Duke University Press The Hispanic American Historical Review

The Nutritional Link with Slave Infant and Child Mortality in Brazil
Author(s): Kenneth F. Kiple

Source: The Hispanic American Historical Review, Vol. 69, No. 4 (Nov., 1989), pp. 677-690
Published by: Duke University Press
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The Nutritional Link with Slave Infant

and Child Mortality in Brazil
KENNETH F. KIPLE*
IN 1970, a World Health Organization consultant wrote that

"[B]eriberi has never been endemic in the large areas
in the tropics and subtropics where rice is not a staple
food."' This study has three aims: (i) to prove the consultant wrong by
demonstrating through the "discovery" process of beriberi in Brazil that
it was, in fact, endemic there in the nineteenth century and earlier, espe-
cially among the slaves although rice was not an important part of their
diet; (2) to explain how this could have been the case; and (3) to indicate
the implications of widespread beriberi in Brazil for slave infant and child
mortality and thus for slave demography. Among the methods I use is one
of shining present-day medical knowledge on the past, which is fraught
with some danger. Disease descriptions of yesterday can frequently mis-
lead, and therefore "presentism" of this sort is sometimes frowned on by
medical historians. On the other hand, beriberi has a number of distinc-
tive symptoms, and thus, if Brazilian diets should have produced the dis-
ease, and if the symptoms of that disease were widespread, then it seems
a reasonable supposition that the disease itself was rampant in Brazil.
Beriberi is normally associated with the rice-eating cultures of Asia be-
cause the basic cause of beriberi is thiamine or vitamin B1 deficiency, and
the practice of stripping away the rice husk to prevent spoilage also strips
away almost all of the thiamine that the grain contains. Thus, persons
whose diets center too closely on rice become thiamine deficient, and, as
this occurs, they lose their appetites, further exacerbating the deficiency
and rendering them even more beriberi-prone. Women with bodies nutri-
tionally depleted by pregnancy or the process of giving birth and males
*1 wish to thank the National Endowment for the Humanities for a summer stipend in
1988 which supported the writing of this study. I also wish to thank Robert Paquette who
commented on an earlier version presented at the annual meeting of the American Historical
Association held in Cincinnati in December 1988.
i. W. R. Aykroyd, Conquest of Deficiency Diseases (Geneva, 1970), i8.
678 | HAHR I NOVEMBER I KENNETH J. KIPLE
doing hard physical labor are the main adult victims.2 Yet in Brazil, save
for isolated spots in the Northeast, rice played little part in the diet until
this century. Thus, it was something of a shock for nineteenth-century
physicians there to discover the disease in their midst. That discovery was
largely the work of Dr. Jose Francisco de Silva Lima, one of the members
of what has come to be known as the Bahian School of Tropical Medicine.3
Such a discovery was complicated by more than the absence of rice
in the diet. Because beriberi takes a "wet" form, so called because of the
edema that the victim develops along with cardiac symptoms, and a "dry"
form manifested in peripheral nerve lesions that affect different muscular
systems often causing paralysis, it was frequently considered two distinct
diseases, or even three when the wet and dry symptoms combined. In
i866, Silva Lima began a series of articles in the Gazeta Medica da Bahia
on an unknown disease (or diseases) with these symptoms that was rife
among the people of Bahia, and had been at least since 1863.4 About a year
later, in the last 1867 issue of the Gazeta, Silva Lima first ventured the
opinion that all of these symptoms stemmed from a single disease entity,
namely beriberi. Few of Silva Lima's Brazilian colleagues were instantly
persuaded, but at least one foreigner was. The Siglo Medico of Madrid
had reprinted the articles of Silva Lima, and these had been noticed in
turn by Dr. A. Leroy de Mericourt, a distinguished French physician and
an expert on beriberi who had already identified the disease in the West
2. Erwin H. Ackerknecht, History and Geography of the Most Important Diseases

(New York, 1965), 150 and A Short History of Medicine, rev. ed. (Baltimore, 1982), 125;
Edward B. Vedder, "Beriberi and Epidemic Dropsy," in The Oxford Medicine, 8 vols.,
Henry A. Christian, ed. (New York, 1949-55), IV, 276; Richard H. Shryock, "Nineteenth
Century Medicine: Scientific Aspects," Journal of World History, 3 (1957), 899; Robert R.
Williams, Toward the Conquest of Beriberi (Cambridge, MA, 1961), passim; B. S. Platt,
"Thiamine Deficiency in Human Beriberi and in Werewicke's Encephalopathy," in Thia-
mine Deficiency, G. E. W. Wolstenholme and Maeve O'Connor, eds. (Boston, 1967), 135-
145; Stanley Davidson, et al., Human Nutrition and Dietetics, 6th ed. (Edinburgh, 1975),
335-342; Oscar Felsenfeld, Synopsis of Clinical Tropical Medicine (St. Louis, 1965), 320;
Grace A. Goldsmith, "The B Vitamins: Thiamine, Riboflavin, Niacin," in Nutrition: A Com-
prehensive Treatise, 2 vols., George H. Beaton and Earle Williard McHenry, eds. (New
York, 1964-66), II, 143.
3. It should be noted, however, that Ant6nio Augusto de Azevedo Sodr6 has credited
John Patterson of the Bahia School with first recognizing the disease as beriberi. See Sodr6,
"Consideraac6es hist6ricas s6bre o beriberi," in Liqaes de pathologia intertropical (Rio de
Janeiro, 1893), repr. in Brasil Medico, 53 (1961), 1-7. See Ant6nio Caldas Coni for A escola
tropicalista Bahiana: Patterson, Wiicherer, Silva Lima (Bahia, 1952).
4. Vedder, "Beriberi and Epidemic Dropsy," IV, 277. The paralytic form was gener-
ally more widespread but less deadly in large part because coordination problems reveal
themselves quickly on a reduced vitamin B intake. See J. Brozek et al., "Motor Perfor-
mance of Normal Young Men Maintained on Restricted Vitamin B Complex," Journal of
Applied Psychology, 30 (1946), 359-379; Gazeta Medica da Bahia (hereafter GMB), 1 (1866-
67), 110-115, 125-128, 138-139, 158-16o, 183-185, 196-198, 219-220, 232-235, 243-245,
268-270.
NUTRITION AND MORTALITY IN BRAZIL 679
Indies. His subsequent article in the Archives de Medicine Navale was

