Mount Nebo and the development and the end of an era: Jacinto Convit (1913-2014) and Francisco Kerdel-Vegas (1928-2020)

In the second half of the 20th century, an important series of scientific and sociopolitical events took place in Venezuela. These developments were related to changes in the world and particularly in the United States. In dermatology, beneficial and marked advances germinated and grew. They were propelled in Venezuela by particular characteristics in the local development of this specialty and critically by personal features of two major leaders, Dr Francisco Kerdel-Vegas, who died June 18, 2020, at the age of 92, and Dr Jacinto Convit, who died in 2014 at the age of 101. The interaction of these two cooperating leaders and the scientific and social environment with which they acted are presented.

Dr José Maria Vargas, standard bearer of Venezuelan medicine: The doctor and the statesman

José Maria Vargas, (1786-1854), who was born on March 10, 1796, graduated with a Doctor of Medicine degree from the Central University of Venezuela in 1808. He was subsequently imprisoned in 1813 by the Spanish authorities for his independence activities. When finally freed, he traveled to Edinburgh for postgraduate medical training and became the first Venezuelan to earn a Fellowship of the Royal Colleges of Surgeons of Edinburgh. He worked afterward in medicine, surgery, botany, and chemistry, practicing in Scotland, France, and Puerto Rico. Upon his return to Venezuela in 1825 from 1827 to 1829, he became Professor of Surgery and later, President (Rector) of the Central University of Venezuela. He was elected the second president of newly independent Venezuela serving from 1835 to 1836 and carried out his tasks with honor and dignity, even after surviving a coup d'état. Finally, he resigned his position as president and returned to the practice of medicine and his teaching duties. He reasoned and wrote a beautiful differential diagnosis in a case supposedly of pellagra, but actually of erythema marginatum. Dr Vargas died in New York on July 13, 1854, after a long illness.

Tulio Briceño-Maaz, MD, and his time: the story of Venezuela

Tulio Briceño-Maaz, MD, was a multifaceted man. During his long life, he developed very many activities in several fields of medicine, including dermatology and mycology. All were signaled by quiet work, firm objectives, and measurable achievements. They showed tenacity, genteelness, and lasting positive results. His life span coincided with the sinusoidal transition of Venezuela from a rural background country, plagued by armed and civil unrest, to a nation ready to position herself in the ranks of countries achieving development. By the time of Dr Briceño-Maaz's death, unfortunately, Venezuela involuted into a process of degeneration and autophagy still present today.

Alliances: fair or lethal

Alliances are necessary for the development of individuals, institutions, and civilizations. Optimally, alliances provide benefits to their components; nevertheless, gains are not always symmetrical. Some alliances may prove detrimental or even lethal to some or all of the allies. I analyze some types of covenants using examples of history to provide a framework for drawing salient features of the alliance between the legal and the medical professions. This joint effort should be inherently beneficial to both; yet, particularly in the United States, the equilibrium is skewed against the medical profession. If it is not redressed, medicine and its specialties-in particular, dermatology-will go into a decline and wilt.

The balancing act of societies and of clinical histories

Individuals and societies are, respectively, confederations of cells and individuals. They function well only if their constituents work in a complementary and harmonious way. This is regulated by control mechanisms. Failure or malfunction of these leads to disease or social upheaval, respectively. Medicine, including dermatology, and government act by restoring homeostasis when self-regulation is unable to do so. Long-term or even permanent survival of individuals and societies can be achieved when profound understanding of control mechanisms becomes a reality.

The "dangers of cybernetic medicine-a dermatologist's warning"

Confining the actions of physicians to iron-clad directions and blind following of rules and regulations is creating many problems. Not to err does not mean to be right. Overall supervision of medical research and practice is a must for society; yet, minute regulations become a major obstacle for good practice and progress. Medicine is about patients and physicians. Pre-established rules and directives are only tools, not ends in themselves. Societies or institutions that become rigid and inefficient tend to be wiped out when unexpected situations or enemies appear. As a result, the stereotyped measures are not sufficiently effective. The deterioration of the Roman empire, and of its formidable army, is used as an historical example of the viewpoint proposed by the author. The analysis presented here applies to dermatology in particular, but also, and very acutely, to medicine in general.

A practical method to detect mycoses of the nails

The authors present a method that allows for reliable identification of fungal structures in nails with suspected colonization by fungi. The method is based on the well-known technique of heating nail fragments in 20% potassium hydroxide, but its details allow for reliable and quick processing of samples, when convenient. The method requires simple equipment and is designed for individual practices but might be employed as is or with minor technical improvements by a dermatology department. Minor changes will make it feasible to simultaneously process several samples. The results that were obtained show that while experienced clinicians achieve positive clinical diagnoses in the majority of instances, inaccuracies occur in a sizable proportion of cases. In addition, the varied combination of yeasts and hyphae that were found, bolster the view that microscopic examination is necessary to justify and optimize systemic treatment of mycoses of the nails. Our technique permits the processing and observation of the totality of samples obtained from a single nail or several nails.

History, dermatology, and medicine: another outlook

The History of Medicine and of Dermatology tends to analyze what happened in these disciplines in a given time and place. Contributions of relevant leaders are studied carefully, and their appropriate value to knowledge is determined. This is fundamental to understanding present knowledge and what might be expected in the future. There is, yet, an additional perspective, namely, the relationships between the above and historical phenomena in their wider sense; particularly, the correlation between politics, economy, psychohistory, and medicine. Evolution of medical knowledge does not occur in a vacuum. This contribution provides examples of this viewpoint and how knowledge of history makes clearer the development of medicine and vice versa. Emphasis is also made on the history and development of dermatology, but rather as an illustration of the overall philosophical point of view of the writer than as an analysis of the history of dermatology in itself. One may summarize metaphorically this viewpoint by stating that while the microscope and the dermatoscope are very important, the telescope is vital for integral knowledge.

Reflections on relationships between national and world events and development of dermatology. Venezuela as a model

From a personal vantage, the author tries to understand evolution of medicine and dermatology as relating to political, ideological,and economic factors.He analyzes the evolution of Venezuelan Dermatology research and practice from 1936 to present, relating it to the events that have taken place in that country during this period and integrating the latter to events in the world. There is a close relationship between Venezuelan and US history particularly since the late nineteen-thirties.Physicians in general and dermatologists in particular should not dismiss or just bear the events that take place in the society as a whole. They should try to influence them by acting in harmony with forces that propitiate freedom, rule of law, free inquiry, and meritocracy.

In it but not of it: relationships of medicine with government and politics

Medicine evolved in parallel with religion. Its practitioners developed their skills by selection, training, and culling. Codes of loyalties, behavior, and ethics emerged. This made them distinct. In common with government and politics, medicine has to do with the common weal. Still, the relationship of patients with physicians is based on a different kind of agreement than that with government or politics. Although physicians must participate in specific functions of government and politics related to their tasks, they act as a body that has specific limitations and rights (fuero). This is the backbone of medicine as a profession. Current tendencies favor the strengthening of governments and economic realities tend to favor the submission of physicians to those that control means of payment. A further enhancement of these trends might mark the end of medicine as a liberal profession. Individual decision by physicians to maintain a proud and necessary heritage and the creation of an effective World Medical College are 2 strategies that might thwart the danger of medicine's demise.

Letter: Erythema dyschromicum perstans revisited

The recent Dermatology Online Journal article entitled, "Erythema dyschromicum perstans," is discussed to clarify the history of the disease and the contributions of those who have reported it.