[The state and possibilities of the Soviet Health Care in 1960-1980s].

The article presents materials characterizing the state of health care system in the USSR in 1960-1980s. The main attention is paid to the complex of unresolved problems that had negative impact on capacity and quality of population medical care. The conclusions concerning factors weakening state health care system during last decades of the USSR existence are expressed and justified.

Desde el ISET al InDRE. III. Instituto de Salubridad y Enfermedades Tropicales: crisis y renovación, 1965-1989.

This paper analyzes the situation and the changes made in the Institute of Sanitary and Tropical Diseases between 1965 and 1989 to become the National Institute of Epidemiological Diagnosis and Reference. Three major stages are identified during this period: crisis, transition and renewal. The factors that led to the crisis, the decisions made to overcome it and to harmonize the work of laboratories with epidemiological and public health criteria are discussed. The recognition obtained by researchers of the Institute despite the crisis is described, as well as the way the institution managed to continue with projects despite the changing global situation. The transition included the arrival of a new generation of professionals with modern computer-based and conceptual tools and the remarkably well met challenge of participating in national surveys with rigorous criteria. All this moved the institution to define its profile towards diagnosis and reference.

El artículo analiza la situación y los cambios efectuados en el Instituto de Salubridad y Enfermedades Tropicales entre 1965 y 1989 para transformarse en el Instituto Nacional de Diagnóstico y Referencia Epidemiológicos. Se identifican tres grandes etapas en el periodo: crisis, transición y renovación. Se señalan los elementos que llevaron a la crisis, las decisiones que se tomaron para salir de ella y armonizar el trabajo de los laboratorios con criterios epidemiológicos y de salud pública. Se citan las distinciones obtenidas por investigadores del Instituto a pesar de la crisis y se describe cómo la institución logró seguir con proyectos a pesar de la cambiante situación mundial. La transición incluyó la llegada de una nueva generación de profesionales con modernas herramientas informáticas y conceptuales y el desafío de participar en encuestas nacionales con criterios rigurosos. Todo ello movió a la institución a definir su perfil hacia el diagnóstico y la referencia.

History of primary health care in Iran.

Background: The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation. Introduction: The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all.Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens. Discussion: Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system. Conclusions: The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all.

The insidious return of cholera in the Eastern Mediterranean Region, Lebanon and Syria: a worrying signal! Past, present, and future forthcoming.

Introduction: War, hunger, and disease continue to decimate the populations of many countries in the world. Owing to conflicts, environmental instability and natural disasters, many people, especially the poorest, fall victim to epidemic diseases. One such disease, cholera, began to spread again in 2022, striking Lebanon and Syria, countries that have experienced serious social troubles for years. The return of cholera immediately alarmed the scientific community, which is now making every effort, most notably by implementing a major vaccination campaign, to prevent this disease from becoming endemic in these two countries, thus making them a reservoir for its potential spread in the Eastern Mediterranean Region. Discussion: Cholera is a disease that draws its strength from poor hygiene, primitive sanitation and the consumption of contaminated water and food. From the 19th Century onwards, its spread was facilitated by overcrowded housing and lack of hygiene, which became commonplace features of urban life. Method: In outlining the spread of cholera in Lebanon and Syria, the authors raise the question of the possible resurgence of epidemic cholera, especially in the light of the consequences of the devastating earthquake that hit the border area between Turkey and Syria last February. Conclusion: These events have had a devastating effect on the population, destroying, among other things, the few existing health facilities and aggravating the already difficult living conditions of millions of people who, owing to the ongoing war, have been living for years in makeshift settlements, bereft of water, sanitation and any form of health care.

One hundred years after the death of the writer and novelist Giovanni Verga (1922) and his relationship with public health: a glimpse of the past in the era of the SARS-CoV-2 (COVID-19) pandemic.

Background: In 1922 the famous Italian novelist Giovanni Verga died in Catania (Italy). In Verga's works there are many suggestions to the world of medicine, in particular the diseases described in the poor society of southern Italy of that time. One of the most common diseases described by Verga was cholera. Methods: The authors researched and reviewed Verga's works, detecting references to public health. These are topical issues in the current period of the COVID pandemic. In Verga's works the theme of hygiene, epidemiology, and infectious diseases occur. There are many hints related to medicine, especially as far as the typical diseases of poor society and the difficult social environments of the time are concerned. One of the most common diseases described by Verga was cholera but also malaria and tuberculosis occur. Results: It was estimated that 69,000 people died of cholera in Sicily, of whom 24,000 in Palermo. The public health situation in Italy was difficult. Verga denounces people's ignorance and the survival of past beliefs. Conclusion: Verga describes a culturally and economically humble society, in a region characterized by large class gaps. It draws a difficult picture of the public health situation in the second half of the 19th Century and people's daily lives. The authors believe that today it is important that the centenary of Verga's death be an opportunity to read his works, also from a medical historical point of view.