titled (in translation) "Beriberi Is Not a Disease Exclusive to the East: It
Occurs in the Antilles and Brazil as Well."5
In the study, Mericourt pointed out that although beriberi was thought
to be restricted geographically to Asia, French physicians had reported
epidemics of the illness among blacks on the sugar plantations of the
French Antilles, and Cuban physicians had reported its occurrence on
Cuba's ingenios, where during annual appearances it carried off numer-
ous slaves and Chinese contract workers. He next proceeded to analyze
the work of Silva Lima, whose clinical observations had been so carefully
set forth and who had correctly identified all three forms of the disease.
Mericourt joined Silva Lima in pronouncing the disease in Brazil beriberi,
which had clearly escaped its eastern confines.6
Brazilian physicians, however, were far from convinced, for while beri-
beri in the Caribbean had been linked to a rice diet, no such linkage was
possible in Brazil. Even to the extent that they accepted the existence of
beriberi, Brazilian authorities, according to August Hirsch, as late as 1887
were "most decided and almost unanimous in disputing all connection in
the pathogenesis with deficient or improper diet." Hirsch then echoed
the difficulties expressed by Brazilian physicians in determining the eti-
ology of beriberi by stating that "there has been no general diffusion of
it [beriberi] until recent times, while there has been no such change in
the state of the food of the people as would render its phenomenal out-
burst intelligible."7 The outburst was indeed phenomenal, for by 1899 a
medical graduate of Rio de Janeiro had shown beriberi to be rampant in
Brazil, with a "notable presence" in Amazonas, Para, Maranhdo, Bahia,
Espirito Santo, Rio de Janeiro, Sdo Paulo, Parana', Santa Catarina, and
Matto Grosso.8
Interestingly, in 1887, the same year that Hirsch had written, Hernani
da Silva Pereira, a Bahia medical graduate, inadvertently addressed the
question of beriberi's etiology in Brazil while investigating regional eating
patterns in a chapter of his thesis entitled "The Most Common Foods in
5. GMB, 2 (1867-68), 49-55, 157, 162-163.

6. Ibid., 162-163.
7. August Hirsch, Handbook of Geographical and Historical Pathology, tr. from the 2d
German ed. by Charles Creighton, 3 vols. (London, 1886), II, 593.
8. T. P. Corbally, "Brazil: Movements of the Population, the Climate, and Diseases of
the Chief Cities," The Sanitarian, 18 (1887), 62; Ismael de Senna Ribeiro Nery, "Analogia
entre o beri-beri e a malaria . . ." (thesis presented to the Faculty of Medicine of Rio de
Janeiro, 1889). In 1907, Afrdnio Peixoto, Clina e doengas do Brasil (Rio de Janeiro, 1907),
26-28 reported the disease "contained" insofar as epidemics were concerned, but he also
reported a sufficient number of deaths from beriberi to indicate that the disease remained
endemic in Rio de Janeiro, Bahia, Pernambuco, Pard, and Amazonas.
68o I HAHR I NOVEMBER I KENNETH J. KIPLE
Our Provinces."9 He wrote that in Rio de Janeiro and Sdo Paulo provinces
the diets were stratified between the well off and the poor, with the former
consuming much fresh meat and beans, while those "without great finan-
cial resources" substituted dried meat for the fresh and replaced beans
with cornmeal or manioc flour. In Minas Gerais, the diet was "more uni-
form," and both rich and poor consumed a great deal of pork, cornmeal,
and beans. On the other hand, in the far south, in Rio Grande do Sul,
the diet of all classes centered on fresh meat, cereals, and vegetables.
Finally, in the Northeast, the base of the diet was dried meat and manioc
flour. Fresh meat there was "in general tired, very expensive, and what is
worse, bad." Thus, a little dried beef and a lot of manioc flour were the
normal fare for the working classes of that region.'0
The regional differences are revealing where beriberi is concerned.
One of the constants, and certainly the most important of the culprits, is
manioc flour, which is even lower in thiamine than milled rice (although
this is not widely known). But another, more interesting, constant is the
dried meat. In the Northeast, where the diet of most centered on it along
with manioc meal, beriberi was at its most virulent. In Rio de Janeiro
and Sdo Paulo, where the poor made up the greater proportion of beri-
beri victims, only the diet of the poor centered on dried meat. In Minas
Gerais, where all classes consumed pork, there was little beriberi, and in
Rio Grande do Sul, where the diet consisted of fresh meat, there was no
beriberi." Rio Grande do Sul was the center of Brazil's meat-drying indus-
try, and Pereira found it significant that while the people there produced
dried beef for the whole of the country they would not eat it themselves.
He explained that the drying process consisted of first salting the beef
and then placing the beef slabs on racks to dry in the sun for a minimum
of two months-thus providing one of the major reasons for beriberi in
Brazil. 12
9. Hernani da Silva Pereira, "Hist6ria da alimentaqdo" (thesis presented to the Faculty

