Introduction

The epigraph opening this article expresses the hopes of the staff members at the Rockefeller Foundation (rf) for the Ribeirão Preto Medical School (fmrp, for its initials in Portuguese), officially established and integrated into the University of São Paulo (usp) in 1948 and regulated in 1951. The rf was an international agency that originated in 1913 from the philanthropic ideals of millionaire John D. Rockefeller Jr. and was funded with oil money. He argued that philanthropy should not be confused with charity but rather regarded as an investment directed to government agencies, not individuals. It should have a limited duration to prevent dependency and be provided to organizations committed to sustaining the work once the aid ceases.¹

Thus, medicine and science were combined on the agenda of the rf, which would result in a series of actions to develop education and research in medical schools. In this regard, the rf’s efforts primarily focused on eradicating diseases and financing various institutions worldwide, aiming to establish modern medical education throughout the twentieth century.²

This article will analyze the modernization of medical education in Brazil between 1951 and 1964 from the viewpoint of the establishment and operation of the fmrp. The period spans from the legal establishment of the Medical School to the resignation of its founder and director, Zeferino Vaz. The central question guiding the analysis is: How did a network of players, interests, and practices configure the fmrp in light of the financing dynamics offered by the rf in the context of the Cold War?

The documentary sources used in this study were collected from the Rockefeller Archive Center (rac) in New York and the Historical Museum at the Ribeirão Preto Medical School (fmrp-mh, for its initials in Portuguese) in São Paulo. The rac documents consist of official reports and correspondence, much of which is confidential, containing information about the relationships established between the international agency and Zeferino Vaz. The documents from the fmrp-mh include newspaper articles, handwritten documents, and reports produced by Vaz and other Brazilian medical professionals. The use of both local and international archives has been consequential for global health studies, as it allows for understanding the processes under analysis from different perspectives. Carlo Ginzburg’s works provided the methodological foundation for selecting the sources and writing the article: the documents were selected applying the nominative methodology, which proposes using names as a guiding thread for archival research. Similarly, the analysis was based on the evidential paradigm, which recommends paying attention to small details considered “signs” of processes that are not readily evident in the documentation.³

A dialogue is established with the historiographical production on the role of the rf in sciences during the Cold War.⁴ These studies have shown the international agency’s political stances in a context marked by ideas of modernization, development, and communism. For example, in his reflections, John Krige identifies the “strategic value of science,” a process of politicizing scientific and philanthropic knowledge during the Cold War. Some of the authors, however, focus on the persecution carried out by the rf against communist researchers based on institutional resolutions and its ideological alignment with the United States government. Nicole L. Pacino’s analysis of medical education in Bolivia even identifies divergences between the positions of the us government and the interests of the rf; however, her research emphasizes the refusal of their field representative, Johannes Bauer, to implement a medical education program in that country due to the alleged presence of communism in the universities.⁵

The analysis conducted here on the project for medical education modernization in São Paulo contributes to consolidating what Ricardo dos Santos Batista⁶ and Batista, Porto, and Ferreira⁷ have already indicated in their research on the trajectories of rf fellows: at many points, local contexts challenged the positions taken by the rf. Through its field representatives and the relationships established in the countries where it operated, apparently rigid norms “slipped” and enabled the achievement of its institutional objectives. Thus, in dialogue with the Foundation, local agents negotiated and modified the official strategies. The experience of the fmrp demonstrates that Zeferino Vaz’s involvement with communism was vigorously refuted by rf staff members, seeking to create a new medical school in Latin America to develop an educational project with a deliberate emphasis on basic sciences such as pharmacology, physiology, and biochemistry. Building on this original proposition, this article analytically advances the understanding of the strategies employed by the rf in its global activities by studying a specific case that contrasts with the evidence of contemporary historiography, namely the case of the fmrp.

Even though its foundation date remains controversial, the Parish of São Sebastião do Ribeirão Preto was probably established in 1856. The first settlers arrived in the village of Ribeirão Preto in the wake of the expansion of coffee plantations into the region served by the Mogiana Railway Company, which connected the area with Campinas, a city with important rail-served warehouses in the State of São Paulo. At the turn of the nineteenth to the twentieth century, with the formerly enslaved people who had contributed to its wealth now freed, the municipality was populated by Italian, German, and Swiss immigrants who began to arrive in the second half of the nineteenth century, along with migrants. By this time, Ribeirão Preto had become, along with the entire region served by the Mogiana Railway Company, the country’s primary coffee producer. In line with the logic of capital reproduction as experienced in Brazil, Ribeirão Preto produced enormous wealth alongside severe poverty and destitution. This situation led to epidemics, endemic diseases, and sanitary issues related to water supply, sewage, and housing. To ensure the development of the State of São Paulo and keep its labor force healthy, it was necessary to provide high-quality medical and sanitary services. For this purpose, medical training had to be aligned with the actual needs of the Mogiana Railway Company.

The path taken by the political project developed in São Paulo intertwined economic recovery, the valorization of municipalities, and the provisions outlined in the 1947 São Paulo State Constitution, “further improving education and professional training for certain groups and promoting the establishment of educational institutions, including universities, in the interior regions.”⁸ Ribeirão Preto occupied a prominent place in this project, which was aligned with the rf’s goals in proposing a school that would provide favorable conditions for research, with adequate laboratories and equipment, hire full-time professors, and implement projects to benefit the health of the local community, thereby fostering regional development.