A CONTRIBUTION TO THE STUDY OF THE ORIGINS OF PUBLIC HEALTH MEDICINE FROM 1912 TO 1919 WITH AN EMPHASIS ON THE WORK OF ANDRIJA STAMPAR / PRILOG PROUCAVANJU POCETAKA MEDICINE NARODNOG ZDRAVLJA OD 1912. DO 1919. S NAGLASKOM NA DJELOVANJE ANDRIJE STAMPARA

The paper examines the forerunner of the development of public health medicine since 1912, as well as the actions of Andrija Stampar as a municipal physician in the Nova Gradiska Posavina region from 1913 to 1918. The predecessors of public health medicine are considered in the context of the emergence of societies for the protection of public health in Belgrade and Zagreb, as well as the connection between Andrija Stampar and these societies. Analysing the archival material of the Croatian State Archive, laws, journals, and newspapers, the paper attempts to link the theoretical phase of Andrija Stampar's work with the practical phase, beginning in 1912 with his work in Karlovac and his relocation to Nova Gradiska in 1913. The paper notes that Stampar had already laid the foundation for many of his future ideas at this stage, as can be observed in the example of his reflections on eugenics, which he has defended since 1912. His experiences of rehabilitation efforts after the epidemics of cholera and smallpox in the Nova Gradiska Posavina region and his work at the Red Cross military hospital in Nova Gradiska influenced the formation of the basic principles of social medicine and public health. Special attention was paid to the set of preventive and epidemiological measures that Stampar implemented during the 1913 - 1916 epidemics. He regarded them as "perfect", and, ten years later, introduced them into the postulates of public health medicine. Andrija Stampar conceived the main part of his ideas under the influence of theoretical knowledge and practice until 1918, and thanks to his ability to perceive circumstances and opportunities within the newly created legal framework and with the support of Rockefeller donations, he turned them into a functional health policy, which has been implemented at the School of Public Health and the Institute of Hygiene since 1926.

The Story of the plague in the Maritime Republic of Genoa (Italy) (1656-1657): An innovative public health system and an efficacious method of territorial health organization.

Introduction: With the recent COVID-19 pandemic, the terms quarantine, contagion and infection have again become part of our everyday speech, prompting historians to reflect on the settings in which they were originally used and to make comparisons with the present time. How did people cope with epidemics in the past? What measures were taken? Objectives: Here, we analyse the institutional response of the Republic of Genoa to a calamity that shook the city - the plague of 1656-1657. In doing so, we focus particularly on the public health measures implemented, as recorded also in unpublished and archival documents. Discussion: In order to tighten control over the population, Genoa was divided into 20 zones, each of which was placed under the authority of a Commissioner endowed with criminal jurisdiction. The Commissioners' duties concerned the spheres of public health, public order and those tasks which today we would assign to "civil protection". Through the official documentation and the trial records kept by the Chancellor of one of these zones, we can shed light on the Commissioners' everyday activities and assess the impact of the public health measures on the population. Conclusions: The 17th century plague in Genoa provides us with an important testimony of a well-organised and structured public health policy - an institutional response involving the adoption of efficacious measures of safety and prevention in the field of hygiene and public health. From the historical-social, normative and public health perspectives, this meaningful experience highlights the organisation of a large port city, which was at the time a flourishing commercial and financial hub.

The history of vaccinology and hygiene through Achille Sclavo and the cultural patrimony conserved in the archives and museums: the key role of medical museology.

Over the centuries, the oldest universities have amassed an extraordinary patrimony of material and immaterial cultural assets, which have been created or acquired for the purposes of research or teaching. Now on display in museums, they testify to the evolution of knowledge and its diversification in various disciplines. In order to safeguard, conserve and study this precious heritage, we need to implement a cultural project that activates that "process of awareness" on which cataloging is based. This is a "reasoned awareness" that enables an object to be framed within a system of scientific knowledge and historical-critical relationships, which are essential to its conservation and, consequently, to its public exploitation. Through this process, we can uncover the history of an object, its characteristics and its uniqueness. This is the case, for example, of an optical microscope on display in the Museo di Strumentaria medica (Medical Equipment Museum), which is part of the Museum System of the University of Siena.

