Uma história da doença de Carrión: clínica e bacteriologia (1842-1913)
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2011-12-05
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Universidade Federal de Goiás
Resumo
This doctoral thesis is a historical and epistemological research of the clinical age of
Carrion's disease (1842-1885) and of the early age of his bacteriologic study (1885-1913). That´s
a disease born within a historical narrative about the medical effects of experimental inoculation
that the medical student Daniel Alcides Carrión, was made to do in August 1885. According to
the peruvian historical narrative about the origins and consequences of the medical experiment,
the student was inoculated with the blood of a disease known as Peruvian wart, but developed
and died, in October five, from the disease called Oroya fever. The experiment would then have
shown that there are not two diseases, but only one, that which, since then, bears his name as a
tribute to the heroic gesture of inoculation. According to current knowledge about the disease, it
has two stages in its evolution or syndromes. A febrile phase, anemiante, acute and of high risk
for the patient's life; another phase, which follows the first, is the development of a characteristic
skin neoformation, with the form of papules blood, called Peruvian wart. The historiography of
the disease, after 1940, suggests that this duality of pathological manifestation represented the
clinical difficulty explaining the genesis and outcome of the experiment of Carrion. However,
research of documents relevant to the experiment of 1885, made in the first chapter of our thesis,
showed that the experiment was not aimed at overcoming the dichotomy of two diseases. The
student already had an advanced understanding of the overall clinical progression of the disease,
including its two stages. From our investigation, moreover, we conclude that the peruvian
medicine considered demonstrated that the inoculation produced Oroya fever, but the peruvian
medicine does not present anywhere the ways in which one can recognize the Oroya fever. Due
to these problems was undertaken in the second chapter, the study of the period of foundation of
Peruvian wart clinic (1842-1872) and came to the conclusion that at this time there already was a
complete understanding of the evolution of disease, including its stages and forms of
development. At this point in our investigation, the existence of the notion of Oroya fever has
appeared as unnecessary for the clinical knowledge of the disease. Therefore, the third chapter of
our thesis investigated the period from 1872 to 1885, a time when the notion of Oroya fever
appears in medical literature. Our investigation has shown that the notion appeared in Peruvian
medicine because it regarded the disease as being a strictly benign, afebrile rash. Consequently,
the Peruvian nosological dualism appears as a result of its inability to explain the phenomena of
the general economy’s commitment that anticipate the eruption of Peruvian wart. With this new
understanding of the clinical description of disease, we retake, in the fourth chapter, what
happened in the study of disease, after the experiment of Carrión. A review of medical literature
of the period between 1885 and 1898 showed that the historical narrative of Lima on the
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experiment of Carrion became a guiding discipline of all research on the disease of this new
period. During one stage of that Peruvian research (1885-1898), required to remain still only
clinic, the study of disease was a prisoner of its assumptions - it became necessary, to keep the
interpretation of the experiment as true, to define the concept of Oroya fever. But the final
solution was not reached because the effort of maintaining doctrinal assumptions was placed
above the results of observation. This closed circle began to be broken with the discovery of
Tamayo, in 1905, that part of what physicians called Oroya fever was the result of a very
common complication of severe cases of Peruvian wart with paratyphoid bacilli. The fourth
chapter is concerned, yet, to the period after the discovery of Tamayo, from 1905 to 1913, to
know the fate of Oroya fever. This research shows that the Peruvian medicine did not give up of
the traditional historical narrative about the Carrion’s experiment. After Tamayo’s explanation of
the reasons of part of what is called Oroya fever, the Peruvian medicine refused to give up of the
use of this notion. Arce, the main Peruvian defender of the traditional historical narration about
the disease, in 1913, meaning to seek the recovery of significance of Oroya fever that kept alive
the dual polarity needed to remain true to the idea that, in 1885, has been demonstrated the unity
between the two diseases. This doctoral thesis has obtained, thus, the construction of a new
history of knowledge of Carrion’s disease, for the period 1842 to 1913.
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Citação
SUGIZAKI, E. Uma história da doença de Carrión: clínica e bacteriologia (1842-1913). 2011. 248 f. Tese (Doutorado em História) - Universidade Federal de Goiás, Goiânia, 2011.