Homens, Instituições, Políticas (séculos XVI–XX)€¦ · ere is a vast historiographic...
19
Homens, Instituições, Políticas (séculos XVI–XX) Alexandra Esteves (coord.)
Transcript of Homens, Instituições, Políticas (séculos XVI–XX)€¦ · ere is a vast historiographic...
Homens, Instituições, Políticas (séculos XVI–XX)
Alexandra Esteves (coord.)
Intr
oduç
ãoA
lexa
ndra
Est
eves
Pobr
es v
estid
os d
e pr
eto:
Ass
istê
ncia
, ind
umen
tári
a e
esm
ola
a pa
dres
em
Bra
ga (sé
culo
s XV
II-XV
III)
Luís
Gon
çalv
es F
erre
ira
Entr
e o
bara
ço e
o p
regã
o: A
min
oria
cig
ana
nas
polít
icas
nor
mat
ivas
por
tugu
esas
, na
Époc
a M
oder
naFáb
io L
opes
Fer
reir
a
Gaf
aria
s de
pois
da
lepr
a: A
prox
imaç
ão à
his
tóri
a do
H
ospi
tal d
e S. L
ázar
o de
Coi
mbr
a na
mod
erni
dade
An
a M
arti
ns
The
inst
itutio
nalis
atio
n of
med
ical
kno
wle
dge
and
its im
plic
atio
ns for
oU
cial
hea
lthca
re p
rofe
ssio
nals
in
Por
tugu
ese
Am
eric
aL
auri
nda
Abre
u
Entr
e fo
rast
eiro
s e
pobr
es d
a ci
dade
: As
esco
lhas
as
sist
enci
ais
dos
adm
inis
trad
ores
da
cari
dade
em
Évo
ra n
os s
écul
os X
VII e
XVI
IIR
ute
Par
dal
Dot
es d
e ca
sam
ento
: Exe
mpl
o da
San
ta C
asa
da
Mis
eric
órdi
a de
Man
gual
de (sé
culo
s XV
III e
XIX
)P
edro
J. B
arbosa
da
Silva
O P
urga
tóri
o a
estr
emec
er: C
apel
as la
rgad
as e
m
issa
s at
rasa
das
nas
conf
rari
as d
as A
lmas
de
Brag
a (s
écul
o XV
III)
Mari
a M
art
a L
obo d
e A
raújo
S. R
afae
l, “C
eles
tial M
édic
o”: D
evoç
ão e
ca
rida
de n
o sé
culo
XVI
II em
Fr.
João
de
S. J
osé,
da
Ord
em H
ospi
tale
ira
Mari
a d
e F
áti
ma R
eis
Enfe
rmei
ros
e en
ferm
eira
s no
s ho
spita
is p
ortu
gues
es
dos
sécu
los
XVIII
e X
IX: C
ontin
uida
des
e ru
tura
sM
aria
An
tón
ia L
opes
Excl
usão
Soc
ial e
“lo
ucur
a” fem
inin
a em
Por
tuga
l em
pri
ncíp
ios
do s
écul
o XX
: Est
udos
de
caso
Rosá
rio B
elo
Fra
ncis
co
A e
pide
mia
de
grip
e pn
eum
ónic
a pe
la im
pren
sa
loca
l: O
cas
o de
Coi
mbr
aA
na
Mar
ia D
iam
anti
no C
orr
eia
Fran
cisc
o de
Pau
la R
odri
gues
Alv
es: O
hom
em,
o po
lític
o e
o sa
nita
rist
aA
lexa
ndra
Est
eves
Alim
enta
r os
des
valid
os: O
s do
nativ
os e
m g
éner
o à
Ass
ocia
ção
Prot
ecto
ra d
a In
fânc
ia D
esva
lida
e do
s Po
bres
do
Lum
iar
(192
7–19
64)
Raq
uel
Caç
ote
Rap
oso
7 12 32 44 60 92 102
120
144
154
174
184
198
218
61
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU*
60
e in
stit
uti
onal
isat
ion
of
med
ical
kn
owle
dge
an
d
its
imp
lica
tion
s fo
r o5
cial
h
ealt
hca
re p
rofe
ssio
nal
s
in P
ortu
gues
e A
mer
ica
* Universidade de Évora
er
e is
a v
ast h
isto
riog
rap
hic
lite
ratu
re o
n h
ealt
h, s
ickn
ess
and
tr
eatm
ent i
n c
olon
ial B
razi
l. M
any
di?
eren
t asp
ects
hav
e be
en
dis
cuss
ed, b
ut t
her
e ar
e th
ree
idea
s th
at c
rop
up
qu
ite
con
sist
entl
y.
e
firs
t is
the
maj
or r
ole
that
the
Jesu
its
pla
yed
in h
ealt
h c
are
– p
rod
uci
ng
rem
edie
s, r
un
nin
g ap
oth
ecar
ies’
sh
ops
and
per
form
ing
surg
ery1
. Sec
ond
ly, t
he
trea
tmen
ts u
sed
wer
e ge
ner
ally
der
ived
fr
om a
mix
ture
of
know
led
ge a
nd
bel
iefs
gat
her
ed f
rom
the
vari
ous
di?
eren
t cu
ltu
ral t
rad
itio
ns
in th
e co
lony
, wh
ich
wer
e h
old
ing
thei
r ow
n a
gain
st E
uro
pea
n a
ttem
pts
at s
tan
dar
dis
atio
n2.
e
thir
d p
oin
t is
the
shor
tage
of
qual
ified
doc
tors
an
d s
urg
eon
s in
the
colo
ny,
wh
o w
ere
mos
tly
con
cen
trat
ed a
lon
g th
e co
ast a
nd
/or
in th
e la
rger
to
wn
s, a
lth
ough
sch
olar
s d
i?er
in th
e re
ason
s th
ey p
ut f
orw
ard
fo
r th
is: w
hil
e so
me
poi
nt t
o P
ortu
gal’s
neg
lect
of
Bra
zil i
n th
is
and
oth
er a
reas
, oth
ers,
incl
ud
ing
Már
cia
Moi
sés
Rib
eiro
, Ver
a R
egin
a B
eltr
ão M
arqu
es a
nd
Nau
k M
aria
de
Jesu
s3, b
elie
ve th
e p
robl
em s
hou
ld b
e co
nte
xtu
alis
ed a
nd
qu
esti
on th
e ad
equ
acy
of
the
info
rmat
ion
that
is c
urr
entl
y av
aila
ble
on o
5ci
ally
rec
ogn
ised
h
ealt
hca
re p
rofe
ssio
nal
s in
the
colo
ny.
is
art
icle
see
ks to
ad
d to
this
deb
ate
wit
h in
form
atio
n f
rom
a
rela
tion
al d
atab
ase
of s
ome
24,0
00
nom
inat
ive
reco
rds
der
ived
fr
om d
ocu
men
ts in
the
Por
tugu
ese
cen
tral
arc
hiv
es. M
ost o
f th
ese
reco
rds
con
cern
lice
nce
s to
pra
ctic
e an
d a
pp
oin
tmen
ts o
f d
octo
rs, s
urg
eon
s an
d a
pot
hec
arie
s to
pos
itio
ns
o?er
ed b
y ce
ntr
al
gove
rnm
ent o
r lo
cal a
uth
orit
ies
in P
ortu
gal a
nd
its
emp
ire
betw
een
14
30 a
nd
182
6.
e or
igin
al in
ten
tion
of
pro
du
cin
g a
com
par
ativ
e st
udy
of
Por
tuga
l’s c
olon
ies
was
soo
n a
ban
don
ed b
ecau
se o
f th
e la
rge
nu
mbe
r of
rec
ord
s re
lati
ng
to P
ortu
gues
e A
mer
ica
– 2,
688
reco
rds
on 1
,325
ind
ivid
ual
s [F
igure
1].
e
anal
ysis
has
ther
efor
e be
en r
estr
icte
d to
Bra
zil b
etw
een
154
9, th
e d
ate
of th
e fi
rst k
now
n
reco
rd, a
nd
180
8, w
hen
the
Por
tugu
ese
roya
l cou
rt h
ad a
rriv
ed in
B
razi
l du
rin
g th
e P
enin
sula
r W
ar a
nd
the
Cro
wn
dec
ided
to r
efor
m
hea
lth
care
reg
ula
tion
. In
Jan
uar
y 18
09,
the Protomedicato,
the
body
th
at h
ad r
egu
late
d th
e h
ealt
hca
re p
rofe
ssio
ns,
was
rep
lace
d b
y th
e Fisica,
ra-M
or4,
wh
ich
als
o ca
me
to c
entr
alis
e in
form
atio
n o
n
bloo
dle
tter
s, m
idw
ives
, too
th-p
ull
ers
(den
tist
s) a
nd
man
y ot
her
ki
nd
s of
hea
ler.
It s
hou
ld b
e n
oted
that
the
dat
a co
llec
ted
do
not
incl
ud
e al
l th
e h
ealt
hca
re w
orke
rs th
at w
ere
acti
ve in
Bra
zil i
n th
e p
erio
d in
qu
esti
on f
or tw
o re
ason
s: p
riva
te p
ract
itio
ner
s w
ere
only
occ
asio
nal
ly r
ecor
ded
by
gove
rnm
ent a
gen
cies
, an
d m
any
of th
ose
exam
ined
did
not
take
the
trou
ble
to p
ay f
or a
per
man
ent
lice
nce
, th
e fe
e fo
r w
hic
h w
ould
be
reco
rded
in th
e ch
ance
ller
y.5
at
was
init
ially
the
case
wit
h J
oaqu
im J
osé
Per
pét
uo,
an
ap
oth
ecar
y in
Vil
a d
o P
rín
cip
e, w
ho
in 1
782
was
pro
mp
ted
to
conv
ert t
he
pro
visi
onal
lice
nce
aw
ard
ed to
him
in 1
770
by
his
ex
amin
er, t
he
com
mis
sion
er a
nd
jud
ge a
pp
oin
ted
by
the
chie
f su
rgeo
n (cirur1ão-mor
), fo
r fe
ar h
e w
ould
be
dis
cove
red
by
insp
ecto
rs s
ent b
y th
e n
ewly
cre
ated
Protomedicato.
6
62
63
LAURINDA ABREU
In th
is e
xplo
rato
ry s
tudy
, I w
ill a
ttem
pt t
o tr
ace
the
stor
ies
of p
hysi
cian
s, s
urg
eon
s an
d a
pot
hec
arie
s w
ho
wer
e bo
rn,
live
d o
r w
orke
d in
Bra
zil a
t som
e p
oin
t in
thei
r ca
reer
s. I
t is
not
my
inte
nti
on to
exa
min
e h
ow k
now
led
ge c
ircu
late
d in
the
emp
ire,
a to
pic
thor
ough
ly e
xam
ined
by
oth
ers7
. ?e
subj
ect i
s ap
pro
ach
ed f
rom
the
view
poi
nt o
f th
e m
oth
erla
nd
, not
on
ly b
ecau
se
Por
tuga
l was
the
sou
rce
of th
e re
gula
tory
fra
mew
ork
app
lied
in
its
colo
nie
s, b
ut i
n p
arti
cula
r be
cau
se it
has
not
bee
n p
ossi
ble
to
enga
ge w
ith
mu
ch o
f th
e li
tera
ture
pro
du
ced
in B
razi
l or
wit
h lo
cal
sou
rces
. In
ad
dit
ion
, man
y d
ocu
men
ts in
the
Arq
uiv
o H
istó
rico
do
Con
selh
o U
ltra
mar
ino
(AH
U –
His
tori
cal A
rch
ive
of th
e O
vers
eas
Cou
nci
l), a
vit
al r
esou
rce
for
rese
arch
ing
know
led
ge tr
ansf
er a
cros
s th
e A
tlan
tic
in b
oth
dir
ecti
ons,
rem
ain
to b
e st
ud
ied
in d
epth
.
From Portugal to Brazil:
Healthcare professionals and
the regulatory environment
It w
as o
nly
in th
e se
con
d h
alf
of th
e 17
th c
entu
ry, w
ith
the
adm
inis
trat
ive
reor
gan
isat
ion
of
Bra
zil a
nd
the
exp
ansi
on o
f it
s p
opu
lati
on, t
hat
the
Por
tugu
ese
Cro
wn
beg
an to
inve
st to
any
sign
ifica
nt d
egre
e in
fu
rnis
hin
g it
s co
lony
– o
r th
e P
ortu
gues
e se
ttle
rs m
ovin
g th
ere
– w
ith
hea
lth
care
pro
fess
ion
als
from
the
mot
her
lan
d. U
p to
that
poi
nt,
the
info
rmat
ion
we
hav
e on
su
ch
pro
fess
ion
als
is s
par
se a
nd
lack
s d
etai
l. ?
e fi
rst d
octo
rs h
ired
by
the
gove
rnm
ent,
Jorg
e V
alad
ares
an
d J
orge
Fer
nan
des
, wen
t ou
t wit
h th
e fi
rst t
wo
gove
rnor
s ge
ner
al o
f B
ahia
, Tom
é d
e So
usa
in
154
38 a
nd
Dom
Du
arte
da
Cos
ta in
155
3,9
resp
ecti
vely
. Am
ong
the
du
ties
sp
ecifi
ed in
Val
adar
es’s
thre
e-ye
ar c
ontr
act w
ere
dai
ly
visi
ts to
the
sick
in th
e ci
ty’s
hos
pit
al.1
0In
155
6 B
ahia
als
o h
ad a
su
rgeo
n, ‘
Mes
tre
Ped
ro’,
wh
o tr
eate
d
and
ble
d th
e ‘m
en o
f th
e ro
yal n
avy
(arr
ivin
g) in
this
cit
y’,1
1 an
d
anot
her
was
ther
e in
the
foll
owin
g ye
ar: A
fon
so M
end
es, a
‘New
C
hri
stia
n’ (
a fo
rced
con
vert
fro
m J
ud
aism
or
a d
esce
nd
ant o
f on
e),
had
bee
n th
e ch
ief
surg
eon
in P
ortu
gal b
ut h
ad c
hos
en to
lose
his
p
osit
ion
ther
e an
d fl
ee to
Bra
zil r
ath
er th
an s
tay
and
be
arre
sted
by
the
Inqu
isit
ion
.12
Fro
m th
en u
nti
l th
e en
d o
f th
e 16
th c
entu
ry th
e d
atab
ase
incl
ud
es o
nly
five
mor
e re
fere
nce
s to
Bra
zil:
Lu
ís A
ntu
nes
w
as a
pp
rove
d a
s an
ap
oth
ecar
y in
159
1 to
wor
k in
‘Per
nam
buco
an
d th
e p
arts
of
Bra
zil’,
an
d f
our
‘pro
visi
onal
phy
sici
ans’
(méd
icos
a te
rmo)
, in
this
cas
e su
rgeo
ns
and
med
ical
stu
den
ts, w
ere
gran
ted
te
mp
orar
y li
cen
ces
to p
ract
ise
med
icin
e by
the
chie
f p
hysi
cian
(,
sico
-mor
) un
der
hig
hly
res
tric
tive
con
dit
ion
s, a
s w
as th
e n
orm
13.
All
of
thes
e p
rofe
ssio
nal
s in
ten
ded
to w
ork
in B
razi
l an
d M
adei
ra,
or in
Cap
e V
erd
e an
d ‘o
ther
isla
nd
s in
the
par
ts o
f B
razi
l’, o
r ev
en
per
hap
s in
Gu
inea
an
d A
ngo
la, a
lth
ough
it is
not
kn
own
wh
eth
er
they
act
ual
ly c
ross
ed th
e oc
ean
.14
At t
he
begi
nn
ing
of th
e fo
llow
ing
cen
tury
, th
e ch
ance
ller
y re
cord
s sh
ow a
ver
y sl
igh
t, gr
adu
al r
ise
in th
e n
um
ber
of p
riva
te
ind
ivid
ual
s w
ho
set s
ail f
or P
ortu
gues
e A
mer
ica
on th
eir
own
ac
cou
nt.
?is
was
the
case
of
two
apot
hec
arie
s (o
ne
in 1
621
hol
din
g a
surg
eon
’s li
cen
ce a
nd
the
oth
er in
163
3 li
cen
sed
as
a p
rovi
sion
al
phy
sici
an),
two
surg
eon
s (1
625
and
163
6, o
ne
of th
em a
pro
visi
onal
p
hysi
cian
) an
d o
ne
med
ical
stu
den
t (16
35, p
resu
mab
ly a
lso
inte
nd
ing
to w
ork
as a
sh
ip’s
doc
tor)
.?
e on
ly r
efer
ence
to a
Bra
zili
an m
un
icip
al p
ar/
do –
a p
ost f
or
a h
ealt
hca
re p
rofe
ssio
nal
wh
o w
as h
ired
an
d w
hos
e sa
lary
was
p
aid
by
a lo
cal c
oun
cil –
con
cern
ed th
e re
new
al o
f a
phy
sici
an’s
co
ntr
act a
nd
the
hir
ing
of a
su
rgeo
n in
Bah
ia in
161
8. W
hat
was
n
ew w
as th
e in
crea
sin
g ev
iden
ce o
f m
ilit
ary
surg
eon
s d
uri
ng
the
Du
tch
–Por
tugu
ese
War
. ?e
lett
er th
at th
e ca
pta
in o
f th
e G
rão-
Par
á ga
rris
on s
ent t
o th
e ki
ng
in J
anu
ary
1623
, req
ues
tin
g a
surg
eon
an
d m
edic
ines
alo
ngs
ide
mu
nit
ion
s, s
tan
dar
ds
and
d
rum
s, s
how
s h
ow w
ell i
nte
grat
ed th
ey w
ere,
as
if th
ey w
ere
just
an
oth
er w
eap
on in
the
arse
nal
of w
arfa
re.1
5 As
wel
l as
surg
eon
s,
the
fort
s an
d g
arri
son
s al
so b
egan
to r
ecei
ve p
erm
anen
t med
ical
p
erso
nn
el, a
s h
app
ened
in O
lin
da
in 1
622
and
Bah
ia in
162
6, d
uri
ng
thei
r ar
med
res
ista
nce
to th
e in
vasi
on b
y th
e D
utc
h W
est I
nd
ia
Com
pan
y. I
n 1
635,
at o
ne
of th
e d
ires
t mom
ents
in th
e co
nfl
ict,
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
Figure 1
Doctors, surgeons and
apothecaries in the
Portuguese Empire
(1496–1808)
Sou
rce:
Med
ical
P
rofe
ssio
ns
Dat
abas
e,
1430
–182
6
05001000 KM
1283
300
750
1325
64
65
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
Dom
Lu
ís d
e R
ojas
y B
orja
, arm
y co
mm
and
er o
f th
e C
apta
incy
of
Per
nam
buco
, ap
pea
led
to K
ing
Fil
ipe
III
to s
end
phy
sici
ans,
su
rgeo
ns
and
med
icin
es s
o h
e co
uld
set
up
a fi
eld
hos
pit
al.1
6 M
any
oth
er s
urg
eon
s m
ust
als
o h
ave
con
trib
ute
d to
the
war
eH
ort
betw
een
the
inva
sion
of
Salv
ador
(162
4–25
) an
d th
e P
ern
ambu
co
Insu
rrec
tion
(164
4–54
), bu
t th
e ce
ntr
al a
rch
ives
con
tain
no
trac
e of
them
. Rey
do
show
, how
ever
, th
at in
164
1 M
anu
el D
oliv
al P
aiva
, ch
ief
surg
eon
of
the
nav
y, a
pp
lied
to b
ecom
e su
rgeo
n to
the
roya
l h
ouse
hol
d in
rec
ogn
itio
n o
f h
is s
ervi
ces
du
rin
g th
e w
ar; t
hat
in
1651
a p
hysi
cian
, Dio
go P
erei
ra, w
as m
ade
a kn
igh
t (C
aval
eiro
Fid
algo
da C
asa
Rea
l);17
an
d th
at S
ebas
tião
Mar
tin
s w
as a
pp
oin
ted
su
rgeo
n
to th
e R
io d
e Ja
nei
ro g
arri
son
.18
Re
arm
y re
mai
ned
the
pre
ferr
ed c
hoi
ce f
or h
ealt
hca
re
pro
fess
ion
als
un
til t
he
end
of
the
17th
cen
tury
. Sin
ce th
ey
corr
esp
ond
ed to
the
ran
k of
lieu
ten
ant,1
9 m
ilit
ary
chie
f-su
rgeo
n
pos
ts w
ere
hig
hly
sou
ght a
fter
, wit
h th
e ri
ch C
apta
incy
of
Per
nam
buco
an
d th
e re
cen
tly
fou
nd
ed (1
680
) Col
ônia
do
Sacr
amen
to (n
ow in
Uru
guay
) at t
he
top
of
list
. In
Col
ônia
do
Sacr
amen
to th
ere
wer
e se
ven
can
did
ates
for
a s
ingl
e p
osit
ion
in
1688
,20
dem
onst
rati
ng
Por
tuga
l’s c
onfi
den
ce th
at it
cou
ld h
old
th
e te
rrit
ory
agai
nst
Sp
anis
h c
laim
s. L
ess
attr
acti
ve w
ere
sold
ier-
surg
eon
pos
ts, t
wo
vari
etie
s of
wh
ich
hav
e be
en id
enti
fied
alt
hou
gh
not
yet
qu
anti
fied
: on
e co
nsi
sted
of
sold
iers
wit
h s
ome
exp
erie
nce
of
su
rger
y w
ho
pra
ctis
ed a
s if
they
wer
e qu
alifi
ed p
rofe
ssio
nal
s; th
e ot
her
incl
ud
ed s
urg
eon
s re
cru
ited
by
forc
e an
d tu
rned
into
sol
die
rs
of c
ircu
mst
ance
at t
he
mer
cy o
f th
e p
ower
ful –
‘eve
n if
he
has
to
be c
oerc
ed w
ith
vio
len
ce’,
wro
te th
e go
vern
or g
ener
al o
f B
razi
l, D
om J
oão
de
Len
cast
re, o
n 3
0 A
ugu
st 1
698
to th
e ca
pta
in-m
ajor
of
Par
aíba
, ord
erin
g h
im to
incl
ud
e a
surg
eon
in th
e re
gim
ent t
hat
was
be
ing
form
ed to
figh
t in
dig
enou
s gr
oup
s in
Rio
Gra
nd
e.21
As
the
cen
tury
dre
w to
a c
lose
, th
e p
eop
le (t
hro
ugh
the
loca
l co
un
cils
that
rep
rese
nte
d th
em) c
alle
d e
ver
mor
e in
sist
entl
y fo
r h
ealt
hca
re p
rofe
ssio
nal
s, w
hic
h m
ay a
ccou
nt f
or th
e fa
ct th
at s
ome
mil
itar
y su
rgeo
ns’
con
trac
ts s
tip
ula
ted
that
they
sh
ould
att
end
the
poo
r in
the
area
s w
her
e th
ey w
ere
stat
ion
ed. M
ore
ofte
n, h
owev
er, i
t w
as m
erel
y im
pli
citl
y as
sum
ed th
at th
at w
as p
art o
f th
eir
du
ties
, not
le
ast b
ecau
se m
any
of th
em w
ere
pai
d b
y th
e lo
cal c
oun
cils
. In
Ap
ril
1728
the
surg
eon
s M
anu
el F
erre
ira
da
Cos
ta a
nd
In
ácio
Cap
elo
de
Val
len
cive
la, w
ho
wer
e at
tach
ed to
the
infa
ntr
y re
gim
ents
sta
tion
ed
in B
ahia
, com
pla
ined
of
the
un
cert
ain
ty s
urr
oun
din
g th
eir
role
s.
