Doctors in the slaveholding city: São Luís do Maranhão

A brief examination of Maranhão’s nineteenth-century demographics reveals the foundations of an agrarian society sustained by a large population of enslaved Africans, brought primarily from the second half of the eighteenth century (Mota Reference Mota2007; Carreira Reference Carreira1988). Situated at the edge of the Amazon rainforest in northeastern South America, the former Captaincy of Maranhão maintained enduring connections to the transatlantic slave trade, especially after 1750, through commercial networks tied to the Upper Guinea ports of Cacheu and Bissau. This system was inseparable from a violent process of territorial conquest, marked by the genocide of Indigenous peoples to clear land for agriculture and to secure profits for merchants and slaveholding landowners. These historical dynamics mirrored those of other slave-based economies in the Americas, which were linked through mercantilist interests and received substantial annual influxes of enslaved men and women (Hawthorne Reference Hawthorne2010, 50–59).

In 1821, shortly before Brazil’s break from colonial ties with Portugal, a local census estimated Maranhão’s population at approximately 152,893 inhabitants. Of these, 55.2 percent were enslaved Africans and Creoles, 22.5 percent were free Black and mixed-race individuals, 15.6 percent were white, and only 6.3 percent were Indigenous (Lago Reference Lago2001, 86–89).Footnote ³ The population’s composition on the eve of Brazil’s independence revealed a white minority—barely one-sixth of the inhabitants—contrasted with a majority of enslaved Africans and Creoles, followed by free and freed people who continued to face highly coercive labor conditions (Assunção Reference Assunção2014, 59–63). The colonial bureaucracy and most of the economic elite, whose wealth remained concentrated in white hands, were based in the capital, São Luís. This coastal city expanded in tandem with the colony’s penetration into the hinterlands and served as the primary port for exporting interior agricultural production, especially cotton and rice. As Maranhão’s main gateway to the Atlantic, São Luís linked the Amazonian interior to African, European, and other global ports. Between the late eighteenth and early nineteenth centuries, it rose in importance within the Portuguese imperial network. Travelers and chroniclers praised its architecture and emerging bourgeois character, portraying it as a growing commercial hub (Caldeira Reference Caldeira1991).

Henry Koster, a British observer who visited São Luís in 1811, emphasized its prosperity. He estimated that roughly twelve thousand people lived in the more urbanized parish of Nossa Senhora da Vitória. His account also underscored the city’s stark inequalities: The wealth of a few was reflected in “clean and beautiful” residences that sharply contrasted with the numerous small, thatched-roof houses that he described as “humble and somber,” scattered throughout its streets, alleys, and outskirts (Koster Reference Koster1942, 234).

The area highlighted in Henry Koster’s account was the subject of an official census conducted decades later, in 1855, which estimated a population of nine thousand residents within its boundaries. Of these, 35.4 percent were white, and 64.6 percent were Black and mixed-race individuals, 61.9 percent of whom were enslaved and 38.1 percent of whom were free.Footnote ⁴ The survey categorized the mixed-race population into “pardos” (descendants of mulattos and whites), “mulattos” (descendants of Blacks and whites), and “cafuzos” (descendants of Indigenous people and whites or Blacks), labels that carried clear racializing force and reflected how nineteenth-century Brazil structured social difference. The census did not indicate how many among them were free. Indigenous people, meanwhile, were not mentioned or classified at all, whether as free or enslaved.

The census recorded, on a house-by-house basis, both enslavers and enslaved individuals, while also identifying the presence of various liberal professionals, including apothecaries, cigar makers, hatters, goldsmiths, tailors, typographers, shopkeepers, and architects, as well as lawyers and physicians.Footnote ⁵ During this period, Maranhão’s newspapers regularly advertised the services of liberal professionals, especially physicians who were becoming increasingly prominent in São Luís. The capital’s urban landscape served as their principal arena of practice, where they attended above all to an exclusive clientele of wealthy enslaver families.

Table 1 lists doctors and surgeons residing in the Parish of Nossa Senhora da Vitória, as recorded in the 1855 census of São Luís. It brings together names, ages, and places of birth drawn from the original census register. Although the final census count identifies fifteen doctors and surgeons, a close examination of the 206 handwritten pages reveals the presence of sixteen medical professionals. The compilation cross-references these data with César Augusto Marques’s (Reference Marques1970) study, which offers information on their educational backgrounds and professional trajectories.

Table 1.

Doctors and surgeons recorded in the parish of Nossa Senhora da Vitória, São Luís, 1855

Table 1. Long description

The table presents data on sixteen doctors and surgeons residing in the Parish of Nossa Senhora da Vitória, São Luís, as recorded in the 1855 census. It includes columns for names, ages, birthplaces, and educational institutions. The table lists individuals such as Afonso Saulinier, aged 24, born in France and educated at the University of Paris, and Antonio Henrique Leal, aged 27, born in Maranhão and educated at the Faculty of Medicine of Rio de Janeiro. Notable entries include Joaquim José de Carvalho e Castro, aged 53, born in Portugal and with no information on educational background, and Silvestre Marques da Silva Ferrão, aged 70, born in Portugal and educated at the Faculty of Medicine of Bahia. The table cross-references data from the original census register with Csar Augusto Marques’ study, providing insights into their educational backgrounds and professional trajectories.