The avid eaters of lives. New and old infectious diseases in Italy at the time of World War I: a historical overview of military medicine and public health.

World War I hit Italy from different perspectives. The one here described under an historical point of view regards the health of military and civil population, with a special focus on infective diseases. The 20th Century was the fuse of degeneration and eugenetics theories; which grew in the melée of war and technological innovation. Indeed, war is interestingly depicted as an entity capable of emphasizing the differences between those who wore a uniform and those who did not. As a matter of fact, some infections spared the civilian population while others felt with greater vengeance on this subgroup. Moreover, the incidence of different feared diseases was brought back to the rates of the late 19th Century. Thanks to a statistician, Giorgio Mortara (1885-1967) the impact of infective diseases in Wolrd War I on Italian demography is well established. Moreover, different military and civilian sources contribute to enrich the picture of the consequences of war. In conclusion World War I could see considered as a litmus paper. The litmus paper of successes and failures of italian public health management to face new medical challenges exacerbated by the crisis.

SARS-CoV-2 (COVID-19) and the Teaching of Ignaz Semmelweis and Florence Nightingale: a Lesson of Public Health from History, after the "Introduction of Handwashing" (1847).

Ignác Fülöp Semmelweis (1818-1865) and Florence Nightingale (1820-1910) were two important personalities in the history of medicine and public health. They dealt with the problem of handwashing. Semmelweis is also known as the "father of hand hygiene"; just in 1847 he discovered the etiology and prophylaxis of puerperal sepsis and imposed a new rule mandating handwashing with chlorine for doctors. He also tried to persuade European scientific community of the advantages of handwashing. During the Crimean War, in Scutary (Turkey), Florence Nightingale strengthened handwashing and other hygiene practices in the war hospital where she worked and her handwashing practices reached a reductions in infections. Unfortunately the hygiene practices promoted by Semmelweis and Nightingale were not widely adopted. In general handwashing promotion stood still for over a century. During current pandemic SARS-CoV-2 (COVID-19) one of the most important way to prevent the spread of the virus is still to wash the hands frequently.

Genetic Control in Historical Perspective: The Legacy of India's Genetic Control of Mosquitoes Unit.

In the early 1970s, a World Health Organization-initiated and United States-funded project released lab-reared mosquitoes outside New Delhi in the first large-scale field trials of the genetic control of mosquitoes. Despite partnering with the Indian Council of Medical Research and investing significantly in outreach to local communities at the release sites, the project was embroiled in controversy and became an object of vehement debate within the Indian parliament and diplomatic contretemps between the United States and India. This early episode of genetic control research demonstrates how a scientific collaboration was entangled in geopolitics and shaped by the legacy of colonialism. This historical case study has implications for public deliberation in the present, pointing to the challenges of shared decision-making in the context of structural inequality, the way that a backdrop of military interest in a technology can impede trust, and the long-term consequences of projects that foster mistrust.

Diagnósticos e tratamentos em pacientes no hospital do Juquery na Era Vargas / Diagnósticos e tratamentos em pacientes no hospital do Juquery na Era Vargas / Diagnóstico y tratamiento de pacientes en el hospital Juquery durante la Era Vargas

Objetivo: analisar diagnósticos e tratamentos em pacientes no Hospital do Juquery no período Vargas. Método: estudo quanti-qualitativo, exploratório-descritivo, análise dos dados pelo referencial da análise documental e documentos históricos. Resultados:analisados 2.166 prontuários; épocas de conflitos sociais e guerras com incremento de prisões e internações; múltiplos diagnósticos para paciente; diagnósticos inconclusivos; principais diagnósticos.: esquizofrenia (23,59%), psicose maníaca depressiva (4,20%), psicoses diversas (4,02%), delírio (3,83%), parafrenia (3,60%), depressão (3,19%), confusão mental (2,91%) configuravam 45,34% (982) do total; quadros sem serem estritamente psiquiátricos, mas poderiam ter sintomatologia derivada.: sífilis (10,80%), deficiência intelectual (8,08%), epilepsia (4,06%), alcoolismo (3,81%); 2.023 (93,40%) prontuários sem observação médica; 08 (0,37%) pacientes diagnosticados "sem perturbação mental"; 37 (1,71%) "sem diagnóstico conclusivo"; 920 (42,47%) prontuários sem dados de tratamentos; 213 (9,83%) sem definição de tratamentos. Conclusão: múltiplos diagnósticos para mesmo indivíduo; alguns pacientes não tinham quadros psiquiátricos; tratamentos repetidos, majoritariamente orgânicos, não produziram resultados efetivos

