History of Latin American Dermatology

ELBIO FLORES-CEVALLOS, LUIS FLORES-CEVALLOS, ZUÑO BURSTEINLazarus and was very soon occupied by many patients; African slaves were very proneto leprosy and smallpox.Soon after the end of the Conquest, other hospitals were founded in Lima and othercities of Peru such as Cuzco, Trujillo, Huamanga and Arequipa. These hospitals werefounded under the encouragement of clergymen and and charity brotherhoods.The Protomedicato Royal Court was created in Peru by King Philip II for the controlof the medical profession; it was inaugurated in 1570, under the rule of Viceroy Toledo.During the Viceroyalty, many epidemics took place, especially of the viral kind. Thepopular muse highlighted the presence of these unwelcome guests:Measles knocks on the doorSmallpox asks, “who’s there?”And scarlet fever answers:“All three of us are here.”Smallpox, measles, wart, exanthematic typhus, and flu epidemics were very frequent;they primarily affected the indigenous population.Tuberculosis was a very widespread disease during the time of the Colony and the Republic.St. Rosa of Lima, patroness of Hispano-America and the Philippines, died of tuberculosison August 24, 1617 at the early age of 31. Simón Bolívar, after his liberatingcampaign in Peru, retired to the island of Santa Marta and died of the same disease.Smallpox continued producing constant epidemics throughout the period of theColony and in the first years of the Republic. One of the worst epidemics, which alarmedall of Peru, took place in April 1584. It started in Cuzco, with a disease that some identifiedas chickenpox, while others as tabardillo or mumps. It was not easy to pinpoint thetype of disease due to the “backwardness in which medicine lay, but later, symptomsshowed that it was probably a case of smallpox”. This disease affected “almost exclusivelythe Indians, who died by the thousands, especially the young” 7 .This epidemic lasted until 1590. Because of the magnitude of its devastation, in thehistories that were written in the different provinces of Peru it was considered similar tothe plague in Florence, described by Alessandro Manzoni. Corpses were in some casesleft unburied, or else ditches were dug in the streets themselves to save the trouble oftransportation.The Peruvian population decreased considerably from the 10,000,000 inhabitants theInca Empire is believed to have had at the time of the Conquest. The census carried outby Viceroy Gil de Taboada y Lemos between 1792 and 1795 yielded a population of1,400,000 inhabitants within the boundaries of the Peruvian Viceroyalty. The cause ofthis tremendous depopulation is explained not only by the high mortality rate producedby viral diseases brought by the conquistadores, but also by the terrible conditions underwhich the natives worked and lived 7 .Throughout the period of the Colony and first years of the Republic, there were no attemptsto make graphic representations of the various diseases with visible skin lesions,as the ancient Peruvians had made. Medical works were very scarce; they were all filteredby the Court of the Holy Inquisition set up in Lima during the rule of Viceroy Toledoin 1570, which lasted practically up to 1821, when Peru became independent. The medicalcircles of the largest Viceroyalty in South America were basically not interested indermatological diseases.In 1818, the Protomédico Melchor de Amusgo, a presbyter clergyman, published “anaccount of measles or about measles,” which was much praised by doctors of his time. AsLastres has proved, in those times there was a solid link between medicine and religion.In 1630, the Spanish Protomédico Pedro Gago de Vadillo published what would turnout to be the first Peruvian book on surgery, Light of True Surgery, in which the wart is308