Volume 22 - Novembro de 2017 Editor: Walmor J. Piccinini - Fundador: Giovanni Torello |
Agosto de 2016 - Vol.21 - Nº 08 História da Psiquiatria JULIANO MOREIRA E OS AMERICANOS Walmor João Piccinini Ao
longo dos anos temos escrito artigos sobre um grande brasileiro, o primeiro foi
em 2002 e procurava resumir uma biografia deste grande brasileiro. (http://www.polbr.med.br/ano02/wal0702.php) Escrevendo sobre Juliano, junto com dois
historiadores da psiquiatria, tivemos a honra de publicar sobre Juliano no
American Journal of Psychiatry: Juliano Moreira (1873-1933): founder of
scientific psychiatry in Brazil. Amer. J. Psychiatry, 2005, 162 (4) Oda, Ana Maria
Raimundo // Piccinini, Walmor J. // Dalgalarrondo, Paulo At the beginning of the twentieth century, the
Afro-Brazilian doctor Juliano Moreira, adopting many of Kraepelin’s ideas on
classification, started a theoretical renovation of Brazilian psychiatric
ideas, which up to this point had a marked French accent. Moreira devoted much time to the study of
cross-cultural psychiatry (Kraepelin´s compared psychiatry). He
investigated especially dementia caused by syphilis, concluding, against
dominant views, that the racial condition would not immunize against nor favor
the emergence of such condition. At Moreira’s time, most Brazilian intellectuals endorsed racial biases
and prejudices regarding medical and scientific ideas. This was not the case of
Moreira, who took a clear and courageous stance, both personally and scientifically,
by carefully investigating mental diseases in the different Brazilian ethnic
groups and fighting the intense and widespread color prejudice of his time. Dez
anos depois publicamos a contribuição da Professora Ana Maria Galdini Oda para a antologia Latino - americana de Psiquiatria na Polbr de
Fevereiro
de 2012 - Vol.17 - Nº 2 JULIANO MOREIRA: CLIMA, RAÇA, CIVILIZAÇÃO E ENFERMIDADE MENTAL. No ano seguinte publicamos O Japão e Juliano
Moreira
www.polbr.med.br/ano13/wal0913.php O interesse na vida e obra de Juliano é
permanente. Neste número da Polbr estamos
reapresentando um trabalho do JOURNAL OF THE
NATIONAL MEDICAL ASSOCIATION, VOL. 78, NO. 7,1986. Trabalho de muitos anos atrás que pode ser
encontrado na Internet, mas nem sempre lido a não ser por quem se interessa
pela vida de Juliano. Porque publicá-lo? Por apresentar o ponto de vista de
professores americanos sobre um fenômeno latino-americano e por tecer
comparações com americanos da mesma época. J Natl Med Assoc. 1986 Jul; 78(7): 679–683. PMCID: PMC2571382 The extraordinary career of Juliano Moreira:
Afro-Brazilian psychiatrist.
R. Fikes, Jr and D. A. Cargille THE EXTRAORDINARY CAREER OF JULIANO
MOREIRA: AFRO.BRAZILIAN PSYCHIATRIST Robert Fikes,
Jr., MA, MALS, and Douglas A. Cargille, MA, MLS San
Diego, California In 1921 the American College of
Physicians and Surgeons sponsored a select group of doctors to observe medical
practices in several South American countries. Upon returning to the United
States, one Midwesterner in the party commented on the salutary racial climate
in Brazil. To demonstrate his point that blacks there were better able to
realize their full potential and to support his contention that there was
hardly any evidence of color prejudice, he cited (in a report to the
organization) the case of Dr. Juliano Moreira, the country's leading
psychiatrist and an internationally recognized medical researcher. Fluent in
French, German, Spanish, Portuguese, and English (the latter spoken with the
facility of a polished upper-class Englishman), Moreira received the
distinguished Midwesterner in his spacious library where, as on so many other
occasions, he charmed the guest with his warm, gentle nature and won him with
his "high intelligence, culture, and ability. "1 By the time Moreira
had escorted him to the entrance and wished him farewell in his deep, mellow
voice, the American was convinced that his host had indeed lived up to his
reputation as being "generally considered one of the representative men of
Brazil. . .an exceptional man [who] well illustrated the possibility of the
Negro in South America."1 Born on January 1, 1873, in Salvador, the
picturesque seaport capital of Bahia, a Brazilian state comprised largely of
unmixed blacks and mulattoes, young Juliano Moreira could view firsthand the
system of slavery, which was not to be outlawed in Brazil until 1888, the last
country in the Western Hemisphere to do so. By then more Africans had been
imported to work in that Juliano Moreira, MD mines and plantations than had
been brought to the United States. But unlike the United States, Brazil was
spared the fratricidal bloodletting of a civil war over the issue of slavery.
