FEDERAL UNIVERSITY OF RIO DE JANEIRO Medical School History, Health and Society Laboratory

1. FEDERAL UNIVERSITY OF RIO DE JANEIRO Medical School History, Health and Society Laboratory FRY FOUR OR SIX SMALL LIZARDS THE JOURNEYS OF a MEDICAL PRESCRIPTION Diana Maul de Carvalho¹, Rafael Mello Galliez², ¹ Medical School/ UFRJ ² Resident in DIP/Oswaldo Cruz Foundation e-mail dianamaul@hotmail.com

2. Smallpox is a viral disease transmitted directly from person to person or through contact with contaminated clothes or other materials that may preserve the virus, and is one of the oldest so called “pestilences”, having been clearly described for more than a thousand years and probably known to man, in Asia, Africa and Europe, for more than two thousand years, having its aetiological agent adapted to man as a consequence of animal husbandry (McNeill,1993). In the Americas there is no register of its presence before the arrival of Europeans in the XV century. Smallpox is clearly registered in Brazil from the XVII century on(Fernandes,1999). Considered eradicated in the 1980s, as the result of a major international effort, its severe form, associated with dead and deformity, was present in Africa and parts of Asia in the late 1960s but was practically unknown in Brazil since the 1930s. The mild form, known as alastrim,occurred in Brazil, mainly in the hinterland, up to 1971.

4. In contrast with the great interest of Brazilian public health researchers and historians in the smallpox campaigns at the beginning of the XX century, particularly those led by Oswaldo Cruz, the Eradication Campaign of the 1960s has been the object of little attention. The disease itself progressively loses visibility after World War II as it migrates away from the urban centers and the cases diminish both in number and severity (FSESP,1964-1969). Impact of the disease for the population at the time of the campaign and of the campaign itself have not been well documented. As part of a research project on the Eradication Campaign of the 1960s, we have defined the need to investigate these questions, both in areas were the disease still occurred regularly and in those were it only occurred eventually and mainly from imported cases, at the time of the beginning of the campaign.

5. In Brazil, the Chapada Diamantina, a plateau region in the state of Bahia, was one of the last endemic smallpox areas in the 1960s and also seems to be one of the last areas to register severe cases of the disease (FSESP, 1964-1969).Based on those criteria, we selected this as one of the areas for our fieldwork. Fieldwork was developed in two ten days periods, when we interviewed 19 residents in the area since at least the 1950s, aged from 62 to 94 years. Interviews were done mostly at the home of the interviewees and were extended to 8 different localities: Lençóis, Seabra, Iraquara, Palmeiras, Wagner, Cachoeirinha, Utinga and Andaraí. Interviews were recorded with a standard tape recorder, always including explicit agreement of the interviewee as to the use of its contents for the research project in compliance with the National Ethics in Research Commission requisites. Interviews were loosely conducted starting with a brief explanation on the purposes of the research, and questions were asked as to knowledge of the disease called variola or bexiga.

8. Interviews were analyzed according to three content categories: Naming and describing the disease: identification of the disease as a distinct morbid entity, through its signs and symptoms, by the interviewee. Caring for the sick: preventive and therapeutic measures defined as such and adopted by individuals and the collectivity, once the presence (or the threat) of the disease had been identified. Death by the disease: changes in the death rituals related to the disease and behavior towards the dead and their relatives. We present here some of the results of the second content category, i.e., therapeutic measures, particularly prescriptions using animals or animal products. Other results are presented only to give context to the therapeutic propositions. We confront our findings with prescriptions for the pox, that we could identify in XVIII century medical treatises published in Portugal and England.

12. All the interviewees knew the disease that was commonly denominated bexiga. It is said to have occurred in two forms, a milder one that is known as white pox, spotted pox and variola. It is common knowledge that the milder disease followed the times of the most severe, references being as to a tamingof the disease. The most severe form known as strong pox, black pox, coarse pox, is related with high lethality (“it killed the whole house, it caused death after death”) and left scars in the survivors. The severe disease was most likely to come upon those that had “thin blood”. “In the old days, when I was a boy, there was the strong pox, later on there came the variola or weak pox. Both came with three days of fever before the pustules appeared. The strong one caused dark sores even in the face. The scars remained for life. If they (the sores) would open in the heart, one would die. The weak disease did not pass to those who slept or ate with the sick and killed no one. The scars would disappear after three years.” Sr. Lindolfo, 92 years