As
they
did
not
kn
ow p
reci
sely
wh
at th
eir
du
ties
con
sist
ed o
f, th
ey
wer
e re
quir
ed to
trea
t not
on
ly th
e so
ldie
rs in
the
barr
acks
bu
t als
o ‘o
uts
ide
assi
stan
ts f
rom
sai
d c
ity
and
thei
r h
ouse
hol
ds
and
, in
thos
e of
the
hig
her
-ran
kin
g oo
cers
, th
eir
serv
ants
an
d s
lave
s’; f
eeli
ng
exp
loit
ed a
nd
‘hig
hly
inco
mm
oded
in th
eir
per
son
s’, th
ey p
etit
ion
ed
the
kin
g to
gra
nt t
hem
a r
egu
lati
on s
etti
ng
out t
hei
r d
uti
es s
o th
at
they
cou
ld b
ette
r se
rve
him
.22 W
hil
e it
was
un
dou
bted
ly d
iocu
lt
for
thes
e m
en to
take
car
e of
a c
onst
antl
y gr
owin
g p
opu
lati
on
– th
ere
wer
e be
twee
n 2
00
,00
0 a
nd
30
0,0
00
peo
ple
su
bjec
t to
the
Por
tugu
ese
Cro
wn
by
that
tim
e23
– it
is a
lso
clea
r th
at th
ey w
ere
mor
e w
illi
ng
to d
o so
wh
en th
ey w
ere
pai
d s
epar
atel
y fo
r it
.It
ap
pea
rs th
at R
io d
e Ja
nei
ro h
ad o
nly
fou
r d
octo
rs in
167
1 –
‘not
en
ough
for
so
man
y p
eop
le’,
acco
rdin
g to
the
auth
orit
ies.
24
In P
ern
ambu
co th
ere
was
on
e: th
ere
was
a r
epor
t th
at a
Fre
nch
d
octo
r w
ith
a ‘g
ood
rep
uta
tion
in s
cien
ce’ b
ut ‘
litt
le e
xper
ien
ce
of B
razi
l’25 h
ad b
een
ther
e th
at y
ear,
bu
t he
had
left
bec
ause
he
had
n
ot b
een
pai
d. R
is, c
omp
lain
ed th
e go
vern
or o
f R
io d
e Ja
nei
ro,
set a
poo
r ex
amp
le to
oth
er d
octo
rs, a
s it
now
mad
e th
e p
acka
ge
oHer
ed to
any
doc
tor
wh
o w
ish
ed to
go
ther
e le
ss a
ttra
ctiv
e.26
Not
on
ly d
id th
e m
oth
erla
nd
not
sen
d th
em d
octo
rs (‘
we
don
’t u
sual
ly g
et a
ny d
octo
rs f
rom
Por
tuga
l’), b
ut i
t als
o d
epri
ved
them
of
the
ones
wh
o w
ere
ther
e. R
e N
ew-C
hri
stia
n d
octo
r A
nd
ré
Rod
rigu
es F
ran
co f
rom
Id
anh
a-a-
Nov
a in
eas
tern
Por
tuga
l, w
ho
had
bee
n c
onvi
cted
by
the
Inqu
isit
ion
of
Jud
aism
in 1
658
and
d
epor
ted
,27 w
as s
ubs
equ
entl
y st
rip
ped
of
all t
he
pos
itio
ns
he
hel
d in
Bah
ia b
y a
dec
ree
of 9
Mar
ch 1
673,
aft
er f
aili
ng
to w
in th
e p
osit
ion
of
chie
f su
rgeo
n in
166
5. R
e ci
ty u
nsu
cces
sfu
lly a
pp
eale
d
on b
ehal
f of
the
doc
tor,
poi
nti
ng
out h
is ‘w
ide
exp
erie
nce
an
d
know
led
ge a
nd
ch
arit
y w
ith
wh
ich
he
trea
ted
ric
h a
nd
poo
r, to
w
hom
we
fin
d h
e ga
ve m
any
alm
s, a
nd
bec
ause
he
is a
n in
div
idu
al
wh
ose
age
mad
e it
eas
ier
for
wom
en in
thei
r m
odes
ty to
tell
him
of
thei
r ai
lmen
ts’;
furt
her
mor
e, w
ith
out h
im, t
he
pop
ula
tion
of
the
city
w
as le
ft in
the
han
ds
of tw
o lo
cal d
octo
rs, ‘
both
you
ng
(an
d f
resh
) ou
t of
sch
ool’.
28In
Nov
embe
r 16
94, i
t was
the
resi
den
ts o
f P
araí
ba w
ho
wer
e d
eman
din
g th
at th
e lo
cal a
uth
orit
ies
hir
e a
doc
tor
from
Por
tuga
l.29
São
Pau
lo h
ad b
een
pro
test
ing
to th
e O
vers
eas
Cou
nci
l abo
ut
the
lack
of
a d
octo
r an
d a
pot
hec
ary
sin
ce 1
638
at le
ast;
the
loca
l co
un
cil s
ugg
este
d th
at a
s n
o d
octo
rs w
ante
d to
mov
e th
ere
of th
eir
own
acc
ord
the
kin
g sh
ould
ord
er ‘o
ne
wh
o h
as le
ss im
ped
imen
t in
this
cou
rt’ t
o go
, an
d th
e co
un
cil w
ould
pro
vid
e h
im w
ith
goo
d
livi
ng
con
dit
ion
s an
d a
goo
d s
alar
y.30
Rey
rep
eate
d th
eir
pet
itio
n
in 1
700
31 a
nd
aga
in in
174
8 (i
n 1
753
the
pos
t had
sti
ll n
ot b
een
fi
lled
32),
aski
ng
the
Cro
wn
to s
end
on
e of
the
‘doc
tors
wh
o ar
e le
arn
ing
at th
e u
niv
ersi
ty a
t roy
al e
xpen
se’.3
3 Su
ch a
req
ues
t cou
ld
not
be
gran
ted
, how
ever
, bec
ause
the
fate
of
gran
t-h
old
ing
med
ical
st
ud
ents
did
not
lie
dir
ectl
y in
the
Cro
wn
’s h
and
s.It
was
in th
e co
nte
xt o
f th
e D
utc
h–P
ortu
gues
e W
ar a
nd
the
grow
ing
nu
mbe
rs o
f su
rgeo
ns
in B
razi
l th
at th
e C
row
n to
ok th
e fi
rst s
tep
s to
reg
ula
te h
ealt
hca
re p
ract
ice
in th
e co
lony
. It d
id s
o by
m
ean
s of
the
dec
ree
of 2
8 M
arch
163
4 ap
poi
nti
ng
Fra
nci
sco
Vaz
C
abra
l, a
doc
tor
trai
ned
in C
oim
bra,
as
chie
f p
hysi
cian
an
d c
hie
f su
rgeo
n o
f B
razi
l. R
e d
ocu
men
t sp
ecifi
ed th
at th
e d
ecis
ion
had
th
e ‘c
onse
nt o
f th
e ch
ief
phy
sici
an a
nd
the
chie
f su
rgeo
n o
f th
is
Kin
gdom
’.34
Ris
mov
e n
ot o
nly
du
pli
cate
d th
e tw
o p
osts
bu
t als
o as
sign
ed th
em b
oth
to th
e sa
me
per
son
in B
razi
l, th
ereb
y d
eval
uin
g
66
67
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
them
. Cab
ral,
in f
act,
had
pu
t h
imse
lf f
orw
ard
at
a ti
me
wh
en t
hes
e p
osi
tio
ns
in P
ort
uga
l wer
e so
cial
ly d
esir
able
an
d u
sual
ly a
war
ded
as
a f
avo
ur
to d
oct
ors
of
the
roya
l ho
use
ho
ld. H
e ba
sed
his
req
ues
t o
n t
he
serv
ice
he
had
ren
der
ed a
s ch
ief
phy
sici
an in
In
dia
an
d o
n
his
per
son
al c
on
nec
tio
ns
to t
he
bish
op
an
d g
over
no
r o
f B
ahia
, wh
o
had
alr
ead
y p
rom
ised
him
th
e p
ost
of
mu
nic
ipal
do
cto
r.In
Sep
tem
ber
1639
Cab
ral a
lso
obt
ain
ed t
he
‘po
st o
f ch
ief
phy
sici
an o
f th
e ar
my
that
is g
oin
g to
Per
nam
buco
’, th
us
– u
nu
sual
ly f
or
Po
rtu
gal –
bri
ngi
ng
toge
ther
th
e ci
vili
an a
nd
mil
itar
y w
orl
ds.
No
te t
hat
th
is w
as n
ot
the
sam
e as
bei
ng
chie
f p
hysi
cian
o
f th
e P
ort
ugu
ese
arm
y as
a w
ho
le, a
po
st t
hat
was
th
e m
ilit
ary
equ
ival
ent
of
the
civi
lian
ch
ief
phy
sici
an o
f th
e ki
ngd
om
. In
th
e ar
my
the
titl
es o
f ch
ief
phy
sici
an a
nd
ch
ief
surg
eon
wer
e ap
pli
ed
no
t o
nly
to
th
e o
Hce
rs w
ith
ove
rall
res
po
nsi
bili
ty f
or
hea
lth
car
e in
th
e m
ilit
ary
sph
ere
but
also
to
th
e h
igh
est-
ran
kin
g p
hysi
cian
an
d s
urg
eon
in a
ny
par
ticu
lar
loca
tio
n, w
het
her
it w
as a
ho
spit
al,
a ba
ttal
ion
, a g
arri
son
or
any
oth
er m
ilit
ary
enti
ty.
Cab
ral r
emai
ned
in h
is p
osi
tio
ns
un
til h
is d
eath
in 1
665,
wh
en
he
was
rep
lace
d b
y V
entu
ra d
a C
ruz
Arr
ais,
a d
oct
or
wh
o h
ad b
een
li
vin
g in
Bah
ia a
t le
ast
sin
ce t
he
pre
vio
us
year
. At
that
po
int,
An
dré
R
od
rigu
es F
ran
co, t
he
New
-Ch
rist
ian
do
cto
r m
enti
on
ed p
revi
ou
sly,
w
rote
to
th
e ki
ng
po
inti
ng
ou
t th
e u
nsu
itab
ilit
y o
f as
sign
ing
both
p
osi
tio
ns
to t
he
sam
e p
erso
n a
nd
pu
ttin
g h
imse
lf f
orw
ard
to
se
rve
as c
hie
f su
rgeo
n. I
n t
his
he
was
co
un
tin
g o
n t
he
sup
po
rt o
f th
e ch
ief
surg
eon
of
Po
rtu
gal,
wh
o in
dee
d a
pp
oin
ted
him
ch
ief
surg
eon
of
Bra
zil o
n 3
Dec
embe
r th
at y
ear,
th
e ap
po
intm
ent
bein
g re
cord
ed in
th
e ch
ance
ller
y th
e fo
llow
ing
Mar
ch.3
5 V
e ch
ief
phy
sici
an o
f th
e ki
ngd
om
, how
ever
, fav
ou
red
Cru
z A
rrai
s, a
nd
his
o
pin
ion
pre
vail
ed. C
ruz
Arr
ais
pro
ved
to
be
a co
ntr
over
sial
figu
re
wh
o c
lash
ed w
ith
th
e B
ahia
mis
eric
órdi
a, w
hic
h d
ism
isse
d h
im
fro
m it
s h
osp
ital
in 1
6793
6, t
he
city
co
un
cil,
wh
ich
was
res
po
nsi
ble
for
the
garr
iso
n w
her
e h
e al
so w
ork
ed, a
nd
th
e go
vern
or,
wh
o
even
tual
ly fi
red
him
as
both
ch
ief
phy
sici
an a
nd
ch
ief
surg
eon
an
d
app
oin
ted
Man
uel
de
Mat
os
de
Viv
eiro
s in
his
pla
ce.3
7 Viv
eiro
s,
wh
o h
ad a
lrea
dy
take
n o
ver
fro
m C
ruz
Arr
ais
in t
he
mis
eric
órdi
a h
osp
ital
, als
o b
ecam
e em
bro
iled
in d
isp
ute
s, b
oth
per
son
al,
as in
168
7 w
ith
his
nei
ghbo
urs
th
e C
apu
chin
mo
nks
of
San
to
An
tôn
io,3
8 an
d p
rofe
ssio
nal
, wit
h t
he
hea
ds
of
all t
he
inst
itu
tio
ns
in w
hic
h h
e w
ork
ed.3
9In
169
9, K
ing
Ped
ro I
I in
Lis
bon
to
ok
the
un
usu
al s
tep
of
app
oin
tin
g bo
th a
new
ch
ief
surg
eon
fo
r th
e ki
ngd
om
, Man
uel
d
e P
ina
Co
uti
nh
o, o
n 2
3 Ju
ne
and
tw
o d
ays
late
r a
new
ch
ief
phy
sici
an, D
iogo
Men
des
de
Leã
o.4
0 V
e fa
ct t
hat
late
r th
e sa
me
year
th
e C
row
n a
uth
ori
sed
th
e ch
ief
phy
sici
an t
o n
om
inat
e co
mm
issi
on
ers
for
Bra
zil s
ugg
ests
th
at V
ivei
ros
may
hav
e be
en
the
last
do
cto
r to
ho
ld b
oth
po
siti
on
s co
ncu
rren
tly
in t
he
colo
ny,
an
d t
hat
th
e ch
ief
phy
sici
an a
nd
ch
ief
surg
eon
of
Po
rtu
gal w
ere
them
selv
es t
akin
g ba
ck c
on
tro
l by
sen
din
g re
pre
sen
tati
ves
to B
razi
l
as t
hei
r su
bord
inat
es, a
s h
app
ened
in t
he
Po
rtu
gues
e p
rovi
nce
s.
In a
way
, th
is c
on
clu
ded
th
e re
form
beg
un
in 1
678,
wh
en t
he
kin
g ag
reed
to
all
ow t
he
chie
f p
hysi
cian
an
d c
hie
f su
rgeo
n t
o a
pp
oin
t p
ract
itio
ner
s to
dep
uti
se f
or
them
ou
tsid
e L
isbo
n a
t ti
mes
wh
en
they
cla
imed
th
ey w
ere
too
bu
sy t
o c
arry
ou
t th
e ex
amin
atio
ns
and
insp
ecti
on
s th
at t
hei
r re
gula
tio
ns
req
uir
ed t
hem
to
per
form
p
erso
nal
ly e
lsew
her
e in
th
e co
un
try.
Alt
ho
ugh
th
e 16
78 d
ecis
ion
on
ly c
on
cern
ed t
he
app
oin
tmen
t o
f d
epu
ties
by
the
chie
f p
hysi
cian
, it
sugg
ests
th
at t
he
chie
f su
rgeo
n
had
alr
ead
y be
en g
ran
ted
th
e sa
me
pri
vile
ge.4
1 S
om
e w
rite
rs h
ave
clai
med
th
at B
razi
l was
rec
eivi
ng
a se
con
d w
ave
of
New
-Ch
rist
ian
im
mig
ran
ts a
t th
at t
ime,
du
e ei
ther
to
th
e eh
ects
of
the
dec
ree
of
1671
pre
ven
tin
g d
oct
ors
rec
on
cile
d b
y th
e In
qu
isit
ion
fro
m
pra
ctis
ing
in P
ort
uga
l ‘o
n p
ain
of
dea
th’,
or
to t
he
wid
ely-
hel
d
beli
ef t
hat
th
e m
ajo
rity
of
Po
rtu
gues
e h
ealt
hca
re p
rofe
ssio
nal
s al
read
y in
th
e co
lon
y w
ere
New
Ch
rist
ian
s. H
owev
er, o
ur
sou
rces
d
o n
ot
con
firm
th
is; t
he
case
of A
nd
ré R
od
rigu
es F
ran
co s
how
s th
at B
razi
l was
no
t su
ch a
saf
e h
aven
fo
r N
ew C
hri
stia
ns
as s
om
e h
isto
rian
s h
ave
pro
po
sed
.W
hat
ap
pea
rs c
erta
in is
th
at, a
lth
ou
gh B
razi
l was
incr
easi
ngl
y as
soci
ated
wit
h h
ealt
hca
re c
aree
rs r
eco
rded
in L
isbo
n, u
nti
l th
e en
d o
f th
e 17
th c
entu
ry it
was
no
t th
e p
refe
rred
des
tin
atio
n f
or
such
pro
fess
ion
als,
par
ticu
larl
y d
oct
ors
. Yet
it w
as n
ot
just
th
e va
st d
ista
nce
, th
e d
iHcu
ltie
s o
f th
e vo
yage
an
d t
he
pro
blem
s o
f ad
apti
ng
to c
on
dit
ion
s d
elet
erio
us
to n
ewco
mer
s u
nu
sed
to
loca
l d
isea
ses
that
kep
t th
em a
way
fro
m S
ou
th A
mer
ica.
Sin
ce t
he
Cro
wn
had
set
up
a s
cho
lars
hip
sch
eme
in 1
568
to t
rain
do
cto
rs
and
ap
oth
ecar
ies
at t
he
Un
iver
sity
of
Co
imbr
a, f
un
ded
by
loca
l co
un
cils
in P
ort
uga
l, th
e jo
b m
arke
t fo
r h
ealt
hca
re w
ork
ers
in t
he
mo
ther
lan
d h
ad b
een
gro
win
g st
ron
gly.
Ve
rela
tive
ly c
om
ple
x sy
stem
of
mu
nic
ipal
hea
lth
care
po
siti
on
s th
us
crea
ted
rev
eals
an
em
bryo
nic
red
istr
ibu
tio
n o
f re
sou
rces
bet
wee
n t
he
cou
nci
ls t
hat
fu
nd
ed t
he
trai
nee
do
cto
rs a
nd
ap
oth
ecar
ies
and
th
e m
un
icip
alit
ies
that
ben
efite
d f
rom
th
eir
serv
ices
. Vis
sys
tem
cam
e to
abs
orb
a
larg
e p
rop
ort
ion
of
the
sch
ola
rsh
ip h
old
ers,
no
t to
men
tio
n m
any
surg
eon
s as
wel
l, w
ho
gai
ned
fro
m t
he
new
dyn
amic
s cr
eate
d b
y th
e in
terp
lay
of
cen
tral
an
d lo
cal g
over
nm
ent
inte
rest
s.
The 18th century
It w
as o
nly
in t
he
1730
s th
at t
he
reco
rds
anal
ysed
beg
in t
o s
how
an
in
crea
se, a
lbei
t sl
igh
t, in
th
e n
um
ber
of
hea
lth
care
pro
fess
ion
als
goin
g to
or
livi
ng
in B
razi
l [Fig
ure
2].
Rio
de
Jan
eiro
bec
ame
the
mo
st c
om
mo
n d
esti
nat
ion
aft
er t
he
tran
sfer
of
the
cap
ital
th
ere
fro
m B
ahia
in 1
763.
By
the
end
of
the
cen
tury
, mo
st li
cen
ces
for
surg
eon
s [F
igure
6] a
nd
ap
oth
ecar
ies
wer
e be
ing
awar
ded
to
in
div
idu
als
born
or
resi
din
g in
th
e ci
ty.