The Brazilian attitude concerning interracial relationships will be discussed
later, since this point is central to understanding the successful career of
Moreira and other prominent Afro-Brazilians around the turn of the century.
Even before the emancipation of slaves, mulattoes far outnumbered unmixed
blacks, and nowhere in Brazil was the African presence more visible than in the
staid and rather isolated state of Bahia where blacks and mulattoes still
outnumbered whites. As the oldest city in Brazil, Salvador could also boast of
churches of unrivaled grandeur and, of interest to the precocious Moreira, the
oldest medical school in the nation, the Faculdade de
Medicina da Bahia. Having completed humanistic studies
at the Gymnasium Pedro II and the Lyceu Bahiano, he matriculated at the medical school at the
incredible age of 13, completing his doctoral thesis five years later on
malignant syphilis praecox "with the highest mark" from his thesis
committee.2 After graduating from medical school, he journeyed to Europe to
study under Virchow, Unna, Nothangel, Dejerine, Magnan, and others.
Though early in his medical studies Moreira was intrigued with the treatment of
skin diseases, he soon developed a commensurate fascination with the study of
nervous and mental disorders. Proficiency in research helped him to secure
faculty positions at the Anatomical Institute, the Medical School of Bahia and,
following the publication of a paper on the effects of arsenic poisoning in the
Journal ofNervous and Mental Disease, he was
appointed Professor of Psychiatry at the University of Bahia in 1896.
Increasingly, he focused his attention on the origin and effects of mental
diseases and the administration of mental care institutions. While teaching at
the University, he established the Clinic for Neurology and Psychiatry at St.
Isabel Hospital,2 the first of its kind in Bahia, where he introduced lumbar
puncture for diagnostic purposes in cases of tabes dorsalis, dementia paralytica,
cerebral syphilis, and various meningitic diseases.2
By 1899, Moreira realized that he could no longer delay travel abroad. He
proceeded to make his second extended voyage to Europe, which would deepen his
expertise and eventually focus international attention on his pioneering work
in Brazil. He attended the International Congress of Medicine in Paris and
became a corresponding member of the Royal Medico-Psychological Association of
London. At lectures and conferences, he kept abreast of recent advances in
psychiatry by such notables as Kraepelin, Kraff-Ebing, Jolly, Hitzig,
Leyden, Flechsig, Raymond, and Fournier. Of these, none was more influential
than the revered German psychiatrist Emil Kraepelin, whose classification of
mental disorders, as set forth in the clinical concepts of dementia praecox and
manic-depressive psychosis (or schizophrenia), brought order to psychiatric
thinking and greatly assisted scientific research in the field. It was through Moreira,
his friend and disciple, that Kraepelin's nosology was transmitted to Brazil. Moreira concluded his
first trip to Europe with visits to psychiatric clinics in several countries.
