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Thursday
Aug282008

Project proposal



Jean Baptiste Debret, Voyage Pittoresque et Historique au Bresil (Paris,1834-39),vol. 2, plate 46, p. 142. (Copy in the John Carter Brown Library at Brown University)

Brazil’s Era of Epidemics

A series of unfamiliar and devastating epidemics struck Brazil in the second half of the nineteenth century. Up to this time Brazil had earned a reputation of being a “salubrious” country, based on the observation that influenza and cholera pandemics, killing hundreds of thousands from Bengal to Hamburg to Havana, had not dipped below the South American portion of the equator. Brazil’s reputation did indeed sour, beginning first with a yellow fever epidemic that struck in 1849. Following this outbreak, waves of smallpox, cholera, and bubonic plague battered Brazil. For historians, these diseases signal a general decline in Brazilian health that lasted until the early 1900s. Historians have also claimed the scourges to be one of multiple causes for the Brazilian monarchy’s collapse in 1889, and a factor behind the volatility of the young Republican governments. Unquestionably, disease at this time had a significant impact on Brazilian society, politics and the economy, and has provided fertile ground for large historical claims. Despite this, a history of the “era of epidemics” remains to be written. In fact, we have little idea which diseases were the deadliest, where they appeared and how different groups faired when the epidemics struck.

This project intends to study the broad pattern of the health environment during the late Brazilian Empire and early First Republic (1849-1901) using geographic information system (GIS) tools, digital records derived from archival research, and database organizational techniques. I plan to produce results that will illuminate three historical questions. First, when and where did major epidemics appear in Brazil during this period? Second, what factors were involved in the spread of these diseases? Finally, did these diseases represent an overall decline in Brazilian health and did they harm certain groups disproportionately? Answers to these questions would provide insight into the medical history of Brazil and the Atlantic world at a time when transportation technology and mass migration were moving people and goods at a rapidly expanding rate. My project has the additional goal of adapting functional methods commonly employed by medical geographers to the craft of history. I believe that this project can make a useful contribution to an imperfectly understood but important aspect of the Brazilian past, and in addition make a documented contribution to the use of cross-disciplinary approaches in the study of history.

My project would be carried out in two stages: the first to study Brazilian historical records concerning the onset and spread of disease and the second to use detailed archives to garner broad insights into disease sources and effects. In the first stage of research (requiring four months), I plan to use the provincial reports and government correspondence located in Brazil’s National Archive to build a comprehensive record of the locations, movement, and duration of Brazil’s major epidemics. I have already begun collecting information from thousands of pages of government reports at are available online. Since epidemics follow the flow of people and goods, research in the first phase will incorporate general information on shipping, migration, and commerce. For the second stage of the project (requiring eight months), a team of two Brazilian research assistants and I will examine the records of three coast Charity Hospitals (Santa Casa de Misericórdias) in Brazil. Both of these stages will require financial support to assist with travel, research and equipment costs. By combining the information collected in these two phases, I will gather sufficient material to write a book-length account of Brazil’s era of epidemics.

I will take a cross-discipline approach to this work. The project requires digital technology to discover and accurately represent the historical processes under study. In additional, the project can benefit from the increasingly sophisticated tools employed by health geographers: GIS programs, spatial and network analysis, and infection cluster detection. Historians can profit from these methods. For example, the study of how epidemics moved is greatly enhanced by GIS programs, which can process and visually represent data on demographic and social conditions in the context of the physical environment.

Historical Background and Approach

Research on epidemic and endemic diseases will contribute to a better understanding of the social, political, and economic history of Brazil, and additionally further our knowledge of the actual etiology of specific diseases such as yellow fever and smallpox. The research conducted so far, while limited, has led to important changes in ideas about Brazil’s past and the ways specific diseases operate. For example, we know now that endemic diseases such as tuberculosis and neonatal tetanus were deadlier in the long run than epidemic diseases in Southeastern Brazil. Epidemics, however, prompted so much fear that they had an outsized influence on Imperial policies and government attitudes toward slavery, sanitation, and immigration. Epidemics were very costly; at their worst they could empty towns of all mobile residents and halt commercial activity. Yet in social terms, the impact of epidemics may not have been greater than endemic disease nor was it evenly shared among groups in society. Strong evidence exists that cholera killed more slaves and poor Brazilians of African descent, while yellow fever was far deadlier among European sailors and immigrants.

Historians know only the broadest outline of Brazil’s nineteenth-century experience with epidemics. Yellow fever took hold in Brazil after arriving in 1849 aboard a ship carrying American gold prospectors en route to California. This is probably no coincidence. The California Gold Rush marked an upturn in the number of migrants carrying disease at a time in which coastal population density had become ripe for epidemic vectors. Brazil may have lacked a sufficient number of disease carriers or its coastal population may have been diffuse enough to prevent the influenza and cholera pandemics that had spread throughout most of the world in 1802 and 1831. After 1849, the growing coffee trade attracted an increasing number of ships, sailors and, eventually, immigrant; all these factors which could facilitate epidemics. Only in the early 1900s, when thousands of Brazilians were vaccinated against smallpox and urban renewal programs eliminated the stagnant and polluted water conducive for yellow fever and cholera, did this period of epidemics end.

