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
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.
The extraordinary career of Juliano Moreira: Afro-Brazilian psychiatrist.
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.
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.