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Sickness, Recovery, and Death among the Enslaved and Free People of Santos, Brazil, 1860–1888

Published online by Cambridge University Press:  17 February 2015

Ian Read
Ian Read*
Affiliation:
Soka University of AmericaAliso Viejo, California
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Extract

Between 1802 and 1849, cholera and influenza pandemics killed hundreds of thousands from Shanghai to Seville to New York, but these diseases did not dip below the South American portion of the equator. As a result, Brazil gained a reputation of good health, an opinion confirmed by European travelers and some provincial authorities. This rosy reputation wilted in 1849 when a yellow fever epidemic devastated several seaports, including the imperial capital of Rio de Janeiro. Following this outbreak, waves of epidemics swept the nation with unfamiliar and terrifying virulence. Brazilians were struck again and again by cholera, smallpox, yellow fever, and bubonic plague until the early 1900s.

Type
Research Article
Information
The Americas , Volume 66 , Issue 1 , July 2009 , pp. 57 - 80
Copyright
Copyright © Academy of American Franciscan History 2009 

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References

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5 Richard Graham wrote “the epidemics of yellow fever, smallpox, and cholera” that marked the decade of the 1850s especially ravaged “the already debilitated slaves.” Bethell, Leslie, Brazil: Empire and Republic, 1822–1930 (Cambridge, England; New York: Cambridge University Press, 1989), p. 125.CrossRefGoogle Scholar According to Mary Karasch, slaves in Rio de Janeiro during the first half of the nineteenth century died at a higher rate than those of the free population. In her discussion of slave punishment, Karasch argues that there were “many interrelated reasons for the deaths [of slaves] at an early age, only one of which was physical torture by owners. Although some slave owners murdered their slaves, the majority of slaves died for other reasons: public punishments, imprisonment, and suicide to escape punishments; inadequate shelter, bedding, and clothing; overwork in an insalubrious city; inadequate medical care; malnutrition; and especially disease.” Karasch, Mary C., Slave Life in Rio de Janeiro, 1808–1850 (Princeton: Princeton University Press, 1987), pp. 109–113.Google Scholar Historians have explored a variety of social and legal risks that slaves faced. For example, police in Florinopolis, Rio de Janeiro, and Santos spent much of their time and resources in the nineteenth century arresting and whipping slaves. On this, see Holloway, Thomas H., “The Brazilian “Judicial Police” in Florianopolis, Santa Catarina, 1841–1871,” Journal of Social History 20:4 (1987), pp. 733–756;CrossRefGoogle Scholar Holloway, Thomas H., Policing Rio de Janeiro: Repression and Resistance in a 19th-century City (Stanford: Stanford University Press, 1993);CrossRefGoogle Scholar Read, Ian, Unequally Bound: The Conditions of Slave Life and Treatment in Santos County, Brazil, 1822–1888 (PhD diss., Stanford University, 2007), pp. 194–209.Google Scholar After arrest or wrongdoing, slaves could be severely punished, as explored by de Queirós Mattoso, Kátia M., To be a Slave in Brazil, 1550–1888 (New Brunswick, N.J.: Rutgers University Press, 1986), p. 101;Google Scholar and Karasch, , Slave Life in Rio de Janeiro, 1808–1850, pp. 141–145.Google Scholar

6 Mary Karasch studied records pertaining to the history of the health of Brazilian slaves who lived in Rio de Janeiro during the first half of the nineteenth century. Karasch, Slave Life in Rio de Janeiro, 1808–1850. Robin Anderson used cemetery records reprinted in a São Paulo newspaper to explore the leading causes of death in that city during the late 1800s, but perhaps because of limitations of her source, Anderson did not discuss the health of slaves. Anderson, Robin, “Public Health and Public Healthiness; Sao Paulo, Brazil, 1876–1893,” Journal of the History of Medicine 41 (1986), pp. 293–307.Google Scholar Others have looked at the health of slaves indirectly. Sidney Chalhoub argued that yellow fever epidemics altered the political response towards slavery and race. Chalhoub, , “The Politics of Disease Control,” pp. 441–463.Google Scholar For information on yellow fever in Rio de Janeiro, see Chalhoub, , Cidade febril: cortiços e epidémicas na Corte imperial (São Paulo: Cia. das Letras 1996);Google Scholar Needell, Jeffrey D., The Party of Order: The Conservatives, the State, and Shivery in the Brazilian Monarchy, 1831–1871 (Stanford: Stanford University Press 2006);Google Scholar Graden, Dale T., “An Act ‘Even of Public Security’: Slave Resistance, Social Tensions and the End of the International Slave Trade to Brazil, 1835–1856,” Hispanic American Historical Review 76:2 (1996);Google Scholar and Graham, Sandra Lauderdale, The House and the Street: The Domestic World of Servants and Masters in Nineteenth-Century Rio de Janeiro (Austin: University of Texas Press, 1988).Google Scholar

