Continued from here...
Epidemic diseases worsened during the second half of the nineteenth century. This paralleled and, perhaps, connected with heightened growth and integration into global networks of trade and communication. Much of the new growth was driven by coffee: world demand increased enormously at the same time that Brazil monopolized the market. This brought enormous profits, new development, especially in the Southeast, and attracted thousands of European immigrants. When deadly epidemics of different types began appearing regularly, they captured the attention of foreign newspapers nearly as much as news that coffee bean trees were spreading across large parts of the Brazilian Southeast. The provincial and Imperial (or Republican—after 1889) governments were determined to attract immigrants and were often desperate to find solutions that would reduce the negative publicity. Millions of dollars were spent on public sanitary reforms, but since etiology was largely unknown for the deadliest diseases (invisible “miasmas” were usually the suspect), these reforms often caused as much social upheaval and intrusive government regulations as it did lead to better public health.
Government efforts finally began to have an effect in the early 1900s for three important reasons. First, many deadly gastrointestinal disorders, including cholera, were eliminated by clean water programs. Little is still known about where and when the first drops of chlorine were added to water supplies in Brazil, but when the chemical was used, far fewer people were sickened and killed by contaminated water. Second, for the first time, government smallpox operations were funded and organized sufficiently to be effective. Many historians have recounted the famous 1904 “vaccine revolts” in Rio de Janeiro, but comparatively little has been written about the thousands of lives saved by increased levels of immunity. The smallpox vaccine came (and still comes) with many risks, but these were outweighed by its benefits. Finally, anti-mosquito campaigns largely eliminated yellow fever, at least in most Brazilian urban areas.
Soon after these public health reforms, GDP growth and immigration accelerated. It is still an open question as to whether this is a correlation or a coincidence. It seems logical that once the era of epidemics ended, reputation improved, attracting more immigrants, capital, and trade.
Although the history that I recounted above can be confirmed with strong evidence, there is no major textbook or published overview of Brazilian history that tells this story. Historians often acknowledge the worsening period of disease, but most authors either do not dedicate much attention or mistakenly give misinformation about the period of epidemics (I give examples here). As a consequence of the dearth of research on the medical history of Brazil, we do not know what diseases killed and sickened most Brazilians before 1950. Furthermore, hospitals have been assumed to have been dangerous places, but new research is revealing that most patients recovered and many probably improved because of their medical treatment. Finally, contrary to common belief, it appears that enslaved and free people faced the same epidemiological environment and did not receive dissimilar health care during the nineteenth century.
