Made available in DSpace on 2013-01-07T15:55:01Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 35.pdf: 648897 bytes, checksum: fe00a841e330620d0f600bef361bc214 (MD5) Previous issue date: 2009 / Esta dissertação tem como objetivo compreender de que maneira a assistência psiquiátrica fez parte do projeto governamental de prestação de saúde pública durante as décadas de 30 e 40 do século XX, no período em que Getúlio Vargas esteve à frente da presidência da República brasileira, e se notam grandes mudanças no que concerne a organização da área ministerial relativa à área da saúde. À esta época, também, percebem-se alterações significativas nos rumos que tomava a psiquiatria, como ciência, quando de sua associação com a eugenia, privilegiando a idéia da prevenção que viria a constituir categorias como a profilaxia e a higiene mental dentro das diretrizes da atividade psiquiátrica. Acompanhando estes acontecimentos, este trabalho pretende demonstrar que foi, justamente, essa mudançada psiquiatria que a alçou ao lugar de importância que encontrou neste período selecionado. Todavia, apesar do foco preventivo, que se apresentava como a novidade, a política federal de saúde não ignorava a atividade assistencial e a área psiquiátrica fora organizada a partir do eselecimento do Plano Hospitalar Psiquiátrico, que apesar das alterações que sofreu devido à realidade financeira enfrentada pelos órgãos governamentais competentes, foi posto em prática de forma a garantir o desenvolvimento institucional e assistencial da psiquiatria em todo o país, tendo como exemplo significativo, a Colônia Juliano Moreira, hospital que teve papel de grande importância, dentro da estratégia dual de prevenção e assistência, na promoção de políticas públicas de saúde do Governo Federal .

Made available in DSpace on 2013-01-07T15:55:05Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 41.pdf: 848742 bytes, checksum: 1d293ae153616b59c2b8699f6667eac2 (MD5) Previous issue date: 2003 / Pretende contribuir para o entendimento dos diferentes significados do Chernoviz - enquanto representante da medicina legitimada pelas instituições oficiais, como a Academia Imperial de Medicina e as Faculdades de Medicina - no ambiente médico da Corte. O Chernoviz foi lido e utilizado por pessoas de diversas categorias sociais e profissionais, para as quais facilitou o entendimento da hermética ciência médica. A fim de precisar algumas caracteríticas do Chernoviz, são introduzidos dois problemas: um deles diz respeito à interpretação do papel dos manuais por uma parte da literatura, segundo a qual, estes livros seriam repositórios de crendices; o segundo reside numa possível antítese entre o estatuto individual do saber médico acadêmico, em relação ao diagnóstico e à terapêutica, e o caráter generalizador que os manuais imputaram a esse mesmo conhecimento.

O objetivo desse trabalho é analisar a singularidade das estratégias terapêuticas introduzidas pelo modelo das Clínicas da Dor, através de um estudo genealógico desse projeto terapêutico e sua contextualização no âmbito da racionalidade científica moderna. Mais especificamente, pretende-se analisar as transformações na racionalidade médica que permitiram, sucessivamente, a apreensão da dor pelo discurso médico, a concepção da dor como uma doença e a construção e a consolidação do modelo terapêutico das Clínicas da Dor. Para tal, inicialmente, analisamos o modelo terapêutico desenvolvido pelo médico anestesista John Bonica, idealizador do modelo das Clínicas da Dor, destacando as ferramentas conceituais que possibilitaram a compreensão da dor crônica como doença e como fenômeno biopsicossocial. Num segundo momento, realizamos uma descrição e análise dos principais eventos que permitiram a consolidação da medicina da dor como uma prática específica e multidisciplinar, dando destaque à inserção deste modelo no contexto do Sistema Único de Saúde Brasileiro. Finalmente, a partir de uma experiência clínico-institucional buscamos refletir sobre os limites e possibilidades da aplicação prática deste modelo, lançando luz sobre os impasses da clínica e tensões oriundas da problematização, do dualismo mente e corpo e das práticas terapêuticas interdisciplinares. / The aim of this work is to analyze therapeutic strategies singularities that have begun by the Pain Clinics, through a genealogical study of this therapeutic project and its place on the modern scientific rationality. More specifically, we intend to analyze changes in medical rationality that allow the comprehension of pain by the medical thinking, the understanding of Pain as a disease and the building and consolidation of Pain Clinics therapeutic models. In this way, it was analyzed the therapeutic thinking developed by Bonica, anesthesiologist, that idealized the new model of pain Clinics, detaching the new conceptual instruments that enabled the understanding of pain as a disease and a biopsychosocial phenomenon. Forth with we described and analyzed the main events that allowed the pain medicine as specifical practice, emphasizing the insertion of Pain Clinics in SUS (Brazilian Unified Health System). At last, based on an institutional experience, we tried to think about the bounds and possibilities in the feasibility of this model, enlighten the tensions and stalemates about the mindbody dualism problems and the diversity of different therapeutic practices.

