Portuguese Physician Research Articles

CRIME or PUNISHMENT: Penal or Administrative Sanction Concerning Medical Liability in Medically Assisted Reproduction Techniques in the Iberian Context

The existing Portuguese and Spanish laws on medically assisted reproduction are in general not much different, but this study shows they go completely different ways with respect to medical liability and sanctions for the physicians or medical teams that perform them against these laws in Portugal and Spain. Our study describes both legislative solutions in terms of legal sanctions for medical wrongful actions in this matter. This is a comparative study between the Iberian laws on medically assisted reproduction – Law 14/2006, in Spain, and Law 32/2006, in Portugal – which analyses based on these 2 punitive approaches the solutions for medical liability justice in medically assisted reproduction techniques in the Iberian context.In our study, we show both legal solutions from a critic and constructive point of view, through a comparative analysis of the texts of the laws in question, showing that the Portuguese law on criminal and penal justice concerning wrongful medical conduct is very different from the Spanish administrative system sanctioning wrongful actions as regards medical liability in medically assisted reproduction techniques. We therefore conclude that in order for these systems of reproductive human rights in health to be protected and growth together in the future (as we suggest), the Spanish approach, which is more open and does not apply criminal sanctions to wrongful medical conducts at once, but rather first applies administrative sanctions to medical professionals and hospitals that perform them outside of the law, should indeed, in this field, influence more profoundly the Portuguese system. The latter has a more conservative approach that, in our opinion, should be similar to the Spanish one, because there really is not a scientific reason for handling medical conduct in Portugal and in Spain differently. In the former, the same conduct could easily constitute a criminal offence and imply imprisonment for the Portuguese physician, while in Spain the same conduct is only subject to a fine and administrative legal action. In conclusion, the criminalization of medical liability, in general, and in terms of medically assisted reproduction, in particular, does not help protect human and reproductive rights in health care. Keywords: Medically Assisted Reproduction Techniques Liability, Comparative Iberian Medical Law, Penal Justice, Administrative Justice, Human Rights. DOI: 10.7176/RHSS/11-11-04 Publication date: June 30 th 2021

The medical ethics of Amatus Lusitanus

The authors of this study discovered in annals of history the "Oath" of the Portuguese physician Amatus Lusitanus (1511-1568) and translated it into Russian for the first time. The mentioned historical document represents a sort of Code of Honor of European physician of XVI century that both took in ethical norms of Hippocrates and determined one's own rules of doctoring. The ethical principles of Amatus are akin Hippocrates' ones and they are in parallel on seven positions. However, the "Oath" of A. Lusitanus also includes other aspects of medical ethics that are completely organic to the very personality of author and distinguish themselves by courage and novelty for its time. To mention reward of physician for one's labor, difficulties and hardships falling on representatives of medical profession, theme of glorification and exaltation of physician and and medical tolerance. Amatus Lusitanus can be considered as a precursor of initiation of tolerance in European medical ethics that he anticipated with his "Oath".

John Hill (1714?–1775) on ‘Plant Sleep’: experimental physiology and the limits of comparative analysis

ABSTRACT The phenomenon of ‘plant sleep’ – whereby vegetables rhythmically open and close their leaves or petals in daily cycles – has been a continual source of fascination for those with botanical interests, from the Portuguese physician Cristóbal Acosta and the Italian naturalist Prospero Alpini in the sixteenth century to Percy Bysshe Shelley and Charles Darwin in the nineteenth. But it was in 1757 that the topic received its earliest systemic treatment on English shores with the prodigious author, botanist, actor, and Royal Society critic John Hill’s The Sleep of Plants, and Cause of Motion in the Sensitive Plant. As the present article aims to illustrate, Hill and his respondents used this remarkable behaviour, exhibited by certain plants, as a lens through which to reassess the nature of vegetables, and to address pressing questions of wider natural philosophical import, particularly the degree of continuity between the structures and functions of plants and animals and whether similar mechanisms necessarily account for related movements in different life forms. These disputes, this paper contends, also had profound methodological implications regarding the proper way to conduct experiments, the extent to which it was acceptable to extrapolate from observations, and the status of causal explanations.

