A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX / Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century

Resumo Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

Abstract In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

The World Health Organizations changing goals and expectations concerning malaria, 1948-2019 / As mudanças nos objetivos e expectativas da Organização Mundial da Saúde com relação à malária, 1948-2019

Abstract From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

Resumo Desde sua origem, em 1948, a Organização Mundial da Saúde priorizou o controle da malária. Os primeiros êxitos induziram à crença na viabilidade da erradicação, apesar de sérias dúvidas quanto ao continente africano. À medida que se somavam comprovações de que a erradicação da malária não seria simples, o projeto com essa finalidade foi rebaixado a uma unidade em 1980. O reavivamento do interesse na malária ocorreu após a iniciativa Roll Back Malaria, criada em 1998. Este artigo apresenta um panorama histórico das mudanças nas ideias, em âmbito global, ligadas ao controle e à eliminação da doença e defende a tese de que a atenção dada ao fortalecimento dos serviços de saúde e a recursos humanos especializados foi insuficiente.

Debordering public health: the changing patterns of health border in modern Europe / Tirando as fronteiras da saúde pública: mudanças nos padrões de fronteira sanitária na Europa moderna

Abstract According to David Fidler, the governance of infectious diseases evolved from the mid-nineteenth to the twenty-first century as a series of institutional arrangements: the International Sanitary Regulations (non-interference and disease control at borders), the World Health Organization vertical programs (malaria and smallpox eradication campaigns), and a post-Westphalian regime standing beyond state-centrism and national interest. But can international public health be reduced to such a Westphalian image? We scrutinize three strategies that brought health borders into prominence: pre-empting weak states (eastern Mediterranean in the nineteenth century); preventing the spread of disease through nation-building (Macedonian public health system in the 1920s); and debordering the fight against epidemics (1920-1921 Russian-Polish war and the Warsaw 1922 Sanitary Conference).

Resumo Segundo David Fidler, a gestão de doenças infecciosas entre meados do século XIX e e o XXI guiou-se por uma série de acordos institucionais: Regulamento Sanitário Internacional (não interferência e controle de doenças em fronteiras), programas verticais da OMS (campanhas de erradicação da malária e varíola), e posicionamento pós-vestefaliano além do estado-centrismo e interesse nacional. Mas pode a saúde pública internacional ser reduzida à tal imagem vestefaliana? Examinamos três estratégias que destacaram as fronteiras sanitárias: prevenção em estados vulneráveis (Mediterrâneo oriental, século XIX); prevenção à disseminação de doenças via construção nacional (sistema público de saúde macedônico, anos 1920); remoção de fronteiras no combate às epidemias (guerra polaco-soviética, 1920-1921 e Conferência Sanitária de Varsóvia, 1922).

Historical epidemiology and global health history / Epidemiologia histórica e história global da saúde

Abstract The subdiscipline of historical epidemiology holds the promise of creating a more robust and more nuanced foundation for global public health decision-making by deepening the empirical record from which we draw lessons about past interventions. This essay draws upon historical epidemiological research on three global public health campaigns to illustrate this promise: the Rockefeller Foundation's efforts to control hookworm disease (1909-c.1930), the World Health Organization's pilot projects for malaria eradication in tropical Africa (1950s-1960s), and the international efforts to shut down the transmission of Ebola virus disease during outbreaks in tropical Africa (1974-2019).

Resumo A subdisciplina epidemiologia histórica se propõe a criar um alicerce robusto e refinado para o processo de tomada de decisões em saúde pública global, aprofundando registros empíricos que nos ensinam sobre intervenções passadas. Este artigo se baseia na pesquisa epidemiológica histórica de três campanhas globais de saúde pública para ilustrar essa proposta: os esforços da Fundação Rockefeller para controle da ancilostomose (1909-c.1930), os projetos-piloto da Organização Mundial da Saúde para erradicação da malária na África tropical (décadas de 1950-1960), e os esforços internacionais de interrupção da transmissão do vírus Ebola durante surtos na África tropical (1974-2019).

