History of Latin American Dermatology

History of Dermatology in GuatemalaDon Tomás de Arana conquered the people with his kindly and consoling attitude, onthe occasion of the earthquakes of the year 1717.In his poems, Don Cristóbal de Hincapié praised the humanitarian conduct of theJudge, who daily visited the destroyed households and freely provided all manner ofcharity.Beginning in the year 1729, Judge Arana began to suffer a serious ailment in themouth, which utterly altered his life and his character. The affable, broad-minded andkindly person became transformed; all forms of bitterness and susceptibility derivedfrom the painful and malignant illness.Unfortunately, it was the Judge’s private peace that was destroyed; and the fistulae inhis mouth were causing him more harm than all the disputes in public business.Don Manuel de Arteaga y Carranza, hospital “protosurgeon” and anatomical dissectorat the Royal University of St. Charles, was at that time the most outstanding surgeonin the city of Santiago, and was for that reason the first to participate in the treatment ofthe Dean Judge.The detailed observation of the disease appears in a report that this surgeon submittedto the Royal Court:In the year 1729 I began to treat Judge D. Tomás Ignacio de Arana, for a cankeroushop on the lower lip of the mouth, toward the left side, with extremely severe painand erysipelas around the entire circumference. I could not prevent its ulcerationand it later would not be cured by any poultice. For that reason, Dr. José Medina wascalled in, who prescribed purges, bloodletting, which did not make him better owingto his warm and austere nature. The treatment lasted until the year 1732, in whichhe suffered a murine typhus that was seen as deadly, and which was cured by Dr.Medina. The bowel movements and the great heat of the fevers dried out the ulcer inthe mouth and he was left at their mercy, suffering from other diseases which werecured by Dr. Ávalos y Porres. And so until the year 1738. At the end of that year hewas stricken by a rheumatic distillation which gave him several small scirrhous tumors,which degenerated into ulcers so malignant that they mortified him enormously;one of them perforated his lower lip from the outside in and extended to themolars, destroying part of the jaw, at the level of the wisdom tooth, after which hismasseter became swollen and he was unable to open his mouth. When this ulcerbegan to heal, the other small tumors ulcerated, reaching the ear and the eye on thatsame side. All treatments were to no avail; then Dr. Santiago Estebanson passedthrough here, and he prescribed mercury, which exasperated the illness to such a degree,that he came close to losing his life, were it not for a miracle of Our Lord of thePains of the Hill. He did not heal entirely and several sources were made which divertedthe ulcers. Afterwards five ulcers, the same as those on the face, appeared onhis right arm, very swollen and erysipelous. Masters Justo González and PedroZúñiga treated him daily, and his condition has become so serious, that the day hewent to an event at the Royal Chapel, his tumors became very swollen. The biggesttumor may become so large, that it will destroy the face. The ulcer is incurable of theNoli Me Tangere.” (June 26, 1744)Don Manuel de Ávalos y Porres also reported on the Judge’s ailment, diagnosing acankerous tumor of the cheek, ulcerated within and without. He diagnosed other diseases,such as hemorrhages, asthmatic attacks and colics. The tumor was incurable, thereport added, and only frequent washing, diets and rest would be able to make him better.It is believed that this suffering may have been caused by a malignant tumor, lupusor osteomyelitis.The Dean Judge Don Tomás de Arana, disappointed by his material incurability,249