Memories of Dr. Santos Silva
Dr. Vítor Santos Silva was born in the year that the Hospital Colónia Rovisco Pais (HCRP) was inaugurated and his father – Dr. Manuel dos Santos Silva – was appointed member of the respective Installation Committee (27-09-1947). He grew up surrounded by the more or less evident reference to the existence of a hospital designed to treat Hansen patients at the Tocha.
These facts and the importance of getting to know the first director of the HCRP better, justified the relevance of this interview where memories were recorded around that institution and where elements are provided for the reconstruction of the biographical path of Dr. Manuel dos Santos Silva, a prominent figure in prophylaxis and leprosy therapy in Portugal, who was responsible for running the Leprosaria Nacional Rovisco Pais between 1947 and 1958.
This interview started with the reconstitution of Dr. Manuel dos Santos Silva’s academic path through the prompt contribution of Dr. Vítor.
Dr. Manuel dos Santos Silva was a native of the Torch, where he was born in 1906, he was “Son of a modest family, and it was even an uncle priest who provided him with the necessary means, which certainly his parents did not have, so that he could continue his studies. . After concluding that it was primary education, which he attended at Escola de Cadima, Dr. Manuel dos Santos Silva, from an early age, revealed himself to have a work capacity and very rich intelligence skills. And the first public recognition of his high intellectual qualities took place at the Liceu de Aveiro, where he completed all secondary education and where, uprooted from his family, in an unknown environment and without any help, he nevertheless won the Anastácio Nicolau de Bettencourt prize, the only that then existed in that educational establishment and that was destined to consecrate the students considered there distinct. ” He went on to the Faculty of Medicine of the University of Coimbra where he graduated in Medicine and “where he was always a brilliant student and very dear and esteemed among his colleagues”.
In 1931, Dr. Manuel dos Santos Silva was appointed assistant in that Faculty in the chair of Medical Pathology and in 1946 he completed his doctorate, with the dissertation entitled The anemias of cirrhotics: clinical and laboratory study (copper and vitamins) that obtained the “classification very good with distinction ”. That same year he went to Brazil with “the sponsorship of the Institute for High Culture and on an official mission of the Portuguese Government, (…) to study the organization of the fight against leprosy, having known well and attended the best centers for prophylaxis, assistance and leprological research, hospitals and dermatology clinics, namely in the States of São Paulo, Rio de Janeiro, Minas Gerais, Bahia and Pernambuco, having then attended the Second Pan American Leprosy Conference, which took place in the city of Rio in October of that year. ”
Between 1947 and 1950 he held the positions of “President of the Regional Council of Coimbra of the Ordem dos Médicos” and “member of the General Council”.
On September 27, 1947, he was appointed member of the HCRP Installing Committee “with his performance and then as Clinical Director, [of which he took office on 11/15/1948) an important role in the organization and assembly of all services and main executor of technical activities, either within that hospital establishment or outside it, throughout the country. The functions mentioned ended on 18-07-1958, date when he took office as Clinical Inspector of the Institute for Assistance to Lepers . ”
In the academic and professional path of the first director of the HCRP, Dr. Vítor also underlines the intense scientific activity, saying: “(…) a highly recognized professor, scientist and doctor with extensive professional experience, he has always continued to be very active as a lecturer and moderator in all leprology courses, which in successive years took place between 1960 and 1968 at the Hospital Colónia Rovisco Pais. ” In addition to these, he was present at the most important Congresses on the subject, namely at the “3rd International Leprology Congress, held in Havana” where he was “elected member of the Social Assistance Commission” (1948); at the “6th International Leprology Congress, held in Madrid in 1953” where he was elected to “the Therapeutic Commission”; “In 1963, as a fellow of the World Health Organization, he represented Portugal at the 8th International Leprology Congress, held in Rio de Janeiro, being again elected member of the Therapeutic Commission, taking advantage of the opportunity to study the then most recent acquisitions of leprological science and new methods of leprosy prophylaxis. ” In the context of these events and not only had the opportunity to be “in Spain, in official service” and to know “the organics of leprological services in Cuba”, as well as to visit the “United States of North America (…) and to know the functioning and the available means to fight the disease in hospitals, sanatoriums and, especially, in the model and then only leprosy of that country, located in Carville in Louisiania.”