La gripe de 1918 en Cuba / The 1918´s influenza epidemic in Cuba

Introducción: A finales de la segunda década del siglo XX, entre los años 1918 y 1919, a nivel mundial se propagó la pandemia de influenza que se conoce como gripe española. En Cuba causó una elevada morbilidad y mortalidad, lo que motivó una gran preocupación en la población y las autoridades sanitarias del país. Objetivos: Caracterizar la epidemia de gripe de 1918-1919 en Cuba a partir del análisis de los documentos que se conservan sobre su evolución y medidas preventivas. Método: Se realizó una investigación cualitativa a partir del análisis documental como procedimientos para la aplicación del método teórico histórico-lógico. Se revisaron estadísticas, artículos, directrices y planes de enfrentamiento a la epidemia, de la dirección de Sanidad, e informes sobre su control. Resultados: Entre 1918 y 1920, se reportó la mayor mortalidad en Cuba por gripe. La morbilidad se recoge desde 1942, con cifra mayor en 1957 (tasa de 1419.86 x 105 habitantes), 1951 (6.92 x 105 habitantes), 1947 (5.88 x 105 habitantes). La mortalidad más elevada correspondió a los años 1918- 1920 (193,92 x 105 habitantes; 50,11 y 47,46). Conclusiones: La epidemia de gripe de 1918, causó en Cuba una elevada morbilidad y mortalidad, se elaboraron planes adecuados de contingencia para frenarla, de acuerdo a su naturaleza y al desarrollo de los conocimientos científicos del momento(AU)

Introduction: At the end of the second decade of the 20th century, between the years 1918 and 1919, there was a global outbreak of influenza known as Spanish flu. In Cuba, it caused a high morbidity and mortality, which led to a great concern in the population and the health authorities of the country. Objective: To characterize the 1918-1919´s influenza epidemic in Cuba by analysing the documents preserved on its evolution and preventive measures. Methods: A qualitative research was carried out by performing a documentary analysis as a procedure for the implementation of the historical-logical theoretical method. There were reviewed statistics, articles, guidelines and plans of confrontation to the epidemic, and also reports on its control issued by the Health´s Directorate. Results: The epidemic was intense until early 1919; then it had some outbreaks with a relative frequency, but in a most benign form, until 1920. The morbidity data have records from 1942, with higher figures in 1957 (rate of 1419,86 x 105 inhabitants); 1951 (6.92 x 105 inhabitants); 1947 (5.88 x 105 inhabitants). The higher mortality rate corresponded to the years 1918-1920 (193.92 x 105 inhabitants; 50.11 and 47.46, respectively). Conclusions: The 1918´s Influenza Epidemic caused in Cuba a high morbidity and mortality. Adequate contingency plans were developed to halt it, according to its nature and the development of scientific knowledge at the time(AU)

Del "armamento antituberculoso" al Sanatorio para Tuberculosos de Huipulco en la Ciudad de México, 1920-1940 / The road from the "antituberculosis armory" to the Huipulco Tuberculosis Sanatorium in Mexico City, 1920-1940

Resumen Este artículo estudia las diferentes propuestas y estrategias para prevenir los contagios de la tuberculosis pulmonar implementadas en la Ciudad de México a partir de la década de 1920, al comenzar la primera campaña de largo aliento contra esa enfermedad, y analiza las limitaciones y problemas a los que ésta se enfrentó hasta 1940. Se destaca por qué la contención de los contagios de esa enfermedad ocupó un lugar prioritario después de diez años de guerra civil; se presta atención a los modelos y estrategias implementados y se examinan los problemas por lo que atravesó la construcción y el funcionamiento del Sanatorio para Tuberculosos de Huipulco, sustento clave de la lucha antituberculosa desde tiempo atrás a nivel internacional.

Abstract This article discusses the various proposals and strategies to prevent the transmission of pulmonary tuberculosis in the City of Mexico from the 1920s decade onwards, when it was launched the first long-term campaign against the disease, and analyses the limitations and challenges faced until 1940. It looks upon the motives that led the need to contain the transmission of the disease to occupy a dominant role after ten years of civil war; it focuses on the models and strategies implemented, and examines the challenges faced by the construction and operation of the Huipulco Tuberculosis Sanatorium, a key component of the fight against tuberculosis at the international level since long ago.

Salud pública, espacio urbano y exclusión social en la España de posguerra: la epidemia de tifus exantemático en la ciudad de Valencia, 1941-1943 / Public health, urban space and social exclusion in postwar Spain: the exanthematic typhus epidemic in the city of Valencia, 1941-1943

Resumen Tras la Guerra Civil, las deficientes condiciones higiénico-dietéticas de gran parte de la población española favorecieron la aparición de enfermedades epidémicas. El tifus exantemático puso en jaque a las autoridades sanitarias, especialmente durante la primavera de 1941, cuando el ciclo epidemiológico de la enfermedad y la falta de infraestructuras se aliaron para provocar una grave crisis sanitaria. El régimen franquista, consciente de que esta situación dificultaba su legitimación, no dudó en utilizar la exclusión social como parte de su política sanitaria contra esta epidemia. El artículo analiza en profundidad el caso de Valencia, una ciudad que durante la guerra, por hallarse en la retaguardia republicana, había acogido sucesivas oleadas de refugiados a medida que avanzaban las tropas franquistas.

