History of Latin American Dermatology

ELBIO FLORES-CEVALLOS, LUIS FLORES-CEVALLOS, ZUÑO BURSTEINFigure 25. Andean leishmaniasisFigure 26. Jungle leishmaniasisFigure 27. Late mucouscutaneous jungleleishmaniasisThe name uta, as Llanos explains 17 , derives from theQuechua word hutu, which means to gnaw, to prick, to rot. TheSpanish called it llaga (ulcer) in the Huallaga basin, and alsomal de los Andes (ailment of the Andes). Other Quechua or Aymaraidiomatic expressions refer to this pathology with thename quecpo, due to the belief, in Abancay, that the burning ofthe face by the sun or the cold produced injuries that startedthe disease. The term tiac-araña (tiac-spider) is due to the beliefthat these household arthropods licked the skin of the faceand hands at night where honey residues were present, andthus started leishmaniasis. Other terms used regionally includejucuya, kjapa and anti-honcoy, among others 18 ; but, later, thetendency to give the name of uta to the leishmaniasis from thenorth of the country and espundia to that of the south of Peruhas been predominant.Antiquity of tegumentary leishmaniasis in PeruIn Peru, all the researchers who currently work with tegumentaryleishmaniasis consider it an ailment that precedes thearrival of the Spaniards; the evidence, for most of them, is themutilating lesions represented in certain Peruvian anthropomorphichuacos of the pre-Columbian era. The etiological identificationof these representations has been the cause ofnumerous discussions, and the first one to associate them withuta was the Spanish naturalist historian Marcos Jiménez de laEspada, cited by Tamayo, in 1905 19 , who picked up and backedthis suggestion. Urcia, in 1913 20 , upon making a historicalanalysis of uta, upheld its pre-Columbian age, based on huacorepresentations and on very precocious references to this diseaseby the Spanish; he quotes Pedro Pizarro, who, in 1571,refers to the “incurable ailment of the noses,” and Dr. CosmeBueno, who speaks of “a corrosive ulcer especially in the face,of very difficult healing, caused by an insect, called uta.”Weiss, in 1943 9 , upholds the great antiquity of tegumentaryleishmaniasis in our territory, based, in addition to the previousarguments, on the benignity of uta (tendency to spontaneoushealing in around a year). Herrer, in 1956 21 , says, “withoutdenying the old age of this disease in America, we believe it isdifficult to prove it, and the main argument put forth in its favorso far, that of the anthropomorphic huacos with mutilations onlips and nose, presents quite serious objections.” Among theseobjections, he points out that it is not accurate to ascertain thatthe huacos come from places near uta focuses; that some ofthem present the extremities mutilated with a different shapeand aspect to those of utous lesions; that they still have the entire,some times widened, nasal partition, contrary to what happenswith leishmaniasis; that they do not show lesions on theear pavilion, something that happens with the disease, and that would not have gone unnoticedby the pre-Columbian potters. Instead, this researcher provides considerationsbased on the geographical distribution of uta, which could indicate its remarkable age.As we can see, the arguments posed can be questioned, but it is evident that they allagree in admitting the great antiquity of leishmaniasis in Peru.340