The Bartonellas and Peruvian Medicine: The Work of Alberto Leonardo Barton

By Graciela S Alarcón, Renato D Alarcón, Rolly Barton Gonzales and 3 more

The Bartonellas and Peruvian Medicine explores the events surrounding the discovery of the etio-pathogenic agent of the Oroya Fever, also known as Peruvian Verruga or Carrión’s disease (an endemic infectious disease in South America’s Andean regions) by Dr. Alberto Leonardo Barton. Graciela S. Alarcón and Renato D. Alarcón recount Barton’s persistent work against skepticism, obstacles, and limitations imposed by members of Peru’s medical elites of the time, as well as his eventual successful scientific career and the delayed but well-deserved global recognition of his contributions.
 
The book is the result of intense bibliographic research and of original documents aimed not just at the examination of Barton’s life and work, but also the examination of today’s perspectives and future work in the field of infectious and “neglected” diseases. The authors address current scientific information on the relevant bacteria Bartonella bacilliformis, besides current research and clinical status of the other Bartonellas, making it a useful and practical text for those studying infectious diseases. 

• Language: English
• Publisher: Rutgers University Press
• Release date: Jan 8, 2019
• ISBN: 9780813596150

Book preview

The Bartonellas and Peruvian Medicine

Rutgers Global Health

Series Editor: Javier Escobar

Graciela S. Alarcón and Renato D. Alarcón, The Bartonellas and Peruvian Medicine: The Work of Alberto Leonardo Barton

The Bartonellas and Peruvian Medicine

The Work of Alberto Leonardo Barton

Graciela S. Alarcón and Renato D. Alarcón

RUTGERS UNIVERSITY PRESS

NEW BRUNSWICK, CAMDEN, AND NEWARK, NEW JERSEY, AND LONDON

Library of Congress Cataloging-in-Publication Data

Names: Alarcón, Graciela S., author. | Alarcón, Renato D., author.

Title: The bartonellas and Peruvian medicine : the work of Alberto Leonardo Barton / by Graciela S. Alarcon and Renato D. Alarcon.

Description: New Brunswick, New Jersey : Rutgers University Press, [2019] | Series: Rutgers global health | Includes bibliographical references and index.

Identifiers: LCCN 2018009732 | ISBN 9780813596143 (cloth : alk. paper) | ISBN 9780813596136 (paperback : alk. paper) | ISBN 9780813596150 (e-pub) | ISBN 9780813596174 (web pdf)

Subjects: | MESH: Barton, Alberto Leonardo, 1870–1950. | Microbiology | Microbiology—history | Bartonella Infections—history | Bartonella | History, 19th Century | History, 20th Century | Peru | Biography

Classification: LCC QR41.2 | NLM WZ 100 | DDC 579—dc23

LC record available at https://lccn.loc.gov/2018009732

A British Cataloging-in-Publication record for this book is available from the British Library.

Copyright © 2019 by Graciela S. Alarcón and Renato D. Alarcón

All rights reserved

No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, or by any information storage and retrieval system, without written permission from the publisher. Please contact Rutgers University Press, 106 Somerset Street, New Brunswick, NJ 08901. The only exception to this prohibition is fair use as defined by U.S. copyright law.

www.rutgersuniversitypress.org

To our children and grandchildren

Who have taught us so much

And continue to teach us all the time

To our teachers

Who showed us the way

Contents

An Introduction to the Rutgers Global Health Series

Javier I. Escobar

Foreword

Eduardo Gotuzzo

Preface

Contributors

Chapter 1. Alberto Leonardo Barton: Biographical Notes

Graciela S. Alarcón

Chapter 2. Bartonella bacilliformis

Graciela S. Alarcón

Chapter 3. The Other Bartonellas

Ciro Maguiña, César Ugarte-Gil, and Graciela S. Alarcón

Chapter 4. Reflections and Perspectives: Barton, the Bartonellas and Peruvian Medicine

Renato D. Alarcón and Graciela S. Alarcón

Chapter 5. Conclusions

Graciela S. Alarcón, Renato D. Alarcón, and Ciro Maguiña

Chapter 6. Comments: Alberto Leonardo Barton and Bartonella bacilliformis

Uriel García Cáceres

Acknowledgments

On Behalf of the Family

Rolly Barton Gonzales

Index

About the Authors

AN INTRODUCTION TO THE RUTGERS GLOBAL HEALTH SERIES

I am very pleased to introduce a new book series for Rutgers University Press that will have a particular focus on global health. Global health is a topic that is coming of age and becoming very popular in North America, with governments, international associations, and universities adopting new programs to address the various facets of this perspective, especially during the last decade.