Objective: to analyze diagnoses and treatments in patients at the Juquery Hospital during the Vargas period. Method: a quantitative-qualitative, exploratory-descriptive study, analyzing the data using documentary analysis and historical documents. Results: 2. 166 medical records analyzed; times of social conflict and war with an increase in arrests and hospitalizations; multiple diagnoses for patients; inconclusive diagnoses; main diagnoses: schizophrenia (23.59%), manic depressive psychosis (4.20%), various psychoses (4.02%), delirium (3.83%), paraphrenia (3.60%), depression (3.19%), mental confusion (2.91%) made up 45.34% (982) of the total; conditions that were not strictly psychiatric, but could have derived symptoms: syphilis (10.80%), intellectual disability (8.08%), epilepsy (4.06%), alcoholism (3.81%); 2. 023 (93.40%) medical records without medical observation; 08 (0.37%) patients diagnosed "without mental disorder"; 37 (1.71%) "without conclusive diagnosis"; 920 (42.47%) medical records without treatment data; 213 (9.83%) without treatment definition. Conclusion: multiple diagnoses for the same individual; some patients did not have psychiatric conditions; repeated treatments, mostly organic, did not produce effective results

Objetivos:analizar los diagnósticos y tratamientos de los pacientes del Hospital de Juquery durante el período de Vargas. Método:estudio cuantitativo-cualitativo, exploratorio-descriptivo, analizando los datos mediante análisis documental y documentos históricos. Resultados: 2. 166 historias clínicas analizadas; época de conflicto social y guerra con aumento de detenciones y hospitalizaciones; diagnósticos múltiples para los pacientes; diagnósticos no concluyentes; principales diagnósticos: esquizofrenia (23,59%), psicosis maníaco depresiva (4,20%), psicosis diversas (4,02%), delirio (3,83%), parafrenia (3,60%), depresión (3,19%), confusión mental (2,91%) constituyeron el 45,34% (982) del total; afecciones no estrictamente psiquiátricas, pero que podían tener síntomas derivados: sífilis (10,80%), discapacidad intelectual (8,08%), epilepsia (4,06%), alcoholismo (3,81%); 2. 023 (93,40%) historias clínicas sin observación médica; 08 (0,37%) pacientes diagnosticados "sin trastorno mental"; 37 (1,71%) "sin diagnóstico concluyente"; 920 (42,47%) historias clínicas sin datos de tratamiento; 213 (9,83%) sin definición de tratamiento. Conclusión: múltiples diagnósticos para el mismo individuo; algunos pacientes no tenían afecciones psiquiátricas; los tratamientos repetidos, en su mayoría orgánicos, no produjeron resultados efectivos

Public health experiences from interwar Croatia (Yugoslavia) and making western medicine in the 1930s China

To gain control and domination over a particular territory, medicine was often used as a tool for promoting different interests. Using the activities of the League of Nations Health Organization and the Rockefeller Foundation on the territory of China in 1930s, this paper analyses the interconnection of the international and local factors in the transformation of the traditional Chinese milieu to suit the new and trendy public health projects. These activities were conducted not only to improve the public health conditions in the country, but also to introduce the Chinese public health to the processes of internationalization and standardization to the west oriented type of medicine and medical education. Initiated processes necessarily interfered with the political influences, economical interests and cultural environment as well as with military actions in this very turbulent time of Chinese history. Public health activities were carried out by the group of international experts. Among them the main position took two Croatian physicians: Andrija Stampar (one of the founders of the World Health Organisation later) and Berislav Borcic (a director of the School of Public Health in Zagreb). On the basis of correspondence between these two physicians, as well as the travel diary of Andrija Stampar, this essay presents some less known details about the situation in China and the interlacing between politics and medicine.

