For a sanitized city : Revista Pesquisa Fapesp

Large flows of people between the countryside and cities of late nineteenth-century Brazil led to a slew of epidemics in São Paulo State. Following outbreaks of typhoid fever, bubonic plague and smallpox, state authorities responded with a set of new public-health strategies: in 1892 they created the Sanitary Service, an agency tasked with the management of the Bacteriological Institute and the Vaccine Institute—now the Adolfo Lutz and Butantan institutes, respectively—and began policing and conducting health surveillance inspections at large public and private establishments. Despite their efforts, disorderly city expansion, an increasingly impoverished population, and poor living conditions in working-class neighborhoods led to increased disease incidence and infant mortality rates. The state needed an institution to train medical specialists in hygiene and public health. This need was met in February 1918 with the creation of the Laboratory of Hygiene, the precursor of the School of Public Health of the University of São Paulo (FSP-USP).

The Laboratory of Hygiene was created under a collaboration agreement between the São Paulo State Government and the Rockefeller Foundation, one of the oldest philanthropic institutions in the United States. Knowing the foundation was keen to contribute toward public health in foreign countries, physician Arnaldo Vieira de Carvalho (1867–1920), the director of the newly created School of Medicine and Surgery of São Paulo, wrote a letter to the institution requesting support for the creation of two new programs in pathology and hygiene. In 1916 the Rockefeller Foundation sent a medical commission to Brazil to visit medical schools, hospitals, health services, and research centers in a number of state capitals and to establish contact with academic leaders. “The commission was impressed by the success that São Paulo State authorities had achieved in managing epidemics, and found it in their interest to intensify collaboration between the Rockefeller Foundation and the Government of São Paulo,” says historian Luciana Cristina Correia, a master’s alumnus of the Institute of Philosophy and Human Sciences at the University of Campinas (UNICAMP).

From the collection of The Historical Museum at the University of São Paulo School of Medicine American sanitarian Wilson Smillie, the second head of the Laboratory of HygieneFrom the collection of The Historical Museum at the University of São Paulo School of Medicine

A cooperation plan was agreed between the foundation and the state government, to which the School of Medicine would be subordinate. Under the cooperative arrangement, a laboratory linked to the discipline of hygiene would provide training to students in the fifth year of medical school. The government would lease a building to house the laboratory and would defray its maintenance expenses. The Rockefeller Foundation would pay expenses toward purchasing necessary equipment and setting up a library, plus an annual sum of US$15,000 over five years. The property selected for the facility was a mansion next to the School of Medicine, in the center of São Paulo.

“The agreement also provided that doctoral scholarships at the newly established School of Hygiene and Public Health at Johns Hopkins University would be granted to two physicians from the São Paulo School of Medicine, and that the head of the Laboratory of Hygiene would be an American sent to Brazil from the United States,” says sociologist Nelly Martins Ferreira Candeias, a retired professor at FSP-USP’s Public Health Department. “The appointed head was sanitarian Samuel Taylor Darling [1872–1925], a specialist in yellow fever, hookworm, and malaria,” says the researcher. Candeias authored the first study on the creation of the Laboratory of Hygiene, published in 1984 in Revista de Saúde Pública (Public health journal). Darling remained as head of the laboratory until late 1921, when he was replaced by Wilson George Smillie (1886–1971). Physicians Francisco Borges Vieira and Geraldo Horacio de Paula Souza were the Brazilians granted scholarships for training in the United States, becoming the first in the country to receive doctoral degrees in Hygiene and Public Health.

From the collection of The Historical Museum at the University of São Paulo School of Medicine The first class of sanitary educators, trained in 1927From the collection of The Historical Museum at the University of São Paulo School of Medicine

Born in Itu, a town in São Paulo State, Paula Souza (1889–1951) then had two degrees: one in pharmacy, completed in 1908, and another in medicine, completed at the Rio de Janeiro School of Medicine in 1913. In October 1918 the young physician went for his doctoral training at Johns Hopkins. There, he studied, conducted research, and visited sanitary institutes and works. “On returning to São Paulo in 1921, he became head of the Laboratory of Hygiene, with Borges Vieira as deputy,” says sociologist Cristina de Campos, author of the book São Paulo pela lente da higiene: As propostas de Geraldo Horácio de Paula Souza para a cidade (1925–1945) (São Paulo through the lens of hygiene: Geraldo Horácio de Paula Souza’s propositions for the city [1925–1945]).