of Medicine of Bahia, 1887).
lo. Ibid., 61, 74, 8o.
11. Nery, "Beri-beri e a malaria," 13; Te6filo de Almeida, "O beri-beri no Brasil
(thesis presented to the Faculty of Medicine of Rio de Janeiro, 1916), 17, 68-69. Manioc
varies somewhat in type and, thus, in yields of the various nutrients. See, for example,
Bruce F. Johnston, The Staple Food Economics of Western Tropical Africa (Stanford, 1958),
16o, table; A. Von Muralt, ed., Protein Calorie Malnutrition (Heidelberg, 1969), 147-177,
tables; and Juan Navia et al., "Nutrient Composition of Cuban Foods 1: Foods of Vegetable
Origin," Food Research, 20 (Jan.-Dec. 1955), 97-113, tables. For comparative purposes,
cornmeal yields about .14 mg. of thiamine per ioo grams, beans (in this case represented
by the pigeon pea) .72 mg., milled rice .o8, and manioc, depending on the type, from so
little that it cannot be measured to .07. W-T. W. Leung and M. Flores, Food Composition
Tables, for Use in Latin America (Washington, 1961), 17, 19, 26, 68.
12. Pereira, "Hist6ria da Alimentagdo," 67, 68-70, 72.
NUTRITION AND MORTALITY IN BRAZIL 68i
All living things contain some thiamine, and though animal tissue,
save for pork, is not a particularly good source of the vitamin, most vic-
tims of beriberi in Asia were individuals whose diet contained very little
meat or fish. In Brazil some meat seems to have been eaten by practically
everyone, and still beriberi was widespread. Significantly, however, those
who consumed fresh meat did not get the disease, only those who ate the
dried meat, and the latter came down with it for a number of reasons that
would only emerge as the science of nutrition grew more sophisticated.13
One important reason is the destruction of thiamine in the meat: whereas
salting and drying are hard on the thiamine content of tissue, irradiation
destroys it. Moreover, salting and drying meat make it tough. Conse-
quently, it is normally prepared by soaking it to remove the salt, and then
cooking it for a lengthy period; this process would have eradicated any
thiamine that might have survived the two or more months of exposure
to sunlight. Thiamine is highly soluble in water, therefore much would
have been thrown away in the salty water that was discarded after the
soaking process was completed. Finally, thiamine is sensitive to heat, and
is destroyed in prolonged cooking. To put it plainly: had humans deliber-
ately tried to devise a method of thiamine destruction in beef it is doubtful
that they could have invented a better system than salting, sun drying,
then soaking and cooking.'4 Nor would all of this have produced merely a
neutral effect, i.e., the denial of the original thiamine in the meat to the
consumer. To be properly utilized, the B complex must be in balance.
Sunlight also destroys riboflavin, and thus the beef would have undersup-
plied both thiamine and riboflavin relative to niacin and thereby raised
the normal vitamin B requirements of the consumer considerably. 15
To be sure, few subsisted solely on a dried beef and manioc regimen,
and other foods bearing thiamine such as beans and maize must have
found their way into diets from time to time. But there is still one more
deadly feature of the dried beef to take into account which would have
assured that in many cases those foods could not have prevented beriberi.
For, in drying meat, a good deal of the fat is removed, and the diet of
many in Brazil was already extraordinarily low in fats. When the intake
13. Felsenfeld, Synopsis, 319; Williams, Conquiest of Beriberi, 151-153.