L’isolement de la cinchonine par Bernardino António Gomes (1768-1823) et l’importance de la science française dans la diffusion de sa découverte

The isolation of cinchonine by Bernardino António Gomes (1768-1823) and the importance of French science in the dissemination of his discovery – This article aims to highlight the repercussion, in France, of cinchonine’s isolation by the Portuguese physician Bernardino António Gomes (1768-1823). This was the first alkaloid isolated from cinchona bark, a plant known for its antimalarial properties. This work resulted in new studies in France, more notably, Pelletier and Caventou’s chemical analysis of cinchona barks, and their ensuing isolation of quinine in 1820, the alkaloid that replaced cinchona bark in clinical practice. The French scientists were crucial for the recognition of Gomes’ work, although they criticized his non-detection of the alkaline properties of cinchonine.

Geraldino Brites e as questões de ensino (1926-1934)

Geraldino da Silva Baltazar Brites (1882-1941) - médico e professor universitário português que se destacou nas áreas científicas da Histologia e da Embriologia - foi um republicano fervoroso e um defensor dos ideais de igualdade e de laicidade da ordem social e dos costumes, combatendo por uma Universidade livre das grilhetas do conservadorismo e do marasmo intelectual. Frequentador de círculos republicanos e colaborador assíduo em revistas e jornais com fortes conotações anarco-sindicalistas e antifascistas, este cientista português viveu sob o signo da modernidade contrariando, através dos princípios da liberdade e da tolerância, todas as formas de opressão. A sua absoluta rejeição da adoção do ensino religioso pelas escolas, compreendendo que este se devia confinar a espaços privados ou a locais estritamente apropriados colocou-o, em 1926, no centro de uma disputa cultural e religiosa com Manuel Gonçalves Cerejeira, amigo íntimo de Salazar e futuro Cardeal-Patriarca de Lisboa. Explora-se, neste trabalho, não só as suas diferentes convicções e fundamentações acerca do ensino como, em simultâneo, se pretende dar a conhecer uma figura republicana que permanece esquecida.

Contributions of Cunha Rivara (1809–1879) to the Development of Konkani

Joaquim Heliodoro da Cunha Rivara (1809–1879) was a Portuguese physician, professor of philosophy, politician, librarian and secretary of the governor-general of India (1855–1870). During his job in Goa, he gave a strong impulse to the development of Konkani, a provincial language of Goa. On 28 November 1857, he was appointed by the governor-general to lead a commission established to coordinate, prepare and print Portuguese-Konkani and Konkani-Portuguese dictionaries and other “monuments” of the same language. In addition to many books with primary documentation of the history of Portuguese in India, he published a Historical Essay on Konkani Language that he wrote himself; a grammar by Thomas Stephens, S.J. (1549–1619); an anonymous grammar, possibly written in the 17th century by a Franciscan or Jesuit living in Thane, on Salsette Island; and a grammar and a dictionary written probably by the Vicar Apostolic of Verapoly from 1831 to 1844, Francesco Saverio di Sant’Anna, O.C.D. (1771–1844), which circulated as manuscripts. His intense editorial activity in the defense and the dignity of Konkani, against the “despreso da lingua materna” [the contempt of the native language] (Rivara 1857b: CXIII) by Goans, allows us to consider Cunha Rivara the pioneer of the Renaissance of Konkani studies in the 19th century. Despite the fact that he did not know Konkani, Cunha Rivara paved the way for the 20th century Konkanists scholars who were inspired by his publications, such as Gerson da Cunha (1844–1900), Sebastiao Dalgado (1855–1922), Shennoi Goembab (1877–1946), Mariano Saldanha (1878–1975) and Joaquim Antonio Fernandes (1889–1975). He also had a substantial impact on the overall development of the study of Konkani.

La censura inquisitorial en las Centurias de Amatus Lusitanus

En este artículo analizamos la censura inquisitorial expresada en expurgaciones de algunos extractos de Centurias de Curas Medicinales, escrito por el médico portugués João Rodrigues de Castelo Branco (1511-1568), más conocido como Amatus Lusitanus. Nuestras fuentes han sido las Centurias II, III y IV (atadas juntas, Florencia, 1551) y Centuria VII (Venecia, 1566), ambas conservadas en la Biblioteca General de la Universidad de Coimbra, Portugal. Para la reconstitución de los textos recurrimos a otras ediciones disponibles online y a la nueva traducción portuguesa, preparada a partir de la edición de Burdeos de 1620. Concluimos que la mayoría de los extractos censurados se refieren a afecciones de sexualidad, ginecología y obstetricia, el resto se relacionan con asuntos de naturaleza estrictamente religiosa.