Under Paula Souza, the Laboratory of Hygiene was upgraded to the status of hygiene institute. “Public health became an interdisciplinary concern, and not just a medical one,” says Correia. Following the end of the collaboration with the Rockefeller Foundation, he developed a proposal to transform the laboratory into a public-health school, a venue for research and training of professionals for the School of Medicine and Sanitary Service.

“The Institute of Hygiene, officially established in 1924, was innovative in that it trained professionals in both sanitary and medical disciplines.”

From the collection of The Historical Museum at the University of São Paulo School of Medicine The laboratory was initially housed in this mansion on Brigadeiro Tobias street, in the center of São PauloFrom the collection of The Historical Museum at the University of São Paulo School of Medicine

Its hygiene and public-health programs included lectures on sanitary administration, bacteriology and immunology, epidemiology, and prophylaxis of infectious diseases. In research, the institute’s Department of Rural Hygiene, headed by parasitologist Samuel Pessoa (see Pesquisa FAPESP, issue no. 255), and Department of Epidemiology, under Borges Vieira, developed studies on the treatment of hookworm and prophylaxis of malaria, typhoid fever, and venereal diseases. The institute built extensive and valuable collaboration with the Health Service, of which Paula Souza became head in 1922 while still head of the Institute of Hygiene.

During his tenure at the Sanitary Service, he undertook a structural reform and created programs in hygiene and public health for physicians, and sanitary education for secondary students in training as teachers. “His proposition was to shift the focus of public-health efforts from the sanitary police to sanitary education,” says education historian Heloísa Helena Pimenta Rocha from the School of Education at UNICAMP.

From the collection of The Historical Museum at the University of São Paulo School of Medicine Borges Vieira published prolifically during his time as deputy head of the Institute of HygieneFrom the collection of The Historical Museum at the University of São Paulo School of Medicine

Both Paula Souza and Borges Vieira advocated a “neutral” approach to science that could guide society on a rational path, lifting it from backwardness through education. In 1924 Paula Souza successfully applied for support from the Rockefeller Foundation to build a new building for the institute, says Rocha, author of the book A higienização dos costumes: Educação escolar e saúde no projeto do Instituto de Hygiene de São Paulo (1918–1925) (Introducing hygiene into customs: Scholastic and health education within the São Paulo Institute of Hygiene [1918–1925]).

In 1938, the School of Hygiene and Public Health was incorporated into USP and again came under the aegis of the School of Medicine. It was only in 1945 that it gained the status of an independent school. A number of important public policies implemented in the 1950s and 1960s derived from research conducted at the institution. One such policy was water fluoridation. In a survey of 334 cities in the state and 12 reservoirs, nutritionist Yaro Gandra found that fluoride levels in the water were less than ideal. His work led to a decision in 1952 to add fluoride to water supplies in São Paulo.

From the collection of The Historical Museum at the University of São Paulo School of Medicine

A Veterinary Public Health program was created in 1957, followed the next year by a Graduate Program in Public Health for dentists. In 1959 this program offering was extended to nurses. In the 1960s, the university undertook demographic and health research programs in collaboration with the School of Philosophy, Languages and Literature, and Human Sciences (FFLCH) at USP, leading to the creation of the Center for Population Dynamics Studies (CEDIP), founded and led by statistician Elza Berquó at FSP-USP, in 1966 (see Pesquisa FAPESP, issue no. 262).

During the National Tuberculosis Eradication Campaign in 1968, the school was selected to host training courses on interpreting tuberculosis screening tests and administering BCG vaccines. In 1987, FSP-USP and the School of Law at USP created a working group on Sanitary Law, which later became the Center for Research in Sanitary Law (CEPEDISA).

From the collection of The Historical Museum at the University of São Paulo School of Medicine Paula Souza (circled) during the 3rd Brazilian Congress on Hygiene in 1926From the collection of The Historical Museum at the University of São Paulo School of Medicine

The school now has two centers carrying out education, research, and community service activities. One is the Centro de Saúde Escola Geraldo de Paula Souza in São Paulo. The other is the Special Health Service of Araraquara (SESA), in the interior of São Paulo.

The institution continues to play a prominent role in conducting research and training high-caliber professionals, advising on public-health policy, and contributing to the improvement of Brazil’s national healthcare system (SUS).

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