Abstract After the Spanish Civil War, poor hygiene and nutritional deficiencies among a large part of Spain's population contributed to the rise of epidemic diseases. Exanthematic typhus posed a challenge to the health authorities, especially during the spring of 1941, when the epidemiological cycle of the disease and the lack of infrastructures combined to create a serious health crisis. The Franco regime, aware that this situation posed a threat to its legitimacy, promptly used social exclusion as part of its health policy against the epidemic. This article provides an in-depth analysis of the case of Valencia, a city that was behind Republican lines during the war, and therefore received successive waves of refugees as Franco's troops advanced.

An imperial laboratory: the investigation and treatment of treponematoses in occupied Haiti, 1915-1934 / Um laboratório imperial: investigação e tratamento da treponematose no Haiti ocupado, 1915-1934

This article examines anti-treponematoses work as part of US occupation public health policy in Haiti, a unique event in the history of international health. Yaws was highly prevalent in Haiti, but occupation doctors initially ignored it because of its close association with syphilis and stigmas attached to sexually transmitted disease. This changed when C.S. Butler asserted that yaws was "innocent" and that the two diseases should therefore be considered as one. Treatment increased as an anti-treponematoses campaign was now believed to hold great benefits for the occupation's paternalist and strategic aims, even though it ultimately failed. This work reflected Haiti's status as a public health "laboratory" which affected Haitian medicine for years to come and significantly influenced future campaigns aimed at disease eradication.

Este artigo investiga o trabalho anti-treponêmico como parte da política norte-americana de saúde pública na ocupação do Haiti, evento inédito na história da saúde internacional. Era alta a incidência da bouba no Haiti, mas médicos da ocupação a ignoravam por ser parecida com a sífilis e pelos estigmas da doença sexualmente transmitida. A situação mudou quando C.S. Butler afirmou que a bouba era "inocente" e que as duas doenças deveriam ser consideradas uma. Surgiram mais tratamentos com uma campanha anti-treponêmica que trazia benefícios aos objetivos paternalistas e estratégicos da ocupação, apesar do seu fracasso final. Esse trabalho ilustra o Haiti como "laboratório" de saúde pública, o que afetou a medicina haitiana por anos e influenciou campanhas futuras para erradicar a doença.

El teatro guiñol, la televisión mexicana y la educación para la salud a mediados del siglo XX / Puppet shows, Mexican television and health education in the mid-twentieth century

Resumen Este artículo rescata la obra de teatro guiñol Las calenturas de Don Ferruco, televisada a finales de la década de 1950 para promover la erradicación del paludismo en México como un útil instrumento de educación para la salud. Se analiza cómo la difusión del teatro guiñol educativo en la televisión mexicana evidenció la necesidad de mantener vigente la enseñanza dirigida a prevenir enfermedades y se subraya la importancia de la televisión como una producción educativa para promover la salud hacia mediados del siglo XX. El artículo muestra los inicios de su uso como una herramienta de especial importancia para lo que posteriormente sería la masificación de los discursos emitidos por la Secretaría de Salubridad y Asistencia.

This article resurrects the puppet show Las calenturas de Don Ferruco (Don Ferruco’s Fevers), which was televised in the late 1950s in order to help eradicate malaria in Mexico, as a useful instrument for health education. It analyzes how the spread of educational puppet shows on Mexican television showed the need to keep updating preventive healthcare pedagogy and it underlines the importance of television as an educational health-promotion production in the mid-twentieth century. The article discusses the early use of puppet shows as an especially important tool for what would later become mass-media transmission of discourses from the Secretaría de Salubridad y Asistencia (Department of Health and Healthcare).

