Map showing leprosy organisations in Brazil in 1936
According to Maurano (1944), the Portuguese were responsible for introducing leprosy to Brazil. Hypotheses about the origin of leprosy in this region support what is now known from genomics about the spread of M. leprae. It appears that the disease arrived with in Rio de Janeiro, Salvador and Recife, at the end of the sixteenth and beginning of the seventeenth centuries. (Maurano) It came with European immigrants and African slaves.
In 1640, what was known as Campo dos Lázaros (Leprosy Camp), in Bahia, Brazil was situated two miles from the Fortalezo de Nazaré do Cabo (Fort of Cape Nazareth). The governor of the city of Rio de Janeiro called for a report on the prevalence of leprosy in the city on 1696. (Souza Araújo) The following year he asked the king to authorise the construction of a leprosy hospital. By 1740, the King of Portugal, Dom João V, ordered Dr Euzebio Ferreira to study the subject of leprosy in Rio de Janeiro. Drs Francisco Teixeira and Jose Rodrigues, of Lisbon were appointed to plan a strategy for leprosy control in Brazil. As a result, the first anti-leprosy law for Brazil was drawn up by a committee of three Lisbon doctors. They regarded leprosy to be a contagious disease of greater or less degree according to its clinical type, and they recommended segregation of all confirmed cases. Eventually, in 1763, the Catholic Fraternity “Irmandade da Candelaria” took over the leprosy asylum in Rio de Janeiro which was called the Hospital dos Lázaros. Meanwhile, asylums were established elsewhere in Brazil; for example, in Bahia, in 1787, São Christovam dos Lazaros; and two years later, the Hospital dos Lazaros of Recife was established in Pernambuco. In 1815, the Governor, Count dos Arcos, built an asylum at the Hospital dos Lazaros, Santa Casa da Misericordia, in Tocunduba, near Belém, in Pará.
In the early twentieth century, Emílio Ribas called the government’s attention to the constant rise in leprosy cases, and proposed isolation in ‘asilos-colônia’, where the patients should lead a life similar to that of healthy people.(Maurano) At the American International Leprosy Congress in Rio de Janeiro, Carlos Chagas approved a raft of anti-leprosy measures that included leprosy censuses for all Brazilian states; consolidation of the different anti-leprosy legislation in force; opening of colonies; implementing a uniform plan to combat the disease, to be applied simultaneously across the whole country; permitting, in certain circumstances, isolation at home; and providing specialist treatment for patients. (Velloso)
A National Department of Public Health was formed in 1920 (Departamento Nacional de Saúde Pública), with an “Inspectoria de Prophylaxia da Lepra”. It estimated that there were 12,000 people with leprosy in Brazil. (Souza Araújo) Carlos Chagas was its architect. This was the first time that anti-leprosy activities were organised as a matter of public health. The end result was that from 1927 onwards, people were systematically isolated.
By 1929, estimates have increased significantly. Out of a population of 36,000,000, there are 24,000 people with leprosy: i.e. 0.67 per 1000 according to Souza Araújo. There were major foci in the States of Amazonas, Pará, Maranhão, Minas Gerais, São Paulo and minor foci the north east and south of Brazil. At this time, there were leprosy asylums in the following states:
Hospital dos Lazaros of Rio de Janeiro
Hospital dos Lazaros of São Salvador, Bahia
Hospital dos Lazaros of Recife, Pernambuco
Hospital dos Lazaros of Tocunduba, Belem, Para
Hospital dos Lazaros of Sabara, Minas Gerais
Hospital dos Lazaros of Guapira, São Paulo (1904)
New leprosaria were planned or already established in the following:
Lazaropolis do Prata, Pará (1924)
Leprosario Santa Angelo founded by Santa Casa da Misericordia (1928)
Leprosario São Luiz, St Luiz
Leprosario Santa Izabel, of Minas Gerais
Leprosario de Paricatuba, Estado do Amazonas
States of Ceará and Rio Grande do Norte
In 1946, an extensive leprosy census was carried out for the whole of Brazil by Ernani Agrícola, under the supervision of the National Department of Health (Departamento Nacional de Saúde) of the Ministry of Education and Health (Ministério da Educação e Saúde). The results showed a constant rise in the number of new cases, while the prevalence level showed that the increase of the disease had not been detected, leading to a conclusion that the ‘tripé’ (triple action of leprosários (where patients with advanced leprosy were kept), dispensários (which had the function of examining those in contact with patients, suspected cases and less advanced cases, and preventórios (where children of parents with leprosy were brought up and educated, away from their parents.) was an insufficient measure in impeding the propagation of the disease.(Velloso)
In 1948, when dapsone treatment became available, a National Leprosy Campaign (Campanha Nacional de Lepra) commenced in 1950 and ended in 1964, at which time leprosy responsibility for leprosy control was transferred from the national to the state level.
One notable event coming out of the Eighth International Leprosy Congress in Rio de Janeiro (1963), held by the International Leprosy Association, was the elimination of the derogatory term “leper” as a medical category.
Between 1986 and 1990, the Projeto de Intervenção in Brazil led to the elaboration of the Plano de Emergência Nacional. Brazil is still battling leprosy, but the numbers of new cases have gone down. Between 2011 and 2013, the 10 most endemic clusters are mainly located in the states of Mato Grosso, Pará, Maranhão, Tocantins, Goiás, Rondônia and Bahia. They represent 44% (13,597 / 31,044) of new cases diagnosed in 2013. (WHO)
F. Maurano, Tratado de leprologia. História da lepra no Brasil e sua distribuição geográfica. Rio de Janeiro: Ministério da Educação e Saúde. Departamento Nacional de Saúde. Serviço Nacional de Lepra, 1944. V.1, pp. 16-19. Cited in: AP Velloso, & V Andrade, Hanseníase: curar para eliminar. Porto Alegre, 2002.
H. C. de Souza Araújo, História da lepra no Brasil. Rio de Janeiro: Imprensa Nacional, 1946. Cited in: AP Velloso,& V Andrade, Hanseníase: curar para eliminar. Porto Alegre, 2002.
H. C. de Souza Araújo, “The Leprosy Problem in Brazil” Am J Trop Med, May 1925.
WHO http://www.who.int/lep/resources/Cluster_analysis/en/ December 12, 2015