Diseaseofthecentury:tuberculosisanditseffectsonRiodeJaneiro

"Boca de lobo" - Criolo - Songwriters: Criolo; Nave; Daniel Ganjaman

Tuberculosis is an old acquaintance of Rio's residents. As early as 1772, cases of "tísica" were already being reported, as one of the variants of Mycobacterium tuberculosis was also called. At that time, the disease was fought with infusions and syrups made from medicinal plants such as watercress, jatobá and cipó-chumbo. The "white plague" was brought by Europeans to Portuguese America during the colonization of the continent. Since then, dispensaries, sanatoriums, religious brotherhoods, hygiene and prophylaxis posts, health centers, outpatient and hospital networks, philanthropic institutions and, more recently, the Unified Health System (SUS) have been essential in fighting the disease in the city.

Image description: The image is a black-and-white photograph of a group of visiting nurses from the Inspetoria de Propylaxia da Tuberculose. They are standing in a line, with their backs to the camera, in front of a building. At the top of the image, there are two signs reading "D.N.S.P." and "Inspectoria de Propylaxia da Lepre e das Doenças Venereas" and "D.N.S.P. Inspectoria de Propylaxia da Tuberculose." The nurses wear white uniforms and white caps.

A decisive chapter in this history of scientific innovations and medical achievements was the Carlos Chagas Reform, in 1920, which, among other actions, created the National Department of Public Health (DNSP). This agency was responsible for greater training in preventive patient care through education campaigns, combating infectious agents and means of transmission, oversight and intervention in risk areas, home care, and public service. All these efforts were carried out by teams of public health physicians, health inspectors, and visiting nurses. Another important step was taken in 1927, with the creation of the Brazilian League Against Tuberculosis -- now the Ataulpho de Paiva Foundation -- responsible for manufacturing the Bacillus Calmette-Guérin (BCG) vaccine in Rio de Janeiro.

Institutional Video. Dir.: Ricardo van Steen, 2008. YouTube, Fundação Ataulpho de Paiva channel

Over the centuries, tuberculosis has manifested in different forms and varying levels of contagion. Between 1840 and 1950, the disease was considered a constant threat to the health of residents of the hillside communities, favelas, and suburbs of what was then the federal capital. It was a chronic disease, the worsening of symptoms was slow, and it was directly linked to the precarious living conditions of patients.

Febre, hemoptise, dispneia e suores noturnos A vida inteira que podia ter sido e que não foi Tosse, tosse, tosse Mandou chamar o médico: - Diga trinta e três - Trinta e três... trinta e três... trinta e três... - Respire - O senhor tem uma escavação no pulmão esquerdo e o pulmão direito infiltrado. - Então, doutor, não é possível tentar o pneumotórax? - Não. A única coisa a fazer é tocar um tango argentino.

Everyone was subject to the contagion: from the enslaved person, who could barely rest on the floor of the slave quarters after a day of forced labor; to the factory worker, who struggled on the job to pay rent for a room in the unhealthy tenements downtown; to the inveterate bohemian, who spent the small hours in maxixe, chorinho, and samba circles in Cidade Nova. Despite the aura of romanticism surrounding the disease - the image of a "consumptive" was associated with the idea of sensitivity to the arts, to love, to refinement of feeling - at the moment of death there was no distinction, it killed poets, writers, and workers alike.

Image description: This is a black-and-white photograph of a historical scene. On the left, we see two women and a baby. One of them holds the baby while the other looks on. On the right, a man is seated in a chair, apparently receiving medical care. In front of him, there is a table with medical equipment. In the lower part of the image, we see a large ceramic container. In the background, there is a simple structure with an open window.

From time to time, cases would rise dramatically, causing the disease to take on the traits of an epidemic, a scourge, a calamity, and tuberculosis became part of Rio de Janeiro's urban imagination. Because of this, it was widely debated by the population through newspaper headlines, magazine covers, popular songs, poems, cartoons, novels, films, and soap operas. There was no shortage of real stories and events that marked daily life in Rio, strengthening the collective memory surrounding the disease and its unwelcome closeness to the city.

Poster for the exhibition "Images of the White Plague." Cover of the Liga Brasileira contra a Tuberculose almanac, 1929. Collection: Fundação Oswaldo Cruz.

Image description: The image is a photograph of a woman with short, wavy hair, wearing a green outfit. She has her hands resting on her chin, looking to the side. In the background, there is a light blue backdrop. In the upper left corner, there is a red cross. At the top of the image, it reads "ALMANACK = 1929" in blue. Below, it reads "LIGA BRASILEIRA CONTRA À TUBERCULOSE" in larger letters.

The death of Sinhô, known as the "King of Samba," is one of these sad events. In 1930, with his health already quite weakened by illness and his musical career in crisis, the composer relied on the solidarity of friends who helped him with his daily expenses. On August 4th, Sinhô was crossing by ferry from Ilha do Governador, where he lived, to the Pharoux pier, in Praça XV, carrying a new samba in his pocket, when he suffered a violent respiratory crisis. The other passengers aboard the vessel still tried to help him. However, he did not survive the coughing up of blood from his lungs. The next day, samba woke up in mourning.

Another victim of the disease was Noel Rosa, considered the "bachelor of Vila," when it came to samba and street smarts. Around 1935, he had been away from the buzz of Rio nightlife: word was going around that the "philosopher of samba" was ill and was spending some time in Belo Horizonte, a city famous for its air favorable to tuberculosis treatment. But he stayed there only a short while because he felt compelled to return to try to win back the love of Cecy, a cabaret dancer from Lapa. Without proper medical care, the disease would worsen in the following months. His last composition was a sad samba, in the form of a farewell, dedicated to his muse: "Último Desejo." Noel Rosa did not have time to hear the recording released posthumously. He passed away on May 4, 1937, at the age of 26.

Although the treatment is quite effective, the disease is still currently responsible for a large number of deaths. The rates are still as alarming as they were at the turn of the 19th and 20th centuries, especially in a context in which a large part of the population faces conditions of social, economic, and sanitary vulnerability, the main factor in its spread. In the contemporary scenario, the prison population is the most affected, due to the lack of adequate epidemiological surveillance in prisons. Current data on the disease in Rio de Janeiro remain alarming.

In 2020, the national mortality rate reached 2.2 per 100,000 inhabitants. In Rio, that number is more than double. According to the report by the City Council's Parliamentary Front for the Fight Against Tuberculosis, 102 cases per 100,000 residents are recorded in the city. The lack of investment in public health policies is one of the causes of this situation. Bangu has the highest number of records in the capital: 723 cases per 100,000 people. In June 2020, there were 355 cases. Rocinha and Complexo do Alemão, among other communities, also have alarming rates.

Em brigas não tomo parte, A morros não subo não: Que se nunca tive enfarte, Só tenho meio pulmão. No amor ainda tomo parte, Mas não me esbaldo, isso não: Que se nunca tive enfarte, Só tenho meio pulmão. De Eros a arriscada arte Sempre usei com discrição Que se nunca tive enfarte, Só tenho meio pulmão. Bem que desejara amar-te Sem medida nem razão. Mas qual! Se não tive enfarte, Só tenho meio pulmão.

"To my friend Edgard" - João Bosco - Composers: Noel Rosa and João Bosco - 1978