Returning home, he began agitating for improved mental institutions, the need
for laboratories in hospitals, and the employment of clinotherapy
to aid in treating psychosis.2 The current trends and thought Moreira absorbed
while in Europe would be put into practice in 1903 when, at aged 30 years, he
was appointed director of the National Hospital for the Insane in Rio de
Janeiro. He immediately enacted reforms at the asylum. Iron bars were taken
down and mechanical restraints were removed to provide the sense of a benign
environment for the 2,000 patients at the asylum. Other improvements
inaugurated by Moreira during his 30-year superintendency
included: Separate departments were established for juveniles, for infectious, and tuberculous
patients. A surgical ward and a department for eye cases were added... the
anatomical unit, with the beautifully designed Virchow Lecture Hall, was
equipped with laboratories for bacteriology, biochemistry, and experimental
psychology.... Occupational therapy shops were opened and two farm colonies
added to the institution.4 Furthermore, his staff of 30 physicians could take
advantage of a modern central laboratory and a library amply stocked with
professional literature. Spinal tap, cytologic
investigations, studies based on the Wasserman reaction, and the installation
of patient baths assisted in upgrading treatment.2 Upon returning from Europe
the year before he assumed the directorship of the National Hospital for the
Insane, he married his German fiancee, Augusta Peick. His work in Bahia had not gone unnoticed by
government officials and the medical community. Before leaving Salvador he
cofounded the Society of Medicine of Bahia and published an article in a German
journal of dermatology on ainhum, a strange tropical
condition that causes a callus to form tightly around the fourth or fifth toe,
gradually resulting in the amputation of the toe3 (this condition is believed
to affect only persons of African descent). Moreira celebrated his first year
as head of the asylum with the passage of a law on December 22, 1903, mandating
enlightened and humane treatment of the mentally ill in Brazil. Drafted by
Moreira and his colleague, Dr. T. Branda, and
approved by both chambers of Congress, it was the culmination of a frustrating
campaign to get legislators to agree on an overdue comprehensive new law. Among
other things, it addressed the procedures for commitment and its legal basis,
redress for patients and relatives, and sundry administrative matters. One
section of the law stated: "It is forbidden to imprison the mentally ill
or to house them among criminals. Where no insane asylum exists, the
responsible authorities must put them in a specially designated residence until
it is possible to transport them to an institution."5 Another section
read: "Anyone who commits a crime of violence or an attack on the morals
[a euphemism for rape] of an insane person will be legally punished." 5
Virtually unaltered since 1841, this law became a model of its kind in South
America, thanks largely to Moreira. The massive shift toward better treatment
for the mentally ill in Brazil effected by this law
remains the most enduring monument to Juliano Moreira. By 1913 when Moreira
traveled to London to participate in the 17th International Congress of
Medicine and to Ghent for the Congress of Psychiatry and Neurology, he was able
to boast of a "New Brazil" to fellow practitioners around the globe.
Somehow, despite his frequent travels overseas to represent Brazil at such
conferences and heavy administrative chores at the asylum, he managed to do
research and write for publication. His 100 articles and monographs published
between 1896 and 1927 spoke to a variety of topics. As with
his mentor Emile Kraepelin, he was perhaps most concerned with the causes of
mental ailments, particularly the relationship between psychosis and infectious
diseases. For example, in "Geistesstorung
bei Leprakranken" (Allgemeine Zeitschrift Fuer Psychiatrie und Ihre Grenzgebiete, 1910), he
concluded that there were various forms of mental disorders afflicting victims
of leprosy, but that the disorders were not the result of having contracted the
disease. In A Neli' Contribution to the Study of Demenitia Paralytica in Brazil
(London, 1913), he deduced that climate was not a contributing factor to the
increase in reported cases of syphilis in the urban centers of Brazil, and that
he could find neither pathological nor anatomical differences in the paresis
affected brains of blacks, whites, and mestizos.
