A Showcase for the Doctors of the Sertão: the Revista Goiana de Medicina and Chagas Disease in Goiás (1955-1962)

ABSTRACT

As the official journal of the Goiás Medical Association, the Revista Goiana de Medicina transcended its original frontiers and became a vehicle for disseminating medical research by doctors from Central Brazil, giving them a high level of visibility. The editorial emphasis on Chagas disease, a serious rural endemic that threatened the interior of the country in the mid-twentieth century, is identified as a determining factor in the prominence achieved by them. Setting out from an analysis of articles and institutional correspondence, and taking the journal in question as both the source and object of research, the article reflects simultaneously on the importance of the Goiás medical journal for the institutionalization of local medicine and its relevance among scholars of American trypanosomiasis.

Keywords:
medical journals; Goiás state (Brazil); Chagas disease

RESUMO

Órgão oficial da Associação Médica de Goiás, a Revista Goiana de Medicina ultrapassou suas fronteiras originais e tornou-se veículo de divulgação das pesquisas dos médicos do Brasil Central, dando-lhes muita visibilidade. O destaque conferido em sua linha editorial à doença de Chagas, grave endemia rural que ameaçava o interior do país em meados do século XX, é fator determinante da proeminência por eles alcançada. Com base na análise de artigos e correspondência institucional, e tomando o periódico em questão como fonte e objeto de pesquisa, busca-se refletir simultaneamente sobre a importância da revista goiana para a institucionalização da medicina local e sua relevância entre os estudiosos da tripanossomíase.

Palavras-chave:
periodismo médico; Goiás; doença de Chagas

The journal of the Goiás Medical Association was born amid widespread disbelief, with only half-a-dozen colleagues deeming it possible to keep a scientific publication running deep in the interior of the country.

(RGM / Posted to Alfredo Lima Jr. on 5 February 1959)

The official journal of the Goiás Medical Association, the Revista Goiana de Medicina (RGM) was launched in the third quarter of 1955, announcing itself as a prime space of dialogue for doctors working in Central Brazil. It would continue to be published until the 1990s, despite financial problems and the irregularity with which some of its issues were released (Rezende, 2001). Among its goals were the publication of original and up-to-date articles, including those by ‘illustrious doctors’ from other states, and the exchange with other medical-scientific journals. Its primary objective was: “to continually improve the standard of medicine practiced in Goiás, preparing the ground for our future Faculty of Medicine” (Editorial, 1955, p. 1) - an objective attained in 1960. Analysing the period spanning between 1955 and 1962, this article explores two main aspects: the importance of this editorial project for the institutionalization of medicine in Goiás, and the influence acquired by the journal among scholars of American trypanosomiasis.

Although working on the periphery of national science, the Goiás doctors were among the most ideally located for studying a number of tropical afflictions, including Chagas disease. Possessing ready access to a nearby research field, since the people with these diseases visited them for treatment in their practices and clinics, these doctors were able to deepen the research into these pathologies, publishing articles on these themes and presenting works at congresses that highlighted these questions. Little by little they became identified as an unrivalled constellation of professionals in the interior of Brazil and gained national and international recognition for their activities. This fame was due not only to the originality of their research, but also to the networks of exchange and collaboration that they succeeded in establishing with Brazilian and foreign institutions and researchers. The building of this network was made possible by various strategies that increased the visibility of their activities, among them publication of Revista Goiana de Medicina. Reading through its pages we can accompany the weaving of this network and comprehend the visibility achieve by the doctors of the sertão, especially among scholars of Chagas disease.

In order to realize the proposed objectives, in the first section of this article we analyse the journal, examining it as a strategy employed by Goiás’s doctors to achieve greater integration in the national medical community. According to its editor, Joffre Rezende, the RGM was conceived from the outset as a publication at the same level as the best international scientific periodicals. Pursuing its ambition to be included in the most prestigious academic indexes of the period, the journal had a polished form and content: it was printed on high-quality paper and included in its publication guidelines the stipulation that its articles were original and previously unpublished. With a large print run, the RGM circulated among the libraries of universities, hospitals and scientific institutions, ensuring ample projection of the works published in its pages. First, therefore, we shall analyse the journal as an object, emphasizing the distribution and circulation strategies adopted.

In the second and third sections we turn to the periodical’s content, seeking to identify the themes most commonly found in its pages and the doctors publishing in it. Comprehending the RGM as a prime space of sociability, the journal reveals the main interlocutors of the Goiás doctors, along with the regions and institutions where they worked, thus enabling us to produce a map of this interaction. Access to the journal’s correspondence, both sent and received, also allowed us to map these networks of exchange and mutual support, providing an insight into the backing that the research developed locally - focused on regional pathologies, especially Chagas disease - received beyond the borders of Goiás. The international prestige of the journal and the tactics that the Goiás doctors employed to obtain this status are aspects covered in the article’s fourth and final section (Ferreira, 1996; Luca, 1999; Duarte, 2004; Dutra, 2005; Biccas, 2008).¹

From the outset it is important to emphasize the sociopolitical context of the country during the period when the journal was in circulation, which is closely related to the interest that it awakened in the Brazilian medical world. This was the 1950s, more precisely the government of Juscelino Kubitschek (1956-1960), when the links between developmentalist rhetoric and the fight against rural endemics was at a peak. Concerned with the productiveness of the rural worker, the government was mindful of the need to implement sanitary measures in order to ensure full development of the country (Hochman, 2009). Consequently, a journal focused on the pathologies most heavily afflicting the population of the interior drew attention. The emphasis given to trypanosomiasis in its editorial line reflected the fact that the disease was one of the major concerns of the period, and we attribute the journal’s notable impact to the interest that the theme attracted in the national and international medical community during the period under study.

