ABSTRACT

Based on the investigation of medical discourses referring to school sanitation, this study addresses the spread of the Hygiene science in the State of Paraná, southern Brazil, between 1920 and 1937. Discourses to schools present in many sources, mainly periodicals, Archivos Paranaenses de Medicina and Revista Medica do Parana, pointed out the perception of medicine underpinned by Hygiene, in which doctors advocated a new social function: educators. By discussing intervention in schools and their users, doctors intended to "care for, protect and sanitize infancy", a task aiming to insert the territory of Paraná in the national process of hygienic and social sanitation. It is a historical research study, inspired by Norbert Elias' ideas of Civilizing Process. Thus, its purpose is to recognize civility proposals in the medical discourses created to the schools of the State of Paraná. Educational conceptions in the studied period evolved from knowledge, prescriptions and discourses on Hygiene science and its greatest advocates - the doctors.

Keywords: School health. Eugenics. History of medicine. Medical education.

RESUMO

Com base na investigação dos discursos médicos referentes à higienização da escola, este estudo problematiza a difusão da ciência Higiene na sociedade paranaense no período compreendido entre 1920 e 1937. Os discursos para a escola presentes em várias fontes, com destaque para Archivos Paranaenses de Medicina e Revista Medica do Paraná, emergiram a percepção de uma medicina na qual os médicos defendiam uma nova função social: a de educadores. Ao tematizarem sobre uma intervenção nas escolas e nos seus usuários, pretendiam "cuidar, proteger e higienizar a infância", tarefa assumida com vistas à inserção do território paranaense no processo de saneamento sanitário e social. Trata-se de uma pesquisa de caráter histórico, inspirada nas ideias de processo civilizador de Norbert Elias. Assim, propõe-se reconhecer propostas de civilidade contidas nos discursos médicos. As concepções de educação e as prescrições para a escola no período estudado, produzidas pela Ciência Higiene, são aqui apresentadas.

RESUMEN

Con base en la investigación de los discursos médicos referentes a la higienización de la escuela, este estudio plantea el problema de la difusión de la ciencia Higiene en la sociedad paranaense en el periodo comprendido entre 1920 y 1937. Los discursos para la escuela presentes en varias fuentes destacándose los Archivos Paranaenses de Medicina y la Revista Médica del Paraná, estado de Brasil, hicieron emerger la percepción de una medicina en la cual los médicos defendían una nueva función social: la de educadores. Al plantear los temas sobre una intervención en las escuelas y en sus usuarios, pretendían "cuidar, proteger e higienizar la infancia", tarea asumida hacia la inserción del territorio paranaense en el proceso nacional de saneamiento sanitario y social. Se trata de una investigación de carácter histórico inspirada en las ideas de proceso civilizador de Norbert Elias. De este modo se propone reconocer propuestas de civilidad contenidas en los discursos médicos. Los conceptos de educación y las prescripciones para la escuela en el período estudiado producidas por la Ciencia Higiene son aquí presentadas.

Palabras clave: Salud escolar. Eugenia. Historia de la medicina. Medicina y educación.

INTRODUCTION

Since the 1750s, "taking care of oneself" was recommended by means of medical advices published in good conduct manuals that were impregnated with the illuminist ideal of use of human reason to promote social progress (Marques, 2003).

The concern about the hygiene of people and cities and its transformation into a set or norms and laws, with the aim of controlling diseases and improving life in society, was the result of a long historical route (Hochman, 1998). Hygiene as science and medical practice dates from the beginning of the 19^th century. Understood as "the art of conserving life", it indicated directions to its utilization, either by those who affirmed the individual responsibilities in the process of becoming ill and dying or as a concept for those who boasted its social determination (Arouca, 1975).

Understood as a measure to reduce the waste of human resources caused by diseases, Hygiene was also a "scientific guide". As an academic discipline it stood out in Germany in the 1860s, supporting progress and social regeneration (Arouca, 1975). As science, it was institutionalized, produced practices and discourses, which echoed and found visibility in the action of the doctors in the State of Paraná (Southern Brazil).

