IHPST THIRTEENTH BIENNIAL INTERNATIONAL CONFERENCE RIO DE

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Science Education and History of Science:

learning from archive films

Luiz Augusto Rezende Marcia Bastos de Sá

Federal University of Rio de Janeiro Federal University of Rio de Janeiro
Brazil Brazil
luizrezende.ufrj@gmail.com marciabsa@hotmail.com

Abstract
This work discusses a methodological approach to analyze scientific archive films as
historical artifacts, aiming their use in teaching history of science. It is assumed such
materials testify about certain states of scientific knowledge and about their relations with
society. In order to demonstrate the potential of the use of scientific archive films for
science education, two films about Hansen’s disease were analyzed according to notions of
Foucault's Archeology. In this analysis we compare elements of the knowledge
contemporary to the selected films and the images and information the films themselves
present. We proceeded to the analysis by extracting the fundamental statements of the films
to finally confront these statements, aiming a discussion about possible changes in the way
the disease was explained, treated and situated in society, whether in relation to scientific
knowledge and to the social, economic and political broader interactions. From the
confrontation of the films’ statements it can be affirmed that they enable discussion,
reflection and teaching on: (1) how determined state of knowledge about Hansen’s disease
constituted and was formed; (2) how, and to what extent, there has been a displacement in
the way the disease was showed and narrated in Brazil.
Keywords: Archive films. History of Science. Michel Foucault. Science education.

Introduction
Assuming images and films are historical documents, as long as they are understood and
analyzed as reconstructions of history and not as direct presentations of facts (Ferro 1988),
we propose in this paper to take the reconstructive character of scientific archive films
(produced in the past) as a means to understand how they can be considered sources for the
teaching of history of science. From this perspective, the idea that films are neutral
materials is dropped in favor of the idea that films are discourses in which aspects related to
the historicity of science can be identified.
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From this point of view, the use of archive films as documents for teaching history of
science implies in a specific methodological stance. Among the principles that sustain it are
highly relevant: an analytical work on the conceptions and concepts present in the films,
and a clear definition of the context, the perspectives and assumptions upon which the films
are constructed. Since it is not possible to work with history as a whole, it is necessary to
work with clear cut-outs and instruments accordingly adjusted to the analyst’s objectives
(Ferro 1988).
This work presents the analysis of two films on the same theme – Hansen’s disease – but
made at distinct times: Combate à Lepra no Brasil (1945) and Prá onde é que eu vou?
(1988). This “distance in time” is central to our proposal of approach to history of science,
because it allows us to look at the displacements of discourses through time. By the review
of some notions of Foucault's Archeology (Foucault 1972), we took into account especially
notions like rarity and field of correlations, in order to operationalize a visual discourse
analysis.
The principle of rarity – in archives and documents – is the principle according to which is
supposed that “not everything is always said”. Although the statements are numerous, they
are always to a lesser amount compared to everything that was possible to say. It is
assumed, therefore, that in every historical age, relatively few things are said and one has to
analyze the availability of archives, documents and images as products of certain conditions
that shaped the existence and conservation of such material sin the exact way they are. Thus
to analyze the conditions of rarity (or rarefaction) of documents or archives is ‘to discover’
among all that could be “said”, what was really said and why it was said exactly in the way
it was.
The notion of field of correlations sustains that documents and archive images are
statements linked to a set of external relations (Foucault 1972), established by such images,
documents or archives both at the time of their production and at the time of their re-use or
re-appropriation. For this reason, these fields exist in potentiality and appear only when
documents are submitted to contemporary issues / problems. Therefore, a correlational field
is related both to the formal, thematic, historical, aesthetic characteristics of the document,
i.e. the gesture that created it, and to the aesthetic-political gesture that “was created” by the
re-appropriation of the considered document.

Methodology
After a brief presentation of each film, the analysis and extraction of their fundamental
statements were accomplished in order to finally compare the obtained statements, discuss
the changes in the way the disease was/is explained, treated and placed in society as it
relates to scientific knowledge and/or to the social, economic and political broader
interactions in society.
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By analyzing the films we attempted to identify what each document documents, to what
they affiliate or oppose. This implied gathering information about the document’s
contemporaneity: its conditions of possibility, discourses, knowledge and practices. This
procedure allowed the extraction of statements by analyzing the relationships between text
and images in the films.
The principles of analysis obeyed the following three premises: films operate as filters and
it is essential to search for information about topics, images and issues the film effectively
treats and highlights; films carry a tension between what is and what is not shown, which
involves working with the contrast between the information in the film and information
gathered from other documents; films eventually have conceptual errors, and it is important
to know of what these errors are documents, and thus to identify correlational fields and
political projects to which the films relate.