THE JOURNAL AS A ‘VISITING CARD’: DISTRIBUTION AND CIRCULATION STRATEGIES

It has long been my wish to congratulate the noble Goiás colleagues who run the Revista Goiana de Medicina, one of the best publications that we have of the kind in Brazil, beginning with the quality of the paper on which it is printed, as well as the perfection of the graphic design that honours the medical journal in such a distinctive fashion.

(RGM / Received - sent by Alfredo Lima Jr. on 19 January 1959)

Support for the Goiás editorial project came immediately in the very first issue of the journal from the Brazilian Medical Association - the institution representing all the regional medical associations. A letter was published from the association’s president, Alípio Corrêa Netto, complementing the Goiás Medical Association (AMG) for the initiative, which demonstrated “the high degree of progress of the Goiás medical scene” (Netto, 1955, p. 2). The welcome given by this eminent figure from the medical-scientific world conferred credibility to the journal, which it would invest not only in the content, but also in the form in which it presented itself to its readership. Everything from the type of paper on which it was printed to the composition of the front cover and the layout of the articles received special attention and care from the Goiás doctors, seeking to ensure that their ‘visiting card’ (Noticiário, 1959, p. 71) was a match for the renowned scientific journals already in circulation in the country and worldwide.

Until 1957 the journal presented itself to the public with the table of contents on its cover. Though seemingly a strategic form of disseminating the new periodical, since it allowed quick access to the content, this was a very common model at the time, adopted even outside of Brazil. In 1958 the cover was modernized and the contents page moved inside the journal. A competition run by the AMG to create a new design resulted in an emblematic image, related, its creator explained, to the “Brazilian present, the transfer of the capital to the Country’s interior” (Rassi, 1958, p. 4). According to Luiz Rassi, the association’s president at the time, the new graphic layout reflected the desire for progress among the Goiás medical class (Rassi, 1958).

It is worth emphasizing that the moment when the Goiás journal emerged was already one of huge expectation concerning the prospective transfer of the federal capital to the Central Plateau region of the state. An air of euphoria is perceptible in its inaugural editorial, anticipating the numerous possibilities that would be opened up by relocation of Brazil’s capital to the interior, as well as the concern of the doctors not to be side-lined by the changes already making themselves felt. Although in 1955 there was still no certainty that the capital would be transferred, studies carried out by the government for this purpose into the 1950s,² as well as the substantial participation of Goiás’s doctors in this process, explained the huge enthusiasm shared by the doctors and expressed in the journal’s pages at its launch. While in mid-1955 this remained just a hope, albeit one motivated by concrete political decisions, by 1958 construction work on Brasília was in full swing. The new cover to the Goiás medical journal thus reflected the great transformations being experienced by the state of Goiás, especially the local medical profession, whose visibility increased as construction of the new capital advanced, drawing the country’s attention to the importance of the political project now located there.

Figure 1
Cover of the first issue of the magazine (vol. 1, no. 1, January/March 1955)

Figure 2
First cover after the modification of its design, in the first quarter of 1958

Published quarterly, each volume of Revista Goiana de Medicina was composed of four issues of approximately 100 pages each (a high number when compared to the journals of other medical associations of the time). Over the time span under consideration here, marked by the journal’s first issue and the last one before it became the official journal of the Goiás Faculty of Medicine, its publication requirements underwent few alterations. Prospective authors were informed that any original and previously unpublished work on medical sciences would be accepted for publication.³

The journal was distributed for free to all doctors of Goiás and the Minas Triangle, in consideration of the “traditional cultural and friendly ties” (RGM / Posted on 24 January 1958 to Mário Salomão). Later, in 1958, the journal widened its reach and began to be distributed freely to the doctors of Cuiabá too, a group with whom it sought to increase exchanges (RGM / Posted on 13 March 1958 to José Vinagre). The number of copies of the Goiás journal destined to these regions - accounting for more than half of its print run in 1961 (though by this time, for financial reasons, it was no longer distributed free of cost to doctors of the Minas Triangle and Mato Grosso) - demonstrates the importance that the medical professionals of Goiás, Minas Gerais and Mato Grosso attached to closer liaisons between them (Table 1).

