Tetanus among slaves and freeborn in Brazil

Vivian Mannheimer | Blog HCS-Manguinhos
Interview with Ian Read, professor of Latin American Studies at Soka University, California, US.

Between 1849 and 1910 Brazil experienced a really unusual and terrible wave of epidemics. First, yellow fever arrived. In early to mid 1800s, cholera came. Less severely than the others, the bubonic plague also affected Brazil at that time. Smallpox was terrible problem, worse than the others. However, during that period, endemic dieses, such as tuberculosis and tetanus killed far more.

Ian Read*, who teaches Latin American Studies at Soka University, California, has dedicated his years to the project “An Era of Epidemics” available at empireofbrazil.org, which offers an extensive research and database about epidemics in the eighteen hundreds Brazil.

As part of this larger project, Ian has also studied tetanus and written the article  “A triumphant decline? Tetanus among slaves and freeborn in Brazil.” Ian said that having a good understanding of the changing epidemiological environment in Brazil is crucial for understanding the most important political, economical and demographical changes that occurred in the twentieth century. According to him, the story about health and medicine is needed to understand the transition from empire to the republic.  In a telephone conversation, the researcher answered some questions about his work on tetanus.

What was the impact tetanus had on Brazilian society in the eighteen hundreds?  

Well, very little is known. It was very hard to find information on it. But I think it deserves our attention because it was a top killer and affected infants far more than adults. It was a tragic thing, because the nervous system begins to malfunction, muscles contract and it is very painful. Imagine a newborn child with severe muscle pains till the point that he or she cannot eat. That would be disturbing to see.

I think that the overall high mortality of children added to a different perception of infancy.  I think that people in the 19th century, in Brazil and another places, did not really see a newborn as a fully developed human, given such a high risk of dying and so many did die.

But I think that with additional research, historians can continue to identify the ways that the perception of childhood has changed. Today, for example, we live in a society in which the expectation is that every child born should live and if they don’t, something deeply tragic happened. I don’t think that this belief was strongly present in eighteen hundreds.

In your article, you talk about the reasons why tetanus has declined. Which are those reasons?

It’s a very interesting story because tetanus declined well before anyone had a belief in germ theory. Today we see tetanus as a bacterium transmitted through soil or infected material. That is not at all how people saw the causes of tetanus a hundred years ago. There was great uncertainty about what cause it. Most medics, including Brazilian medics, recognized it was an unsolved mystery.

It declined before anyone knew it was caused by a germ. So, we cannot see it as a story of scientific discovery leading to a medical improvement. There are some other factors in play. My article offers a few possibilities. The first is that there were changes in midwifery.  Older practices were replaced by more modern ones. There was greater attention to cleaning instruments. If they were not clean this was one of the best ways for this bacteria to be delivered unintentionally into the belly of a newborn.

So, it could be that midwifes – and this was mostly in the domain of women, and not in the domain of doctors – changed some of their practices. The other possibility is that adult tetanus declined because more people began to wear shoes, so they had less direct contact to the dirt. Another reason is because there were more people living in cities and in this environment people probably has less direct contact with the soil. What is clear is that the rate of tetanus declined, but it declined before the germs theory was accepted and we need further explanations.

What kind of relationship can we make between tetanus and the social context of that time?  For example, what was the comparative analysis about tetanus on slaves and non slaves?

That’s a great question. I did find that there were different rates among slaves and free people. In fact in most of the cities I looked at, data demonstrated that slaves were more affected, were more likely to die from tetanus. And this was the first time I found a diversion when it comes to endemic disease. The biggest killers on eighteen hundreds were endemic diseases, tuberculosis, tetanus, gastrointestinal disorders, smallpox. So, to find a significant change in one of the top killers is an important finding,

I have written elsewhere about the causes of death and hospitalization in the city of Santos. And there I found that in many cases slaves and free do not diverge greatly when it came to the causes of death. This was not what I was expecting to find. The standard story is that slaves face a worse environmental contact than free people. They were mistreated, they were oppressed and therefore they must have experienced worse conditions of health. But this was not the case for Santos.
The research happening in Brazil right now is amazing. There are more researches dedicated to understanding the cause of disease and death among the slave population.  Even though in the US there are many more researches and much better funded, North American historians know less about this subject, there is still to little research being done to compare slaves and free people. Most of research being conducted is just on slaves.

To sum up, which were the main conclusions of your research on tetanus?

One big conclusion I haven’t mentioned yet in this conversation is that between 1890 and 1920 Brazilian population grew enormously, exponentially. This is most often attributed to the arrival of Europeans, after all this was a time in which Spanish, Portuguese, Italians and other Europeans coming to Brazil grew greatly. But what is not recognized is that the Brazilian population growth between 1890 and 1920 boomed in many ways mostly by natural reasons.

What I mean is that for some reason, or multiple reasons, the mortality rates may have dropped and the rate of survival of infants grew. Historians still don’t know why this happened. But is seems that the population expansion in this period was driven mostly by natural reasons, not because Europeans arrived in Brazil. Immigrants added a considerable portion to the population increase, but the population still would have grown without immigration.

And what it has to do with tetanus? As I have mentioned, tetanus was one of the top causes of deaths in Brazilians and especially for infants. And when it became much less a risk, the Brazilian population expanded. I am not claiming that it was the most important factor, but it was one important factor for this big change.

 

* Ian read teaches Latin American Studies at Soka University of America, in California. He has previously taught at Stanford University, University of Puget Sound and the University of California, Berkeley.  He wrote the book The Hierarchies of Slavery in Santos, Brazil, 1822 – 1888 and idealized the project  “An Era of Epidemics, available at http://empireofbrazil.org.

See the full article “A triumphant decline? Tetanus among slaves and freeborn in Brazil”

For other related article see:

“Slave mortality during the cholera epidemic in Rio de Janeiro (1855-1856): a preliminary analysis.”
“Cholera among slaves in 19th century Brazil.”