14. Reav Tannahill, Food in History (New York, 1973), 275; L. E. Lloyd, B. E. McDon-
ald, and E. W. Crampton, Fundamentals of Nutrition, 2d ed. (San Francisco, 1978), 163-
164; Leung and Flores, Food Composition Tables, 72, 73. Significantly, Hirsch, Handbook,
II, 589-590 noted that the disease was especially prevalent among sailors whose only animal
protein was in the form of dried, salted beef See also Davidson et al., Humani Nutrition,
i65.
15. Davidson et al., Human Nutrition, 170. Tropical or subtropical residence also raises
thiamine requirements. See H. H. Mitchell and Marjorie Edman, Nutrition and Climatic
Stress (Springfield, IL, 1951), 92.
of fats is low, the body adjusts by utilizing carbohydrates as the major
energy source. But while fats do not require thiamine for metabolization,
carbohydrates do. In other words, a low fat diet significantly increases the
thiamine requirements of the body.'6
We have thus far established that the diet of many Brazilians was seri-
ously thiamine deficient, and that beriberi, the major deficiency disease
which lack of thiamine produces, was "discovered" to be a serious prob-
lem of health during the last half of the nineteenth century. The next
question is: how pervasive was beriberi in Brazil before that discovery?
The answer would seem to be that it was quite pervasive, for there are
numerous glimpses of the disease through the mist of a still more distant
past. Aristides Moll asserts that Brazil was plagued by it from early colo-
nial times, although the first real description of what appears to have been
beriberi in Brazil seems to have originated from the pen of Willem Piso.
This physician, in the country during the Dutch occupation, made a num-
ber of medical observations which he published in his Historia naturalis
Brasiliae (1648). Among them was his report of a disease that attacked
the nerves and produced a "profound torpor in the limbs." He called it
"chronic and common." 17
In the middle of the eighteenth century, Jodo Cardoso de Miranda,
in writing about the diseases of Brazil, devoted a chapter to "stupor and
paralysis." Significantly, he wrote that this condition could be cured by
fresh meat. The Brazilian-born naturalist, Alexandre Rodrigues Ferreira,
who had studied at the University of Coimbra and was sent back to Bra-
zil by the crown in 1783 to study its flora and fauna, encountered and
reported on a strange but widespread disease which he actually called
beriberi.'8 The French physician Joseph Francois Xavier Sigaud, writing
in the nineteenth century, recalled an epidemic that had raged in Rio in
1780, which he called the "grippe," but which Brazilian physicians much
i6. Roger J. Williams et al., The Biochemfistry, of the B Vitamins (New York, 1950), 296;
Mellville Sahyuiim, ed., Proteins and Amnino Acids in Nutrition (New York, 1948), 474, table;
Pedro Tito Regis, "Duas palavras sobre a provincia da Bahia: Ou, breve mem6ria sobre o
seu clima, e molestias . . ." (diss. presented to the Faculty of Medicine of Bahia, 1845),
19; Francisco Fernandes Padilha, "Qual o regimen alimentar das classes pobres do Rio de
Janeiro" (thesis presented to the Faculty of Medicine of Rio de Janeiro, 1853), 15-17; Lloyd
et al., Fundamentals of Nutrition, 164-166.
17. Aristides A. Moll, Aesculapitus in Latin America (Philadelphia, 1944), 501; Willem
Piso, Hist6ria natural do Brasil ilustrada (Sdo Paulo, 1948, orig. pub. in 1648), 23. Piso
(1611-78) apparently had seen beriberi previously or thought he had, for he felt that the dis-
ease he observed in Brazil was distinct from it because the victims trembled less. Trembling,
however, is not a common symptom of the disease.
i8. Jodo Cardoso de Miranda, Relagdo cirurgica e mndica (Lisbon, 1747), 159-184, esp.
173; L6cio 0. N. de Senna, "Estudo hist6rico-clinico das doengas que afetavam o gentio e o
negro do Brasil," Revista Brasileira da Hist6ria da Medicina, 3 (1952), 28.
later came to believe was beriberi based on the symptoms Sigaud had
described. Visitors to Salvador in 1819 remarked that the city had more
"dropsy" cases than any other they had visited, while Hirsch pronounced
beriberi "endemic" to Brazil, from at least the 1820S, and still another ob-
server denounced it as the "most notorious" of Brazil's nineteenth-century
ailments.19
Clearly then, the literature seems to contain ample justification for
the suspicion that beriberi was causing people to swell and hobble, not
to mention die, long before the physicians of Bahia identified it, and this
means that the slaves (euphemistically the poor mentioned so often) had to
be among the chief sufferers. For historically the disease has been espe-
cially attracted to closed populations who had little control over their diet,
such as prison inmates, soldiers on campaign, and sailors confined to ships.
Similarly, slaves on plantations often had little control over their diets, and
the literature leaves no doubt that during the nineteenth century, at least,
those diets in many cases amounted to little more than manioc and dried
beef. Before the nineteenth century when dried beef became a mainstay,
the slave diets of the Northeast seem to have focused heavily on manioc,
and whenever and wherever there was insufficient supplementation, in
the form of whale meat, shellfish, chickens, beans, and so forth, beriberi
would have quickly appeared. Thus, a historian of medicine in Pernam-
buco mentions beriberi as one of the diseases of slaves from the sixteenth
century onward, and Santos Filho, perhaps the most famous of Brazil's
medical historians, believes that the disease was present among the slaves
from the very onset of slavery.20 Unfortunately, neither of these authori-
ties tells us how widespread it was, nor what guise or guises it assumed
before its detection in Brazil, which suggests the need to probe some of
the more mysterious, as well as the more notorious, of the slave illnesses,
19. Joseph Frangois Xavier Sigaud, Du climnat et des maladies du Bresil (Paris, 1844),
185; Silva Lima, "Contribugao," GMB, i (1866-67), 185; Almeida, "0 beri-beri," 59; Sodr-6,
"Considerag6es," 53-54; J. B. von Spix and C. F. von Martius, Viageln pelo Brazil, 4 vols.,
tr. from the orig. pub. in Munich in 1823 by Lucia Furquimn Lahmeyer (Rio de Janeiro,
1938), II, 297, 303; Hirsch, Handbook, II, 577; Peixoto, Clina e doengas do Brasil . . ., 26.
20. That the dried meat industry in Rio Grande do Sul was an extensive one by 1784 is
suggested by a quotation in Roberto Simonsen's Hist6ria econinsica do Brasil (1500-1820),
8th ed. (Sdo Paulo, 1978), 378. Another quotation in Stuart Schwartz, Sugar Plantations
in the Formulation of Brazilian Society: Bahia, 1550-1835 (Cambridge, 1985), 138 indicates
that dried meat was part of the core diet for slaves in Bahia from at least i8oo. In .Rio de
Janeiro, Mary Karasch, Slave Life in Rio dejaneiro, i8o8-1850 (Princeton, 1987), 143, i65,
182 indicates that by i8oo slaves in Rio de Janeiro were consuming either fat pork or dried
beef. Not until the 1830s did a shift begin toward an increased consumption of the latter. For
the treatment of slaves before the nineteenth century, see Charles Boxer, The Golden Age
of Brazil (Berkeley, 1962), 173 and passim; Leduar de Assis Rocha, Hist6ria da medicine
em Pernambuco (sc~ulos XVI, XVII e XVIII) (Recife, 1960), 137-138; Lycurgo Santos Filho,
Hist6ria geral da inedicina brasileira, 2 vols. (Sdo Paulo, 1977), I, 137.
even though such a quest leads straight into a semantic jungle of Brazilian
nosology.
One heretofore unexplained slave disease was called "cansago" (fatigue
or exhaustion), which Stuart Schwartz discovered among about 6 percent
of the slaves on some of the sugar estates of Bahia. A Bahian physician,
writing on the foods of his region in 1845, commented that a great num-
ber of slaves on the engenhos were victims of this ailment "that the vulgar
call cansao" but that was properly termed opilaqdo, which in his day
meant inward "obstruction" diagnosed on the basis of outward swellings.
Significantly, he proceeded to blame the symptoms of swellings and gen-
eral weakness on precisely what would cause them the slave diet. He
deplored the fact that manioc, although the "bread of Bahia," was not a
healthy nutriment, and, when united with dried beef, brought on opila-
qdo. To clinch his case, he reported that on one engenho he knew, where
the master substituted cornmeal for manioc flour, the slaves were more
robust and opilaq6es were rare.2' A few years later, a physician in Rio de
Janeiro wrote about opilaqao on the engenhos of that region. He consid-
ered that manioc might be the culprit, but rejected the idea because, even
though that flour was the slaves' principal food, he knew of slaves with
the illness whose masters provided them with wheat flour. He could not
know that which beriberi researchers later discovered that a diet con-
sisting of mostly wheat flour which has not been enriched will also cause
the disease, especially when combined with the dried beef.22
In Pernambuco, opilaqdo was often called "frialidade," but here the
connotation was a disease of the liver and stomach which reportedly killed
many slaves. Importantly, gastrointestinal and liver complaints are both
early signals of beriberi.23 Frialidade sometimes seems to have meant
weakness or laziness, and students of Brazilian slavery have pointed out
the frequent complaints by masters of the laziness and lassitude of their
slaves. Though few would suggest that slavery was a highly motivating
institution there may have been more at work in many of the instances
than simply laziness or indifference. In fact, in the past many individu-
als in prisons or doing outside forced labor who have been accused of
malingering actually turned out to be suffering from beriberi.24
One extreme form of suspected slave malingering in which death
21. Schwartz, Sugar Plantations, 370; Regis, "Duas palavras," 17.