Note: For entries marked with an asterisk, the sources present differing indications of the physicians’ places of birth.

To attend to the nine thousand inhabitants recorded in the parish in the 1855 census, a total of sixteen physicians and surgeons were present.Footnote ⁶ These medical professionals, educated at institutions in Brazil and at universities in Portugal, France, and Belgium, sought out their patients across the city. Their daily interactions exposed them to a diverse urban population, including porters, street vendors, laundresses, water carriers, and domestic servants, within a society that remained deeply segregated, violent, and racist, shaped by enduring ideas of blood purity reminiscent of the Portuguese nobility (Jesus Reference Jesus2015).

By the mid-nineteenth century, São Luís had outgrown its earlier status as a modest colonial settlement. The capital expanded beyond the Parish of Nossa Senhora da Vitória as new streets emerged, lined with refined residences whose facades displayed the distinctive Portuguese azulejos that later became emblematic of the city. An 1853 map already captured this urban growth, marked by a variety of townhouses, especially the two-story solares, with service areas for enslaved laborers on the ground floor and the private quarters of property owners above (Figueiredo et al. Reference Figueiredo, Varum and Costa2012). A key element of São Luís’s modernization was the popularization of the press, which circulated both among elite households and through the streets frequented by enslaved and freed poor people (Machado and Cardoso Reference Machado and Cardoso2024, 172).

Local newspapers often published editorials that extended beyond the political disputes between the Bem-te-vis (Liberals) and Cabanos (Conservatives). They recorded daily events, police incidents, fugitive enslaved individuals, advertisements for hired servants, and burial notices. Among these entries were the deaths of enslaved women, men, and children, individuals who frequently appeared in public records only when sold or at the moment of death.

Medical professionals played a central role in certifying these deaths. They treated the terminally ill and provided the official endorsements of the cause of death that appeared in cemetery lists. When enslaved individuals became gravely ill or died, enslavers summoned physicians they trusted, often family friends or relatives, seeking discretion and confidentiality. This was especially important when death resulted from physical punishment or other forms of torture that risked exposing household abuses to public scrutiny.

Carolina’s cries and medical testimonies

While most death notices in the São Luís press passed unnoticed, some provoked widespread alarm, gossip, and suspicion. Such was the case of Carolina, a twenty-five-year-old enslaved woman who died from an acute tetanus infection. Her name and cause of death appeared alongside other cases in the June 26, 1856, edition of the Publicador Maranhense, the official newspaper of the provincial government.Footnote ⁷ These announcements, detailing illnesses and deaths, were routinely approved by physicians who had examined the dying before their final rites. The cold calculations of fatal diseases and burial counts reduced the lives of the enslaved to mere statistics, devoid of public concern. Carolina’s case, however, did not fade into obscurity like so many others. Following its publication, various public statements challenged the official version of her death as presented in the Publicador Maranhense. Critics questioned the credibility of Dr. Paulo Saulnier de Pierrelevée, the physician who had conducted the final examination of her body. He had diagnosed tetanus as the cause of death.Footnote ⁸ Yet the controversy surrounding Carolina’s passing cast doubt on this conclusion, revealing tensions between medical authorities and public perception in São Luís. Witnesses contradicted the physician’s claims, asserting that Carolina had died as a result of severe torture. The case drew public attention and led to a police inquiry that implicated both the doctor and the enslaver’s family.

Dr. Carlos Fernando Ribeiro, Carolina’s owner, belonged to a wealthy family with extensive slaveholding estates in Alcântara, a town near São Luís. Born in 1815, he received an elite education, earning a law degree in Olinda, a medical degree in Philadelphia, and a degree in agronomy from Yale University. He inherited the Gerijó sugar plantation in Alcântara, where he introduced mechanized improvements to sugar production, aligning with international trends in the export market. Despite his medical credentials, his social standing set him apart from most other physicians in the city, as he was a prominent member of Maranhão’s upper elite. Notably, although he held a medical degree, Dr. Carlos Fernando was far better known for his role as a plantation owner and influential liberal politician (Machado and Cardoso Reference Machado and Cardoso2024, 78–79).

His wife, Ana Rosa Viana Ribeiro, also belonged to an affluent and influential family. Born in Codó in 1823, a town along the Itapecuru River in the Maranhão interior, she came from a French-descended lineage that controlled extensive landholdings and enslaved laborers. Carlos Fernando and Ana Rosa married in 1853, forming what was considered an exemplary couple among the local elite—wealthy, well connected, and supported by powerful kinship networks (Coutinho Reference Coutinho2015, 296).