In a study on the fmrp, Marcelo José Araújo states that the inaugural speech took place on May 17, 1952, delivered by the Governor of the State of São Paulo, Lucas Nogueira Garcez. The theoretical and practical courses of the medical program were temporarily conducted at the School of Pharmacy and Dentistry. However, there were plans to establish permanent facilities at the former Practical School of Agriculture, located on the Monte Alegre Farm, a few kilometers from the city center. It was a rural environment where scientific knowledge was produced, featuring houses for professors and staff and accommodations for students.⁹ Thus, it represented a local experience linked to modernization projects in the State of São Paulo and the interests of the rf, shaped within the logic of the Cold War, whose temporalities must be understood and elucidated.

Modernization, Development, and Rockefeller Foundation Programs

The idea of modernizing medical education originated in the late nineteenth century when us public healthcare was institutionalized in state and local health departments; however, few public health physicians had specialized training. In general, the doctors were offered part-time jobs paid by political sponsors, and they could be promoted or dismissed based on their political alliances and personal relationships. Whatever knowledge of public health principles they had was the result of independent study and practical experience.¹⁰

With the advisory support of the American Medical Association and the backing of the Carnegie Foundation, the Flexner Report-published in 1910 by philosopher and educator Abraham Flexner-transformed the nature of medical education by establishing the biomedical model as the gold standard.¹¹ It was believed that medical schools needed modern facilities and that having hospitals under their control was as essential as having well-equipped laboratories. Moreover, the faculty should consist of physician-scientists, and students should be admitted based on selection criteria.

Flexner served as secretary on the General Education Board, established in 1902 with funding from the Rockefellers. The Board aimed to improve public education in the United States, particularly in southern states. Subsequently, Flexner turned his attention to universities and medical education. The first biomedical institution to receive funding was the Johns Hopkins School of Hygiene and Public Health in Baltimore. us physician William Henry Welch had sought to create an institute of hygiene since his visit to the Max von Pettenkofer Institute in Munich in the 1880s. He envisioned an institute affiliated with the Johns Hopkins University School of Medicine and specifically dedicated to research on sanitation and hygiene.¹² At the time of the construction of the school, money and enthusiasm for his project were scarce; however, 20 years later, he had enough resources and support from leaders in the us public health movement and the international philanthropic agency. The rf diverged in many aspects from Welch’s project, as the agency intended to create a specialized training center for healthcare professionals from around the world, including its own staff. Out of the negotiations to develop a form of healthcare professional education that reconciled scientific research on sanitation and hygiene with the dissemination of existing knowledge emerged the school’s new profile. According to Elizabeth Fee, “the School of Hygiene ultimately represented a compromise between the visions of Welch and the International Health Board: a compromise worked out in extensive negotiations over the period between 1916 and 1922.”¹³

While Johns Hopkins adopted the model proposed by the Flexner Report, the rf entered into a cooperation agreement with the usp School of Medicine and Surgery (fmcsp, for its initials in Portuguese; currently the usp School of Medicine) to teach hygiene.¹⁴ A study by Maria Gabriela Marinho¹⁵ analyzes the agreements that enabled the fmcsp to develop a world-class physical, academic, and research infrastructure following the model of the Rockefeller Schools in the first half of the twentieth century. In that case, the rf’s International Health Board (ihb) agreed to create and maintain for five years the Hygiene Chair-later called Hygiene Laboratory and subsequently Hygiene Institute-at the fmcsp. It also committed to providing an estimated $10,000 worth of initial equipment and spending between $15,000 and $20,000 per year throughout the agreement term. Another pledge was that the ihb would grant two scholarships in hygiene and public health to Brazilian students in the United States, covering their travel and accommodation expenses. Lastly, the board agreed to provide the fmcsp with two scientists to head the Hygiene Institute for five years, during which they would supervise two assistants. In return, the fmcsp should pay for the rent and renovation of the facilities to make them suitable for academic and laboratory work. Additionally, the school committed to providing annually a minimum of $3,000 to cover operational costs.¹⁶

Between 1940 and 1950, the United States undertook a reform of its healthcare system. The reform criticized the fragmentation of medical education, advocated for better integration among curriculum disciplines, and acknowledged the necessity of changing professional practices in light of the new social needs regarding medical care.¹⁷ These needs were based on a preventive approach rather than curative practices applied after illness onset, a model that would be replicated at the fmrp. In 1956, for instance, the Department of Hygiene and Preventive Medicine conducted a pioneering educational experience by instructing students through visits to underprivileged families in peripheral neighborhoods of Ribeirão Preto, aimed at bringing medical education closer to the reality experienced by impoverished communities and finding ways to prevent diseases.¹⁸ Concurrently, the Pan American Health Organization (paho) promoted the development of preventive medicine departments, and the debate on integrating medical education with communities and their actual needs was further intensified. Amid this mix of proposals, the State of São Paulo began the process of decentralizing medical schools toward interior cities. In that context, the rf increasingly redirected its financing agenda from public health toward biomedical sciences done in the laboratory, aiming to expand technology usage in medicine, especially in view of the specificities that emerged from the Cold War context. In this manner, the fmrp would incorporate into its curriculum preventive medicine principles and scientific research models recommended by the rf and implemented in the form of grants.

Thus, during the 1940s and 1950s, projects were developed by international organizations such as the paho, private and philanthropic institutions such as the rf, and national and local governments aiming to modernize medical schools and scientific research. These projects were part of various and multiple development models that sometimes complemented each other but could also come into conflict or be modified in response to the dynamics of the Cold War. As Michael Weis¹⁹ has clearly demonstrated, the development promoted by Juscelino Kubitschek and the one intended by João Goulart were quite different and also took on distinct characteristics regarding us interests. Kubitschek’s idea of development entailed a strong economic alignment with the United States, as evidenced by the investment in technological and industrial modernization. Furthermore, there was strong encouragement for the establishment of universities in all Brazilian states to train the personnel necessary for development, with medical schools playing a crucial role in this process. Goulart, on the other hand, believed that modernization meant addressing the issue of social inequalities through measures such as implementing agrarian reform and approving a Rural Workers’ Statute, intentions that undoubtedly explain the 1964 military coup. Paradoxically, from the perspective of international relations, Kubitschek confronted the United States by seeking to establish an independent foreign policy.

