ALTITUDE MEDICINE IN PERU GENERAL MORBIDITY 
Butrón Hospital Manuel Nuñez, Puno REVIEW OF THE HISTORY OF MEDICINE OF THE HEIGHT IN PERU In 1992 was published in the journal Medical Herediana 3 ( 2): 74-77 The enclosed article, which reflects the history of research in Peru to date.
information little known them critically reviewed by Drs. David Frisancho Pineda, Oscar Frisancho Velarde, father and son, both physicians and recognized researchers Puno of High Altitude Medicine is presented for information and source is acknowledged. Dr. Achilles
Monroy
Height Investigations in Peru Frisancho David, Oscar Frisancho
in 1590, was first published in English, "The History Natural y Moral de las Indias, written by the Jesuit José de Acosta, who had been in Peru from 1572 to 1574. In the third book is a description of his journey across the mountains of Pariacaca to 4500 meters above sea level, where he and his companions had different symptoms as "deadly sorrow", "retching and vomiting, some had" vomiting and cameras, almost all had a sense of death, even the beasts (horses) "is becalmed, so that there is sufficient to move spurs" . These complaints, says the chronicler, did not last but 3 to 4 hours until they went down to a lower altitude. The cause of these complaints was attributed to the "air element is there so subtle and delicate that it is not provided to human respiration, which requires thicker and warmer." He also referred to cold air and "penetrating" (1)
Most authors accept this story as correspondence to acute mountain sickness or altitude sickness. We agree with this thesis have observed and cared for many people affected by the severe mismatch to the task. In summary we can say that the story of the Jesuit Acosta, is the first clinical description of altitude sickness or acute mountain sickness.
Since that time, many travelers, scientists, explorers, soldiers, etc.., Have fallen victim to altitude sickness, describing his discomfort in his diaries, notes and publications; Humboldt in 1802 to explore the heights of Chimborazo (Ecuador), Darwin in 1835 to cross the Andes on their journey from Santiago to Mendoza, and Liberator St. Martin in 1820 on his way from the Andes are famous personalities who suffered (2).
Jourdanet Denis, a French surgeon, had spent several years in Mexico, interested in problems of acclimatization in height, supported by his government planned to expand its overseas dominions. In 1861 he published in Paris two books about his comments, unfortunately its conclusions are clouded by his belief in the supposed European racial superiority in relation to the U.S. (3).
Jourdanet interested the young French physiologist Paul Bert, in the study of the lowest barometric pressure altitude. In 1878, Bert described his Animal experiments in hypobaric chambers introduced for the first time saying that the crucial factor of the causes of death in exposure to high altitude was the partial pressure of oxygen and barometric pressure not by reducing the partial pressure of oxygen, decreasing the amount of oxygen available to the human body (3.4). Bert
convinced his assistant Francois Gilbert Viault, to conduct the first scientific expedition to the Andes. Viault biologist and physiologist at the University of Bordeaux (France), with the approval of the Faculty of Medicine of Lima and accompanied the bachelor Juan Mayorga left Lima on October 4, 1889 to Morococha mining camp (Junín) located at 4.500 meters above sea level (4).
Viault spent a month and a half in Morococha, demonstrating a "significant increase" the number of red cells in the native high, postulating that the polycythaemia was an adaptive mechanism to match. His blood gas studies showed that the proportion of oxygen in the blood of animals subjected to the environment of the height was the same as at sea level, this finding rebutted the presumption of probable Jourdanet "anoxyemia" height of the settler (5).
In 1921 an expedition of the Universities of Oxford and Yale, led by physiologist English Joseph Barcroft, visited Cerro de Pasco, Peru's population at 4300 meters above sea level for three months Studies on the effects of altitude on humans. Barcroft published a book in which he stated that the tall man was physically and mentally inferior to men in sea level (6).
When they met in Lima, the findings of Barcroft, caused surprise, particularly Dr. Carlos Monge Medrano. Monge decided to organize an expedition to La Oroya to refute Barcroft.