68
69
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
Tab
le 1
com
pare
s th
e n
umbe
r of
lice
nce
s is
sued
in P
ortu
gal a
nd
B
razi
l to
apot
hec
arie
s, s
urge
ons
(in
clud
ing
som
e li
cen
ces
to
‘trea
t wit
h m
edic
ine’
) an
d p
hysi
cian
s (a
ccre
dit
atio
ns
of m
edic
al
deg
rees
aw
ard
ed b
y fo
reig
n u
niv
ersi
ties
, con
vers
ion
s of
sur
gica
l qu
alifi
cati
ons
or u
pgra
din
g of
med
ical
stu
den
ts),
acco
rdin
g to
ch
ance
llery
rec
ord
s. C
e to
tals
for
Bra
zil i
ncl
ude
all r
efer
ence
s to
d
iDer
ent i
nd
ivid
uals
foun
d in
the
arch
ives
con
sult
ed. A
s al
read
y po
inte
d o
ut, p
rofe
ssio
nal
s in
pri
vate
pra
ctic
e ar
e on
ly e
xcep
tion
ally
co
unte
d h
ere,
so
it is
impo
ssib
le to
say
how
man
y of
the
prac
titi
oner
s in
clud
ed u
nd
er ‘P
ortu
gal’
in T
able
1 a
ctua
lly w
orke
d in
Bra
zil.
A li
ttle
bac
kgro
und
info
rmat
ion
wil
l hel
p in
inte
rpre
tin
g th
ese
dat
a. F
irst
, in
the
mid
-18th
cen
tury
the
Cro
wn
str
engt
hen
ed it
s co
ntr
ol
over
pub
lic
life
, in
clud
ing
thes
e ar
eas
of a
ctiv
ity.
Sec
ond
ly, a
nd
mor
e ci
rcum
stan
tial
ly, t
he
post
s of
ch
ief p
hysi
cian
an
d c
hie
f sur
geon
w
ere
left
vac
ant f
or c
onsi
der
able
per
iod
s, th
e fo
rmer
aft
er it
was
su
spen
ded
in 1
770
an
d th
e la
tter
bet
wee
n 1
724
and
173
8 fo
llow
ing
the
dea
th o
f th
e oS
ce h
old
er a
nd
aga
in b
etw
een
177
2 an
d 1
779
afte
r th
e pu
blic
atio
n o
f th
e st
atut
es o
f Coi
mbr
a U
niv
ersi
ty. C
ese
stat
utes
tr
ansf
erre
d c
ontr
ol o
ver
empi
rics
to th
e un
iver
sity
, th
us fo
rcin
g th
e ch
ief s
urge
on to
cea
se h
is a
ctiv
itie
s. C
e un
iver
sity
, how
ever
, pro
ved
in
capa
ble
of c
arry
ing
out t
he
task
that
the
Cro
wn
had
ass
ign
ed to
it
and
lice
nsi
ng
rem
ain
ed a
t a s
tan
dst
ill u
nti
l Que
en M
aria
I r
eviv
ed
the
posi
tion
of c
hie
f sur
geon
to p
ut a
n e
nd
to th
e ‘d
isor
der
in w
hic
h
the
art o
f sur
gery
has
bee
n th
roug
hou
t th
is m
y K
ingd
om d
ue to
the
lack
of e
xam
inat
ions
and
rel
ease
of o
Den
ders
who
wer
e im
pris
oned
or
the
pun
ish
men
t of o
ther
s w
ho
proc
eed
ed fr
eely
wit
h g
reat
pre
jud
ice
to th
e pu
blic
cau
se a
nd
inco
mpa
rabl
e d
amag
e to
the
hea
lth
of m
y su
bjec
ts.’4
2 C
e tw
o po
sts
wer
e al
so s
ubsu
med
for
a ti
me
in th
e Protomedicato
Boa
rd, f
rom
178
243.
Tw
o im
por
tan
t reg
ula
tion
an
d in
spec
tion
mea
sure
s w
ere
the
Sta
+te
of
that
wh
ich
th
e co
mm
issi
oner
s de
lega
te o
f th
e C
hie
f P
hys
icia
n
of t
he
Kin
gdom
mu
st o
bser
ve i
n t
he
Sta
te o
f B
razi
l, of
174
2–44
,44 a
nd
th
e S
ta+
te o
f th
e pr
ices
at
wh
ich
th
e A
poth
ecar
ies
of t
he
Sta
te o
f B
razi
l
shal
l se
ll m
edic
ines
.45 A
s m
enti
oned
pre
viou
sly,
the
com
mis
sion
ers’
st
atu
te c
lari
fied
for
Bra
zil t
he
scop
e of
the
pow
ers
dev
olve
d to
th
e ch
ief
phy
sici
an’s
rep
rese
nta
tive
s, u
sin
g th
e 15
21 s
tatu
te a
s it
s m
odel
, bu
t it f
ocu
sed
pri
mar
ily
on a
pot
hec
arie
s an
d th
eir
busi
nes
ses,
wit
h b
rief
not
es o
n th
e in
spec
tion
of
surg
eon
s an
d a
ny
oth
er in
div
idu
als
wh
o p
ract
ised
med
icin
e w
ith
out a
uth
oris
atio
n.
Ce
stat
ute
exp
lici
tly
con
firm
ed th
at th
e p
ower
to a
war
d li
cen
ces
to ‘t
reat
wit
h m
edic
ine’
was
the
chie
f p
hysi
cian
’s a
lon
e; th
e sa
me
app
lied
(alt
hou
gh th
e in
form
atio
n is
om
itte
d) to
his
mos
t im
por
tan
t fu
nct
ion
: th
at o
f ac
cred
itin
g m
edic
al s
tud
ies
un
der
take
n a
t fo
reig
n u
niv
ersi
ties
.C
e st
atu
te s
etti
ng
the
pri
ces
of m
edic
ines
sou
ght t
o re
gula
te
a ra
pid
ly g
row
ing
mar
ket a
nd
the
nu
mbe
r of
ap
oth
ecar
ies
sup
ply
ing
the
colo
ny’s
peo
ple
, hos
pit
als,
sh
ips,
gar
riso
ns,
por
ts,
thea
tres
of w
ar a
nd
exp
lora
tory
exp
edit
ion
s. A
mon
g th
em w
ere
man
y gr
eedy
ap
oth
ecar
ies
wh
ose
pri
ces
pu
t med
icin
es o
ut o
f re
ach
of
the
poo
r, a
s th
e co
un
cils
of V
ila
do
Car
mo
and
Vil
a R
ica
com
pla
ined
bot
h b
efor
e an
d a
fter
the
new
sta
tute
s,46
as
did
the
cou
nci
ls o
f M
aria
na
and
São
Joã
o d
el-R
ei47
an
d e
ven
Gom
es F
reir
e d
e A
nd
rad
e, th
e go
vern
or o
f R
io d
e Ja
nei
ro a
nd
Min
as G
erai
s.48
C
ere
wer
e go
od g
rou
nd
s fo
r su
ch w
ides
pre
ad c
ond
emn
atio
n,
as s
how
n b
y th
e le
tter
that
the
apot
hec
ary
of N
ova
Col
ônia
, Joã
o P
edro
Fre
ire,
sen
t in
173
9 re
iter
atin
g a
lon
g-st
and
ing
des
ire
to s
ell
med
icin
es a
t dou
ble
the
pri
ce s
et in
the
stat
ute
so
that
he
cou
ld
pas
s on
his
bu
sin
ess
loss
es a
nd
oth
er c
osts
to h
is c
ust
omer
s.49
Ce
two
stat
ute
s on
the
pri
ce o
f m
edic
ines
an
d o
n th
e ch
ief
phy
sici
an’s
com
mis
sion
ers
brou
ght u
p to
dat
e d
ecis
ion
s m
ade
by th
e C
row
n in
162
7 an
d 1
678,
res
pec
tive
ly, a
nd
ad
apte
d
them
to B
razi
lian
cir
cum
stan
ces.
Alt
hou
gh th
e d
eleg
atio
n o
f p
ower
s to
Bra
zil h
ad b
een
in f
orce
sin
ce th
e en
d o
f th
e p
revi
ous
cen
tury
, th
ese
stat
ute
s d
raft
ed s
pec
ifica
lly f
or th
e co
lony
gre
atly
st
ren
gth
ened
the
chie
f p
hysi
cian
’s a
uth
orit
y an
d a
Dor
ded
him
n
ew m
ech
anis
ms
of c
ontr
ol. C
e 17
42–4
4 st
atu
te p
rese
nte
d th
e co
mm
issi
oner
s fo
r d
octo
rs a
nd
vis
itin
g ex
amin
ers
for
apot
hec
arie
s as
a k
ind
of
pu
blic
ser
vice
that
wou
ld a
pp
ly to
eve
n th
e m
ost
com
pet
ent p
rofe
ssio
nal
s bu
t, al
thou
gh th
ey a
ttra
cted
com
pla
ints
fr
om th
e in
div
idu
als
they
insp
ecte
d, t
hes
e tw
o oS
ces
wer
e in
fac
t h
igh
ly p
rofi
tabl
e, e
spec
ially
that
of v
isit
ing
exam
iner
s, w
hic
h w
ere
ofte
n in
the
han
ds
of p
ower
ful m
erch
ant a
pot
hec
arie
s to
the
roya
l h
ouse
hol
d. C
is s
yste
m p
ersi
sted
wit
hou
t maj
or c
han
ge u
nti
l th
e P
roto
med
icat
o w
as f
oun
ded
, wh
ich
ush
ered
in m
ore
com
ple
x lo
cal
insp
ecti
on b
odie
s; f
or e
xam
ple
, th
e fi
rst a
pp
oin
tmen
ts o
f sc
rive
ner
s to
the
com
mis
sion
ers
of th
e m
edic
ine
and
ph
arm
acy
dep
artm
ent
in B
ahia
an
d P
ern
ambu
co w
ere
reco
rded
in F
ebru
ary
1784
.50
Fig
ure
2
Lice
nce
s to
pra
ctis
e
hea
lthca
re p
rofe
ssio
ns
in B
razi
l (1
700–1
808)
Sou
rce:
Med
ical
P
rofe
ssio
ns
Dat
abas
e,
1430
–182
6
Physicians
Surgeons
Apothecaries
1701
–171
0
1711–1
720
1721
–173
0
1731
–174
0
1741
–175
0
1751
–176
0
1751
–175
0
1771
–178
0
1781
–179
0
1791
–180
0
1801
–180
8
400
350
250
200
150
100
50 0
300
450
70
71
THE INSTITUTIONALISATION OF M
EDICAL KNOWLEDGE
LAURINDA ABREU
A g
lan
ce a
t th
e fi
gure
s in
Tab
le 1
sh
ows
that
the
tren
ds
in th
e n
um
bers
of
lice
nce
s re
lati
ng
to B
razi
l gen
eral
ly tr
acke
d th
ose
of
the
mot
her
lan
d, d
esp
ite
the
obvi
ous
di>
eren
ces
in s
cale
. @is
is
par
ticu
larl
y cl
ear
in th
e d
ecad
e 17
70–8
0, w
hen
ther
e w
as n
o ch
ief
phy
sici
an to
val
idat
e th
e ex
amin
atio
ns
of a
pot
hec
arie
s, a
nd
als
o in
17
40–5
0, w
hen
the
nu
mbe
r of
su
rgeo
ns’
lice
nce
s ro
se o
win
g to
the
incl
usi
on o
f ex
amin
atio
ns
per
form
ed d
uri
ng
the
abse
nce
of
a ch
ief
surg
eon
; th
ese
nu
mbe
rs a
gain
ros
e si
gnifi
can
tly
in th
e ea
rly
year
s of
the
Pro
tom
edic
ato.
@e
mos
t dis
crep
ant t
ren
d w
as in
the
nu
mbe
rs o
f su
rgeo
ns
arou
nd
the
turn
of
the
cen
tury
(esp
ecia
lly a
fter
179
9), r
eflec
tin
g th
e p
rom
otio
n o
f th
e P
roto
med
icat
o to
the
stat
us
of a
roy
al
trib
un
al, a
s d
iscu
ssed
bel
ow. @
is tr
ibu
nal
was
mor
e ac
tive
in
Bra
zil t
han
in P
ortu
gal,
wh
ere
it f
aced
op
pos
itio
n f
rom
oth
er
auth
orit
ies
wit
h p
ower
s in
the
fiel
d o
f m
edic
ine.
On
e re
ason
for
th
is o
pp
osit
ion
, wh
ich
was
als
o ec
hoe
d in
Bra
zil,
can
be
seen
in
the
nu
mbe
rs o
f li
cen
ces
to ‘t
reat
wit
h m
edic
ine’
, a c
ateg
ory
of
hea
lth
care
pro
fess
ion
als
in w
hic
h th
ere
was
less
of
a d
i>er
ence
be
twee
n P
ortu
gal a
nd
the
colo
ny.
Alt
hou
gh th
e n
um
ber
of li
cen
ces
issu
ed a
nd
the
nu
mbe
r of
act
ive
pro
fess
ion
als
are
not
mu
tual
ly d
epen
den
t qu
anti
ties
, th
e d
ata
der
ived
fro
m th
e d
ocu
men
ts c
onsu
lted
sh
ow c
lose
ly
corr
elat
ed tr
end
s, a
s m
enti
oned
abo
ve. @
rou
ghou
t th
e fi
rst h
alf
of th
e 18
th c
entu
ry, t
her
e w
ere
very
few
doc
tors
an
d s
urg
eon
s in
Bra
zil,
exce
pt,
com
par
ativ
ely
spea
kin
g, in
Bah
ia a
nd
Rio
de
Jan
eiro
– in
175
3 th
e ar
my
base
d in
Rio
de
Jan
eiro
had
at l
east
fi
ve s
urg
eon
s an
d tw
o p
hysi
cian
s.51
Els
ewh
ere
ther
e ar
e re
cord
s of
su
rgeo
ns
(in
clu
din
g p
osti
ngs
, firs
t ap
poi
ntm
ents
an
d r
enew
als)
on
ly f
or S
anto
s (1
702)
, Nov
a C
olôn
ia (f
our
in 1
718)
, Rec
ife
(172
4),
São
Lu
ís (1
727,
plu
s a
pro
pos
al to
sen
d a
phy
sici
an th
ere)
, Par
á an
d
Itam
arac
á ga
rris
on (1
733)
, tro
ops
from
the
Min
as G
erai
s ga
rris
on
(173
3), C
uia
bá (1
735,
on
the
dea
th o
f th
e in
cum
ben
t), B
elém
(173
8),
the
garr
ison
on
San
ta C
atar
ina
isla
nd
(173
9–40
), an
d P
araí
ba (1
739,
p
hysi
cian
an
d s
urg
eon)
.52@
ere
was
als
o a
requ
est f
or a
phy
sici
an
for
the
Cap
tain
cy o
f P
ern
ambu
co (1
703)
an
d f
or s
urg
eon
s fo
r th
e fo
rt o
f Tam
and
aré
(173
2) a
nd
the
garr
ison
s of
Mor
ro d
e Sã
o P
aulo
(w
hic
h h
ad 1
70 m
en in
174
0) a
nd
Rio
Gra
nd
e d
e Sã
o P
edro
(173
9).53
@e
mid
dle
of
the
cen
tury
saw
a s
ign
ifica
nt c
han
ge, l
arge
ly
du
e to
the
crea
tion
of
new
mu
nic
ipal
itie
s an
d, i
n p
arti
cula
r, th
e ex
ped
itio
nar
y fo
rces
sen
t to
dem
arca
te th
e co
un
try’
s bo
rder
s.
Aft
er th
e T
reat
y of
Mad
rid
(175
0) a
nd
su
bseq
uen
t tre
atie
s,
surg
eon
s w
ith
thei
r fi
eld
med
icin
e ch
ests
acc
omp
anie
d th
e tr
oop
s at
all
tim
es, a
ssis
tin
g en
gin
eers
an
d m
ath
emat
icia
ns
or, i
n th
eir
abse
nce
, car
ryin
g ou
t mea
sure
men
ts a
nd
mak
ing
map
s th
emse
lves
in
ad
dit
ion
to tr
eati
ng
the
men
– ‘I
hav
e th
em m
ake
som
e m
easu
rem
ents
an
d m
aps
of th
ose
cou
ntr
ies
and
(per
form
) th
e ot
her
ex
erci
ses
of th
eir
pro
fess
ion
’.54
@es
e ex
ped
itio
nar
y fo
rces
, tog
eth
er w
ith
new
infa
ntr
y re
gim
ents
su
ch a
s th
ose
of P
ará
and
the
Fort
of
Mac
apá,
55
exp
and
ed th
e n
um
ber
of o
pen
ings
for
ch
ief
surg
eon
s an
d a
few
ch
ief
phy
sici
ans
wh
o al
read
y h
ad s
ome
pro
fess
ion
al e
xper
ien
ce.
@at
was
the
case
of
the
phy
sici
an P
asco
al P
ires
de
Cas
tro,
wh
ose
care
er h
ad b
egu
n a
s a
volu
nte
er a
t th
e Fo
rt o
f M
azag
ão in
nor
th-
wes
t Afr
ica;
that
hel
ped
him
gai
n a
pos
itio
n a
t Tod
os o
s Sa
nto
s H
osp
ital
in L
isbo
n in
175
2, f
rom
wh
ere
he
mov
ed to
the
fron
tier
as
ch
ief
phy
sici
an f
or th
e n
ewly
ren
amed
Sta
te o
f G
rão-
Par
á an
d
Mar
anh
ão, t
o w
hic
h h
e w
as a
pp
oin
ted
on
1 J
un
e 17
53.56
Oth
er c
hie
f p
hysi
cian
s w
ere
to b
e fo
un
d in
Goi
ás, P
ern
ambu
co,
Mar
ian
a p
riso
n, S
ão L
uís
Mil
itar
y H
osp
ital
, Par
á, S
ão P
aulo
, San
ta
Cat
arin
a is
lan
d, B
ahia
an
d V
ila
Ric
a, a
mon
g ot
her
pla
ces.
Mor
e th
an th
e ar
my
itse
lf, i
t was
mil
itar
y h
osp
ital
s th
at d
octo
rs f
oun
d
mos
t att
ract
ive,
esp
ecia
lly th
e R
oyal
Hos
pit
al in
Rio
de
Jan
eiro
, w
her
e th
e cr
iter
ion
for
hir
ing
ofte
n s
eem
s to
hav
e be
en c
lien
teli
sm
rath
er th
an th
e ca
nd
idat
e’s
own
mer
its.
Jos
é So
ares
de
Oli
veir
a co
mp
lain
ed o
f th
is a
t th
e ve
ry e
nd
of
the
cen
tury
: alt
hou
gh h
e h
ad
won
firs
t pla
ce in
the
com
pet
itiv
e ex
amin
atio
n f
or a
pos
t th
ere,
he
was
pas
sed
ove
r in
fav
our
of J
oão
An
tón
io D
amas
cen
o, a
pro
tégé
of
the
vice
roy
of B
razi
l.57 A
not
her
pro
spec
tive
ch
ief
phy
sici
an a
t th
at h
osp
ital
was
Jos
é P
into
de
Aze
red
o, w
ho
alre
ady
had
the
pos
t of
ch
ief
phy
sici
an o
f An
gola
to h
is n
ame.
58A
fter
175
0, t
he
Arq
uiv
o H
istó
rico
Ult
ram
arin
o co
nta
ins
hu
nd
red
s of
req
ues
ts f
or th
e ap
poi
ntm
ent o
f su
rgeo
ns
and
fo
r le
tter
s p
aten
t for
the
pos
itio
ns
of c
hie
f su
rgeo
n a
nd
ch
ief
phy
sici
an. A
s w
ith
pro
fess
ion
al e
xam
inat
ion
s, a
pp
oin
tmen
ts to
th
ese
pos
itio
ns
– ge
ner
ally
pro
pos
ed b
y vi
cero
ys, g
over
nor
s or
ca
pta
ins-
gen
eral
of
the
cap
tain
cies
– o
nly
bec
ame
e>ec
tive
on
ce
they
wer
e re
gist
ered
in th
e ch
ance
ller
ies.