Gênese da saúde global: a Fundação Rockefeller no Caribe e na América Latina / Genesis of global health: the Rockefeller Foundation in the Caribbean and Latin America

O nascimento da chamada Saúde Global e as relações criadas entre agentes globais e locais de saúde pública em regiões como a América Latina e o Caribe são abordados de forma totalmente inovadora. O autor, pesquisador pioneiro no estudo da América Latina como laboratório médico, partiu dos arquivos médicos nacionais da Costa Rica para investigar como foi a atuação da Fundação Rockefeller, organização de saúde internacional, em pequenos países da América Central e no Caribe, no início do século XX. A edição do livro em português tem novidades como informações sobre a atuação da Fundação Rockefeller no Brasil e um novo capítulo sobre o tratamento com óleo de quenopódio, o que causou muitas mortes, principalmente entre crianças, e as questões éticas decorrentes dessa decisão...

The Disease and Treatment of the Frontline Soldiers in Han Dynasty / 의사학

This paper purports to identify and analyze the medical information of the frontline soldiers in the Northwest borderland provinces of Han Dynasty, especially Juyan and Dunhuang region, through an heuristic reading of the Juyan Bamboo Slips and the Dunhuang Bamboo Slips of the Han Dynasty. My findings are as follows. The most frequent disease found in the bamboo slips was the external injury. The injury of the frontline soldiers mainly occurred from the quarrels among armed soldiers using weapons. The bamboo slips also demonstrate that the quarrels usually arose due to the fierce tension caused by the frontier line service such as heavy guard activity and labour duty. Undernourishment and chronic stress the soldiers suffered might be another reasons. The second most common disease harassing the soldiers was exogenous febrile disease. In most cases reviewed in this paper, the exogenous febrile disease was usually concurrent with complex symptoms such as chills, fever, headache, etc. The bamboo slips show that the exogenous febrile disease was related to the harsh climate of the Northwest provinces, featuring extremely dry weather and the large magnitude of diurnal temperature fluctuations. In addition, the annual temperature range in the Northwest province was huge, fluctuating between very cold and dry winter and very hot and dry summer. The third most common disease this study identified was the disorder of the digestive system and respiratory system. However, these two types of disease were virtually indistinguishable in the bamboo slips, because the ancient Chinese chroniclers did not distinguish them, usually dubbing both diseases simply 'abdominal pain.' It should be mentioned that a few slips mention contagious disease such as dysentery and dermatolosis, and sudden death, as well. Overall, the bamboo slips demonstrate extremely poor status of the soldiers' heath condition and poor medical environment surrounding the soldiers stationing in the Northwest borderland military camps. The records also show that acupuncture, applying a plaster, drugs were the most common medical treatment. Drugs among them was the most frequently used. Whereas Acupuncture, applying a plaster were very rarely used. Medication has been used in three ways: powdered medicine, medicinal decoction and pill. Medicinal decoction was the most commonly used way.

Historia del control del paludismo en la Argentina / History of malaria control in Argentina

Se presenta la evolución del programa de control y de erradicación del paludismo en la Argentina analizando a las diferentes intervenciones en su contexto histórico, los hombres que las implementaron, el desarrollo y los resultados obtenidos desde sus inicios, hace 150 años, hasta el año 2000. Se determinan 4 etapas: modernización a través de la higiene, Plan Alvarado, Plan 46 y 47 y Programa de Erradicación de la Malaria y se describen las actividades realizadas. Los datos presentados corresponden a publicaciones científicas, administrativas de las acciones de gobierno (leyes, decretos, resoluciones y administrativas de los archivos del programa) y a comunicaciones personales a los autores. Este trabajo reseña los desarrollos locales que luego fueron aplicados internacionalmente, la influencia de los conocimientos foráneos en el desarrollo de las intervenciones locales, las decisiones políticas que influyeron en los resultados y las acciones de hombres dedicados a la investigación y la salud pública que impactaron sobre la vida de millones de personas, el desarrollo de países y en la mejora de la salud en las comunidades.

The evolution of control and eradication of malaria programmes in Argentina and the men who participated in them are analyzed since 150 years ago till 2000. Four stages that characterize activities as well as the knowledge of every age are determined: modernization through hygiene, Plan Alvarado, 46 and 47 Plan and malaria eradication program and activities carried out were described. Data presented correspond to scientific publications, administrative actions of Government (laws, decrees, resolutions and administrative files of the program) and personal communications to authors. This paper reviews local developments later applied internationally, the influence of the foreign expertise in development of local interventions, political decisions that influenced the results and the actions of men dedicated to research and public health that impacted on the lives of millons of people, the development of countries and in the improvement of health in communities.

