Ardentes trópicos: febres e saúde pública no Brasil joanino / The scorching tropics: fevers and public health in Brazil during the Joanine period, 1808-1821

Resumo Com exceção da febre amarela, as febres ainda foram pouco exploradas pela historiografia da saúde brasileira. No século XIX, contudo, sua presença na vida social era quase incontornável, atingindo enormes parcelas da população. Suas vítimas padeciam de uma grande variedade de sintomas em que a identificação e a terapêutica eram objeto de intensos debates nos círculos médicos. A intelectualidade luso-brasileira, atenta tanto aos debates médicos europeus quanto a experiências clínicas, esforçou-se para fornecer respostas na forma de intensa produção impressa; no entanto, as manifestações febris encontradas nos trópicos representavam um desafio extra à sua formação europeia, forçando-a a conjugar experiências adquiridas em partes distintas do Império na constituição de saberes específicos sobre as febres tropicais.

Abstract Although fevers (with the exception of yellow fever) have not yet been fully explored by the historiography of Brazilian health, they were almost inevitable in nineteenth-century Brazilian society, affecting huge portions of the population. Their victims suffered from a wide variety of symptoms, and identification and treatment of these symptoms were the object of intense debates in medical circles. The Luso-Brazilian intelligentsia considered European medical debates as well as their own clinical experiences and attempted to provide answers in a flurry of publications. Even so, the manifestations of fever in the tropics presented a challenge that lay beyond their European training, forcing them to combine experiences acquired in different parts of the Empire to comprise specific knowledge on tropical fevers.

Iatrogenia institucional y muerte materna: semmelweis y la fiebre puerperal / Institutional iatrogeny and maternal death: semmelweis and puerperal fever

La fiebre puerperal es una enfermedad que asume carácter epidémico en el siglo XVIII como consecuencia de dos factores: las masas trabajadoras urbanas generadas por la revolución industrial, y la progresiva hegemonización y medicalización de la atención del parto en grandes hospitales públicos. La mortalidad materna institucionalizada alcanza cifras superiores al 30%, en tanto con la atención por parteras es menor al 2%. Semmelweis, médico húngaro, postula que los médicos contaminaban a las parturientas por insuficiente higiene luego de realizar necropsias, e implanta medidas profilácticas en el Hospital de Viena, las cuales reducen dramáticamente la mortalidad, pero sus ideas son rechazadas por que afectan el proceso de institucionalización de la medicina basado en el altruismo y honor, por los que supuestamente era imposible que causen daño a sus pacientes. Es obligado a retirarse del Hospital de Viena, y continua su lucha en Budapest, pero el rechazo y la incomprensión de sus colegas por su doctrina afecta su salud mental. Muere en un asilo, pocos años antes que Pasteur y Koch demuestren las bacterias causantes de enfermedades como la fiebre puerperal.

Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever.

[Tow viewpoints of fever; old and new]

In modern medicine fever is considered as a symptom and result of temperature change in hypothalamus. Fever was known as hommi and hommeat in traditional medicine. Hommi and hommeat are important subjects in CANON of Avicenna. Various aspects of hommi and hommeat have been studied in this book by Ave-sina. New diagnostic and therapeutic point of view of traditional medicine and physician like Ave-sina may help to solve problems and open new windows for research about fever. Fever is a stranger heat that triggering in heart and spread throughout the body. Avesina classified fever to three type based on involved organ, time and etiology. Fever is caused by changes in hypothalamus set point. This is influenced by bacterial exotoxins or lipopolysaccharides. We investigated fever in our study in view of traditional and modem medicine. In a comparative study we evaluated Ave-cina's theories about fever and compare it with principle of modern medicine. Paying attention to Ave-cina's theories might be helpful to find the cause of fever. It can also open windows toward new research and studies and represent new therapeutic methods

Heat and Fever in Ancient Greek Physiology / 의사학

This paper aims at clarifying the relationship of physiological heat and pathological heat(fever) using the theoretical scheme of Georges Canguilhem as is argued in his famous book The Normal and the Pathologic. Ancient authors had presented various views on the innate heat and pathological heat. Some argued that there is only pathological heat while others, like Galen, distinguished two different kinds of heat. Galen was the first medial author who had the clear notion of the relationship between the normal heat and the pathological heat. He conceptualized their difference as the heat conforming to nature (kata phusin) and the heat against nature (para phusin). However, the Peripatetic authors, such as ps-Alexander Aphrodisias, who laid more emphasis on physiology tended to regard pathology in continuation with physiology as Claude Bernard attempted to do it. Therefore, Canguilhem's theoretical scheme turns out to be very useful in analysing the relationship of normal heat and pathological heat as is manifested in ancient Greek physiology.

