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Benvenuti, Doctors!

Arrival of Italian physicians in São Paulo at the turn of the 20th century impacted both education and medical research

CAPH-USP Aerial view of the complex of buildings of the São Paulo School of Medicine and Surgery, established in 1912, situated on Avenida Dr. ArnaldoCAPH-USP

The expansion of coffee-growing throughout the interior areas of São Paulo at the end of the 19th century sparked a surge in immigration of European workers, especially Italians, in search of better living conditions. The arrival of those immigrants to work on farms and in the factories that had begun to proliferate in São Paulo’s cities contributed to the state’s economic development and significant population growth. Little known, however, are the stories of the Italian physicians who also found their way to São Paulo, encouraged by the expansion of their arena of activity as a result of the establishment of public health care facilities. It is estimated that about 250 doctors who were trained in Italy settled in São Paulo between 1880 and 1930. Despite their relatively low numbers, quite of few of them played prominent roles in the formation and development of scientific research in São Paulo, leaving their mark on the history of health in that state.

At the end of the 19th century, São Paulo began to have to deal with the same illnesses that were wreaking havoc in the city of Rio de Janeiro. Outbreaks of epidemics of yellow fever, Bubonic plague, smallpox, and other ailments brought about by extremely poor sanitary conditions and spread by the intense traffic of human beings between cities and the countryside altered sanitary conditions in the state. The Italian government, learning of the deterioration in the living conditions of a burgeoning population from reports by agents who had been sent to inspect the conditions under which immigrants lived and worked, went so far as to recommend that its people not move to Brazil. Pressured by an increase in outbreaks and epidemics that affected not only the population but economic progress, the São Paulo government conceived a series of ways to reform the public health system.

Collection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP) Engraving of the Vaccinology Institute building by São Paulo artist Wasth RodriguesCollection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP)

Those actions culminated in the establishment of institutions such as the Bacteriology Institute in 1893 and the Vaccinology Institute in 1894. Eventually those institutions would merge to become the Butantan Institute. However, when it detached from that institution in 1940, the Bacteriology Institute took the name Adolfo Lutz Institute. “São Paulo was the state that invested most heavily in public health and in fighting epidemic diseases at the turn of the last century,” says historian Claudio Bertolli Filho, a professor in the Graduate Program in Education for Science at the São Paulo State University (Unesp) in Bauru, in inland São Paulo State. According to Bertolli, the seriousness of the epidemics accelerated the pace of institutional advances in that field and increased the demand for health care professionals. Attracted by the improved conditions, Italian physicians who were already established in Brazil moved to São Paulo from other states or arrived directly from other countries.

Businessmen of Italian origin like Francesco Matarazzo (1854-1937) played an important role in São Paulo spurring the establishment of hospitals, philanthropic health care centers, and mutual aid societies such as the Sociedade Italiana de Beneficência in São Paulo—which administered the Umberto I Hospital that functioned in the Bela Vista neighborhood between 1904 and 1993—attracting even more foreign professionals. “Italian doctors were already somewhat familiar with microbiology and tropical diseases,” says Bertolli. “Others came here believing that their captive clientele would be made up of Italian immigrants, but soon began serving the entire population.”

Collection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP) Alfonso Bovero established and organized the Anatomy Department of the USP School of MedicineCollection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP)

The status of Italian science and clinical medicine stood out from that of the rest of Europe in the late 19th century, as sociologist Maria do Rosário Rolfsen Salles, from the Anhembi Morumbi University reported in the book Médicos italianos em São Paulo (1890-1930): Um projeto de ascensão social (Sumaré, 1997) [Italian physicians in São Paulo (1890-1930) – A study of upward social mobility]. According to the researcher, the secularization of health care that followed the Protestant Reformation in Europe did not affect Italy. “Church control over hospitals and medical practices made it hard for doctors to advance professionally and apply what they had learned,” she says. Their decision to emigrate therefore found additional support in the conditions under which Italian science and medical practices were developing.

At the time, São Paulo physicians were attending medical school in either Rio de Janeiro or in Salvador, Bahia State. In rare cases, they would study abroad. “By introducing and disseminating new knowledge and practices from Europe, Italian doctors played an important role in the education and medical research carried out in São Paulo,” recalls sociologist Luiz Antonio de Castro Santos, a professor at the Institute of Humanities, Arts and Sciences of the Federal University of Southern Bahia (UFSB). Castro Santos, alongside Salles, studied the careers of the Italian physicians in São Paulo during the First Republic. One of the men profiled was Giovanni Sanarelli, known for having isolated the icteroid bacillus, then considered to be the cause of yellow fever. Today we know that the disease is caused by an arbovirus of the genus Flavivirus.

Collection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP) In the Bela Vista neighborhood of São Paulo, the Umberto I Hospital attracted Italian physicians who had settled in different parts of BrazilCollection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP)

Sanarelli disembarked in São Paulo in 1898 and was an active participant in the campaign to eradicate yellow fever in São Carlos do Pinhal in the rural area of the state. Other physicians began arriving from Italy in 1900, including Alfonso Splendore. At age 22, Splendore became involved in activities at the Bacteriology Institute, then headed by physician Adolfo Lutz (1855-1940), researching and writing about toxoplasmosis, leishmaniasis, South American blastomycosis—a kind of fungal infection—and syphilis, one of the diseases considered to be the biggest threat to public health in Brazil in the first two decades of the 20th century.

