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ACP Leaders On The Road:
Kesavan Kutty, MD, MACP

6th Latin American Congress of Internal Medicine (SOLAMI) and the Peruvian Society of Internal Medicine 31st Internal Medicine International Course in Lima, Peru

My uncle was an obstetrician and a general medical practitioner. The pharmaceutical representatives who regularly visited him briefed him on new medications, supplied him samples that he gave the poor and dispossessed, and knick-knacks that captured my attention during my visits to his clinic in the faraway metropolis. I remember a calendar from Parke-Davis (anyone remember them?) with reproductions of lithographs of medical art. One featured an ancient Incan surgeon performing a trephination. The subject had rope around the ankles and a muscular attendant held down his outstretched arms to the ground. Another sat on his knees. His placidity was at odds with the bloody hole in his head and the necessity for all the restraints. The patient might as well have been receiving a modern general anesthetic. There was an air of equanimity about all that, as a priest looked on and presumably blessed the proceedings.

The calendar vanished one day, leaving behind ephemeral memories that lay dormant, but surfaced in late October last year, as I sat listening to a presentation at the Sociedad Latinoamericana de Medicina Interna (SOLAMI) meeting in Lima, Peru. The eloquent speaker, using PowerPoint and powerful anecdotes, won applause after applause as he recalled Peru's robust, ancient Incan medicine and how modern it was for the prehistoric times over which it evolved. Human civilizations elsewhere, for example, would let a stricken warrior die of a traumatic intracranial bleed, but the intrepid Incan surgeons, using knives of obsidian, bronze or stone, would trephine the skull to let out the offensive blood clot. The trephines around depressed skull fractures indicate that such fractures were treated by surgery. Skulls with multiple trephinations done at different periods in the individual's life, as displayed at the museums, only proclaimed the success and reproducibility of such trephinations. Some estimate the recovery rate at 60%1. Perhaps such interventions were needed, because erecting buildings with rock and stone in rough terrain, or fighting battles using blunt instruments such as clubs and maces, made the Incans particularly prone to head injury. The parallels between dicta by Hippocrates (e.g., the need to treat depressed skull fractures) and the Incan treatment methods made the speaker wonder if Hippocrates indeed visited Peru. [Cultural and scientific exchange in those days must have been free and certainly without facilitation by agencies such as Education Council for Foreign Medical Graduates.]

Trephination was only one attribute of Incan medicine. Ancient Incans knew the medicinal value of coca leaves and the anesthetic properties of its active ingredient. They also knew that an active ingredient of these leaves, when administered as a "tea" prevented high-altitude illness. Almost every hotel in the town of Cusco provides its guests coca tea free of charge.

I was a guest of SOLAMI and the Peruvian Society of Internal Medicine at their combined meeting as the representative of ACP. The meeting was held at the Delfines Hotel in Lima, famous for the dolphin show in the large pool adjacent to and visible from the restaurant of the hotel. The dolphins had taken a vacation at an undisclosed location at the time of our visit.

The meeting boasted almost 2500 attendees. There were several educational sessions running concurrently, but these were separated by 2-3 unopposed joint educational sessions to be attended by all, and featuring international speakers. Dr. William Hall, MACP, one of ACP's former presidents, was one. He presented an update on Geriatric Medicine in two sessions, and I presented two sessions on Pulmonary Diseases. I also talked about Pulmonary hypertension.

Dr. Penny and Dr. Kutty

It was an enthusiastic gathering of physicians, who were keen on learning and improving their skills. Many visited the ACP booth, ably managed by Wendy Rivera Craig, ACP's Administrator of International Activities. My facility with Spanish being limited to just a few words, Ms. Craig's fluent Spanish came in handy during the times I volunteered at the booth. The interest in the College and its educational products was palpable; the interest in College membership and advancement to Fellowship was clearly heartening. The meeting and the educational sessions were organized well and ran remarkably on time. I wish to take the opportunity to thank Dr. Eduardo Penny Montenegro, FACP, the President of SOLAMI (pictured above with Dr. Kutty) and Dr. Rosa Cotrina Pereyra, FACP, the President of the Peruvian Society of Internal Medicine, for their kind hospitality and to congratulate them for the success of this fine meeting.

Machu Picchu

Our weeklong stay in Peru involved three days at the meeting and four days of sightseeing. Travel to Cusco, the original capital of Peru prior to the Spanish invasion, afforded my wife, Claire and I, an excellent insight into the ancient Incan culture. We visited Machu Picchu, a UNESCO-designated World Heritage Site. Access to the site is becoming increasingly limited because of the damage done by recalcitrant tourists. The famous settlement and the familiar mountain behind it are shown in the photo at left.

So how did they keep the trephine patient calm? They used herbal extracts to induce sleep and analgesia. It is possible they used small amounts of muscle relaxants without unduly slowing respirations. Years after my ephemeral encounter with the Parke-Davis calendar, I would learn as a medical student that the ancient natives of South America hunted animals with arrows laced by an emulsion from curare leaves that paralyzed the stricken animal. By that time, I was being lectured on the refined product, namely, tubocurarine, called so because it was shipped in tubes.


1scienceblogs.com/neurophilosophy/2008/01/
an_illustrated_history_of_trep.php
, accessed 1/9/2010.


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