To the long curriculum described is added the “vast, appreciated and fruitful written work, related either to research work that he carried out or collaborated with while developing functions at the Faculty of Medicine of Coimbra, or later as Director of the Hospital Colónia Rovisco Pais and Inspector Leprosy Assistance Institute (…). ” As Dr. Vítor notes, the valuable bibliography produced results from “innumerable actions, such as colloquiums, lectures, conferences throughout the country and lessons for medical students and medical and health improvement courses at the Faculty of Medicine of Coimbra, in Ricardo Jorge Institute, Geography Society, etc. ”
Regarding the memories that Dr. Vítor retained, and that directly relate to HCRP, he shared the following:
“I don’t know the reasons for his initial connection to Hansen’s disease (…). I was still a young boy when my father held the position of Clinical Director of Hospital Rovisco Pais and, therefore, I do not remember having had dialogues of interest on the subject with me. I remember, however, of his frequent absences on duty due to his professional performance, which led him, integrating multidisciplinary teams, made up of other doctors, laboratory technicians, social and administrative assistants, to travel the country. other times its absence is due to trips to foreign countries, where events related to leprology were taking place. I have not yet forgotten the satisfaction with which I saw him buying musical instruments in Coimbra at the “Olímpio Medina” to satisfy the requests made to him by several inpatients, who knew how to play them. And I am also very aware of his care when he came home from the hospital, in order to prevent infection with family and friends. ”
Regarding the activity of the Hospital, Dr. Vítor recalled that:
“(…) I don’t remember my father sharing with me, so a young boy, details about his clinical or therapeutic activity at Rovisco Pais, in addition to some brief references, made much later, to the fact that some sometimes they were sent to that hospital sick, with the diagnosis of nervous leprosy when, after being studied there, it was found that they were finally victims of another disease, paramyloidosis. As an adolescent, I also accompanied him a few times at conferences and lectures that he gave as Inspector of the Institute for Assistance to Lepers, in various parts of the country, jointly with the Health Delegations, on leprosy matters. (…) I remember (…) he was always deeply knowledgeable and up-to-date with all the most modern and advanced solutions that, over time, were given to the most delicate and complex issues that arose in the fight against leprosy, which also it is not surprising given not only his academic preparation, but also the permanent contact with the most prominent leprologists and institutions at national and international level, who dedicated themselves to the study of Hansen’s disease, later used to avoid stigmas linked to the initial one. ”Between 1947 and 1950 he held the positions of” President of the Regional Council of Coimbra of the Ordem dos Médicos “and” member of the General Council “.
Due to an accident, Dr. Manuel dos Santos Silva became paraplegic in 1972 and died in 1985. His name was forever linked to HCRP, the starting point at which Dr. Manuel dos Santos Silva “(…) started and developed the frontal and vigorous fight against leprosy, being its main technical advisor and executor and who most disseminated leprological knowledge in Portugal”, as recalls Dr. Vítor. And adding, he also mentions: “After having retired, with the consequent greater availability of time, I was curious to read some of the studies published by him, not really on the scientific part, but those that were more accessible and of greater interest to me, related to the origin of the Rovisco Pais Hospital and the history surrounding the beginning of the fight against leprosy in the referred health establishment. ” These readings, which Dr. Vítor shared brought him answers to some questions that he was asking over time. Among the bibliography already consulted, mentions an article published in the Revista Portuguesa da Doença de Hansen (vol. 1, nº 3, September-December, 1962), entitled “Hospital-Colónia Rovisco Pais: last leprosaria on the Portuguese continent” by Dr Manuel dos Santos Silva [PDF], where he picked up aspects of the history of the fight against leprosy in Portugal, of which he highlighted the concern about the disease and its spread registered at the International Congress of Medicine in Lisbon, in 1906, to after the appointment of a commission to study leprosy in 1930, the prohibition of leprosy patients to be admitted to the Hospitals of the University of Coimbra in 1931, and the availability of fifty to five places for these patients at the Joaquim Urbano Hospitals, in Porto , Lisbon Civil Hospital and Curry Cabral pavilion at Hospital do Rego “in less proper conditions”. Also underlining the campaign “We help the lepers!” directed by Professor Bissaya Barreto in the newspaper A Saúde since 1938.
Dr. Vítor also shared aspects that he retained from the analysis of the “Lesson he did in Coimbra, on December 9, 1957, to the Improvement and Review Course of the Faculty of Medicine, in collaboration with the Ordem dos Médicos and the Direcção-Geral de Saúde, later published in the Jornal do Médico, XXXV (784): 277-298, February, 1958 ”whose reading allowed him to better understand the father’s position regarding the new therapeutic means or issues inherent to the hospitalization of Hansen patients. Thus, Dr. Vítor stresses that, in this article, Dr. Manuel dos Santos Silva revealed himself “frankly and prudently confident with the new therapeutic means that were being discovered at the time and based on them he left there the principles of leprological science more recent”. Likewise, Dr. Vítor sought “to inform himself of the need for the mandatory or not admission of patients with Hansen’s disease” and found that the issue was “at the time a cause for concern, study and deep reflection”, highlighting about the subject, in that article, the following excerpts: “The ideal would be to have treatments that, due to the good tolerance, speed and infallibility of their efficacy, would satisfactorily solve all cases, (…).