‘What Others Write’: Roderigo Lopez and The Jew of Malta

IT was 7 June 1594: The crowd had gathered outside Tyburn to see an execution. Such events were not uncommon, of course, but this one was special: after being held for four months in the Tower, the Queen’s Portuguese physician, Roderigo Lopez, had been found guilty of planning to poison her. But, more importantly, Lopez was a Jew, and while the existence of a secret ‘crypto-Jewish’ community in London was England’s worst kept secret, Judaism had been illegal in England for over two centuries, and the crowd must have been excited to see a real, live Jew.1 In preparation for the event, a revival of Christopher Marlowe’s The Jew of Malta had been staged at the Rose Theatre: Dominic Green notes that the revival had double the showings of the original run, and Margaret Hotine shows that production dates of The Jew line up with major moments in the Lopez trial, ensuring that Barabas and Lopez would be intimately connected in the audience’s mind.2 The plan worked: at the execution, attempting to proclaim his innocence, Lopez famously said that he ‘loved the Queen as [he] loved Jesus Christ’, to which the audience laughed. In the mind of the spectators, there was little difference between the Jew on the scaffold and the Jew they had seen on the stage. Much has been said connecting Lopez to Shakespeare’s Shylock, but the connections between Lopez and Barabas that seemed so evident to the original audience, connections which I hope to explore here, have been largely ignored by scholarship.

Evidences of the circulation of natural philosophical knowledge about Brazil in a 1763 manuscript by António Nunes Ribeiro Sanches.

António Nunes Ribeiro Sanches was a Portuguese physician and the author of several works about education and science in Portugal and its Empire. Many of these texts circulated and were made public through letters written by him and sent to other intellectuals. This article sheds light on an unpublished manuscript written by Sanches in 1763, in which he argued for the recognition of Brazilian natural resources and their exploitation for trade and medicine.

Forecasting the medical workforce: a stochastic agent-based simulation approach.

Starting in the 50s, healthcare workforce planning became a major concern for researchers and policy makers, since an imbalance of health professionals may create a serious insufficiency in the health system, and eventually lead to avoidable patient deaths. As such, methodologies and techniques have evolved significantly throughout the years, and simulation, in particular system dynamics, has been used broadly. However, tools such as stochastic agent-based simulation offer additional advantages for conducting forecasts, making it straightforward to incorporate microeconomic foundations and behavior rules into the agents. Surprisingly, we found no application of agent-based simulation to healthcare workforce planning above the hospital level. In this paper we develop a stochastic agent-based simulation model to forecast the supply of physicians and apply it to the Portuguese physician workforce. Moreover, we study the effect of variability in key input parameters using Monte Carlo simulation, concluding that small deviations in emigration or dropout rates may originate disparate forecasts. We also present different scenarios reflecting opposing policy directions and quantify their effect using the model. Finally, we perform an analysis of the impact of existing demographic projections on the demand for healthcare services. Results suggest that despite a declining population there may not be enough physicians to deliver all the care an ageing population may require. Such conclusion challenges anecdotal evidence of a surplus of physicians, supported mainly by the observation that Portugal has more physicians than the EU average.

A saúde pública entre a Medicina e a Política: as propostas de Ribeiro Sanches no Portugal das Luzes

Based on the analysis of the Portuguese physician Antonio Nunes Ribeiro Sanches’ intellectual production, this article seeks to investigate how his reformist proposals for the Portuguese population health preservation were appropriate and engendered public health policies, many of them implemented by the Intendencia Geral da Policia. For this purpose, it is necessary to inquire into the Enlightenment movement in eighteenth century’s second half - context of Sanches’ works - paying attention to the debates about the potential uses of scientific knowledge. Therefore we aim to understand how public health conjugated scientific issues - the consolidation of medical knowledge as a science - and political issues – the strengthening of Portuguese monarchy’s power.

