AFTERNOON SEMINAR ABSTRACTS

LEPROSY IN BRAZIL: HISTORY AND DAILY LIFE IN THE COLONIES

Yara Nogueira Monteiro
Instituto de Saúde, São Paulo, Brazil

Beginning in the thirties of the past century, in an attempt to control leprosy the state of São Paulo adopted a prophylactic policy of compulsory isolation of all individuals diagnosed with this disease. This initiative by São Paulo state had considerable influence throughout the country in terms of the establishment of "asylum-colonies". This policy was maintained in Brazil until 1963, and in the state of São Paulo until 1967. Thousands were compulsorily isolated from society, forming a world apart that was governed by very specific rules.
We studied the mechanisms of control instituted by the State that allowed the imposition of norms, control and strict surveillance of every deed of these people during the decades of isolation. This study examines how the State gained the right of absolute control on those lives, in the name of common good, that surpassed even the limits of the individual under its control, by interfering in the family life. Analysing this practice, we verified how it was possible to establish measures that were imposed in spite of being against the established legal precepts, were imposed through tacit social consent, or at least with the absence of opposition that revealed the practice. We also studied forms of conviviality in the asylums and the role exercised by religion in such limit-situation
To carry out this study, we analysed not only the specific literature, but also the legislation regarding leprosy, the patient's medical records, photographs, correspondences, and interviews.

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A MONUMENT TO LAZARUS: THE LEPROSY HOSPITAL OF RIO DE JANEIRO

Thomas Hunter Smith
Tulane University, New Orleans, Louisiana, USA

Soon after the Portuguese made landfall in 1500, Europeans and African slaves introduced leprosy and St. Lazarus, the patron saint of its victims, into Brazil. By the middle of the eighteenth century those in the city of Rio de Janeiro with the disease suffered scorn and ostracism. Social and political pressure mounted to remove those unfortunates from the city's streets even before the move of Brazil's capital to Rio de Janeiro in 1763. A few months before the first viceroy arrived, Frei Antonio, the bishop of Rio, founded the venerable Leprosy Hospital of Rio de Janeiro that occupied a monastery built by the Jesuits in 1752 in the neighborhood of São Christovão. Frei Antonio requested that a Catholic brotherhood, the Irmandade do Santissimo Sacramento da Candelária, provide oversight and administration. The brotherhood remained faithful to its commitment during the patients' exile to a nearby island in 1817, to another island in 1823, and after their merciful return in 1833 to São Christovão. Today, the brotherhood continues to honor its covenant of 239 years ago. The original hospital, renamed the Hospital Frei Antonio, remains open today for 5 elderly patients with no other home. The history of this hospital reflects life in the surrounding community and provides insight into the complex relationships that existed between the citizenry and church and state. Rio's Hospital Frei Antonio had an important role in the evolution of the health care professions, progress in medical science, and the genesis of the hygienic movement in Brazil. This study also contributes to the history of a disease that persists in 2002 Brazil as a public health issue.

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LEPROSY, MEDICINE AND POWER IN LATE NINETEENTH CENTURY COLOMBIA

Diana Obregón
Universidad Nacional de Colombia

As imperialist nations rediscovered leprosy in their colonial world in the late nineteenth century, Colombian physicians found endemic leprosy in their own country. The medical community was interested in constructing a national medicine to conform to 'universal' science. To medicalise leprosy doctors provoked fears through exaggerating the number of leprosy sufferers to demonstrate that charity was incapable of dealing with the problem. The government approved laws of compulsory segregation of leprosy patients in the 1890s, while the 1897 international conference on leprosy held in Berlin gave international sanction to isolation. Lepers actively resisted segregation as a violation of their individual rights. Doctor Juan de Dios Carrasquilla studied the disease, experimented serotherapy to cure it, and claimed that the flea was its agent of transmission. He combated segregation and proposed instead a hygienic programme to improve environmental living conditions, but his approach was defeated. When the early twentieth century saw the consolidation of the Colombian state, modernisation of the country became a national priority. The government started to take control of lazarettos enforcing segregation of lepers, who were confined within an area circumscribed by a sanitary cordon. This strategy was a failure, since patients resisted segregation.