Representações sócio-históricas de uma doença: um estudo sobre cartazes de campanhas para o combate à hanseníase na segunda metade do século XX / Socio-historical representations of a disease: a study of posters from campaigns against Hansen's disease during the second half of the twentieth century

Resumo Este artigo analisa o uso de fontes iconográficas no contexto das campanhas educativas para o combate à hanseníase numa perspectiva sócio-histórica em quatro momentos: décadas de 1950, 1960, 1980 e 1990. São analisados quatro cartazes para identificar os elementos (textuais, visuais ou gráficos) utilizados para elaborar um discurso sobre a doença e os doentes; suas transformações discursivas e permanências, além de verificar como se tornaram parte de uma narrativa de memória institucional ligada à saúde pública paulista. As fontes estudadas fazem parte da coleção Cartazes de Campanhas de Saúde, cujos itens foram produzidos por diversas instituições ligadas à saúde pública e integram o acervo do Museu de Saúde Pública Emílio Ribas.

Abstract This article analyzes the use of iconographic sources in the context of educational campaigns to combat Hansen's disease from a socio-historical perspective at four points in time: the 1950s, 1960s, 1980s, and 1990s. Four posters are analyzed to identify the elements (textual, visual or graphic) used to develop discourse on this disease and those it affected and transformations and permanences in this discourse, as well as to verify how they became part of a narrative of institutional memory linked to public health in the state of São Paulo. These were produced by various public health institutions and are part of the Health Campaign Poster Collection held by the Emílio Ribas Public Health Museum.

Conexões históricas entre as políticas de rastreamento do câncer de colo do útero e a educação profissional em citopatologia no Brasil / Historical connections between cervical cancer screening policies and professional education in cytopathology in Brazil / Conexiones históricas entre las políticas de rastreo del cáncer de cuello uterino y la formación profesional en citopatología en Brasil

Resumo Os técnicos em citopatologia são fundamentais para o rastreamento do câncer de colo do útero, porém existem lacunas na sua formação. Nesta revisão de literatura, com abordagem qualitativa, realizada na Biblioteca Virtual em Saúde e na SciELO, sem recorte temporal, descrevemos o histórico das políticas públicas de combate ao câncer de colo de útero, relacionando-o à história da educação profissional técnica em citopatologia, analisando as conexões entre tais sequências de eventos. Numa perspectiva histórica, a educação profissional em anatomia patológica se deu principalmente pela formação em serviço, porém o campo da formação técnica em citopatologia destoa desse modelo. Esforços diversos para estruturar os currículos na área e reduzir as discrepâncias nessa formação foram realizados. Contudo, disputas entre interesses político-econômicos, marcando a divisão técnica do trabalho no país, somadas a embates corporativos no trabalho em citopatologia, e o descompasso entre ações de educação e de rastreamento impediram a materialização efetiva desses esforços. A demanda pela incorporação de novas tecnologias acentua ainda mais a fragilidade na formação da categoria. Somente com ações governamentais concretas de formação e de regulamentação profissional será possível transformar esse cenário, favorecendo o desenvolvimento e a ampliação das campanhas de detecção precoce do câncer.

Abstract Cytopathology technicians are fundamental for cervical cancer screening, but there are gaps in their training. In this literature review, with a qualitative approach, carried out in the Virtual Health Library and in SciELO, without temporal clipping, we describe the history of public policies to combat cervical cancer, relating it to the history of technical professional education in cytopathology, analyzing the connections between such sequences of events. In a historical perspective, professional education in pathological anatomy was mainly through in-service training, but the field of technical training in cytopathology differs from this model. Various efforts have been made to structure curricula in the area and reduce discrepancies in this training. However, disputes between political and economic interests, marking the technical division of labor in the country, added to corporate clashes in the work on cytopathology, and the mismatch between education and screening actions prevented the effective materialization of these efforts. The demand for the incorporation of new technologies further accentuates the fragility in the formation of the category. Only with concrete government actions of training and professional regulation will it be possible to transform this scenario, favoring the development and expansion of campaigns for early detection of cancer in Brazil.