A Behind-the-Scenes Glimpse into the Princeps Edition of Colóquios dos simples (Goa, 1563)

Considered by many to be the most learned Portuguese physician who lived in Goa during the sixteenth century, Garcia de Orta (c. 1500-1568) was the author of CoIoquios dos Simples, e Dro gas he cousas medicinais da India [Colloquies on the Simples and Drugs of India] (Goa, 1563). Devoted entirely to the description of Asian natural resour ces, very little is known about how this treatise came into existence. Publish ed at the edges of the Portuguese empire, and a hostage to technical, structural and human constraints, the princeps edition had a limited circulation. The diffusion around Europe of the novelties described in Col6quios dos Simples owed in part to the efforts of Clusius (1526-1609), one of the leading botanists of the time. This scholar promptly published Aromatum et Simplicium (Antwerp, 1567), a Latin epitome of Coloquios dos Simples. This complete reframing of Orta's treatise guaranteed the wide dissemination of the new knowledge about Asian plants, fruits and drugs validated by the Portuguese physician on the periphery of the empire. In this essay I analyse the background to the publication of the Portuguese treatise and demonstrate that, especially due to structural constraints, the princeps edition had a limited circulation. I show that the wide diffusion of the novelties about the natural resources of the Indies was dependent on the technical equipment, artistic skills and editorial criteria dictated and managed by European academics, artists and printers. I propose that the appropriation of local knowledge collected and validated in the Iberian Empires by imperial agents challenged European academics and typographers to create innovative treatises about the Indies' natural resources that assured the widespread circulation of an entirely new natural knowledge.

La piccolezza dei corpicelli: O conceito de doença epidêmica e contagiosa segundo Estêvão Rodrigues de Castro

In the early seventeenth century, the Portuguese physician Estevao Rodrigues de Castro (1559-1638) proposed an innovative understanding of epidemic and contagious diseases based upon a brand new philosophy of nature. His conception of those morbid manifestations was strictly connected with his theory of the composition of things. In the book De meteoris microcosmi (1621), Estevao Rodrigues launched the principles on which he established his entire medical theory and practice, demonstrating that, in the early-modern period, philosophy was a propaedeutic discipline to medical thought. His theory consists by and large of a synthesis of pneumatic and atomist philosophies. Those principles were expanded in the books Compendio (1630) and Il curioso (1631), written and published at the same time of the outbreak of a plague in northern Italy, in 1630-33, with the purpose of defining what should be conceived as a universal disease (i.e. epidemic). His theory was considered an alternative to the one suggested, few decades earlier, by Girolamo Fracastoro in his De contagione (1546). Although influenced by many elements of Lucretian philosophy, Fracastoro’s proposal explained the mechanism of contagion through the use of an Empedoclean notion of sympathy.Keywords: medical thought, theories of diseases, early-modern medicine.

Em diferentes escalas: a arquitetura do Hospital-Colônia Rovisco Pais sob o olhar do médico Fernando Bissaya Barreto

In 1938, Portuguese physician Fernando Bissaya Barreto spearheaded the creation of a 'nursing home for lepers' in the center of Portugal, away from big towns and cities, but still accessible from any part of the country. Opened in 1947, Hospital-Colônia Rovisco Pais followed the model of a colony/hospital/hospice, and was divided symmetrically into buildings of equal features and numbers for both sexes. According to a disciplinary, non-exclusionary rationale, the urban design, building design and furniture and fittings were conceived, under the direct influence of Bissaya Barreto, as instruments for intervention in the physical and moral bodies of the patients, and also, on a different scale, for the control and modification of Portuguese society as a whole.

Between East And West: Garcia de Orta’s <i>Colloquies</i> and the Circulation of Medical Knowledge in the Sixteenth Century

This paper analyses the importance of Garcia de Orta’s Colloquies on the simples and drugs of India (Goa, 1563) in the construction and circulation of Asian botanical and medical knowledge in the sixteenth century. It begins by examining the combined importance of experience and testimony in Orta’s assessment of materia medica from India. It then considers the relevance of interaction and exchange of medical systems between the West and the East in the Portuguese physician’s understanding of medical knowledge and practices. Finally, it analyses how medical and botanical information provided by this work was reframed by Carolus Clusius and circulated in new forms in Europe.