Other contributions examined psychosis due to malaria and influenza. To Moreira
also belongs the distinction of being the first authority on the history of
science in Brazil. In 0 progresso da ciencias no Brazil (Rio de Janeiro, 1916), he blamed
Portugal's policy of isolation during colonial times, which ",always sought to prevent the contact of foreigners with the
people of Brazil,"6 for postponing the latter's exposure to modern
science. In another historical piece, "Les origines
plus eloignee de la lepre
au Brezil" (Lepra,
1907), he traced the course of leprosy in Brazil since 1575. Some of his publications
were co-authored with colleagues, eg, Les maladies mentales dans les climats tropicaux (Rio de
Janeiro, 1905) with Afranio Peixoto
and "Die allgemeine progressive Paralyse bei Greisen"
(Zeitschrift Fuer die Gesamte Neurologie und Psychiatrie, 1913) with Ulysses Vianna.
He also authored works about his friends and associates, most notably short
biographies of Virchow and, of course, Kraepelin. As significant as the spirit
of compassion, evinced in his empirical studies, was Moreira's defense of the
mental competency of blacks and meztizos vis-a-vis whites. Sensitive to
the social consequences of repugnant, but widely held, pseudoscientific
theories of Caucasian superiority, he cast his lot with the anti-racists led by
the German-born American Franz Boas, who by the 1920s had successfully
challenged the prevailing opinion held by most intellectuals and scientists of
the day.7 In a paper entitled "Algo sobre doencas nervosas e mentaes
no Brasil," read in 1929 at a Conference at the School of Medicine of the
University of Hamburg, he again sided with the environmentalist explanation of
racial differences in intelligence. He asserted that psychological tests used
in Brazil (eg, Benet-Simon and Terman)
proved that so-called variations among persons of different races depends
"more on the level of instruction and education of each individual being
examined than on his ethnic group," and that those belonging to
"groups considered inferior" who lived in urban areas had a
"better psychological profile than individuals of Nordic extraction who
were raised in a backward area of the interior. "8
Another important aspect of Moreira's professional life was his role in
establishing vehicles that would promote scientific study in Brazil. A Chicago
surgeon visiting Sao Paulo in the early 1920s, seeking to account for his
counterparts being such "voluminous readers" of foreign medical
literature, quoted a local physician who explained: "We have to read much
because we produce nothing."' Doing his share to help remedy the situation,
and in large part to publicize the work of his staff at the asylum, Moreira co-founded
three journals: Archivos Brasileiros
de Psychiatria, Neurologia
e Medicina Legal, Archivos Brasileiros de Neuriatria, and Archivos Brasilerios de Medicina. He created, co-founded, and served as an officer
in professional associations such as the National Academy of Medicine, the
Brazilian Academy of Sciences, and the Brazilian Society of Neurology,
Psychiatry and Forensic Medicine. Abroad, in recognition of his accomplishments
in Brazil, he was named an honorary member of the Medical-Legal Society of New
York, the League of Mental Hygiene of Paris, the Society of Psychiatry of
Buenos Aires, the Psychiatric Society of Belgium, the Anthropological Society
of Munich, and the Royal Medico-Psychoanalytical Association of London. He was
named honorary president of the International Congress of Neurology and
Psychiatry when it convened in Amsterdam, Milan, Moscow, and other cities. His
leadership in the world scientific community was also acknowledged with awards,
among them a gold medal presented to him by the German Red Cross, "the
highest honor to be awarded a foreign professor,"9 and another gold medal
received from the medical faculty of the University of Hamburg. In a
beautifully sculptured garden on a sunny July afternoon in 1928, a class of 30
young school children, most dressed in colorful kimonos, gathered around an
aging dark-skinned gentleman and his European wife to pose for a photograph. In
the background loomed a three-storied hospital, one of several Moreira visited
while in Japan at the invitation of the Universities of Tokyo, Sendai, Hokaido, Fuknoka, and Osaka. He
lectured at these universities and, on at least one occasion, allowed himself
to be interviewed by radio and newspaper reporters.* Before
departing on the second leg of an around-the-world tour, he was bestowed the
Order of the Sacred Treasure by Emperor Hirohito'° and made an honorary member
of the Society of Neurology and Psychiatry of Japan. Pausing to see some of the
major cities in the Far East, he later arrived in Europe to deliver more
lectures in Germany, Italy, France, and Great Britain. At each destination he
was shown deference as one of the world's foremost advocates of comparative psychiatry.
