado-ciencia, visited on August 10th, 2019.
Belisário Penna (1868–1939) is among the most important figures of public health history in Brazil. He started his professional health career as health inspector under Oswaldo Cruz’s Directorship of the Public Health Department in 1904 and reached the position of Ministry of Education and Health in 1931. Meanwhile, Penna made several scientific expeditions into the hinterlands of Brazil, whereby he defined his intellectual legacy, searching for and mapping endemic diseases in the country. In 1918, he founded the Sanitation League and published the book Sanitation of Brazil, which are considered milestones of the Sanitary Movement of 1920s. http://brasilianafotografica.bn.br/?p=12777, visited on August 10th, 2019.
The purity-of-blood laws was a set of laws and institutional measures that socially and institutionally segregated and discriminated Jews, blacks, gipsy and natives in the Iberian Peninsula since the fifteenth century. They were applied in the colonial territories in the Americas (Rodrigues 2011).
All translations into English by the author unless otherwise indicated.
Hemoglobin is a molecule found in great amounts in blood cells; it gives the red color to them due to the iron atoms.
Ernani Martins da Silva (1914–1948) graduated in medicine from the Federal University of Rio de Janeiro and ran the Microbiology Seminars of the Oswaldo Cruz Institute. There, he worked at the Hematological Section during the 1940s until his death on a scientific exploration in the hinterlands of Brazil (Cruz 1949).
Despite being less common, there were still studies on the different incidence of infectious diseases’ between white and black people (Leite 1957).
The author also stressed that there were “fundamental structural differences of erythrocytes in two races [black and white] (Gesteira 1950, p. 24).”
Arthur Ramos accepted a position in UNESCO’s Social Science Department in 1949 and was the key figure behind the establishment of the UNESCO Project in Brazil (Maio 1999). More information about UNESCO Project is found below in this paper. Ramos was one of the pioneers in making important studies of the African contribution to Brazilian culture during the 1930s (Skidmore 1976, p. 209). Arthur Ramos de Araujo Pereira (1903–1949) received his medical degree in 1926 with the thesis “Primitiveness and Madness” (Primitivo e Loucura) and during the next decade focused on studies about the black population in Brazil. The book O Negro Brasileiro (1934) put him in closer contact with foreign scholars interested in studying “black issues” nand, at the end of the 1930s, he traveled to the United States. Back in Brazil, Ramos founded the Society of Anthropology and Ethnography in Rio de Janeiro in 1941, and revised his decade-long work. In 1945 he obtained a PhD in Social Sciences and planned a trip to Africa, which was canceled by his acceptance of a position in UNESCO (Campos 2002).
Wagley, Charles. Letter to Arthur Ramos requiring some confidential information regarding Dr Ernani. Martins da Silva. New York, March 4th, 1947. 2 p. Orig. Dat. In English. Trad. in Portuguese. Research plan devised by Wagley is given in Appendix. I-36,7,2.702, Archive Arthur Ramos//Brazilian National Library asil. Charles Wagley (1913–1991) “became the leading Brazilianist of his time, a pioneer in the ethnographic study of Indigenous peoples and peasants of the Amazon and Northeast” and a key scholar of the studies of acculturation and cultural change. More of his biography see in Pace (2014).
Physician, serologist and geneticist, Arthur Ernest Mourant (1904–1994) directed the Blood Group Reference Laboratory (BGRL) in London (1946–1965), which then became the WHO’s centre for antisera production in 1950. In 1952, Mourant also directed the newly established Nuffield Blood Group Centre, which was administered by and housed in the Royal Anthropological Institute. In 1965, Mourant retired from the BGRL and became Head of the Medical Research Council's newly established Serological Population Genetics Laboratory (SPGL) (Bangham 2014). https://genmedhist.eshg.org/record-sets/archival-resources/mourant/, visited on August 5th, 2019.
William Clouser Boyd, author of Genetics and the Race of Men. An Introduction to Modern Physical Anthropology (1950), critiqued Silva’s methods on blood group analysis.
Many physicians considered the hypothesis of a recessive hereditary mechanism for SCD, but few published on this issue (Feldman and Tauber 1997). It is not the purpose of this paper to discuss matters of priority, but there is an account that Jessé Accioly, professor at the Bahia Faculty of Medicine (Faculdade de Medicina da Bahia), expressed a similar hypothesis to Neel’s in 1947, but achieved no international prominence because it was published in Portuguese in a local medical journal (Azevedo 1973; Accioly 1947).
James van Gundia Neel (1915–2000) was a leading figure in human genetics in post-war era due to his early paper on the inheritance of SCD (1949) which lead him to in-depth studies of human genetics. He participated in the creation of the American Society for Human Genetics (1948), and in 1956 one of the first Departments of Human Genetics in the United States, at the University of Michigan. Soon after the Second World War he was commissioned to research on the effects of the nuclear explosions in Japan, in which he would work for two decades. In post-war era he began to develop studies on hemoglobinopathies genetics, particularly sickle-cell anemia, which took him to Africa. During the 1960s and part of the 1970s, Neel’s research concentrated mostly on the genetics of Amazonian indigenous peoples (Santos et al. 2014b). Linus Carl Pauling (1901–1994) completed his Ph.D. in chemistry in 1925, when he was also elected Research Associate at the California Institute of Technology. He was twice awarded the Nobel Prize: Chemistry in 1954 and the Peace Prize in 1963. https://www.nobelprize.org/prizes/chemistry/1954/pauling/biographical/, visited on August 5th, 2019.