Resumen Los técnicos en citopatología son fundamentales para el rastreo del cáncer de cuello uterino, pero existen lagunas en su formación. En esta revisión bibliográfica, con abordaje cualitativo, realizada en la Biblioteca Virtual en Salud y en SciELO, sin marco temporal, se describe la historia de las políticas públicas de combate al cáncer de cuello uterino, relacionándola con la historia de la formación técnico-profesional en citopatología, analizando las conexiones entre tales secuencias de eventos. Desde una perspectiva histórica, la formación profesional en anatomía patológica se basó principalmente en la formación en servicio, pero el campo de la formación técnica en citopatología difiere de este modelo. Se han hecho varios esfuerzos para estructurar los planes de estudio en el área y reducir las discrepancias en esta formación. Sin embargo, las disputas entre intereses políticos y económicos, que marcan la división técnica del trabajo en el país, sumadas a los enfrentamientos empresariales en el trabajo de citopatología, y la discrepancia entre las acciones de educación y de rastreo impidieron la materialización efectiva de estos esfuerzos. La demanda por la incorporación de nuevas tecnologías acentúa aún más la fragilidad en la formación de la categoría. Solo con acciones gubernamentales concretas de capacitación y regulación profesional será posible transformar este escenario, favoreciendo el desarrollo y la expansión de las campañas de detección temprana del cáncer en Brasil.

A saúde como campo de batalha: doenças e artes de curar no Brasil, 1750-1822 / Health as a battlefield: diseases and the healing arts in Brazil, 1750-1822

Resumo O artigo explora como as doenças eram pensadas e enfrentadas na América portuguesa no início da década de 1820, pouco antes da consolidação da ruptura política com Portugal que tornou o Brasil um país independente. Analisa quem foram os indivíduos chamados para tratar as doenças da população sofredora, seus saberes e terapêuticas. Para tanto, inicia-se com um recuo no tempo, enfatizando as influências das reformas do Império português sobre o saber médico na segunda metade do século XVIII. A primeira parte do artigo se dedica a explorar as complexas e multifacetadas práticas de cura na América portuguesa, resultantes das misturas entre as concepções tradicionais sobre o corpo e a doença que faziam parte das referências culturais da população local. Em seguida, analisa alguns dos embates institucionais e políticos envolvidos na consolidação da medicina científica no Brasil, especialmente após a transferência da Corte portuguesa para o Rio de Janeiro. Apesar do prestígio político dos médicos acadêmicos, os praticantes das artes da cura contavam com amplo apoio da população, além de encontrarem mobilidade social nas brechas das relações clientelistas que marcavam a cultura política do período.

Abstract This article explores how diseases were contemplated and faced in Portuguese America in the early 1820s, shortly before the consolidation of the political rupture with Portugal that made Brazil an independent country. It analyzes who the individuals called to treat the diseases of the suffering population were, along with their knowledge and their therapies. To achieve this, we must begin by taking a step back in time, emphasizing the influences of the reforms of the Portuguese Empire on medical knowledge in the second half of the eighteenth century. The first section of the article is dedicated to exploring the complex and multifaceted healing practices in Portuguese America, resulting from the mixtures between traditional concepts about the body and the diseases that were part of the cultural references of the local population. The article then moves on to analyze some of the institutional and political conflicts involved in the consolidation of scientific medicine in Brazil, especially after the transfer of the Portuguese Court to Rio de Janeiro. Despite the political prestige of academic doctors, practitioners of the healing arts had broad support from the population, in addition to finding social mobility in the breaches of clientelistic relationships that marked the political culture of the period.

A "realidade do saber e da habilidade que se inculca": clima, médicos e saúde pública no Brasil, 1808-1835 / The "reality of the knowledge and the ability instilled": climate, doctors, and public health in Brazil, 1808-1835

Resumo Esse artigo analisa os esforços de construção de espaços próprios à intelectualidade médica no Brasil a partir da transferência da Corte de Lisboa para o Rio de Janeiro em 1808, passando pelo processo de independência do país, até a criação da Academia Imperial de Medicina, em 1835. A partir dessas iniciativas, procurou-se afirmar a proeminência do saber médico-científico diante das práticas de cura tradicionais, bem como uma agenda higiênica para a nação independente, fortemente atrelada à legitimação de uma expertise local sobre a climatologia brasileira. Ao longo desse processo, algumas lideranças médicas envolvidas buscavam afirmar a convergência entre o discurso higiênico e os interesses do Estado imperial nascente, ao mesmo tempo em que anunciavam renovar os mecanismos de legitimação da carreira que, supostamente, passavam a se dar pelo mérito científico em detrimento dos favorecimentos clientelares típicos do Antigo Regime.