O objetivo desse trabalho é analisar a singularidade das estratégias terapêuticas introduzidas pelo modelo das Clínicas da Dor, através de um estudo genealógico desse projeto terapêutico e sua contextualização no âmbito da racionalidade científica moderna. Mais especificamente, pretende-se analisar as transformações na racionalidade médica que permitiram, sucessivamente, a apreensão da dor pelo discurso médico, a concepção da dor como uma doença e a construção e a consolidação do modelo terapêutico das Clínicas da Dor. Para tal, inicialmente, analisamos o modelo terapêutico desenvolvido pelo médico anestesista John Bonica, idealizador do modelo das Clínicas da Dor, destacando as ferramentas conceituais que possibilitaram a compreensão da dor crônica como doença e como fenômeno biopsicossocial. Num segundo momento, realizamos uma descrição e análise dos principais eventos que permitiram a consolidação da medicina da dor como uma prática específica e multidisciplinar, dando destaque à inserção deste modelo no contexto do Sistema Único de Saúde Brasileiro. Finalmente, a partir de uma experiência clínico-institucional buscamos refletir sobre os limites e possibilidades da aplicação prática deste modelo, lançando luz sobre os impasses da clínica e tensões oriundas da problematização, do dualismo mente e corpo e das práticas terapêuticas interdisciplinares. / The aim of this work is to analyze therapeutic strategies singularities that have begun by the Pain Clinics, through a genealogical study of this therapeutic project and its place on the modern scientific rationality. More specifically, we intend to analyze changes in medical rationality that allow the comprehension of pain by the medical thinking, the understanding of Pain as a disease and the building and consolidation of Pain Clinics therapeutic models. In this way, it was analyzed the therapeutic thinking developed by Bonica, anesthesiologist, that idealized the new model of pain Clinics, detaching the new conceptual instruments that enabled the understanding of pain as a disease and a biopsychosocial phenomenon. Forth with we described and analyzed the main events that allowed the pain medicine as specifical practice, emphasizing the insertion of Pain Clinics in SUS (Brazilian Unified Health System). At last, based on an institutional experience, we tried to think about the bounds and possibilities in the feasibility of this model, enlighten the tensions and stalemates about the mindbody dualism problems and the diversity of different therapeutic practices.