@e
doc
um
ents
sh
ow
Table 1
Healthcare practice
in Brazil and Portugal
(1700–1808)
Sou
rce:
Med
ical
P
rofe
ssio
ns
Dat
abas
e,
1430
–182
6
Apothecaries
Surgeons
Physicians
Brazil
PortugalBrazil
Portugal
Brazil
Portugal
Dates
Licences
Total refs
LicencesLicences
Total refs
Licences
Licences
Total refs
Licences
170
1–10
49
133
623
439
124
11
1711
–20
816
183
1640
518
293
1721
–30
56
320
561
264
117
1731
–40
920
386
490
496
3912
1741
–50
1141
408
5613
696
141
18
1751
–60
1522
423
4113
490
61
3321
1761
–70
2636
553
6711
594
717
16
1771
–80
910
314
373
125
1
1781
–90
6794
574
135
252
802
429
27
1791
–180
042
5733
588
261
765
241
9
180
1–0
841
8137
210
140
140
42
805
Tot
al22
839
136
8762
216
5672
3310
369
130
72
73
THE INSTITUTIONALISATION OF M
EDICAL KNOWLEDGE
LAURINDA ABREU
to a
$or
d th
eir
sala
ries
. Wh
en in
173
4 th
e w
ard
er o
f th
e p
riso
n
in V
ila
Ric
a ac
cuse
d th
e lo
cal c
oun
cil o
f be
ing
the
only
on
e th
at
did
not
hir
e su
rgeo
ns
or p
hysi
cian
s fo
r th
e ‘g
ood
reg
imen
of
the
pu
blic
goo
d a
nd
rem
edy
of th
e p
oor’,
he
pro
babl
y kn
ew th
at th
at
was
not
tru
e. H
is a
im w
as to
for
ce th
e co
un
cil t
o p
rovi
de
med
ical
ca
re f
or h
is p
riso
ner
s, w
hic
h it
fin
ally
did
late
r th
at y
ear6
6. O
ther
m
un
icip
al h
ealt
hca
re p
osts
in th
e fi
rst h
alf
of th
e 18
th c
entu
ry h
ave
been
iden
tifi
ed in
Par
á ca
pta
incy
(172
7), V
ila
Ric
a (1
730
), Sã
o L
uís
(1
734)
, Oli
nd
a (1
704)
, Par
aíba
(174
6), B
elém
(173
5), A
rrai
al d
as M
inas
d
e P
arac
atu
(174
6), V
ila
do
Car
mo
(173
6)67
an
d V
ila
da
Cac
hoe
ira
in B
ahia
(173
5). O
ther
loca
liti
es, s
uch
as
Vil
a d
e Sã
o F
ran
cisc
o d
e Se
rgip
e d
o C
ond
e (1
712)
, Goi
ana
(173
6), S
anto
s (1
736)
,68 A
raca
ti
(175
5) a
nd
Vil
a N
ova
da
Rai
nh
a (1
756)
(Fra
nco
, 20
11: 2
22),
wer
e m
akin
g e$
orts
to s
et u
p s
uch
pos
ts (S
anta
Cat
arin
a is
lan
d, 1
749)
or
res
tore
them
(Oli
nd
a, 1
745)
an
d w
ere
atte
mp
tin
g to
con
vin
ce
the
gove
rnm
ent i
n L
isbo
n th
at th
ey h
ad th
e m
ean
s to
pay
for
them
; th
e go
vern
ors
of th
e co
lony
oft
en in
terv
ened
on
thei
r be
hal
f,
as h
app
ened
in S
anto
s, P
araí
ba, M
ato
Gro
sso,
São
Lu
ís, P
iau
í, P
aran
agu
á an
d I
gara
çu.
Non
eth
eles
s, e
ven
if a
ll th
e p
osts
that
the
loca
l cou
nci
ls
wan
ted
to s
et u
p h
ad b
een
au
thor
ised
, wh
ich
was
not
the
case
, an
d a
ll e
xist
ing
pos
itio
ns
had
bee
n r
egu
larl
y re
new
ed –
the
abov
e-m
enti
oned
cas
e of
Oli
nd
a p
rove
s th
e op
pos
ite
to b
e tr
ue
– th
e ov
eral
l nu
mbe
r of
phy
sici
ans
and
su
rgeo
ns
hir
ed b
y th
e co
un
cils
w
ould
sti
ll h
ave
been
ver
y sm
all f
or th
e si
ze a
nd
pop
ula
tion
of
Bra
zil.
Alt
hou
gh th
ere
was
sti
ll a
dem
and
for
med
ical
doc
tors
–
phy
sici
ans’
pos
ts w
ere
requ
este
d f
or S
ão J
oão
del
-Rei
, Lag
un
a an
d D
este
rro
in th
e 17
60s;
69 B
ahia
in 1
772;
70 M
aria
na
in 1
797
(hir
ed
in 1
799)
;71 B
elém
(tw
o p
osts
);72 V
ila
Ric
a in
179
9;73
an
d S
abar
á in
th
e fo
llow
ing
dec
ade7
4 –
afte
r th
e 17
60s
the
cou
nci
ls s
how
ed a
p
refe
ren
ce f
or s
urg
eon
s. C
ontr
acts
for
su
rgeo
ns
(firs
t ap
poi
ntm
ents
an
d r
enew
als)
hav
e be
en f
oun
d f
or V
ila
Bel
a, V
ila
de
São
José
d
as M
inas
, Par
anag
uá
and
São
Lu
ís.75
re
tow
ns
of S
ão J
oão
del
-Rei
an
d V
ila
Ric
a h
ave
a w
ell-
doc
um
ente
d h
isto
ry in
this
res
pec
t. W
hen
the
form
er w
ish
ed
to h
ire
a p
hysi
cian
in 1
764,
the ouvidor
(mag
istr
ate)
has
ten
ed to
as
sure
the
Cro
wn
that
the
mu
nic
ipal
ity
had
su
sci
ent i
nco
me
to p
ay h
is s
alar
y.76
Six
yea
rs la
ter,
how
ever
, th
e d
octo
r h
ad to
p
etit
ion
the
Cro
wn
to h
elp
him
rec
over
all
his
bac
k p
ay. I
n J
un
e 17
74 th
e co
un
cil i
tsel
f ap
pli
ed to
abo
lish
the
pos
t of
phy
sici
an
on th
e gr
oun
ds
of fi
nan
cial
con
stra
ints
.77 V
ila
Ric
a h
ad a
lrea
dy
don
e th
e sa
me
in 1
770
, kee
pin
g on
ly tw
o su
rgeo
ns,
78 th
us
pu
ttin
g an
en
d to
a s
erie
s of
rec
ipro
cal a
ccu
sati
ons
abou
t un
pai
d s
alar
y an
d p
oor
per
form
ance
.79In
178
7 th
e co
un
cil o
f Vil
a d
o Sa
bará
ask
ed to
rep
lace
it
s p
hysi
cian
wit
h a
su
rgeo
n a
nd
an
ap
oth
ecar
y,80
alt
hou
gh
subs
equ
entl
y it
trie
d to
get
an
oth
er d
octo
r’s
pos
t ap
pro
ved
. Cas
es
such
as
that
of V
ila
da
Cam
pan
ha
da
Pri
nce
sa, w
hic
h in
180
2
that
sev
eral
yea
rs c
ould
ela
pse
bet
wee
n a
nam
e be
ing
pro
pos
ed
in B
razi
l an
d c
onfi
rmed
in L
isbo
n. r
at m
igh
t of
cou
rse
be
du
e m
erel
y to
the
ines
cien
cy o
f th
e O
vers
eas
Cou
nci
l an
d th
e d
iscu
ltie
s of
lon
g-d
ista
nce
com
mu
nic
atio
ns,
as
was
the
case
w
ith
so
man
y ot
her
pet
itio
ns
rela
tin
g to
ser
vice
s re
nd
ered
to th
e C
row
n59
, bu
t th
ere
are
also
sig
ns
that
the
gove
rnm
ent e
mp
loye
d
del
ayin
g ta
ctic
s so
as
to p
ostp
one
hav
ing
to p
ay th
e co
rres
pon
din
g sa
lari
es. r
at w
as th
e ex
per
ien
ce o
f Jo
aqu
im J
osé
Fre
ire
da
Silv
a,
the
firs
t doc
tor
app
oin
ted
for
the
garr
ison
an
d tr
oop
s of
São
Pau
lo
cap
tain
cy. H
avin
g re
ques
ted
his
lett
ers
pat
ent i
n 1
770
, he
was
st
ill b
ein
g as
ked
in 1
774
to s
up
ply
the
nam
e of
his
pre
dec
esso
r.60
Fo
r m
any
app
oin
tees
, how
ever
, it a
pp
ears
that
the
fact
of
hav
ing
app
lied
to th
e C
row
n f
or th
eir
lett
ers
pat
ent a
cted
as
a ki
nd
of
pre
-con
firm
atio
n o
f th
eir
pos
itio
n.
ris
is n
ot th
e p
lace
to e
xplo
re c
onn
ecti
ons
betw
een
thes
e is
sues
an
d th
e se
quen
ce o
f m
ilit
ary,
eco
nom
ic a
nd
ad
min
istr
ativ
e ev
ents
, bu
t tw
o se
par
ate
tren
ds
invo
lvin
g ch
ief
surg
eon
s d
eser
ve
men
tion
. re
firs
t is
a w
ave
of a
pp
oin
tmen
ts u
p u
nti
l 178
0, c
lose
ly
lin
ked
to g
old
pro
spec
tin
g in
the
new
cap
tain
cy o
f M
ato
Gro
sso
and
the
exp
edit
ion
s re
ferr
ed to
abo
ve, f
or C
uia
bá, P
itan
gui a
nd
th
e ca
pta
incy
of
Esp
írit
o Sa
nto
, Goi
ás, P
ará,
Rec
ife,
Rio
Gra
nd
e d
o N
orte
, Oei
ras
do
Pia
uí,
Min
as a
nd
Vil
a R
ica.
re
seco
nd
oc
curr
ed a
fter
180
0 a
nd
invo
lved
ass
ista
nts
to c
hie
f su
rgeo
ns
app
lyin
g fo
r th
eir
sup
erio
rs’ p
osts
, her
ald
ing
the
imm
inen
t en
d
of th
e la
tter
’s p
rofe
ssio
nal
car
eers
.A
not
her
not
ewor
thy
feat
ure
of
the
tim
e w
as th
e n
um
ber
of
pro
fess
ion
als
app
lyin
g to
ret
ire
‘wit
h c
hie
f su
rgeo
n’s
hon
ours
’. r
is
was
a w
ay o
f as
kin
g fo
r so
me
sort
of
fin
anci
al c
omp
ensa
tion
for
a
pro
mot
ion
that
had
nev
er b
een
for
thco
min
g, a
s m
ay b
e ga
ther
ed
from
the
lett
ers
wri
tten
by
An
tón
io H
enri
ques
de
Alm
eid
a61
and
M
anu
el P
erei
ra P
ach
eco.
62 r
e d
istr
ibu
tion
of
thes
e m
en g
ener
ally
m
atch
ed th
e ro
ute
s fo
llow
ed b
y th
e P
ortu
gues
e in
occ
upy
ing
the
colo
ny: p
rim
aril
y d
own
the
Atl
anti
c se
aboa
rd63
fro
m th
e n
orth
-wes
t to
the
sou
th, f
ollo
win
g th
e ‘m
ain
sp
atia
l dyn
amic
s of
the
evol
uti
on
of th
e sy
stem
of
gove
rnm
ent’
64 [F
igures 3 and 4].
Acc
ord
ing
to D
auri
l Ald
en65
, th
e 19
th c
entu
ry b
egan
wit
h 6
2%
of th
e P
ortu
gues
e p
opu
lati
on c
once
ntr
ated
in th
e ca
pta
inci
es o
f P
ern
ambu
co, B
ahia
an
d R
io d
e Ja
nei
ro, a
nd
19.
7% in
Min
as G
erai
s.
rat
is a
lso
wh
ere
mos
t of
the
surg
eon
s, d
octo
rs a
nd
ap
oth
ecar
ies
men
tion
ed in
the
cen
tral
arc
hiv
es w
ere
to b
e fo
un
d.
Municipal posts for doctors and
surgeons – few jobs and few pro
spects
In P
ortu
gal a
nd
its
emp
ire
it w
as u
p to
the
loca
l cou
nci
ls to
hir
e h
ealt
hca
re p
rofe
ssio
nal
s, w
hic
h im
pli
ed th
at th
ey h
ad to
be
able
7475
05001000 KM
Bra
zil (Treaty of Madrid, 1750)
Main River Routes
Main Overland Routes
Physicians
Apothec
aries
Surgeo
ns
Others
THE INSTITU
TIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
hir
ed a
do
cto
r, a
su
rgeo
n a
nd
an
ap
oth
ecar
y81
– th
e st
and
ard
tri
o
of
hea
lth
care
pro
fess
ion
als
hir
ed b
y m
un
icip
alit
ies
in P
ort
uga
l –
seem
to
hav
e be
en r
are
in B
razi
l. O
ur
do
cum
enta
tio
n in
fac
t sh
ows
that
few
ap
oth
ecar
ies
wer
e h
ired
fo
r m
un
icip
al p
ar#
dos,
alt
ho
ugh
it
can
no
t be
ru
led
ou
t th
at t
hat
was
du
e to
per
son
al c
ho
ice,
sin
ce
pri
vate
pra
ctic
e w
as m
ore
pro
fita
ble.
82Sa
nto
s co
un
cil p
rovi
des
on
e o
f th
e be
st-d
ocu
men
ted
exa
mp
les
of
the
diD
cult
ies
that
loca
l au
tho
riti
es f
aced
in e
stab
lish
ing
and
m
ain
tain
ing
med
ical
po
sts.
At
the
begi
nn
ing
of
the
18th
cen
tury
it
was
ser
ved
by
a si
ngl
e m
ilit
ary
chie
f su
rgeo
n, w
ho
tre
ated
so
ldie
rs,
the
reli
gio
us
com
mu
nit
y an
d t
he
gen
eral
pu
blic
, bu
t by
172
1 h
e w
as n
o lo
nge
r w
ork
ing
ther
e.83
Ler
e w
as s
till
no
med
ical
car
e in
Sa
nto
s o
r it
s su
rro
un
din
gs in
173
2, e
xcep
t fo
r th
e ca
re p
rovi
ded
in
the
ho
spit
al b
y ‘p
oo
rly
pre
par
ed s
urg
eon
s’, a
s th
e co
un
cil c
laim
ed.
Sin
ce t
he
on
ly in
com
e av
aila
ble
to t
he
cou
nci
l – t
he
‘dri
nks
subs
idie
s’ –
had
bee
n ta
ken
by
the
roya
l exc
heq
uer
to p
ay f
or
Do
na
Cat
arin
a d
e B
raga
nça
’s d
owry
, th
e co
un
cil b
egge
d th
e C
row
n to
hel
p
it p
ay f
or
on
e d
oct
or;
84 f
oll
owin
g Sã
o P
aulo
’s le
ad, i
t su
gges
ted
that
it
co
uld
be
sen
t on
e o
f th
e d
oct
ors
wh
o w
ere
stu
dyi
ng
at C
oim
bra
‘wit
h th
e o
blig
atio
n to
go
wh
erev
er th
ey w
ere
nee
ded
’.85
In 1
733
the
cou
nci
l was
au
tho
rise
d to
est
abli
sh a
po
siti
on
fo
r a
phy
sici
an o
n
con
dit
ion
that
it w
as f
or
the
infa
ntr
y re
gim
ent –
in o
ther
wo
rds
the
do
cto
r w
ou
ld b
e sh
ared
by
the
sold
iers
an
d t
he
civi
lian
po
pu
lati
on
–
but
it w
as o
nly
in 1
739
th
at t
he
cou
nci
l man
aged
to
fin
d s
om
eon
e to
fill
th
e p
ost
.86
José
Bo
nif
ácio
de
An
dra
de,
a C
oim
bra
grad
uat
e w
ho
had
bee
n b
orn
in B
razi
l, d
eman
ded
do
ubl
e th
e sa
lary
set
by
the
Cro
wn
an
d t
hre
aten
ed t
o le
ave
wh
en K
ing
João
V o
rder
ed t
he
cou
nci
l to
an
nu
l th
e ag
reem
ent
it h
ad m
ade
wit
h h
im.8
7 He
no
t o
nly
wo
n t
his
bat
tle,
bu
t al
so b
oo
sted
his
inco
me
wit
h t
he
sala
ry
of
garr
iso
n d
oct
or
and
vis
ito
r o
f sh
ips.
88
Figure 4
Distribution of healthcare
professionals in Brazil,
1751–1808
So
urc
e: M
edic
al P
rofe
ssio
ns
Dat
abas
e, 1
43
0–
182
6
Figure 3
Distribution of healthcare
professionals in Brazil,
1549–1750
So
urc
e: M
edic
al P
rofe
ssio
ns
Dat
abas
e, 1
43
0–
182
6
05001000 KM
Bra
zil (Treaty of Madrid, 1750)
Main River Routes
Main Overland Routes
Physicians
Apothec
aries
Surgeo
ns
Others
85
207
57
10
85
207
57
10
76
77
THE INSTITUTIONALISATION OF M
EDICAL KNOWLEDGE
LAURINDA ABREU
Mu
nic
ipal
hea
lth
care
pos
ts in
Bra
zil s
eem
to h
ave
been
hig
hly
in
con
stan
t, u
nli
ke th
e p
eop
le’s
con
cern
s, w
hic
h c
onti
nu
ed to
bo
mba
rd th
e O
vers
eas
Cou
nci
l. A
dm
itte
dly
, sev
eral
tow
ns
wer
e st
ill a
ble
to u
se th
e se
rvic
es o
f ce
rtai
n h
osp
ital
s, s
omet
imes
eve
n
brea
chin
g re
gula
tion
s to
do
so, a
s in
the
case
of
the
Roy
al M
ilit
ary
Hos
pit
al in
Goi
ás89
. Fis
ass
ista
nce
sh
ould
not
be
over
esti
mat
ed,
how
ever
, bec
ause
mos
t mil
itar
y h
ospi
tals
wer
e sm
all a
nd
oft
en
tem
pora
ry fa
cili
ties
; th
e on
e in
Goi
ás h
ad o
nly
nin
e be
ds
in th
e la
te
1740
s, fo
r ex
ampl
e. L
arge
r h
ospi
tals
had
20
–30
bed
s, a
s in
Rio
de
Jan
eiro
in 1
752
and
Per
nam
buco
in 1
724,
res
pect
ivel
y. I
n th
e R
io d
e Ja
nei
ro h
ospi
tal i
n th
e m
id-1
8th c
entu
ry a
nd
in th
e V
ila
Ric
a h
ospi
tal,
foun
ded
in 1
771,
the
doc
tor
and
sur
geon
on
ly p
ut in
an
app
eara
nce
in
the
dir
est c
ircu
mst
ance
s. H
ow m
uch
the
hos
pita
ls in
Par
á (u
nd
er c
onst
ruct
ion
in 1
754)
, Cac
hoe
ira
(175
7) a
nd
Par
aíba
(176
5)
con
trib
uted
to h
ealt
h c
are
in th
e co
lony
is n
ot k
now
n b
ut, a
s R
enat
o F
ran
co90
has
poi
nte
d o
ut, t
hey
wer
e n
ot ju
st fe
w a
nd
far
betw
een
but
th
ey w
ere
also
poo
r, n
ot u
nli
ke h
ospi
tals
in P
ortu
gal i
tsel
f.B
razi
l’s a
dop
tion
of
the
Por
tugu
ese
syst
em o
f h
irin
g h
ealt
hca
re
pro
fess
ion
als
rais
ed th
e h
opes
of
phy
sici
ans
and
su
rgeo
ns,
bu
t th
ey w
ere
soon
das
hed
. Fe
idea
of
a st
able
cen
tral
or
loca
l go
vern
men
t pos
itio
n s
eld
om m
ater
iali
sed
. Fes
e d
i_cu
ltie
s se
em
to h
ave
a`ec
ted
phy
sici
ans
mor
e th
an s
urg
eon
s, a
nd
not
just
in
term
s of
thei
r ca
reer
pro
spec
ts. J
ust
how
litt
le v
alu
e w
as p
lace
d o
n
phy
sici
ans
is r
evea
led
in c
orre
spon
den
ce f
rom
174
8–49
bet
wee
n
the
com
mis
sion
er a
nd
the provedor
of
the
roya
l exc
heq
uer
in R
io d
e Ja
nei
ro o
n th
e re
leva
nce
of
buil
din
g a
mil
itar
y h
osp
ital
in th
e ci
ty.
Am
ong
the
cost
-cut
tin
g m
easu
res
prop
osed
was
the
sugg
esti
on th
at
phys
icia
ns
shou
ld o
nly
be
hir
ed fo
r oc
casi
onal
wor
k, s
ince
‘th
ere
wil
l be
no
lack
of d
octo
rs w
ho
wil
l agr
ee in
exc
han
ge fo
r m
eagr
e pa
y’.91
Fe
fier
ce c
omp
etit
ion
for
thes
e p
osit
ion
s is
a c
lear
sig
n th
at
very
few
jobs
wer
e av
aila
ble,
an
d th
is is
bac
ked
up
by
the
fact
that
m
any
peo
ple
wor
ked
for
fre
e w
hil
e th
ey w
aite
d f
or th
e in
cum
ben
t in
the
cove
ted
pos
itio
n to
leav
e or
die
. Wh
ile
this
oft
en h
app
ened
in
Por
tuga
l as
wel
l, a
feat
ure
that
ap
pea
rs to
be
spec
ific
to B
razi
l was
fo
r p
rofe
ssio
nal
s to
acc
ept a
mun
icip
al h
ealt
hca
re p
ost o
n c
ond
itio
n
that
they
‘did
not
req
uest
pay
men
t wit
hou
t His
Maj
esty
’s a
pp
rova
l’.
Fe
serg
ean
t-m
ajor
Man
uel F
erra
z d
e A
breu
agr
eed
to th
is w
hen
he
took
the
pos
t of
surg
eon
of V
ila
do
Car
mo
on 2
9 D
ecem
ber
1736
. W
hen
he
aske
d fo
r h
is s
alar
y ar
rear
s to
be
pai
d, h
e w
as r
emin
ded
in
May
174
1 of
the
term
s of
his
con
trac
t: w
ith
out r
oyal
ap
pro
val t
her
e co
uld
be
no
pay
men
t, an
d th
e ap
pro
val w
as d
elay
ed.92
Suc
h is
sues
n
eed
to b
e bo
rne
in m
ind
wh
en a
nal
ysin
g so
me
of th
e ba
ttle
s w
aged
by
phy
sici
ans
agai
nst
sur
geon
s, b
lood
lett
ers
and
oth
er p
oten
tial
ri
vals
, as
hap
pen
ed in
Rio
de
Jan
eiro
in 1
753.