Within this broad picture of Brazilian medical history, this project proposes a specific and manageable approach. When epidemics occurred, the provincial authorities notified the Imperial and Republican governments. Where and when epidemics struck can be mapped using government correspondence and provincial reports that were published annually. These phenomena can be displayed visually, as in the sample map of disease outbreaks in the provinces of Sergipe and Pará (included as an appendix). The government reports give important geographic details that can be matched with information about shipping and migration to give a picture of how and why deadly diseases such as yellow fever and smallpox moved across the landscape. Exploring and recreating the “topography” of epidemic outbreaks is part of the primary phase of research.

In the second phase, I plan to gather detailed information from two main sources: 1) patient registers located in three coast Charity Hospitals, and 2) cemetery registers from matching municipalities. The archives of Charity Hospitals have rarely been used by historians despite the wealth of information they contain. Hospitals were required to keep detailed information about eh patients the admitted, the diseases they treated, and the rates of recovery or death. Since most Brazilians who could afford private care were treated in their homes, we must also turn to the cemetery records to gain a more complete picture of disease occurrence and death rates. Cemetery registers, commonly safeguarded in municipal or provincial archives, provide details about the deceased and the cause of death. When these two sources are used in combination, investigator can track an individual form the moment of contacting an illness to the time of recovery or death. As a whole, these data can validate or invalidate the claim that Brazil’s health worsened during this period.

The three Charity Hospitals of Porto Alegre, Vitoria, and Recife are the strongest candidates for research. Using a small team of researchers in 2005, I gathered information from thousands of deceased and buried individuals in the busy Southeastern port city of Santos. I have prepared this database so it can be expanded to include patient and cemetery information from additional locations.

Method and Design

In order to complete this project several digital tools are necessary. First, in order to get a sense of the geography of disease, geographic information system (GIS) programs will be employed. GIS has the capability to visually present historical phenomena in spatial terms and to analyze variables that may have contributed to the ways that disease spread or recede. The partnership of geography and disease etiology has a rich history. In 1854 the celebrated physician John Snow used maps to prove that the Broad Street Pump was the source of the deadly London cholera contamination, effectively showing that cholera was spread by water. For today’s medical geographers, the search continues for helpful insights into the etiology of disease that are revealed by spatial patterns. Recent research, for example, has contributed to our understanding of the West Nile virus and childhood leukemia. For this project, GIS provides a way to visually represent disease incidence and a way to compare epidemiological, social and environment variables.

Communicable disease move across a landscape in a particular way, so that the environment, both natural and constructed, and the pathways that people follow are critical variables for discerning epidemiological ecologies. Beyond visually representing epidemics outbreaks, GIS will allow a comparison of landscape types, population density, navigable rivers and roads, and agricultural and commercial activity. Some nineteenth-century municipalities reported epidemic outbreaks with such detail that infections within town neighborhoods can be mapped. Beyond GIS, clusters of infection points can be detected using a variety of means (i.e., “partial point,” “nearest neighbor,” or “local rate” scanning). Similarly, communicable diseases create networks of infected individuals that can also be observed and analyzed using a variety of network tools. For example, the hospital and cemetery registers include the names of patients’ slave owners or the names of sailors’ ships. Slaves who shared an owner or sailors from the same ship create “infection networks” useful for comparing epidemics.

My professional experience will be useful for this project. I am fluent in Portuguese, I have spent much time researching in a variety of local, provincial and national archives, I use efficient techniques for colleting and processing information (e.g., document digitalization and database design), and I have numerous contacts in Brazil. In the United States, I am affiliated with “The Terrain of History,” an international collaborative research project that seeks to utilize GIS in researching Brazil’s past (http://shc.stanford.edu/digital/rio.html). I plan to expand my collaboration with this program to make my data and research available to the public through their website.

Since this proposed project encompasses history, geography and medicine, there is a wide range of suitable conferences at which to present its results. I would be eager to present papers at a regional American Historical Association conference, for example, or to attend the newly founded Public health Geomatics Conference. In addition, another conference could be organized with the “Terrain of History” project team, as was done in 2006. I believe that the results of my project will find a wide audience, clearly appealing to Brazilian historians, but also to medical and geographic historians and public health scholars in general.

The image posted at the top of this page is available at: http://hitchcock.itc.virginia.edu/Slavery/index.php.  This engraving is titled "Le Chirugien Negre" (the black surgeon).  According to the autors of this website, "the engravings in this book were taken from drawings made by Debret during his residence in Brazil from 1816 to 1831. For watercolors by Debret of scenes in Brazil, some of which were incorporated into his Voyage Pittoresque, see Jean Baptiste Debret, Viagem Pitoresca e Historica ao Brasil (Editora Itatiaia Limitada, Editora da Universidade de Sao Paulo, 1989; a reprint of the 1954 Paris edition, edited by R. De Castro Maya)."