There have been many definitions and perspectives on what exactly the concept of global health entails, some emphasizing certain aspects in lieu of others. Key elements of the concept appear to be international collaborations that address specific health issues of relevance to all nations, multidisciplinary approaches, and a prime concern for global equity, all leading to a concentration of efforts in low-income countries.

Koplan and colleagues from the Consortium of Universities on Global Health (CUGH; 2009) provided a definition of global health that has become one of the most widely used and accepted definitions of the term. This definition attempts to dissect and separate the notions of global health, international health, and public health, all of which are imbedded in the original concept. Moreover, the Koplan et al. definition emphasizes health issues relevant to low-income countries, such as infectious diseases and maternal and child health.

Awareness about colonial mentality and implementing collaborations that benefit all countries involved rather than continued domination and control by the wealthiest or most powerful are also crucial components of the concept of global health. Thus the health of populations is viewed in a global context, transcending the perceptions and selfish interests of individual nations. Besides addressing global threats without regard to national borders such as infectious diseases, climate change, and others, global health places a priority on improvement of health and achievement of health equity worldwide.

For the purpose of this series, we will use an older and broader definition of global health, this one emerging from one of the early reports from the Institute of Medicine of the National Academy of Sciences in 2009. It defined global health as health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions. I would add to this mix the essential ingredient of multidisciplinary collaboration. Indeed, besides health experts, the proper implementation of global health initiatives requires the input of engineers, architects, sociologists, psychologists, and other professionals. Consequently, many of these professions are now becoming quite active in the field of global health.

The fact that global health is becoming so multidisciplinary fits nicely with current realities at Rutgers University. A few years back, Rutgers incorporated all health-related institutions of the former University of Medicine and Dentistry of New Jersey into the Rutgers Biomedical and Health Sciences (RBHS), thus expanding the university’s interest in global issues in addition to the traditional emphasis on local or domestic ones, as evidenced in the popular slogan Jersey roots, global reach.

Thanks to the size and diversity of the student population it serves and the richness of its faculty and its various institutional settings, Rutgers is uniquely placed to become a leader in the area of global health. A growing number of students from other countries now join Rutgers University. As of fall 2017, it is estimated that almost 7,000 international students are enrolled at Rutgers. Moreover, global collaborations across the university now flourish. Various Rutgers departments and institutions, such as RBHS as well as the honors college and the schools of psychology, arts and sciences, engineering, sociology, anthropology, and many others, have become interested in the field, have started global collaborations, and are expanding study-abroad programs. In the last three years, about 2,400 Rutgers students participated in study-abroad programs, a number that is certain to increase significantly in the next few years. Finally, important international research collaborations in several areas, including toxicology, infectious diseases, and mental disorders, now involve faculty members from Rutgers University, and all of these interested parties, I believe, will welcome the availability of this new series as a source of educational materials and a convenient venue to present results of their global work.

THE BARTONELLAS AND PERUVIAN MEDICINE: THE WORK OF ALBERTO LEONARDO BARTON

We start this series with a focus on infectious diseases and present an important contribution from Latin America, coauthored by Professors Graciela and Renato Alarcón, both Peruvian-born physicians with current appointments at North American universities (University of Alabama in Birmingham, Alabama, and Mayo Clinic in Rochester, Minnesota, respectively). They are also professors at Cayetano Heredia School of Medicine in Lima, Peru. Peru, the land of historical places such as Cusco and Machu Pichu, has also yielded significant medical landmarks.