Amid the globalization of us foreign policy after World War ii, in the 1940s and 1950s, Latin America and Brazil lost prominence among the array of American interests. In the 1960s, however, again according to Michael Weis, in the middle of the advances of communist projects and actions in the Southern Hemisphere, Latin American pieces would once again have a place in the political chessboard of the Americans, with science playing a crucial role here. It was not coincidental that in 1962 the medical schools of Brazil would convene to establish the Brazilian Association of Medical Schools (abem, for its initials in Portuguese). At the time, there were 35 schools, 16 private and 19 public ones, all engaged in debates about the importance of preventive medicine departments, the modernization of laboratories in medical schools, and community medicine. These debates were promoted by international organizations and private foundations such as the rf, the Milbank Memorial Fund, and the W. K. Kellogg Foundation.²⁰

The us Department of State, in collaboration with universities and philanthropic organizations, implemented a policy that tied the development of Latin American countries to us national security. This policy was aligned with the intentions of the Truman administration.²¹ The increasing Soviet influence made it urgent to intensify the “Americanization” of Latin America initiated by the Good Neighbor policy, a us effort to conquer cultural hegemony since the 1940s. In the second half of the twentieth century, this policy also meant the establishment of ideological ties that manifested, for example, in the founding of the Alliance for Progress by the Kennedy administration in 1961. According to Michael E. Latham, the endeavor carried with it the notion that the North American experience would provide answers to the poverty issues faced by the so-called Third World.²²

The modernization of medical schools in the 1950s and 1960s was often linked to development projects that involved alignments with nations considered “more modern” or “more developed.” Onofre Santos Filho²³ states that, amid the polarization between the United States and the Union of Soviet Socialist Republics (ussr), the ideas of development and modernization found fertile soil to spread. According to the projects and intentions of the United States, especially from the fourth foreign policy goal mentioned by President Harry Truman (1945-1953) in his inaugural speech, North-South relations should be based on the provision of assistance by developed countries, enabling underdeveloped nations to transcend their conditions of destitution and poverty, so that it would suffice for the latter to emulate the footsteps of the former, acquiring the scientific and technological knowledge that would enable them to free themselves from poverty and ignorance, the only plausible explanation for their backwardness.²⁴ Enlightened elites and economic growth would ensure the advancements that would keep the Third World within the orbit of capitalist and liberal countries, as elucidated by Michael E. Latham.²⁵ Medical schools played a prominent part in this global ideological game: they trained personnel responsible for disease control, sanitation, preventive medicine, and the organization of public healthcare systems for the poor.

International technical collaboration was a crucial aspect in attempting to achieve the much-desired modernization of medical education. With a dwindling number of Brazilian researchers interested in scientific exchange in Europe during and after World War ii, the time was ripe for those who, espousing developmentalist ideals, wanted to modernize Brazilian medical education, passing from the French to the us zone of influence.

While the rf had been active internationally since 1916, promoting the training of technical personnel and financing institutions, the post-World War ii context and the ideas of modernization and development exerted considerable influence on its activities, placing particular emphasis on technological advancement. According to Marcos Cueto,²⁶ around the 1950s, rf representatives renewed their visits to Latin American education and research centers, and they found out that, after years of financial grants and donations, most books in their libraries were in English. Cueto points out that one notable change, in comparison to previous years, was the expansion of the ideological rhetoric of scientific legitimation during a period marked by the efforts of us governments to curb the spread of communism. This rhetoric was embraced by Latin American developmentalist governments, which believed modernization involved investment in every scientific field, including the biomedical sciences, regarded as vital for healthcare professional training and the sanitary safety of the population.²⁷

In studying the dynamics of scientific funding policies in Brazil, particularly at the Institute of Biological Sciences of the Federal University of Minas Gerais (icb/ufmg, for its initials in Portuguese), Paloma Porto²⁸ has identified two programs implemented by the rf. These programs received financial support from the philanthropic agency and played a crucial role in the modernization of medical education in Brazil, yielding significant impacts in the second half of the twentieth century. The first program took shape thanks to the increasing priority science had been enjoying in systematic public policies from the us government following World War II. According to Porto, mathematician Warren Weaver, one of the greatest enthusiasts of the molecular biology paradigm, proposed to reformulate one of the rf programs to apply mathematical and chemical quantitative techniques to biological problems. His proposal was implemented worldwide by the Division of Natural Sciences.²⁹ Between the 1940s and 1950s, this program was carried out in South America by Harry Miller Jr., who was tasked with finding potential “talents” to conduct research in basic science. As will become clear, Miller was one of the main figures responsible for the rf’s investment in Zeferino Vaz, the Brazilian physician who founded the fmrp under the usp umbrella.

Concurrently, another program was conceived by the Division of Medical Education and Public Health to modernize Latin American medical schools. The rf’s field representative charged with the program’s execution was Robert Briggs Watson, who had developed a similar project in India years before.³⁰ The new program aimed to send medical school professors abroad to receive training in preclinical areas and improve their English skills. Back in Brazil, they would upgrade the teaching of basic science in medical schools:

Similar to the scientific endeavor of the Division of Natural Sciences, the program of the Division of Medical Education and Public Health aimed to identify educators with managerial and leadership qualities who could elevate their research areas into centers of excellence, serving the professional development needs of the entire country […].