In the 1950s, only the Brazilian physician Luis Montenegro followed Ernani Silva’s approach by searching for sickle cell in indigenous groups. However, he did not travel to their communities or make the examinations personally. The blood of indigenous peoples came from a section of the National Institute of Research of Amazonia settled in Parintins, a region far away from Manaus, capital of the state of Amazonas. Montenegro was a scientist of the hematology laboratory of this institute and published two articles about sickle cells: a page-article relating its absence in indigenous from the Maêus people and a review concerning the trait and the disease (Montenegro 1958a, b). As far as I could investigate, he did not engage in anthropological discussions like Ernani Silva.
This work could not include analysis of other Latin America medical works on SCD, but Torrealba et al. (1955) is cited because it was published in an important Brazilian medical journal—Memórias do Instituto Oswaldo Cruz.
Since the 1930s, chemists applied electrophoresis to differentiate molecules, observing their distinct electric charges when exposed to an electric current (Wailoo 1997, pp. 154–155).
The suspicion that they were two different conditions, the sickle cell trait and the disease, was older than the works from 1940s. Many physicians suspected the existence of two separate conditions—not everyone with sickle cells would manifest the disease—based on clinical observation (Feldman and Tauber 1997, pp. 635–636).
The work of Zaidan (1958) was published in a Brazilian newspaper with a larger public. “NOTAS CIENTÍFICAS. Eletroforese (em papel) de hemoglobinas”, Correio Paulistano, 24 ago. 1958, p. 5: http://memoria.bn.br/DocReader/DocReader.aspx?bib=090972_10andpesq=falciformeandpasta=ano%20195, visited on April 1st, 2019. “Entre centenas de ácidos aminados, uma pequena substituição causa uma grande anomalia; anemia falciforme”, O Dia, 14 set 1958, p. 12: http://memoria.bn.br/DocReader/DocReader.aspx?bib=092932andPagFis=97923andPesq=falciforme, visited on April 1st, 2019. During the 1950s, SCD rarely reached the public stage. Some reports became public later in the same decade to inform about electrophoresis technology, but none introduced any kind of race debate. Worthy of note is a report—among daily bulletin about the Rio de Janeiro city—revealing the effort of a father to bring his daughter to a famous medical professor of in order to ‘cure’ her sickness. “’Cura da Anemia Falciforme’: UH trouxe ao Rio a Filha do Operário de Volta Redonda”, Última Hora, 28 set. 1959, p. 10: http://memoria.bn.br/DocReader/DocReader.aspx?bib=386030andpesq=falciformeandpasta=ano%20195, visited on April 1st, 2019.
It is worth mentioning that a physician questioned the racial specificity of SCD in a clinical case discussion on the 5th medical Clinics of National Faculty of Medicine in Rio de Janeiro in 1953 “It seems that it is not anymore accepted the hypothesis that this anemia is exclusively from blacks (Silva 1953, p. 309).”
Alvaro Serra de Castro (1911–1970) graduated in medicine in Rio de Janeiro, and in 1944 presented the work “Eritrofalcemia” (Sicklemia) to obtain a position on the Pediatric Clinics of Federal University of Rio de Janeiro. He was member of the Pediatric Brazilian Society and also the French and American ones, taking part in many congress and publishing works on blood diseases and syphilis (Rocha 1970).
João Maia de Mendonça worked in the Army Health Service in many regions of Brazil (1934–1938) until went to the Army Biology Institute, where he retired in 1963. ARQUIVO HISTÓRICO DO EXÉRCITO, Ficha de Informações do General de brigada João Maia de Mendonça.
The dissipation notion also happened outside Brazil. In 1951, an extensive work on SCD published in the North American journal Medicine stated that “the less frequent occurrence of sickling in the Western hemisphere may be attributed to the less pure strain of Negro blood found in the Americas” (Margolies 1951, p. 427). In reality, the widespread belief in the USA was that race mixing triggered the disease as an editorial of the Journal of American Medical Association in 1947 pointed: “sickle cell anemia (…) is independent of either geography or customs and habits. Its occurrence depends entirely on the presence of Negro blood (Wailoo 1997, pp. 148–149).”
It is not a coincidence that both papers are permeated by Julius Bauer’s concept of “status degenerative” of SCD. For Krynski et al (1952, p. 697): “We consider sickle cell anemia not a morbid condition strictly differentiate as a nosology entity, but as a general organism manifestation in the sense of abnormality and very specific as a developmental delay.”
By a very similar procedure, medical works on SCD in Senegal continue to reconstruct the history of ethnicities, following the legacy left by French scientists (Fullwiley 2011).
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Acknowledgements
Versions of this paper were presented at the Symposium “Blood, Food, and Climate: historical relationships between physiology, race, nation-building and colonialism/globalization”, occurred in Rio de Janeiro during the 25th International Congress of the History of Science and Technology in 2017 and in the Workshop Genealogies of Admixture Studies, in the Post-graduated Program of History of Science and Health from Casa de Oswaldo Cruz/Fiocruz in 2018 and benefited greatly from the comments and feedback of the participants. I am also gratefully to reviewers comments that certainly contributed to improve my argument. This material is based upon work supported by the financial resources of the Programa Nacional de Pós-Doutoramento (PNPD) from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes).
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Cavalcanti, J.M. Racial mixture, blood and nation in medical publications on sickle cell disease in 1950s Brazil. HPLS 41, 51 (2019). https://doi.org/10.1007/s40656-019-0289-3
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DOI: https://doi.org/10.1007/s40656-019-0289-3