93 F
at is
not
to s
ay
that
phy
sici
ans
thou
ght s
cien
tifi
c an
d p
rofe
ssio
nal
mat
ters
wer
e u
nim
por
tan
t, bu
t th
ey w
ere
not
the
only
issu
es th
at a
rou
sed
thei
r ir
e ag
ain
st th
eir
com
pet
itor
s. A
goo
d e
xam
ple
is th
e fi
ght t
hey
pu
t u
p in
Rio
de
Jan
eiro
in 1
789
agai
nst
a G
erm
an c
olle
agu
e, J
osep
h
Stru
ks, b
ecau
se h
e h
ad b
egu
n to
pra
ctis
e m
edic
ine
alm
ost a
s so
on
as h
e h
ad a
rriv
ed in
the
city
wit
h a
vie
w to
set
tlin
g th
ere.
94 Y
et ju
st
fou
r ye
ars
pre
viou
sly
the
city
cou
nci
l had
bee
n c
omp
lain
ing
of th
e la
ck o
f d
octo
rs.
Alt
hou
gh s
urg
eon
s w
ere
bein
g h
ired
for
cou
nci
l par'dos
in e
ver
grea
ter
nu
mbe
rs a
nd
they
wer
e al
so b
ein
g gr
ante
d m
ore
pow
ers,
th
ey h
ad th
eir
di_
cult
ies
as w
ell.
Fat
was
not
just
bec
ause
they
too
face
d c
omp
etit
ion
– a
s sh
own
by
the
app
eal m
ade
in 1
787
by th
e go
vern
or o
f Sa
lvad
or, R
odri
go M
enez
es, o
n b
ehal
f of
lan
dow
ner
s an
d s
uga
r m
ill p
rop
riet
ors
to a
llow
un
lice
nse
d in
div
idu
als
to
pra
ctis
e as
if th
ey w
ere
lice
nse
d95
– b
ut a
lso
beca
use
som
e of
th
em e
ven
had
to p
ay to
wor
k, c
over
ing
thei
r p
atie
nts
’ exp
ense
s an
d w
aiti
ng
to b
e re
imbu
rsed
by
thei
r em
plo
yers
, as
app
aren
tly
hap
pen
ed in
the
Mil
itar
y H
osp
ital
of
Min
as a
nd
the
mu
nic
ipal
su
rgeo
n’s
pos
t in
Vil
a R
ica
in 1
760
an
d 1
777.
96F
e co
mbi
nat
ion
of
bein
g ov
erw
orke
d a
nd
un
der
pai
d, o
r of
ten
not
pai
d a
t all
, is
rep
eate
dly
men
tion
ed a
nd
see
ms
to h
ave
pro
mp
ted
man
y h
ealt
hca
re p
rofe
ssio
nal
s to
mov
e on
in s
earc
h
of b
ette
r w
orki
ng
con
dit
ion
s. S
alar
ies
in a
rrea
rs a
re o
ne
of th
e m
ost c
omm
on to
pic
s d
ocu
men
ted
in th
e ar
chiv
es. I
n c
erta
in
circ
um
stan
ces
the
Cro
wn
mig
ht b
e re
spon
sibl
e fo
r p
ayin
g p
art
of th
e sa
lary
, par
ticu
larl
y in
the
case
of
mil
itar
y p
rofe
ssio
nal
s w
ho
add
itio
nal
ly c
ared
for
loca
l civ
ilia
ns,
bu
t usu
ally
, as
men
tion
ed
abov
e, s
alar
ies
wer
e p
aid
ou
t of
mu
nic
ipal
rev
enu
es o
r, w
her
e th
ese
wer
e in
su_
cien
t or
non
-exi
sten
t, fr
om fintas,
ext
raor
din
ary
taxe
s im
pos
ed o
n th
e p
oore
st s
ecti
ons
of th
e p
opu
lati
on, w
ho
wer
e p
reci
sely
the
ones
wh
o co
uld
not
a`
ord
pri
vate
doc
tors
.W
hil
e th
e ex
act t
erm
s on
wh
ich
thes
e co
ntr
ibu
tion
s w
ere
dis
trib
ute
d a
re n
ot k
now
n, t
her
e w
as a
mov
e in
the
late
18th
cen
tury
to
see
k al
tern
ativ
e so
luti
ons,
su
ch a
s th
e ‘li
tera
ry s
ubs
idy’
– a
tax
on
win
e, s
pir
its
and
vin
egar
intr
odu
ced
by
the
Mar
quis
of
Pom
bal t
o fu
nd
the
refo
rm o
f p
ubl
ic e
du
cati
on, a
lth
ough
in 1
803
mer
chan
ts
in S
anto
s co
mp
lain
ed th
at it
pla
ced
an
‘un
fair
’ bu
rden
on
trad
ers.
97
A d
i`er
ent s
olu
tion
was
fou
nd
for
Par
aíba
. Wh
en th
e ci
ty c
oun
cil
pro
test
ed a
bou
t th
e fintas,
the
Cro
wn
sen
t a le
tter
on
2 J
un
e 17
99
ord
erin
g th
e d
octo
r’s
sala
ry to
be
cut f
rom
20
0,0
00
to 1
50,0
00
ré
is, w
ith
10
0,0
00
réi
s co
min
g fr
om th
e co
un
cil’s
ass
ets
and
the
oth
er 5
0,0
00
fro
m th
e ro
yal e
xch
equ
er. E
ven
thou
gh h
is s
alar
y h
ad b
een
cu
t, th
e d
octo
r’s
du
ties
sti
ll in
clu
ded
car
ing
for
the
city
’s
infa
ntr
y ga
rris
on.9
8R
egar
dle
ss o
f h
ow th
eir
sala
ries
wer
e m
ade
up
, phy
sici
ans,
so
me
apot
hec
arie
s99
and
su
rgeo
ns
all s
u`
ered
fro
m n
on-p
aym
ent.
Loc
al c
oun
cils
, hos
pit
als,
the
arm
y an
d s
hip
s –
in r
elat
ion
to
ship
s’ s
urg
eon
s, p
osts
that
the
surg
eon
s of
Bah
ia, s
up
por
ted
by
the
city
’s c
omm
issi
oner
phy
sici
an, t
ried
to m
ake
com
pu
lsor
y in
17
5010
0 –
ofte
n r
an u
p a
rrea
rs, s
omet
imes
ove
r se
vera
l yea
rs. F
ere
wer
e co
nst
ant c
omp
lain
ts a
bou
t non
-pay
men
t du
rin
g th
e p
erio
d
in q
ues
tion
, in
crea
sin
g si
gnifi
can
tly
afte
r 17
60. B
reac
h o
f co
ntr
act
7879
THE INSTITUTIONALISATION OF M
EDICAL KNOWLEDGE
LAURINDA ABREU
by th
e em
plo
yer
occu
rred
as
mu
ch in
larg
e ci
ties
like
Bah
ia o
r R
io d
e Ja
nei
ro a
s in
sm
alle
r to
wn
s an
d a
8ec
ted
bot
h c
ivil
ian
an
d
mil
itar
y h
ealt
hca
re p
erso
nn
el. ;
e la
tter
wer
e al
so p
aid
di8
eren
tly
dep
end
ing
on w
her
e th
ey p
ract
ised
: su
rgeo
ns
in C
olôn
ia d
o Sa
cram
ento
ear
ned
less
than
thos
e in
the
‘Ter
ços
do
Bra
sil’
(172
2);
infa
ntr
y su
rgeo
ns
in R
ecif
e le
ss th
an th
ose
in B
ahia
(172
4); P
ará
pra
ctit
ion
ers
less
than
thos
e in
Mar
anh
ão (1
733)
; an
d th
e on
es in
P
araí
ba le
ss th
an th
ose
in O
lin
da
and
Rec
ife
(in
174
0 a
nd
179
8).1
01;
e fi
rst p
rote
sts
that
hav
e co
me
to li
ght w
ere
in f
act f
rom
m
ilit
ary
surg
eon
s, a
nd
they
als
o h
ad th
e lo
nge
st p
erio
ds
in a
rrea
rs.
In 1
726,
for
exa
mp
le, C
osm
e G
omes
Per
eira
com
pla
ined
that
he
had
nev
er r
ecei
ved
any
sal
ary
in th
e 30
yea
rs h
e h
ad w
orke
d a
s a
surg
eon
in F
orta
leza
do
Cea
rá.1
02 A
t th
e cl
ose
of th
e ce
ntu
ry,
regi
men
tal c
hie
f su
rgeo
ns
and
thei
r as
sist
ants
wer
e al
so to
lose
th
eir
‘bre
ad p
ay’ (
ven
cim
ento
do
pão)
, a s
alar
y bo
nu
s th
at th
ey h
ad
app
aren
tly
been
rec
eivi
ng
un
du
ly; b
y ro
yal o
rder
of
13 J
anu
ary
1799
it
on
ce m
ore
beca
me
pay
able
on
ly ‘d
uri
ng
a ca
mp
aign
or
mar
ch o
f th
e re
gim
ent’.
103
Wh
ile
it w
as c
omm
on p
ract
ice
in a
nci
en r
é/m
e P
ortu
gal f
or p
eopl
e to
pet
itio
n th
e C
row
n to
bec
ome
a m
embe
r of
a m
ilit
ary
ord
er o
r an
ac
tin
g pu
blic
oe
cial
, an
d a
lth
ough
it is
not
alw
ays
poss
ible
to li
nk
such
req
uest
s d
irec
tly
wit
h th
e d
ebts
of h
ealt
hca
re p
rofe
ssio
nal
s,
the
fact
is th
at s
ome
doc
umen
ts e
xpli
citl
y m
ake
this
ass
ocia
tion
an
d
mor
e su
ch e
ntr
eati
es w
ere
ind
eed
mad
e by
doc
tors
an
d s
urge
ons
in
Bra
zil t
han
in o
ther
par
ts o
f th
e em
pire
or
even
Por
tuga
l its
elf.
Mor
e th
an a
sco
re o
f ref
eren
ces
to h
abit
s of
the
mil
itar
y or
der
s of
Ch
rist
, aw
ard
ed e
spec
ially
to p
hysi
cian
s, a
nd
San
tiag
o, m
ostl
y to
sur
geon
s,
hav
e be
en fo
und
, beg
inn
ing
wit
h th
e ch
ief s
urge
ons
of C
olôn
ia d
e Sa
cram
ento
at t
he
turn
of t
he
18th
cen
tury
.In
ad
dit
ion
to la
nd
gra
nts
, mad
e to
mil
itar
y ch
ief
surg
eon
s es
pec
ially
fro
m th
e la
tter
hal
f of
the
18th
cen
tury
onw
ard
s, r
oyal
fa
vou
rs o
f m
akin
g an
ap
pli
can
t an
act
ing
pu
blic
oe
cial
or
even
an
ac
tual
oe
ce h
old
er –
alm
ost a
lway
s as
a s
criv
ener
– b
ecam
e m
ore
com
mon
in th
e ea
rly
19th
cen
tury
, eit
her
alo
ne
or in
com
bin
atio
n
wit
h m
embe
rsh
ip o
f a
mil
itar
y or
der
. Som
e of
th
e ex
amp
les
fou
nd
w
ere
scri
ven
ers
atta
ched
to
the
cou
rt t
hat
ad
min
iste
red
mis
sin
g p
erso
ns’
pro
per
ty in
th
e d
istr
ict
of V
ila
do
Prí
nci
pe,
th
e bo
ard
of
mag
istr
ates
an
d e
ccle
sias
tica
l cou
nci
l of
the
bish
opri
c of
Min
as
Ger
ais,
th
e co
urt
of
liti
gati
on a
nd
pro
bate
of
the
bish
opri
c of
R
io d
e Ja
nei
ro, t
he
cham
ber
of o
rph
ans
of th
e to
wn
of
San
to A
mar
o,
and
the
cou
rt o
f ap
pea
l of
Rio
de
Jan
eiro
.
Final considera
tions on
an exp
anding field of study
;e
pre
cise
nu
mbe
r of
oe
cial
ly r
ecog
nis
ed p
hysi
cian
s, s
urg
eon
s an
d a
pot
hec
arie
s th
at w
orke
d in
Bra
zil b
efor
e 18
08
is u
nli
kely
eve
r to
be
know
n. ;
ere
are
seve
ral r
easo
ns
for
this
, mos
t not
ably
the
vici
ssit
ud
es a
ssoc
iate
d w
ith
the
regi
stra
tion
of
lice
nce
s to
pra
ctic
e an
d a
pp
oin
tmen
ts to
cen
tral
or
loca
l gov
ern
men
t pos
ts. ;
e fa
ct
that
un
iver
sity
deg
rees
did
not
nee
d to
be
reco
rded
in a
ch
ance
ller
y m
ean
s th
at m
edic
al g
rad
uat
es a
re e
ven
mor
e p
oorl
y re
pre
sen
ted
in
the
doc
um
ents
. In
ad
dit
ion
, it i
s al
mos
t im
pos
sibl
e to
trac
e al
l th
ose
wh
o w
ent t
o B
razi
l an
d p
ract
ised
ther
e p
riva
tely
in th
e to
wn
s or
on
su
gar
pla
nta
tion
s; o
nly
loca
l his
tori
es w
ould
be
able
to r
evea
l wh
o th
ese
virt
ual
ly a
non
ymou
s p
eop
le w
ere.
;e
abse
nce
of
refe
ren
ces
to th
e w
ell-
know
n s
urg
eon
s L
uís
Gom
es F
erre
ira
and
Jos
é A
ntó
nio
M
end
es10
4 gi
ves
an id
ea o
f th
e ga
ps
in th
e so
urc
es c
onsu
lted
her
e.W
hat
the
doc
umen
ts d
o re
veal
un
equi
voca
lly is
the
pred
omin
ance
of
sur
geon
s, w
hic
h in
itse
lf is
not
hin
g n
ew e
ith
er in
Bra
zil o
r an
ywh
ere
in E
urop
e in
the
earl
y-m
oder
n p
erio
d. ;
e d
i8er
ence
lies
pa
rtly
in th
eir
hug
ely
dis
prop
orti
onat
e n
umbe
rs, b
ut th
ere
is a
not
her
fa
ctor
. Aft
er 1
782,
dur
ing
the
tim
e of
the
Pro
tom
edic
ato,
sur
geon
s sp
read
to a
reas
wh
ere
they
had
not
bee
n fo
und
bef
ore,
esp
ecia
lly
alon
g th
e n
orth
an
d n
orth
-eas
t coa
sts.
[Fig
ure
s 5 a
nd 6
];
e ac
tual
num
ber
of m
edic
al g
rad
uate
s p
rod
uced
by
Coi
mbr
a U
niv
ersi
ty b
efor
e 18
00
is n
ot y
et k
now
n fo
r ce
rtai
n, b
ut th
e av
aila
ble
dat
a su
gges
t th
at it
was
less
than
ten
per
yea
r fo
r lo
ng
per
iod
s in
the
16th
–18th
cen
turi
es. O
ngo
ing
rese
arch
has
so
far
foun
d th
at b
etw
een
14
95 a
nd
180
1 th
e ch
ief
phy
sici
an r
ecog
nis
ed 6
59 p
hysi
cian
s tr
ain
ed in
fore
ign
un
iver
siti
es, e
spec
ially
Sal
aman
ca. ;
e n
umbe
r of
sur
geon
s is
kn
own
wit
h m
ore
cert
ain
ty: 1
2,17
7 w
ere
awar
ded
qu
alifi
cati
ons
by th
e ch
ief
surg
eon
or,
in e
xcep
tion
al c
ircu
mst
ance
s,
the
chie
f p
hysi
cian
bet
wee
n 1
495
and
182
6. S
urge
ons
wer
e p
refe
rred
by
the
peo
ple
, giv
en th
at th
ey w
ere
soci
ally
clo
ser
to th
eir
pat
ien
ts,
char
ged
low
er fe
es a
nd
oft
en p
rovi
ded
the
sam
e ki
nd
of
serv
ice
as p
hysi
cian
s. A
s th
e su
rgeo
n J
osé
da
Silv
a Fe
rnan
des
ass
erte
d in
L
isbo
n in
172
9, ‘i
t is
a fa
ct th
at p
eop
le a
re in
the
hab
it o
f ca
llin
g fo
r a
surg
eon
rat
her
than
for
a d
octo
r.’10
5D
ecad
es la
ter
in P
aris
, th
e p
hysi
cian
An
tón
io R
ibei
ro S
anch
es
mad
e th
e sa
me
kin
d o
f re
mar
k, w
hic
h P
ina
Man
iqu
e, th
e in
ten
dan
t-ge
ner
al o
f p
olic
e, w
as to
rep
eat a
t th
e en
d o
f th
e ce
ntu
ry w
hen
h
e d
ecid
ed to
inve
st in
trai
nin
g an
d s
pec
iali
sati
ons
for
surg
eon
s.
It s
hou
ld n
ot b
e fo
rgot
ten
that
at t
he
tim
e th
ere
was
a g
row
ing
dem
and
for
phy
sici
ans
in P
ortu
gal f
or b
oth
oe
cial
par
1do
s an
d
pri
vate
pra
ctic
e, in
clu
din
g p
osit
ion
s le
ft v
acan
t aft
er th
e va
riou
s p
urg
es o
f N
ew C
hri
stia
ns.
It i
s u
nli
kely
, how
ever
, th
at p
eop
le in
P
ortu
gal w
ere
awar
e of
the
die
cult
ies
that
doc
tors
had
to c
ope
wit
h in
Bra
zil.
Eve
n th
ose
(few
) nat
ive-
born
Bra
zili
ans
that
stu
die
d
81
THE INSTITU
TIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
med
icin
e at
Coi
mbr
a –
arou
nd
90
% c
hos
e to
stu
dy la
w in
the
17th
ce
ntu
ry, r
isin
g to
94%
in th
e 18
th10
6– o
r ab
road
pre
ferr
ed to
sta
y in
E
uro
pe1
07. E
ere
wer
e ex
cep
tion
s, o
f co
urs
e, p
arti
cula
rly
in th
e la
st
quar
ter
of th
e 18
th c
entu
ry, w
hen
the
inte
rest
s of
the
stat
e co
inci
ded
w
ith
thos
e of
the
Lu
so-B
razi
lian
inte
llec
tual
eli
te in
its
ques
t to
dis
sem
inat
e an
d s
har
e in
form
atio
n o
n a
larg
e sc
ale1
08. S
uch
ex
cep
tion
s li
e ou
tsid
e th
e sc
ope
of th
is s
tudy
, wh
ich
on
ly s
eeks
to
iden
tiP
pat
tern
s of
act
ion
an
d g
ener
al tr
end
s.M
app
ing
the
pro
fess
ion
al li
cen
ces,
ap
poi
ntm
ents
to p
osts
, re
ques
ts f
or m
ilit
ary
ran
ks a
nd
all
the
oth
er a
cts
reco
rded
in th
e ce
ntr
al a
rch
ives
con
firm
s th
e fa
ct th
at h
ealt
hca
re p
rofe
ssio
nal
s p
refe
rred
the
coas
tal r
egio
ns
of B
razi
l – B
ahia
an
d R
io d
e Ja
nei
ro
to a
n o
verw
hel
min
g ex
ten
t – f
or r
easo
ns
that
are
alr
eady
wel
l kn
own
. In
par
ticu
lar,
in th
eir
choi
ce o
f wh
ere
to s
ettl
e an
d p
ract
ice,
p
roxi
mit
y to
the
cen
tres
of
pol
itic
al p
ower
as
a m
ean
s of
car
eer
adva
nce
men
t is
a fa
ctor
that
sh
ould
not
be
un
der
esti
mat
ed.
Ee
sou
rces
als
o re
veal
the
com
ple
xity
of
the
chal
len
ges
faci
ng
both
the
Cro
wn
an
d in
div
idu
als
as a
res
ult
of
the
tran
sfer
of
Eu
rop
ean
mod
els
to P
ortu
gues
e A
mer
ica.
A p
oin
t th
at I
bel
ieve
is
ess
enti
al f
or a
bet
ter
un
der
stan
din
g of
the
pro
blem
is th
at,
exce
pt i
n s
pec
ific
situ
atio
ns,
it w
as n
ot C
row
n p
olic
y to
pro
vid
e th
e p
eop
le d
irec
tly
wit
h m
edic
al c
are
and
wel
fare
res
ourc
es, a
nd
th
is w
as n
ot ju
st a
Por
tugu
ese
trai
t. F
rom
Kin
g M
anu
el I
onw
ard
s,
the
mon
arch
s sy
stem
atic
ally
reg
ula
ted
bot
h fi
eld
s an
d c
reat
ed a
n
inst
itu
tion
al f
ram
ewor
k fo
r th
e or
gan
isat
ion
of
loca
lly g
ener
ated
re
sou
rces
, en
tru
stin
g th
eir
adm
inis
trat
ion
an
d d
istr
ibu
tion
to th
e m
un
icip
alit
ies
and
thei
r el
ites
. How
ever
, th
e sy
stem
on
ly w
orke
d
and
ach
ieve
d s
ome
succ
ess
in P
ortu
gal b
ecau
se it
was
bu
ilt o
n a
d
ense
fab
ric
of m
un
icip
alit
ies
and
mis
eric
órdi
as w
ith
est
abli
shed
el
ites
an
d/o
r in
div
idu
als
seek
ing
soci
al m
obil
ity
wh
o w
ere
cap
able
of
neg
otia
tin
g w
ith
the
Cro
wn
. It w
as in
the
Cro
wn
’s in
tere
sts
to
enco
ura
ge th
ese
rela
tion
s as
they
incr
ease
d it
s in
flu
ence
in th
e ev
eryd
ay li
fe o
f lo
cal c
omm
un
itie
s.E
e si
tuat
ion
in B
razi
l cou
ld n
ot h
ave
been
mor
e d
i`er
ent.