7 When cholera struck Brazil in 1855 and 1856, it killed as many as 200,000, targeting mostly the poor and people of color. Historians do not yet know why cholera spared Sao Paulo and Santos but struck in many other places. Paulista authorities may have been more diligent cordoning their province, but many other provinces took similar precautions and were not spared. Furthermore, the government of Sao Paulo did not prevent the arrival of yellow fever in 1850 or smallpox in 1863. Cooper, , “Brazil’s Long Fight Against Epidemic Disease,” pp. 672–696 Google Scholar and Cooper, , “The New ‘Black Death’: Cholera in Brazil,” pp. 467–488.Google Scholar

8 It is difficult to estimate how many people were “urban” residents compared to “rural” residents because the only clear boundaries of the town were drawn by the harbor on the northern edge and the tall hills to the south. To the west and east, the town gradually faded into vegetable gardens, fields and marshlands. In addition, many of the wealthier Santistas owned a town home and a sitio, or country estate, and they moved between the two. A census of 1818 rural property holdings listed about one thousand people living in the rural areas, but many of these people also owned a house in town. “Nominal lists (Santos),” 1818, Arquivo do Estado do São Paulo (AESP).

9 Patient registers, 1861–1883, Arquivo da Santa Casa de Misericórida de Santos (ASCMS). Hospital San Nicolás de Bari was the first hospital founded in the Americas, built in Santo Domingo between 1503 and 1508. The oldest hospital to be providing service without interruption is the Hospital de Jesus in Mexico City, built in 1523, with funds given by Hermán Cortés. Palm, Erwin Walter, Los hospitales antiguos de la Españla (Dominican Republic: Secretaría de Estado de Sanidad y Asistencia Pública, 1950).Google Scholar

10 “Almanak administrativo, mercantil e industrial da Córte e provincia do Rio de Janeiro” (1881). The almanac “Laemmert” from 1844–1889) is available online through The Latin American Microfilm Project (LAMP) at the Center for Research Libraries (CRL), http://www.crl.edu/content.asp711=4&12=18&13=33.

11 Patient registers, 1861–1883, ASCMS.

12 Cemetery registers, 1857–1886, A Fundação Arquivo e Memória de Santos (FAMS).

13 Patient registers, 1861–1883, ASCMS.

14 Sufferers from tuberculosis and parasitic worms were rarely admitted to the hospital, either because they believed that hospitalization would not help them or because the doctors refused to admit them. The same was true for cases of tetanus; see the text below. Cemetery registers, 1857–1886, FAMS. Robin Anderson also found tuberculosis as the leading cause of death among people in São Paulo (capital). “Gastrointestinal disturbances” and heart disease were the second and third deadliest ailments, respectively. Anderson, , “Public Health and Public Healthiness,” p. 296.Google Scholar

15 Smallpox was epidemic in Santos in 1863, 1874, 1888, and 1892. Yellow fever was epidemic in 1873, 1876, 1878, 1889, 1891–1892, 1895–1896, 1898, and 1900. See Alvaro, Guilherme, A campanha sanitaria de Santos, suas causas e seus effeitos (São Paulo: Duprat, 1919),Google Scholar quoted in de Andrade, Wilma Therezinha Fernandes, O Discurso do Progresso: a Evolução Urbana de Santos, 1870–1930 (PhD diss., FFLCH, Universidade de São Paulo, 1989), pp. 77, 85.Google Scholar

16 Virases mutate and may become more or less virulent over time. This complicates any comparison of evidence of epidemiology in the nineteenth century to descriptions of epidemiology taken from modern studies of diseases. Viruses themselves differ in mutation rates. RNA virus (i.e., yellow fever and influenza) are much more capable of mutating than DNA viruses (i.e., smallpox). See Sompayrac, Lauren, How Pathogenic Viruses Work (Boston: Jones & Bartlett 2002).Google Scholar Despite the possibilities of mutation, I believe that what doctors identified as the deadliest diseases are those that scientists identify today because symptoms and rates of morbidity and recovery remain similar.

