MEDICAL RESEARCH IN LATIN AMERICA

By A. A. MOLL, Ph. D.

Scientific Editor, Pan American Sanitary Bureau

NDOWED as all medical history is with a charm of its own, some

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of its most fascinating and romantic as well as dramatic pages in the investigative and also the more immediately practical fields have been written in the Latin section of the New World. Carrión* stands out to this day as the prototype of medical research, who, in the pursuit of truth and in his love for humanity, does not stop even at self-sacrifice, and almost in the same category we must place Miguel Otero, Lazear, and Ricketts,* as well as Noguchi, who lost his life in Africa while completing studies begun in America. In addition, some medical events staged in the Western Hemisphere, for instance, the discovery of cinchona and the conquest of yellow fever and hookworm disease, are epoch-making deeds. The use of the Countess's powder inaugurates the era of scientific medication, and Finlay's* theory and its confirmation by Reed* and his group herald the advent of modern mass sanitation and the reclamation of the Tropics for the white race. Finally, the creation of national laboratories, second to none in the world, and the development of a body of trained research workers speak eloquently of the fostering of the scientific spirit, which is one of the cornerstones of human progress.

I. THE PAST

The Indian treasure house. —The Indians must have had but the barest idea of the wealth of curative material that they could offer their conquerors. Rich as the Potosi mines proved, their value could. not approach that contained in the depths of the New World forests. Even leaving aside quinine, or rather, cascarilla, never before or afterwards in history has there been sprung suddenly upon the world such a collection of remedies as those found in America-cannabis indica, castor oil, chaparro, chenopodium, coca, condurango, copal, curare, damiana, guaiac, hualtata, ipecac, jaborandi, jalap, krameria, mandragora, the misnamed Peruvian balsam, sabadilla, sarsaparilla, Tolu balsam, vervain. Imperfectly deciphered monuments and records testify to the aboriginal knowledge of rubber syringes, circumcision, trephining, and embryotomy, as well as of embalming, cremation,

The scientists of modern times will be discussed in the second part of this article, which the BULLETIN will have the privilege of publishing in the next issue.-EDITOR.

1 After this imposing list, it is almost amazing to see how little the mineral kingdom of the Indies contributed to the medical armamentarium,

and surgical measures for pterygion and trachoma. How deep their medical lore actually was must remain largely a matter of conjecture. Some have even doubted their knowing the antimalarial properties of the Loxa bark. Others credit them with the introduction of fever

therapy in general paralysis.

The Aztecs, for whom disease was, as for the Greeks, a divine punishment, had already connected some ills, such as rheumatism, colds, and gout, with chilling and dampness; others with the abuse of drink and sexual contact. They also had some ideas of contagion and had formed a group of infectious diseases, including epidemics. In fact, one favorite method of getting rid of a disease was by passing it on to some stranger or enemy. Diet was depended on a great deal. Isolation was enforced, especially against skin troubles. Martial made fun of the Egyptians who could find gods in their back yards. The Aztecs had only to go on the open street to find drug sellers. Moctezuma's botanical garden, so highly praised by Prescott, could furnish practically any herb prescribed by doctors. There was at least one plant against practically every disease and any number of remedies against bleeding, diarrhoea, and parasites. Thus Hernández learned from Mexican Indians the names of over 3,000 plants used by them in treatment.

Spain's medical status.-The Spaniards have been reproached rather unjustly with failing to derive the fullest scientific advantage from their early dealings with the Indians. The pages of the cronistas bear eloquent testimony to the contrary. Even Columbus exhibited from the very beginning a most meritorious, if untrained, curiosity into the products of the New World and their possible use in medicine as well as trade. Álvarez Chanca, the physician who went along on his second trip, was undoubtedly the first medical man to study the diseases of the Indians, and possibly to report scurvy. The Conquistadores can hardly be blamed for not leaving behind a more perfect record; their deficiencies were the unavoidable consequence of their times. Medical science drowsed then in a condition of chaos from which the Renaissance was about to show the way out. The first germ had still to wait nearly two centuries to be seen and over three centuries to be identified. The microscope had not been discovered, and almost two centuries elapsed before Kircher used it for the investigation of disease. Smallpox, measles, scarlet fever, and diphtheria had not been differentiated. Typhus fever, typhoid fever, malaria, and influenza were vague entities, disguised under various names, such as charalongo, chucho, modorra, etc. Under those con

2 The references to drugs on the part of Columbus and Peter Martyr de Angleria are purely incidental, although the latter mentions guaiac as a remedy against the "French disease" and the poisonous properties of the manzanillo tree. From a trip to Brazil, Yánez Pinzón brought canna fistula. A discovery of greater importance was that of coca by Vespuccio, to be described first by Monardes and more methodically by Plukenet and Jussieu.

ditions it is easy to see how, even to this day, we lack conclusive data as to the pre-Columbian existence in the New World of such diseases as malaria, smallpox, leprosy, and typhus fever; while the origin of both syphilis and yellow fever will probably remain a source of dispute through the centuries, although modern research tends to free America from blame for the introduction of either scourge.