Las 'fiebres del Magdalena': medicina y sociedad en la construcción de una noción médica colombiana, 1859-1886 / Magdalena fevers: medicine and society in the construction of a Colombian medical notion, 1859-1886

Explora los fundamentos teóricos, sociales e ideológicos del surgimiento y consolidación de la noción médica colombiana 'fiebres del Magdalena'. Muestra cómo el naciente cuerpo médico colombiano elaboró unas nociones peculiares sobre las fiebres articulando las teorías médicas europeas con la valoración negativa sobre el clima cálido. Explica la forma en que las políticas librecambistas de mediados de siglo así como el impacto económico e ideológico del boom agro exportador del tabaco y el añil determinaron el interés de los médicos por las epidemias ocurridas en los centros productores de estos bienes y, por tanto, el surgimiento de la noción 'fiebres del Magdalena'. Muestra cómo los médicos establecieron una asociación causal entre el proceso productivo de dichos artículos y las fiebres.

In this article, I explore the theoretical, social and ideological bases of the emergence and consolidation of the Colombian medical notion of the 'Magdalena fevers'. Firstly I show how, in the late 1850s, the emerging Colombian body of medical doctors elaborated peculiar notions on fevers by articulating the European medical theories (i.e. the miasmatic theory and the climatic determination of diseases) with the negative valuation of the hot climate. Secondly, I explain how free trade policies in the mid-1800s, and the economic and ideological impacts of the agricultural export of tobacco and indigo determined doctors' interest in the epidemics occurring in the production centers and also, therefore, the emergence of the notion of 'Magdalena fevers'. I also show how doctors established a causal association between the productive process of those goods and the fevers.

JWARA (fever)- a medico historical perspective.

"JWARA" is important and critical among all the diseases, because it affects each and every living being. Hence, it has been given first place in the classical texts of Ayurveda. Atharvaveda (AV) has also referred Jwara with the name Takman (son of God Varuna) and drugs like Kustha, Jangida and Anjana have been prescribed for its management. References with regard to Jwara are also found in other non-medical literature Viz., Mahābhārata, Purānas etc. Acārya Suśruta has mentioned that, man comes to this world with Jwara and departs with it. Jwara affects the whole body, the organs of senses and also the mind. According to mythology, Jwara was originated from the hot and destructive breath of Lord Siva, which was produced from his nostrils during the paroxysms of grief and rage on the death of his wife, Durga. It attacks all persons of all ages and in all conditions. Jwara is the king of all diseases, destroyer of all creatures and severe hence a physician should be practically cautious in treating it. All these medico-historical aspects of Jwara have been presented in this article.

Treatment of fevers in Camatkāra Cintāmaņi.

Utility of the various formulae of Camatkāra Cintāmaņi can not be minimised due to limited and easily available ingredients. Because the efficacy of the formulae in curing the various diseases has proved them very useful. Treatment of fevers cover near about 93 verses in Camatkāra Cintāmaņi. Therefore an attempt has been made to check the potency and usefulness of the formulae in treatment of fevers.

A Study on Background of Doctrine for Seasonal Febrile Diseases in The Qing Dynasty / 의사학

The seasonal febrile diseases had been studied before Qing dynasty, but it was accomplished in Qing dynasty because of high incidence of the epidemics in those days. I studied and analyzed epidemics in Zai Yi Zhi of Qing Shi Gao on the reasons and patterns as yearly, regional, and seasonal parameters. Based on these analyses, I want to report how the doctrine of seasonal febrile diseases could be established in Qing dynasty. The incidence of epidemics was very high during the regimes of Kang Xi(1662~1722), Yong Zheng(1723~1735), and Qian Long(1736~1795) Emperors, the most advanced period in Qing dynasty. The diseases occurred at least once per two years, although, somtimes twice or 5 times per a year. Once it was developed and then smashed through the whole China, especially in Jiang Nan. It was the main reason why the four greatest scholars in the doctrine of seasonal febrile diseases came out from Jiang Nan. These diseases appeared most highly and worst in summer as pestilence. These resulted in the development of the studies of epidemics in those days. Based on the clinical studies of fever-related diseases, the scholars of seasonal febrile diseases tried to cure them with endless and continuous efforts. Finally, they could complete the doctrine of seasonal febrile diseases in Qing dynasty.