In Brazil, the medical prescriptions entered into the 20^th century impelled by the powers of the Hygiene Science, so as to summon adhesion to other types of knowledge. Little by little, they became "health rituals", with the purpose of boosting citizenship, in a crusade for health, education and civility (Rocha, 2003a). The school was a privileged locus of these prescriptions, the place where hygiene formatted proposals for the construction of educational models, teacher education, student inspection and organization of spaces and equipment, aiming to form new and sanitized citizens.

Viewed as a "vehicle for the harmonic formation of the body and spirit", the school received the mission to model the future citizens who were necessary to the construction of the Brazilian nation. The medicalization of infancy and the intervention in the possible degenerations would happen, according to the physicians, by means of prescriptions and campaigns in favor of hygiene education, enabling the transposition of the good habits acquired at school to the domestic life, thus promoting the medical and social sanitation of the country (Marques, 1994).

Some doctors in Paraná adhered to the civilizing and hygiene discourses, particularly at the beginning of the 20^th century. Among the vehicles they utilized which enabled to listen to their clamors, we highlight the periodicals Archivos Paranaenses de Medicina¹ (APM) and Revista Médica do Paraná (RMP)², which circulated in the 1920s-1930s. By recognizing themselves as the spokespeople of hygiene, and working, according to its norms, in the contention of Paraná's scourges, as well as in the national regeneration, they orchestrated a bold crusade: the construction of a new sanitary order, aiming to bring civility to Paraná.

The process sanitation-education would result in civility, viewed as the codification of conduct norms, conditioning, training and acting over the self-control of drives, so as to submit individuals to modeling interventions (Elias, 1994, 1993). Moreover, civility was one of the components of the civilizing process, considered to be not only a set of technological or economic achievements, but, above all, a stage in the relationship among human beings.

The school was then chosen as the focus for the interventions in human relationships, developed by means of detailed medical prescriptions, with the purpose of controlling drives. This control was considered essential in the organization of social medicine, at the beginning of the 1900s, aiming to build civilized citizens.

It was a vibrant period of knowledge production and attempts to disseminate hygienic precepts to the teachers - the most indicated ones to transmit them to the little citizens who were being educated.

In fact, the teachers were in places where the doctors did not circulate; they had a territorial domain that the physicians lacked; therefore, they were potential civilizing agents and they needed to be summoned to the crusade. Building a State molded by health and education was the great challenge.

The mission of sanitizing - prescribing to the school

The school was responsible for stanching the national degeneration. And, in this intent, educating teachers to work as sanitary educators had become indispensable. Studies conducted by Rocha (2003b, p.400) show that instruction, morality and health would form a tripod capable of supporting "[the action of the new health messengers, responsible for the sublime apostolate of taking to all the corners of the State the good news of the regeneration of the Brazilian race" (emphasis in the original text). Guiding infancy would make teachers become "Crusaders" able to lead children to the "health gospel" and to promote their conversion to the "religion of hygiene" (Rocha, 2003b, p.400).

This role would be part of the education of vigorous and virtuous citizens capable of the national enhancement, taking Brazil to the "vanguard of civilization" (Rocha, 2003b).

Discourses with eugenic emphases arrived at Paraná. In the 1920s, eugenic ideas circulated more densely in the medical publications of that State. Eugenics was the theme of an original work by Fontenelle (1923), published in the Archivos Paranaenses de Medicina: "[…] word that means ‘good generation' and scientific knowledge that contributes to the physical and mental improvement in the future generations and the need to restrict the propagation of ill, monstrous, degenerated and  mentally deficient individuals" (p.107).

As race hygiene, eugenics discussed the national scourges, mainly: tuberculosis, consanguinity, alcoholism and sexually transmitted diseases. Civility and self-regulation, according to Paraná's doctors, would occur through many strategies, among which, developing the fertile field of the school space, as the child was considered a "moldable clay" capable of reproducing, in the family environment, the sanitizing prescriptions. It is important to consider: the sanitary reality of the children, families, schools and teachers acquired new contours in the 20^th century.