Abstract This article analyzes the efforts to build spaces for the medical community in Brazil since the transfer of the Court from Lisbon to Rio de Janeiro in 1808, through the country's independence process, until the creation of the Imperial Academy of Medicine, in 1835. Such initiatives affirm the prominence of medical-scientific knowledge in the face of traditional healing practices, as well as a hygienic agenda for the independent nation, strongly linked to the legitimation of local expertise in Brazilian climatology. Throughout this process, some medical leaders involved sought to affirm the convergence between the hygienic discourse and the interests of the nascent imperial state, while at the same time announcing the renewal of the mechanisms of legitimation of the career that, supposedly, started to be given by scientific merit instead of the patronage system typical of the Ancien Régime.

Entre a ausência em Alma-Ata e o Prevsaúde: a atenção primária à saúde no ocaso da ditadura / Between absence from Alma-Ata and Prevsaúde: primary health care in the twilight of the Brazilian dictatorship

Resumo Com base em documentos pessoais de Ernesto Geisel e matérias na imprensa, o artigo discorre sobre os bastidores da decisão de o Brasil não participar da Conferência Internacional sobre Atenção Primária à Saúde, realizada em 1978, em Alma-Ata, URSS. Sugere que os ministérios da Saúde e das Relações Exteriores avaliaram de maneiras distintas a importância da reunião no Cazaquistão, resultando em encaminhamentos conflitantes ao presidente da República. Estabelecida a ausência brasileira, o artigo traz contribuições acerca das formas pelas quais os preceitos consolidados na declaração de Alma-Ata foram compartilhados pelos círculos sanitaristas no país das mais distintas posições ideológicas, tendo inclusive orientado a formulação de programas ainda no regime militar e com implicações importantes sobre iniciativas posteriores.

Abstract Drawing on personal documents from Ernesto Geisel and press reports, this article discusses the background to the decision by Brazil not to take part in the International Conference on Primary Health Care held in Alma-Ata, USSR, in 1978. It is suggested that the Ministry of Health and the Ministry of Foreign Affairs had different views on the importance of the meeting in Kazakhstan, resulting in their submitting conflicting recommendations to the president of Brazil. It also investigates how the precepts consolidated in the Declaration of Alma-Ata were shared among Brazilian health specialists of different ideological persuasions, even to the point of serving as a blueprint for programs devised under the dictatorship, with implications for the development of later initiatives.

Dona Ivone Lara e terapia ocupacional: devir-negro da história da profissão / Dona Ivone Lara and Occupational Therapy: the becoming-black of the profession's history

Resumo Este ensaio apresenta uma análise das contribuições de memórias negras que perpassam a terapia ocupacional - colocando em tela a história de Yvonne Lara. Yvonne Lara foi enfermeira, assistente social e especialista em terapia ocupacional. A partir dos anos 1940, realizou práticas voltadas para o cuidado de pessoas com transtornos mentais, utilizando a música como atividade terapêutica e o trabalho de articulação com a família e comunidade, na busca de processos de desinstitucionalização dos sujeitos. O texto aponta a inovação dessas práticas de cuidado, tendo em vista a hegemonia da corrente organicista e asilar que marcava a psiquiatria na época. Defende-se que o resgate de histórias como de Yvonne seja central para a reconstituição histórica da profissão, rompendo com o epistemicídio racista das contribuições do conhecimento dos povos negros. Busca-se visibilizar figuras marginalizadas pelas narrativas oficiais e construir uma diversidade epistêmica no campo, o que denominamos como o devir-negro da terapia ocupacional.

Abstract This essay presents an analysis of the contributions of black memories within Occupational Therapy field - highlighting the story of Yvonne Lara. Yvonne Lara was a nurse, social worker and specialist in Occupational Therapy. From the 1940s, her practices aimed to care for people with mental disorders using music as a therapeutic activity and working in cooperation with families and communities in her efforts to deinstitutionalize individuals. The article discusses the innovation of these care practices bearing in mind the hegemony of the organicist current and the asylum-based model that marked psychiatry at that time. It is argued that the salvaging of Yvonne's history is central to the historical reconstruction of the profession, turning from the racist epistemicide against the contributions of the knowledge of black people. Herein, we seek to give visibility to individuals who were marginalized by official narratives and to build an epistemic diversity in the field, which we denominate the becoming-black of Occupational Therapy.