Eer
e, th
e m
iser
icór
dias
arr
ived
late
an
d in
som
e ca
ses
face
d
resi
stan
ce f
rom
cen
tral
gov
ern
men
t – e
igh
t wer
e fo
un
ded
in th
e 16
th c
entu
ry, o
nly
fou
r in
the
17th
an
d th
e sa
me
agai
n in
the
18th
109.
In
com
par
ison
, Por
tuga
l had
aro
un
d 3
00
by
1640
, des
pit
e li
nge
rin
g u
nce
rtai
nty
abo
ut s
ome
of th
eir
dat
es. M
un
icip
alit
ies
form
ed th
e n
ucl
eus
arou
nd
wh
ich
Por
tuga
l org
anis
ed it
s ad
min
istr
atio
n o
f th
e co
lony
, tra
ckin
g ‘th
e ex
pan
sion
of
the
pop
ula
ted
are
as f
rom
the
late
16th
cen
tury
onw
ard
s’, a
s d
etai
led
by
Mag
alh
ães
(20
11: 1
46–1
68).
How
ever
, th
e si
ze a
nd
geo
mor
ph
olog
y of
Bra
zil d
ilu
ted
the
imp
act
that
the
wel
fare
mod
el h
ad h
ad in
Por
tuga
l, ev
en in
are
as c
lose
to
the
cen
tres
of
pow
er. A
s th
e su
rgeo
n F
ran
cisc
o A
ntó
nio
Mar
tin
s d
e A
nta
s, w
ho
had
com
e fr
om V
alen
ça d
o M
inh
o in
nor
ther
n P
ortu
gal,
wro
te o
n 1
8 Ju
ne
1776
in h
is a
pp
lica
tion
for
the
par*
do th
at th
e Sa
nto
An
tôn
io d
e Sá
tow
n c
oun
cil w
ish
ed to
est
abli
sh, e
ven
thou
gh
Figure 5
Distribution of surgeons
in Brazil, 1751–1781
Sou
rce:
Med
ical
Pro
fess
ion
s
Dat
abas
e, 1
43
0–
182
6
05001000 KM
Brazil (Treaty of Madrid, 1750)
Main River Routes
Main Overland Routes
Brazil (Treaty of Madrid, 1750)
Main River Routes
Main Overland Routes
05001000 KM
Surgeons
127
33 9
Surgeons
127
33 9
Figure 6
Distribution of surgeons
in Brazil, 1782–1808
Sou
rce:
Med
ical
Pro
fess
ion
s
Dat
abas
e, 1
43
0–
182
6
82
83
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
the
tow
n b
elon
ged
to th
e d
istr
ict o
f R
io d
e Ja
nei
ro a
nd
lay
nea
r th
e co
ast,
the
14–l
eagu
e jo
urn
ey f
rom
the
cap
ital
had
to b
e u
nd
erta
ken
by
boa
t ‘ac
ross
the
bay
of th
at c
ity
and
then
up
the
Mac
acu
riv
er,
wit
h e
vid
ent d
ange
r’. T
rave
llin
g w
ith
in th
e m
un
icip
alit
y it
self
was
n
o ea
sier
, as
it w
as c
omp
osed
of
‘sev
en v
ast p
aris
hes
’ th
at la
y si
x le
agu
es f
rom
the
tow
n.1
10A
not
her
asp
ect t
o be
bor
ne
in m
ind
is f
un
din
g. G
e fi
nan
cial
d
iIcu
ltie
s fa
ced
by
mu
nic
ipal
cou
nci
ls in
pay
ing
hea
lth
care
p
rofe
ssio
nal
s’ s
alar
ies
and
the
obst
acle
s th
at th
e C
row
n p
ut i
n th
e w
ay w
hen
they
wan
ted
to e
stab
lish
new
pos
ts h
ave
alre
ady
been
d
escr
ibed
. Ge
reas
ons
are
not
on
ly th
e ce
ntr
al g
over
nm
ent’s
gre
ed
for
the
inco
me
gen
erat
ed b
y lo
cal a
uth
orit
ies,
bu
t als
o th
e fa
ct th
at
in B
razi
l th
e m
un
icip
alit
ies
wer
e re
gula
rly
burd
ened
wit
h th
e co
sts
of m
ilit
ary
def
ence
. Ges
e w
eigh
ed h
eavi
ly in
dec
isio
ns
mad
e ab
out
incr
easi
ng
exp
end
itu
re, p
arti
cula
rly
wh
ere
the
new
exp
ense
s la
cked
ro
yal a
uth
oris
atio
n, d
esp
ite
the
loca
l cou
nci
ls’ ‘
ten
den
cy to
war
ds
self
-gov
ern
men
t’111
.N
otw
ith
stan
din
g al
l th
e ob
stac
les
con
fron
tin
g th
e U
niv
ersi
ty
of C
oim
bra,
wh
ich
the
Cro
wn
had
au
thor
ised
to c
olle
ct th
e ta
xes
to p
ay f
or th
e sc
hol
arsh
ips
to tr
ain
phy
sici
ans
and
ap
oth
ecar
ies
– co
llec
ted
in w
hat
was
term
ed th
e ‘D
octo
rs’ a
nd
Ap
oth
ecar
ies’
C
hes
t’ (A
rca d
os
médic
os
e d
os
bo-
cári
os)
– P
ortu
gues
e m
un
icip
alit
ies
wer
e fo
rced
to c
ontr
ibu
te th
e am
oun
ts s
et b
y th
e go
vern
men
t. F
rom
this
vie
wp
oin
t, h
irin
g h
ealt
hca
re p
rofe
ssio
nal
s co
uld
als
o be
see
n a
s a
way
for
loca
l cou
nci
ls to
rec
over
the
inve
stm
ent t
hey
h
ad m
ade.
On
ly a
t th
e en
d o
f th
e 18
th c
entu
ry, i
n 1
798,
aft
er th
e im
ple
men
tati
on o
f P
omba
l’s r
efor
m to
col
lect
the
sch
olar
ship
ta
x ev
enly
acr
oss
the
cou
ntr
y, d
id th
e C
row
n a
ttem
pt s
omet
hin
g si
mil
ar in
Bra
zil.
Ge
form
at w
as d
iYer
ent,
how
ever
, not
leas
t in
te
rms
of th
e st
ud
ents
fu
nd
ed b
y th
e sc
hol
arsh
ips:
the
phy
sici
ans
rem
ain
ed b
ut t
he
apot
hec
arie
s w
ere
rep
lace
d w
ith
su
rgeo
ns,
an
d
fou
r en
gin
eers
– tw
o p
rin
ters
an
d tw
o hy
dra
uli
c en
gin
eers
– a
nd
on
e ac
cou
nta
nt w
ere
add
ed.
In c
ontr
ast t
o th
e fa
te o
f sc
hol
arsh
ip h
old
ers
in P
ortu
gal,
in
Bra
zil t
hey
wer
e al
l exp
ecte
d to
ret
urn
to th
eir
pla
ce o
f or
igin
to
wor
k in
the
sam
e fi
eld
ther
e. G
ere
are
few
rep
orts
on
the
app
lica
tion
of
thes
e m
easu
res,
an
d th
ose
that
exi
st a
re li
mit
ed
in d
etai
l,112
bu
t it s
hou
ld b
e bo
rne
in m
ind
that
a p
roje
ct o
f th
is
scal
e n
eed
ed ti
me
to e
stab
lish
itse
lf. G
e be
st r
epor
t was
pro
du
ced
by
the
gove
rnor
of
Min
as G
erai
s, B
ern
ard
o Jo
sé d
e L
oren
a. G
e in
form
atio
n h
e se
nt t
o R
odri
go d
e So
usa
Cou
tin
ho,
the
Min
iste
r fo
r O
vers
eas
Dom
ain
s, in
Ju
ly 1
799
reve
als
amon
g ot
her
thin
gs th
at
the
cap
tain
cy h
ad e
stim
ated
its
exp
end
itu
re o
n s
even
stu
den
ts a
t 2.
25 m
illi
on r
éis
and
pro
pos
ed th
at th
e m
oney
sh
ould
com
e fr
om
the
stam
ped
pap
er r
ein
trod
uce
d tw
o ye
ars
pre
viou
sly
to b
e u
sed
for
al
l ju
dic
ial a
cts,
con
trac
ts a
nd
wil
ls11
3. G
e d
ecis
ion
was
des
ign
ed
to p
rote
ct th
e p
oore
st p
eop
le, ‘
wh
o fo
r th
at v
ery
reas
on h
ave
less
bu
sin
ess’,
an
d h
ad th
e ad
van
tage
of
spar
ing
min
ing,
agr
icu
ltu
re
and
trad
e. T
o gi
ve th
e p
rop
osal
gre
ater
su
bsta
nce
, th
ey in
clu
ded
th
e am
oun
t th
ey c
alcu
late
d w
ould
be
coll
ecte
d w
ith
the
new
tax
– 20
,073
,60
0 r
éis
– an
d p
rom
ised
that
the
mu
nic
ipal
cou
nci
ls w
ould
co
ntr
ibu
te f
rom
thei
r ow
n in
com
e if
nec
essa
ry.1
14E
qual
ly im
por
tan
t in
the
doc
um
ents
exa
min
ed is
the
evid
ence
of
ten
sion
s an
d c
onfl
icts
bet
wee
n th
e va
riou
s au
thor
itie
s w
ith
re
spon
sibi
liti
es in
the
hea
lth
fiel
d. G
ey w
ere
ofte
n d
omin
ated
by
peo
ple
wit
h in
tere
sts
that
diY
ered
fro
m th
ose
of th
e co
un
try
they
rep
rese
nte
d a
nd
wh
ich
oft
en c
han
ged
acc
ord
ing
to th
e ci
rcu
mst
ance
s an
d th
e p
arti
es in
volv
ed. O
ne
exam
ple
is th
e P
roto
medic
ato
Boa
rd, w
hic
h in
May
178
9 d
ecla
red
that
if s
omeo
ne
shou
ld p
ract
ise
med
icin
e w
ith
out b
ein
g a
lect
ure
r in
the
Facu
lty
of M
edic
ine
or h
avin
g p
asse
d it
s ex
amin
atio
n th
e eY
ects
wou
ld
be ‘t
erri
ble
and
pre
jud
icia
l’ –
this
was
in r
eply
to th
e qu
een
, wh
o h
ad a
sked
it to
rea
sses
s th
e p
etit
ion
fro
m R
io d
e Ja
nei
ro c
ity
cou
nci
l to
revo
ke th
e or
der
ban
nin
g su
rgeo
ns
from
pra
ctis
ing
med
icin
e w
ith
out t
akin
g th
e ex
amin
atio
n.1
15 S
ome
ten
yea
rs
late
r, h
owev
er, i
ts c
omm
issi
oner
s w
ere
bein
g ac
cuse
d in
Bah
ia
of c
reat
ing
doc
tors
ou
t of
un
trai
ned
su
rgeo
ns
and
gra
nti
ng
them
eq
ual
sta
tus
to d
octo
rs w
ho
wer
e ‘g
rad
uat
es o
f an
d a
pp
rove
d b
y th
e U
niv
ersi
ty o
f C
oim
bra’
.116
In B
ahia
the
lack
of w
ell-
qual
ified
pro
fess
ion
als
low
ered
the
bar
for
asse
ssm
ent;
mea
nwh
ile,
in R
io d
e Ja
nei
ro th
e co
un
cil h
ad
sim
ilar
ly a
rgu
ed th
at th
e ci
ty h
ad o
nly
eig
ht g
rad
uat
e d
octo
rs,
two
of w
hom
wer
e p
reve
nte
d f
rom
wor
kin
g by
ail
men
ts a
nd
ol
d a
ge (o
ne
was
70
an
d th
e ot
her
ove
r 80
) an
d th
e ot
her
s w
ere
over
burd
ened
wit
h w
ork,
117 b
ut e
ven
so
its
surg
eon
s w
ere
not
gr
ante
d m
edic
al li
cen
ces
mor
e ea
sily
.G
e P
roto
medic
ato
Boa
rd h
ad b
een
set
up
to p
ut a
n e
nd
to th
e d
ereg
ula
tion
an
d c
orru
pti
on th
at w
as r
ife
in th
e w
orld
of
emp
iric
s an
d th
eir
exam
iner
s, a
nd
to a
ct a
ccor
din
g to
ru
les
that
wer
e in
ten
ded
to b
e tr
ansp
aren
t. G
e co
mp
lain
ts a
bou
t abu
ses
of p
ower
th
at h
ave
been
dis
cove
red
for
Bra
zil u
nti
l 178
2 ar
e n
ot v
ery
diY
eren
t fr
om th
ose
fou
nd
for
Por
tuga
l, al
thou
gh n
one
was
as
dir
ect a
s th
e ac
cusa
tion
mad
e by
Joã
o M
anu
el d
e M
elo,
the
gove
rnor
an
d
cap
tain
-gen
eral
of
Goi
ás, i
n a
lett
er s
ent t
o th
e se
cret
ary
of s
tate
for
th
e n
avy
and
ove
rsea
s te
rrit
orie
s in
Feb
ruar
y 17
69, a
gain
st th
e tw
o co
mm
issi
oner
s w
ho
wer
e in
spec
tin
g h
is c
apta
incy
at t
hat
tim
e. H
e ca
lled
them
ver
itab
le th
ieve
s, a
nd
he
only
ref
rain
ed f
rom
hav
ing
them
thro
wn
into
the
du
nge
ons
beca
use
‘th
ey b
ore
lett
ers
from
th
eir
min
iste
rs c
onfi
rmed
by
His
Maj
esty
.’118
In a
sim
ilar
vei
n, i
n J
un
e 17
74, t
he
new
gov
ern
or a
nd
cap
tain
-ge
ner
al o
f G
oiás
lod
ged
a c
omp
lain
t aga
inst
the
chie
f su
rgeo
n’s
co
mm
issi
oner
, th
e su
rgeo
n J
osé
An
tón
io M
end
es, f
or d
eleg
atin
g h
is p
ower
s to
wh
oeve
r m
ade
it m
ost w
orth
his
wh
ile,
in th
is c
ase
‘a c
har
lata
n, w
ho
even
in th
e la
nd
of
ign
oran
ce c
ould
not
mak
e a
figu
re, b
ecau
se e
ven
if th
ere
is n
ot a
sin
gle
doc
tor
in th
e w
hol
e ca
pta
incy
ther
e ar
e m
any
surg
eon
s w
ho
hav
e w
orke
d a
t th
e R
oyal
84
85
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
Hos
pit
al in
Lis
bon
an
d d
one
thei
r ex
amin
atio
ns
in a
nat
omy
wh
o h
ave
bett
er ju
dge
men
t th
an th
is m
an w
ho
has
nev
er le
ft A
mer
ica.
’119
Bu
t cre
atin
g a
new
gov
ern
ing
body
– th
e P
roto
med
icat
o B
oard
– w
as
not
goi
ng
to r
esto
re p
eace
; far
fro
m it
.In
Por
tuga
l, th
e P
roto
med
icat
o cl
ash
ed w
ith
the
Un
iver
sity
of
Coi
mbr
a ov
er th
e aw
ard
ing
of li
cen
ces
to ‘t
reat
wit
h m
edic
ine’
an
d th
e va
lid
atio
n o
f d
egre
es a
war
ded
by
fore
ign
un
iver
siti
es; w
ith
th
e C
hu
rch
ove
r th
e ap
oth
ecar
y sh
ops
run
by
reli
giou
s h
ouse
s;
and
wit
h th
e in
ten
dan
t-ge
ner
al o
f p
olic
e, w
ho
accu
sed
the
Boa
rd
of b
ein
g in
com
pet
ent a
nd
ineI
ecti
ve. I
n P
ortu
gues
e A
mer
ica,
its
maj
or q
uar
rels
wer
e w
ith
the
Cro
wn
’s a
gen
cies
; su
ch d
isp
ute
s w
ere
quit
e co
mm
on a
mon
g th
e va
riou
s tr
ibu
nal
s an
d c
oun
cils
120.
Me
up
grad
ing
of th
e P
roto
med
icat
o to
a r
oyal
trib
un
al in
179
9,
shor
tly
afte
r F
ran
cisc
o T
avar
es a
nd
Jos
é C
orre
ia P
ican
ço h
ad b
een
ap
poi
nte
d c
hie
f p
hysi
cian
an
d c
hie
f su
rgeo
n, r
esp
ecti
vely
, was
to
has
ten
its
dis
inte
grat
ion
. Hav
ing
un
der
gon
e tw
o re
form
s in
179
8,
one
adm
inis
trat
ive
and
the
oth
er f
un
ctio
nal
, th
e P
roto
med
icat
o B
oard
Tri
bun
al d
id n
ot e
njo
y co
mp
lete
juri
sdic
tion
al in
dep
end
ence
an
d w
as th
eref
ore
un
able
to im
pos
e it
s w
ill i
n P
ortu
gal1
21.
Mat
doe
s n
ot s
eem
to h
ave
been
the
case
in B
razi
l, w
her
e lo
cal
pol
itic
al d
ynam
ics
enab
led
the
Pro
tom
edic
ato
to e
xert
its
pow
er
in a
n a
uth
orit
aria
n a
nd
arr
ogan
t man
ner
. Mis
att
itu
de
hel
ped
to
infl
ame
feel
ings
aga
inst
the
inst
itu
tion
. On
e ex
amp
le is
sh
own
by
the
gove
rnor
of
Per
nam
buco
cap
tain
cy, C
aeta
no
Pin
to d
e M
iran
da
Mon
ten
egro
, in
Ju
ne
180
7 re
gard
ing
a co
mp
lain
t mad
e by
the
surg
eon
Jos
é d
a Fo
nse
ca e
Sil
va a
gain
st th
e Protomedicato’s
co
mm
issi
oner
mag
istr
ate,
Joã
o L
opes
Car
dos
o M
ach
ado,
wh
o w
as
the
fron
t man
for
the
trib
un
al’s
en
croa
chm
ent o
n th
e ju
risd
icti
on
of g
over
nor
s an
d c
apta
ins-
gen
eral
. Mon
ten
egro
pro
test
ed th
at th
e co
mm
issi
oner
s, w
ith
out a
ny le
gal r
igh
t, w
ere
sett
ing
them
selv
es
up
as
mag
istr
ates
of
the
cap
tain
cy, h
old
ing
hea
rin
gs in
the
city
co
un
cil,
awar
din
g ex
ecu
tive
pri
vile
ges
to a
pot
hec
arie
s an
d
surg
eon
s to
col
lect
deb
ts, s
eizi
ng,
dis
trai
nin
g an
d s
ervi
ng
not
ice
wit
h v
iole
nce
, wit
hou
t acc
epti
ng
susp
ensi
ons
or a
ny a
pp
eal ‘
oth
er
than
to th
e Su
pre
me
Tri
bun
al o
f th
e R
oyal
Protomedicato
Boa
rd’.1
22A
mid
bit
ter
argu
men
ts, P
ican
ço’s
ap
poi
ntm
ent o
n 6
Jan
uary
18
08
to th
e p
ost o
f ch
ief
surg
eon
of
the
arm
y, a
pos
itio
n h
e h
eld
co
ncu
rren
tly
wit
h th
at o
f ch
ief
surg
eon
of
the
kin
gdom
, may
hav
e h
aste
ned
the
dis
mis
sal o
f Tav
ares
as
chie
f p
hysi
cian
thre
e d
ays
late
r an
d p
reci
pit
ated
the
even
ts th
at fo
llow
ed. A
roy
al o
rder
of
7 Fe
brua
ry
exp
and
ed th
e ti
tles
of
Ch
ief
Phy
sici
an a
nd
Ch
ief
Surg
eon
of
the
Kin
gdom
to in
clud
e th
e ‘O
vers
eas
Stat
es a
nd
Dom
ain
s’, w
ith
Man
uel
Vie
ira
da
Silv
a n
ow r
epla
cin
g T
avar
es a
s ch
ief
phy
sici
an. A
dec
ree
of 2
3 N
ovem
ber
that
yea
r re
ahrm
ed th
e le
giti
mac
y of
the
stat
utes
of
152
1 an
d 1
631
regu
lati
ng
the
acti
viti
es o
f th
e ch
ief
phy
sici
an a
nd
ch
ief
surg
eon
, res
pec
tive
ly. I
n f
act,
nei
ther
of
them
had
eve
r be
en
rep
eale
d, b
ut th
e le
gisl
atio
n r
esto
red
thes
e oh
ce h
old
ers’
exc
lusi
ve
juri
sdic
tion
an
d r
emov
ed it
fro
m th
e Protomedicato
Boa
rd.