The couple resided on São João Street, in a neighborhood where affluent families had begun to settle more densely, near the Church of São João Square. Their home, an imposing sobrado (two-story house), was designed to confine enslaved laborers in windowless alcoves on the ground floor, with access only to an internal courtyard leading to the kitchen. A staircase from this enclosed space led to the upper floor, where the owners’ quarters opened onto a series of wide, balconied windows overlooking the street (Costa Reference Costa2014, 167). While living in this grand townhouse, known as a solar, Ana Rosa gave birth to their first child in 1854.Footnote ⁹

Among the women responsible for domestic labor in the household was Carolina, whose death was reported in the Publicador Maranhense. A “crioula,” as mentioned by sources, born in the Itapecuru River region, she had likely been sent from the plantations owned by her enslaver’s family to serve in the home of a relative who had recently given birth in the capital.Footnote ¹⁰ However, the imposing townhouse of Ana Rosa Viana Ribeiro and Carlos Fernando Ribeiro attracted attention not for its elegant facade or the cries of an infant but for the persistent screams of horror from Carolina, often accompanied by the commanding voice of her enslaver. The sounds of blows, hurried footsteps, and desperate pleas for help filled the air. It was not long before accounts of the young enslaved woman’s suffering spread beyond the household’s walls, fueling public speculation about the private life of one of the city’s wealthiest new elite families.

Although slavery was both legally sanctioned and deeply entrenched in society, the ruling class typically cloaked its brutality in the guise of paternalism. Even in a social order defined by violence, excessive cruelty and public displays of torture were deemed breaches of decorum. Elite slaveholders were expected to maintain a veneer of propriety to preserve both social harmony and domination. Crossing that boundary risked provoking public outrage. Carolina’s cries of agony marked such a rupture, unsettling the neighborhood and exposing the sustained torture within the Ribeiro residence. Public alarm likely compelled the Chief of Police, Antonio Marcelino Nunes Gonçalves, to act, yet the formal investigation began only months later after her death, revealing how slowly the machinery of justice moved when confronted with the crimes of the powerful.

Three months after Carolina’s death, interrogations began, focusing on individuals living near the Ribeiro household.Footnote ¹¹ On September 29, 1856, the first witness, a woman named Anna Raimunda, appeared at the police station. A neighbor whose home adjoined the townhouse, Raimunda provided chilling details about the relentless abuse inflicted upon Carolina in the days leading up to her death. According to Raimunda, Carolina endured repeated beatings on her back, hands, feet, and knees. She recounted not only the screams she had heard but also the accounts of other enslaved people in the household, who spoke of their companion’s ordeal and shared news of her suffering.

The witness asserted that the young woman’s deteriorating health resulted not only from isolated instances of punishment but also from the cumulative effects of daily beatings. She also recounted seeing the enslaved woman wandering the streets in distress, attempting to tear off her clothes in a desperate effort to alleviate her pain. This scene was witnessed by the deponent and also by other anonymous onlookers who observed and discussed her worsening condition. At the height of her suffering, Carolina attempted to throw herself from one of the townhouse’s windows, further alarming the neighborhood. Only then, realizing the public scandal that would erupt were one of her enslaved servants to commit suicide, Ana Rosa confined Carolina to an upstairs room.Footnote ¹²

The witness stated that Carolina’s torment continued in isolation, provoking outrage among neighbors “to the point that they hurled a great number of stones at Dr. Carlos’s house in an attempt to curb the excesses of the punishments.”Footnote ¹³ She did not specify who took part in the stoning, only implying that anonymous individuals carried out the attack. It is worth noting that Rua São João, where the townhouse stood, had only recently become a stronghold of the elite and was still surrounded by modest families living in single-story houses, as well as vacant lots overgrown with vegetation, which may have served as hiding places for those who sought retribution. The individuals responsible for the attack were likely part of the networks of communication that followed the brutal routines inside the Ribeiro household. Among them were likely enslaved people familiar with Carolina, who took direct action in a covert yet impactful act of defiance.

After their home came under attack, the couple made a brief yet ultimately ineffective attempt to change course. According to the witness, it was at this point that Ana Rosa sought treatment for Carolina’s wounds, keeping her under strict supervision on the upper floor. She first summoned a barber-surgeon named Luís Carlos, ordering him to apply cupping therapy to Carolina’s back. The excruciating pain caused by the procedure provoked fresh screams of agony, once again echoing through the neighborhood. Upon realizing the ineffectiveness of the palliative treatment for the inflamed and partially gangrenous wounds, Ana Rosa summoned the family’s trusted physician, Dr. Paulo Saulnier de Pierrelevée. After examining the young woman’s condition, he declared that she had no more than three days to live. Shortly thereafter, Carolina succumbed to her injuries.Footnote ¹⁴