To achieve this, the doctors of Paraná organized strategies. And the sanitary education of teachers by means of specific courses was the first step, as the school was chosen as the "primary headquarters" of the formation of hygienic habits", corroborating the relations between health-education and their respective representatives. The Archivos Paranaenses de Medicina (Redacção..., 1922, p.191-2) highlighted:

Since the middle of the 19^th century, European intellectuals and scientists, whose ideas echoed in Paraná, believed that the universe was ruled by mechanical, causal and evolutional laws, limiting individual freedom. It would be a situation in which the sum of the physical characteristics of a race would determine its relationship to the environment. The individuals' phenotype was considered "a mirror of the soul", especially regarding virtues and vices (Schwarcz, 1993). Therefore, it was necessary to recognize, in the children, vices and virtues, and to make interventions in the former and promote the latter - and the school was the ideal space for such action.

The establishment of a "modern" paradigm to the Brazilian health - fundamentally recognized as a set of actions capable of introducing hygienic and eugenic habits in the population and of restructuring the "national type" - guided the discourses produced in the medical-scientific societies in the first thirty years of the 20^th century (Herschmann, Pereira, 1994). We recognize, in the construction of a national sanitary order, stages of a civilizing process, in which, according to Elias (1997), some social figurations can be analyzed in the perspective of coercions, in which, by distinct ways, the human beings are subject to interdependence relations within specific social dynamics. Such dynamics would be represented by changes in the relations between internal social coercions and individual self-coercions, a broadly recognized role of the medical-hygienic prescriptions of the beginning of the 20^th century.

Our hypothesis was that, besides the participation of technicians from Paraná in scientific and professional events and societies, one of the determinant factors in the dissemination of the sanitary ideal in the State was the publication of local periodicals.

In the 1920s, an agreement celebrated with spheres of the federal government organized, in Paraná, a "new sanitary service": the Rural Prophylaxis Service (Relatório..., 1923).

Studies conducted by Fernandes (1988) showed that the disruption with the federal agreement, at the end of the 1920s, produced the incorporation of the Rural Prophylaxis Service into the Board of Sanitary Services of the State of Paraná, which can explain the interruption of the publication of the periodical.

The public health of the State of Paraná gradually entered the school space, an "extremely efficient" place to build a local sanitary order and to disseminate the hygienic ideals (Fernandes, 1988).

The sanitary education of Paraná's teachers

In this study, we consider that the publication of the studied periodicals is a link between Paraná's medicine and the school - a proposal to raise the awareness of the local teachers, because the journals intended, among other objectives, to expand the number of hygiene "messengers" in the state.

In 1920, a strategy to disseminate the possibility of national regeneration through education was, upon the request of the general teaching inspector Cezar Martinez, the Elementary Hygiene Course for teachers, which had the objective of "[…] preparing them not only to guide the education of their pupils, but also to form among the teachers a group of advertisers of the modern public hygiene" (Araujo, 1921, p.373).

The two-month free course, divided into two parts, had conferences open to the public, with theoretical classes held at the "Gymnasio Paranaense". The approached themes are listed on Table 1.

To Marques and Farias (2007), when they mastered this knowledge, the teachers would be considered capable of performing surveillance and propagation of the hygiene ideal, a role that was theirs in the exemplary mission of educators.

Created by Law 2095 of March 31, 1921, the Medical Inspection Service at schools was based on São Paulo's experience, brought, not without reservations, to Paraná, by the General Teaching Inspector Prieto Martinez. One of the aims of the service was to visit schools, examining "in detail students and teachers" to understand the influence that school life had on children's lives (Marques, Farias, 2007).

Marques (1994) explains that, in teacher education, the close relation hygiene-education was highlighted in theses, congresses and conferences. However, the messengers needed to be tested and not always were they able to accompany the themes and classes, composed of what was considered, at the time, the best of the modern public health.