Natural history in India during the 18th and 19th centuries

European access to India was multi-dimensional: The merchant-rulers were keen to identify commodities that could be profitably exported to Europe, cultivate commercial plants in India that grew outside their possessions, and find substitutes for drugs and simples that were obtained from the Americas. The ever-increasing scientific community in Europe was excited about the opportunities that the vast landmass of India offered in natural history studies. On their part, the Christianity enthusiasts in Europe viewed European rule in India as a godsend for propagating the Gospel in the East. These seemingly diverse interests converged at various levels. Christian missionaries as a body were the first educated Europeans in India. As in philology, they were pioneers in natural history also. They constituted a valuable resource for naturalists in Europe. European interest in their field work brought them scientific recognition as well as the much needed cash. More significantly, they introduced the colonial administrators, especially the medical men, to systematic botany. One can make a clear distinction between pre-Linnaean and Linnaean phases in European foray into Indian natural history. Europe was introduced to western Indian drugs and simples by the 1563 work of the Goa-based Portuguese physician Garcia d’Orta (1501/2–1568). A century later, during 1678–1693, the Dutch administrator Hendrik Adriaan van Rheede tot Drakenstein (1636–1691) furnished Europe with information from South India. In both cases, the initiative originated in the colonies itself (Kochhar 2012). Things changed in the second half of the 18th century. Now, individual European naturalists and institutions wanted not only specimens from India but also bits of tacit knowledge resident in the local population. European India was ready and willing to oblige, but as a collaborator rather than a courier. We shall focus on India-based Europeans who built a scientific reputation for themselves; there were of course others who merely served as suppliers.

Teresa Huguet-Termes, Jon Arrizabalaga and Harold J. Cook (eds), Health and Medicine in Hapsburg Spain: Agents, Practices, Representations, Medical History Supplement No. 29 (London: The Wellcome Trust Centre for the History of Medicine at UCL, 2009), pp. vi + 158, £35.00/€40.00/$60.00, hardback, ISBN: 978-0-85484-128-8.

Anyone wishing to take the pulse (so to speak) of the history of early modern Spanish medicine would do well to start with this slim but valuable book. Its half-dozen essays provide a well-rounded sample of recent work in a field that, as Harold Cook stresses in his introduction, still remains largely unnoticed in the English-reading world. Maria Luz Lopez Terrada opens the collection by reviewing the efforts of various institutions to police the health sector in sixteenth-century Valencia. She highlights the lively diversity of this marketplace, and suggests that competition and confusion among different authorities – city and viceregal governments, guilds, and the Protomedicato, or special royal tribunal – wound up encouraging medical pluralism. That one of the physicians whom King Philip II (1556–98) named Protomedico proved to be a committed Paracelsian leads appropriately to the next chapter, Mar Rey Bueno’s overview of alchemical activities in Philip’s court. She argues that, while the King showed little interest in the occult (unlike his relative Rudolf II), he was certainly willing to employ such chemists for their skills in distilling waters and devising other remedies. From this markedly therapeutic (and Lullian) alchemy one moves on to witches, or rather, the saludadores or folk healers, whose many attributes included the ability to detect witches, along with other innate skills, such as the power to cure rabies with their saliva. Maria Tausiet has unearthed numerous intriguing references to these ambiguous figures, who, not surprisingly, were often accused of practising the same sort of black magic they claimed to offer protection against. Teresa Huguet-Termes then focuses on efforts to reorganise the medical sector of Madrid following its designation as capital of the Hispanic empire in 1561. While the runaway growth of the city’s population predictably frustrated these reforms, she joins a larger historiographic consensus in finding little to distinguish Counter-Reformation initiatives in public healthcare from those which prevailed in the Protestant north. Monica Bolufer also keeps the broader European picture in mind while tracing the changing representations of women within a series of texts which ranged from Juan Huarte de San Juan’s best selling The Examination of Wits of 1575, to the enlightened cleric Benito Feijoo’s essay ‘The Defence of Women’, published in 1726. She discerns a few important shifts amid underlying continuity in views of women within learned culture, and suggests that Iberian discourse on sexual difference evolved closely in tandem with medical writing outside the peninsula. Jon Arrizabalaga closes the volume with a portrait of Rodrigo de Castro (c.1546–1627), a Portuguese physician of Jewish background who re-converted to the faith of his ancestors after moving to Hamburg. There he achieved prominence for two publications, a handbook on female diseases and a weighty guide to medical ethics. Arrizabalaga places particular emphasis on the latter, which he sees as marking an important step forward in the self-consciousness of the higher ranks of the healing profession, while it defended Jewish (as well as Islamic and Scholastic) contributions to the long-term development of medical knowledge. The reader of these essays will come away with a strong sense, not only of the dynamism that characterises the small but energetic community of historians of medicine and science in Spain, but also of how, thanks to their efforts, many old cliches are now biting the dust. One certainly bids them well. At the same time, the sympathetic observer may wish that they had taken a few more risks in their analysis, which is heavily outweighed by description. Sacrificing any of the rich empirical detail that is so often found in early modern Spanish documentation would obviously be a mistake. But leavening that detail with a sharper and more sustained analytical effort would help attract greater attention to a sphere of historical research that – as this volume clearly demonstrates – deserves to be much better known.