In the weeks following Anna Raimunda’s testimony, additional depositions were collected. Dr. Silvestre Marques da Silva Ferrão, the chief surgeon of the Santa Rita infirmary and physician at the Casa de Recolhimento de Nossa Senhora da Anunciação e Remédios, was among those called to testify.Footnote ¹⁵ A resident of the same neighborhood as the enslaver, he stated that he had learned of Carolina’s death upon witnessing the funeral procession. When questioned by the police chief, he recounted hearing from the townspeople that “word had spread that the Black woman had died as a result of punishments.”Footnote ¹⁶

Regarding the stoning of the house, Dr. Ferrão confirmed that he had heard about the incident from his daughter, Ermelinda Marques da Silva Ferrão. The police chief promptly summoned her for questioning. When asked about the beatings, Ermelinda admitted to hearing the sounds of “punishments being carried out” in the residence but was unable to specify the exact methods used or to identify the victims. She also acknowledged having heard about the stoning of Dr. Carlos’s house and noted that he had been absent at the time. This detail complemented another part of her testimony, in which she mentioned the solitary voice of Ana Rosa Viana Ribeiro berating enslaved individuals during the punishments.Footnote ¹⁷

The neighbors’ willingness to testify publicly challenged the authority of the powerful family, which also faced the defiance of those who had hurled stones at their residence. However, amid the collective denunciations, one testimony stood in stark contradiction to the others. On October 18, 1856, Dr. Paulo Saulnier de Pierrelevée appeared at the police station. He was the very physician who had examined Carolina in her final moments. A graduate of the University of Paris in medicine (1818), he also held a degree in Natural and Philosophical Sciences from the University of Leipzig (1821) (Marques Reference Marques1970, 462–463). Having resided in Maranhão’s elegant capital since 1835, he was highly regarded there, and his professional assessments carried significant weight. It was in this context that Dr. Pierrelevée provided the official cause of death for Carolina in a brief obituary published in the Publicador Maranhense, a statement that placed him at the center of the investigation by contradicting testimonies describing her prolonged torture and mistreatment.

At the police station, Dr. Pierrelevée stated that he had visited the townhouse at the request of his colleague, Dr. Carlos Fernando Ribeiro, to examine a severely ill enslaved woman. According to his account, her death resulted from a transverse fracture of the left kneecap, which had developed an acute infection caused by tetanus. He attributed the fracture to an alleged fall down a stone staircase while she was performing her daily tasks, possibly while carrying a water pot on her head. Other injuries found on her body, such as “occasional bruises and contusions on the lips and minor ones on the limbs,” were dismissed as insignificant to the cause of death.Footnote ¹⁸

Dr. Pierrelevée firmly denied that any blows or violent punishment had contributed to Carolina’s death. Ignoring the extensive wounds, swelling, and lacerations described in the testimonies, he focused exclusively on the fractured kneecap. He claimed the injury could have resulted only from a fall, dismissing the possibility that repeated blows to her legs were responsible. When questioned about additional wounds on her feet, hands, and back, he again rejected any connection, insisting that the acute inflammation of the knee was the sole cause of death.

As the interrogation continued, the police chief questioned the physician about the possible presence of “mental derangement,” meaning any indication that the patient may have suffered psychological distress as a result of severe punishments. In response, Dr. Pierrelevée asserted that during his consultation, the enslaved woman “could not speak at all and, at most, experienced the delirium typical of traumatic fevers caused by her injury.” Finally, he was asked whether cupping therapy had been applied to the young woman’s already-suppurating back wounds. He replied simply that he did not remember.Footnote ¹⁹

In summary, the physician framed his testimony in a way that attributed Carolina’s death primarily to an accident, absolving the Ribeiro couple of any responsibility. Further reinforcing his position, Dr. Paulo Saulnier de Pierrelevée authored a letter published in the Diário do Maranhão on October 31, 1856, just days after the testimonies had concluded. The letter responded to a series of questions posed by Dr. Carlos Fernando Ribeiro, who sought to refute the “satanic invention” surrounding his wife’s reputation.Footnote ²⁰ Dr. Pierrelevée affirmed that he had frequently had the “honor” of treating Dona Ana Rosa Viana Ribeiro, her young son, and several of the enslaved individuals in their household.

Regarding Carolina’s cause of death, the physician was even more categorical than in his statement to the police, focusing solely on tetanus and omitting any reference to other wounds. He declared without hesitation that he had examined her thoroughly and found nothing but a “slight injury on one of her knees,” insisting that “the rest of her body bore no trace of any wounds.” The bone trauma was once more attributed exclusively to a fall, which he presented as the definitive cause of death, sidelining the abrasions he had previously acknowledged to the authorities. In closing, Dr. Pierrelevée authorized his colleague, Ana Rosa’s husband, to use the letter as he wished and expressed his satisfaction in supporting and defending, with the highest regard, the honor of his esteemed friend.