Controle da hanseníase no Estado de São Paulo: análise histórica / Control de la hanseníasis en el Estado de Sao Paulo, Brasil: análisis histórico / Hansen's disease control in the State of São Paulo: a historical analysis

Para controle da hanseníase, doença infectocontagiosa conhecida desde os tempos bíblicos, são mostradas as intrincadas convergências de histórias nacionais, de políticas médicas, governamentais e internacionais. O estudo descreve a história e as ações de controle da hanseníase, a partir do começo do século XIX, no estado de São Paulo, e sua conexão com o desenvolvimento da saúde pública, utilizando análises bibliográficas e documentais.

Para control de la hanseníasis, enfermedad infectocontagiosa conocida desde los tiempos bíblicos, se muestran las intrincadas convergencias de historias brasileñas, de políticas médicas, gubernamentales e internacionales. El estudio describe la historia y las acciones de control de la hanseníasis, a partir del comienzo del siglo XIX, en el estado de Sao Paulo, y su conexión con el desarrollo de la salud pública, utilizando análisis bibliográficas y documentales.

¿Hubo infectólogos en la Antigua Roma? / Were there infections diseases specialists in the Ancient Rome?

The existence of infectious diseases specialists in Ancient Rome is unlikely, but there were at least three authors able of keen observations on infectious matters, with enough merit to be considered our predecessors: Varro, Columella and Vitruvius, none of them physicians. Varro, in his first Book on Agriculture recommended, "Build the houses distant from swamps, because certain minute creatures are bred which cannot be followed with the eyes but which float in the air and enter the body through the mouth and nose, giving rise to severe diseases". Also in a text of agriculture and in the same sense, Columella says "that with heat a swamp releases a pestilential vapor and produces a very dense swarm of insects, which come flying over us armed with harmful stings Vitruvius, the great architect was worried about drinkable water: its sources and properties, how to obtain it and the methods for testing its quality. The concern on its distribution and disposal of sewage started on 614 B.C., little after the foundation of Rome, with the building of the first aqueduct, the Aqua Marcia. This aqueduct in Trajan's times (century II A.D.), reached a total of 443 km, with 49,500 meters of arcades, which were up to 32 meters high, plus 2.4 Km. of an underground net. This system released 947.200 m3 of water per day, two thirds of which were for public use and one third for private customers.

Si mal pudo haber infectólogos en la Antigua Roma, hubo al menos intelectuales capaces de agudas observaciones en materia de infecciones, con merecimientos suficientes para postularse como nuestros predecesores: Varrón, Columela y Vitruvio, ninguno de ellos médico. Varrón, en el primero de sus Libros de Agricultura, recomendaba ubicar la casa evitando los pantanos, porque allí crecen ciertos animales, tan diminutos que no se pueden seguir con los ojos y flotan en el aire y entran al cuerpo por la boca y la nariz causando graves enfermedades. También en un texto de agricultura y en el mismo sentido, Columela dice que una laguna desprende con los calores un vapor pestilencial y produce enjambres espesísimos de insectos, que vienen volando sobre nosotros armados de aguijones dañinos... Vitruvio, el gran arquitecto, se ocupó del agua potable: sus fuentes y sus cualidades, cómo obtenerla y los métodos para probar su calidad. Esta preocupación por la distribución de aguas y disposición de excretas había nacido en el 614 A.C., poco después de la fundación de Roma, con la construcción del primer acueducto, el Aqua Marcia, para alcanzar en tiempos de Trajano (siglo II D.C.) un total de 443 km, con 49.500 metros de arcadas de hasta 32 metros de altura, más 2,4 km de red subterránea. Éstos entregaban 947.200 m³ por día, de los cuales dos tercios eran para uso público y un tercio privado.

Launching global health: the Caribbean odyssey of the Rockefeller Foundation / Conversations in medicine and society

First book to explore the inaugural Rockefeller Foundation campaigns in depth and to treat them as an ensemble—as a laboratory for discovering and testing the elements of a global health system for the twentieth century. Orienting the study according to the priorities and perspectives of the social and cultural history of medicine and marrying the results with social science and institutional approaches, the author rediscovers elements and dynamics in the original history of global health that were either discarded or that have continued to operate beneath the radar of scholarship. In particular, the author examines the extraordinary encounters that took place between the Rockefeller proselytizers of biomedicine and public health and the diverse populations whom they were attempting to help. Launching Global Health devotes special attention to the health narratives and practices of laboring people of different ethnicities and how they clashed and blended with the stories and rituals being promoted by the Rockefeller Foundation, ultimately showing the locally assembled health teams of microscopists, inspectors, and dispensers to have been active agents in the shaping of encounters between imperial and popular medicine.