*Moreira and his wife wrote a 150-page account of their visit to Japan, which
was published in 1935 in Rio de Janeiro. Back in Rio de Janeiro in 1929 he
could take time to rest and hear his favorite operas and the music of his
adored Bach, Wagner, and Chopin. Both spiritually and artistically, he had an
affinity for things German.1I Whatever relaxation he
may have enjoyed was probably short-lived as he soon contracted pulmonary
tuberculosis. Forced to abdicate his directorship of the asylum in 1930, his
condition grew slowly but progressively worse until he died in a sanitorium in the fashionable resort city of Petropolis on
the morning of May 2, 1933. Two days later in Rio de Janeiro, a large
procession of dignitaries filed into the asylum chapel where Moreira's body lay
in state. A solemn, religious ceremony was not held, since Moreira was not a
religious man.12 The funeral cortege traveled in more
than 100 automobiles to the grave site at the Cemetery of Saint John the
Baptist, causing a massive traffic snarl in the vicinity. 13 Many tributes have
been paid to Moreira but few were as eloquently phrased as that by one of his proteges, Ulysses Vianna, who
wrote: The influence of J. Moreira on the care of the mentally ill in Brazil
can be compared with that of Pinel, Chiarugi, John Konolly, Griesingnor, Magnan and Kraepelin in France, Italy,
England, and Germany.... [He] attempted to treat the problems of the sick, who were special to him, with kindness and gentleness. He
raised the category of the mentally ill to that of other regular illnesses who deserve every kind of physical and moral comfort as
modem theories of psychiatric care dictate.... He was a good man and his
goodness was an integral component of his psychological profile. He became a
tirelessly creative patriot who, through the work that he accomplished in
neuropsychiatry and the social sciences, brought the name of Brazil to respect
in all of the scientific centers of the world.2 Moreira's legacy was manifested
in the work of his students who fanned out across the continent, prompting
innovations and advancing research. Finally, a more visible monument to his
greatness was effected three years following his death
when the Joao de Deus Hospital in his native Salvador was renamed the Juliano
Moreira Hospital. 14 In Negroes in Brazil: A Study of Race Contact in Bahia, 14
Pierson, an American sociologist, repeatedly stressed that: "The general
tendency throughout Brazilian history has been to absorb, gradually but
eventually, all ethnic elements into the dominant European stock." Writing
several years
after Moreira's death, Pierson included a chapter entitled "Black and
White Bahia" in which he listed 20 "facts" about the racial
situation in Brazil. Among those of particular relevance to this study are the
following excerpts: The Brazilian white has never at any time felt that the
black or mixed-blood offered any serious threat to his own status. No feelings
of fear, distrust, apprehension, dread, resentment, or envy have been stirred
up, as in our South during and following the Civil War, no sense of unwarranted
aggressions or attacks. Since, then, the blacks, the mixed-bloods, and the
whites do not constitute endogamus occupational
groupings, the social structure is not that of caste, nor does the Negro in
Brazil appear to be, as he is in the United States, developing into a
self-conscious racial minority in free association with, but not accepted by, a
dominant racial majority. Instead, the entire organization of society tends to
take the form of a competitive order in which the individual finds his place on
the basis of personal competence and individual achievement more than upon the
basis of racial descent. There is no deliberate segregation as one finds where
races have been embittered for a long time.... Prejudice exists in Brazil; but
it is 'class' rather than 'race' prejudice. Thus, the race problem in Brazil,
in so far as there is a race problem, tends to be identified with the
resistance which an ethnic group offers, or is thought to offer, to absorption