Despite the veneer of normalcy projected by local elites, cases of mistreatment continued to surface in São Luís. Physician Paulo Saulnier de Pierrelevée repeatedly emerged as a key intermediary, routinely called on to validate the accounts of slaveholders accused of violence. In May 1862, he issued another public letter concerning his examination of Narcisa, a “preta fula” (i.e., “as black as can be,” a nineteenth-century racial label used in Brazil to denote a very dark-skinned Black woman), of about thirty, enslaved by Trajano Cândido dos Reis. After allegedly attempting suicide by throwing herself into a well, she was rescued by neighbors, and speculation spread quickly through the local press, which followed the case closely.Footnote ²¹ Trajano claimed she had acted under the influence of alcohol rather than in response to punishment. Saulnier endorsed this explanation, asserting that she bore no signs of torture, only injuries consistent with a fall. His report aligned with statements collected by the police and with a subsequent forensic examination, resulting in the full exoneration of her owners.Footnote ²²

The case ultimately underscores how medical expertise operated not as a neutral diagnostic tool but as a resource that could be aligned with the interests of slaveholders. In a society where bodily harm, coercion, and discipline structured everyday relations, physicians occupied a privileged position as arbiters of credibility, capable of translating violence into accident, punishment into misfortune, and injury into mere circumstance.

Doctors and slave owners: Collaboration and confrontation

In the following decades, other cases of torture against enslaved individuals emerged, revealing the direct involvement of doctors collaborating with slave owners. One of the most infamous cases that shook Maranhão in the mid-1870s was the death of two “escravinhos,” that is, two enslaved children, involving the same Ana Rosa Viana Ribeiro and her husband.Footnote ²³ The deceased children, Jacintho, aged six, and Inocêncio, aged eight, were the sons of a recently freed woman named Geminiana. They had been placed for sale at a public auction to settle part of the outstanding debts of their deceased owners’ estate. Ana Rosa purchased the two boys with the stated intention of “educating them properly before gifting each to one of her children studying in France.”Footnote ²⁴

Both Inocêncio and Jacintho were classified as “escravinhos” in historical sources because they were born before the enactment of the Free Womb Law in Brazil in 1871. This law declared that children born to enslaved mothers were legally ingênuos, meaning they were no longer considered slaves but remained under the guardianship of their mother’s owner for an extended period, potentially until the age of twenty-one.

Ultimately, what was the worth of an enslaved child’s life in São Luís during the decade of the Free Womb Law? Throughout their lives, Geminiana’s sons held little significance in local society, appearing in historical records as nothing more than two additional “escravinhos.” Like many other dark-skinned enslaved children scattered across the city, they were seen as unprofitable in the short term, acquiring economic value only if they survived into adolescence or adulthood. In Portuguese, the term escravinho is the diminutive of escravo, reinforcing a paternalistic ideology that portrayed domestic slavery as a system of supposedly affectionate and benign relationships between enslavers and enslaved children. This diminutive logic paralleled the discourse surrounding ingênuos, a legal category that nominally granted freedom to children born after 1871 while keeping them under the authority and economic control of their mothers’ owners for years. The language used for both escravinhos and ingênuos reveals how slavery sought to extend its influence beyond formal legal boundaries and maintain de facto control over enslaved families.

As escravinhos, Geminiana’s children became publicly visible only in death. The unusual attention to enslaved children was striking, as their names appeared outside the usual contexts of sales, runaway notices, or brief obituaries. Inocêncio and Jacintho quickly became central to the medical debate that emerged from the autopsy reports and the police investigation into their owner, who was immediately suspected of murdering them. From the moment Ana Rosa Viana Ribeiro acquired the two boys, both initially described as healthy, she began claiming that she had made a costly mistake, insisting that they suffered from the so-called vice of eating dirt and were therefore in declining health.Footnote ²⁵ She reinforced this narrative in close collaboration with her personal physician, Dr. Antonio dos Santos Jacintho. When Jacintho, the younger of the two, died in October 1876, reportedly from diarrhea, his death was attributed to this “terrible habit,” as geophagy was commonly regarded at the time (Oda, Reference Oda2008). Dr. Jacintho issued a death certificate listing diarrhea as the official cause of death.

Originally from Sergipe, Dr. Jacintho did not belong to Maranhão’s elite families. He earned his medical degree from the Faculty of Medicine of Bahia in 1852 and, between 1853 and 1869, practiced medicine in the province’s interior. This trajectory likely reflected his lack of connections in the capital, which prevented him from accessing the exclusive clientele of the upper class. Only after establishing strong social ties in São Luís did Santos Jacintho gain prominence, securing wealthy and influential patients and improving his financial standing. His strategy appeared successful: By the 1870s, in addition to gaining recognition as a doctor, he had accumulated several prestigious positions, including physician for the police corps and the public prison, and he became a professor at the esteemed Liceu, São Luís’s only secondary school. Among his patients were prominent figures such as Ana Rosa Viana Ribeiro and her family (Marques Reference Marques1970, 468). Like Dr. Paulo Saulnier de Pierrelevée years earlier, who, despite recognizing the clear signs of torture on Carolina’s body, deliberately omitted their connection to her death in his medical report, Jacintho used his medical authority to serve the same family’s interests. His dependence on this affluent clientele led him to issue unreliable diagnoses, sign dubious death certificates, and participate in autopsies that ultimately shielded Ana Rosa from a murder charge.