22. Padilha, "Qual o regiment alimentary" 18; Veder, "Beriberi and Epidemic Dropsy,"
i8.
23. Rocha, Hist6ria, io8; Joaquim Jeronyvio Serpa, "Topographia da Cidade do Recife,"
Annaes dA Medicina Pernambucania, 1 (1842), 79; Lloyd et al., Fundamentals of Nutrition,
165; Felsenfeld, Synopsis, 321.
24. Karasch, Slave Life in Rio, 181; Robert Edgar Conrad, ed., Children of God's Fire
(Princeton, 1983), 298, 360; Davidson et al., Hunian Nutrition, 338.
almost invariably claimed the victim was called "banzo" in Brazil. Plant-
ers thought it a form of suicide and knew its symptoms well. The slave
developed a melancholic appearance, sank into lethargy, and refused to
eat until he or she quite literally starved to death. Because one of the
functions of thiamine is to maintain the normal urge to eat, and because
one of the first symptoms of thiamine deficiency is anorexia, along with
"mental changes" and "easy exhaustion," the suspicion is sharpened that
many purported cases of banzo were actually cases of beriberi.25
Other slave diseases may also have camouflaged beriberi, especially
leprosy and elephantiasis. But one more mysterious disease that deserves
mention because it seems to have frequently been beriberi in disguise
was called the mal d'estornach. Just to add to semantical chaos, it was also
called cansapo, opilaqdo, hypoemia intertropical, and cachexia africana
by different physicians in different parts of the country, although the de-
scriptions make it clear that, no matter what it was called, the intention
was to give a disease label to the practice of geophagy that was reportedly
widespread (but secretly done) among the slaves.26
After hookworm was discovered in Brazil, this infection gradually re-
ceived credit for slave dirt eating as well as many of the opilaq6es or
obstructions already mentioned. There was good reason for this, since
many of the symptoms of beriberi such as lassitude, shortness of breath,
anorexia, and swelling of the legs could also be those of hookworm disease
and vice versa. Yet when Rockefeller Foundation physicians began to in-
vestigate hookworm in Brazil they discovered that blacks there, as in the
West Indies and the southern United States, possessed a relative immu-
nity to hookworm disease and thus, as a rule, would not have exhibited
the abnormal appetites that whites and those of Asian descent so often did
with heavy hookworm loads. Moreover, it should be understood that dirt
eating rarely kills anyone, and hookworm disease, if it kills at all, only
does so slowly and in conjunction with intercurrent infections. Yet the
various mysterious ailments that have been discussed frequently killed in
an epidemic fashion compatible with a diagnosis of beriberi but not with
hookworm disease. Finally, it is important to note that physicians con-
tinued to observe that where the slave diet was based on a core which
contained a substitute for either the dried beef or the manioc flour, deadly
25. Orlando Sattamini-Duarte, "Contribuigdo ao estudo clinico-hist6rico do banzo," Re-

