Manuel Dias de Abreu (January 4, 1894 – January 30, 1962) was a Brazilian
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
and
scientist
A scientist is a person who conducts scientific research to advance knowledge in an area of the natural sciences.
In classical antiquity, there was no real ancient analog of a modern scientist. Instead, philosophers engaged in the philosoph ...
, the
inventor of ''
abreugraphy
Chest photofluorography, or abreugraphy (also called mass miniature radiography), is a photofluorography technique for mass screening for tuberculosis using a miniature (50 to 100 mm) photograph of the screen of an X-ray fluoroscopy of the th ...
'', a rapid
radiography
Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeu ...
of the
lungs
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side ...
for screening
tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...
.
He is considered one of the most important Brazilian physicians, side by side with
Carlos Chagas
Carlos Justiniano Ribeiro Chagas, or Carlos Chagas (; July 9, 1879 – November 8, 1934), was a Brazilian sanitary physician, scientist, and bacteriologist who worked as a clinician and researcher. He discovered Chagas disease, also called ''A ...
,
Vital Brazil
Vital Brazil Mineiro da Campanha, known as Vital Brazil (; April 28, 1865 – May 8, 1950), was a Brazilian physician, biomedical scientist and immunologist, known for the discovery of the polyvalent anti-ophidic serum used to treat bites of v ...
and
Oswaldo Cruz
Oswaldo Gonçalves Cruz, better known as Oswaldo Cruz (; August 5, 1872 – February 11, 1917), was a Brazilian physician, pioneer bacteriologist, epidemiologist and public health officer and the founder of the Oswaldo Cruz Institute.
He occup ...
.
Early career
Abreu was born in
São Paulo
São Paulo (, ; Portuguese for ' Saint Paul') is the most populous city in Brazil, and is the capital of the state of São Paulo, the most populous and wealthiest Brazilian state, located in the country's Southeast Region. Listed by the Ga ...
,
Brazil
Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...
, and obtained his
M.D.
Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. ...
in
medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
at the
Federal University of Rio de Janeiro
The Federal University of Rio de Janeiro or University of Brazil (UFRJ; pt, Universidade Federal do Rio de Janeiro or ') is a public research university located in the state of Rio de Janeiro, Brazil. It is the largest federal university in the ...
in 1914.
Shortly afterwards, he travelled to France, where he first worked in the service of Dr.
Louis Gaston, at the
Nouvel Hôpital de la Pitié, in 1915. Charged with photographing
surgical pathology
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves gross and microscopic examination of surgical specimens, as well as biopsies submitted by surgeons and ...
specimens, Abreu quickly developed new and better devices and methods for this. In 1916, Abreu started to work at the
Hôtel-Dieu and had his first contact with medical
radiography
Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeu ...
, which had been discovered by the German physicist
Wilhelm Röntgen
Wilhelm Conrad Röntgen (; ; 27 March 184510 February 1923) was a German mechanical engineer and physicist, who, on 8 November 1895, produced and detected electromagnetic radiation in a wavelength range known as X-rays or Röntgen rays, an achie ...
just 20 years before. He became the director of the laboratory of
radiology
Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...
of the hospital in substitution to the previous director, Dr.
Jean Guilleminot, who was conscripted to fight in the
First World War
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
. It was in this position, by suggestion of Guilleminot, that Abreu became interest in
fluorography, or the photographic recording of
fluoroscopic x-ray images of the lungs. He soon was able to perceive the immense diagnostic value of these images for tuberculosis and other pulmonary affections, and he began his
photographic
Photography is the art, application, and practice of creating durable images by recording light, either electronically by means of an image sensor, or chemically by means of a light-sensitive material such as photographic film. It is employed ...
studies of the lungs in 1918, now at the
Laennec Hospital (also in France).
Abreu's first landmark contribution to the radiography of soft tissues (until then not much utilized as a diagnostic radiographical method, due to the low definition of images) was to develop an x-ray
densitometry
Densitometry is the quantitative measurement of optical density in light-sensitive materials, such as photographic paper or photographic film, due to exposure to light.
Overview
Optical density is a result of the darkness of a developed picture ...
method, by comparing the degree of white density of biological tissues to water's and to other highly dense references, such as bones, and to point out its value for radiodiagnosis. In 1921 he first published his pioneering work on the radiological interpretation of pulmonary injuries in pleuropulmonary tuberculosis, titled ''"Le Radiodiagnostic dans la Tuberculose Pleuro-Pulmonaire"''. This and his method of pulmonary densitometry gave him an invitation to join the prestigious
Académie de Médicine de Paris.
In 1922 Abreu returned to Brazil and accepted a post as the head of the X-Ray Department at the Federal public health service for the
prophylaxis
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
of tuberculosis in Rio de Janeiro. The city was at that time going through a devastating
epidemic
An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time.