Less than a month after Jacintho’s death, his older brother, Inocêncio, died in the Ribeiro family’s household. Once again, Ana Rosa’s personal physician insisted that Inocêncio suffered from the same illness as his late brother, diagnosing him with hipoemia intertropical and dysentery. According to Dr. Jacintho, both conditions stemmed from the child’s “vice” of eating dirt, reinforcing the same justification that had previously absolved Ana Rosa of any suspicion.Footnote ²⁶ A physician who moved within the wealthiest circles of the slaveholding elite wielded considerable influence over medical diagnoses. Since the colonial period, slave owners had believed that the “habit” of eating dirt, commonly observed among enslaved people, resulted from a self-destructive addiction that could lead to death and was sometimes practiced deliberately to harm their masters. Many assumed that enslaved individuals consumed large quantities of soil as an act of defiance or a means of ending their own suffering. Planters, overseers, estate administrators, apothecaries, and physicians experimented with ways to suppress this perceived vice, which they claimed caused not only the deaths of the enslaved but also financial losses for their owners. Among the most notorious punishments used to curb the practice was the máscara de flandres (face iron), a metal muzzle that prevented the ingestion of soil or other substances. Made of tinplate or other metals, it covered the mouth tightly and was fastened around the head, causing pain, difficulty breathing, and deep wounds. The device embodied the extreme measures enslavers employed to control enslaved bodies and behaviors, reinforcing both physical suffering and social degradation (Goulart Reference Goulart1971, 71, 139).

Only in the mid-nineteenth century did slave owners find apparent scientific validation for their long-held beliefs about dirt eaters. Although the newly identified disease hipoemia intertropical possessed some basis in medical observation, misconceptions about the causes of geophagy persisted. While modern research acknowledges a variety of cultural factors behind this practice, a growing consensus among scholars attributes it primarily to nutritional deficiencies, including a lack of essential minerals and vitamins (Abrahams Reference Abrahams2012). Among children, geophagy is even more clearly associated with anemia and malnutrition. Nevertheless, nineteenth-century medical discourse framed the behavior as a pathological “vice” that required immediate correction.

Moreover, the classification of this condition by physicians at the Rio de Janeiro Medical School in the mid-nineteenth century gave a scientific framework to a long-standing concern among slaveholders. In 1835, Dr. Cruz Jobim defined hipoemia intertropical as a disease caused by the humid climate that disproportionately affected the lower classes, especially enslaved people. He described symptoms such as dysentery, anemia, and geophagy. Later, other medical researchers linked the condition to the presence of Ancylostoma duodenale, a parasitic hookworm found in the human intestine. Within this emerging medical discourse, the so-called habit or vice of eating dirt appeared both as a cause and as a symptom of helminth infection, providing an ambiguous explanation for a practice that slaveholders regarded as dangerous and self-destructive (Edler Reference Edler2004; Sigaud Reference Sigaud1844). Dr. Xavier Sigaud also described máculo, a disease he claimed was peculiar to Black individuals and supposedly caused dysentery and severe rectal lesions.

However, physicians failed to recognize the direct link between geophagy and nutritional deficiencies, overlooking the urgent physiological need that compelled many enslaved individuals to consume dirt. Their studies did not establish a clear causal chain: Did parasitic infections cause geophagy, or was it the other way around? This incomplete understanding of the cycle of malnutrition and anemia reinforced the deeply ingrained conviction that dirt eating was an inherent flaw of Africans and their descendants.

Despite the uncertainties surrounding medical discourse, no signs of anemia or parasitic infection were evident at the time Ana Rosa acquired the two boys in early August 1876. Each witness who testified during the criminal investigation into Inocêncio’s death, including Dr. Santos Jacintho, confirmed that both children appeared healthy and well at the time of purchase.Footnote ²⁷ Yet within months, they were repeatedly accused of eating dirt and suffering from severe bouts of diarrhea. Inocêncio, in particular, developed acute dysentery, along with rectal prolapse and anal fissures. Following his death, Dr. Santos Jacintho issued a death certificate attributing the boy’s passing to hipoemia intertropical.Footnote ²⁸

Although Ana Rosa and her physician insisted that the child had succumbed to natural causes, the initial autopsy, conducted by two military doctors, told a different story. Their examination revealed that Inocêncio’s body bore numerous scars, burns, rope marks, and lash wounds. He was severely malnourished and suffered from rectal prolapse and intracranial hemorrhaging.

Despite this damning evidence, Dr. Jacintho repeatedly reaffirmed, both in this case and in subsequent instances, that hipoemia intertropical caused the child’s death as a result of his alleged habit of eating dirt. According to his assessment, Inocêncio had died of natural causes. However, he did not deny that the child had endured physical punishment—after all, the right to discipline enslaved individuals through “moderate correction” was a fundamental prerogative of slaveholders. He also acknowledged that Inocêncio had been deprived of proper nourishment at regular intervals, a failure he attributed directly to Ana Rosa’s neglect. In his own carefully chosen words, he admitted that the child had suffered from hunger.