vista Fluminense de Medicina, i6 (1951), 6i-88; Platt, "Thiamine Deficiency," 136; Davidson
et al., Human Nutrition, 165; John D. Kirschmann, ed., Nutritional Almanac, rev. ed. (New
York, 1979), 22; Sattamini-Duarte, "Contribuigdo" also suspected that thiamine deficiency
was the cause, see 79-80; Davidson et al., Human. Nutrition, 339; Padilha, "Qual o regime
alimentar," 19.
26. Hirsch, Handbook, II, 314; Bengt Ai-ell and Sture Lagercrantz, Geophagical Cus-
toms (Uppsala, Sweden, 1958), 63; Walsh, Notices of Brazil, II, 184.
ailments characterized by "obstructions" were rare. Similarly, these symp-
toms were seldom a problem in those parts of Brazil where the diet was
sufficiently thiamine rich to keep beriberi at bay.27
There was, however, still another kind of beriberi to be discovered
in Brazil. In 1916, Bahian physicians had the opportunity to read in the
Gazeta of the infantile variety, and the article must have surprised many,
for it had previously been believed that beriberi was rare or nonexistent
in the young.28 But researchers now know that thiamine deficiency is the
only serious nutritional deficiency that can be passed along from mother
to nursing infant and child. In fact, human milk is so low in thiamine to
begin with that, even with well-nourished mothers, the baby normally has
a "slender margin of supply." When the mother is thiamine deficient, her
milk and consequently her nursing infant will also be deficient.29
That deficiency may be one that the mother has lived with and will
continue to live with for many years without showing outward signs of
beriberi, for thiamine deficiency is best thought of as a spectrum with
overt beriberi symptoms as signals in only the most severe cases. But even
though women can live with thiamine deficiency, their infants, with no
other source of food but their mothers' milk, will almost certainly die.
27. Jose Alipio Goulart, Da paimat6ria ao patibulo (Rio de Janeiro, 1971), 71; James C.
Fletcher and D. R. Kidder, Brazil and the Brazilians, 9th ed. (London, 1879), 132; Walsh,
Notices of Brazil, II, 184; Conrad, Children of God's Fire, 287-288. Conrad presents a re-
port on slavery from a nineteenth-century observer who refers to "secret" dirt eaters (p. 75).
The same was true in the Caribbean. Slaves were seldom seen consuming earth. But if they
displayed a certain set of remarkably beriberi-like symptoms they were branded as "secret"
dirt eaters. See Kenneth F. Kiple, The Caribbean Slave: A Biological History (New York,
1984), 99-103. While Silva Lima was occupied with uncovering beriberi in Brazil, Otto
Wiicherer of the "Bahia School" devoted his energies to the discovery of hookworm disease
in the country. See his "Patologia interna sobre a mol6stia vulgarmente/Denominada oppili-
,co ou cansago," GMB 1 (1866-67), 27-29, 39-41, 52-54, 63-64 and subsequent series of
articles entitled "Sobre o ancylostontnun duodenale ou stronylus duodenalis Dubini," GMB
3 (1868-69), 170-72, 183-84, 198-220; Jodo Vicente Torres Homem, Estudo clinico sobre as
febres do Rio deJaneiro, 2d ed. (Rio de Janeiro, i886), 124-128. The resistance of blacks to
hookworm disease in the southern United States and the Caribbean, as well as Brazil, was
discovered by Rockefeller researchers during their hookworm eradication campaign in the
early decades of this century. The information was handled gingerly in the United States for
fear that widespread knowledge of black hookworm resistance would exacerbate an already
racially oppressive situation in which blacks were branded as carriers of tuberculosis and
syphilis and viewed collectively as a serious menace to white health. Researchers, however,
spoke openly of black hookworm resistance in the other regions of the hemisphere. For
Brazil, see, for example, L. W. Hackett et al., "Report on Work for the Relief and Con-
trol of Hookworm in Brazil," ms. dated Aug. i6, 1919 in the Rockefeller Archive Center,
International Health Board, 29:5, series 2, box 4, folder 149.
28. "Beriberi infantil," GMB (1916), 470-474; Francisco Braulio Pereira, "Hist6ria-
patologia-terap6utica do beriberi no Brasil" (thesis presented to the Faculty of Medicine of
Bahia, i881), 50.
29. Michael Latham et al., Scope Manual of Nutrition (Kalamazoo, 1972), 39; Williams
et al., Biochemistry of the B Vitamins, 399-400.
Similarly, children kept too long on the breast-and the slave young were
nursed upwards of three years-without adequate dietary supplementa-
tion run the risk of their mothers becoming thiamine deficient during this
prolonged period although healthy at the time they gave birth. That beri-
beri kills far more infants than adults can be seen from the case of the
Philippines, where of the 25,ooo deaths annually from beriberi during the
1950s, close to 8o percent were infant victims.30
In light of the experience of the Philippines with beriberi, I would sug-
gest for Brazil in the first place, that the mortality precipitated by beriberi
in adults represented only the most severe cases of thiamine deficiency-
cases which generally became manifest during that time of the year when
supplemental foods were in shortest supply. But these cases were only the
tip of an iceberg of thiamine deficiency, because estimates suggest that
about go percent of those suffering from beriberi display mild or subacute
symptoms, and for every case of overt beriberi in a population, hundreds
or even thousands of individuals are suffering from thiamine deficiency to
some extent. From this it follows, secondly, that because thiamine defi-
ciency was widespread in Brazilian adults, infantile beriberi had to be a
major killer of their infants as it was in Manila at the turn of this century,
where it has been estimated that the disease killed about 40 percent of all
babies born, before they reached six months of life.3'
Clearly then, Brazil's problems with beriberi were hundreds or even
thousands of times greater than physicians initially suspected, and because
of a limited diet the disease doubtless fell with much greater weight on the
slaves than on the free population. That beriberi would have been virulent
among this group, in turn, has important implications for slave demogra-
phy in Brazil. Many who have studied slave fertility there have found it
to be high. Yet, at the same time, most report that the slave population
was always naturally decreasing even in the last decades of slavery.32 High
30. Williams, Conquest of Beriberi, 93.