Epidemics of infectious ...
of tuberculosis. He intensified research on thoracic radiography for the purpose of early diagnosis of tubercular lesions, but the results were initially discouraging, due to the low quality of fluoroscopic images at the time.
Mid career
As a result of the improvements of fluoroscopic and photographic devices and techniques, in 1935 he took again his experiences in the old German Hospital of Rio de Janeiro, and was then able to conceive a cheap and fast method to take small (50 or 100 mm) photographic plates of lungs in a single roll of film, which became a standard tool for an easier diagnosis of tuberculosis for many decades to come, with a corresponding impact on its prophylaxis and cure.
Abreu's ideas for a new mass screening radiography apparatus was made true by the construction of a first device by the Lohner House, a representative of
Siemens in Rio de Janeiro. The first service of Thoracic Census was established in 1937. The first results indicated the usefulness of abreugraphy: the screening of 758 asymptomatic and apparently sane individuals in July 1937 revealed that 44 of them had already tuberculosis lung lesions, which allowed for early treatment and a better survival. Mobile units were also employed, and soon abreugraphy became a mandatory examination for anyone applying to a public job or school in Brazil. By the end of the 1940s, Dr. Manuel de Abreu could present the first positive impact of mass screening on tuberculosis mortality.
Abreugraphy
The invention was named ''abreugrafia'' in his honor by the Society of Medicine and Surgery of Rio de Janeiro in 1936. Abreugraphy was largely discontinued as a mandatory screening tool in Brazil in the 1970s, after
antibiotic treatment and public health programs greatly decreased the incidence of the disease, and also out of fear of unnecessary exposure to x-rays, particularly in children and pregnant woman. The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
recommended its discontinuance and the Brazilian health service stopped to pay for it in 1999.
Abreugraphy was not used in other countries so intensively as in Brazil and a few other Latin America countries. It received several different names, according to the country where it was adopted: mass radiography, miniature chest radiograph (United Kingdom and United States), roentgenfluorography (Germany), radiophotography (France), schermografia (Italy), photoradioscopy (Spain) and photofluorography (Sweden). The importance of abreugraphy was outlined by the creation of the Brazilian Society of Abreugraphy, in 1957, and the publication of the ''Revista Brasileira de Abreugrafia''.
Further accomplishments
Abreu was also one of the first radiographists to develop quantitative methods to evaluate the area of internal anatomical structures and to use it in medical
diagnosis
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...
, an approach which he used to quantitate images of the
mediastinum, and which he named
radiogeometry. His ideas were collected and published in 1928 in his book ''"Essai sur une nouvelle Radiologie Vasculaire"''. Furthermore, Abreu was instrumental in developing new techniques for x-ray planar
tomography
Tomography is imaging by sections or sectioning that uses any kind of penetrating wave. The method is used in radiology, archaeology, biology, atmospheric science, geophysics, oceanography, plasma physics, materials science, astrophysics, ...
of the thorax using the simultaneous exposure of several films, as well as the use of tracheobronchic washout as technique for precise detection of Koch bacilli in infected individuals.
Manuel Dias de Abreu lectured in the field of medical radiology in innumerable Brazilian and foreign scientific institutions, and was a member of the most important medical organizations of the world. He was awarded the French ''
Légion d'Honneur
The National Order of the Legion of Honour (french: Ordre national de la Légion d'honneur), formerly the Royal Order of the Legion of Honour ('), is the highest French order of merit, both military and civil. Established in 1802 by Napoleon ...
'' and several other scientific prizes, among them the Gold Medal of the
American College of Chest Physicians, in 1950 and the Gold Medal of the Argentinian Radiological Society, in 1953.
Besides several books on medicine, Abreu published also two poetical works: ''Substâncias'', which was illustrated by famous Brazilian painter
Emiliano Di Cavalcanti
Emiliano Augusto Cavalcanti de Albuquerque Melo (September 6, 1897 – October 26, 1976), known as Di Cavalcanti, was a Brazilian painter who sought to produce a form of Brazilian art free of any noticeable European influences. His wife was the ...
and ''Poemas sem Realidade'', illustrated by himself.
Tragically (and ironically, for a pneumologist), Dr Abreu, a
smoker, died in
Rio de Janeiro
Rio de Janeiro ( , , ; literally 'River of January'), or simply Rio, is the capital of the state of the same name, Brazil's third-most populous state, and the second-most populous city in Brazil, after São Paulo. Listed by the GaWC as a ...
in 1962 from
lung cancer
Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. Lung carcinomas derive from transformed, malign ...
.
Quotation
References
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External links
Abreugrafia Brazilian Inventors Network. In Portuguese.
WorldCat Identities Entry
{{DEFAULTSORT:Abreu, Manuel Dias De
1894 births
1962 deaths
Brazilian inventors
Brazilian male poets
Brazilian radiologists
Brazilian scientists
Federal University of Rio de Janeiro alumni
20th-century Brazilian poets
20th-century Brazilian scientists
20th-century Brazilian male writers
20th-century inventors