In p
ract
ical
term
s, th
e d
ecre
e of
23
Nov
embe
r 18
08
pu
t an
en
d
to th
is b
ody
crea
ted
in 1
782,
alt
hou
gh th
e ac
t th
at o
hci
ally
kil
led
it
oI w
as o
nly
pro
mu
lgat
ed o
n 7
Jan
uar
y th
e fo
llow
ing
year
. Mis
was
se
en a
s a
pol
itic
al m
anoe
uvre
to a
llow
the
chie
f p
hysi
cian
an
d c
hie
f su
rgeo
n to
sh
ed th
e ba
d r
epu
tati
on a
ttac
hed
to th
e Protomedicato
, ev
en th
ough
they
had
alw
ays
in f
act c
ontr
olle
d th
e in
stit
uti
on, i
f n
ot
dir
ectl
y th
en a
t lea
st th
rou
gh th
eir
stat
ute
s.A
fin
al p
oin
t th
at d
eser
ves
to b
e em
ph
asis
ed c
once
rns
the
mu
ltip
le r
oles
that
hea
lth
care
pro
fess
ion
als
wor
kin
g fo
r th
e ar
my
per
form
ed in
the
soci
al a
nd
med
ical
con
stru
ctio
n o
f co
lon
ial
Bra
zil.1
23 I
n p
arti
cula
r, m
any
hu
nd
red
s of
su
rgeo
ns
pra
ctis
ing
at lo
cal a
nd
reg
ion
al le
vel i
nte
ract
ed w
ith
, ad
apte
d to
or
hel
ped
ch
ange
loca
l dyn
amic
s in
a c
oun
try
that
aI
ord
ed th
em m
any
mor
e op
por
tun
itie
s th
an th
ey w
ould
hav
e h
ad in
Por
tuga
l – o
r th
an
thei
r co
un
terp
arts
in P
ortu
gal a
ctu
ally
en
joye
d. M
at w
as th
e ca
se
des
pit
e th
e d
omin
ant s
ocia
l ord
er in
Bra
zil,
wh
ich
mai
nta
ined
th
e ba
lan
ce o
f so
ciet
y an
d w
hic
h th
e go
vern
men
t mad
e ev
ery
eIor
t to
safe
guar
d, a
s is
cle
ar f
rom
a r
oyal
ord
er o
f 17
45 th
at
ban
ned
the
craf
tsm
an J
osé
de
São
Boa
ven
tura
Vie
ira,
a m
un
icip
al
surg
eon
in th
e to
wn
of
Nos
sa S
enh
ora
do
Car
mo,
fro
m b
ecom
ing
a ca
pta
in-m
ajor
124.
It is
hig
hly
like
ly th
at th
e w
ell-
know
n fi
gure
of
José
Cor
reia
Pic
anço
, men
tion
ed a
bove
, wh
o w
as b
orn
in G
oian
a p
reci
sely
in 1
745,
wou
ld h
ave
foll
owed
a v
ery
diI
eren
t pat
hway
in
life
had
he
clu
ng
to h
is d
iplo
ma
in s
urg
ery,
wh
ich
was
reg
iste
red
in
the
Ch
ance
ller
y of
Kin
g Jo
sé I
in M
arch
176
5.12
5A
lth
ough
the
civi
lian
au
thor
itie
s of
ten
sta
ted
that
they
wan
ted
to
bri
ng
mil
itar
y h
ealt
hca
re p
rofe
ssio
nal
s u
nd
er th
eir
con
trol
, th
ese
pra
ctit
ion
ers
in f
act r
emai
ned
gov
ern
ed b
y th
eir
own
law
s w
ith
out t
he
Cro
wn
sh
owin
g m
uch
inte
rest
in c
onfr
onti
ng
them
. Its
fi
rst r
eally
for
cefu
l att
emp
t at i
nte
rven
ing
in th
is a
rea
was
the
roya
l d
ecis
ion
of
26 M
ay 1
786,
mad
e at
the
requ
est o
f th
e Protomedicato
, as
sign
ing
to it
the
‘exc
lusi
ve ju
risd
icti
on th
at th
is B
oard
(has
) ove
r m
ilit
ary
surg
eon
s, a
s su
bjec
ts th
at p
ract
ise
the
sam
e ar
ts’.
Me
old
ar
gum
ent t
hat
‘ass
ista
nts
an
d s
urg
eon
s w
ere
app
oin
ted
to s
erve
in
the
mil
itar
y co
rps
wit
hou
t lic
ence
s, e
xam
inat
ion
s or
the
skil
l to
let
bloo
d o
r p
erfo
rm s
urg
ery,
let a
lon
e to
“tr
eat w
ith
med
icin
e,”’
wit
h
no
kin
d o
f su
per
visi
on,1
26 w
as tr
otte
d o
ut a
gain
, bu
t th
e or
der
had
li
ttle
or
no
eIec
t.M
e su
rgeo
n g
ener
al o
f th
e ar
my
resp
ond
ed to
the
crit
icis
m
by c
laim
ing
that
he
was
up
hol
din
g th
e la
w, s
ince
he
only
ac
cred
ited
su
rgeo
ns
‘in p
lace
s w
her
e (t
her
e w
as) n
o d
octo
r w
ith
in
a le
agu
e’s
dis
tan
ce’,
a cr
iter
ion
wh
ich
it h
as to
be
said
was
not
ve
ry d
ihcu
lt to
mee
t.127
Me
inco
rpor
atio
n o
f th
e ch
ief
phy
sici
an
of th
e ar
my,
des
ign
ated
in 1
798,
into
the Protomedicato
Boa
rd a
nd
th
e ap
poi
ntm
ent o
f th
e ch
ief
surg
eon
of
the
kin
gdom
to th
e p
ost
of c
hie
f su
rgeo
n o
f th
e m
ilit
ary
ten
yea
rs la
ter
rep
rese
nte
d a
n
imp
orta
nt s
tep
tow
ard
s m
ergi
ng
the
two
sph
eres
into
a s
ingl
e,
cen
tral
ised
au
thor
ity,
bu
t it e
nd
ed u
p b
ein
g u
nd
erm
ined
by
the
86
87
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
vici
ssit
ud
es o
f th
e p
olit
ical
sit
uat
ion
. In
dic
ativ
e of
this
was
the
argu
men
t use
d in
his
def
ence
by
Ild
efon
so J
osé
da
Cos
ta d
e A
breu
, ch
ief
surg
eon
of
the
Roy
al M
ilit
ary
Hos
pit
al o
f R
io d
e Ja
nei
ro s
ince
17
72, w
hen
cau
ght b
y th
e au
dit
car
ried
ou
t by
the
Pro
tom
edic
ato
com
mis
sion
er, t
he
phy
sici
an M
anu
el M
oura
de
Bri
to, t
o u
nm
ask
un
auth
oris
ed p
ract
itio
ner
s of
med
icin
e. A
breu
poi
nte
d o
ut t
hat
h
e an
d h
is c
olle
agu
es e
njo
yed
mil
itar
y p
rivi
lege
, wh
ich
mea
nt
that
‘by
the
Reg
ula
tion
he
has
the
righ
t to
trea
t wit
h m
edic
ine’
an
d
ther
efor
e h
e sh
ould
not
be
sum
mon
sed
, per
secu
ted
an
d d
istu
rbed
as
was
hap
pen
ing.
128
In c
ontr
ast t
o th
e si
tuat
ion
in P
ortu
gal,
ever
yday
pro
ced
ure
in
Bra
zil b
lurr
ed th
e bo
rder
s be
twee
n th
e tw
o w
orld
s, s
omet
imes
as
a r
esu
lt o
f C
row
n in
itia
tive
s an
d s
omet
imes
dec
isio
ns
mad
e by
mil
itar
y h
ealt
hca
re p
rofe
ssio
nal
s or
loca
l au
thor
itie
s.
Con
sequ
entl
y, in
cas
es w
her
e th
e C
row
n r
equ
ired
loca
l cou
nci
ls
to p
ay th
e sa
lari
es o
f su
rgeo
ns
and
phy
sici
ans
serv
ing
the
regi
men
ts s
tati
oned
in th
eir
com
mu
nit
ies,
the
pra
ctit
ion
ers
wer
e ex
pec
ted
, if
not
alw
ays
con
trac
tual
ly b
oun
d, t
o ca
re f
or th
e ci
vili
an
pop
ula
tion
as
wel
l. E
ven
in o
ther
cir
cum
stan
ces,
sev
eral
cas
es
hav
e be
en f
oun
d w
her
e th
ere
app
ear
to h
ave
been
pre
-est
abli
shed
ag
reem
ents
bet
wee
n th
e p
arti
es in
volv
ed, t
o th
eir
mu
tual
ben
efit.
On
e of
man
y p
ossi
ble
exam
ple
s is
that
of A
ntó
nio
Jos
é V
ieir
a d
e C
arva
lho,
a q
ual
ified
su
rgeo
n f
rom
the
regi
on o
f Tom
ar in
P
ortu
gal,
wh
o at
the
begi
nn
ing
of th
e 19
th c
entu
ry w
as a
pp
oin
ted
ch
ief
surg
eon
of
the
regu
lar
cava
lry
regi
men
t of
Min
as G
erai
s C
apta
incy
129
and
mu
nic
ipal
su
rgeo
n f
or V
ila
Ric
a.13
0A
lth
ough
the
loca
l cou
nci
ls w
ere
poo
r p
ayer
s, s
ome
mil
itar
y su
rgeo
ns
con
tin
ued
to s
eek
them
ou
t bec
ause
su
ch p
osit
ion
s in
som
e w
ay le
giti
mis
ed th
e on
-th
e-jo
b tr
ain
ing
they
acq
uir
ed in
th
e ar
my,
an
d it
is te
llin
g th
at m
any
mor
e ca
reer
s be
gan
in th
e ar
my
and
en
ded
in m
un
icip
al p
ar+
dos
than
the
oth
er w
ay r
oun
d.
As
Abr
eu, t
he
afor
emen
tion
ed c
hie
f su
rgeo
n a
t th
e R
io d
e Ja
nei
ro
mil
itar
y h
osp
ital
, sta
ted
, su
ch s
urg
eon
s w
ere
auth
oris
ed to
‘tre
at
wit
h m
edic
ine’
. Pen
etra
tin
g th
ese
mod
i op
eran
di w
as n
ot a
n e
asy
task
, an
d b
reak
ing
them
was
mor
e d
i\cu
lt s
till
, as
the
Pro
tom
edic
ato
Boa
rd d
isco
vere
d.
I am
ind
ebte
d to
Ren
ato
Fra
nco
an
d M
arga
rid
a So
bral
Net
o fo
r th
eir
crit
ical
rea
din
g of
the
man
usc
rip
t an
d to
Lu
ís G
onça
lves
for
p
rep
arin
g th
e m
aps.
I m
ust
als
o th
ank
Ch
rist
oph
er J
. Tri
be f
or
tran
slat
ing
the
orig
inal
Por
tugu
ese
vers
ion
into
En
glis
h.
cis
art
icle
was
ori
gin
ally
pu
blis
hed
in P
ortu
gues
e in
Tem
po,
Nit
erói
, vol
. 24
(20
18),
no.
3 (S
ept./
Dec
.), p
p. 4
93–5
24, u
nd
er th
e ti
tle
‘A in
stit
uci
onal
izaç
ão d
o sa
ber
méd
ico
e su
as im
pli
caçõ
es
sobr
e a
red
e d
e cu
rad
ores
ofi
ciai
s n
a A
mér
ica
por
tugu
esa’
.
1. S
anto
s F
ilho
, Lyc
urgo
, His
tóri
a ge
ral
da m
edic
ina
bras
ilei
ra, S
ão P
aulo
, Huc
itec
/E
dusp
, 199
1; L
eite
, Ser
afim
, Ser
viço
s de
saú
de
da C
ompa
nh
ia d
e Je
sus
no
Bra
sil (
154
4–17
60
),
Lis
bon
, Typ
ogra
fia
do P
orto
, 195
6; L
eite
, B
run
o M
arti
ns
Bot
o, M
edic
ina
de p
adre
: es
Jdo
sobr
e os
Kn
dam
ento
s cu
lJra
is d
a m
edic
ina
jesu
í+ca
no
Bra
sil C
olon
ial,
Un
publ
ishe
d
rese
arch
rep
ort,
Rio
de
Jan
eiro
, Bib
liot
eca
Nac
ion
al, 2
011
; Fle
ck, E
lian
e C
rist
ina
Dec
kman
n, E
nO
e a
cari
dade
e a
ciê
nci
a: a
prá+
ca m
issi
onár
ia e
cie
nR
fica
da
Com
pan
hia
de J
esu
s (A
mér
ica
pla+
na,
séc
ulo
s X
VII
e X
VII
I),
São
Leo
pold
o, O
ikos
/Un
isin
os, 2
014
.2.
Rib
eiro
, Már
cia
Moi
sés,
A c
iên
cia
dos
Oóp
icos
: a
arte
méd
ica
no
Bra
sil d
o sé
culo
XV
III,
São
Pau
lo, H
uci
tec,
199
7; M
arqu
es,
Ver
a R
egin
a B
eltr
ão, N
aJre
za e
m b
oiõe
s:
med
icin
as e
bo+
cári
os n
o B
rasi
l set
ecen
+st
a.
São
Pau
lo, U
nic
amp
, 199
9; S
á, M
ário
, “O
un
iver
so m
ágic
o d
as c
ura
s: o
pap
el d
as
prá
tica
s m
ágic
as e
fei
tiça
rias
no
un
iver
so
do
Mat
o G
ross
o se
tece
nti
sta”
, in
His
tóri
a,
Ciê
nci
as, S
aúde
– M
an^
inh
os, 1
6(2)
, 20
09,
p
p. 3
25–3
44; N
ogu
eira
, An
dré
Lu
ís L
ima,
“S
aber
es te
rap
êuti
cos
nas
min
as c
olon
iais
: d
iálo
gos
entr
e a
med
icin
a ofi
cial
e a
s cu
ras
não
lice
nci
adas
(séc
. XV
III)
”, in
His
tóri
a
Un
isin
os, 1
8(1)
, 20
14, p
p. 1
5–26
; Vio
tti,
An
a C
arol
ina
de
Car
valh
o, “
En
tre
hom
ens
de
sabe
r, d
e le
tras
e d
e ci
ênci
a: m
édic
os e
ou
tros
age
nte
s d
a cu
ra n
o B
rasi
l col
onia
l”,
in C
lio
– R
evis
ta d
e P
esqu
isa
His
tóri
ca, 3
2(1)
, 20
14, p
p. 5
–27.
3. R
ibei
ro, M
árci
a M
oisé
s, o
p. c
it.;
Mar
ques
, Ver
a R
egin
a B
eltr
ão, o
p. c
it.;
Jesu
s, N
auk
Mar
ia d
e, S
aúde
e d
oen
ça:
prá+
cas
de c
ura
no
cen
Oo
da A
mér
ica
do
Su
l (17
27–
180
8),
Un
pu
blis
hed
Mas
ter’
s d
isse
rtat
ion
, Cu
iabá
, Un
iver
sid
ade
Fed
eral
d
e M
ato
Gro
sso,
20
01.
4. P
imen
ta, T
ânia
Sal
gad
o,
“Bar
beir
os-
san
grad
ores
e c
ura
nd
eiro
s n
o B
rasi
l (18
08–
28)”
, in
His
tóri
a, C
iên
cias
, Saú
de
– M
an^
inh
os, 5
(2),
1998
, pp
. 349
–372
.5.
Arq
uiv
o N
acio
nal
Tor
re d
o T
ombo
(A
NT
T),
Ch
ance
lari
a (C
HR
) D. J
oão
V, b
ook
96, f
ol. 3
28.
6. A
NT
T, C
HR
D. M
aria
I, b
ook
84, f
ols
147v
-148
.7.
Coo
k, H
arol
d J
., an
d W
alke
r,
Tim
othy
D.,
“Cir
cula
tion
of
Med
icin
e in
the
Ear
ly M
oder
n A
tlan
tic
Wor
ld”,
in
Soc
ial H
isto
ry o
f M
edic
ine,
26(
3), 2
013
, pp
. 33
7–35
1; B
asto
s, C
rist
ian
a, a
nd
Bar
reto
, R
enil
da
(ed
s), A
cir
cula
ção
do c
onh
ecim
ento
:
med
icin
a, r
edes
e i
mpé
rios
, Lis
bon
, Im
pre
nsa
d
e C
iên
cias
Soc
iais
, 20
11.
8. F
urt
ado,
Jú
nia
Fer
reir
a, “
A m
edic
ina
na
époc
a m
oder
na”
, in
Sta
rlin
g, H
eloi
sa M
.
et a
l. (e
ds)
. Med
icin
a: h
istó
ria
em e
xam
e, B
elo
Hor
izon
te, U
FM
G, 2
011
, pp
. 21–
81.
9. D
ocu
men
tos
his
tóri
cos
(DH
), v.
35,
193
7,
p. 1
84–1
86.
10. D
H, v
. 35,
p. 1
937/
p. 3
59–3
61.
11. H
e h
ad b
een
in B
ahia
sin
ce 1
553
at
leas
t, ac
cord
ing
to D
H, v
. 14,
p. 1
929,
p. 4
28.
12. D
H, n
. 35,
193
7, p
. 418
. Acc
ord
ing
to S
erafi
m L
eite
, Art
es e
oj
cios
dos
jesu
ítas
no
Bra
sil,
Lis
bon
, Ed
içõe
s B
roté
ria,
195
3, p
. 85,
h
e d
id n
ot a
ct a
s ch
ief
surg
eon
.13
. Abr
eu, L
auri
nd
a, “
Ten
sion
s be
twee
n th
e F
ísic
o-M
or a
nd
the
Un
iver
sity
of
Coi
mbr
a: c
e A
ccre
dit
atio
n o
f M
edic
al
Pra
ctit
ion
ers
in A
nci
en-R
egim
e P
ortu
gal”
, in
Soc
ial H
isto
ry o
f M
edic
ine,
31(
2), 2
018
, pp
. 23
1–25
7.14
. Med
ical
Pro
fess
ion
s D
atab
ase,
14
30–1
826.
15. A
HU
, Par
á, b
ox 1
, doc
. 23.
16. A
HU
, Per
nam
buco
, box
3, d
oc. 1
75.
17. A
HU
, Rio
de
Jan
eiro
, box
27,
doc
. 614
1.18
. AH
U, R
io d
e Ja
nei
ro, b
ox 4
, doc
. 70
9;
AN
TT
, CH
R D
. Joã
o IV
, boo
k 22
, fol
. 10
0;
Rem
sto
Ger
al d
e M
ercê
s (R
GM
), bo
ok 2
2, f
ol.
216v
. 19. S
ee, f
or e
xam
ple
, th
e ca
se o
f L
uís
F
urt
ado
de
Men
don
ça, i
n A
HU
, Par
á, b
ox
137,
doc
. 10
415.
20. A
HU
, Rio
de
Jan
eiro
, box
9, d
oc. 1
640
.21
. DH
, v. 3
8, 1
937,
pp
. 445
–446
.22
. AH
U, B
ahia
, box
27,
doc
. 55.
23. C
un
ha,
Maf
ald
a So
ares
da,
an
d
Nu
nes
, An
tón
io C
astr
o, “
Ter
rito
rial
izaç
ão
e p
oder
na
Am
éric
a p
ortu
gues
a: a
cri
ação
d
e co
mar
cas,
séc
ulo
s X
VI-
XV
III”
, in
Rev
ista
Tem
po, 2
2(39
), 20
16, p
p. 1
–30
.24
. DH
, v. 6
, 192
8, p
. 163
.25
. DH
, v. 6
, 192
8, p
. 166
.26
. DH
, v. 6
, 192
8, p
p. 1
63–1
64.
27. A
NT
T, C
HR
D. A
fon
so V
I, b
ook
20, f
ol. 8
3; R
GM
, Mer
cês
de D
. Afo
nso
VI,
bo
ok 1
2, f
ol. 3
01v
; Tri
bun
al d
o S
anto
Oj
cio
[Tri
bun
al o
f th
e H
oly
Oq
ce],
Lis
bon
, cas
e fi
le
11 4
63.
28. A
HU
, Bah
ia, b
ox 2
2, d
oc. 2
525.
29. A
HU
, Par
aíba
, box
3, d
oc. 1
89.
30. A
HU
, São
Pau
lo, b
ox 1
, doc
. 7. A
lso
DH
, v. 5
3, 1
951,
pp
. 80
–81.
31. A
HU
, Rio
de
Jan
eiro
, box
12,
d
oc. 2
403.
32. A
HU
, São
Pau
lo, b
ox 2
0, d
oc. 1
969.
33. A
HU
, São
Pau
lo, b
ox 1
8, d
oc. 1
811.
34. D
H, v
. 27,
193
4, p
p. 3
85–3
88.
35. A
HU
, Bah
ia, b
ox 1
8, D
ocs.
20
95–
2096
; DH
, v. 1
9, 1
930
, pp
. 238
–240
. AN
TT
, C
HR
D. A
fon
so V
I, b
ook
20, f
ol. 8
3; R
GM
,
Mer
cês
de D
. Afo
nso
VI,
boo
k 12
, fol
. 30
1v.
36. I
t was
for
ced
by
a ro
yal o
rder
to r
e-em
plo
y h
im; D
H, v
. 68,
194
5, p
p. 6
9–70
.
Notes
88
89
THE INSTITUTIONALISATION OF MEDICAL KNOWLEDGE
LAURINDA ABREU
37. D
H, v
. 68
, 19
45
, pp
. 69
–70
.
38
. AH
U, B
ahia
, bo
x 2
5, d
oc.
30
37.
39
. DH
, v. 2
9, p
. 19
35
, pp
. 44
5–
44
8; v
.
57,
19
42
, pp
. 63
–6
4; v
. 4, 1
92
8, p
p. 1
89
–19
0;
v. 5
, 19
28
, pp
. 45
4–
45
5; v
. 27,
pp
. 22
9–
23
1.