The funding mechanisms for this program comprised the provision of overseas scholarship grants, the establishment of a full-time work regime, and, in collaboration with the Division of Natural Sciences program, financial support for laboratory and library infrastructure.³¹

Zeferino Vaz and the Rockefeller Foundation: Converging Paths

In her analysis of the activities developed by the rf at the usp, Maria Gabriela Marinho³² emphasized the leadership of Ernesto de Souza Campos and Zeferino Vaz as international interinstitutional facilitators. She states that Souza Campos’ trip to the United States in the 1920s as a Rockefeller grant holder enabled him to strengthen ties with Richard Mills Pearce. Throughout that decade, Pearce would become, as director of the Division of Medical Education, a key figure in the global development of strategies and policies at the rf. Souza Campos is said to have functioned as “a herald of the modernization of university institutions in Brazil,” and, from the 1940s onward, his legacy passed on to Zeferino Vaz, who emerged as a pragmatic facilitator of exchanges and alliances within the scientific community of São Paulo at large, with a particular focus on the usp (emphasis in the original).³³

Zeferino Vaz began his professional career in 1926 when he enrolled as a student at the São Paulo School of Medicine and Surgery (fmcsp). Two years later, he assumed the role of teaching assistant for the parasitology course taught by Lauro Travassos.³⁴ After completing an internship at the São Paulo Biological Institute, where he established the Department of Animal Parasitology in collaboration with Clemente Pereira, Vaz graduated in 1931. He subsequently worked as an assistant to André Dreyfus, a professor of histology and embryology at the usp School of Medicine. After passing a selection exam for the post, he assumed the chair of medical zoology and parasitology at the University of São Paulo’s School of Veterinary Medicine (fmv-usp, for its initials in Portuguese) in 1935.³⁵ In 1938, as director of that school, he became a member of the University Council, a position that secured him “visibility and prestige among the members of the local and international scientific community-including at the Rockefeller Foundation-, which paved the way for the establishment of the Ribeirão Preto Medical School.”³⁶

However, the relationship between Zeferino Vaz and the rf staff was not devoid of suspicions regarding Vaz’s political-ideological orientation. This can be observed in an episode that occurred in 1951, where Vaz requested financial assistance from the international agency for the fmv-usp. He then worked at the fmcsp Department of Parasitology, collaborating with Professor Pedreira de Freitas, studying diseases common to humans and household animals, such as parasitological diseases. For this purpose, he needed a four-wheel station wagon to navigate the poor roads in the northern regions of São Paulo and Minas Gerais.³⁷ If the purchase were approved, the vehicle would become the property of the fmv-usp, which would cover its maintenance and operational expenses and make it available to researchers from other departments when not in use.

The assessment of that request for financial aid was part of a mail exchange between two us individuals-one based in the United States, the other in São Paulo-who were discussing the “communist threat” in Brazil. On August 13, 1951, Harry Miller Jr. addressed a letter to Julian C. Greenup, the us Consul General in Brazil, about the physicists the rf was financially supporting in São Paulo. The rf’s field representative stated that the agency’s financing to the group of physicists from the University of São Paulo’s School of Philosophy, Sciences, and Literature (ffcl-usp, for its initials in Portuguese) had ended a few years ago, but that an extension had been granted in $5,000 for equipment purchase. He emphasized that the rf did not finance research in modern physics anywhere in the world, as that field was well-supported by other institutions. Olival Freire Jr. and Indianara Silva³⁸ have analyzed the rf’s first steps toward financing physics research in Brazil. The authors say that Harry Miller Jr. recommended an initial aid under the Good Neighbor policy to cause a “psychological effect” on Brazilians. The hurdles faced by the usp Department of Physics started to be overcome thanks to the interference of us physicist Arthur Holly Compton, who regarded the team assembled by Ukrainian-Italian physicist Gleb V. Wataghin as the most promising in South America: “Between 1942 and 1949, the Rockefeller Foundation contributed $82,500 to Wataghin’s team, with a share of $57,500 from the Brazilian government, totaling $140,000. This amount, adjusted for inflation since 1945, would correspond to approximately $1,894,690.”³⁹

Miller knew that, during his trip to South America, he would be questioned about new possibilities for funding, given the relevance of the research teams in São Paulo and Rio de Janeiro-this latter led by former Rockefeller grant holder César Lattes. Miller said he could only offer further support (modest, this time) “provided we were certain that their [the Brazilian researchers’] activities involved no security risks to our country.”⁴⁰ He therefore requested that the us Consul General look into the matter and provide him with a report before his departure to South America, which was scheduled for around September 1 but actually took place in mid-October.

On September 17, 1951, the consul responded to Miller but, thinking he had already left for the South, addressed the letter with classified information to the New York office. Among the classified information was a list of 17 usp researchers under investigation. The authorities in São Paulo did not report any “suspicious” activities for any of the investigated professionals, except for Zeferino Vaz, with the following information:

2. In April 1945, VAZ took part in the Scientific Exchange Section of the Instituto Cultural Brasil-urss. In May 1946, he was president of the Associação Brasileira de Amigos do Povo Hespanhol, an association which was composed of numerous communist elements. In June 1946, he wrote an article in the communist newspaper ‘Hoje’ protesting the government of FRANCO. In July 1946, as a representative of the Associação Brasileira de Amigos do Povo Hespanhol, he spoke at the Club Pinheiros. In his speech, he again attacked the political regime of FRANCO.