Sénèque respecte scrupuleusement l’orthodoxie stoïcienne en affirmant à plusieurs reprises que la santé physique, en tant qu’« indifférent » moral, ne doit en aucun cas être un objet d’attention. Toutefois, parallèlement à ces considérations, il compose une œuvre dans laquelle la souffrance physique occupe une place considérable. La présente étude, à travers l’examen des théories et des représentations du dolor physique dans l’œuvre philosophique de Sénèque, se propose de résoudre ce paradoxe apparent et de déterminer précisément les fonctions d’un tel emploi. Dans un premier moment, après avoir défini la notion de dolor physique et établi une typologie précise, nous démontrons l’omniprésence du motif du corps souffrant et en dégageons les raisons externes, qu’elles soient socio-anthropologiques et culturelles, politiques, littéraires et même personnelles. Dans un deuxième temps, nous étudions la dimension médicale des représentations de la souffrance, afin de définir chez le philosophe le niveau de sa connaissance des auteurs spécialisés et l’origine possible des théories pathologiques et thérapeutiques qui affleurent dans son œuvre. Dans un troisième temps, nous envisageons le dolor physique au sein de la pensée philosophique de Sénèque. Nous nous employons à démontrer que le dolor physique possède une fonction éthique de premier ordre et que Sénèque ne se limite à présenter des éléments dogmatiques, mais développe également une série d’exercices pratiques permettant de sortir vainqueur du combat contre la douleur physique. / Seneca scrupulously respects Stoic orthodoxy by repeatedly asserting that physical health, as a moral “indifferent”, should never be an object of attention. However, alongside these considerations, he composed a work in which physical suffering holds an important place. The intent of this study, through the analysis of theories and representations of physical dolor in Seneca’s philosophical works, is to solve this apparent paradox and to accurately establish the functions of such use. In a first time, after having defined the notion of physical dolor and established a precise typology, we demonstrate the omnipresence of the pattern of the suffering body and draw external reasons for it, whether they might be socio-anthropological and cultural, political, literary and even personal. In a second time, we study the medical aspect of the representations of suffering in order to define in the philosopher the level of his knowledge of specialized authors and the possible origin of the pathological and therapeutic theories that emerge in his work. In a third time, we consider the physical dolor in Seneca’s philosophical thought. We apply to demonstrate that the physical dolor has a first order ethical function and that Seneca does not confine himself to submitting dogmatic elements, but he also develops a series of practical exercises that allow to emerge victorious from the fight against physical pain.

Os Laboratórios de Investigação Médica (LIM) do HCFMUSP foram criados com a publicação do Decreto n. 9.720, de 20 de abril de 1977, que oficializou o Regulamento do Hospital das Clínicas da FMUSP (HCFMUSP). Por esse instrumento, os LIM se apresentam como uma das unidades do HCFMUSP, ao qual se vinculam administrativamente. Pelo mesmo instrumento, vinculam-se academicamente à Faculdade de Medicina da USP (FMUSP). Esse conjunto de laboratórios desenvolve pesquisa básica e aplicada nos diversos campos das ciências da saúde, além de métodos diagnósticos. Até a implantação da Reforma Universitária, em 1968, as atividades de pesquisa básica transcorriam nos departamentos básicos da FMUSP, articuladas com os departamentos aplicados, que se estabeleceram no HCFMUSP desde sua criação, em 1943, resultando no avanço da assistência médica prestada aos pacientes. Os departamentos básicos, com seus laboratórios e salas de aula, ocupavam quase todo o edifício sede. Com a aplicação das medidas da Reforma Universitária e presentes no Estatuto da USP, esses departamentos foram transferidos para o campus da Cidade Universitária, onde nuclearam, sobretudo, o Instituto de Ciências Biomédicas (ICB). Decorreu da Reforma importante ruptura na produção de conhecimentos na FMUSP, além do arriscado esvaziamento do prédio. O objetivo desta dissertação é reconstituir, pela perspectiva histórica, a trajetória institucional percorrida para sanar as perdas sofridas pela FMUSP e pelo HC e que culminaram com a criação dos LIM no período compreendido entre a implantação da Reforma Universitária até sua efetiva incorporação à estrutura do HCFMUSP, em 1977. O percurso da criação dos LIM foi reconstituído pelo diálogo entre os vestígios encontrados na documentação institucional e as memórias de atores institucionais que viveram esse período, apoiado pela historiografia acerca do ensino e das práticas médicas da FMUSP e do HCFMUSP / The Medical Investigation Laboratories (LIMs) of the University of São Paulo Medical School Clinics Hospital (HCFMUSP) were created with the passing of decree n. 9.720 of April 20, 1977, which formalized the latter\'s by-laws. As set by the decree, the LIMs are one of the units of HCFMUSP, to which they are administratively connected. The same instrument also establishes an academic link between the labs and the Medical School of the University (FMUSP). This set of labs conducts basic and applied research in the most diverse fields of health sciences, and develops diagnostic methods. Up until the 1968 University Reform in Brazil, basic research activity was conducted by the basic departments in conjunction with the applied departments of the Medical School - which existed at HCFMUSP since its foundation in 1943. This arrangement resulted in improvements in the medical care provided to patients. The basic departments, along with their labs and classrooms, occupied almost the entire headquarters building. With the enforcement of the measures defined by the University Reform - also present in the by-laws of the University of São Paulo - these departments were transferred to the main campus (Cidade Universitária) and mostly placed under the umbrella of the Institute of Biomedical Sciences (ICB). As a consequence of the Reform, there was a risky emptying of FMUSP\'s building, and a disruption in its knowledge production. The objective of the present dissertation is to reconstruct, from a historical perspective, the institutional path taken with the aim of overcoming the losses faced by the medical school and its hospital, which culminated in the creation of the LIMs in the period between the implementation of the University Reform and the laboratories\' actual incorporation into HCFMUSP\'s structure in 1977. The LIMs\' creation process was reconstructed based on a dialogue between the traces found in the institution\'s documents and the recollections of players who witnessed the process, with the support of historiography on FMUSP and HCFMUSP\'s medical and teaching practices