The program was complex and, we dare say, inadequate for the proposed objective. According to Pykosz (2007), it is possible to perceive, between the educational and sanitary scopes, a distance between what was prescribed and what effectively happened. Respect for the hygiene precepts and modern pedagogy was hindered by the structural and human conditions for its compliance.

In the State of Paraná, the official inclusion of the hygiene content to be developed with students included knowledge related to the main diseases that raged here, their prophylaxis and treatment, as well as first aid notions, which ended up exposing needs regarding the education of the local teachers to undertake that task (Pykosz, 2007).

The report of the end of the Elementary Hygiene Course (1920) clarified:

The director of the course, the doctor Souza Araujo, registered, in the text, his satisfaction with the result of the action, and emphasized that "a great pleiad of compatriot teachers revealed intelligence, perseverance and activity, causing the best impression on the assistants […]"(Araujo, 1920b, p.266). Great names of the Brazilian public health area wrote in the Archivos, giving to the sanitizing discourse credentials to highlight the missionary role of the doctors, their civilizing crusade, besides the indispensable role to be played by the local teachers in this "sanitizing battle".

According to the local intellectuals, Paraná's prosperity would not be achieved without a broad and deep interchange between doctors and the people. Thus, we consider that the teachers were "recruited soldiers" to battle along the children and their families, disseminating the civilizing wind brought by the Hygiene Science.

An assiduous partner of the Archivos Paranaenses de Medicina was the doctor Belisário Penna, who lectured on sanitary conscience during a visit to the city of Curitiba: "In any civilized country hygiene is no longer promoted without resort to propaganda and sanitary education […]"(Penna, 1921, p.73).

Some contributions to the national sanitation were highlighted by the campaign against the four universal scourges: alcoholism, syphilis, tuberculosis and consanguinity, which did not respect: "[…] climate, regions, or civilizations […]"(Penna, 1921, p.76-7).

To Penna, the combat against these ills would take place through a positive, experimental and biological science - hygiene - which, together with the application, by the teachers, of hygiene education at schools, would be able to develop in the children the control of desire. Such process would have a solid moral basis, with numerous duties, whose performance would avoid, to societies, the dangers that their non-observance caused to the human species:

In fact, hygiene education became, in the 1920s, a great ally of Paraná's doctors. The Archivos Paranaenses de Medicina started to publish a section called Hygiene Education, which would serve as a scientific subsidy for teachers to develop hygiene actions with the students.

Believing in medicine and hygiene as civilizing weapons was fundamental to delimit a professional field to the doctors of Paraná, where there was no space for superstitions and quackeries:

What had been done in relation to the education of the teachers was considered by the local doctors as very little. In their opinion, the independence of the teaching of hygiene would give the opportunity, for the graduates of Escola Normal⁴, to acquire a larger sum of knowledge.

Twelve years after the beginning of the Rural Prophylaxis Service, in February 1932, the director of the Medical Inspection at Schools submitted an article to the Revista Medica do Paraná, in which he proposed the effective separation between the teaching of human biology and that of hygiene.

To achieve that, he presented a script for a course entitled Sanitary Education, in which the questions of school hygiene would require, from teachers, knowledge of several areas. Resuming the strategy of educating teachers, efficient collaborators in the formation of sanitary conscience, was indispensable. To fulfill this objective, the Medical Inspection at Paraná's Schools included, in its service programs, the Sanitary Education Course, destined to "teach students in the last year of Escola Normal necessary, although elementary, knowledge of hygiene and preventive medicine, and brief notions of transmissible diseases […]" (Macedo, 1932, p.123).

The course offered by the Medical Inspection at Schools did not intend, according to its organizers, to solve the problem "of the mental education of the teacher to perform her sublime educational mission, nor to substitute the chair in hygiene of the normal course" (Macedo, 1932, p.124). It was considered a rehearsal that aimed to provide them with concrete bases to understand the State's hygiene program, so as "[…] to include our teacher in the problems referring to healthy practices in the school environment and the consequent repercussion in the homes" (Macedo, 1932, p.125).