3. In June 1948, there was distributed throughout the University of São Paulo a pamphlet entitled ‘O Século de Linneu’ attacking the Governor of the State of São Paulo, the Mayor of São Paulo, and the Rector of the University, Linneu PRESTES. In an investigation which followed the publication of this pamphlet, it was learned that one of the participants in the group attacking the Rector was Zeferino VAZ.⁴¹

The request for an investigation with an emphasis on the “security of the country” and into the individuals regarded as capable of threatening it-in that case, the communists-could lead to the assumption that the rf’s interests were fully in line with us foreign policy. According to Rodrigo Patto Sá Motta,⁴² the United States took it upon itself to be an anti-communist fortress, assuming a leading role in the war against the “Red Scare.” This stance was derived from ideological commitments and geostrategic and economic interests in response to a growing ussr influence during the Cold War. This war further intensified the anti-communist sentiment, with the United States committing all its power and wealth to supporting groups willing to confront the communist enemy. The case of Zeferino Vaz, however, shows that the rf did not refrain from investing in researchers or making grants based solely on indications of the beneficiary’s communist activities. As will be observed, from the 1950s to the 1960s, the rf often prioritized its institutional interests over ideological alignments or values defined by state policy.

Back in the United States, Miller read the consul’s letter. In his reply, he put forward arguments that, in his opinion, might not prove that Vaz was “politically dependable,” but that could support a favorable decision regarding the financial aid requested by the Brazilian physician.⁴³ Miller dispelled every suspicion the us consulate had raised against Vaz, proving the autonomy of the rf, a private institution, from potential expectations of the us government.

An analysis of the philanthropic agency’s institutional moves must consider not only its official guidelines but also the decisions made by its staff members, which, to a certain extent, were also influenced by subjective criteria. Batista, Porto, and Ferreira,⁴⁴ for example, have investigated how Portuguese physician Augusto Tito de Morais-considered a potential communist for his family’s republican history and close ties with his anti-Salazarism father-in-law-forged a close friendship with Robert Watson, thereby gaining immunity against potential censure by the rf. Other professionals, nonetheless, did not have the same good luck. Samuel Pessoa, an openly communist parasitologist, faced severe persecution by the same rf field representative, as demonstrated by Hochman and Paiva.⁴⁵ There obviously is a significant difference between a “suspect of communism” and a “declared communist”; however, it was in this process of differentiation that “gaps” or “loopholes” might be found, which allowed for protection for some and persecution for others, depending on what interests the rf had in the grant applicant.

Miller also declared that Zeferino Vaz was one of the most prominent intellectuals at the usp, a member of the University Council for at least 12 years, actively engaged in scientific research, and a close friend of the São Paulo state governor. In fact, it was during Miller’s visit to the state in March 1951 that he learned Vaz was the potential new rector of the usp. Moreover, Vaz enjoyed the trust of Ernesto Leme, who served as the rector of the usp from 1951 to 1953 and appointed Vaz as president of the university’s Research Committee.

Miller’s favorable disposition towards Zeferino Vaz was likely mainly due to the role played by the Brazilian physician at a new institution that was arousing interest at the time:

[H]e was tasked with the establishment of a new school of medicine at the university that is being created in Ribeirão Preto. The regulations he formulated for that school draw inspiration from North American rather than from European schools or from other Brazilian schools where (to mention only one example) a professor or assistant is not required to hold a degree in medicine to occupy a position at a scientific department if they have the necessary qualification for the post.⁴⁶

Even though the us consulate suspected Zeferino Vaz to espouse communist values, he was a competent man with a solid academic background. Within the political and scientific milieu of the time in São Paulo, he emerged as a potential implementer of the curricular proposal advocated by the rf for the institutions it funded. Support was still strong in the mid-twentieth century for demonstration-effect projects-supposed to work as examples to be emulated by local state actors and present in the philanthropic agency’s repertoire of methods since its inception.

Miller’s last arguments in favor of Vaz were that, between 1945 and 1946, most scientists opposed the persecution unleashed against their colleagues in Spain under Franco’s rule, that Linneu Prestes, Vaz’s friend and former usp rector, increased the red tape at the university, arousing fierce opposition from most serious researchers at numerous usp schools, and that he regarded Vaz as an intellectual of courage and, therefore, began to respect him and rely on his judgement about the scientific capabilities of his colleagues.⁴⁷ Based on the evidence adduced, Miller decided to grant the financial support that would make it possible to purchase the vehicle for the fmv-usp. He said, however, that he would wait until the consul expressed any concerns should he consider Miller’s action imprudent. On December 7, 1953, Zeferino Vaz wrote to Harry Miller Jr., informing him of the purchase of the station wagon and thanking the rf’s Board of Directors.⁴⁸

Zeferino Vaz served as founding director of the fmrp from 1951 to 1964. During this period, he increasingly strengthened ties with the rf to the point where he was privileged with being provided with specialized bibliographic material. By looking at all the resources allocated to Zeferino Vaz, it is possible to see how strongly the rf influenced the political trajectory of its beneficiaries. This can be observed in the fact that, after the 1964 military coup, Zeferino Vaz showed clear alignment with us anti-communist policies in the letters he exchanged with Robert Briggs. These letters have been studied by Gabriela Marinho.⁴⁹

Even on vacation, Miller requested that his secretary, Florence Bryant, send Vaz copies of the first three monthly issues of the journal Science. She said she would thereafter send copies periodically.⁵⁰ Miller also wanted to find the best way to send Vaz a complete collection of the Journal of Parasitology. He thought that if he addressed it to the Brazilian National Council for Research,⁵¹ there would be fewer obstacles to customs clearance in Brazil.