To paraphrase one of Cajal's purple passages, the wheel of science had not fallen as yet off the chariot of Iberic culture. There were already seven universities in the country, one dating from 1214, and others were soon to be founded. Palencia had had a chair of anatomy since 1240 and Lérida had been (1391) among the first European universities to authorize public autopsies. Spain had also led the whole world in creating schools for deaf mutes and the blind. Toledo proved for several centuries both the repository and distributing center of Arabic culture. Arnold of Vilanova and Raymond Lull maintained and revived the Aristotelian tradition of encyclopedical knowledge. Mérida had a hospital (580) centuries before one was built in England (St. Albans, 794). The great Isabella had organized the first field army hospitals, and the military orders probably had them as early as the XIIth century. The insane asylums at Seville, Saragossa, and Valencia not only were among the very first in Europe, but paved the way in the humane care of patients. An Aragonese physician was soon to describe, fully a century before Harvey, the circulation of the blood, already anticipated by the Cordovan Averroes. The Spanish monarchs called to their side the best physicians in the land, such as Gutiérrez, Torella, Villalobo, Laguna, Lobera, Montaña, Mercado, Valléz, and, in addition, invited to the court foreigners such as the great Vesalius. It may be recalled that, while there were no physicians on the Mayflower, Columbus, Cortez, Magalhães, Balboa, and Mendoza carried medical men on their ships," and, in the 1492 agreement, Columbus was specifically required to do so.

Early research.-American research entered an orderly and promising phase with the advent of the first official cronista, Oviedo, who made not fewer than eight trips to America, where he filled a number of important positions. Not only did he describe and draw medicinal plants but pointed out their alleged healing virtues, devoting to the subject four books of his Historia General y Natural de las Indias (1535). Don Gonzalo is entitled to more than passing recognition in medical history, since the remarks on bubas (yaws) in his Sumario

3 The XVIth century is precisely the golden age of Spanish medicine, and Valladolid, with Montpelier and Bologna, was one of the three great centers of medical study.

• Salamanca University was founded several years before Oxford received her first charter.

Thus history repeats itself, as the first Latin American hospital, that in Santo Domingo (1503 or earlier) anteceded by many years the first hospital in the English colonies (Long Island, 1663).

6 Sebastian Cabot was explicitly ordered to carry physicians and druggists on his trip to South America in 1536.

(1526) mark the beginning of tropical medicine, and his statements, with the later ones (1542) of Díaz de la Isla, initiated the bitter ageold controversy as to the origin of syphilis.

Monardes, a Seville physician of Italian extraction (1508-1588), went farther into the study of American plants and, although he never crossed the ocean, built the first garden devoted to plants from the New World. The wealth of material accumulated by him was embodied in two books published in 1565 (De las Drogas de las Indias) and 1574 (Historia Medicinal de las cosas que se traen de Nuestras Indias Occidentales), which became a classic on the subject for several centuries and was translated into various languages. Another and higher milestone is represented by the researches of Hernández (1514-1587), Philip II's own physician, who spent seven years (15711577) in Mexico, on the first American scientific expedition. Through a series of mishaps, Hernández's monumental work (Historia Natural de las Indias), in 17 volumes remained unpublished for two centuries and known only through mutilated versions. Poor Hernández had the grief of seeing his painstaking tomes buried with their splendid illustrations in the Escorial vaults where fire was eventually to destroy them."

Mexican priority.-Mexico, where Hernández labored so well, had (1580) the first chair of medicine in the New World and one of the first two universities. It also witnessed as early as 1576 the first necropsies in the New World, and its first professor of medicine, de la Fuente, deserves credit for some pathological studies in cases of typhus fever. The first chair of anatomy there dated from 1621, although the teaching of this subject was very deficient until much later. It was perhaps only natural that the first medical books published in America should also appear in the old Aztec capital. Francisco Bravo's Opera Medicinalia (1570) and Alphonso López's Summa y Recopilación de Cirujia (1578) were written by Spaniards; but Fray Agustín Farfán's Tractado Breue de Chirurgia (1592) had

7 Until its official publication in 1791, Hernández's work was known only through incomplete transcriptions such as Ximenes' (1615) and Recchi's (1651). Another of Philip's physicians, Fragoso or Fragosa, was also to write, but at long range, on Las cosas aromáticas, árboles y otras medicinas simples que se traen de las Indias.

