History of Latin American Dermatology

History of Dermatology in PeruHistory of the etiological identification of tegumentary leishmaniasis in PeruAs a precursor of the etiological identification of tegumentary leishmaniasis in our milieu,we may mention Dr. José Julián Bravo, quoted by Weiss 9 , who, in 1852, identifieduta with Aleppo boil. But, according to Urcia 20 , under the influence of Smith Archibald,these lesions were catalogued as forms of cutaneous tuberculosis. This lupoid theory wasupheld until 1908, when Palma 22 demonstrated that tuberculosis is not involved in itsdetermination. However, in 1911, Escomel 23 reported the finding of leishmania, in theirflagellated form, in a case of espundia. Laveran and Nattan Larrere found leishmania inmaterial of espundia cases sent by Escomel. In 1912, Wenyon 24 , with similar findings,arrived at the conclusion that espundia is a leishmaniasis. In 1913, Vélez and Monge 25proved the leishmaniasic etiology of ulcerous processes in the Convención valley (Cuzco).Simultaneously, that same year, Gastiaburú and Rebagliati 26 found leishmania in casesof uta. Finally, the Harvard University Commission concluded, that same year, in a reportpublished by Strong in 1914 27 , that uta is a leishmaniasis, the flagellated form havingbeen obtained, and inoculations in animals having tested positive.Thus ended the problem of the etiological identification of tegumentary leishmaniases inPeru, both in its pure cutaneous variety (uta), and in its mucocutaneous form (espundia).Some considerations regarding the ecology, epidemiology, and the history of the studyof vectors, reservoirs and the treatment of tegumentary leishmaniasis in PeruMany researchers have contributed to the knowledge of the geographical distributionof this ailment in Peru; among whom it is worth pointing out, in chronological order, RaimondiA. in 1885 28 , Pagaza M. in 1904 29 , Escomel E. in 1911 30 , Urcia J. in 1913 20 ,Weiss P., Rojas H. and Guzmán-Barrón A. in 1924 31 , Marroquín J. in 1950 32 , CornejoUbillus J. in 1951 10 ; many reports by Herrer A. of the National Health Institute, as of1951 33 , Kuczynski-Godard M. in 1945 34 , Acurio B. and Valdieso N. in 1964 35 , BursteinZ. in 1964 13 , many works by Tejada A. published as of 1970 36 , and many other morerecent studies by different researchers.As for the vector species of tegumentary leishmaniasis in Peru, the studies necessaryto ascertain which are the phlebotomus (lutzomyias) species that act as vectors of leishmaniastill have not been completed with definitive experimental evidence. In 1943, inthe province of Andahuaylas — coinciding with the endemic utogenous zone — Pesce andPardo 37 found two species of phlebotomus that were classified by Hertig as Ph. Battistini(Hertig, 1943).In 1951, while studying the relation between tegumentary leishmaniasis and phlebotomus,Herrer 38 considered that on the western slope of the Andes, ph. verrucorumand ph. peruensis were those that showed the closest relation to the geographical distributionof uta incidence. This researcher reported to us in person that “regarding the naturaltransmission of tegumentary leishmaniasis, there exists remarkable confusion.Frequently, for example, the lutzomyia species are indicated as vectors only because inthem the presence of promastigotes (leptomonas) has been manifest, without properlyidentifying the flagellate in question.” In agreement with this opinion, Laison andShow 39 point out that a large quantity of natural infections from flagellates among phlebotomescaptured in nature has been observed, but only in a small number of them havethe parasites been positively identified as leishmania. These authors, in a rigorous andvery meticulous critical analysis of the problem, also point out that the presence of infectionin lutzomya transmitted by wild rodents that are not anthropophilic plays no roleas transmitters for humans, and that it is necessary for anthropophilic phlebotomus toparticipate in the epidemiological chain of human leishmaniasis.The study of the presence and distribution of lutzomya in general, and of those whichwould play a role as vectors for tegumentary leishmaniasis, has been carried out andpublished in the country and abroad by Herrer, and, later, by the biologists Drs. Bertha341