The high percentage of eye disease found among Italian immigrants was responsible for the arrival of ophthalmologists like Giuseppe Zaccaro, who helped end an epidemic of granular conjunctivitis, also known as trachoma, in the municipality of Taquaritinga. Trachoma affected a considerable number of people in inland São Paulo during that period. The swift propagation of the disease convinced state officials in 1906 to form committees on the treatment and prophylaxis of trachoma. It was a costly effort that required the installation of treatment clinics statewide in municipalities that in some cases were situated 400 km from the state capital.

Library of the Pasteur Institute Façade of the Pasteur Institute of São Paulo, inaugurated in the state capital in August 1903Library of the Pasteur Institute

Three years earlier, in November 1903, Italian ophthalmologist Francisco Pignatari had already begun taking actions such as later adopted by the São Paulo Sanitary Service in caring for trachoma patients when he founded the Morro Vermelho Ophthalmic Hospital, the first in São Paulo according to researcher Soraya Lodola of the Geosciences Institute of the University of Campinas (Unicamp). The hospital had capacity for 314 patients, large gathering spaces, and rooms suited for accommodating patients suffering from a variety of ophthalmic diseases. “Within only a few months, the hospital became an important care center for trachoma sufferers,” Lodola says. In 1906, she reports, 2,934 patients were served, 2,390 of whom had trachoma while 544 exhibited other ophthalmic diseases. “Pignatari’s contributions were of enormous value in the history of battling against the trachoma epidemic,” she says.

The increase in interest in science associated with medicine and public health in São Paulo culminated in August 1903 with the establishment of the Pasteur Institute in the state capital. Devoted to the development of laboratory medicine through bacteriological research, instruction in microbiology, and production of immunization agents, the institute served as a forum for discussion, education, and scientific investigation, compensating to some extent for the absence of a medical school in São Paulo, which would not be established until 1912.

Reproduction from the book Médicos italianos em São Paulo (1890-1930) Physician Alfonso Splendore worked alongside Adolfo Lutz at the former Bacteriology InstituteReproduction from the book Médicos italianos em São Paulo (1890-1930)

The Pasteur institute was initially headed by Italian physician Ivo Bandi, but he left the post because of disagreements with infectious medicine specialist Emílio Ribas (1862-1925), then director of the São Paulo Sanitary Service. In 1906, Antônio Carini, an Italian bacteriologist and director of the Institute of Bacteriology, Serotherapy, and Infectious Diseases in Bern, Switzerland, accepted the position of director of the Pasteur Institute and expanded its work in the treatment of rabies. “Brazilian doctors expected the Italians to display a more refined knowledge of medicine than what was taught in Brazilian medical schools,” says Bertolli. “That is why they invited them to come to São Paulo.” According to Castro Santos, those professionals were also expected to have had clinical training based on public health research, knowledge later used in training doctors at the Institute of Hygiene—now the School of Public Health of the University of São Paulo (USP), established in 1918.

In 1912, many Italian professionals left the Brazilian institutions where they were working to teach at the newly-created São Paulo School of Medicine and Surgery that opened its doors in 1913. Clinical subjects were usually taught by professors from the São Paulo medical elite, while basic disciplines such as parasitology, microbiology, physiology, pathology, and anatomical pathology were left to the foreign professors. Alessandro Donati became a professor of general and experimental pathology, and Carini left the Pasteur Institute in order to teach microbiology and immunology at the new school.

Collection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP) In 1912, bacteriologist Antônio Carini (above) left the post of director of the Pasteur Institute in order to teach at the São Paulo School of Medicine alongside pathologist Alessandro Donati (at left)Collection of the Historical Museum of the University of São Paulo School of Medicine (FMUSP)

Another important name in the consolidation of São Paulo medical education is that of Italian anatomist Alfonso Bovero, who joined the faculty of the new school at the invitation of physician Arnaldo Vieira de Carvalho (1867-1920), one of the organizers of the School of Medicine and Surgery. That school was among the units that combined to form USP in 1934. Bovero arrived in São Paulo as an “academic superstar” owing to the prestige he had won in Europe. “The Italian anatomy expert founded and organized the school’s Anatomy Department and was one of the first in Brazil to teach that anatomy as a discipline should be considered a separate field of knowledge that gained importance when associated with subjects like physiology and pathology,” wrote Bertolli in an article published in the journal História, Ciência, Saúde — Manguinhos and co-authored by psychologist Ana Carolina Talamoni that discussed the teaching of anatomy in Brazil in light of Bovero’s ideas.

Bovero also found a fertile field for research at the Umberto I Hospital and alongside other physicians and researchers he helped found the journal entitled Revista ARS Médica. According to Salles, that publication was an important vehicle for discussion of the results of studies carried out at the School of Medicine and at the same time brought the fields of education and research closer together, since many of the published works were submitted by professors who taught at the new São Paulo medical school. “Participation by the Italian doctors was a determining factor in formation of São Paulo’s scientific community, the development of scientific research, and the dissemination of microbiological science,” Salles concludes.