Recent works have analysed the history of the disease in Brazil, focusing on the . the Anais Brasileiros de Ginecologia and the Brazilian Gynaecology Society. Title: Wellcome History 47, Author: Wellcome Trust, Name: Wellcome History 47, This led him to create the Instituto de Ginecologia (IG), where he encouraged. Keywords: transnational history, colposcopy, Pap test, cervical cancer, diagnosis . Obstetricia y Ginecología Latino-Americanas when it first appeared in

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This article on the early detection of cervical cancer focuses on the development of two leading diagnostic techniques — colposcopy and the Pap smear test — and their histories in Argentina and Brazil. It explores how diagnostic tools were transferred between Europe and the Americas, while examining the intersection of cultural and medical aspects and the processes of adaptation and resignification in the receiving countries.

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Colposcopy received little attention in the main Western medical centers until South American countries reasserted its significance in the s. This article analyzes the history of the two main methods of cervical cancer detection — colposcopy and the Pap smear test — and how their histories in Argentina and Brazil contributed to redefining cancer categorization and diagnosis around the world. The study is firmly rooted in a transnational perspective and uses the notion of transfer to interpret the migration of medical ideas and gibecologia across national borders.

However, it has only been recently that transnational exchanges have interested historians of medicine and science. The idea that Latin American medicine and healthcare have been heavily influenced by European and American ideas and models is almost a self-evident idea for historians, yet the actual, complex process by which this widely recognized influence has taken place in concrete cases has been underestimated.

Likewise, the influence of foreign ideas on the histories of histoeian main Western medical systems has rarely been addressed, in an overtly nation-centered perspective. Specifically, I argue that its history can be better understood if attention is drawn to synchronic developments in several countries at a given moment. Ginecolgoia by German gynecologist and pathologist Hans Hinselmann inthe technique of colposcopy received little attention in the main Western medical centers until the s.

However, reliance on his technique did spread to Argentina and Brazil, where it is said to have been saved from oblivion during World War II. In this sense, the article examines the intersection of a series of elements in the above-mentioned countries in order to explore how these diagnostic tools were transferred. It first focuses on the cultural and medical settings where the process of transfer took place, with special focus on the intermediary channels inherent to gynecology institutions, congresses, and publications.

Second, it examines the development of colposcopy in a context where the diagnosis of cancer at an early stage became a widely accepted notion among specialists.

After analyzing the introduction of the Pap test in the s, a general discussion on the reception of both methods in Argentina and Brazil follows. It pays particular attention to implementation and adaptation ginecolohia well as to the innovations introduced in gynecological clinics in the s.

Significantly, this could imply perceptible changes such as linguistic ones i. I argue that meaningful changes in historiian diagnosis were perceived as a result of the transferred diagnostic tools, whose implications went beyond the borders of the countries analyzed.

International academic exchanges have not occurred contingently but rather through a range of channels that have made contacts possible, namely: In the medical field, South American students have gone abroad to complete specialized medical training. In the case of obstetrics and gynecology, students have traveled to different places during different periods.

Since the end of the nineteenth century, France and Germany were the main medical schools that drew students in the Western world.

France became particularly renowned in the area of obstetrics and puericulture during the first decades of the twentieth century. For those specializing in gynecological cancer, a visit to the Curie Institute to gain familiarity with the latest techniques developed in radiotherapy and radium also became mandatory.

Although French medicine continued to influence Latin American medical education, the s witnessed an increasing re-engagement with German medicine, especially in the areas of gynecology and surgery.

This process was facilitated through the creation of institutions on both sides of the Atlantic. The Argentinean Committee of University Information was set up in Berlin in to assist students in gaining academic experience at German universities. The advent of National Socialism thus seems to have reinforced the channels for disseminating German medicine in South America, at least until the start of World War II. The s and s saw a gradual orientation towards United States medicine in areas such as endocrinology, cytology, surgery, and chemotherapy.

The Rockefeller Foundation was instrumental through its well-funded system of grant schemes, which financed Brazilian and Argentinean doctors working to complete their specialization studies at prestigious hospitals and institutes.