Table 1
Destination of journal copies by state

Year / print run	Goiás	Minas Gerais	Mato Grosso	Total (%)
1956 / 1,000	283	165	--	44.8
1957 / 1,100	295	171	--	42.36
1961 / 1,200	400	250	50	58.33

• Source: Correspondence posted/sent by RGM - AMG Archive (1955-1962)

The sources reveal the considerable effort made by Goiás’s doctors to establish exchanges with as many scientific institutions as possible in Brazil and internationally, most of the journal’s issues being produced with this aim in mind. As well as doctors working in Central Brazil, the Goiás journal was received by university libraries, medical schools, medical associations, research institutes and hospitals spread across Brazil and globally with whom the Goiás doctors hoped to establish exchanges. Through this system, the medical association succeeded in maintaining and updating its own library, intended for the unrestricted use of the region’s doctors. Table 2 shows a steady increase in the number of publications received in exchange for the Goiás counterpart between 1956 and 1958, a trend that can be projected onto the following years given the expanding circulation of the RGM.⁴

Table 2
Publications received in exchange

Year	Brazil	Abroad	Total
1956	31	23	54
1957	55	43	98
1958	63	64	127

• Source: Correspondence posted/sent by the RGM - AMG Archive (1955-1962)

In terms of international circulation, the United States is the country responsible for the fact that North America figures among the regions that most sent periodicals in exchange for the RGM. Many of these publications came from local medical associations, as well as the Boletín de la Oficina Sanitária Panamericana, published in Washington. Italy and Spain were the European countries that most sent journals in exchange for the Goiás counterpart, accounting for half of the total number coming from this region. Three publications were sent from the United Kingdom, including the Tropical Diseases Bulletin - examined later due to its importance in the dissemination of the RGM - and the British Medical Journal, one of the world’s oldest and most prestigious medical periodicals (Bartrip, 1992). Italy, Germany, France and Portugal each sent at least one publication related to the theme of tropical medicine and parasitology. Chile, Ecuador and Venezuela also exchanged publications related to these themes, though Peru, Argentina and Uruguay headed the list of South American countries with the most titles exchanged, picking out here the Anales del Instituto de Medicina Regional, a publication linked to the Universidad Nacional de Tucumán (Graph 1).⁵

Graph 1
International RGM circulation (1955-1962) (continent / number of periodicals exchanged)

In terms of national circulation, more than half (35) of the 61 periodicals sent from the Southeast region came from Rio de Janeiro. Among these we can highlight Brasil-Médico and Memórias do Instituto Oswaldo Cruz, given the longevity and importance of both publications (the first had been launched in 1887, the second in 1909). São Paulo comes a close second with 24 titles exchanged with the RGM. The South and Northeast regions sent eight journals each, linked to the medical associations of Rio Grande do Sul, Santa Catarina, Piauí, Alagoas, Minas Gerais and Pernambuco (Graph 2).

Graph 2
National RGM circulation (1955-1962) (region / number of exchanged periodicals)

No thematic preferences are evident among the exchanged journals, since all the publications received by the RMG were added to the AMG library. However, it is worth emphasizing the interest in specific periodicals, focused on the themes of parasitology and tropical medicine, even though the discontinuity of the sources does not allow us to infer their predominance over the rest. All the indications are that the primary interest of the Goiás medical profession was to make the RGM known and circulated as widely as possible, especially among renowned institutions - something not always achieved, given the rejections received for some requests for exchange.⁶ Nonetheless, the Goiás doctors were successful in their endeavour, achieving a high circulation for their journal and a good collection of publications, keeping the doctors who used the library up-to-date.

Despite the success of the exchange project, which made the journal known and sought in various regions of Brazil and abroad, the RGM experienced financial difficulties from its first year of life. It was maintained by subscriptions and advertisements placed by companies linked to medicine and pharmaceutics. However, the rise in the price of paper, labour costs and the fabrication of plates led to an imbalance in the accounts from 1958, directly affecting the regularity of publication (RGM / Posted on 31 December 1958 - report). Doctors who waited with works in press, unhappy with the delay in sending out the journal, requested withdrawal of their articles (RGM / Posted on 28 May 1961 to Paulo Becker, Ribeirão Preto Faculty of Medicine). Although the delays threatened to compromise one of the journal’s main stipulations- the unpublished nature of its contents - this criterion was maintained and the articles who did not meet it were rejected.⁷

Responsibility for evaluating the quality of the works sent to the journal and for deciding whether to publish them or not was given to a scientific board composed of ten members. At the top of the administrative structure was the chief director, in this case the acting president of the AMG. His responsibilities included appointing the members of the scientific board and those integrating the redaction and finance committees. Each member’s mandate lasted for an indeterminate period, the director tasked with making any necessary changes. A body of redactors completed this structure.⁸

As Loudon & Loudon (1992) observe in a work on nineteenth-century medical journals, the ‘house journals’ - periodicals linked to institutions, as in the case analysed here - held some advantages over the rest. As well as counting on a captive readership and resources to cover their publication costs, obtained from the annual fees paid by members, they could also find the main authors for their articles among the associated doctors, thereby providing them with an almost inexhaustible source of raw material for enriching their content. In the case of the Goiás journal, remaining in the post of redactor was conditional on continued collaboration with the periodical, its editorial members expected to publish at least one article per year. Despite the large number of doctors who accepted this assignment - almost one hundred during the period studied - in a report produced at the end of 1957 the chief editor highlighted the dearth of contributions and suggested a maximum period for these redactors to submit their work to the periodical or else face dismissal from the journal (RGM / Posted on 31 December 1957 - report). The promise was rigorously fulfilled, with only 39 of the 81 redactors who made up the corpus of redactors in 1959 remaining in the post the following year.⁹