31. Platt, "Thiamine Deficiency," 135.
32. Robert Wayne Slenes, "The Demography and Economics of Brazilian Slavery:
1850-1888" (Ph.D. diss., Stanford University, 1975), 270-340, 363; David Eltis, "Free and
Coerced Transatlantic Migrations: Some Comparisons," American Historical Review, 88
(1983), 269; Santos Filho, Hist6ria geral, 1o0; Louis Couty, Etude de biologie industrielle
sur le cafe (Rio de Janeiro, 1883), 157; Conrad, World of Sorrow (Baton Rouge, 1986), 22-
24; Thomas W. Merrick and Douglas H. Graham, Population and Economic Development
in Brazil 18oo to the Present (Baltimore, 1979), 58-63. An exception is Robert Brent Toplin,
The Abolition of Slavery in Brazil (New York, 1972), who has calculated a natural increase
for the slave population, at least for the period 1873-85. See also Conrad, World of Sorrow,
22-24; Peter L. Eisenberg, "Abolishing Slavery: The Process on Pernambuco's Sugar Plan-
tations," HAHR, 52:4 (Nov. 1972), 581-582; Stanley Stein, Vassouras: A Brazilian Coffee
County, 1850-1900 (Cambridge, MA, 1957), 78; Gardner, Travels, i5-i6; Jacob Gorrender,
0 escravismo colonial (Sdo Paulo, 1978), 445; Boxer, Golden Age of Brazil, 174; Carl W.
Degler, Neither Black nor White (New York, 1971), 69; Agostinho Perdigdo Malheiro, A
mortality rates are generally viewed as the most important reason for the
failure of Brazil's slave population to grow, and I do not quarrel with that,
but I believe that adult mortality was far less important in this regard than
infant and child mortality, which demographic investigators have found to
be "very high" and which one investigator termed "appalling."33
In fact, I would argue that beriberi, as a major killer of slave infants
and children, must bear much of the blame for the failure of Brazil's slave
population to grow by natural means. In Minas Gerais, where a recent
study has indicated that the slave population may have done fairly well
demographically, the diet was varied and included pork which is a good
source of thiamine. But where the slave diet concentrated on manioc and
dried beef, one may catch glimpses of the disease doing its deadly work of
forestalling population growth. For example, Jose Pereira Rego, who was
scrutinizing the causes of infant mortality in Rio during the 1870s, specu-
lated that the infants were dying of "poor milk" from badly nourished
mothers, and thus may have come tantalizingly close to pinpointing the
etiology of infantile beriberi. Because of the nature of the "poor milk" in
question, a characteristic of the disease is that it runs in families, meaning
that a thiamine-deficient mother tends to lose one child after another in
infancy. In this connection, Emilia Viotti da Costa quotes slave owners
who insisted that one white child was more likely to survive infancy than
three or even four black babies because of the blacks' "greater fragility." 34
In Salvador, an investigator who has examined the records of the Santa
Casa da Misericordia located there discovered that patients often "came
without speech," suggestive of the aphonia of adult beriberi. In turn, the
prevalence of adult beriberi during colonial times would help immensely
in explaining another researcher's depiction of slave infant and child mor-
tality in the region as "horrendous." During 1842 in Pernambuco, a dis-
ease was reported that was caused by "aberrations" in the diet and was
killing an increasing number of infants as well as women in pregnancy or
escravidao no Brasil: Ensaio hist6rico-jiiridico-social, 2 vols. (Petr6polis, 1976, orig. pub. in

Rio de Janeiro, 1866-67), II, 129; and Thomas E. Skidmore, Black into White (New York,
1974), 24.
33. Karasch, Slave Life in Rio, 176; Merrick and Graham, Population and Economnic De-
tvelopmnent, 58; Slenes, "Demography and Economics," 270-340; Pedro Carvalho de Mello,
"Estimativa de longevidade de escravos no Brasil na segunda metade do seculo XIX," Estu-
dos Econ6nmicos, 13 (1983), 151-181.
34. Amilcar Martins Filho and Roberto B. Martins, "Slavery in a Nonexport Economy:
Nineteenth-Century Minas Gerais Revisited," HAHR, 63:3 (Aug. 1983), 536-568. Corn-
pare, however, the comments which follow the study (569-592) by Slenes, Warren Dean,
Stanley L. Engerman, and Eugene D. Genovese as well as the work of Wilson Cano and
Francisco Vidal Luna, "La reproducci6n natural de los esclavos en Minas Gerais," Revista
Latinoamericana de Historia Econ6inica y Social, 4 (i985), 130-135; Karasch, Slave Life
in Rio, 175-176 and appendix, 384-389; Emilia Viotti da Costa, Da senzala a col6nia (Sao
Paulo, 1966), 257-258.
who had just delivered a baby. Later, a regional historian wrote of nine
epidemics of beriberi between 1871 and 1885 all this in a region where
Maria Graham and others had reported the death rate of the slave young
to be well over 50 percent. In Rio de Janeiro, where the slave diet in 1849
was reported to consist primarily of manioc flour and dried salted beef
and "obstructions" were "so common among the slaves," a physician de-
nounced that diet as responsible for the great mortality of the slave infants
and children.35
How great that mortality may have been can be inferred from statis-
tics on the mortality in Rio de Janeiro for 1845-47, which revealed that
infants accounted for 30.2 percent of the total mortality. And when these
deaths were combined with the deaths of those aged one to ten years
(mostly in the one-to-three-year-old group), they accounted for 52 per-
cent of the total deaths. This mortality picture was termed "excessively
horrible" and "unnatural" by a local physician who blamed it on a variety
of ailments that, when brought together, fell mostly under the rubrics of
tetanus, gastrointestinal complaints, hepatitis, lung diseases, marasmus,
and mesenteric tuberculosis.36 It is interesting to note that, aside from
neonatal tetanus (which invariably occurred during the first two weeks of
life), the normal course of infantile beriberi would produce symptoms that
fit all of these categories. Severe vomiting and diarrhea (or constipation),
which fall under the gastrointestinal rubric, are almost always present in
infantile beriberi. As a noted beriberi researcher points out, "gastrointes-
tinal derangement" has often concealed infantile beriberi in the statistics.
So has bronchitis, also normally present in infantile beriberi cases, which
in the Rio de Janeiro data would have been subsumed under the lung
ailment category. Hepatitis was a term used by Brazilian physicians when
they thought they were confronting liver problems. Babies with infantile
beriberi tend to retain their urine and develop a "peculiar waxy appear-
ance" that would surely have been taken to mean liver ailment and have
been called hepatitis.37
35. A. J. R. Russell-Wood, Fidalgos and Philanthropists: The Santa Casa do Misericor-

