History of Latin American Dermatology

E. SILVA-LIZAMA, P. H. URQUIZU, P. GREENBERG, S. DE LEÓNPoor nourishment, overcrowding and promiscuity quickly contributed to the spread of thepetechial plague. The poor and the Indians were, as always, the main victims. It can bestated that these epidemics or plagues where the first to be studied scientifically, and toreceive magnificent clinical descriptions; those tragic years saw the founding of the PublicHealth, which arose from the circumstances of the moment.In the year 1780, Guatemala suffered one of its most terrible smallpox epidemics. Allcircumstances were favorable for the development of the plague. The hospitals wereunder construction, there was a lack of venues for isolation, and added to these materialdifficulties were the spiritual ones of a people burdened and exhausted by all manner ofpunishment. The Smallpox Hospital, or St. Joseph Hospital, was founded. The epidemicof the year 1780 allowed Dr. José Felipe Flores to exhibit his qualities as an innovator.The city hall procurator gave Dr. Flores absolute freedom to employ inoculations, accordingto his conscience and with the consent of the patient. The technique was as follows:he placed two irritative patches the size of a real coin on each arm and waited forthem to raise blisters; then, on the ulcerated skin, he placed cotton wool steeped in theserosity of a mature smallpox, maintaining this procedure for twenty-four hours. Accordingto historians, the inoculation yielded magnificent results, as was demonstratedby comparative statistics. Almost none of the vaccinated suffered malignant forms, andrigorous controls only recorded the death of one 13-year-old girl. In the neighborhoodswhere inoculation was not carried out, mortality reached very high figures. The proofwas conclusive and the benefit of inoculation was demonstrated. This method was usedby the Turks, Persians and Chinese, who noted that inoculated smallpox was always lesssevere than that which developed through contagion. This observation led to the discoveryof the vaccine, gaining a century’s march on Pasteur’s ideas on attenuated viruses.The country’s main hospitals began to be built in the eighteenth century; as of thattime the concept of medicine gradually changed 11, 12, 13 .DERMATOLOGY AT THE ST. JOHN OF GOD GENERAL HOSPITALThe St. John of God General Hospital opened in 1778. In this period, in the MaleMedicine department, a clinic for urogenital diseases and syphilis was set up. Under theleadership of Don Rafael Angulo y Urruela, lepers and chronic skin patients were secludedthere, between 1778 and 1875.In 1819 Dr. Narciso Esparragoza y Gallardo wrote his book on subjects such as pruritus,exanthemata and skin ulcers. In 1861 Dr. Mariano Padilla published a treatise onthe origin of venereal disease. In 1863, the physicians at the General Hospital began todraw up a report or log on the activities that were carried out at each of the services; Dr.Francisco Abella, in his report, mentioned numerous diagnoses of diseases of the skinand nails and scrofula. Dr. Eligio Baca presented his report in 1864 and among the numerousdiagnoses makes reference to ecthyma, impetigo, eczema, scabies and elephantiasisof the Greeks. The implantation of skin grafts secondary to the extirpation of anasal basocellular epithelioma, operations on ingrown nails and on rhinoscleroma arementioned in the lengthy list of surgical procedures carried out by Dr. Juan José Ortegaand mentioned in the hospital record for the year 1900 24, 25, 26 .The first specialists in Dermatology joined the general hospital, marking a new stagefor the specialized field. In 1945 Dr. Fernando Cordero was appointed head of internalservices in Dermatology; Dr. Luis Gálvez Molina took over as head of the outpatient officesin 1946; Dr. Arturo García Valdez was head of the men’s Dermatology service in1956. Joining the services later were Drs. Jorge Close de León (1958), Eduardo SilvaMartínez (1963), Leonel Linares (1972), Carlos Cordero (1978), Salvador Porres (1986)and Edgar Pérez Chavarría in the subfield of pediatric Dermatology in 1988. The leadershipof the Service has been in the hands of Dr. Leones Linares since 1980.234