Results and discussion

THE FILM COMBATE À LEPRA NO BRASIL
This film was produced in 1945 by the National Institute of Educational Cinema (INCE)
and the National Leprosy Service (SNL), agencies attached to the Ministry of Education
and Health (MES), and directed by filmmaker Humberto Mauro. Its main purpose was to
disseminate information about the lepers network built by the government as the main
measure for combating leprosy in Brazil. The film was produced in an era marked by
Welfare State policies carried out in parallel with the international health agenda (Moraes
2007), by great concern about controlling tropical diseases and also by the still very
influent hygienist policy.
Combate constitutes firstly an advertising of government actions. The film seeks to
convince the population that patients were treated in a professional, respectful and
humanitarian way (Maciel 2007). The images and texts presented intend to show how the
confined patients enjoy relative freedom and tranquility, and are treated with care, patience,
and security under the auspices of rigor and scientific knowledge. Treatment procedures are
simple and do not seem painful or uncomfortable. This promotes the idea according to
which leprosy treatment at that time could not be more appropriate. Health professionals
would be working according to the government's goals and according to the available
scientific knowledge.
Although the film is clearly identified as institutional-government propaganda, images and
information presented are rare data on the official health policies, especially for the control
of leprosy and about the scientific basis that established these policies, in spite of these
weren’t the most advanced or rigorous at the time.
The practice of isolation was a cornerstone of leprosy control policy in Brazil. Notification
and periodic medical examinations of people in contact with the diseased were mandatory
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(Santos et al 2008). Especially since the 1930s, isolation was not a case involving the
decision and individual acceptance, since it occurred by the means of a police type
operation, which withdrew the patient of his private life (Ducatti 2007). Isolation was
therefore compulsory, whether at home, agricultural colonies, sanatoriums, hospitals or
nursing homes.
The requirement of isolation and its centrality in the state policy made building a broad
infrastructure, such as the film presents, a fundamental objective. To Santos et al. (2008), in
the 1940s, the number of leprosarium, dispensaries and preventorium was still considered
poor, which is why the National Service of Leprosy included in their actions a plan for
building facilities. However, the practice of compulsory isolation was no longer, at the time
the film was produced, consensual. Actually, it never was fully. In Brazil, the compulsory
isolation of patients followed the guidance of a technical elite composed predominantly by
doctors, but also by journalists, lawyers and architects. This elite was divided into two
groups: the “humanitarians” and the “isolationists”.
Humanitarians were concerned with the proximity to the patient and recommend soft
measures of isolation or home isolation (Monteiro cited Ducatti 2007, p. 307). In the other
hand, Salles Gomes, a doctor ahead of São Paulo Health Service in 1931, was a staunch
advocate of compulsory isolation, for example. Under his responsibility, segregation
measures were implemented not only for leprosy, but also for tuberculosis and venereal
diseases, throughout the 1930s. Emilio Ribas, later ahead of São Paulo Sanitary Service,
defended the isolation of lepers, but considered it should only be implemented “after really
capable facilities were made to offer comfort, hygiene and medical care” (Santos et al 2008,
p. 176).Therefore, the defense of isolation created conflicts and scientific, institutional and
professional discussions.
The scientific discussions around treatment and control of the disease en compassing
patients compulsory isolation were, however, much older. The First International
Conference of Leprosy, held in Berlin in 1897, was an example of these disputes (Santos et
al. 2008), about the production of knowledge about the disease, as well as about health
policies to combat it. Hansen proposed isolation as a necessary measure. However, he made
recommendations on the conduct with patients: first home isolation was indicated, and in
the situations in which there were many poor lepers, the government should take steps to
isolate them, and be responsible for their treatment; for him compulsory isolation should be
decided only after an individual examination of each case (Hansen 1897 cited Cunha 2002,
p. 239).
Because of the strategic nature of insulation for Leprosy combat policy in Brazil, the film is
emphatic in highlighting the improvements made in isolation facilities, as to suggest that
patients have decent living conditions and ample opportunity to lead a “normal” life in the
colonies. It is mentioned, for example, the existence in these institutions of appropriate
medical facilities (such as wards, clinics), and cultural, sporting and entertainment
equipment (such as theater, cinema, ballroom, library). Economic and productive activities
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developed by the inmates, generally related to agriculture and livestock, are also
highlighted.
The film also gives prominence to the caring of “non-contagious” patients and to the
surveillance of people in contact with the diseased. The same is true for children born from
“marriage between lepers”: there is reference to the separation of these children from their
parents and to the protection offered by the state or by the adoption by “reputable families”.
It is striking the concern to positively signify the offer of a opportunity of learning a craft
by these children.
The 1940s and 1950s opened new paths: the control of the disease would no longer depend
largely on the isolation and segregation of patients. Outpatients would be treated in clinics.
New prophylactic forms with humanitarian characteristics appear within the so-called New
Posture perspective, advising against isolation. The film, however, doesn’t even mention
any emerging treatments in development or alternative procedures. Below are briefly
described the film statements.
The infrastructure of Leprosy compulsory isolation- an accounting