13. ”..when I went down the river with those girls whose aunts were sick at home. We were going to get some chickens at their house. Walking a little behind, I heard when the girl went into the house and was told that the disease was the pox. I was so scared to catch it that I run to the woods and waited for the girl very far away from that place. Today, I believe that it was no use to run, for the disease comes in the wind after you.Those who came from Utinga or other places where there was the pox, had to be smoked with cow dung before coming into town.” Sr. Nininha,78 years old “I was vaccinated and did not have the pox. I remember that the guards would use the pus of the vaccinated people to give the vaccine to others.”Dona Iara, 87 years old ‘The spotted pox, or weak, and also the strong one, were treated with liquor (cachaça) with camphor and toasted small lizards (as a tea or mixed with food). There was no doctor in town. People used teas and cow dung.”Dona Didi, 76 years old

14. “They used bitter leaves, like marijuana (maconha), gecko tea, camphored liquor and bed rest. Even cow dung was used at that time. Due to the lack of doctors, people treated themselves.”Sr. Pedro de Laura, 82 years old The repeated mention of the use of small lizards tea, with its recipe:fry a few small lizards until well toasted, in good oil, then filter and use the filtrate as an ointment, or mixed with food or to drink as a tea, reminded us of recipes we had come upon in XVIII century medical treatises. We chose to confront our findings from the interviews, with the treatment for smallpox as proposed by Luis Gomes Ferreyra, in his Erario Mineral published in 1735. The author was a Portuguese surgeon that practiced medicine in the gold mining regions of Brazil for twenty years. In his book we can read the same recipe, for the same indications, and the reference to Curvo Semmedo, a well known Portuguese physician from the late XVII/ early XVIII century.

15. In fact, in the work of Semmedo, Atalaya da vida contra as hostilidades da morte (1720) we can read the recipe: “fry four or six small lizards, alive, in half a cup of old olive oil, until they are completely toasted, then filter and use the oil to rub the affected parts, and cover the sick, and the pox will come out well”. The author informs that he learned the recipe from a peasant. The practices of so called popular medicine in Brazil have been extensively studied especially by anthropologists, mainly interested in the discussion of ‘alternative’ medical systems and have often focused on religious rituals of African or native American origin (Canesqui, 1998). The various prescriptions and the plants and other elements that compose them are usually described as part of such rituals. Teas and herbal products of traditional medicine have also been identified and studied as possible sources of new pharmacological active principles.

16. On the other hand, authors (many of them physicians) focusing on the history of medical practice in Brazil from the XVII to the XIX century, have described the many prescriptions found in the medical texts and other documents, notably those of the Jesuits, generally considering that such practices disappeared with the advent of the “scientific medicine” of the XX century (Ribeiro, 1971; Santos Filho, 1991). In the 1700, the territory of the Chapada Diamantina is a route to the gold mining areas of Minas Gerais and the expansion of the cattle raising areas of the northeast (Boxer, 2000), and the Portuguese migration due to the “gold rush” was sufficiently intense to lead to the court decree of march 1720, limiting migration to Brazil (Boxer, 1981).

17. In the late 1800, even though there are diamond prospecting activities, the area progressively loses economic and demographic relevance and becomes what members of scientific expeditions describe as a “forgotten region” (Neiva, & Pena, 1916). At this time, due to the economic changes, the Chapada Diamantina had many areas with no access to “western medicine”. In the last twenty years it has been “rediscovered” for tourism, especially eco-tourism, but is still scarcely populated.Medical facilities are still practically non existent.

18. The encounter of “archaisms” has been well documented in linguistic studies in many areas of the Brazilian north and northeast (Rosa, 2003), but we have not found similar discussions relative to the medical systems of diagnosis and therapeutics. This is just a first approach to this subject, but we consider that the findings from the interviews and the documental research so far, justify the proposal that a considerable part of what is today “folk medicine” in this area, represents the persistence of prescriptions that were commonly used in “European medicine” up to the XIX century, and that were known in Brazil at that time. This practice was totally rejected in the late 1800 with the change of paradigms represented mainly by the works of Claude Bernard, Koch and Pasteur.

19. As a final remark, we would like to point out that the “small lizards recipe” which we did not find in the English documents, is clearly stated by Curvo Semmedo as having been learned from a peasant in Portugal, and is also not to be found in the Pharmacopea Lusitana of 1704. So, it is highly tempting to suggest that this recipe may have, as so many others, made its way from “folk medicine” to “official medicine” and back again, and this is the trajectory we are mapping now.