In nineteenth-century Rio de Janeiro, physicians, surgeons and apothecaries were mostly white and belonged to the better social classes. Meanwhile, bloodletters, folk healers, midwives, and wetnurses were almost always slaves, freed Blacks, and impoverished free people including both immigrants and free Africans. It was these disadvantaged people who cared for the most urgent health problems among those who needed them, rich as well as poor. Bloodletters offered their services in the city streets and squares and barber shops, while midwives worked within homes, caring for issues not only related to childbirth, but also abortions and genital diseases.
From 1808 to 1828, the Fisicatura-mor, an agency established by the central government and headquartered in Rio de Janeiro (at that time, the capital of the Empire), monitored and regulated the “healing arts,” which included activities practiced by doctors as well as those undertaken by people without academic training. This agency established that doctors were responsible for diagnosing and treating diseases within the body, while surgeons cared for external ailments. Apothecaries, in turn, prepared the medications prescribed by doctors and surgeons. “Officially, bloodletters and midwives were expected to deal with simple cases of disease and do only what physicians or surgeons ordered. But the population turned to them because they shared their concepts of disease and health,” observes historian Tânia Salgado Pimenta, a researcher at the Oswaldo Cruz House/Oswaldo Cruz Foundation (COC/FIOCRUZ) and professor in the graduate program in the History of the Sciences and Health.
The above scenario is described in Escravidão, doenças e práticas de cura no Brasil (Slavery, disease and healing practices in Brazil) (Outras Letras, 2016), edited by Tânia Pimenta and the historian Flávio Gomes from the Institute of History at the Federal University of Rio de Janeiro (UFRJ). In the book, they present the results of a research project conducted at FIOCRUZ from 2013 to 2016 with funding from the Brazilian National Council for Scientific and Technological Development (CNPq) and FIOCRUZ itself. The studies show that services essential to the health of Brazilian society at that time were provided by slaves and freed people in an era when academic medicine competed with popular healing practices.
Pimenta explains bloodletting, citing that since the time of Hippocrates (460 BC to 370 BC), academic medicine understood the human body to be comprised of four humors: blood, phlegm, yellow bile, and black bile, which came from the heart, the respiratory system, the liver, and the spleen, respectively. Especially after Galen (in the second century AD), doctors believed that imbalances between these elements in parts of the body could be combated through bloodletting or other methods that would make the patient vomit, pass stool, or urinate. Bloodletting was consequently used to treat diseases like cholera, as well as fevers, coughs, and colds, which were also considered diseases at that time. “It was the popular therapists and not the doctors who performed this activity, which was considered inferior because of the need to touch the patient’s body and deal with blood,” says Pimenta. She explains that many bloodletters also worked as barbers, using their cutting tools for incisions as well as to cut men’s hair and beards. If they were slaves, the bloodletters made arrangements with their masters to give them part of the income earned from this activity. Pimenta states that during the nineteenth century, students at the first two medical schools established in Brazil in 1832, in Salvador and Rio de Janeiro, began to take over this work, discrediting the role played by African descendants.
“After the discoveries by the French [scientist] Louis Pasteur in microbiology and the development of microbial medicine, bloodletting gradually stopped being recommended,” she explains. Pimenta adds that in the nineteenth century, medicine did not have the same credibility it enjoys today among the Brazilian population, which is related to the institutionalization of this field in the country. This process, which was only consolidated in the twentieth century, began in the first half of the nineteenth century with the creation of the medical schools in Rio and Bahia, specialized medical journals during the late 1820s, and the Rio de Janeiro Society of Medicine in 1829, which was transformed into the Imperial Academy of Medicine in 1835.
The historian Rodrigo Aragão Dantas, a doctoral student at FIOCRUZ, explains that in the early nineteenth century, registration with Fisicatura-mor was required to work as a bloodletter or midwife, a possibility which disappeared in 1828 when the responsibility for public health services passed to the municipal councils. According to Dantas, at this time bloodletters were unable to obtain this official registration to work and began to work clandestinely. Even so, they did not lose their credibility among the population.
The population of slaves and freed people also played a central role in the survival of newborns in the middle and upper classes. White women did not usually breastfeed their babies. This activity was seen as work, and they consequently resorted to milk from Black women who had just given birth, whether these were slaves they owned, leased from third parties, or even freed women. “At that time, newborns who were not breastfed rarely survived, among the upper classes as well as in impoverished families,” says Maria Helena Pereira Toledo Machado, a professor in the Department of History at the School of Philosophy, Languages and Literature, and Human Sciences at the University of São Paulo (FFLCH-USP). Machado says that the Americans Charles Windship and Elijah Pratt invented baby bottles between 1841 and 1845, while processes for pasteurizing and sterilizing milk were invented in 1859 and 1886, respectively. In 1867, the first factory producing powdered formula was established in Europe. “Little by little, these events made artificial feeding of newborns safer. In Brazil, some advertisements for infant milk powder appeared as early as the 1870s, but the products did not circulate widely because they were imported, expensive, and there was little stock,” Machado. As a result, during the second half of the nineteenth century in Brazil wetnurses were still preferred.