The Medical Inspection at Schools did not have, "for its mission", the necessary resources to spare "the collaboration intelligently developed in the school environment by the teacher. Without this assiduous and permanent collaboration, any and every effort of the school doctor will be negatively affected" (Macedo, 1932, p.125).

On Table 2, we reproduce the semiannual program, presented in 1931, of the Sanitary Education Course of the Medical Inspection at Paraná's Schools for the 5^th year of Escola Normal. Composed of thirty items, the course could be considered a brief exposition of the Hygiene Science and the main factors for the diseases and mortality of Paraná's inhabitants.

In terms of contents, we have not noticed significant differences between the Elementary Hygiene Course (1920) and the Sanitary Education Course of the Medical Inspection at Paraná's Schools (1932). It is important to highlight, in the first course, a moralizing tone, perceptible through the themes "sanitation of Brazil", "general hygiene and school hygiene", which were not included in the 1932 course, but which would certainly be diluted in the discussions about syphilis. Perhaps, more important than the conceptual difference between the courses, was the distinction between their promoters: The Rural Prophylaxis Service (connected with the National Public Health Department) and the Service of Medical Inspection at Schools, in an attempt to, through the second one, value education and the local doctors.

In addition to the courses, the future teachers received the regular visit of Paraná's doctors at Escola Normal. Summoned to comply with the moral duty of engaging in the sanitation mission, they had contact, among others, with Milton Munhoz, professor of Hygiene of the School of Medicine of Paraná.

When he talked about health through education, in a lecture given at the Noble Hall of Escola Normal, as the closure of the Education Week, on November 25, 1933, Munhoz stated, to his public, that he was convinced that the hygiene-education partnership was the true path to fulfill the "most beautiful dreams of Social Medicine". He attributed relevance to the doctors' role, whose mission was to be

To Munhoz and other doctors, theirs was also the role of raising the awareness, training and supervising the teachers' action in the support to the sanitation mission in Paraná. According to him, the doctor's interference should not be lesser in education, because he believed that the educator should work in partnership with the former, who would, in fact, be the technician capable of determining the physical and mental possibilities of the students, thus "[…] orienting, correcting and aiding the teacher's task" (Munhoz, 1933, p.12).

The science that was able to reduce the distance between pedagogy and medicine would be hygiene, because, by incorporating knowledge from other sciences, it enlarged enormously its range of action: "[…] The knowledge it mobilizes, its constant interference in all spheres of human activity, the daily need of it in all our acts, put it in a more advantageous position in relation to the very science from which it came […]"(Munhoz, 1933, p.13).

With powers to interfere in health, "[...] an essential factor for progress and, to the nation, one of the biggest reasons for its greatness", Hygiene would also be capable of producing social cooperation. The teachers' participation in the valuation of health, one of the great "goods granted to man", was neither a privilege nor a prize distributed by luck; rather, according to Munhoz, it was an objective that could be achieved through effort and intelligence. These would have, perhaps, one of their more important roles; after all, this author argues, "perennial health" and the disappearance of diseases were possible to be achieved through the application of hygiene precepts (Munhoz, 1933, p.12).

The set of measures presented by the hygienists would enable, therefore, the continuous enhancement of a society that formulated itself, to the above-mentioned doctor, in a word: progress (Munhoz, 1933, p.13).

More than providing health, hygiene could put the deviants in conditions such that "their energy neither deviates nor falters, that their economic and social contribution is adequate" (Munhoz, 1933, p.14).

Presenting these ideas to the future teachers was part of a strategy of the doctors from Paraná: making them become co-participants in the construction of a national sanitary conscience, in which hygienic education would impose itself as an inseparable complement of general education, and, also, as the basis to form healthy citizens, capable of promoting progress and prosperity.

Under such perspective, health through education, according to Munhoz, needed rules not to be a utopian proposal. He then started to list some precepts which, once developed by the young teachers, would contribute to the success of the sanitation enterprise.