REVISTA GOIANA DE MEDICINA: A JOURNAL FOR DISSEMINATING RESEARCH ON CHAGAS DISEASE

Between 1955 and 1962 the Goiás journal was composed of sections that we could describe as ‘fixed,’ given their regularity, and others that appeared more intermittently in its pages. Among the fixed sections were the Editorial (written by the chief director), original articles, news and reviews (of works published in Brazil and abroad). In the period considered here, the editorials discussed a wide variety of subjects, including Chagas disease - the theme of three issues that corresponded to special editions of the journal dedicated to the sickness.

A disease typical of Central Brazil, caused by a parasite - Trypanosoma cruzi - and transmitted to humans via the bite of the barbeiro, the ‘kissing bug’, Chagas disease was present in all of the journal’s issues from its launch. Given that the sickness primarily affected adult rural workers of working age, it posed a threat to the country’s development and drew the attention of all the specialists committed to its eradication, whether based in the interior or on the coast. Because of the disease, the Goiás journal gained widespread visibility, turning into a key bibliographic reference for all those interested in the subject. Timidly at first, the journal gradually became the main channel for disseminating scientific inquiries into this pathology that plagued the interior of Brazil, despite the criticisms made concerning the prevalence of the theme in its pages:

A number of criticisms have been made concerning the nature and usefulness of some of the published works. Some colleagues have even said that the journal has been dedicated principally to Chagas disease. We deserve neither blame nor merit for this fact. To date no collaboration received has failed to be published and if we have published many works on Chagas disease, this is because we have received works on the subject. Indeed it is precisely the fact that the Revista Goiana de Medicina has been transforming, by virtue of circumstances, into a journal specialized in Chagas disease that has raised the publication’s profile in other countries, making it procured in foreign libraries, and has provided us with valuable exchanges with other medical journals that have enriched the AMG’s collection. It was also thanks to Chagas disease, an eminently Brazilian and Goianiense subject, that our journal has been cited and distinguished by other international journals with citations and abstracts of works published here... (RGM / Posted on 31 December 1957 - report, our italics)

Not by chance, the works on the disease also interested its editor. Joffre Rezende had studied Chagas disease in depth and was a leading figure in the process that culminated in verification of a new form of manifestation of the disease in the 1950s.¹⁰ Reflecting his own research focus, he edited special issues of the journal on the subject at regional (vol. 2, no. 4, 1956), national (vol. 4, no. 2, 1958) and international level (vol. 5, no. 4, 1959). In spite of the criticisms, from 1958 it became a ‘commitment of honour’ assumed by the publication’s directorate to include at least one work on the theme in each issue of the periodical (RGM / Posted on 28 January 1958 to Thereza Freire).

Despite its editor’s affinity with the theme, though, the predominance of Chagas disease in the RGM’s thematic index is primarily related to the profile that the journal acquired over the period under study, namely as a periodical focused especially on the regional diseases that most threatened the workers of Central Brazil. Chagas disease had already been registered as a serious problem in the state since the 1940s, when epidemiological investigations observed the prevalence of the disease in some municipalities (Freitas; Mendonça, 1951). The campaign against the kissing bugs (Triatoma infestans) had been led by the National Malaria Service since 1951 and was later continued by the Goiás division of the National Department of Epidemics, created in 1956 (Carvalho; Verano, 1956). However, the demands of the doctors at regional congresses, especially at the Medical Congresses of the Minas Triangle and Central Brazil,¹¹ allow us to ascertain that the actions implemented by the government were insufficient. The works presented on these occasions indicated that the incidence of the disease was much higher than the public authorities thought, which is why the doctors demanded the realization of more comprehensive serological surveys to evaluate the true extent of the endemic. At the same time, they requested the intensification of the fight against the triatomines by residual action insecticides.

The journal of the Goiás doctors was thus becoming consolidated as an important vehicle for the doctors dealing with such diseases in their day-to-day work, whether in their research laboratories in the major centres, in institutes or faculties, or in their private practices and clinics, as applied to those from Goiás and Minas Gerais especially. Making up more than 50% of the total published articles, American trypanosomiasis became the journal’s ‘flagship.’ The higher number of works dedicated to this disease reflects the commitment of the Goiás medical profession to studying the local pathologies. Along these lines, it is interesting to emphasize the absence of articles on leprosy and tuberculosis, for example - problems that had been concerning the Goiás medical profession and were widely debated in the same regional congresses. Likewise, the low number of works on malaria, schistosomiasis and even pemphigus foliaceus, a disease whose aetiology is still unknown today, is striking. Some of these afflictions had also been prominent themes in the regional medical events, and it is surprising that they did not obtain more space in the periodical.¹²

