History of Latin American Dermatology

ELBIO FLORES-CEVALLOS, LUIS FLORES-CEVALLOS, ZUÑO BURSTEINin charge of Maxime Kuczynski, who, after founding an Anti-Leprosy Dispensary in Iquitosin 1941, reconstructed the San Pablo asylum as a farming colony, attaining remarkableadvances in the exploration of various rivers, especially the Ucayali, conductingvaluable leprological surveys. In 1944, with the creation of the National Anti-LeprosyService, a few months later the Northeast Anti-Leprosy Service was created, taking onthe supervisory roles in the region.Hugo Pesce stated that the focus of child leprosy in Loreto was one of the most severein the world. All the data collected on the clinical forms of child leprosy in that area revealeda process characterized by the absence of considerable signs of defenses on thepart of the population, which meant that it was a rather recent, severe endemic, and withdevelopmental features. Pesce noted that the first cases of leprosy among genuine junglepeople observed in South America were reported by Maxime Kuczynski (Cambo and Cocamatribes), and by himself (Piro tribe). Successive cases were object of study, in 1953,by H. Pesce and R. Montoya. All cases were extremely malignant forms, which indicatesthe extremely serious and lasting danger that all the population of the Northeast wouldbe exposed to if leprosy penetrated in the midst of jungle tribes, of which the number ofmembers has been estimated at 141,000, far from any possibility of sanitary control.History of leprosy control in PeruIn Andahuaylas, Hugo Pesce detected the first cases of Andean leprosy, and founded,in 1937, the Apurímac Anti-Leprosy Service. Moreover, on January 1, 1944, he createdthe National Anti-Leprosy Campaign, as a sanitary entity officially in charge of the fightagainst this disease at the national level. In this manner, the Peruvian school of leprologyschool was born around this master, the Northeast Anti-Leprosy Service being set upthat same year.The structural feature of the anti-leprosy campaign, which in 1954 became known asthe National Anti-Leprosy Service, was that it was a unified organization, with a head officeand various peripheral services. The head office, called the Leprosy Department, hadmanaging, normative and control functions, with specialized sections. The peripheralservices were in charge of conducting the anti-leprosy campaign in the territories undertheir jurisdiction; thus, in every leprogenic region, functional units, called Regional Anti-Leprosy Services, were built, each with its own organization.This organization, methodically planned and implemented, within a short period, permittedthe achievement of a diagnosis of Peruvian leprological realities, and the obtainmentof an effective benefit for patients and the country. Unfortunately, on January 14,1963, the Leprosy Department, previously transformed into the Leprosy Division, wasdissolved by the government of that time, disassembling the meticulously mounted structure;its various constitutive elements were transferred to other organizations, and,starting in 1965, the peripheral levels were integrated into other health services of eacharea of the country.The dismemberment and deterioration of the health actions related to Hansen’s diseaseat the different levels of responsibility, at both central technical and normative, andbasic peripheral executive levels, as well as in research, staff training and others, ledMinister and PAF Lieutenant General M. Campodónico, who was in charge of PublicHealth in 1977, to order the update of the Hansen’s Disease Control Program, consideringthat diagnosis, treatment and research in dermatoleprology was a multi-institutionalresponsibility of national importance, accepting the recommendations of the RegionalSeminary on Hanseniasis, which took place in September 1971 in the city of Pucallpa.Unfortunately, successive replacements of officials and other unpredictable factorslargely delayed the implementation of the established measures.Meanwhile, Dr. Víctor Noria, with his individual and pioneering efforts in chargeof the Leprosy Unit, a central-level technical-normative organization of the Ministry348