Criada em 1864, a Academia Nacional de Medicina passou diversas transformações ao longo da segunda metade do século XIX em decorrência das mudanças no cenário sociopolítico mexicano e da própria dinâmica das ciências médicas no mundo Ocidental. Nesta dissertação, busca-se compreender como ocorreu o processo de institucionalização da medicina acadêmica no México a partir da trajetória da Academia Nacional de Medicina e como foram produzidos determinados saberes entre as décadas de 1860-1880. Assim, foram estudados o processo de consolidação de uma deontologia médica, além da produção, regulação e normatização de saberes médicos relacionados à concepção de vida e aos procedimentos de partos. À luz de uma perspectiva microssociológica e contextualista, demonstram-se como os embates e as controvérsias científicas serviram à organização da academia, às normas de produção e à formulação de saberes sobre vida e parto. Esta pesquisa também apontou como tais saberes serviram à estruturação do Estado mexicano durante a segunda metade do século XIX. Foram analisados os relatórios clínicos e as atas publicados na Gaceta Médica de México (periódico da Academia), os códigos civil e penal sancionados na virada das décadas de 1860-70 e os manuais de medicina legal e medicina obstétrica elaborados pelos médicos Luis Hidalgo y Carpio e Juan María Rodríguez. / Created in 1864, the Academia Nacional de Medicina went through several transformations during the second half of the 19th century as a result of changes at the mexican sociopolitical scenario and the dynamics of medical science in the Western World. Within this dissertation, it is searched to understand how did the process of institutionalization of academic medicine happen in Mexico starting from the trajectory of the Academia Nacional de Medicina and how certain knowledge were produced during the decades of 1860-1880. Therefore, were studied process of consolidation of a physician deontology, in addition to the production, regulation and normatization of medical knowledge related to the conception of life and childbirth procedures. At the light of a microsociological and contextualist perspective, it is shown how the dispute and the scientific controversy served to the organization of the academy, to its norms of production and to the formulation of knowledge about life and childbirth. This research also pointed how such knowledge served to the structuring of the mexican State during the second half of the 19th century. Were analysed clinical reports and minutes published in the Gaceta Médica de México (Academias journal), the civil and criminal Codes sanctioned at the turn of the 1860-70 decade and the manuals of legal medicine and obstetrical medicine made by the physicians Luis Hidalgo y Carpio and Juan María Rodríguez.

This study examines the "Spanish" influenza pandemic of 1918-1919 in the U.S. South, using case-studies of Jacksonville, Savannah, New Orleans, and Nashville to sculpt a "Southern flu" more identical to the Global South and the developing world than the rest of the U.S. I examine poverty and political and economic paralysis in the years between the end of Reconstruction and 1918, and the poor results of political indifference on public health and disease control. I also analyze the social and institutional racism against persons of color that defined high infectious disease mortality in Southern cities. I argue that Southerners faced higher flu mortality than other parts of the country due to the regional poverty and public health underdevelopment that defined previous diseases and made the South distinct in the national epidemiological narrative, namely through yellow fever, malaria, hookworm, and pellagra. I also challenge the conventional orthodoxy by arguing that within the South, African Americans faced exorbitant mortality rates compared to whites. I argue against the myth of a democratic killer flu, but rather, the existence of deep social inequalities and inequities that furthered mortality among the impoverished and marginalized. I argue that the pandemic was like most epidemics and pandemics in Western history, in that it disproportionately killed minorities and those without access to medical care and social services due to conducive social architecture. While pestilence shapes societies, societies simultaneously shape the course of pestilence. This study is divided into five chapters. An introductory chapter examines the scholarship and Southern public health before 1918. The second chapter addresses the pandemic in Jacksonville and Savannah, the third chapter examines New Orleans, and the fourth chapter assesses Nashville. A concluding chapter compares the U.S. South with the Global South, tethering the U.S. South to the global pandemic.