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GLOBAL AND LOCAL CONTEXTS OF A NATIONAL LEPROSY CONTROL PROGRAMME: THE NORTHERN OGOJA LEPROSY SCHEME, NIGERIA, 1945-1960

John Manton
Wellcome Unit for the History of Medicine, University of Oxford, UK

This paper describes the evolution of leprosy control in part of a province in colonial south-eastern Nigeria from 1945 to Nigerian independence in 1960. The Roman Catholic Mission (RCM) Ogoja Leprosy Scheme had primary responsibility for leprosy control in the north of Ogoja Province (roughly contiguous with present-day Ebonyi and northern Cross River States) during the period under scrutiny.

The work of the RCM in Ogoja was contextualised by the formation of a Nigerian national Leprosy Service in 1945 as part of a post-war Development and Welfare agenda in Britain's colonies. At the same time as government focused financial resources on centres at Oji River, Uzuakoli and Ossiomo, increasing attention was being paid to the widespread prevalence of leprosy in Ogoja, further to the east. Collaborating with colonial government and local 'Native Administrations' to
formulate leprosy control strategies appropriate to local conditions, the RCM Ogoja Leprosy Scheme benefited from therapeutic innovations developed in Nigeria and worldwide.

Deriving funding from missionary sources in Ireland, Britain and the USA, and from international leprosy relief organisations such as BELRA (now Lepra), and drawing on developing capacities in international public health under the auspices of
WHO and UNICEF through the 1950s, the RCM Ogoja Leprosy Scheme applied international expertise at a local level with ever-increasing success and coverage. The development of mission medical capacity in Ogoja, alongside rapid innovation in leprosy therapy in the 1940s and 1950s, helped set the scene for the much-vaunted focus on rural public health in post-independence Nigeria.

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LAZARUS IN THE NEW WORLD: LEPROSY HOSPITALS OF COLONIAL SPANISH AMERICA

Thomas Hunter Smith
Tulane University, New Orleans, Louisiana, USA

By the early sixteenth century in Europe, north and south of the Pyrenees Mountains, leprosy's former high profile as a medical and perceived moral threat to medieval society had abated but had by no means disappeared. Leprosy, now more appropriately referred to as Hansen's disease and identified with St. Lazarus (San Lazaro) the patron saint of its victims, reached the New World with the Spanish "encounter" and soon compelled colonial officials to respond to its presence. With the earliest initiative in Santo Domingo in 1509, leprosy hospitals opened throughout the Spanish colonial empire extending from New Spain to the distant Philippine Archilepago.

Governing directives for the earliest and most important of these hospitals closely approximated ordinances of the San Lazaro Hospital of Seville that began operations in the middle of the thirteenth century and remains in service today. Specific statutes, for example those formulated for the hospital in Mexico City, often contained elements that reflected local and regional political and public health priorities. The Bourbon reforms of the eighteenth century illustrate this on a grand scale. By attempting to reverse a decaying system of San Lazaro hospitals while controlling the sexuality and marital life of those stigmatized patients, the Crown confronted problems symptomatic of dilemmas that existed over a wide range of social issues including traditional concepts of charity and morality. This study of the institutions that harbored victims of a disease often used as a metaphor for immorality and degradation contributes to medical, public health, and colonial Latin American history.

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THE FIRST INTERNATIONAL LEPROSY CONFERENCE, BERLIN 1897, AND THE POLITICS OF SEGREGATION

Shubhada S Pandya (absent, paper read by Jo Robertson)
Mumbai, India

The last decade of the nineteenth century saw the West gripped by an extraordinary paranoia about leprosy. The great fear in Europe and the United States, was of contamination entering "civilised countries" via diseased immigrants from the Orient and elsewhere. Compulsory and universal leper isolation in endemic countries was confidently touted as the only means of protection.