Monge in 1924 had told his students about their observations of a mismatch type of man on high: "The height erythremia" whose symptoms disappear when the patient drops to sea level. "These erythema healed on the coast, returning to the great heights" have serious symptoms again. " In 1925 to present their research at the National Academy of Medicine called it "The disease of the Andes" (7.8).
In April 1927, Carlos Monge Medrano, Alberto Hurtado, Enrique Encinas, César Heraud and 8 medical students, under the auspices of the Universidad Mayor de San Marcos started the first scientific expedition to the Peruvian Andean region (La Oroya, Ticlio and Morococha), its objectives were to determine the effects of altitude on the human body. The results published in the Annals of the Faculty of Medicine "showed great physical ability and mental normality of the natives, adapted to the environment for millennia in height, on the other hand extended the initial observations on Monge's Disease the Andes and chronic mountain sickness (7,9,10). On this trip
Carlos Monge Medrano, demonstrated his ability as a physiologist and promoted the study of pathology Andes. Submitted its report to the University of San Marcos, National Academy of Medicine, and in the VII Pan American Sanitary Conference held in Lima this year (1928) (10).
The Paris Faculty of Medicine in 1929 organized a scientific meeting, to discuss the "Disease of the Andes", Carlos Monge was introduced by the famous professor Henry Louis Vasquez, author of several works on polycythemia vera.
Days after Professor Roger GH, submitted a report to the French Academy of Medicine, concluding that the disease of the Andes, was a peculiar disease of the regions of high and should be called the "Monge disease" (10) .
Monge studies published in French, were reviewed in 15 European medical journals, beginning an era of scientific bonanza for the "Peruvian Medical School."
Academies of Rome (1928), Turin (1928), Paris (1929), Buenos Aires (1934), Santiago (1934), the Universities of Lyon and Chicago (1936), the Washington Sanitary Conference (1936); heard attentively to the presentations of Professor Monge on biological problems at altitude (10). Alberto Hurtado
Abbey, after completion of his graduate studies at Harvard University in 1927, he joined the Faculty of Medicine, San Fernando, actively participating in the first scientific expedition to the high Peruvian (10). Howard decided to devote himself entirely to research, early work in those years are devoted the study of anthropometry and hematology of native high (9), (10), (11).
Hurtado in 1937 entered the Academy of Medicine, to work "physiological and pathological aspects of life at altitude," emphasizing the processes of adaptation and pulmonary gas exchange in humans high (10), (11) , (12). That same year described for the first time in the world Edema High Altitude Pulmonary (10).
In 1944 Humberto Hurtado and Aste discovered the rightward shift of the dissociation curve of hemoglobin in high altitude dwellers. This finding was well interpreted by the authors, who indicated that they facilitated the release of oxygen in tissues (12). About
Monge and Hurtado joined many physicians from different specialties, participate in the 8 Andean expeditions to different areas of Peru, between 1927 to 1932 (10), (13). In 1931, being rector of the Universidad Mayor de San Marcos Dr. José Antonio Encinas, created the Institute of Andean Biology and Pathology. Dr. Carlos Monge Medrano was its first director.
In 1940 the institution was formalized as the National Institute of Andean Biology in 1944 finally joined the University of San Marcos. There they worked Alberto Hurtado, Humberto Aste, Andrés Rotta, Cesar Merino Cesar Reynafarje, Reynafarje Baltazar, Cesar Faura, Fausto Garmendia, Tulio Velasquez, Emilio Picon. Dr. Tulio Velásquez it now runs (11).
In 1961, when he founded the University of Medical and Biological Sciences (now the University Peruana Cayetano Heredia), was also born the Institute of High Altitude Research (IIA). Founded by Alberto Hurtado with 8 research laboratories has been directed by Humberto Aste, Federico Moncloa, Roger Guerra García, Eduardo Pretell, Luis Ruiz and Francisco Sime (12).