Nonetheless, the scarcity of works on these diseases makes sense if we take into account the weight that research into Chagas disease came to acquire within the medical-scientific knowledge network constructed by the Goiás doctors ever since the foundation of their medical association in 1950. Bearing in mind that the emphasis on this disease guaranteed higher circulation of the periodical, stimulating even renowned figures from the national medical scene to submit works, as we shall see in the next section, it was no more than natural that they continued to foment this exchange network by focusing research and articles on the theme. In this sense, it the projection achieved by the Goiás journal can be said to have been due to Chagas disease. Because of the latter, a large number of scientific institutions, doctors and students of medical faculties in Brazil and abroad began to request the journal. There were many requests both for special issues and for annual subscriptions to the RGM, which thus began to circulate beyond national frontiers in the process.¹³

WEAVING THE NETWORK: THE INTELLECTUAL EXCHANGE FOMENTED BY TRYPANOSOMIASIS

Goiás doctors made up the majority of the authors published in the journal (Graph 3), but were closely followed by doctors from São Paulo and Rio de Janeiro. Minas Gerais, Bahia and Mato Grosso completed the national pictures, in which Brasilia also stood out. An issue commemorating the 50th anniversary of the discovery of Chagas disease, published in 1959, is responsible for the articles written by foreign authors.

Graph 3
Distribution of doctors to publish in the RGM by origin (1955-1962)

Next we can provide a more detailed account of the origin - by municipality - of these authors (Graph 4). Although other Goiás towns and cities were represented in the journal, we can see that most of the state’s doctors resided and worked in the capital, Goiânia. Rio de Janeiro comes soon after, followed very closely by Ribeirão Preto - the city which places São Paulo second on Graph 3, since 19 of the 29 doctors from this state worked in this city in the interior of São Paulo. Eight doctors from the city of São Paulo wrote for the RGM, while seven authors from the cities of the Minas Triangle (Araguari, Uberaba and Uberlândia) sent an article to the journal for publication. Combined, doctors working in Goiás, Ribeirão Preto and the Minas Triangle amounted to just over half of the total number publishing in the journal during the period under consideration, which enables us to conclude that it achieved one of the goals listed in its very first editorial and functioned, therefore, as a means for doctors from Brazil’s interior to increase the visibility of their work (Editorial, 1955, p. 1).

Graph 4
National distribution of the doctors who published in the RGM by the city in which they worked (1955-1962)

This quantification provides an insight into the close ties maintained between the Goiás medical profession and the doctors working in Ribeirão Preto and the Minas Triangle with whom they established dense networks of mutual collaboration. In relation to Ribeirão Preto, this exchange was constructed through the mediation of the medical faculty, founded in the city in 1952 and linked to the University of São Paulo (USP). A shared interest in Chagas disease brought these doctors together in the mid-1950s. Fritz Koeberle, head of the Pathology Department of the Ribeirão Preto Faculty of Medicine (FMRP), and José Lima Pedreira de Freitas, from the Department of Hygiene and Preventative Medicine of the same institution, maintained very close ties with the Goiás doctors, comprising their main interlocutors. Beyond the intense collaboration in studies related to Chagas disease, these doctors participated actively in regional congresses and forged genuine partnerships with the Goiás medical professionals, contributing decisively to the visibility achieved by the latter. Pedreira de Freitas, indeed, was among the honorary members of the AMG and one of the personalities who most inspired the Goiás doctors (RGM / Posted on 4 August 1956 to José L. Pedreira de Freitas).

Meanwhile the relation with the doctors from the Minas Triangle had begun to take shape a little earlier, in the 1940s, at the first editions of the medical congresses to be held in the region. The growing participation of the Goiás doctors in these events led not only to the expansion of their scope and the addition of the designation ‘Central Brazil’ to their name (becoming the Medical Congress of the Minas Triangle and Central Brazil), but above all to the intensification of the intellectual exchanges between the two groups, stimulating collaborations and increasing the backing given to the research being conducted by both groups. One sign of the affinity between the doctors of Goiás and the Minas Triangle is the fact that the latter shunned the periodical linked to the Minas association in favour of the Goiás counterpart, chosen as the best vehicle for disseminating their work.

Among this group we can highlight Calil Porto, a clinical physician working in Araguari, and Adib Jatene, professor of topographic anatomy at the Minas Triangle Faculty of Medicine, located in Uberaba. Like the Ribeirão Preto doctors, both were interested in Chagas disease. As observed earlier, this disease comprised a priority for the RGM and this fact was perceived by the doctors interested in the topic, who opted to submit their articles to the Goiás journal rather than those of other local associations or journals with a wider circulation:

As promised while I was there, I am enclosing the work on Chagas disease and blood transfusion. Here they suggested that I send it to the AMB journal. I believe that the most advisable would be in the Revista Goiana, which you have sought to enhance through much work, dedicating it more to the problems arising from the great scourge of our region... (RGM / Received - sent on 29 December 1958 by Adib Jatene)

Emmanuel Dias, one of the doctors most engaged in the fight to eradicate Chagas disease (Kropf, 2009), was another important figure to prioritize the RGM. Director of the Chagas Disease Centre of Studies and Prophylaxis in Bambuí (MG), an advance post of the Oswaldo Cruz Institute (IOC) and an important reference point in the methodology for combatting the kissing bug, thought it more appropriate to publish his work in the RGM than in the traditional publication O Hospital:

Dear Dr. Joffre, I have just received your latter of 31st of December, to which I take delight in replying. It is with pleasure that I shall see published in the Revista Goiana de Medicina my report presented to the Roundtable on Chagas Disease at the Ninth Medical Congress of Central Brazil and read by my son João Carlos Pinto Dias, who left the typed copy (without the defects of mimeographed copies) there for publication. I am sending a new copy, however, since I am very interested in the article appearing in the RGM, which has been giving so much attention, happily, to the momentous subject of Chagas disease... That is why I was surprised by the request for authorization to publish the work. I really thought that its publication in the RGM was obligatory, which is why I did not send it to O Hospital... (RGM / Received - sent on 10 January 1959 by Emmanuel Dias)

In addition to the aforementioned doctors, with whom relations were closer and more frequent, many others were interested in the Goiás journal. C. Magarinos Torres, Head of the Pathology Division of the Oswaldo Cruz Institute (IOC), Geraldo Siffert de Paula e Silva, Professor of Gastroenterology at PUC-Rio, Samuel Pessoa, Chair of the Department of Parasitology of the USP Faculty of Medicine, Aluizio Prata, Chair of the Clinic of Tropical and Infectious Diseases, and Zilton Andrade, Pathologist of the Clinical Hospital, both from the Faculty of Medicine of the University of Bahia, are some of the names worth highlighting given the position that they occupied on the national scientific scene. Each appeared with at least one article in the RGM, honouring the editorial work performed by their Goiás colleagues. By refraining from publishing in periodicals with larger circulations, tradition and weight, these high-profile figures in the medical-scientific world helped establish the RGM as a more suitable space for publishing works related to the diseases that most threatened rural populations. As we have seen, it is no mere coincidence that all the articles published by the cited researchers concerned the same topic: Chagas disease.

CROSSING NATIONAL FRONTIERS: THE INTERNATIONAL PRESTIGE OF THE RGM

As we saw previously, the circulation of the RGM abroad was an outcome of the considerable efforts of its directors, who sought to broaden the periodical’s readership and establish a stable system of exchanges, which would ensure an always up-to-date collection of journals available to Goiás’s doctors. However, the interest that the journal awoke in the English professor of tropical medicine Philip Marsden signalled the potential to disseminate the periodical outside of Brazil and further boost its prestige. According to Rezende, Marsden revised the English abstracts contained in the journal and sent them for inclusion in the Tropical Diseases Bulletin, published in London (Rezende, 2001, tape 4 / side B). As one of the oldest in the line of reference works, the bulletin contains abstracts of studies published in journals from countries all around the world relating to tropical diseases.¹⁴ Among the works from the Goiás journal that were summarized in this periodical were those referring to Chagas disease.

According to Martins (2003), one of the roles of a science journal editor is to promote the periodical’s maximum dissemination. To meet this requirement, the editor needs to make efforts to expand the network of subscribers to the journal and strive for the periodical to be included and maintained in databases and indexes, thereby assuring increased visibility among the members of the scientific community. As we have been able to observe thus far, there was a conspicuous endeavour by the RGM’s directors to increase the journal’s readership. Achieving the goal of its inclusion in indexes with considerable international prestige was a major challenge, principally given some of the requirements that had to be met, among them the regularity of publication - something that the RGM had not succeeded in maintaining, as we have already seen above.

Begun in the second half of the nineteenth century, the indexation of the scientific literature emerged as a result of the growth in academic production. According to Martins, the scientists began to demand instruments that kept them up-to-date with the literature produced in their speciality - something increasingly difficult given the growing volume of publications. Assuming a major role in the dissemination of scientific information in contemporary society, little-by-little these indexes would incorporate new functions. Today they operate, according to Martins, like ‘designer labels,’ valorising the selected periodicals to integrate their collections (Martins, 2003, p. 49). The new meaning acquired by the indexes may have persuaded the Goiás doctors to request the inclusion of their periodical in such renowned instruments for disseminating academic production.

Hence the awareness of the reach of the Goiás journal led its directors to request its inclusion, already in 1956, in major international indexes like the Quarterly Cumulative Index Medicus, edited by the American Medical Association, and the Current List of Medical Literature, edited by the National Library of Medicine, also based in the United States. To this end they sent a complete collection of the journal to these institutions in the expectation that the journal could be included in them (RGM / Posted on 26 November 1956 to Quarterly Cumulative Index Medicus - American Medical Association / Chicago, Illinois, USA). Although the request was not met immediately, the insistence of the Goiás medical profession led to the partial inclusion of the periodical in the Index Medicus in the 1960s (RGM / Posted on 19 January 1961 to National Library of Medicine / Washington D.C. - USA).¹⁵

The international prestige of the RGM can also be ascertained by the interest shown by foreign doctors in publishing in the journal. Involved in research linked to Chagas disease, Cecílio Romaña (Argentina), Amador Neghme (Chile), Juan José Osimani (Uruguay), Rodrigo Zeledón (Costa Rica), Aristides Herrer (Peru) and Luiz Mazzotti (Mexico) were some of the doctors who accepted the invitation to write articles for a commemorative issues of the Goiás periodical in honour of the 50th anniversary of the disease’s discovery. The acceptance of these doctors reinforced the importance acquired by this vehicle for disseminating work in research spaces outside of Brazil too.