The Alarcóns are true cross-cultural scientists, and they present to us a highly unique contribution, the first book in English that depicts the original history of bartonellosis, Oroya fever, or verruga peruana, all names given to a disease of the Peruvian high plains, paying homage to Alberto Leonardo Barton, the physician who first discovered the organism.

It is important to note that since its discovery very early in the twentieth century, Bartonella bacilliformis was the only known Bartonella until the 1990s. Currently, up to twenty-eight species of Bartonella have been discovered, some of them in the United States, such as the Bartonella that causes cat scratch disease.

This book presents a detailed historical account of the early research on the fever epidemics in Peru and an excellent portrait of Barton, nicely documented with photographs, figures, and facsimiles. Interestingly, it is noted in the book that the main impetus for the study of Peruvian verruga came from Henry Meiggs, an American engineer who had the vision to build the central railway in Peru, during which more than ten thousand workers lost their lives to the disease, an interesting historical example of the relevance of non–health professionals to advances in global health.

Javier I. Escobar MD, Associate Dean for Global Health, Rutgers-Robert Wood Johnson Medical School, Series Editor

FOREWORD

Several significant landmarks have been recognized in the history of Peruvian medicine. More than one thousand years ago, for example, the great value of cranial trepanations, performed by members of the pre-Inca Paracas culture, was clearly demonstrated, as the procedure showed a very high postsurgical survival rate. In mummies recovered in Ica, probably from the Nasca culture, and studied by Dr. Alejandro Pezzia, a large variety of lesions caused by tuberculosis have been recognized. Likewise, the prominent place of medicinal plants in precolonial times has been documented by Dr. Fernando Cabieses’s studies. And more recently, the world medical community has recognized other Peruvian achievements, such as the Weiss lymphoma and the Arias-Stella phenomenon. In this context, there is now a broad recognition of the presence of Dr. Alberto Barton’s work as an important, axial chapter in the study of Carrión’s disease, a clinical condition carrying the name of the young medical student Daniel Alcides Carrión, who has, in fact, become the hero of Peruvian medicine because he sacrificed his life to prove that two clinical variants, verruga and Oroya fever, were two forms of the same disease. A few decades after Carrión’s demise, another student’s name and accomplishments emerged: Alberto L. Barton devoted his efforts to uncovering the causal agent of the disease.

This unique book by Drs. Graciela S. Alarcón and Renato D. Alarcón presents the most important facts of the life and work of Dr. Barton. Since this work is based on extremely valuable documentation and extensive bibliographic sources, all wisely organized and easily readable, it allows a clear appreciation of the significant development of biomedical knowledge during a period that has left an indelible mark on the history of our discipline.

Timelines, tables, figures, diagrams, and illustrations demonstrate the landmarks of this valuable history: the protagonist’s situation as a student in Lima and as a physician in London and his return to Peru, crowning the early findings of the endoglobular elements recognized as the causal agents of the disease. These investigations defined the truth about the clinical entity’s etiology, conclusively corroborated years later by Drs. Manuel Cuadra and Juan Takano’s electronic microscopy studies.

This book emphasizes the slew of confirmations and rejections of Barton’s studies by distinguished contemporary physicians who would not come to the point of total acceptance. The description of the discrepancies and the narrative of Barton’s activities in those times are well presented in the dimensional context of events as they occurred. The fact that it was not mandatory then to publish in international journals prevented, for many years, the just and fair recognition of Barton’s high-quality research. This situation was perpetuated even by Barton’s mentors, who insisted that taking care of patients and continuing with purely clinical tasks were absolute priorities over other endeavors.

Thus I want to take the opportunity to comment on not only the enormous effort required to put together the history of Carrión’s disease around Dr. Barton’s time but also the work done by Peruvian and international researchers who were consulted for this book and the studies on epidemiological and clinical treatment, prevention, and other aspects of the disease that helped solidify this work.

The medical-scientific activity in the field of tropical and infectious diseases prevalent in Peru during the early part of the twentieth century reflects the stage on which Barton’s multiple studies of conditions impacting the lives of Peruvians—such as typhoid fever, tuberculosis, brucellosis, and other infections—took place. In recognition of his worldwide influence, his name has been given to a genus of bacteria, the Bartonellas, that started