However, this is not the case, therefore, with the best therapy we currently have – sulfones – the effects achieved are not immediately decisive or always definitive. Hence the eagerness to discover and test new medications (…). The truth is that, even with sulfones, good results take some time to become patent, and it is common to achieve bacteriological negativization only after a few years of treatment (…). At Hospital Rovisco Pais there are inmates with six, eight and even ten years of duly administered therapy and that – despite their spectacular clinical improvement – continue to reveal themselves with positive and therefore contagious bacteriological analyzes. ” (…) However, once the desired whitening of patients and their bacteriological negative results have been achieved, this is not definitive and limp, particularly if the medication is interrupted or insufficient. ” “(…) Several leprosy patients, who stayed at the Rovisco Pais Hospital for a long time and were discharged only after a long period of successive negative analyzes, later revealed positive bacteriological tests.”
He also underlined that another aspect – “the absence of the patient’s spirit of foresight” that his father explains as follows in the aforementioned article: “… as soon as clinical improvement is achieved, the suffering disappears and, nodules, plaques, ulcers and other symptoms of the disease, – the patients, although still contagious, judge themselves or announce themselves cured, claim freedom and, having no obvious signs to denounce them, they then become more dangerous in their relations with their contacts, who, unwary, do not take prophylactic care. For this reason, this phase of success with modern therapy has already been called the paradoxical aspect of sulfonotherapy ”.
Dr. Vítor adds: “(…) my father expressly rejected the indiscriminate internment from other times, stating in the same work:“ We have always thought, defended and acted towards it (wanting to refer to Hospital Rovisco Pais ) only those contagious patients who do not offer obvious possibilities, as well as unquestionable material and social guarantees to be treated at home, can be admitted. ”
Still on the subject of hospitalization, Dr. Vítor goes on to state:
“(…) In favor of the hospitalization of some of the patients, their very precarious economic and housing conditions were not forgotten, which made it impossible for them, while staying at home, to comply with“… the minimum hygiene rules and everything that would require the prophylaxis of leprosy… ”on the other hand, it was also considered“ (…) the need to treat the complications inherent or not to Hansen’s disease and the benefit that for them represented a good diet, hygiene and rest inherent to this situation, guaranteed with internment. ”
And, in a parallel between the situation then lived and that of Covid 19, Dr. Vítor says: “It is curious that, after more than six decades and in a very different political regime, the current pandemic situation will show us after all, internment and other measures that also restrict the freedom of patients with highly contagious disease are the solutions that health authorities at national and international level find themselves in need of continuing to adopt. ”
Emphasizing another characteristic of his father, Dr. Vitor highlights the “manifest human sensitivity and solidarity with the sick” demonstrated in the following appeal of his father: “… when demanding from some leprosy the sacrifice of the internment and consequent separation from the family – undoubtedly in their interest, but, on a large scale as well, for the benefit of society – they incur a debt that demands and imposes to provide them with complete medical and social assistance. (…) it would be extremely useful that, among the social actions to be developed in favor of leprosy, there was a litigation service and it was possible to exempt them from paying their contributions, military fee and other tax charges, while the internment lasted (… ). (…) Despite the free admission and remuneration for the work they perform at the Hospital-Colonia, the problem of isolated patients and some others does not have a good solution until they have guaranteed a convenient and regular material support… ”
From this trip to memories and research, Dr. Vítor added, by way of conclusion: “(…) with magnificent and exquisitely equipped facilities, with an area so wide and suitable for the occupation of patients in their different professions, enjoying a life intense and complete social work, which was not lacking in recreational and occupational activities and lavished on patients “… everything that medical science in general and leprology can count on more up-to-date…”, it is not surprising that Hospital-Colónia Rovisco Pais was considered in a grand and model institution. That was what they proclaimed with technical appraisals, experts, scholars, personalities linked to the fight against leprosy and different entities after having visited him and knowledgeable of the work carried out there. Among all of them, I allow myself to transcribe the words spoken by Follereau, tireless protector and rehabilitator of leprosy patients: “The world should come to learn the lesson from the Rovisco Pais Hospital-Colony. You should take advantage of this example to guide yourself in the assistance that needs to be given to lepers. I have already toured the globe 17 times on this mission of fighting for everything that concerns the well-being of lepers. And I’ve never seen anything like it. The Rovisco Pais Hospital is the most beautiful installation of the anti-leprous struggle that I have found in the world ”.
(Text based on oral testimony, in 2020, validated by the interviewee. Interview and writing by Cristina Nogueira – CulturAge)