Saúde e dietética na medicina preventiva medieval: o regimento de saúde de Pedro Hispano (século XIII)

This text is an analysis of a preventive medical work, Liber de conservanda sanitate, composed in the thirteenth century by the Portuguese physician and doctor, Peter of Spain (?1210-1277). His work enables us to look at the conceptions of health and hygiene and understand the social role of university physicians in medieval preventive medicine. The work constantly displays the notion of the balance in corporal health between internal elements, or natural things (complexion, for example), and external ones, or non-natural things (air, sleep, exercise, food, baths, passions of the soul).

The 1932 Macau epidemic of cerebrospinal meningitis: A historical perspective and critical review of the data

Since the first clinical description by Vieusseux (1805) of the epidemic form of meningitis known today as cerebrospinal meningitis, numerous epidemic outbreaks of the disease were reported globally during the nineteenth and early twentieth century. Historical medical data confirmed that clinical disease may occur either sporadically or in an epidemic form. Moreover, it may afflict children, young military recruits and/or populations living under crowded conditions. In 1932, an epidemic of meningitis occurred in Macau. The disease was sufficiently unusual to justify the publication of a special report by the Portuguese physician in charge of the control services of the epidemic. Here we present a critical review of the Macau epidemic data.

Portuguese physician and pharmacist attitudes towards the use of herbal complementary and alternative medicines in oncology

Background Complementary and alternative medicines (CAM) are becoming extremely popular among health products consumers and patients in Portugal. Although many forms of CAM pose no risk or a minimal risk to consumers and patients, others make use of some herbal substances and preparations containing ingredients known to be toxic, genotoxic and carcinogenic, which may become reasons of concern at specific levels of exposure. The use of herbal complementary and alternative medicines is growing among Portuguese cancer patients, contributing to a higher risk for unwanted interactions, especially due to the narrow therapeutic index of most oncolytic drugs. Although physicians and pharmacists are becoming aware that patients use some forms of CAM, few discuss these therapies with them. Therefore, it is very important to assess both physicians and pharmacists familiarity with most commonly used forms of CAM and to evaluate their attitude towards its use by cancer patients. Unfortunately, in Portugal, no questionnaires have been developed to measure this topic. Objective Evaluate the reproducibility of ad hoc designed questionnaires. Methods Questionnaires were separately constructed for physicians and pharmacists. Both included 3 questions related with 15 most common CAM therapies and 1 set of questions related with phytotherapy. To assess reproducibility, each questionnaire was used in a pilot test. One pilot test was performed at the Hospital Infante D. Pedro (Aveiro) on a sample of 15 doctors and the other was performed at 8 pharmacies in the surrounding area of the Hospital, on a sample of 15 pharmacists. The questionnaires were administered twice, with 3 weeks interval. The questionnaires reproducibility was assessed using Cohen's kappa coefficient. Results Kappa values obtained in the pilot studies were above 0.6 for the majority of the questions, revealing a substantial degree of agreement. Conclusion The level of reliability estimated suggests that physicians and pharmacists familiarity with CAM, and attitude towards its use by cancer patients, can be adequately measured by the developed questionnaires.