In 1954, the rf started to allocate funds to the fmrp, aiming to turn it into a modern school. One of the mechanisms the agency deployed to that end was to offer overseas scholarships to Ribeirão Preto physicians. The rf adopted this approach in all countries where it was present, aiming to train professionals who, enriched by their international experiences, would return to their countries of origin and work in the civil service. These professionals would function as “key elements” or “initial seeds” in propagating the institution’s model of science.⁵² In Brazil, some examples can be found at Bahia School of Medicine, where physicians Octávio Torres, Enoch Torres, and Eduardo Araújo were awarded grants,⁵³ and at the São Paulo State Bacteriological Institute, which sent Ernesto de Souza Campos and Sebastião Calazans to study abroad,⁵⁴ all of them in the 1920s. The Federal University of Bahia’s Nursing School, with support from the Special Public Health Service (sesp, for its initials in Portuguese) and the rf, managed to send women such as Radcliff Guanais Dourado to the University of Toronto’s Faculty of Nursing in the 1940s.⁵⁵ The usp School of Medicine was awarded three grants in the 1950s and 1960s, which covered travel costs for more than 15 professors to different us universities and financed laboratory equipment and library material. This round of investments by the rf in Brazilian medical schools indicated that, amid the alignments and realignments common to the Cold War, the project of generating development from these schools was maintained, prompting their gradual “modernization” according to the principles of the rf and the interests of Brazilian elites.

Between 1954 and 1959, the rf extended travel financial aid to fmrp faculty members, but Zeferino Vaz was yet to be benefited.⁵⁶ rf staff members reported that the institution had spent five years trying to persuade Vaz to acquaint himself with us medical education models but to no avail.⁵⁷ This is an interesting fact since the prestige Vaz enjoyed at the funded institution should have earned him priority.

At last, in 1959, he agreed to travel at the rf’s expense to visit medical education institutions in the United States and Latin America and to participate in the Second World Conference on Medical Education in Chicago, to which he was invited as a speaker.⁵⁸ The invitation to speak at such a distinguished event shows that Zeferino Vaz was already internationally renowned for his work in modernizing medical education in Brazil, starting at the fmrp. In this regard, Harry W. Kum, the rf’s associate director of medical and natural sciences, devised a travel itinerary that would take Vaz to San Juan, New York City, Chicago, Madison, Mexico City, Panama, Cali, and various other destinations.⁵⁹ Thus, although he was already a renowned figure, including among the rf staff, Vaz still needed to be persuaded about the contents of the modernization advocated by the rf, particularly the development of basic research and the specialization of medical careers. In Ribeirão Preto, while following Pedreira de Freitas’s work, he was certainly more engaged in debates concerning the role of preventive and community medicine in constructing public health systems.

In a letter to Robert Watson, in which he recounts his interactions with various prominent professionals in the United States, Zeferino Vaz seems to acknowledge how influential international experience is in the field of medical education. He had never left the country before and admitted that the funds allocated by the rf for his education were well invested:

Add to all this the quite substantial knowledge I have gained at the Medical Schools of Madison, St. Louis (Washington University), and now at Western Reserve through discussions and idea exchange with some “top men,” and you can begin to imagine how much I have benefited from this journey. Now, I am certain that the Rockefeller Foundation is investing in me for constructive purposes […].

In the three schools, I have engaged in conversations, visited laboratories, and observed educational and research activities in various sectors, both basic and clinical. I am overly impressed with the development of biochemistry […] I was invited by Kenneth Holland, president of the Institute of International Education, to return to the United States in March 1960 as a member of the Council on Higher Education in the American Republics for further visits to American universities (emphasis added).⁶⁰

Vaz divided his attention between invitations to return to the United States and his special interest in biochemistry, an area heavily funded by the rf in the second half of the twentieth century. He also had the opportunity to strengthen ties with rf staff members. He expressed his gratitude to Harry Miller Jr. and his wife for their “kind and affectionate hospitality” and conveyed greetings and appreciation to “Drs. Morison, Weiss, Scott, and Kum, as well as Mrs. Greenfieldt and Mrs. Kale for the caring assistance” they provided during the journey.⁶¹

In the following year, Zeferino Vaz returned to the United States. In correspondence, Robert Barton, director of the Inter-American Department of the Council on Higher Education in the American Republics (chear), informed John M. Weir, associate director of the Division of Medical and Natural Sciences at the rf, that Vaz was interested in studying university administration, specifically focusing on medical schools.⁶² His travel expenses were covered by the chear program, initiated in 1958 by the Carnegie Corporation of New York and the Institute of International Education to improve inter-American relations in higher education and serve as a forum where educators could discuss their common problems and experiences.⁶³

Zeferino Vaz increasingly expanded his international network and became a point of reference for the rf. He played a key role in facilitating the funding provided to the fmrp to modernize medical education in Brazil, a process analyzed subsequently.

The Rockefeller Foundation’s Financial Support to the Ribeirão Preto Medical School

On August 24, 1951, Zeferino Vaz gave an interview to the usp Boletim Radiofônico, in which he stated that he had been appointed by Ernesto Leme, then usp rector, to make plans for the installation of the fmrp and report them to the University Council.⁶⁴ The school had already been established by Law 161 of September 24, 1948, but Vaz thought there was a considerable difference between establishing a medical school and putting it into operation. Vaz said that the fmrp would not be an institution like its counterparts: “However, some substantial changes will be introduced, based on the experiences of the professors from São Paulo and at their advice” (emphasis added).⁶⁵ The notions of education and research that guided the creation of the fmrp would be put into practice by numerous educators trained at the usp School of Medicine, even though among the fmrp faculty members were also foreign scholars deemed valuable to the new institution.

The reasons that justified the creation of the fmrp included the need to accommodate a large number of medical student candidates, many of whom were successful in the entrance examination but were not enrolled due to a lack of available slots at the usp School of Medicine, the desire to train physicians accustomed to life in rural towns, as most of those graduating in major cities tended to settle there, and the need to establish research centers in the interior of Brazil that would produce original thought, setting off a cultural march to the West and keeping pace with economic development. Based on these premises, on December 26, 1951, State Law 1467 was enacted, which regulated the organization and purpose of the fmrp.⁶⁶

The school’s educational structure differed from that of similar institutions, seeking to respond to transformations in medical science occurred in the previous 20 years and the resulting changes in the knowledge of pathologies. According to Zeferino Vaz, the introduction of new chemotherapeutic and antibiotic agents relegated infectious and communicable diseases to a secondary position. On the other hand, the substantially increased knowledge of nutritional and endocrine diseases, facilitated by new techniques in the study of biochemical phenomena, contributed to surpassing the morphological and statistical phase of biological studies and reaching a dynamic and functional-therefore deeper-understanding of these phenomena.