The first step would be to create, in the individuals, healthy habits:

The school, to some doctors from Paraná, was

In this way, Munhoz presented, to the students of Escola Normal, prescriptions, described on Table 3.

All these involvements were meant to tackle two of the biggest national problems, according to the hygienist: education and hygiene.

In 1937, the Revista Medica do Paraná published a theme that highlighted the ills of the rural area, referring to ignorance as the biggest of them. It proposed that the primary school should be strategically recognized as an Education Center: "[…] the schoolchildren are physically and spiritually healthier, and because of this, happier; the new ideas of progress and civilization are more easily disseminated by the means of communication […]"(Gonzaga, 1937, p.301-2).

However, progress alone did not guarantee a civilizing process:

The cabloco (countryman) has become reference in the recognition of the great problems related to the national progress, so that his redemption or the impediment of his emergence would be achieved by the application of the hygienist ideal, in which education and eugenics would be fundamental. However, only the apostolate of the teachers would not be capable of such a change:

The categorical imperative was to summon doctors to educate teachers in sanitary terms, because even after attending courses, there were criticisms, maybe due to the distance that existed between the courses that were taught and the daily pedagogical practice:

Then, some conclusions were presented that already configured the practice of some doctors at Paraná, according to the quotation: "Combating illiteracy is not enough; it is necessary to sanitize through education and sanitation […] The teaching of hygiene at Escolas Normais must be intensive, handling both urban and rural hygiene […](Gonzaga, 1937, p.304).

Final Remarks

At the end of the 19^th century and beginning of the 20^th century, the ideal of progress acquired, for Paraná's doctors, distinct meanings, but with the same prescriptions guiding their discourses: hygiene should be taught and learnt at school.

In that period, the organization of a medical order in the State of Paraná, centered on a model for the school based on the scientific rationality arising from the hygiene science, produced more than discourses; it started to make prescriptions to its users, even though the access to them was a complicating factor to the great majority of Paraná's inhabitants.

The construction of a local legitimacy and the desire of an identity forged the dissemination of a Europeanized ideal, in which doctors discoursed about the "extremely salutary climate" and about an idealized space for Paraná. Contradictorily, they lived with the non-"civilized" statistics of the population morbidity and mortality, with the organization and construction of hospitals and asylums, among other establishments to "combat diseases".

In their eagerness to transform this scenario, they elected the school and infancy to be sanitized and, thus, climb steps in the construction of a civilizing process. It is worth remembering that children molded by hygiene became important disseminators of sanitized habits, being also transformed in health agents, acting especially with their families.

Our intention was to give visibility to the science of hygiene in the movement of medicalization of Paraná's society, entering into spaces occupied by the hygienist rhetoric, in the daily interventions, in a civilization process that was considered the path to the national progress and redemption.

Following a set of positivistic ideas from the end of the 19^th century, hygiene and education entered into the 20^th century, consolidated in their role of disseminators of the scientific spirit, indispensable to social regeneration, although, in many moments, the social dimension was left aside in the discussions and the so-called sanitized ways of living that were proposed were not accessible to the poor populations. By considering themselves "intellectuals", the doctors from Paraná transformed themselves into agents of science dissemination and valued the potential of sanitation as a civilizing strategy.

As the central focus of the discursive practices of Paraná's doctors, hygiene and education were the framework of this study. The medical knowledge that was constructed was close to the pedagogical knowledge, frequently exposing contradictory aspects, but their basis was the sanitization of the school and its users. Stephanou (1999) compared this production of knowledge and prescriptions to a kaleidoscope, whose infinite view enables to unveil relations between sanitizing and sanitized subjects and the production of control and dependence procedures.

COLLABORATORS

Liliana Müller Larocca was responsible for the elaboration of the manuscript (based on a chapter of her doctoral dissertation). Vera Regina Beltrão Marques was responsible for the analysis of the theoretical framework, analysis of the sources and thematic discussions.

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