In Dr. Jacintho’s view, both corporal punishment and food deprivation were private matters, belonging exclusively to the slaveholding domain. He believed that no person had the right to interfere in the relationship between master and enslaved. Slaveholding power itself depended on the supremacy of the private sphere over the public (Mattos Reference Mattos1987, 103–191). For slave owners like Dona Ana Rosa and Dr. Jacintho, even the idea of public oversight in regulating slavery was intolerable.

Inocêncio died on the night of November 13. The next day, despite Dona Ana Rosa and her physician’s efforts, the child was not buried, as the police had not yet authorized the release of the body—a delay she tried urgently to circumvent. As news of the boy’s death spread, crowds gathered at the cemetery. When his mother saw the corpse, she confronted the horrifying condition of her son’s body, prompting public outrage. The district subdelegate of São João requested a forensic examination and autopsy, but no doctor appeared. Despite repeated summonses, none of the five notified physicians agreed to perform the procedure. Each feared the professional consequences of signing a report that could implicate a woman of Maranhão’s elite, as well as the public’s anger if the autopsy failed to confirm or seemed to obscure the violence inflicted on the escravinho. No one was willing to assume such a risk.

On the morning of November 15, at eight o’clock, two army surgeons, Dr. Augusto José de Lemos and Dr. Raimundo José Pereira de Castro Júnior, examined the body. In nineteenth-century Brazil, military physicians, trained in centralized academic institutions and serving in structured careers, contrasted with civilian doctors, who relied on private patrons, often slaveholding elites, reflecting how medicine mirrored the hierarchies of slavery. The examination occurred in public. Second Lieutenant José Maria da Rocha Andrade reported three head wounds, a deep cut on the right wrist, rope marks on the wrists and upper arms, a prolapsed rectum with three ruptures, bruised buttocks, and swollen hands and feet. The witness also confirmed that the doctors, using a surgical saw, opened the boy’s skull and discovered a small amount of intracranial bleeding.Footnote ²⁹

The forensic report confirmed the military’s observations. The two army surgeons identified the case as homicide. Inocêncio’s condition left no doubt that he had suffered repeated physical punishment. With proper care, he might have survived. The report concluded that his death resulted from the repeated use of ropes and a whip, punishments his body could no longer withstand.Footnote ³⁰ Following this initial forensic report, a second examination took place after the exhumation of the body on November 16.Footnote ³¹

As medical reports published in newspapers suggested, widespread suspicions of corruption surrounded the second autopsy. First, the chief of police appeared to be orchestrating a political maneuver to minimize the severity of the charges. Furthermore, the forensic team included none other than Dr. Jacintho himself, who had already gone to great lengths to validate his questionable initial death certificate regarding Inocêncio’s cause of death. The second appointed examiner, Dr. Fábio Augusto Bayma, also raised concerns, as he was a third-degree relative of the accused. Although no legal provision prevented his participation, his involvement cast serious doubts on the neutrality required for a credible forensic evaluation.Footnote ³²

The body was exhumed sixty hours after death, already in decomposition, but the examination proceeded. As anticipated, the second autopsy attributed the child’s death to a supposedly natural cause: severe anemia linked to preexisting hipoemia intertropical. To support this conclusion, the physicians reported finding a few hookworms (Ancylostoma) in the duodenum, though they collected only four specimens, which raised doubts about whether the organs were truly infested or whether the claim served to obscure the real cause of death. The autopsy also revealed flour, small pieces of meat, and red earth in the stomach, indicating soil ingestion. In addition, the examiners challenged the first autopsy’s diagnosis of cerebral hemorrhage, arguing that the small wound on the child’s head did not substantiate such a finding. The numerous signs of physical punishment and mistreatment recorded in the initial examination were largely set aside. Although decomposition caused visible swelling that complicated the analysis, the physicians concluded that while the marks could have resulted from punishment, they were not severe enough to cause death.Footnote ³³ Later, Dr. Jacintho proposed that the injuries might have resulted from postmortem handling of the corpse when the body was removed from the coffin.Footnote ³⁴

One of the records from the second autopsy described undigested flour mixed with soil in the child’s stomach, a finding that prompted different interpretations. The medical examiners argued that the child had eaten this mixture shortly before dying, leaving no time for digestion. The subdelegate, who had been appointed by the chief of police, offered a far graver explanation. In his final report, after comparing conflicting testimonies, he concluded that Dona Ana Rosa and her physician had forced the dying child to swallow flour mixed with soil as part of their attempt to conceal the crime. This act was meant to fabricate evidence supporting claims that the child suffered from the “habit of eating soil” and the alleged hypoemia intertropical.Footnote ³⁵