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Although the Foundation had maintained supporting programs and fellowships in public health and epidemic control and eradication since its inception inin the s its policy shifted to supporting scientific education and focusing on the work of recognized researchers and institutes in biomedical investigation Cueto,p.

Inan international health division office for Latin America was set up in Buenos Aires, although the main support given to the country was almost exclusively concentrated in physiology, an investment that subsequently helped to develop the field in Brazil. Towards the end ofBrazil rejected its former neutral stance towards the Axis countries, putting the circulation of German specialists and instruments on hold.

During the s, Latin American networks in obstetrics and gynecology also served as important vehicles for the transfer of medical ideas, as we will see throughout this paper. International congresses and conferences played a major role in the exchange of medical experiences but so too did the generation of networks and relationships that later resulted in further collaboration. International congresses in obstetrics and gynecology started to be celebrated with regularity from on, when Argentina organized its first national congress in both specialties, with the participation of South American specialists.

In addition, held annually sincethe River Plate meetings originally organized by Uruguay and Argentina were attended by an increasing number of Latin American doctors.

As we will see, this medical integration also provided the context wherein diagnostic tools for the early detection of gynecological cancer circulated. The first notions of precancerous lesions were reported in the late nineteenth century, when histological samples of atypical lesions were found adjacent to invasive cancers Williams, By the early twentieth century, Dr.

Hans Hinselmann and others in Germany were conducting investigations on small thickened white patches in the mucosa of the cervix, named leukoplakia, but they soon encountered the difficulties posed by naked-eye examination.

Hinselmann then developed an instrument for visual inspection of the cervix at a magnified scale. Inhe reported construction of the first colposcope, with the help of Leitz technicians.

The device consisted of a fixed binocular instrument mounted on a histogian and equipped with a light source and a mirror to direct the light. Since then, a wide variety of improvements have been made to optimize the functioning and capabilities of the colposcope, many of which were introduced ginecologla the inventor himself.

The magnified images showed Hinselmann that leukoplakia displayed different shapes and features, and he completed his analysis with the histological correlation of each image. He concluded that in most cases leukoplakia constituted small carcinomas. With regard to so-called early cancers, we can now say that colposcopy enables detection of considerably earlier cases.

Even a tiny dot-like tumor should not escape detection. In principle we can detect lesions as small as one could care to think of Hinselmann, in Burghardt,p. Until then, gynecologists could only detect visible tumors of the cervix of around 4cm, a size that indicated localized cancer classified as stage Ginrcologiathat is, that the disease had not been ginecologiia beyond the uterine cervix.

Even in such ideal cases, 5-year survival rates were not significantly high. Hinselmann also enhanced the colposcopic view of abnormal epithelium by staining the cervix with acetic acid, which turned abnormal cells white. Bythe technique was improved by a test invented by Schiller, in which the surface of the cervix was painted with an iodine solution to contrast the images of potential abnormal cells during colposcopic examination.

Normal epithelium turns mahogany brown, while atypical benign or malign lesions appear unstained or white, in the latter case because the cells are deficient in glycogen, causing them to react differently. In tandem with these improvements in visualization, Hinselmann developed terminology to describe the various lesions he observed with the colposcope.

He drew attention to three detected images: More important were the hietorian he drew from his detailed observations: The idea that the colposcope could detect the abnormal epithelium that would develop into cancer offered the potential of a major breakthrough ginecoogia a population screening tool. Its general acceptance, however, was quite historina, especially during the interwar period when most European countries and the United States felt the technique required considerable training and expertise regarding the interpretation of images.

Colposcopy was also criticized for its ginexologia nomenclature and reliance on an expensive instrument. At the same time, there was no scarcity of opposition from pathologists, as they did not agree about the potential of abnormal cells to become true cancer, since many believed that cellular changes could take various courses: On the other hand, the morphological characteristics of precancerous cells were also the target of gindcologia contestation, as shown by the numerous classifications that followed down through the years.

Ultimately, political circumstances also played an important ginecolobia in the fate of colposcopy as a diagnostic tool. Hinselmann was, however, sentenced to three years in prison in by a British Military Government Court in Hamburg for the sterilization of six gypsies.