Medicine, however, had been taught at the University of Santo Tomás in Santo Domingo since 1538 and in Mexico in the two schools for Indians organized by Bishop Zumarraga and Pedro de Gante. The Lima school (authorized in 1551) dates from 1621, if not 1638; that of Caracas from 1721 (actually 1763); Habana, 1728; Bogota, 1758 or 1760 (the Rosario College has existed since 1652); Chile, 1769 (professor appointed in 1756); Quito, 1787 (actually 1791-92); Buenos Aires, 1801; Guatemala, 1805 (Florez became teacher of medical anatomy about 1785); Bahia and Rio de Janeiro, 1808; Léon, Nicaragua, 1811-12, Puerto Rico (classes), 1816; Bolivia (classes), 1827, San Salvador, 1847; Haiti, 1860; Costa Rica, 1874; Montevideo, 1875; Asuncion, 1898. Especially in the early times, such institutions were mere shells, if not pretenses. Practically all these schools had to be reorganized and almost recreated after the wars of independence.

The Spanish Government authorized only reluctantly the study of anatomy even in the mother country itself; for example, in Chile, despite frequent requests to that effect, permission to create a chair of anatomy was given only in 1773, and in Buenos Aires, in 1801; in Lima, the amphitheater had to wait until 1792.

for its author a Mexican, one of the first medical graduates (1567)10 in the University. Benavides' Secretos de Chirurgia was written in Mexico but published in Spain in 1567. In Cuba the first medical book dates from 1707; in Guatemala, from 1782; in Brazil, from 1808; in Puerto Rico, from 1866. Medical pamphlets were published in in Caracas in 1804; in Buenos Aires, in 1805; in Chile, in 1820." It may be well to add here that the first survey of a sanitary nature in the New World was that ordered by Philip II in 1577, asking, among other things, for data on the increase or decrease of the Indian population and causes of this change. By 1599 the Viceroy Márquez de Salinas had a census of Lima made, and, in 1612, Herrera did likewise with the Indians in the Rio de la Plata region. At Quito censuses were taken in 1645 and 1757. The first hospital statistics published in America were also probably those appearing in the Gaceta de México in 1785. In Mexico, too, her great viceroys, Bucareli and Revilla-Gigedo, in the latter part of the XVIIIth century, had censuses made of inhabitants, property, and occupants.

The first Cæsarean section in the New World (1779) seems also to have been a Mexican achievement, it having been performed by two friars at Santa Clara. Another was recorded in 1795. In Mexico, execution of the Cæsarean by even laymen was urged as a religious duty by the Viceroy Bucareli in 1772, following Charles III's 1749 pragmatic and the injunctions in the book published by a Neapolitan priest in 1745. These were of course post-mortem operations. In Venezuela a Cæsarean operation, probably the first on a live woman in the Western Hemisphere, was performed in 1820 by Ruiz Moreno, who also did the first lithotomy, the first embryotomy and other operations, and introduced smallpox vaccination into the country. The first Cæsarean in the United States was not performed until 1827, although the first Mexican operation may be assigned to this country, since Santa Clara is located in California. The first symphisiotomy was undoubtedly that at Mexico in 1784. In Argentina the first successful Cæsarean (mother and child surviving) dates only from the last decade of last century.

Brazil. -Medical knowledge about the present Portuguese-speaking part of America comes from a later date, but, even so, it is earlier than that of Inca-Araucan medical progress. During his rule of the Dutch possessions in South America (Guiana), Maurice of Nassau brought with him two prominent scientists, Willem Piso and George Marcgrave, who spent six years (1637-1643) exploring

10 Dr. Pedro López was the first graduate, in 1553, his name being also entitled to remembrance as the founder of the first home for children in Mexico and probably in America (1582).

11 The different dates of the introduction of printing, in itself a reflection of the growth and culture of the colony, had something to do with this: Mexico, 1540; Peru, 1584; Santo Domingo, 1600; Guatemala, 1660; Cuba, 1700; Paraguay, 1705; Colombia, 1738; Ecuador, 1755; Tucumán, 1766; Buenos Aires and Chile, 1780; Uruguay and Puerto Rico, 1807; Caracas and Rio de Janeiro, 1808; Panama, 1822.