17 The Merck Manuals Online Medical Library, “Smallpox,” http://www.merck.com/mmhe/sec17/ch198/ch198b.html; Kiple, Kenneth F., The Cambridge World History of Human Disease (Cambridge; New York: Cambridge University Press, 1993), pp. 1008–1013.CrossRefGoogle Scholar

18 While all slaves were included, and free patients were sampled, I do not believe this hinders a comparison of the two groups. The dates sampled for the free population included periods when yellow fever and smallpox were epidemic, endemic, or not present at all.

19 Since year-to-year population changes are not available, I relied on the proportion of infection of different diseases. The propensity of infection of a certain disease is, therefore, relative to all others.

20 Edward Jenner’s cowpox injection method was familiar to Brazilian medics since the early nineteenth century. In fact, provincial authorities organized a small vaccination program in Santos in the 1840s. The program, however, appears to have ended after only a few years because of inadequate funds and government will. Discurso com que o Illustrìssimo e Excellentissimo Senhor Doutor Vicente Pires da Motta, Presidente da Provincial de São Paulo abbrio a Assemblèa Legislativa Provincial, no dia 15 abril de 1850 (São Paulo, Typ. do Governo, 1850). Slave owners may have continued to give vaccinations privately, but I have found no evidence of this.

21 Owners had to pay for their slaves to be treated, while the poor free population entered without charge. Perhaps the destitute smallpox victims avoided the hospital or were turned away, but there is no evidence to support this. Vaccination may explain the better recovery rates among slaves; it runs contrary to the lower infection rates among the free poor population. Two other explanations for the different rates of patient recovery involve the history of exposure and, with more controversy, genetics. Recent research on smallpox has found that nonfatal childhood exposure can give a lifetime of resistance. See MacKenzie, Debora, “Smallpox immunity may last a lifetime,” August 18, 2007.Google Scholar Among burials in Santos, the young children of free people died from smallpox proportionally more than the young children of slaves. If we assume that the history of exposure of these two locally born groups was similar, is this evidence of genetic influence? The role of genes in smallpox reaction is gaining some support in the scientific community. For example, Alison Galvani, a population geneticist, argues that Europeans who have fairly rare genetic resistance to HIV inherited a mutation that developed in response to smallpox centuries before. See Galvani, Alison P., “Smallpox In Europe Selected For Genetic Mutation That Confers Resistance To HIV Infection,” November 20, 2003.Google Scholar

22 Cemetery registers, 1857–1886, FAMS; Patient registers, 1861–1883, ASCMS.

23 Ibid.

24 The Merck Manuals Online Medical Library, “Smallpox,” http://www.merck.com/mmhe/secl7/chl98/chl98b.html.

25 It is hard to tell how much better the first class treatment was compared to the other classes overall. The building had two floors, each about the size of a tennis court. Considering this size, first class patients probably did not get too much more privacy. Patients in the first and second classes were, on average, in the hospital for less time than those in the third class. Sailors had the shortest period of treatment—about ten days—perhaps because they returned to the care of the ship doctors at the first sign of improvement. In terms of mortality rates, 20 to 22 percent of the first, second, and poor class patients died while in the hospital. Surprisingly, sailors and slaves in the post–1877 slave class of service died at much lower rates (8 percent and 13 percent respectively). Patient registers, 1861–1883, ASCMS.

26 McCance, Kathryn L. and Huether, Sue E., Pathophysiology: The Biologic Basis for Disease in Adults and Children, 3rd ed. (St. Louis: Mosby, 1998), pp. 70, 1464.Google Scholar

27 Patient registers, 1861–1883, ASCMS.

28 McCance, and Huether, , Pathophysiology, p. 1466.Google Scholar

29 Ibid., p. 1474

30 Two percent of enslaved patients under 30 years of age were diagnosed with joint disorder. Among free patients of this age group, seven percent were afflicted. The rates equalized for patients over 30 years of age: 8 percent of older slaves were admitted with a joint disorder, while for free patients it was 7 percent. Patient registers, 1861–1883, ASCMS.