FINAL CONSIDERATIONS

More than a connection between the doctors of Central Brazil, the RGM symbolized a broad channel for disseminating the activities and research developed by the region’s doctors - a showcase to repeat the title of this article. The steady increase in its distribution and circulation directly and positively interfered in the process of consolidating the Goiás medical community, enhancing the group’s visibility and drawing attention to the specificity of their work in the interior of the country. This journal, however, formed just one part of a broader strategy of the Goiás doctors of bringing a higher education institution to their state, which also involved the activities promoted by its medical association and the exchange promoted during the regional medical congresses. The investment in this ambitious editorial project yielded positive results for a group that in 1955 had just 5 years of formalized existence and that in 1960 inaugurated a medical faculty in Goiás.

The ample circulation of the periodical, the outcome of the efforts made by the directors to maintain its editorial quality, led to the desired visibility. The emphasis conferred to Chagas disease in its pages was fundamental to the journal’s success in obtaining recognition beyond regional frontiers and becoming a reference work for scholars of the diseases throughout the country and worldwide. Demanded principally by those interested in Chagas disease, the journal could list some influential names among its writers, such as José Lima Pedreira de Freitas, Emmanuel Dias and C. Magarinos Torres, which lent it credibility. As we have observed, however, most of the collaborations involved doctors working in the interior of the country, and among them stood out the Goiás doctors and their main interlocutors, colleagues from Ribeirão Preto and the Minas Triangle. The construction of these ties was directly associated with the mutual interests surrounding Chagas disease, and was fundamental in the institutionalization of medicine in Goiás. Likewise, the renown achieved by the periodical and by the doctors of Central Brazil as a whole because of the emphasis on this theme helps explain this investment.

Considering the RGM one of the “landmarks for the inclusion of the disease in new institutional spaces” (Kropf, 2009, p. 481), the historian Simone Kropf emphasizes the importance of the Goiás journal in providing support for research into trypanosomiasis, highlighting the role of the clinics of the interior in its scientific and social construction. In this sense, at the same time as it became a vehicle for disseminating research into the disease, the Revista Goiana de Medicina also contributed to the legitimacy achieved by the medical community working in Goiás. It is worth emphasizing that the pre-eminence acquired by the periodical and by the group that organized itself around it can also be attributed to the discussions of the themes of health and development, in vogue at the moment when the journal began to circulate and which, at national level, were reflected in the fight against rural endemics, perceived as the main obstacles to development in the country under the Juscelino Kubitschek government. Chagas disease was one of the main targets of its health program. In this setting, the Revista Goiana de Medicina and the Goiás doctors acquired a prominent position, transforming themselves into major allies in this battle against the disease.

FONTES PRIMÁRIAS

• Arquivo da Associação Médica de Goiás - Correspondência Expedida: 1955-1962.
• Arquivo da Associação Médica de Goiás - Correspondência Recebida: 1958-1959.

REFERÊNCIAS

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• FREITAS, José L. P. de; MENDONÇA, Wilson. Inquérito sobre moléstia de Chagas no Município de Rio Verde (Estado de Goiás). O Hospital, Rio de Janeiro, v.39, n.2, p.251-261, 1951.
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• 1
  What most closely links the present article to the authors cited here is the fact that all of them take the periodicals as source and object of research simultaneously. In other words, as they work with the sources, they not only look to explore them as a repository of information in support of their research, they also and primarily seek to reflect on their materiality and historical meaning.

• 2
  Ever since the Cruls Commission at the end of the nineteenth century, the federal government had organized commissions to study the best location for the new federal capital. In 1953 the last of these was set up – the Commission for the Localization of the New Federal Capital – which on 30 April 1955 defined the site where Brasilia exists today. On the same date the governor of Goiás, José Ludovico de Almeida, issued a decree declaring the entire area to be a public utility, thereby avoiding real estate speculation (see VIEIRA, 2007; VIEIRA, 2009; VIEIRA; LIMA, 2011).

• 3
  The articles were to be accompanied by abstracts in Portuguese (the English version would be translated by the author or the editorial team), the bibliographic citations had to adhere to the format of the American Medical Association (author, title, periodical, volume, page and year) and the expenses for up to four plates were covered by the journal. The published articles had no predefined size and the authors were given 25 printed copies of their article – a number that rose to 50 in 1958 and that would double from 1963. Its initial print run was 1,000 copies, rising to 1,200 in 1958.

• 4
  The correspondence sent by the RGM up to 1963 reveals the maintenance of this exchange during the rest of the period under consideration, though it does not allow us to quantify the data. In an article on the first 30 years of the journal, Rezende writes that the number of exchanges already exceeded 300 medical periodicals at the time (REZENDE, 1984).