Surgery was thought to have undergone significant evolution in its technical aspects, primarily due to improvements in anesthetics, particularly in transfusions and rational guidance for rehydration. These advancements enabled large-scale surgeries that were previously impossible. Post-operative techniques also benefited not only from such progress but also the use of antibiotics. The need to change an educational structure that did not prepare professionals for their “real duties” became evident. To achieve this goal, mandatory education was introduced on nutrition-related diseases, endocrinology, hematology, anesthesiology, and other subjects.⁶⁷

Zeferino Vaz’s account of the new educational trends-which included the use of electronic devices to detect, measure, and register with high precision the mechanical, chemical, thermal, and energetic manifestations of living beings-placed the fmrp’s curriculum in line with the principles espoused and financed by the rf in the second half of the twentieth century, on a march moving increasingly away from public health toward the molecularization of science. Therefore, the fmrp’s curriculum reduced the class hours for various morphology-focused courses and extended study time in areas such as biochemistry and physiology. Additionally, it introduced clinical practice in areas such as nutritional diseases, endocrinology, hematology, anesthesiology, emergency care, medical psychology, and preventive medicine. Until then, these subjects had been taught irregularly in Brazil, if at all.⁶⁸

Further alterations included an emphasis on a more formative-and less informative-model of medical education, with active participation of the students in their learning. This model would prepare the student to not only cure diseases but also develop a medical mindset that was preventive, curative, and recuperative at the same time-regarded as integral medicine. The primary goal was to enhance the creative capacity and initiative of the medical trainee. To reach it, first, the number of new students had to be limited to eighty per year.

Then, faculty members were hired who had recognizably original scientific production, the ability to form research groups, and the availability to dedicate themselves full-time to teaching and research. The fmrp was organized into departments in such a way as to systematize learning, ensure that all disciplines were taught, and foster cooperation among different specialists. According to Zeferino Vaz, it was necessary to reassess drastically the number of professors and consolidate similar courses into departments.⁶⁹ Lastly, there was the need for a healthcare center operating jointly with the fmrp and the Hospital of Clinics under the direction of the chair of preventive medicine.

Such an innovative project sparked the interest of the rf, securing funding for the fmrp from the philanthropic agency. Thanks to Harry Miller Jr., in 1954, the school received the first round of financing with $50,000 to be spent on the Departments of Biochemistry, Parasitology, and Histology. The first of these departments used more than half of the funds ($30,000), the second used $7,000, and the third spent $8,000, with the remainder returned.⁷⁰

On June 24, 1955, came another round of funding, worth $278,000, which was distributed among various departments. A total of $74,400 went to the Department of Physiology and Pharmacology; at the same time, Internal Medicine, Anatomy and Histology, Surgery, Microbiology, Parasitology, Pathology, Preventive Medicine, Nursing, and the Library received amounts ranging from $37,200 to $6,000.⁷¹ Figure 1 shows the share of funds received by each fmrp department, with the largest amounts allocated to the Departments of Physiology and Pharmacology, Microbiology, and Internal Medicine. These investments are explained by increased trust in the fmrp on the part of the rf as a consequence of the reports produced by professors from each department detailing the main institutional gains that resulted from the funding, including the purchase of laboratory equipment and publication of scientific articles.

Source: Own elaboration based on Vaz, “University of São Paulo,” 7.

Figure 1. Funding received by the fmrp from the Rockefeller Foundation, related to Grant No. 55,100 

Regarding funding for travel abroad, the Departments of Parasitology and Biochemistry were the most favored, with four professors each. The Department of Preventive Medicine received two travel grants, while the Departments of Internal Medicine, Pediatrics, and Pharmacology each sent one professor abroad.

A brief remark can be made here on the experience of Professor José Lima Pedreira de Freitas (1917-1966). Even though the rf gave precedence to research in biomedical sciences and preclinical disciplines, as stated before, this professor dedicated his career to public health, participating in a breakthrough experiment in 1956 and implementing a primary healthcare project, in addition to unprecedented studies on Chagas disease⁷² in the municipality of Cássia dos Coqueiros in the 1960s. Thus, among the intentions of the rf, the incentives provided by the paho for preventive and community medicine, and the experiences undergone by the professors in their departments, there was a lively circulation of social actors who could forge distinct paths. Pedreira de Freitas was granted funds by the rf and participated in discussions about community medicine for impoverished populations, as advocated by the paho and other foundations such as Kellogg and Milbank. Nevertheless, his work with disadvantaged communities aimed to organize a comprehensive public healthcare system for all, which appeared to be a requirement for Brazil’s development and its consequent modernization. The rf offered grants to young scientists from other research centers as well, who received training in the various departments at the fmrp. These different concepts of modernization thus converged in the experience of the fmrp.

Eventually, Robert Watson realized that one year only of overseas study was often insufficient for a proper education. The rf then began to extend the grants already awarded and offer new grants with a two-year duration. As funds allocated for personnel training were not increased, Zeferino Vaz was informed of a reduction in the number of grants, which would affect, with “absolute and indispensable priority, young individuals working full-time.”⁷³ The rf also requested from the director of the fmrp a projection of the grants that would be requested for the years 1960 and 1961.