The convocation of the first international meeting on leprosy revealed that despite common concerns, there were differing and incompatible views on how the problem was to be addressed. This paper utilises unpublished correspondence and published sources relating to the Conference, to examine the competing interests and their contribution to its scope and final form. The protagonists were Albert Ashmead (New York), Jules Goldschmidt (Paris), Edvard Ehlers (Denmark), Armauer Hansen (Norway), and Phineas Abraham (Britain). Goldschmidt and Ashmead were the polemical originators of the plan to canvass governments for an international "Congress" of official delegates empowered to oversee leper isolation policies world-wide. Ehlers successfully out-manoeuvred them with a counter-proposal of a "Conference" of leprologists and scientists, "official delegates" playing no defined role thereby minimising the political content. On leprosy suppression, the arguments ranged from international control, to exerting pressure on sufferers to segregate, (Hansen), to doubts that compulsory isolation was efficacious. Besides encouraging concealment, it was too politically fraught in India to be workable (Abraham). The "Final Statement" that national policies be tailored to local compulsions, reveals that Hansen, the star participant, could not garner unanimous agreement for his enthusiasm for leper isolation.

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LEPROSY AND THE HISTORY OF TROPICAL MEDICINE IN BRAZIL: THE EARLY CONTRIBUTION OF ADOLPHO LUTZ

Jaime Larry Benchimol & Magali Romero Sá
Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

In 1886 the Brazilian physician Adolpho Lutz travelled to Hamburg to study with Paul Gerson Unna, one of the foremost dermatologists of the time. The clinic founded by Unna in 1881 was a centre for the study of skin diseases, attracting students from all over the word. The description of different illness, as well as new therapies and methodologies used to observe fungi and other micro-organisms, had led Unna to a central position within the dermatological world.
During the time Lutz spent at Unna's clinic (1885-1886), he had the opportunity of investigating the morphology of germs in relation to several skin diseases, having even proposed a new classification of the leper bacillus, removing it from the genus Bacillus and re-classifying it as Coccothrix lepra. Lutz's study of the structure of the leper bacillus was facilitated by a new staining method discovered by him and improved by Unna.
As one of Unna's most prominent students, Lutz was indicated in 1889 by his master to a position as physician of the Leper Settlement in Molokai Island, Hawaii, a place where he intended to use the treatment developed by Unna. After working some months at the Receiving Station of Kalihi (later to become the U.S. Leprosy Investigation Station), Lutz spent some more time in Hawaii working on his own private clinic and continuing his research on leprosy. He left Hawaii in 1892, and after spending some months in California, returned definitively to Brazil in 1893.
As soon as he arrived back, Lutz was invited to work at the newly-founded Bacteriological Institute, in the city of São Paulo, an institution he directed for 14 years. He was later invited to join the scientific staff of the Oswaldo Cruz Institute, in Rio de Janeiro, a position he held for the following 30 years.
A world pioneer in the scientific study of the leper bacillus and leprosy research in Brazil, Lutz kept a lifelong interest in the transmission and prophylaxis of the disease, having turned a strong defender of the polemic theory of the transmission of the leper bacillus by mosquitoes. The relevance of his studies in Germany, Hawaii and Brazil, his insertion in the national and international scientific scenery, and his influence in the formulation of public health policies and prophylactic campaigns in Brazil, are the main aspects discussed in the present work.

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MEMORY AND HISTORY OF LEPROSY IN BRAZIL THROUGH DEPOSITIONS (1960-2000)

Laurinda R Maciel
Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

The history of leprosy in Brazil is well-documented up to the early 1940s by various authors. Beginning in the 1950s and up to the present day, this medical, social, economic and political universe relative to the disease is not found to be properly analysed, making it relevant to undertake a study that will retrieve this period. The Oswaldo Cruz Institute (IOC) and the Oswaldo Cruz Home (COC), in partnership with UFRJ, have developed a research project that gives priority to the constitution of an archive of depositions from characters who played a part in that history in the last half of the twentieth century. The collection of depositions from professionals in the area of health and former patients, using the methodology of oral history, will make the perception of the various nuances possible, such as disputes present in the political universe, analysis of the control policies, location of documentary sources important for the reconstruction of the disease's evolution, identification of different concepts and proposals under dispute and the privileged locus of production and dissemination of ideas and studies, such as periodicals and congresses. The depositions are recorded based on a previously elaborated plan taking into consideration the interviewee's trajectory, their professional and family life and to what extent they came into contact with the disease: next the interview is transcribed and checked and summaries are prepared, in addition to a biographical profile of the interviewee. At the end of the survey, the archives will remain under the care of COC and we shall have a final product which would be the archive itself with the depositions (primary source for the research) and a printed catalogue which will be an instrument for consulting, concentrating the information necessary for the interested researcher in the theme being studied.