The film lists the actions taken by the government against leprosy, and presents isolation as
the primary prophylactic weapon for it, expanding the network of leprosy dependencies. In
conformity with the Brazilian State reconstruction and strengthening project, whose one of
the main elements was healthcare reform; the film is intended as a response to the historical
leprosy control negligence in Brazil. A series of government actions is described in detail.
Search, identification and patient isolation are presented as the correct and scientific way to
combat the disease. The containment and segregation are legitimized. Only the
infrastructure of isolation is presented.
As a result of our research on the contemporaneity of the film, two points must be
highlighted: 1) the film is an anachronistic discourse about leprosy treatment, since by the
time it was made it could be already challenged by scientific knowledge available, and 2)
the film stands for a conservative political stance, as government propaganda, on leprosy
treatment. Thus, compulsory isolation practices were no longer consensual. Its inadequacy
was being already pointed out a few years before, for several reasons, as seen above (Diniz
1958). In addition, during the 1940s treatment with sulfa already presented satisfactory
results and in many countries isolation was no longer considered mandatory as it was in
Brazil (Ducatti 2007, Hochman 2005, Maciel 2007, Pachá 2008). It is symptomatic of the
film’s authoritarian political position the fact that it doesn’t provide any information on
important issues such as infection, transmission and control of Leprosy.
Well-treated patients
The film seeks to naturalize isolation and reinforce that patients were treated “with care,
patience, and security under the auspices of rigor and scientific knowledge” (Rezende et al
2011, p. 5). In none of the documental sources consulted for this study were found
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references to the “capture” of patients happening in a peaceful and respectful manner, as the
film makes emphasizes.
Scientific racism
The film attributes the introduction of leprosy in Brazil to African slaves, but research
contest this information (Ducatti 2007, Minuzzo 2008). Although evidence pointed to the
introduction of the disease by Europeans, the ascendance of scientific racism by the time
the film was produced may explain the rarity of this statement. It’s is not our objective to
point out the historical or scientific error in this statement. Instead we seek to understand
that this error is a document of the interplays between science and certain ideological
stances at that moment. It also documents the film and its producers’ alliance with these
ideological stances.
The surest way towards the eradication of leprosy
The film ends with a statement according to which the disease will be eradicated in Brazil if
the measures proposed are followed. On this point, it is important to mention the document
entitled Prevention of Leprosy in Brazil, produced by Dr. Orestes Diniz in 1958, according
to which statistical and epidemiological data for the period 1946-1957, showed that the
incidence of leprosy increased significantly. According to the author, this increment could
not be explained by “greater intensity in the search for cases”, as there haven’t been in the
period “measures to increase the discovery of patients” (Diniz 1958). In addition, Diniz
(1958) quotes the positions of various medical experts conferences, which pointed the
inadequacy of compulsory isolation for several reasons, including concealment of a large
number of patients for fear of isolation, family disintegration, patient stigmatization and
perpetuation of prejudices. At that time, isolation was already considered
“counterproductive” and the measures advocated by the film would not lead to the disease’s
eradication even if well implemented.
THE VIDEO PRA ONDE É QUE VOU? (Where am I going to?)
This video was produced in 1988 as a result of a partnership between the National Division
of Sanitary Dermatology, Ministry of Health (DNDS-MS) and the Center of Educational
Technology for Health, of the Federal University of Rio de Janeiro (NUTES-UFRJ). It is
one of the materials of a set of educational resources produced for the Project Education-
Service Integration (IES) on Hansen’s disease, composed of a book and two videos. This
video was described by the producers as an “awareness video”, that aimed to foster debate
and reflection about problems experienced by patients and former patients and, especially,
about the complexity of the determinants involved in the processes of falling ill, treatment
and control of Hansen’s disease.
Directed to healthcare professionals and students, the video addresses the issue of prejudice
and lack of knowledge about the disease and its carrier. It is structured into three sequences:
the opening presents the testimony of a former leper who exposes the personal and social
drama lived by those who were submitted to compulsory isolation; in the second,
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passersby’s answers about the disease are presented; and in the last one as tagging of a case
is presented to explain that Hansen’s disease is curable. Further notions about the diagnosis
and treatment are given and a last overview on the prejudice problem closes the video.
The edition of the former leper patient’s testimony focus on personal and social issues
arising from compulsory isolation of lepers, as implemented by Federal Government in the
1920’s, as seen above. The practice of compulsory isolation was discouraged since the late
1940s, not recommended in 1958, officially repealed in 1962 (Brasil 1962), but only
abolished in fact in 1986, after the recommendation of the VIII National Health
Conference. The title of the video takes back the last line of the former leper's testimony as
an evidence of his bewilderment and social exclusion caused, according to him, by the
severe physical deformities left by the disease.
A sequence of street passersby answers to general questions on Hansen’s disease (Do you
know “Hansen’s disease”? Do you know how the contagion is? Are you afraid of catching
it?) follows. The answers to the questions indicate that it is quite common an equivalency
between the terms Hansen's Disease and Leprosy. Some respondents consider that the
terminological change was made to end the stigma around the disease and its sufferers;