Although the practice occurred in other countries where slavery existed, Machado believes it was more intense in Brazil. “In the United States, Southern farmers used slaves who had given birth at the same time to take turns breastfeeding newborns,” she notes. In Brazil, in more than 90% of newspaper advertisements from the period, slave wetnurses were advertised without their own children. The values assigned to these women were three times higher than when they were offered for rent with their own offspring. “We know little about what happened to the children who were separated from their enslaved mothers. Many died from not being fed or were abandoned by the masters of these women in churches, public squares, or charitable institutions,” Machado adds.
The theme of motherhood in slavery was studied in a research project funded by the Arts and Humanities Research Council (AHRC) of the United Kingdom during 2015 and 2016, bringing together Machado and other researchers who also work with slavery and gender. They edited a two-volume dossier titled Mothering slaves: Motherhood, childlessness and the care of children in Atlantic slave societies, which was published in Slavery and Abolition and the Women’s History Review in June and August of this year.
The historian Karoline Carula, professor in the Department of History at Rio de Janeiro State University (UERJ), says that after the 1870s, scientific theories which racialized humanity began to spread throughout Brazil. “For doctors who had a racialized view of humanity and considered Blacks inferior, racial inferiority led to bad milk. So they began to disparage the milk from Black wetnurses,” explains Carula.
In another activity which was central to the health of the population in the nineteenth century, midwives were also mostly slaves and freed women. Babies were delivered at home and only the poorest of women chose to give birth in hospitals or clinics. “At that time, doctors received theoretical training and generally concluded their studies without having attended deliveries, while midwives had years of practical experience,” says Machado.
Historian Lorena Féres da Silva Telles, a doctoral student at FFLCH-USP and author of the book Libertas entre sobrados: Trabalho domestico em São Paulo (1880–1900) (Free among the townhouses: domestic work in São Paulo [1880–1900]) (Alameda, 2014), considers the lack of obstetric practice among doctors to be an issue that spanned the nineteenth century. Doctors were slow to enter this field because of moral barriers, which required the use of mannequins for practical studies in medical school. Telles found in her research that the only opportunities for students to attend deliveries were cases of enslaved, free, or poor women. “In a city maternity ward which operated in Rio in the early 1880s, deliveries took place with students present, who could palpate, observe dilation, and examine the women, probably against their will. Medical knowledge of obstetrics during this period was mainly developed from experience with poor women or slaves,” she notes. These findings came from analyzing clinical cases published in medical journals of the time, medical school dissertations on the topics of breastfeeding and child hygiene which were defended during the nineteenth century, and daily newspapers and medical journals available at the Brazilian National Library and the library at the Health Sciences Center of UFRJ.
A Faith healer at the navy hospital
Between 1808 and 1828, Fisicatura-mor suppressed work by people who were not formally trained to cure disease, a group that included faith healers. Even after they were banned by the agency in 1828, faith healers maintained their credibility among the population. Historian Rosilene Gomes Farias, who holds a doctorate from the Federal University of Pernambuco (UFPE), studied the trajectory of the enslaved African Pai Manoel and his work as a healer during the cholera epidemic in Recife, in 1856. Farias says that when the epidemic first began, Pai Manoel mainly attended the Black and mixed-race population. Then some cases of healing attributed to him attracted attention from wealthy families as well as doctors.
“Researching in newspapers of that time such as Diário de Pernambuco or O Liberal Pernambucano, I saw that the doctors from the Public Hygiene Commission reached out to the healer to learn the details of his treatment, which involved a formula made from herbs,” she adds. When the epidemic was at its most critical point, the authorities allowed Pai Manoel to work at the Navy Hospital. This episode reflected poorly on the Imperial Academy of Medicine and led to the collective resignation of the members of the Public Hygiene Commission, as well as the arrest of the healer. “His story reveals the disputes that existed between doctors and healers in the nineteenth century,” concludes Farias.
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FARIAS, R.G. Pai Manoel, o curandeiro africano, e a medicina no Pernambuco imperial. Hist. Cienc. Saúde-Manguinhos. v.19, p.215-231. 2012.
MACHADO, M.H.P.T. Between two Beneditos: enslaved wet-nurses amid slavery’s decline in southeast Brazil. COWLING, C. et al. (orgs.) Slavery and Abolition. Special Issue: Mothering Slaves: Motherhood, Childlessness and the Care of Children in Atlantic Slaves Societies. v. 38, n. 2. jun 2017.
PIMENTA, T. S. Midwifery and childbirth among enslaved and freed women in Rio de Janeiro in the first half of the nineteenth century. COWLING, C. et al. (orgs.) Women’s History Review. Special Issue: Mothering Slaves: Motherhood, Childlessness and the Care of Children in Atlantic Slaves Societies. on-line. ago 2017.
TELLES, L. F. S. Pregnant slaves, workers in labour: amid doctors and masters in a slave-owning city (nineteenth-century Rio de Janeiro). COWLING, C. et al. (orgs.) Women’s History Review. Special Issue: Mothering Slaves: Motherhood, Childlessness and the Care of Children in Atlantic Slaves Societies. on-line. ago 2017.