History of Latin American Dermatology

ELBIO FLORES-CEVALLOS, LUIS FLORES-CEVALLOS, ZUÑO BURSTEINLlanos and Abraham Cáceres, of the National Health Institute and the Daniel A. CarriónInstitute of Tropical Medicine of the UNMSM, where Dr. Abelardo Tejada — its currentdirector — has contributed many investigations into the matter.In Peru, the reservoirs of the parasite that would provide a satisfactory explanationof this endemic disease that has persisted from remote areas are yet to be detected withaccuracy.Ugaz, in 1886 40 , in his study of uta (called lupus back then) in Peru, brought into evidencethat one of the most widespread ideas among the inhabitants of utogenous zones— found in the towns of Cajamarca, Huamachuco, Ancash, Cerro de Pasco, Valle delRimac and Ayacucho — involved the assignment of an important role in the productionof the ulcerous ailment to mosquitoes that bit at dusk, which had fed on “juice of animalsin putrefaction, especially snakes,” and which inoculated it to their victims; or to the inoculationof the resinous juice of huarango (Acacia puntata), taken up by small whitewingedflies that live in its shade (Cajamarca). In Cuzco, the belief of the generation ofthe disease by “spider licking” was widespread. Likewise, in Cajamarca, an importantrole was attributed to “the antimony that rises from the dry and hot soil of the ravineswith the first rains of Lent.” The disease was also attributed to bad-quality waters (LaLibertad). Urcia, in 1913 20 , picked up Dr. Barranca’s reference, when he recorded thebelief that “the Indian, upon wetting his nose while drinking, acquires the disease.” Urciarelates the very widespread belief of the existence of animals or plants that, directly orindirectly, through bite or contagion, inoculate the uta germ; he is inclined to believe thatstagnant water can contain the producing germs, or the eggs and larvae of the insects;he gives a detailed description of an insect as vector — evidently referring to Phlebotomus— which “they want to call titira, when its name is uta”.In 1914, Antúnez 41 indicated the invariable presence of a shrub called mito (myth) indangerous known sites of uta infection, and said: “uta appears as an epidemic only inthe months of February, March and April, precisely during the time of fructification ofthe mito, disappearing with the exhaustion of the fruit. The uta starts growing in the individualwho liked to eat the fruit at the foot of the shrubs, or in those who live in the immediatesurroundings. It is not necessary to come near to eat the fruit, but it is so to staywithin a two-kilometer radius in the zone of the mitos during the dangerous season”; heattributed the disease to a “white-headed mosquito that likes the fruit of the mito.”In 1930, Maldonado 42 made the following verbatim statement:[…] in Surco, an important focus of the wart and of uta, I have had occasion to findin spontaneous flora, as a characteristic element, J. macrantha Mull Arg., a plant ofthe Euphorbiacea family, known colloquially as ‘female huanarpo’ […] The existenceof this plant allows for the suspicion that it could play some role in the etiology ofleishmaniasis of the dermis, known colloquially as uta, since parasite protozoa havebeen found in the latex of many Euphorbiacea which, perhaps, could be consideredas evolutionary states of the agent of this kind of ulcer. Since the valley of Surco is afocus of warts, the existence of Phlebotomus, known colloquially as titira, can be ascertainedin it. One of its species could be vector of uta, and the female huanarpocould be the reservoir of such a disagreeable ailment.In 1934, Sal y Rosas 43 picked up the phytogenetic aspect of the uta, again pointing tothe mito (Carica candicans), a lactescent plant of the euphorbiacea family, as a constantelement throughout the endemic area, disappearing at the same point at which the radiusof uta’s pathological influence ends. He even affirms that the concomitance betweenmito and uta is so constant, that its absence “clearly marks the limit of the utous strip,a very precise sign to delimit, in uninhabited places, the endemic section from theendemic.” The mito is accompanied by the huanarpo (Jatropha macrantha), popular342