31 Patient registers, 1861–1883, ASCMS.

32 This was true for Rio de Janeiro. Karasch, Slave Life in Rio de Janeiro, 1808–1850.

33 Kiple, , The Cambridge World History of Human Disease, p. 1060.Google Scholar

34 Bates, Barbara, Bargaining for Life: a Social History of Tuberculosis, 1876–1938 (Philadelphia: University of Pennsylvania Press, 1992), p. 1.CrossRefGoogle Scholar

35 Cemetery registers, 1857–1886, FAMS. George Bodington, an English doctor, probably expressed a popular opinion when he said in 1840 that “the common hospital in a large town is the most unfit place imaginable for consumption,” cited in Meachen, George Norman, A Short History of Tuberculosis (New York: AMS Press, 1978), p. 17.Google Scholar René-Théophile-Hyacinthe Laënnec, a prominent early nineteenth-century doctor, recommended a change of climate for tuberculosis victims. Laënnec was the first physician to unify a number of different diseases as all belonging to tuberculosis, and he also invented the stethoscope as a tool to aid pulmonary examinations. See Waksman, Selman A., The Conquest of Tuberculosis (Berkeley: University of California Press, 1964).CrossRefGoogle Scholar Tuberculosis patients in nineteenth-century Ireland were more likely to be nursed in home rather than hospitals or workhouse infirmaries. See Myers, Jay Arthur, Captain of All These Men of Death: Tuberculosis Historical Highlights (St. Louis: W. H. Green, 1977), p. 17.Google Scholar Tuberculosis may have been so deadly among hospital patients partly because doctors only correctly diagnosed the disease when a patient died. When patients recovered, they may have been seen to have only a severe cold or influenza.

36 The Merck Manuals Online Medical Library, “Tuberculosis,” http://www.merck.com/mmhe/sec17/ch193/ch193a.html.

37 The symptoms of tuberculosis were sometimes quite mild. “One person might develop full blown tuberculosis whilst another might experience only the symptoms of a minor cold, recover, be unaware that they had been infected and never developed the disease.” See Myers, , Captain of All These Men of Death, p. 16.Google Scholar Forty-four slaves were treated in the hospital with “colds” (catarrho or resfriamento), and some of these may have had minor cases of tuberculosis. This was even more likely of the 15 slave patients with “pulmonary colds” (catarrho pulmonar). Even if some of these patients are counted as having tuberculosis, the number of treated patients in the hospital is strikingly low compared to the number of people who died with the disease.

38 Cemetery registers, 1857–1886, FAMS.

39 Kiple, , The Cambridge World History of Human Disease, p. 1176.Google Scholar

40 Ibid.

41 Poverty and overcrowded living conditions go hand-in-hand. Great Jones and Neil McFarlane argue that there was a connection between the increasing number of tenements and tuberculosis in Dublin, Ireland and Glasgow, Scotland. See Myers, , Captain of All These Men of Death, p. 80 Google Scholar and McFarlane, N., “Hospitals, Housing, and Tuberculosis in Glasgow, 1911-51,” Social History of Medicine: The Journal of the Society for the Social History of Medicine 2:1 (1989), p. 81.CrossRefGoogle ScholarPubMed

42 In Ireland during the late nineteenth century, 45.6 percent of all deaths of the young adult population aged between 15 and 34 years were caused by tuberculosis. See Myers, , Captain of All These Men of Death, p. 35.Google Scholar The highest rates of tuberculosis death for males in Massachusetts in 1880 and the United States in 1900 were of those between 20 and 40 years. See Frost, W.H. “The Age Selection of Mortality from Tuberculosis in Successive Decades,” American Journal of Epidemiology 141:8 (April 1995).CrossRefGoogle ScholarPubMed According to William D. Johnston, “once a person becomes infected with the bacillus, age has a powerful influence on what follows. Infancy, puberty, and old age are periods of low resistance and high susceptibility to tuberculosis. The younger the individual, the more likely that primary infection will become active disease and result in death. Infants are particularly susceptible to acute miliary tuberculosis.” See Kiple, , The Cambridge World History of Human Disease, p. 1060.Google Scholar

43 Kiple, , The Cambridge World History of Human Disease, p. 1061.Google Scholar

44 Cemetery registers, 1857–1886, FAMS.

45 The Merck Manuals Online Medical Library, “Tetanus,” http://www.merck.com/mmhe/sec17/ch190/ch190t.html.

46 Kiple, , The Cambridge World History of Human Disease, p. 1047.Google Scholar

47 In some parts of Brazil, neonatal tetanus was also called mal de umbrigo, or “the umbilical stump disease.”

48 Patient registers, 1861–1883, ASCMS; Cemetery registers, 1857–1886, FAMS.

49 Karasch, Slave Life in Rio de Janeiro. Parasitic worms are spread in a number of ways, such as contaminated water sources (guinea worm, tapeworm), ingesting contaminated foods (tapeworm, roundworm) contact with soil (tapeworm, hookworm), or by unintentionally bringing worm eggs from a surface to the mouth (pinworms).

