History of Latin American Dermatology

AMALIA M. BORES, INÉS A. BORES, LIDIA E. VALLEThat was one of the reasons that led Miguel O’Gorman, a protomédico, to petitionViceroy Vértiz for the creation of the Protomedicato (medical evaluation board) of theRiver Plate (1777). The Protomedicato was an institution created in Spain and was runby physicians appointed by the king. The authorization, issued in 1780, set the foundationof the teaching of medical and pharmacological science in these lands.Yankilevich points out, with regard to these officials, that they “performed the triplerole of overseeing teaching and governmental issues in matters of medicine, surgery andpharmacy. They administered justice, constituting a special tribunal to punish lapses andexcesses committed by physicians. They suppressed medicine men. They established thefees for examinations and pharmacy visits” 15 .Later, on April 9, 1822, under the government of General Martín Rodríguez (1820-1824),the law for the Organization of Medicine was issued. It contained 98 articles which, inspiredby Rivadavia, stipulated the scope of the new medical tribunal, which was to replace the Protomedicato.It established the form and conditions for medical assistance and pharmacy, createdthe respective schools, setting out in brief articles the judicial procedures for sanitationand sanitary inspections to prevent the spread of infectious diseases. It stipulated the powersof the physicians of the police, of the port and of the countryside. Title IX dealt with the administrationof inoculations and the Academy of Medicine was created under Title X.The danger entailed by the medicine man is that, being ignorant of medicine, he resortsto arbitrary procedures to convince his customer that he is able to cure him, andhis activities are often accompanied by profit-seeking and messianism. Even today, thescarcity of physicians in relation to demographic density impinges on the difficulty instamping out the practice of medicine men.In regard to charlatans, Nerio Rojas defines them as “any certified practitioner (physician,dentist or midwife) who, authorized to exercise the art of healing, promises to healthe patient within a fixed time limit or through secret or infallible means.”The activities of medicine men and charlatans is currently promoted by the publicationof advertisements in the media 16 .In the view of Magrassi and Radovich, great importance attaches in medicine men’ssuccess to “the personalized relationship with their patients. This personalization of theinteraction is due to the fact that the healer’s knowledge and language are almost alwaysthe knowledge and the language of the patient.” Additionally, cultural factors find theircorrespondence both in the illness and in its treatment 14 . At the same time, clandestinityconfers a power of suggestion on them that heightens their gravitation on the clienteleand the persecution they are subjected to generates a current of sympathy amongthose who consult them.There are certain conditions which determine the suitability of the medicine man,such as the day and location of his birth, family inheritance and order of birth within thefamily. Having been born on Maundy Thursday, on Christmas night or on the day of St.Judas, among other days on the Christian calendar of saints’ days, is a favorable mark.Baudouin, intrigued by the positive results sometimes achieved by medicine men,came to the conclusion that they were due to their reputation and to the “bizarre practiceswhose bizarre quality and lack of logic generate the impression of the marvelousand place the ill person in the emotional state the promotes spontaneous autosuggestion;under such conditions, faith heals.” This author analyzed the effects of autosuggestion inthe healing of verruca vulgaris 17 .An investigation with Apache Indians carried out in the state of New Mexico allowedthe researchers Boyer and Boyer to conclude that adults in that ethnic group conjoin thehysterical and the compulsive. The medicine man is expected to have favorable resultson that type of personality, acting on predominantly psychogenic diseases 18 .A new concept acquired currency in 1838 with Max Jacobi’s publication of the article “Newdisquisition on the foundations of psycho-somatic medicine.” Also appearing that year was the52