others that despite this change, the disease is in any case malignant, and the result of
disobedience to divine laws, what evidences the transfer of religious symbolism originally
linked to Leprosy to the new term Hansen’s disease.
Regarding the awareness of the form of contagion of Hansen’s disease, the answers
included in the video indicate the prevalence of misunderstandings about the ways of
contagion, diagnosis, treatment and possible cure. Some respondents admitted fear of being
infected by any disease. Others do not have any fear of developing the disease. One of the
answers brings back the religious explanation for the development of the disease and, on
the other hand, the certainty of divine protection against infection. Below are briefly
described the video statements.
Consequences of compulsory isolation - the suffering of patients
The former leper patient, presented in the video in a way that is possible to observe the
physical deformities he developed because of the disease, attributes to these disabilities his
family and social segregation. As he says with emphasis: “I'm very ugly”, “Who will want
me?” In the light of this abandon a question emerges: the patient received all available
treatment while remaining compulsorily interned?
In the book Controle da Hanseníase (Brasil 1989), prepared for the same project that
originated the video, the theme of the resulting deformities takes a prominent position to
understand fear and stigma associated with the disease and its carriers. The argument
assumes that the threat posed by Hansen’s disease is not enough to explain its stigmatizing
process, because all pathologies bring threats, but not all generate stigmas. Denial reactions
and fear of infection refer to a basic and universal cultural fear: physical deformation.
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In short, the scientific and political understanding contemporary to the video production is
that isolation of patients was a measure that has not proven to be able to control the disease
and, on the other hand, contributed to the increase of fear and stigma associated with it.
A Terminological shift from Leprosy to Hansen's disease (“Hanseníase”) does not end with
misinformation, prejudice and fear
In an attempt to combat fear and stigma related to Leprosy, Brazil had the pioneer initiative
to officially replace the term “leprosy” to “hanseníase”. The replacement of the terms was
definitely made official in Brazil by Law 9.010/1995 (Brasil 1995), which provided that the
term “leprosy” and its derivatives should not be employed in “official documents” or any
other roles. Although legislation on the terminological shift were published in 1975 (Brasil
1975) and 1995, the proposal for such a measure began circulating in academic circles and
public departments since the 1960s, and especially after the adoption of Decree 968/62,
which repealed the practice of compulsory isolation.
The terminology change, however, was not enough, by itself, to remove the stigma, because
its adoption was not international, leading to the simple transfer of the meanings of
“Leprosy” to “Hanseníase”. On the other hand, the change was not followed by an effort to
inform the public and healthcare professionals in order to change understanding and
attitude towards the disease (Brasil 1989, p 17). The collage of plans with answers of
respondents tries to show that the population, regardless of race, gender, economic status,
social status, education level, knows little about the disease, its form of contagion,
diagnosis, treatment or prognosis.
The eradication of the disease in Brazil depends on socio-scientific reorientation of
professionals and health services.
According to information provided by the Brazilian Ministry of Health at the time the video
was produced, since the 1950s Hansen’s disease was understood as an infectious, treatable
and curable disease when diagnosed early, whose eradication was feasible. What was
missing was a work facing “the clarification of the population and in particular the social,
scientific and technological reorientation of health professionals and services” (Brasil 1989,
p. 16). This work would necessarily include investigations about the fears and prejudices
associated to the disease, both founded in misconceptions about transmission and cure.
These, elements, in addition to the repulse caused by visible deformities or ulcers,
hampered the overcoming of rejection to Hansen’s disease (Brasil 1989, p. 17).
In relation to scientific and technological approach, it is important to emphasize that the
adoption of polychemotherapy by the World Health Organization in 1981 drastically cut the
disease treatment time and permitted the reorganization of national and local services for
treating patients (Maciel et al 2003, Opromolla 2011).
In 1986, the VIII National Health Conference recommended the redefinition of the role of
leprosarium, leading to the transformation of many of them in general hospitals and others
in research centers. As a result of the changes taking place in the national health policy, and
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with the disease decentralized treatment, patients began to be treated under the
responsibility of state health departments and county departments. It was also developed in
the same period a public campaign in the national media to help the dissemination of the
terminological chance of the term Leprosy to Hansen's disease (Maciel et al 2003).
The silence about the mobilization of Hansen’s disease patients for the reformulation of
public policy
Echoes in the video the silence about the actions implemented by the organization named
Movement for the Reintegration of Hansen's Disease Patients (MORHAN), created in
1981. According to Maciel et al. (2003 p. 311), this organization “was created initially to
ensure the rights of former leper colonies patients due to their isolation, and it is today one
of the most successful Brazilian social movements”.
Although outside the temporal immediate context of the video production, it is worth to
indicate some of the successful causes obtained by MORHAN in the following decades,
such as the permanent veto to the use of the word “leprosy” and its derivatives, in the
official terminology of disease (Castália 2004); the guarantee of a lifetime special pension
for people who were subjected to isolation until 1986; measures of compensation for
damage committed to children separated from parents at the time of segregation of leprosy.

