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A surgeon’s advice

Republication of an 18th-century practical manual on medicine reveals details of the art of curing

Black surgeon applying leaches, a watercolor by Debret (1826), depicts the black populace dependent on surgeons even into the 19th century, in Rio de Janeiro

CASTRO MAYA MUSEUMSBlack surgeon applying leaches, a watercolor by Debret (1826), depicts the black populace dependent on surgeons even into the 19th century, in Rio de JaneiroCASTRO MAYA MUSEUMS

Anyone who needed medical care between the time of the discovery of Brazil in 1500 and the arrival of the Portuguese royal family in 1808 was in a fix. Portuguese physicians willing to venture to Brazil were extremely rare. In Portugal, physicians were intellectuals with a university education. They discussed the great thinkers of old such as Aristotle and Galen. They enjoyed a high standing and earned significantly more money than those in occupations regarded as manual or mechanical. This was true for surgeons, for example, who were qualified to apply dressings and to perform surgeries, bloodletting and amputations after two years of practical study at the Hospital de Todos os Santos in Lisbon, without any academic training. It was they who brought some relief and knowledge to a populace greatly lacking in any kind of health care in the overseas territories.
Working far away from the Portuguese Court offered surgeons significant advantages: they could become landowners and could gain wealth and social prominence. Physicians became more plentiful in Brazil only when the royal family established itself there in 1808 and created schools of medicine in Salvador and Rio de Janeiro. In efforts to ease this serious shortage, at least three surgeons wrote medical manuals in the 18th century in Brazil.

Luís Gomes Ferreira published Erário mineral (Mineral treasury) in 1735; João Cardoso de Miranda wrote Relação cirúrgica e médica (Surgical and medical description) in 1747; and in 1770, José Antonio Mendes authored Governo de mineiros mui necessário para os que vivem distantes de professores seis, oito, dez e mais léguas, padecendo por esta causa os seus domésticos e escravos queixas, que pela dilação dos remédios se fazem incuráveis e as mais das vezes mortais (Governance for inhabitants of Minas Gerais greatly needed for those who live six, eight, ten or more leagues away from doctors, causing their servants and slaves suffering from afflictions to become incurable and often die as a result of delayed remedies). This 158-page book with its rambling title was republished last month by the Public Archives of Minas Gerais with a critical study by Carlos Alberto Filgueiras, a chemist and science historian from the Federal University of Minas Gerais.

The word “governance” in the title refers to the treatment of ailments. The author received a “surgery certificate” in Lisbon in 1739 and is thought to have come to Brazil soon afterward. There is no information on his birth, return to Portugal or death. In the book, he says that he wrote the manual after 35 years spent working in the “surgical arts.” He is known to have worked in the capitanias (now states) of Bahia and Minas Gerais.

“Although the manual contains a great deal of superstition, some items are quite interesting, particularly the effects of applying lemon juice to cure scurvy,” Filgueiras says. The juice and salt were rubbed onto the mucous membranes of the mouth until they bled, bringing vitamin C into direct contact with the patient’s blood. “The method of application was rather barbaric, but in essence it is consistent with modern medicine” (read the original prescription shown in the photo above).

Original frontispiece of Governo de mineiros and information on curing scurvy

PUBLIC ARCHIVES OF MINAS GERAISOriginal frontispiece of Governo de mineiros and information on curing scurvyPUBLIC ARCHIVES OF MINAS GERAIS

The objective of Mendes and other surgeons was to give masters practical information for administering medical treatment to their slaves, who worked from sunrise to sundown in mining, farm work and hard labor of all kinds.

“In Europe, governors focused on the health of poor men who relied on their physical strength to work. In the colonies, which relied on slave labor, they turned their attention on the black population,” explains historian Márcia Moisés Ribeiro, a researcher with the Institute of Brazilian Studies (IEB) and the School of Philosophy, Language and Literature, and Humanities (FFLCH), both part of the University of São Paulo (USP). Ribeiro also studied the work of Mendes.

In addition to scurvy, the practical manual on surgery gives instructions on treating wounds in general, erysipelas, tumors, edemas, boils and intestinal maladies, calls attention to asepsis for instruments and gives prescriptions for the art of curing. “Some of the remedies he prescribes look clearly foolhardy today, particularly synthetic inorganics like mercury salts, antimony and arsenic,” comments Filgueiras.

Mendes did not disdain the idea of local experience and investigated the effectiveness of Brazilian plants for curing diseases, particularly those of a tropical nature. Much of that information came from indigenous and African traditions. “The physicians trained at the University of Coimbra lacked that knowledge,” Filgueiras concludes.

Prescription for scurvy
When scurvy is in its beginning stage (…) do as follows: if the patient’s tongue is spotted and he has little desire to eat, have him take sour lemon and ground salt and rub them well into the gums until they bleed considerably; have him rub the same mixture on his tongue;

(…) give him an emetic, and the following day give him an ounce of juice of the arroz de telhado plant (…) continuing with this regimen for eight or ten days, all the while accompanied by the aforementioned rubbing of the gums (…)”