Other researchers have noted internationally for its contributions to the knowledge of the biology of man and height are: Javier Arias Stella, Sixto Recavarren, Carlos Monge Cassinelli, Dante Penaloza, Pablo Mori, Jorge Berrios, Luis Llerena, Mario Saldana, Hever Kruger, Luis Sobrerilla, José Whittembury (12), (13).
has been extensive and meritorious scientific work of the Peruvian Medical School Height, your contributions are not only referring to human beings, but also to life at the height of the animals and plants (11), (13).
recognition to all this work, crystallized in the "Premio Bernardo A. Houssay ", awarded in 1972 to Professor Alberto Hurtado by the Organization of American States (OAS). This grand prize has lifted all his collaborators and disciples.
In the National Congresses of Medicine Height: La Oroya (1981), Puno (1983), Cerro de Pasco (1985), Huanuco (1987) and La Oroya (1989), International Conference on Biology Height: Puno ( 1987), La Oroya (1978), Arica (1988), Cuzco (1990), have discussed various aspects of life and pathology in height.
participated in these events the Institute of Andean Biology, Research Institute of height, the Bolivian Institute of Andean Biology (led by Jorge Ergueta), the Pathology Institute of Peace (whose director is Gustavo Zubieta), Center Medical Research Height (directed by Emilio Marticorena of Chulec Hospital of La Oroya). Daniel Alcides Carrión Association (Cerro de Pasco). The Universidad Nacional del Altiplano (Puno) and the Medical Corps Hospital Manuel Núñez Butrón (Puno).
many biological phenomena remain to be addressed, and we believe that the Andean college students have at their disposal a great natural laboratory. Would be worthy rivals of Monge and Hurtado, who gave luster to the Peruvian medical science.
REFERENCES
1.Acosta J. Natural and Moral History of the Indies. Edit. Fondo de Cultura Economica, Mexico 1962.
2. E. Encinas Soroche: definition, history, theories discussed, diagnosis, prophylaxis and treatment. Annals of the Faculty of Medicine, Year: XI, No. 1 and 2, April-June. 1928, p.: 210-248.
3.Villena A. First scientific expedition to the Andes: Centenary. Dominical (El Comercio, Lima), December 10, 1989. 4.Pamo
O. Issues of Medical History in Peru. Megaprint Lima Ediciones SA 1990. 5.Viault
F. On the amount of oxygen in the blood of animals on the high plains of South America. Medical Chronicle 1891, 8:155-157. J. 6.Barcroft
Observations upon the effect of high altitude on the Physiological Process of the Human Body, Carried out in the Peruvian Andes, chiefly at Cerro de Pasco. Transactions of the Royal Philosophical Society of London 1923; 211.
7.Monge C. Disease of the Andes: clinical studies. Annals of the Faculty of Medicine, Lima 1928, 11 (1-2): 76-209.
8.Monge C. L'Altitude Erythrémies them. Préface du Professeur Roger GH, Masson et Cie. Editeurs. Paris 1929. Peruvian 9.Aste
H. Contribution to the study of the biology of high altitude (Introduction to the topic.) Friday Medical Journal 1974, 25: 24-28. R. García 10.Guerra
Biomedical research in Peru. Cope Journal 1974; 5: 27. 11.Velásquez
T. Height: national problem. Proceedings of the First Conference Medicine and Surgery of the height La Oroya (Peru) 1978, p.: 9-14. 12.Universidad
Cayetano Heredia. Research Institute 1961-1986.Betaprint Height SRL Ediciones, Lima 1987. M. 13.Cueto
Scientific Excellence in the periphery. Grade-Ed Concytec, Lima (Peru) 1989.
Huancayo, 120 km south of La Oroya. Panoramic view of the most populous city in the central highlands of Peru 
In Satipo, 170 km east of La Oroya. Typical house of the Peruvian Amazon 
Miraflores, Lima. (A 175 km west of La Oroya), Peruvian capital on the central coast 
Map of Peru, with its three regions, Lima pointing (on the coast) and La Oroya (in the mountains) 
paraganglioma in young female height 
selective carotid arteriography shows vascular paraganglioma at the carotid bifurcation 