Final considerations
From the analysis it can be affirmed that the films enable discussion, reflection and
teaching on: (1) how determined state of knowledge about Hansen’s disease constituted and
was formed through social and political relations at different levels and times; (2) how,
from which changes in social settings in their various fields and levels, and to what extent,
there has been a displacement in the way we approach and treat Hansen’s disease in Brazil.
In general, one can observe a significant shift in how the agencies responsible for managing
and developing health policies for the prevention, maintenance and recovery of the
population’s health concentrated their efforts in setting up a multi-faceted approach to
leprosy such as indicated by the extended concept of health, valuing the fight against
prejudice, particular attention to education and training of health professionals, and at
developing permanent actions to provide correct information to the population. In this way,
health policies were not determined only by the available scientific knowledge, but also by
political and ideological choices.
The mutual comparison between the statements of the films shows up valuable to
reflections on the relationship that may exist between the State political positioning, and the
implementation of public health policies. In the other hand, as much as possible
considerations about the role and function of civil society in the control of public policies
already established and in the proposition of new ones that meet people's needs.
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By analysing the films here presented we attempted to identify what displacements
occurred in the scientific discourses about Hansen’s disease through time. The analysis of
such displacements brings rich information and may foster the use of scientific archive
films for teaching about the history of the disease or the history of medicine. Archive films
such the ones analysed here appear as teaching resources that may provide alternative or
complementary visions about history of science, going far beyond an approach centred only
in historical facts.

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