40
. AN
TT
, CH
R D
. Ped
ro I
I, b
oo
k 2
5,
fol.
210
v. a
nd
bo
ok
53
, fo
l. 1
80
.
41.
AN
TT
, CH
R D
. Afo
nso
VI,
bo
ok
32
,
fol.
116
.
42
. AN
TT
, Ch
ance
lari
a D
. Mar
ia I
, bo
ok
13, f
ol.
20
2.
43
. Ab
reu
, Lau
rin
da,
Pu
blic
Hea
lth
and
Soc
ial R
efor
ms
in P
or<
gal (
178
0–
180
5),
New
cast
le u
po
n T
yn
e, C
amb
rid
ge
Sch
ola
rs
Pu
bli
shin
g, 2
017
.
44
. ReF
men
to d
o qu
e de
vem
obs
erva
r os
com
issá
rios
del
egad
os d
o F
ísic
o-M
or d
o re
ino
no
Est
ado
do B
rasi
l, d
raft
ed b
y th
e ch
ief
ph
ysi
cian
Cip
rian
o d
a P
ina
Pes
tan
a b
y o
rder
of
Kin
g J
oão
V i
n 1
742
an
d i
mp
lem
ente
d b
y
the
roya
l o
rder
of
19 M
ay 1
744
.
45
. AH
U, R
io d
e Ja
nei
ro, b
ox
54
,
do
c. 1
26
19.
46
. AH
U, M
inas
Ger
ais,
bo
x 4
2, d
oc.
15;
bo
x 70
, do
c. 3
0.
47.
AH
U, M
inas
Ger
ais,
bo
x 79
, do
c.
42
(M
aria
na)
; AH
U, M
inas
Ger
ais,
bo
x 79
,
do
c. 9
0 (
São
Jo
ão d
el-R
ei).
48
. AH
U, R
io d
e Ja
nei
ro, b
ox
45
,
Do
cs. 8
9, 8
6 a
nd
90
.
49
. His
pet
itio
n w
as r
ejec
ted
: AH
U,
Rio
de
Jan
eiro
, bo
x 4
5, D
ocs
. 10
612
–10
63
6.
50
. See
AH
U, S
ão P
aulo
, bo
x 2
4, d
oc.
52
.
51.
AH
U, R
io d
e Ja
nei
ro, b
ox
22
,
do
c. 4
96
7.
52
. AH
U, S
ão P
aulo
, bo
x 1,
do
c. 6
4
(San
tos)
; AH
U, C
olôn
ia d
o S
acra
men
to, b
ox
27,
Do
cs. 6
144
–6
146
(N
ova
Co
lôn
ia);
AH
U,
Per
nam
buco
, bo
x 3
0, d
oc.
276
1 (R
ecif
e);
AH
U, M
aran
hão
, do
c. 1
56
8 (
São
Lu
ís);
AH
U,
Per
nam
buco
, bo
x 4
5, d
oc.
40
62
(P
ará
and
Itam
arac
á); A
HU
, Min
as G
erai
s, b
ox
24
, do
c.
89
(M
inas
Ger
ais)
; AH
U, M
ato
Gro
sso,
bo
x 1,
do
c. 6
6 (
Cu
iab
á); A
HU
, Mar
anh
ão, b
ox
24
,
do
c. 2
50
0 (
Bel
ém);
AH
U, R
io d
e Ja
nei
ro, b
ox
36
, do
c. 9
0;
bo
x 4
6, d
oc.
10
,86
0 (
Ilh
a d
e
San
ta C
atar
ina)
; AH
U, R
io d
e Ja
nei
ro, b
ox
35
,
do
c. 2
7; b
ox
7, d
oc.
678
(P
araí
ba)
.
53
. AH
U, P
ern
ambu
co, b
ox
44
, do
c.
39
32
(T
aman
dar
é); A
HU
, Per
nam
buco
, bo
x
20
, do
c. 1
93
7 (P
ern
amb
uco
); A
HU
, Bah
ia,
bo
x 71
, do
c. 2
6; A
NT
T, C
HR
D. J
oão
V, b
oo
k
111,
fo
l. 1
20
; b
oo
k 1
10, f
ol.
219
v (M
orr
o d
e
São
Pau
lo);
AH
U, B
ahia
, bo
x 9
8, d
oc.
57
(Bah
ia);
AH
U, R
io d
e Ja
nei
ro, b
ox
36
, do
c. 9
4
(Rio
Gra
nd
e d
e S
ão P
edro
).
54
. See
AN
TT
, CH
R D
. Jos
é I,
bo
ok
82
,
fol.
174
; AH
U, R
io d
e Ja
nei
ro, b
ox
58
, do
c. 5
64
3
55
. AH
U, P
ará,
bo
x 3
3, d
oc.
314
8.
56
. AN
TT
, CH
R D
. Jos
é I,
bo
ok
65
, fo
l.
22
5; R
GM
, Mer
cês
de D
. Jos
é I,
bo
ok
6, f
ol.
150
; bo
ok
47,
fo
l. 2
99
; bo
ok
28
, fo
l. 6
6; A
HU
,
Par
á, b
ox
37,
do
c. 3
45
1; b
ox
38
, do
c. 3
55
3;
AN
TT
, CH
R D
. Joã
o V
, bo
ok
10
8, f
ol.
314
.
57.
Fir
st m
enti
on
ed i
n A
HU
, Rio
de
Jan
eiro
, bo
x 19
4, d
oc.
16
; AN
TT
, CH
R D
.
Mar
ia I
, bo
ok
66
, fo
ls 1
23
v-12
4.
58
. AH
U, R
io d
e Ja
nei
ro, b
ox
22
3, d
oc.
71.
59
. Hes
pan
ha,
An
tón
io M
anu
el, a
nd
Su
bti
l, J
osé
, “C
orp
ora
tiv
ism
o e
Est
ado
de
po
líci
a co
mo
mo
del
os
de
go
vern
o d
as
soci
edad
es e
uro
-am
eric
anas
do
An
tig
o
Reg
ime”
, in
Fra
go
so, J
oão
, an
d G
ou
vêa,
Mar
ia d
e F
átim
a (e
ds)
, O B
rasi
l Col
onia
l
144
3–
158
0, v
.1, R
io d
e Ja
nei
ro, C
ivil
izaç
ão
Bra
sile
ira,
20
11, p
p. 1
27–
166
.
60
. AH
U, S
ão P
aulo
, bo
x 2
7, d
oc.
25
09
;
bo
x 3
0, d
oc.
26
82
.
61.
AH
U, R
io d
e Ja
nei
ro, b
ox
24
4, d
oc.
61;
bo
x 2
99
, do
c. 1
35
.
62
. AH
U, P
ará,
bo
x 13
7, d
oc.
10
419
.
63
. Mag
alh
ães,
Jo
aqu
im R
om
ero
de,
Con
celh
os e
org
aniz
ação
mu
nic
ipal
na
époc
a m
oder
na,
Co
imb
ra, I
mp
ren
sa d
a
Un
iver
sid
ade
de
Co
imb
ra, 2
011
, p. 1
48
.
64
. Cu
nh
a an
d N
un
es, o
p. c
it.,
p. 8
.
65
. Cit
ed b
y C
un
ha
and
Nu
nes
, op.
cit
.,
pp
. 9–
10.
66
. Fra
nco
, Ren
ato
, Pob
reza
e c
arid
ade
leig
a: a
s S
anta
s C
asas
de
Mis
eric
órdi
a n
a
Am
éric
a po
r<_
esa.
Un
pu
bli
shed
Ph
D
thes
is, S
ão P
aulo
, Un
iver
sid
ade
de
São
Pau
lo, 2
011
, p. 2
22
.
67.
Fo
r th
e sp
ecifi
c ci
rcu
mst
ance
s
surr
ou
nd
ing
th
e p
ost
in
Vil
a d
o C
arm
o,
see
Fra
nco
, Ren
ato
, op.
cit
.; p
. 22
2.
68
. me
com
ple
x si
tuat
ion
in
San
tos
is r
eflec
ted
in
AH
U, S
ão P
aulo
, bo
x 12
,
do
c. 1
155
.
69
. AH
U, M
inas
Ger
ais,
bo
x 8
4, D
ocs
54
an
d 5
5 (
São
Jo
ão d
el-R
ei);
AH
U, S
anta
Cat
arin
a, b
ox
3, d
oc.
217
(L
agu
na)
; AH
U,
San
ta C
atar
ina,
bo
x 3
, do
c. 2
26
(D
este
rro
).
70. A
HU
, Bah
ia, b
ox
171,
do
c. 6
.
71. A
HU
, Min
as G
erai
s, b
ox
143
, do
c.
46
; b
ox
148
, do
c. 8
; AN
TT
, CH
R D
. Joã
o V
I,
bo
ok
7, f
ol.
84
; C
HR
D. M
aria
I, b
oo
k 6
7,
fol.
28
9v
72. A
HU
, Par
á, b
ox
115
, do
c. 8
874
.
73. A
HU
, Min
as G
erai
s, b
ox
147,
do
c. 5
0.
74. A
HU
, Min
as G
erai
s, b
ox
162
, do
c. 2
7.
75. A
HU
, Mat
o G
ross
o, b
ox
17, d
oc.
54
(Vil
a B
ela)
; AH
U, M
inas
Ger
ais,
bo
x 10
5,
do
c. 1
5 (
Vil
a d
e S
ão J
osé
das
Min
as);
AN
TT
,
CH
R D
. Jos
é I,
bo
ok
5, f
ol.
38
4 (
Par
anag
uá)
;
AH
U, S
ão P
aulo
, bo
x 3
0, d
oc.
271
7; A
HU
,
Mar
anh
ão, b
ox
69
, do
c. 5
98
3 (
São
Lu
ís).
76. A
HU
, Min
as G
erai
s, b
ox
84
, do
c. 5
5,
wit
h t
han
ks
to R
enat
o F
ran
co f
or
shar
ing
the
info
rmat
ion
.
77. A
HU
, Min
as G
erai
s, b
ox
107,
do
c. 1
9.
78. A
HU
, Min
as G
erai
s, b
ox
100
, do
c. 5
.
79. m
e p
hy
sici
an i
n q
ues
tio
n w
as
Mat
ias
Fra
nci
sco
de
Mel
o d
e A
lbu
qu
erq
ue,
app
oin
ted
in
174
5 (
AN
TT
, CH
R D
. Jos
é I,
bo
ok
48
, fo
l. 3
01)
. Fo
r fu
rth
er d
etai
ls s
ee
Fra
nco
, 20
11: 2
02
–2
03
.
80
. AH
U, M
inas
Ger
ais,
bo
x 12
6, d
oc.
14
.
81.
AH
U, M
inas
Ger
ais,
bo
x 16
3, D
ocs
17,
18 a
nd
19
.
82
. A s
ub
ject
dis
cuss
ed i
n t
he
fort
hco
min
g P
hD
th
esis
by
Dan
iell
e
San
ches
, O a
ato
das
plan
tas:
os
inte
rmed
iári
os
da c
ura
e o
com
érci
o da
s dr
ogas
na
Am
éric
a
por<
_es
a, 1
75
0–
180
8.
83
. AH
U, S
ão P
aulo
, bo
x 2
, do
c. 2
00
.
84
. AH
U, S
ão P
aulo
, bo
x 8
, do
c. 8
48
.
85
. Cro
wn
in
form
atio
n o
f 18
Ju
ly 1
731.
DH
, v. 1
, 19
28
, pp
. 18
6–
187.
86
. AH
U, S
ão P
aulo
, bo
x 12
, do
c. 1
155
.
87.
DH
, v. 1
, 19
28
, pp
. 40
4–
40
5; A
HU
,
São
Pau
lo, b
ox
16, d
oc.
15
35
.
88
. DH
, v. 1
, 19
28
, pp
. 44
8–
44
9; v
. 2,
192
8, p
p. 3
36
–3
38
; AH
U, S
ão P
aulo
, bo
x 18
,
do
c. 1
80
4.
89
. Ag
e, M
ón
ica
de
Pau
la P
erei
ra
da
Sil
va, O
Hos
pita
l Mil
itar
: sa
úde
e
enfe
rmid
ade
em V
illa
Boa
de
Goy
az (
174
6–
182
7).
Un
pu
bli
shed
Ph
D t
hes
is. G
oiâ
nia
:
Un
iver
sid
ade
Fed
eral
de
Go
iás,
20
14.
90
. Fra
nco
, Ren
ato
, op.
cit
., p
p. 1
77–
23
1.
91.
AH
U, R
io d
e Ja
nei
ro, b
ox
73, d
oc.
66
86
(in
form
atio
n f
rom
Ren
ato
Fra
nco
).
92
. AH
U, M
inas
Ger
ais,
bo
x 4
2, d
oc.
11.
93
. AH
U, R
io d
e Ja
nei
ro, b
ox
72, d
oc.
16,7
54
.
94
. AH
U, R
io d
e Ja
nei
ro, b
ox
143
, do
c. 1
1.
95
. Wis
sen
bac
h, M
aria
Cri
stin
a C
ort
ez,
“Go
mes
Fer
reir
a e
os
sím
pli
ces
da
terr
a:
exp
eriê
nci
as s
oci
ais
do
s ci
rurg
iões
no
Bra
sil-
Co
lôn
ia”,
in
Fu
rtad
o, J
ún
ia F
erre
ira
(ed
.), E
rári
o m
iner
al d
e L
uís
Gom
es F
erre
ira,
v.
1, B
elo
Ho
rizo
nte
, Fu
nd
ação
Jo
ão P
inh
eiro
,
20
02
, p. 1
19.
96
. AH
U, M
inas
Ger
ais,
bo
x 79
, do
c. 4
9;
bo
x 8
4, d
oc.
24
; AN
TT
, CH
R D
. Jos
é I,
bo
ok
5, f
ol.
34
4; A
HU
, Min
as G
erai
s, b
ox
87,
do
c.
5;
bo
x 10
7, d
oc.
56
; AN
TT
, CH
R D
. Mar
ia
I, b
oo
k 6
4, f
ol.
70
v; A
HU
, Min
as G
erai
s,
bo
x 76
, do
c. 4
4. m
is s
yst
em t
end
ed t
o b
e
rep
lace
d w
ith
co
ntr
acts
, as
seve
ral
wri
ters
hav
e n
ote
d.
97.
AH
U, S
ão P
aulo
, bo
x 19
, do
c. 9
37.
98
. AH
U, P
araí
ba, b
ox
34
, do
c. 2
49
6.
99
. me
deb
ts i
n t
his
cas
e w
ere
usu
ally
fo
r th
e p
rov
isio
n o
f m
edic
ines
,
as h
app
ened
wit
h t
he
cou
nci
ls o
f V
ila
do
Rib
eirã
o d
o C
arm
o (
174
1) a
nd
Sab
ará
(177
7).
100
. AH
U, B
ahia
, bo
x 11
2, d
oc.
46
; b
ox
111,
do
c. 4
.
101.
AH
U, R
io d
e Ja
nei
ro, b
ox
20
,
do
c. 4
34
6 (
Sac
ram
ento
); A
HU
, Per
nam
buco
,
bo
x 3
0, d
oc.
276
1 (R
ecif
e); A
HU
, Par
á, b
ox
15, d
oc.
14
22
(P
ará)
; AH
U, P
araí
ba, b
ox
33
,
do
c. 2
417
(P
araí
ba)
.
102
. AH
U, A
vuls
os, b
ox
4, d
oc.
35
4;
AH
U, P
ern
ambu
co, b
ox
30
, do
c. 3
09
5; A
HU
,
Cea
rá, b
ox
2, d
oc.
89
.
103
. AH
U, P
ern
ambu
co, b
ox
211
,
do
c. 1
4,3
15.
104
. Ab
reu
, Jea
n L
uiz
Nev
es, “
Tra
tad
os
e co
nst
ruçã
o d
o s
aber
méd
ico
: alg
un
s
asp
ecto
s d
os
par
atex
tos
no
s im
pre
sso
s d
e
med
icin
a lu
so-b
rasi
leir
os
– s
écu
lo X
VII
I”,
in T
erri
tóri
os &
Fro
nte
iras
, Cu
iab
á, 6
(2),
20
13,
pp
. 21–
34
.
105
. AN
TT
, Min
isté
rio
do R
ein
o, B
un
dle
277
, No
4.
106
. Mo
rais
, Fra
nci
sco
, “E
stu
dan
tes
de
med
icin
a d
e C
oim
bra
nas
cid
os
no
Bra
sil”
, in
Bra
síli
a, S
up
pl.
to
vo
l. 4
, 19
49
.
107.
Bel
la, H
erso
n, C
rist
ãos-
nov
os
e se
us
desc
ende
nte
s n
a m
edic
ina
bras
ilei
ra
(15
00
–18
50
), S
ão P
aulo
, Ed
usp
, 20
03
,
p. 2
27. 10
8. K
ury
, Lo
rela
i, “
Ho
men
s d
e ci
ênci
a
no
Bra
sil:
im
pér
ios
colo
nia
is e
cir
cula
ção
de
info
rmaç
ões
(17
80
–18
10)”
, in
His
tóri
a,
Ciê
nci
as, S
aúde
– M
an_
inh
os, 1
1 (S
up
pl.
1),
20
04
, pp
. 10
9–
129
.
109
. Fra
nco
, Ren
ato
, op.
cit
., p
p. 9
5–
96
.
110
. AN
TT
, CH
R D
. Jos
é I,
bo
ok
26
, fo
l.
39
0v
; D
. Mar
ia I
, bo
ok
17,
fo
l. 2
87;
AH
U, R
io
de J
anei
ro, b
ox
109
, Do
cs 3
1 an
d 4
0.
111.
Bic
alh
o, M
aria
Fer
nan
da,
“As
Câm
aras
Mu
nic
ipai
s n
o I
mp
ério
po
rtu
gu
ês: o
exe
mp
lo d
o R
io d
e Ja
nei
ro”,
in R
evis
ta B
rasi
leir
a de
His
tóri
a, 1
8(3
6),
19
98
,
pp
. 25
1–2
80
.
112
. Jes
us,
Nau
k M
aria
de
, op.
cit
.;
pp
. 12
8–
129
). F
or
São
Pau
lo, s
ee A
HU
, São
Pau
lo, b
ox
15, d
oc.
8.
113
. Sta
mp
ed p
aper
was
bro
ug
ht
bac
k
into
cir
cula
tio
n i
n 1
797
afte
r b
ein
g u
sed
bri
efly
in
16
61–
68
.
114
. AH
U, M
inas
Ger
ais,
bo
x 14
9, d
oc.
2.
115
. AH
U, R
io d
e Ja
nei
ro, b
ox
143
, do
c. 6
1.
116
. AH
U, B
ahia
, bo
x 2
27,
do
c. 3
9; d
oc.
59
; bo
x 2
75, d
oc.
12
9.
117.
AH
U, R
io d
e Ja
nei
ro, b
ox
143
, do
c. 6
1.
118
. AH
U, G
oiás
, bo
x 2
4, d
oc.
15
36
.
119
. AH
U, G
oiás
, bo
x 2
7, d
oc.
178
0.
120
. Hes
pan
ha
and
Su
bti
l, o
p. c
it.
121.
Ab
reu
, Lau
rin
da,
Pu
blic
Hea
lth
an
d
Soc
ial R
efor
ms
in P
or<
gal (
178
0–
180
5),
cit
.;
pp
. 23
2–
24
2.
122
. AH
U, P
ern
ambu
co, b
ox
26
8,
do
c. 1
786
5.
123
. mis
su
bje
ct i
s d
evel
op
ed i
n
the
fort
hco
min
g P
hD
th
esis
by
Mo
niq
ue
Notes
90
LAURINDA ABREU
Pa
lma
, Cir
ur$
ões,
prá
,ca
s e
sabe
res
cirú
r$co
s
na
Am
éric
a po
r67
esa
no
sécu
lo X
VII
I.
124
. Gro
ssi,
Ra
mo
n F
ern
an
de
s, “
Do
s
6si
co
s a
os
ba
rbe
iro
s: a
spe
cto
s d
a p
rofi
ssã
o
mé
dic
a n
as
Min
as
sete
ce
nti
sta
s”, i
n
His
tóri
a &
Per
spec
,va
s, U
be
rlâ
nd
ia, 2
9/3
0,
20
03
–2
00
4, p
. 274
.
125
. AN
TT
, CH
R D
. Jos
é I,
bo
ok
29
,
fol.
25
1.
126
. AN
TT
, Min
isté
rio
do R
ein
o,
Bu
nd
le 4
69
.
127.
See
SS
GL
, 178
3, N
o X
XV
I, 4
Ju
ly.
128
. AH
U, R
io d
e Ja
nei
ro, b
ox
29
8, d
oc.
34
.
129
. AN
TT
, CH
R D
. M
aria
I, b
oo
k 8
5,
fols
32
5v
-32
6;
RG
M,
Mer
cês
de D
. M
aria
I,
bo
ok
19
, fo
l. 1
09
; AH
U, M
inas
Ger
ais,
bo
x
135
, do
c. 5
8.
130
. AN
TT
, CH
R D
. M
aria
I, b
oo
k 1
1,
fol.
20
9;
CH
R D
. Joã
o V
I, b
oo
k 7
, fo
ls 1
34
–
134
v; A
HU
, Min
as G
erai
s, b
ox
15
4, d
oc
. 56
.
Notes