and assimilation. In light of the preceding social analysis, it is easier to
understand the possibility of so extraordinary a career as that of Juliano
Moreira in Brazil. A comparison with the careers of the early black
psychiatrists in the United States is inevitable. The eminent contemporaries of
Moreira in this country were Solomon C. Fuller (1872-1953) and his protege, Toussaint T. Tildon
(1893-1964). Born in Liberia, Fuller received his MD degree in 1897 from the
Boston University School of Medicine where he later taught neurology. Probably
this country's first black psychiatrist, he is best known for his widely
published research on degenerative diseases of the brain. His theory that
Alzheimer's disease was attributable to something other than arteriosclerosis
has since been confirmed. 15 Toussaint T. Tildon,
born in Waxahachie, Texas, finished Harvard Medical School in 1923. He
fashioned his career at Tuskegee's Veteran Hospital where he eventually served
as director. A true comparison of the careers of the two Americans and Moreira
may not be plausible given the cultural and historical forces that produced
them. But one might surmise that Moreira would not have accomplished as much
had he begun his career in the United States in the
early 1900s when the overwhelming majority of medical schools routinely
rejected or discouraged black applicants, when the "home rule" policy
of the American Medical Association meant that few black doctors could become
members, and when black patients were treated in separate wards, if they were
treated at all. "As late as the early twenties," reminded W. Montague
Cobb, "hospital appointments were rare for Negro physicians and
internships difficult to obtain. There was even less opportunity for training
in several specialties." 16 Moreira's success in Brazil, which brought him
international renown, was as much the result of his natural abilities and
character as the social circumstances and good fortune that allowed him to
fulfill his promise. Maybe this is all that really can be said, or should be
said, of the phenomenon from Bahia. Literature Cited 1. Martin FH. South America From a Surgeon's Point of View. New York: Fleming H. Revell, 1922, pp 201-202. 2. Vianna U.
Professor Dr. Juliana Moreira. Zeitschrift Fuer die Gesamte Neurologie
und Psychiatrie 1934; 149:429-432. 3. Moreira J. Ein
neuer pathologisch-anatomischer
und klinischer Beitrag zur Kenntnis des Ainhums. Monatshefte Fuer Praktische
Dematologie 1900; 30:361- 386. 4. Bruetsch
WL. Juliano Moreira. Am J Psychiatry 1933; 13:715. 5. Moreira J. Gesetz
uber lrrenfursorg in Brasilien. Psychiatrisch-Neurologische
Wochenschrift 1905; 1:309. 6. Fernando de Azevedo
F. Brazilian Culture: An Introduction to the Study of Culture in Brazil. New
York: MacMillan, 1950, p 233. 7. Montagu A., ed. Race and IQ. New
York: Oxford University Press, 1975, p 28. 8. Skidmore T. Black Into White: Race and Nationality in Brazilian Thought. New
York: Oxford University Press, 1974, p 189. 9. Gertsch M. Prof. Juliano Moreira in Rio de Janeiro. Schweizer Archiv Fuer Neurologie, Neurochirurgie und Psychiatrie. 1933; 32:173. 10. Dr. Juliano Moreira. Revista Brasileiro de Medicina e Pharmacia. 1933; 9:125. 11. Antonio Austregesilo. 0 Busto de Juliano Moreira. Jornal do Commercio, July 27, 1943, pp 669-671. 12. Desapparece o medico dos loucos! 0 Globo, May 5, 1933, p 2. 13. Professor Juliano Moreira. 0 Estado de Sao Paulo, May 4, 1933, p 1. 14. Pierson, D. Negroes in Brazil.
Chicago: University of Chicago Press, 1942, pp 123, 169, 347-350. 15. Hayden RC. Fuller, Solomon
Carter. In: Logan RW, Winston, eds. Dictionary of American Negro Biography. New
York: Norton, 1982, p 247. 16. Cobb WM. The
future of the Negro medical organizations. J Natl Med Assoc 1951; 43:325-328. JOURNAL
OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 78, NO. 7,1986
683 Requests
for reprints should be addressed to Mr. Robert Fikes,
Jr., University Library, San Diego State University, San
Diego, CA 92182-0511.
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