History of Latin American Dermatology

Notes on the History of Dermatology in Paraguayused to the climate. No one has seen a case of scrofula, as far as I know, among the Indiansof the Guaraní race who live without contact with Christians (Tekokatu).It is noticeable how little the writers of antiquity dealt with most parasite-related sicknesses.Leishmaniasis was wrongly interpreted, being known as syphilis in Spain, that is,bubboe, and since some Guaraní nations called it piã, a name that others gave to an illnessthat was mistaken for syphilis, the confusion was general.They knew malaria perfectly, with its general manifestations and the periodicity of thecrises, according to the variety of parasites.In relation to leprosy, Bertoni refers in detail to empirical treatment, but does not describethe classic lesions of these patients. The Guaraní fought this disease, brought bythe Europeans to America, with the method of sweating profusely.The Paraguayan procedure to cure leprosy seems to be identical to that whichRochefort saw in the Antilles. It is necessary to build an oven with such capacity thata person can sit in it comfortably. The oven is made of ordinary mud. As soon as it isbuilt and when the mud is wet (it should not be allowed to dry), a small fire is used,not to burn it but to heat it; this can be done with dead leaves or hay. Extinguishingthe fire at a proper time and testing the internal heat, to see if the patient will bearit, he or she is completely locked up in the oven which is then covered with kneadedmud leaving two holes or an aperture, for looking through and breathing. The enormoustension of the steam, determined by the saturation with humidity and the hightemperature, doesn’t take long in producing a sweat so abundant that it cannot bematched by any other. Sweat runs down the whole body and then through the bottomof the oven. I believe the operation lasts a little more than half an hour or anhour at most. Then it is opened and the patient comes out. This is a critical and dangerousmoment. The nurses must immediately cover the patient with ponchos andblankets while drying the whole body at the same time. It is indispensable to workquickly and to dry the perspiration, without letting the body get cold, or receive anyair draft, however small. He or she is dried energetically, scrubbing with cotton fabrics.Having done this, the patient is completely wrapped, if possible with wool clothing,and is made to lie down in a closed room, where the patient must remain the restof the day. The next day he or she may get up but not go out, if the weather is not hotor if there is some wind. It is indispensable that the return to a normal temperatureand lastly to an untrammelled life be slow and gradual. Whether the procedureworks and is definitive, is something that cannot currently be stated. I add that it isa general idea that leprosy is an alteration of the blood 6 .Syphilis, that universal disease, offering a surprising versatility in its signs, is also thesubject of analysis by the Paraguayan authors of the time and principally by Moisés S.Bertoni, whom we follow in this chapter. In the excellent work on the History of Dermatologyin Peru, by Drs. Luis and Elbio Flores Cevallos, the origin of syphilis in the Americasis reaffirmed, with testimonial documentation with pre-Columbine huaco pottery.Bertoni, on the other hand, is certain of the absence of the disease before the arrival ofthe Spaniards, highlighting how contradictory and strange it is that a disease be taken tobe American when no peoples of the Americas had had it and when its spread in Europetook place with enormous speed, while in America it had not developed in thousands ofyears. He also underlines the fact that the indigenous Americans had no name to designatethis disease and that to this day the Native Americans of the tribes that remainedwithout carnal contact with the Europeans don’t have one either.All the authors cited by Bertoni (Juan de Léry, Thevet, Guillermo Piso) highlight thedisease called piã or pian which is characterized by the generalized presence of buboewhich are sometimes even seen in children. As a remedy, Rochefort points out, the bitter291