Although some details were omitted from the autopsy report, witnesses who saw young Inocêncio in his final days noted that, besides rectal prolapse, he had two strangulated hernias in the groin, one of them suppurated. These accounts indicate that the rapid onset of the prolapse likely resulted from repeated abdominal trauma, caused by punches or kicks, and possibly aggravated by blows with heavy objects. Even the military physicians recorded evidence of injuries in the child’s abdominal area.Footnote ³⁶

The conflicting conclusions of the forensic reports, one pointing to violent causes and the other to natural ones, became the central point of contention between the prosecution and the defense. Yet this debate diverted attention from the fundamental issue: the prolonged and agonizing deaths of two seemingly healthy children within a short span of time. From the outset, Dona Ana Rosa’s responsibility for the deaths of her escravinhos was evident. The legal proceedings that followed, however, revealed an even deeper moral failure. They ignored the essential question underlying the entire case: What kind of society allows two vulnerable children to be sold separately to a woman known for her cruelty, and what kind of physician remains passive while a child is tortured to death?

Although the physician ultimately avoided legal consequences, the working people of São Luís, who had followed the case closely, refused to accept the version imposed by the powerful Ribeiro family and their doctor. His conduct echoed that of Dr. Paulo Saulnier de Pierrelevée, who decades earlier had concealed the tortures that led to Carolina’s death. Such recurrences reveal how deeply medical authority was entangled with the power of slavery in nineteenth-century Maranhão. Despite his former prestige, the scandal shattered Dr. Jacintho’s reputation. He soon became mockingly known as “Dr. Anquilóstomos,” after the parasite associated with hypoemia intertropical. Pressured by public outrage and by students demanding his dismissal, he resigned from his teaching post at the Liceu. His properties were vandalized with the same derisive name. In disgrace, he closed his house and practice, retreating to the interior to an estate he called Boa Fé—or Good Faith—a bitterly ironic name for a man seeking to cleanse his record through pretense. Yet no matter how much Dr. Anquilóstomos attempted to escape the accusations of complicity in the torture of children, the stigma clung to him for the rest of his life (Almeida Reference Almeida2005, 53–54).

Final considerations

The careers of physicians such as Pierre Saulnier de Pierrelevée and Antonio dos Santos Jacintho reveal how doctors helped conceal acts of violence committed by slave owners. By defending the interests of their wealthy clients, these professionals aligned themselves with those who committed crimes against the enslaved, cloaking their testimonies in the scientific discourse that had gained broad legitimacy in the nineteenth century. Although medical rhetoric appeared most often in newspapers during epidemics, it also worked as a “benevolent sponge,” cleansing the reputations of elite families eager to protect their social standing during police or judicial inquiries.

In this context, medical authority was central to maintaining the public acceptance of paternalistic slaveholding ideologies. It upheld the illusion, especially in public discourse, of humane treatment of the enslaved, even when medical examinations followed torture or illness caused by abuse. Any deviation from this tacit agreement risked provoking public outrage, particularly in the late nineteenth century as abolitionist debates intensified in Brazil. When rumors of domestic violence persisted, such as cries of agony heard from elite homes, loyal doctors became essential allies in suppressing suspicion. Through medical reports, newspaper letters, or courtroom testimony, they diverted scrutiny and protected their patrons.

The case of Ana Rosa Viana Ribeiro illustrates the need to scrutinize the role of white women in perpetuating slavery’s violence. While elite women were idealized as figures of Christian virtue and domestic benevolence, Ana Rosa’s actions exposed the contradictions of that image. Her brutality was not exceptional but part of the same structure that sustained slavery in Maranhão. Her prolonged torture of the enslaved woman Carolina, reinforced by Dr. Pierrelevée’s complicity in withholding medical care and legitimizing her suffering, shows how female slaveholders exercised authority through acts of cruelty, reinforcing racial subjugation. Likewise, her role in the abuse and death of the escravinho Inocêncio, later obscured by Dr. Jacintho’s fabrication of forensic evidence, demonstrates how medical expertise was weaponized to protect slaveholders and preserve the impunity that enabled slavery’s violence to endure.

Many doctors trained at the medical faculties of Bahia and Rio de Janeiro or studied in Europe. Some, like Dr. Carlos Fernando Ribeiro, were landowners and members of the slaveholding elite. Most, however, depended on the patronage of that class to secure their livelihoods. As independent practitioners, they pursued social and economic advancement by aligning with the plantation aristocracy, whose support was essential for success. Unlike major landowners, whose wealth came from agricultural exports and large enslaved workforces, most physicians in São Luís relied on their practice to maintain financial stability and social prestige.

Physicians were not merely service providers catering to slaveholders; many were themselves enslavers. Their complicity extended beyond economic dependence to include personal investments in human property and the use of medical authority to shield elite families from blame. By legitimizing false reports, denying treatment, or downplaying signs of abuse, doctors actively reinforced the structures of domination that upheld slavery in Maranhão. Although a few resisted these pressures, risking their careers by exposing violence, the majority rationalized and concealed brutality, ensuring the system’s persistence well into the late nineteenth century.