Pernambuco League Against Tuberculosis

The battle against tuberculosis, in Pernambuco, has Doctor Octávio de Freitas as its main ally.Before him, just the doctor Joaquim de Aquino Fonseca, when he ran the Province of Pernambuco’s General Council of Salubrity in 1849, was concerned and alerted the government to the steady march of tuberculosis in the Province.

Octávio de Freitas became concerned with the problem from 1894, when he held the position of assistant doctor at Hospital Pedro II and demographist in the Repartition of Public Health. From monthly and annual research data, since 1852, the doctor observed that deaths from tuberculosis had been continually progressing.

With the discovery of Koch’s bacillus as the causative agent for tuberculosis in 1882, by German Dr.Heinrich Robert Koch (1843-1910), and after the turn of the 20th Century, the fight against tuberculosis grew, European medical centres began addressing the matter and the decisions and proposals coming from that continent had repercussions in Latin America, which did not delay long in joining the battle. In 1901, at the Medical Conference held in Chile, the Permanent International Commission for the Prophylaxisof Tuberculosis was established, under the presidency of hygienist Emílio Coni. The first action by the Commission was to create leagues against tuberculosis in various Latin-American countries.

In the city of Rio de Janeiro, Brazil, Dr.Hilário de Gouveia became the representative of this commission who, together with the medical society, created the Brazilian League Against Tuberculosis. Within a short time, each Brazilian state had founded its own League.

In Pernambuco, some doctors, sensitive to the alarming data on tuberculosis mortality presented by Dr Octávio de Freitas,got together and founded the‘LigaPernambucana contra a Tuberculose’ (Pernambuco League Against Tuberculosis – LPCT) on 19 July 1900, solemnly inaugurated at Santa Isabel Theatre on 19 August that year. Its first board of directors was formed by doctors Octávio de Freitas (president), Antonio Hermenegildo de Castro, Costa Ribeiro, Martins Sobrinho and Bernardino Maia. One of the objectives was the construction of a hospital to treat patients with tuberculosis.

In the beginning, the League encountered many difficulties because of the lack of support from Pernambuco society, especially the wealthiest class. To develop its programme, the LPCT took the following initiatives: distributing 1000 letters addressed to the people with high purchasing power asking for donations; hosting a conference at Santa Isabel Theatre, requesting financial help from those invited at the theatre’s exit; and visiting commercial businesses to ask for cooperation. Unfortunately, the result of these attempts was disappointing. The only initiative that brought a significant financial return was a race at the Campo Grande Racetrack: two‘contos de réis’ (two million réis).

With the goal of gaining greater participation of the society’s representatives in the fight against tuberculosis, the LPCT elected a new board: Octávio de Freitas, Costa Ribeiroand Martins Sobrinho (doctors), Oswaldo Machado (lawyer), Lino Braga and Alberto Dias Fernandes (businessmen) and Manoel Medeiros (banker).

To re-establish enthusiasm and the will to continue in the struggle against the devastating disease, the press, through Gonçalves Maia from the newspaper A Província andOswaldo Machado from theJornal do Recife, joined the cause. Joining them was the Ferro Carril Company, issuing coupons which it honoured in the name of the League, the storesA Primavera, Maison Chic, Regulador da Marinha, Salão Pequeno, Café São João, F. Barbosa, Armazém dos Arcos, and many others, bringing in resources from their clients, as well as fairs held by society ladies.

With the money gathered, a plot of land was bought on Gervásio Pires Stin the Boa Vista neighbourhood for the construction, by engineer Theóphilo de Freitas (brother of Dr Octávio de Freitas), of a Model Dispensary for combatting tuberculosis. The corner stone was laid on 10 July 1903, and its inauguration was on 10 January 1904. The Pernambuco League Against Tuberculosis was the 4th League created in Brazil, and the first to have a Model Dispensary.

Many doctors gave their services for free, as the Pernambuco League Against Tuberculosis did not have sufficient resources to pay them. The Dispensary was named after Octávio de Freitas, and was made up of two offices, four rooms, and a closet. There was a waiting room and reception, the consultation rooms,the janitorial closet, the pharmacy and the equipment room. The administrative body was composed of a director, a pharmacist, a janitor and four doctors (two for sanitary vigilance and two for the intern service). Its organisation and operation were complimented by many doctors including Oswaldo Cruz, when he was there in 1906.

The intention of Octávio de Freitaswas to build, in addition to the Dispensary, a Tuberculosis Hospice, but this second endeavour was not possible. Incidentally, the Dispensary was built in a different place to what was wanted. The first idea was to build two pavilions attached to Hospital Pedro II to isolate the sick, but the Santa Casa de Misericórdia, the organ that administrated that Hospital, did not approve. Years later, he received authorisation from Santa Casa to build at the then-called Hospital Santa Águeda (today Hospital Oswaldo Cruz), the Muniz Machado Pavilion for the specific purpose of housing tuberculosis sufferers. It was the first internment unit in Recife for carriers of the disease.

