History of Latin American Dermatology

CÉSAR IVÁN VARELA HERNÁNDEZ■ History of research, infectology infectology and the subfields and the subfieldsFigure 16. Juande DiosCarrasquillaHISTORY OF LEPROSYIt is said that the disease arrived in Colombia in the sixteenth century with the conquerorsand their African slaves, and in the social and sanitary difficulties found the appropriatemedium in which to settle, spread and remain. Since then a series of practiceshave been developed in diverse areas, such as the creation of the first laboratory, governmentalsanitary measures, research and statistics, as well as recognition of the patient’srights in the face of prejudice.It was Cartagena de Indias which in 1610 witnessed the creation of the first leprosarium,the Hospital of St. Lazarus, which, owing to the complaints of the neighbors,underwent a series of moves and had to be encircled with stone walls. Later there wouldcome the creation of the leprosariums of Caño de Loro — according to others, Caño delOro (1808) — Contratación and Agua de Dios. Part of their economic support was obtainedwith taxes on liquor, textiles and beef. In 1646 the first patient with leprosy wasrecorded in Santa Fe, Santibáñez Brochero, cathedral priest. In the seventeenth century,leprosy was rife on the Caribbean coast and the leper was regarded as an outcast whowas separated from his healthy relatives and from society until the end of his days, to besent, with all the standard precautions and with his own furniture, to the leprosarium inCartagena — converted into a cemetery for the living.In the seventeenth century, José Celestino Mutis had a clear idea of the disease, differentiatingbetween slightly and highly contagious patients. In the eighteenth century,leprosy entered the departments of Antioquia and the Santanders; in the town of Socorroit proliferated to such an extent in 1775 that the inhabitants fled from the place and thehouses of patients were stoned 9 . At the end of that century Viceroy Caballero y Góngorawrote, “The instant a patient is declared a leper, he is led to the Cartagena Hospital, heis pointed to his small plot of land and he is handed his house or room to spend the restof his days... so that these unfortunates are condemned to perpetual imprisonment” 2 . Inthe nineteenth century, José Joaquín García described the sensorial and motor manifestationsof the disease; Ricardo de la Parra postulated that leprosy was contagious, hereditaryand curable; Evaristo García, by presenting his piece representing the “Disease ofSt. Anthony” at the Dupuytren Museum, launched the polemic in Paris over arthropathyand bone lesion through neural involvement. In that century, strychnine, the arsenicals,aspirin, snake venoms and chalmugra oil (leprol) were used as treatment.Gabriel José Castañeda managed, on the basis of his work “Leprosy in Colombia — Etiology,Nosology, Prophylaxis and Treatment,” to have the Law on Leprosariums adopted.Juan de Dios Carrasquilla (Figure 16), searching for the first manifestations of the disease,described the “leprous chancre”; he researched and produced an antitoxin whoseuse spread around the world in 1890; he considered that the flea could be a vector;he designed his own method to find the bacillus in the lymph 33, 34 ; he defended theinfectious disease of leprosy caused by a microbe even against the theories of heredity35 . At the end of the nineteenth century, Pablo García Medina managed to havelaws adopted for leprosariums to be converted into colonies for the ill 2 .In the 1920s and 30s Federico Lleras Acosta (Figure 17) carried out manifold researchin bacteriology and especially on leprosy; he described the Lleras Reaction —a test of complement fixing with a sensitivity of 97% and specificity of 99.7% — whichwas tested in more than 7,000 patients, but fell into disuse when its specificity couldnot be confirmed 24 . In the 1950s leprosy began to be managed with sulfona, but, becauseof resistance, polychemotherapy has been employed since 1981. In the recentpast and at present major institutions and prestigious dermatologists have contributedto the history of leprosy, like Fabio Londoño, Luis Alfredo Rueda, MarianoLópez, Gerzaín Rodríguez, Antonio Torres, Luis Hernando Moreno, Adriana124