In den 1950er-Jahren stellte das epidemische Auftreten der spinalen Kinderlähmung (Poliomyelitis) die Gesundheitssysteme weltweit vor große Herausforderungen. Da eine kausale Therapie der Viruserkrankung nicht existierte, kam der Expositionsprophylaxe eine besondere Bedeutung zu. Letztlich gelang es erst durch die Entwicklung von Impfstoffen, die spinale Kinderlähmung nachhaltig zurückzudrängen. In der Deutschen Demokratischen Republik (DDR) wurde 1960 erstmals in Deutschland die Schluckimpfung nach Sabin-Tschumakow verabreicht, mit der binnen eines Jahres die nahezu vollständige Eradikation der spinalen Kinderlähmung in der DDR gelang. Der Artikel zeichnet anhand von unveröffentlichtem Archivmaterial die systematisch angelegte Impfaktion am Beispiel der damaligen Bezirkshauptstadt Halle (Saale) nach. Allein dort wurden im Mai 1960 innerhalb von 3 Tagen 63.328 Kinder und Jugendliche immunisiert. Bei 78.085 im Vorfeld erfassten Impflingen entsprach dies einer Quote innerhalb der poliovulnerablen Bevölkerungsgruppe von rund 81 %. Die Quellen zeigen, dass die staatliche Struktur des Gesundheitswesens der DDR und das Prinzip der aufsuchenden Impfung zum Erfolg der Impfaktion beitrugen. / In the 1950s, the epidemic occurrence of infantile paralysis (poliomyelitis) posed major challenges to health systems worldwide. Since there was no causal therapy for the viral disease, exposure prophylaxis was of particular importance. Ultimately, it was only through the development of vaccines that infantile paralysis could be permanently reduced. In 1960, the Sabin–Tschumakow oral vaccine was administered in the former German Democratic Republic GDR for the first time in Germany. Within one year, this vaccine succeeded in almost completely eradicating polio in the GDR. The article uses unpublished archival material to trace the systematic vaccination campaign using the example of the then district capital Halle (Saale). There alone, 63,328 children and adolescents were immunized within three days in May 1960. With 78,085 vaccinees recorded in advance, this corresponded to a rate within the polio-vulnerable population group of around 81%. The sources show that the GDR’s government healthcare system and the principle of outreach vaccination contributed to the success of the vaccination campaign.

The enlightenment period is often considered a dark age within the history of medicine. Contrary to this sentiment, I argue that the enlightenment spirit of inquiry regarding venereal disease was vibrant, dynamic, and profoundly influenced how syphilis was understood in the subsequent century. Historiography frequently minimises advances of medical knowledge made in the eighteenth century by focusing on the inefficacy of treatments, rather than on developments in medical theories and concepts. This thesis attends to this gap by examining a case study within venereology to demonstrate that physicians engaging in public debate significantly advanced knowledge of syphilis. In doing so, this counters a historiographical trend that claims that French physician Philippe Ricord (1800-1889) was the first to distinguish syphilis from gonorrhoea in the nineteenth century. It uses historical evidence to show that the nature of syphilis was debated throughout the preceding centuries and that this distinction was clearly established in 1793 by Scottish surgeon, Benjamin Bell (1749-1806). This thesis uses the epistemic concepts devised by Ludwik Fleck in his Genesis and Development of a Scientific Fact (1979 [1935]) to illustrate how enlightenment ways of thinking substantially contributed to the development of modern medicine. This thesis therefore invites a reconsideration of the era, not as a dark age, but as a rich period of scientific endeavour.