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A COMPARATIVE STUDY OF SOCIAL REPRESENTATION OF HANSEN'S DISEASE AND LEPROSY AMONG PATIENTS, HEALTH PROFESSIONALS AND GENERAL POPULATION IN RIO DE JANEIRO, BRAZIL

Maria Leide W Oliveira
Universidade Federal do Rio de Janeiro, Brazil

This research was conducted in order to find out the impact of the neologism "Hanseníase" or Hansen's Disease (HD) among the population (800), health professionals (219) and patients (93) of two municipalities of Rio de Janeiro State.
The results indicative of the communication between the HU and the population show that leprosy concepts are transmitted orally, in the streets and at home, whereas the information about Hansen's disease, even though acquired in the HU, seems to be more accessible to those with education corresponding to mid and upper levels, extract corresponding to 13.8% of those interviewed. Based on the theory of social representation (SR) it concludes that HD is part of a process of modernization of common sense, anchored in the traditional representation of leprosy. This finding is understandable as the central structure of one SR is known to have historical determination, so short and middle term changes are not expected. Furthermore there has not been a constant investment in social marketing to divulge the new terminology. Otherwise, health professionals and patients showed a high level of HD concepts incorporation. This allowed us to infer the existence of normative influence from health service.

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IN OR OUT? LIFE AT THE FORMER LEPROSARIUM OF CURUPAITI, BRAZIL

Cassandra White
Tulane University, New Orleans, Louisiana, USA

Curupaiti, currently the Instituto Estadual de Dermatologia Sanitária, in Jacarepaguá (Rio de Janeiro state, Brazil), was founded as a center for tuberculosis patients in 1922, but in 1928, fifty-three leprosy patients were transported there from the Hospital dos Lázaros in Rio de Janeiro. It subsequently operated as a confinement center for leprosy patients. While doing research on cultural aspects of leprosy treatment in Brazil in 1998-1999, I visited Curupaiti several times and attended educational discussions about leprosy in which patients were encouraged to participate. I talked to staff and patients and made use of Curupaiti's library, and I was also provided with papers and dissertations written by some of the psychologists and social workers there. Today, Curupaiti operates as an outpatient facility, but many families of former patients continue to live there. This paper will summarize the history of Curupaiti and will address a phenomenon that has been taking place there in recent years, in which newly diagnosed patients will occasionally attempt to move into the former leprosarium to receive the economic benefits provided to residents (free health care and rent). Perceptions of the leprosarium and its residents held by people in the wider community will also be discussed.

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THE STATE, PHYSICIANS AND LEPROSY IN MODERN COLOMBIA

Diana Obregón
Universidad Nacional de Colombia

In the early twentieth century, leprosy became an obstacle for the civilising and modernising project of the Colombian elites. The Colombian government, with the expert assistance of the medical community, started to take control of lazarettos, and physicians began to medicalise leprosy. The government enacted extremely severe laws in order to control lazarettos. Their main purpose was to block the social and economic links of the town-lazarettos with the external world. The rationale for this position was to arrest the spread of the disease. Lepers were confined within leprosaria. The government also attempted to expel from the lazarettos a large population free of leprosy, mainly composed of relatives of leprosy sufferers. The period in which the Colombian State began to control leprosaria coincided with the formation/modernisation of the Colombian State. Refinement of the arts of government, definition of citizenry (for example, through the establishment of such obligations as denouncing victims of leprosy), and exclusion of a social group defined as "lepers" came together. A disease-apart approach was institutionalised by establishing two distinct domains of public health: a special official agency was set up for leprosy, while all other diseases were handled through a different department. However, in spite of the efforts of physicians and the government, leprosy was not thoroughly medicalised. Patients actively opposed compulsory segregation with attempts at converting lazarettos into prison-asylums. Non-leprous people remained at the lazarettos, and scientific medicine competed with popular healers, herbalists, and charlatans within these institutions. After all, these had been ordinary towns until the state took control of them in the early twentieth century. Since leprosaria were not hospitals, physicians were unable to order treatments. The medicalisation of leprosy was only partially accomplished because of its demarcation as a disease-apart.