Funding for the fmrp was not without strings attached. In certain instances, the school was questioned about the destination of the funds granted and the counterpart contributions expected from the state of São Paulo. One of those instances was on May 6-7, 1959, when Professors Hélio Lourenço de Oliveira and Ruy Ferreira-Santos traveled to Rio de Janeiro as fmrp faculty representatives to present a list of financial support requests for various departments.⁷⁴ They had two meetings with Robert B. Watson and Ernani Braga.⁷⁵ The first was scheduled for a swift review of the lists and questions that illustrate the control the rf sought to keep over the projects it funded. The professors were questioned, for example, on how to address the shortage of nursing professionals and equipment at the fmrp hospital, whether the Department of Preventive Medicine already had an official healthcare center, how the expansion of the Hospital of Clinics was progressing, and why orders for basic equipment for the ophthalmology and dermatology courses had been placed.⁷⁶

The professors’ answers were intended to meet the expectations of the rf. They said that the nursing issue could be addressed only with extra funding from the state, and the Department of Preventive Medicine had no official healthcare center but could rely on an outpatient ward at the Hospital of Clinics. Additionally, they provided information about the progress of the hospital renovation and asserted that the requested materials were a sine qua non condition for instruction, but funds were at the time insufficient for their purchase.

At a certain point, a question from Watson and Braga left the professors at a loss for an answer. They asked how it could be explained at the rf’s headquarters in New York that, despite claiming to lack funds to allocate for new courses and departments or buying complementary equipment for the fmrp, the São Paulo state government was diverting large sums of money to establish new medical schools, such as in Botucatu, as well as an Institute of Tropical Medicine “whose creation has no plausible justification.” The answer was an “embarrassing silence,”⁷⁷ indicating that the efforts of the State of São Paulo to establish medical schools in the interior could sometimes conflict with the rf’s primary interests.

The second meeting was held after Watson and Braga conducted, during the night, an in-depth analysis of the list. The next morning, they presented their conclusion that work at the fmrp lacked coordination across the various departments; there were, for example, duplicated purchase orders, such as for a physiograph. Instead of multiple units, the school should order only one and make it available to all departments in need of it. Watson and Braga had also identified an above-average number of orders for super-specialized microscopes and basic hospital supplies. The Department of Microbiology placed an order for routine supplies, but the material could not be purchased because the funds from the previous round had not yet been completely utilized.⁷⁸ Ultimately, the solution found was to forward the orders to New York, as the Rio de Janeiro office considered itself incapable of technically assessing the list.

Despite all these issues, funding was granted. On May 30, 1959, the newspaper Diário de Notícias announced that the rf had decided to donate $300,000 to the fmrp to continue scientific research.⁷⁹ The São Paulo state government, however, had hoped that the amount would reach the mark of $400,000.

The precise amount was eventually $250,000, intended to be allocated to purchasing equipment and medication for three years.⁸⁰ Unlike with the previous rounds of funding, this time, two committees were designated to overview funds allocation and order placement across the departments: a basic science committee and a clinical science committee,⁸¹ with the larger shares of funds going respectively to the courses of basic and clinical sciences. The two committees were likely formed to optimize funds allocation and expenditure, avoiding, for instance, the duplicated purchase orders found by Watson and Braga.

Conclusion

In his study on the role of private foundations in the construction of us power in the twentieth century, Inderjeet Parmar⁸² highlights the trajectory of the United States from isolationism, which characterized the early decades of that century, to the establishment of strong global power after World War II. In this trajectory, those foundations played an important role, advancing modernization strategies focused on elite formation and social management actions that did not address the structural problems of the so-called Third World countries. In these countries, modernization processes brought technological resources and productive advances to specific areas while keeping other sectors of society in poverty. The case of medical schools is quite illustrative, as investment was made in scientific research and in personnel for the management of laboratories and hospitals, but there was no concern for public healthcare systems that could provide comprehensive healthcare to all citizens. The notion of modernization advocated by the rf emerged as a discourse aimed at contributing to a “rationalization” that would enable the development of countries considered underdeveloped, at least since the early twentieth century. In the second half of the twentieth century, this conception was incorporated into the discourse of international relations, particularly through the propagation of technical cooperation between Northern and Southern countries. However, this was not a rigid process, as it was interpreted, appropriated, and resignified in different ways by the involved parties, especially the agents operating at the local level in countries benefiting from funding. The complexity of the rf staff members’ actions concerning local actors indicates the paths taken in attempting to achieve their objectives, even if, in doing so, the adopted actions contradicted their own official determinations.

From 1951 to 1964, the experience of the fmrp operationalized a modernization process that directed medicine toward the development of health technologies rather than the eradication of diseases, which required massive investments in public health. The case of Ribeirão Preto was characterized by a strong emphasis on areas such as biochemistry, physiology, and pharmacology. Concurrently, the fmrp Department of Preventive Medicine was developing programs to bring medical education closer to the communities, revealing an interest in improving public health in the region served by the Mogiana Railway Company.

This context was marked by the tensions of the Cold War and the actions of rf staff members who, on occasions, ignored suspicions of potential communists among the agency’s beneficiaries-as with Zeferino Vaz-in the name of broader interests espoused by the rf, namely the modernization of medical education at the fmrp.

To conclude this article, it is fitting to state that during the 1950s and 1960s, different modernization projects unfolded in the Cold War and Brazilian political scene, materializing in the creation and development of medical schools in the State of São Paulo. Despite isolated experiences such as the work of Pedreira de Freitas in the Department of Preventive Medicine at the fmrp, the tensions between those projects reinforced the rf’s elitist plans and us intentions for expanding their influence among Third World nations. Zeferino Vaz, despite the contradictory elements present in his career, is undoubtedly a figure who typifies these intentions.