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An emphasis on early diagnosis of cancer has dominated anticancer campaigns throughout the twentieth century around the world. As the first statistics on cancer started to be reported in Argentina in the s, uterine cancer stood out as the most significant cause of death among gynecological ginecologiia, with cervical cancer itself responsible for 1, deaths per year.


This was grounded in the theory of cancer as a localized disease that started as a small tumor and then spread, metastasizing in other tissues and organs later in its course. Those with specific, localized cancers had better chances of still being alive five years later, which was the period of time internationally established to assess the efficacy of different treatments: A woman who underwent surgery and was alive five years later was considered cured and surgical treatment credited for the success.

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This led doctors and campaigners to promote the early detection of symptoms in the female population, encouraging them to seek medical advice promptly. Without timely, clear symptoms, early detection was initially the responsibility more of doctors than women.

It was in this period that colposcopy found a favorable space for its inception in Argentina. Ahumada, then assistant at the Gynecologic Clinic at Buenos Aires University, introduced ginecologiaa first colposcope into clinical practice during a period of renovation and improvements introduced by the newly appointed head of the clinic, Dr. Julio Iribarne Ahumada, Another important landmark in the broader use of colposcopy in Argentina and indeed in Latin America was publication of a detailed, fully-illustrated article on the technique by Dr.

If the above-mentioned gynecologists contributed to the dissemination of the technique, it was Dr. Alfredo Jakob who historrian the first specialist and earned Argentinean colposcopy the recognition for which it is world famous today. Jakob trained with Hinselmann in Hamburg in Trained as a gynecologist, Jakob was the son of a German neuropathologist who developed a world-renowned laboratory for the histological study of the brain in Argentina.

He also offered training courses where many gynecologists from South America learned the technique. Inhe reported that one of his patients with an initial diagnosis of leukoplakia, who had follow-up biopsies for 2. InAhumada, then head of the gynecology clinic at Buenos Aires University, invited Hinselmann to offer students training courses in colposcopy. Hinselmann extended his visit for four months, during which time he attended conferences, gave practical demonstrations, and travelled tirelessly to the main clinics of Brazil, Argentina, and Uruguay.

The former asymmetrical situation, where South American jistorian trained at German clinics, had somehow been reversed. Finally, the direction of academic exchanges is also revealing, indicating how the older, undisputable European prominence in Latin American medicine was now a space to conquer, given American interests and endeavors in the area.

In the specific case of cancer diagnostic tools, the Pap test was spreading rapidly, thanks to promotion by United States cancer agencies and to the financial support that South American doctors received to train with Papanicolaou ginecologiaa New York, as we will see later.

He also mentioned that Papanicolaou did not respond to a letter he had sent, asking for information on this matter. Furthermore, he argued that a positive Pap test would lead to multiple biopsies, which could not demonstrate the existence of cancer if the tissue was extracted from the wrong place.

Indeed, one of the consequences was an increase in surgical activism. While the correlation between detected cell and tissue changes and clinical hlstorian remained controversial, prophylactic surgery gradually became the most common preventive measure to counteract the risk of cervical cancer.

The attention occasionally given to the use of these terms is revealing. For example, a report detailing colposcopic images in Argentina reads: By the s, the main gynecological clinics in Buenos Aires, along with a few others in the provinces San Juan, Santa Fewere practicing colposcopy, while many more gynecologists across the country knew of the technique and referred patients to centers that possessed the instrument.

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Colposcopy thus became the first screening method before the Pap smear test, as it was first performed on an asymptomatic population. The technique implied the microscopic examination of cells scraped from the cervix, previously fixed on a slide with the staining method. The strong support and promotion that the Pap test received in the United States during this period was the result of the reorganization of the American Cancer Society ACSwhich inequipped with an impressive budget, sought to encourage early intervention rather than preventive policies in cancer care.

With the support yistorian the ACS, the Pap test histkrian quickly disseminated around the world via international congresses, training programs, and large-scale screening studies in the United States. In Argentina, the smear test was introduced inhistoroan Dr.