• 5
  Founded in 1942, the institute in question exists still today and remains dedicated to scientific research, epidemiological surveys and teaching on tropical diseases. Its first director was Cecílio Romaña – an important interlocutor of the Brazilians, and the Goiás doctors in particular, due to his research on Chagas disease, having published more than one article on this theme in the RGM.

• 6
  Such was the case of the prestigious Transactions, edited by the Royal Society of Tropical Medicine and Hygiene since 1665, which explained its rejection as based on the long list of exchanges that it already maintained (RGM / Received – sent on 27 January 1958 by the Royal Society of Tropical Medicine and Hygiene); or the Annals of Tropical Medicine and Parasitology, edited by the Liverpool School of Tropical Medicine – another renowned British institution, founded at the end of the nineteenth century. Sometimes, however, the initiative came from the foreign institutions themselves, who offered their periodicals in exchange for the Goiás journal, indicating their circulation figures. This was the case of the Universidad Nacional de San Agustín, in Peru (RGM / Received – sent on 29 April 1958 by the Universidad Nacional de San Agustín) and of the Office de la Recherche Scientifique et Technique Outre-Mer (ORSTOM), based in Paris, which as well as asking about the interest of the Goiás doctors in its Bulletin Signalétique D’entomologie Médicale et Vétérinaire, asked for permission to mention the works of the RGM in its publication (RGM / Received – sent on 4 May 1959 by the Director of ORSTOM).

• 7
  This was the case of a doctor from São Paulo whose article was returned with the following explanation from the journal: “Unfortunately the work in question cannot be published in our journal due to the fact that it has already been published in Anais Paulistas de Medicina e Cirurgia (vol. 76, pp. 243-246, October 1958). According to the journal’s ‘Publication Guidelines,’ only original unpublished works will be accepted...” (RGM / Posted on 27 January 1959 to F. Caldeira Algodoal, São Paulo Municipal Hospital, SP).

• 8
  Initially organized through voluntary inscription by AMG members, the team of permanent redactors was organized according to medical specialities. Although the majority of the members worked in Goiânia, some doctors resided in the cities containing regional association offices, installed in Anápolis, Ceres, Jataí, Morrinhos and Brasília. Rio Verde and Rubiataba did not possess regional offices, but some of the redactors also came from these municipalities.

• 9
  From 1957 a redactors-correspondents section was created in the journal formed by colleagues resident in nearby cities from other states (RGM / Posted on 12 June 1957 to Calil Porto). Between 1957 and 1962, the RGM possessed correspondents in the cities of Uberlândia, Uberaba, Araguari, Frutal and Ituiutaba (Minas Gerais); São José do Rio Preto (SP), Campo Grande and Cuiabá (MT) and Brasilia.

• 10
  Daily treatment of patients suffering from ‘choking sickness’ alerted Rezende to the clinical research on Chagas disease. These studies led him to propose a novel association between the affliction, also known as ‘megaesophagus,’ and infection by Trypanosoma cruzi, arriving at one of the possible forms of manifestation of Chagas disease, the ‘digestive form.’ Along with other doctors from the interior, Rezende would achieve international prominence through this association, anticipated by him since 1956, but fully accepted only some years later (cf. REZENDE, 2009; VIEIRA, 2015b).

• 11
  The Minas Triangle Medical Congresses (later augmented to include ‘Central Brazil’), which began in 1947 at the initiative of the Society of Medicine and Surgery of Uberaba, formed an important space of intellectual exchanges for those doctors working in the interior of the country, as well as a means to put pressure on the public authorities. Initially uniting a few dozen professionals, they were soon bringing together hundreds of participants, some even coming from large centres like Rio de Janeiro and São Paulo. In total, thirteen medical congresses of this kind took place between 1947 and 1965, with Goiânia hosting two of them: in 1951 and in 1958 (VIEIRA, 2015a).

• 12
  Along these lines, it is interesting to observe that there was no precise parallel between the demands expressed in these events and the themes highlighted in the Goiás journal.

• 13
  Especially notable is the interest of Latin American doctors, especially the Argentineans. The relationship between Brazilians and Argentinians vis-a-vis American trypanosomiasis had been developing since the start of the twentieth century, with Argentina one of the first countries to be interested in the works of Carlos Chagas (KROPF, 2009). In the pages of the Goiás journal this relationship was manifested by three articles on the disease, published between 1959 and 1967.

• 14
  The Tropical Diseases Bulletin began to circulate in 1912, in a context where it was necessary to disseminate information on the diseases rampant in the British colonies. It was born from the decision of the governments of Great Britain and the Sudan to fund an office responsible for collecting and publishing information on these diseases, given the name of the Bureau of Hygiene and Tropical Diseases. The bureau was supervised by a committee made up of scientists like Patrick Manson and Ronald Ross (WILCOCKS, 1972; SIX DECADES..., 1972).

• 15
  Currently Medline, one of its electronic bibliographic databases, is globally the most widely used by professionals from the areas of health and medicine (MARTINS, 2003).

• 16
  English version: David Rogers

Publication Dates

• Publication in this collection
  Sep-Dec 2017

History

• Received
  30 Mar 2017
• Accepted
  27 July 2017