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COMMUNITY AT CARVILLE: EXPERIENCES OF LEPROSY IN LOUISIANA

Cassandra White
Tulane University, New Orleans, Louisiana, USA

In 1999, Louisiana's Carville Hospital, or the Gillis W. Long Hansen's Disease Center, ceased to operate as a facility for leprosy treatment and care of former patients. However, since its inception in 1894 and throughout much of the twentieth century, patients with leprosy were confined there, some for a few months, some for the rest of their lives. Patients were isolated from their families, encouraged to change their names, and occasionally used as guinea pigs for new drug testing. While life was difficult for many patients, Carville also developed into a true community, in which patients participated in various activities, including sports competitions, dances, Mardi Gras celebrations, and theater productions. In 1996-1997, I conducted video-oral history interviews with patients, former patients, and staff at Carville. In this paper, I will present a brief picture of what life was like for patients at Carville, particularly from the 1950s to the1990s, when most of the people I interviewed were living and/or working there. I will also discuss the stigma that was experienced by patients both within and outside the gates of Carville.

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ADMINISTERING LEPROSY CONTROL IN OGOJA PROVINCE, NIGERIA, 1950 - 1967: A CASE STUDY IN GOVERNMENT-MISSION RELATIONS

John Manton
Wellcome Unit for the History of Medicine, University of Oxford, UK

The northern Ogoja Leprosy Control Scheme, administered for the Nigerian and Eastern Region Government and the people of Ogoja Province by the mainly Irish Roman Catholic Mission (RCM), was an active participant in the shaping of new accommodations between Nigerians and expatriates taking place during the 1950s and 1960s at local, regional and national level across the country. In this paper I describe the interaction between government and mission in the provision of a leprosy service under the auspices of post World War Two programmes for Colonial Welfare and Development, focusing on the crucial years just before and after Nigerian independence in October 1960.

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IN A STATE OF CORRUPTION: COLONIAL QUEENSLAND AND THE CORDON SANITAIRE

Jo Robertson
Wellcome Unit for the History of Medicine, University of Oxford, UK

On 30 July 1891, the colony of Queensland, under the administration of the Colonial Secretary, Horace Tozer, approved and published "Regulations for the Treatment of Persons Affected with Leprosy and for the Prevention of the Spread of that Disease" in response to a perceived threat - an epidemic of leprosy. Four months after the regulations were passed, The Brisbane Courier reported that a man in Rockhampton" was supposed to be suffering from leprosy." When James Quigley was detained at the Brisbane Hospital and the Central Board of Health met to decide what to do with him, another story of detention and isolation emerged. This one had been going on since 1889 without causing too much of a disturbance anywhere at all. This story is concerned with a few cases of disease and with petty administrative details, but the measures taken by the administration betray a level of panic totally incommensurate with the case numbers. They also reveal that leprosy's symbolic weight was such that the measures taken were considered necessary and were even (if only for a short time) countenanced in spite of their "inhumanity." The archives reveal that seven men had been removed from Cooktown and placed on Dayman Island in the Torres Straits - about as far north as it is possible to get from the mainland without actually being in New Guinea. This paper considers early efforts to control leprosy in colonial Queensland, demonstrating how the fear of the disease generated attempts to create a site of isolation and confinement on Dayman Island. In the process, it touches upon differing medical attitudes to the disease that are underpinned by an all-pervasive and continuing fear of racial contamination.

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