摘要：Public health in Brazil achieved remarkable development at the turn of the 20th century thanks in part to physicians and social thinkers who made it central to their proposals for “modernizing” the country. Public health was more than a set of medical and technical measures; it was fundamental to the project of nation building. I trace the interplay between public health and social ideas in the late 19th and early 20th centuries. Physicians and social thinkers challenged the traditional belief that Brazil’s sociocultural and ethnic diversity was an obstacle to modernization, and they promoted public health as the best prescription for national unity. Public health ideas in developing countries such as Brazil may have a greater impact when they are intertwined with social thought and with the processes of nation building and construction of a modern society. SINCE THE 1980S, THERE HAS been a proliferation of studies on the history of health and medicine in Brazil and other Latin American and Caribbean countries. Along with native historians and social scientists, American and European researchers have also contributed to this research. The creation of specialized scientific journals and graduate courses and the inclusion of medical and health-related topics in the syllabi of research programs on Latin American social and cultural history are other indicators of the progressive consolidation of this field of study. 1 Among recent contributions to this historiography have been studies of the intellectual role of medical doctors, with their elaboration of ideas about the problems in their own societies and possible alternatives for overcoming them. I add to the analysis of this theme, focusing on the Brazilian experience. Two major ideas dominated interpretations of Brazil after its political independence in 1822: “nationhood” and “civilization.” 2 The concept of nationhood implied the desire to integrate a diverse country geographically, racially, and culturally. The concept of civilization—a fashionable and central idea for Brazilian and Latin American intellectuals concerned with the legacy of colonialism and backwardness—represented their desire to achieve levels of material and cultural progress similar to those in Western Europe. From the first decades of the 19th century through the early 20th century, Brazilian medical doctors contributed significantly to developing social thought through their publications on public health issues. These physicians emphasized that to attain progress and civilization, the country’s public health problems would have to be addressed. They asserted that Brazil’s tropical location and climate and its ethnic diversity were not in themselves obstacles to social development. Further, they argued the need to examine European lifestyles and institutions critically rather than to imitate them blindly. 3 These ideas inspired the Brazilian sanitary movement of the early 20th century, which emphasized the need for development of the sertão (the rural areas of the interior of Brazil). This movement, which emerged in Rio de Janeiro, pointed to the devastating effects of infectious diseases and the absence of sound public policies as the central problems of Brazilian society. 4 In the 1930s, these key ideas would strongly influence the then emerging social sciences in Brazil. Medical doctors and social scientists began a fruitful dialog on their interpretations of Brazilian society and its sociocultural contrasts (i.e., its ethnic diversity and its stunted sociocultural and economic development), as well as making proposals for modernizing Brazilian society. I examine this combination of medical and social ideas by describing the work of some of these Brazilian medical doctors and explaining how their work was used and expanded upon by social scientists. A historical examination of this topic is relevant for understanding not only the evolution of public health but also the dynamics of Brazil’s nation building.