On 21 January 1912, doctor Octávio de Freitas founded the second Dispensary, which was called ‘Lino Braga’, in a building built on Conselheiro Peretti St (the former Roda St), in the neighbourhood of Santo Antônio. While the first served exclusively for the treatments of tuberculosis, the second was destined for countless services that would benefit women’s health. In the same way, it helped poor children in their first year of life, medicating them and helping them in feeding. When necessary, the children were visited in their homes. For them, Dr Otávio de Freitas created the ‘Gota de Leite’ (Drop of Milk) programme.

With the operation of these two Dispensaries, it was possible to get state and municipal government help and adopt several means to strengthen and aid in the campaign against tuberculosis. In other words, in the first phase of its existence, (1900-1923), the LPCT, besides the achievements together with the governments, assisted approximately 5,000 tuberculosis patients at its Octávio de Freitas Dispensary.

From 1922 to 1926, when the Department of Public Health was run by Dr Amaury de Medeiros, the campaign against tuberculosis gained official support. There was an agreement between the League and the Department of Health: the services of the Dispensary and the Inspectorate of Tuberculosis Prophylaxis in Pernambuco, whose direction was given to Dr Octávio de Freitas, would fall under the responsibility of that Department. It would work in the following way: the services of the Octávio de Freitas Dispensary in one space within the Department, and the Lino Braga in an area in the building occupied by the Amaury de Medeiros School Group inAfogados. As forthe buildings occupied by the Dispensaries, the League’s director though it was better to sell them and deposit the proceeds in a bank account in Recife. The proceeds gathered from this agreement were extremely pleasing. However, when the revolutionary government took power on 10 October 1930, the Inspectorate of Tuberculosis Prophylaxis was closed down and, with this decision, the actions of the LPCT were compromised.

In 1931, the League returned to working alone, and its president committed himself to the construction of a building to house the praise worthy institution and the new Model Dispensary to combat tuberculosis. The money from the sale of the two Dispensaries was used in the construction of the building on a piece of land in Derby, close to the Faculty of Medicine, today the Medicine Memorial, acquired and donated by the state government. The construction, under the responsibility of Manoel Carneiro de Sá Barretto, began on 1 August 1931 and finished on 13 March 1937. During this period, the League faced many hurdles created by the municipal government, in the shape of Mayor Antonio de Góes who, to address the calls from the prejudiced elite living in that populated neighbourhood, alleged it was an inconvenient location for the construction of an anti-tuberculosis dispensary.All the correspondence sent to the Council and the replies from the municipal authority on the matter can be found in the publication O Dispensário da Tuberculose, no Derby (The Tuberculosis Dispensary, in Derby) by Dr Octávio de Freitas.

The ‘Dispensário da Liga’ (‘League’s Dispensary’ – today the ‘Centro Médico Octávio de Freitas’ – Octávio de Freitas Medical Centre), in the Derby neighbourhood, operated “as a chamber for consultations and treatment; as an immunisation centre for BCG and for the application of the Mantouxand Von Pirquet tuberculosis tests; as a centre for radiological exams, and as a centre for studies and classes for doctors and medicine students who wish to specialise in phthisiology.” (FREITAS, 1948).

On 7 August 1948, the command of the fight against tuberculosis was passed onto the government area with the creation of the Tuberculosis Division within the State Department of Public Health. From then on, the LPCT took on an independent and assisting role.

The League, for a long time the only executive organ in the fight against tuberculosis, was also a centre for didactic discussion on phthisiology, from where all the initiatives in the fight against tuberculosis emanated. It was a very active organism within the specialty. Besides the routine work associated with the specific functions of treating the sick and defending the sound, it held courses and promoted debates that were very influential in the knowledge of this specialisation. (TÁVORA, 1993).

Today, the Pernambuco League Against Tuberculosis has a new social name: Centro Médico Octávio de Freitas (Octávio de Freitas Medical Centre - CEMOF). This change was decided on 23 October 1991, during the League’s Extraordinary General Assembly.
To finish, all that is left is to point out and highlight the extraordinary role played by Dr Octávio de Freitas as head of the Pernambuco League Against Tuberculosis, in all the initiatives that helped to strengthen the fight against the disease in the State of Pernambuco, including: at Hospital Oswaldo Cruz, the Tuberculosis Division; at the Health Centres, special units for working against tuberculosis; the Sanatorium – Hospital do Sancho (today Hospital Gera lOtávio de Freitas); the creation of the Pernambuco Tuberculosis Society, among others.