History of Latin American Dermatology

History of Dermatology in PeruCARRIÓN’S DISEASE (PERUVIAN WART)OverviewDaniel A. Carrión, a medical student who staged a heroic sacrifice by voluntarily inoculatinghimself with the material of a warty button and dying of the systemic processin 1885, consolidated the concept of unity between the anemic fever (Oroya fever) phaseand the eruptive period (Peruvian wart) of this disease, considered by the dualists as twodifferent ailments.Carrión’s disease, or Peruvian wart, is a human bartonellosis, a general infectious,bacterial, non-contagious process, produced by Bartonella bacilliformis, transmitted bya winged vector (Phlebotomus verrucarum). It is an endemic disease, of a regional characterin well circumscribed areas of certain Andean regions of Peru and with some fociin Ecuador and Colombia. Clinically, it presents a first stage, which, due to variouscauses, may not be apparent, with almost no symptoms, but which frequently yields theanemic fever phase, of great seriousness, which leads to death by severe anemia and atoxic-infectious status, formerly known as Oroya fever. If this stage is survived, after aperiod of variable duration, the second eruptive process presents itself, characterized bya warty (angiomatosic) outbreak of varying magnitude, with lesions of different size anddepth, of which the location, besides the tegumentary, can involve internal organs. Thespontaneous involution leads to a state of permanent immunity to the process.The prognosis is bad if it is left to its spontaneous evolution in the severe form of theanemic fever period, and usually good, even in forms with large outbreaks, in the eruptiveperiod. Death in the first stage is produced by severe anemia or by the frequentsalmonellic complication at the onset of the intercalary period. The disease responds favorablyto antibacterial antibiotics, and there is no vaccine against it. It offers epidemicrisk when a non-immune population moves into endemic regions, with no external propagationoutside the endemic area (Figures 28, 29, 30).Figure 28. Peruvianwart – part IFigure 29. Peruvianwart – part IIFigure 30. Peruvianwart: eruptiveperiodHistoryThe Peruvian wart is a local American, more specifically Peruvian, disease, of unquestionablypre-Columbian age. The demonstrative expressions in mochica ceramics 51 ,the accounts of chroniclers of the Indies and other evidence have led Lastres 52 to thinkthat the wart has always existed, geographically speaking, in the same places where it isfound today, mainly in ravines, known by the natives by the Quechua word sirki. The scientificinterest in its study mainly arose, as of 1870, due to the construction of the railroadfrom Lima to La Oroya, through the Andes. Along the stretch that corresponds to345