50 The town may have become more dangerous and violent between 1861 and 1883 since the number of slave patients with injuries increased. Injuries were more common among slave men than slave women. Traumatic injuries also increased at a faster rate during this period for slaves than the free population, although slaves seemed to have been injured less than free people. I do not believe that this reflects a source bias. There are no obvious reasons why doctors or hospital staff may have concealed the diagnosis of slaves suffering from injuries during one decade but not the other.

51 The Merck Manuals Online Medical Library “Yellow Fever,” http://www.merck.com/mmhe/sec17/ch198/ch198k.html.

52 Ibid.

53 Kiple, Kenneth F., The African Exchange: Toward a Biological History of Black People (Durham N.C.: Duke University Press, 1987);Google Scholar Kiple, Kenneth F., Blacks in Colonial Cuba, 1774–1899 (Gainesville: University Presses of Florida, 1976);Google Scholar Kiple, Kenneth F. and King, Virginia Himmelsteib, Another Dimension to the Black Diaspora: Diet, Disease, and Racism (Cambridge; New York: Cambridge University Press, 1981).CrossRefGoogle Scholar

54 Cemetery registers, 1857–1888, FAMS.

55 Patient registers, 1861–1883, ASCMS.

56 Cemetery registers, 1857–1888, FAMS.

57 Watts, S.J., “Yellow Fever Immunities in West Africa and the Americas in the Age of Slavery and Beyond: A Reappraisal,” Journal of Social History 34:4 (2001), pp. 955–967;CrossRefGoogle ScholarPubMed Kiple, Kenneth F., “Response to Sheldon Watts, ‘Yellow Fever Immunities in West Africa and the Americas in the Age of Slavery and Beyond: A Reappraisal’,” Journal of Social History 34:4 (2001), pp. 969–974;CrossRefGoogle Scholar and Watts, S.J., “Response to Kenneth Kiple,” Journal of Social History 34:4 (2001), pp. 975–976.CrossRefGoogle Scholar

58 The rate of burial is determined by dividing annual deaths by the population. In this way, the two populations can be compared with their population differences held constant. The hospital treated 1,238 free non-Africans between 1861 and 1883 (with discernable diseases), of which six percent had yellow fever. There were no free Africans treated for yellow fever and only a single slave who was diagnosed with the disease. Five percent of 532 creole slaves were treated for yellow fever. This figure lends some support to the exposure argument, but the death rates—pointing toward innate resistance—remain the strongest indicator. In addition, the possibility exists that genetic resistance may not always be passed on to off spring. Among the 27 Brazilian born slaves who were treated by yellow fever in the hospital, nearly one-third was categorized as pardo or mulato, meaning they were mixed race. In comparison, the hospital listed the mixed race category to less than a quarter of all creole slave patients.

59 Cemetery registers, 1857–1886, FAMS.

60 This graph includes ingenuos (the freed children of slave mothers as dictated by the Free Womb law of 1871). They have been included in the “slave” category for sake of analysis.

61 The differing trends of slave and free burials were not necessarily a consequence of a much higher rate of population increase of free people over slaves. Since free people and slaves were constantly entering and leaving the town, historians can only guess on overall mortality rates. When the population was controlled for the few years of the census, the burial rate of free individuals still increased at a faster rate than it did for slaves until the 1870s. For example, in 1858 the cemetery dug three graves for free individuals for every slave grave even though free people outnumbered slaves about two to one. Furthermore, 60 free people were buried per thousand in 1858. That year, there were 26 slave burials per thousand. Two decades later, when the rules regarding burials for the single town cemetery were stricter, the mortality rates for free people were still much higher—56 compared to 34 deaths per thousand slaves. Only by the 1880s, when the slave population was aging and shrinking did this slave burial rate surpass the burial rate of free people. In 1886, for example, the mortality rate was 30 for free people and 55 for slaves.

62 Código de posturas (Santos), 1847, 1852 and, 1890, FAMS.

63 The high cemetery sex ratio may be evidence that owners were more inclined to bury their male slaves or it may indicate that rural slave owners in outlying agricultural areas buried their slaves in the cemetery. Slave males may have been more known to the community and expected to have a public funeral. Possibly, relatively secluded female house servants and their baby daughters were more commonly placed in backyards or surreptitiously buried in country graves. Finally, slaveholders on peripheral farms probably held more male slaves than were represented in the 1854 and 1872 town censuses. These farmers may have brought the corpses of dead for burial at the cemetery.

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