dia of Bahia, 1550-1775 (London, 1968), 289; Schwartz, Sugar Plantations, 338 ff.; "Consti-
tuigdo m6dlica, on molestias reinantes," Annoes dA Medicitna Pernambicana, 2 (1842). 102;
Leduarl de Assis Rocha, Hist6ria da medicitna em Pernambico (skcilo XIX) (Recife, 1962),
243; Gilberto Freyre, The Masters and the Slaves (New York, 1946), 382-383; Feliciano
Coelho Duarte, "ELsaio sobre a hygiene da escravatura no Brazil" (thesis presented to the
Faculty of Medicine of Rio de Janeiro, 1849), 24-25, 29.
36. Jose Maria Teixeira, "Causas de mortalidade das criangas no Rio de Janeiro," Annais
da Academia Nacional de Medicina do Rio de Janeiro (1887-88), 142, 26:2-263, 267. For
purposes of comparison with the years 1868-72, see Jose Pereira Rego, Apontanientos sore
a mortalidade da cidade do Rio de Janeiro, particilarien-te das crianqas (Rio de Janeiro,
1878), 29-30 and passim.
37. G. Thomas Strickland, ed., Htunter's Tropical Medicine, 6th ed. (Philadelphia,
690 I HAHR I NOVEMBER I KENNETH J. KIPLE
Even the diagnosis of mesenteric tuberculosis suggests strongly that
physicians were actually confronting infantile beriberi. In the nineteenth
century, the diagnosis of tuberculosis in adults was a haphazard affair at
best, and even today, in the opinion of experts, the "diagnosis of tuber-
culosis in infants and children, except in the presence of obvious clinical
and/or radiographic evidence, is difficult. 38 What was it then that
physicians in Rio de Janeiro were calling mesenteric tuberculosis? If by
the term mesenteric they meant complaints of the abdominal cavity, it
merely indicates another variation of gastrointestinal ailments. If, on the
other hand, they meant the term to more specifically connote what today
is called tuberculosis of the serous membranes (involving the pleura, peri-
toneum, and cerebral meninges), then they may have been diagnosing
on the basis of symptoms of meningitis, and this could easily have been
the pseudomeningeal form of infantile beriberi which strikes infants at
between eight and ten months of age.39
Infantile beriberi thus presents a variety of symptoms, and given the
diet of the slaves and the poor generally it is difficult to believe that the
disease was not deeply implicated in the holocaust in which the infants
and children of Rio de Janeiro were caught up. And a holocaust it was,
according to a physician who wrote of the great number of slave infants
who died, implying that they dominated the infant death lists.40 However,
there were obviously a number of white infants who died as well, and
physicians blamed many of these deaths on the practice engaged in by
white mothers of turning their infants over to slave women to wet-nurse
with "little thought given to their fitness for the task." One doctor reported
dourly that he and his colleagues still heard "too many times" parents ex-
press joy on the death of their infants, for now they had become angels,
and he pointedly referred to the wet-nurses as "angel makers." 4' How ter-
ribly ironic that malnourished slave women may have inadvertently killed
the infants of their masters because of that malnutrition.
1984), 850; Vedder, "Beriberi and Epidemic Dropsy," IV, 300-301; Williams, Conquest of
Beriberi, 8i, 85.
38. Roderick E. McGrew, Encyclopedia of Medical History (New York, 1985), 341;
George I. Lythcott, Calvin H. Sinnette, and Donald R. Hopkins, "Pediatrics," in Textbook
of Black-Related Diseases, Richard Allen Williams, ed. (New York, 1975), i66.
39. Lythcott, Sinnette, and Hopkins, "Pediatrics," i65; Derrick B. Jelliffe, Infant Niitri-
tion in the Subtropics and Tropics, 2d ed. (Geneva, 1968), 99.
40. Teixeira, "Causas de mortalidade," 269-270. The same was true for the year 1876.
See Luis Alvares de Souza Lobo, "Causas da mortalidade das criancas rec6m-nacidas na
capital do Imp6rio," Annaes Brasilienses de Medicina, 28 (1876), 264-282, esp. 278-282.
41. Teixeira, "Causas de mortalidade," 256, 263, 267. For the extensive nature of this
practice, see Perdigao Malheiro, "A escraviddo," II, 96.

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The Nutritional Link with Slave Infant and Child Mortality in Brazil

Author(s): Kenneth F. Kiple

The Nutritional Link with Slave Infant

IN 1970, a World Health Organization consultant wrote that

2. Erwin H. Ackerknecht, History and Geography of the Most Important Diseases

Indies. His subsequent article in the Archives de Medicine Navale was

5. GMB, 2 (1867-68), 49-55, 157, 162-163.

9. Hernani da Silva Pereira, "Hist6ria da alimentaqdo" (thesis presented to the Faculty

13. Felsenfeld, Synopsis, 319; Williams, Conquiest of Beriberi, 151-153.

21. Schwartz, Sugar Plantations, 370; Regis, "Duas palavras," 17.

25. Orlando Sattamini-Duarte, "Contribuigdo ao estudo clinico-hist6rico do banzo," Re-

30. Williams, Conquest of Beriberi, 93.

escravidao no Brasil: Ensaio hist6rico-jiiridico-social, 2 vols. (Petr6polis, 1976, orig. pub. in

35. A. J. R. Russell-Wood, Fidalgos and Philanthropists: The Santa Casa do Misericor-

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