This dissertation analyzes the Brazilian state's institutionalization of medicine through its increased criminalization of traditional medical practices relating to women's healthcare. Three questions are central to explaining institutionalization via criminalization: what was the changing institutional nature of the medical profession, specifically the field of obstetrics and gynecology? How did the state?s push towards medical institutionalization affect the Brazilian population?s access to healthcare, in particular women?s access to pre- and post-natal medical services? And how and why did the state monitor, control, and ultimately, criminalize traditional medicine practices, most notably midwifery?
Although gender continues to illuminate analysis of the legal history of medicine mediciine, legal historical scholarship has yet to explain the role of gender in medicine across places and times. This dissertation seeks to fill that gap in late-nineteenth-century Rio de Janeiro, Brazil. The actions and writings of both the state and licensed doctors reveals the processes of the institutionalization of medicine. Whether the law and rhetoric actually increased or decreased women?s access to affordable pre- and post-natal healthcare is the focus of analysis. The project concludes by explaining how the criminalization of traditional midwifery practices contributed to institutionalization. The legal jurisdiction over the practice of medicine contributed to socioeconomic changes during turn-of-the-century Rio de Janeiro, changing governance patterns, and creating a modern medical infrastructure. These changes included structural inequalities in the class- and race-based society. By using previously untapped court cases, medical theses and journals, public health records, criminal law, and census data, this project is the first study of the intersection of healthcare, gender, race, and the law in late-nineteenth-century Rio de Janeiro.
Health care inequalities remain a cross-national concern today, and this study will provide a contribution to ongoing discussions of how inequalities have been created and continued.
This project addressed the legal parameters surrounding the institutionalization of medicine in the city of Rio de Janeiro, Brazil from 1850-1930 from a gendered angle. It asked three important questions. One, what was the changing institutional nature of the medical profession, specifically the field of obstetrics? Secondly, how did the state’s push towards medical institutionalization affect the Brazilian population’s access to healthcare, in particular women’s access to pre- and post-natal medical services? And finally, how and why did the state monitor, control, and ultimately, criminalize traditional medicine practices, most notably midwifery? Doctors in late-nineteenth- and early-twentieth-century Rio de Janeiro became increasingly professionalized. For instance, in the first decades of the twentieth century, the number and scope of medical publications increased. The National Academy of Medicine, founded in 1829 as the Society of Medicine of Rio de Janeiro, increased in size. During this period, the field of obstetrics and gynecology saw the rise to prominence of leaders in the field. These men served as guiding voices in the state’s creation of public maternity hospitals and later maternal-infant protective legislation. Looking at medical dissertations, journal articles, and debates in the National Academy of Medicine, this project found that the field of obstetrics saw the most pressing public health issues as neonatal and infant mortality in addition to the supposed ‘plague’ of criminal abortions performed by midwives and doctors alike. The data shows that compared to other urbanizing centers at the time, Rio de Janeiro had high neonatal mortality rates, although it had lower rates than other cities in Brazil. No data exists to support the established view in the obstetric field that criminal abortions occurred frequently. While doctors worked to organize and professionalize their specialties, throughout the late-nineteenth century the Brazilian state passed a series of laws that sought to monitor the practice of medicine—including dentistry, veterinary medicine, and pharmacy. In the early-twentieth century, these laws combined with public health regulations to normalize sanitation practices and public and private hospital procedures. Despite the increased state interest in standardizing and controlling the medical profession, this project found that there remained a disparity between the number of hospitals and medical care providers and the population’s healthcare needs. This discrepancy was particularly noticeable in the realm of obstetrics. For instance, it was common practice at the time to give birth at home, yet many poor women did so unattended or helped by a layperson or unlicensed midwife. The problem of neonatal mortality that accompanied these birthing practices was a common theme in medical writings. Yet between 1890 and 1930, when data becomes available, no significant decrease in these statistics occurred, nor did access to obstetric services increase. Obstetric specialists wrote about the need for improving birthing conditions, and the state passed laws regulating practices, opened public maternity hospitals, and even tried unsuccessfully to implement ambulatory obstetric services, but women continued to give birth at home. Depending on the social class of the woman in question, these births often occurred in unsafe conditions. Interestingly enough, while the data shows no significant increase in access to healthcare, it does show increase in the number of people investigated and tried for practicing medicine without a license and related activities including healing and charlatanism. The licensed medical field saw unlicensed midwives or curiosas as one of the major obstacles to achieving what doctors saw as ‘modern’ obstetric care and to improving the neonatal and infant mortality statistics, which, in addition to epidemics, was seen as a main public health problem. Police action towards unlicensed practitioners was more indiscriminate, however. In fact, court cases involving midwives or obstetric practices account for only 9 of the 102 judicial cases directly involve midwives. The majority of cases involved men and women who employed a variety of religious and medical practices in their healing trade. Thus, police persecution of all types of alternative medicine did not specifically target midwifery. This finding falls in line with the increase in police investigations of all types of behavior associated with the lower-class and working populations, including gambling and vagrancy, after the creation of Brazil’s first republican state in 1890. In addition, all of the midwives in these cases were white. While described by the medical profession as a relic of its slaveholding past, midwifery appears in these cases as white-dominant profession. Despite a state push to regulate and improve healthcare during the period of this study, and particularly after 1890, no real expansion of obstetric services occurred. In fact, the increased criminalization of traditional healthcare, while not specifically focusing on midwives, hindered lower-class access to any sort of medical attention. During this period of state formation, unequal access to healthcare based on gender, race, and class became entrenched.
