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PERUVIAN MEDICINE
Two important studies were published for medical science in our country: Four hundred years of public health in Peru, by Carlos Bustios Romani, and The physiological challenge of living in the Andes by Carlos Monge C. and Fabiola Leon-Velarde.

MEDICAL STUDIES IN THE EARLY REPUBLIC. SCHOOL OF INDEPENDENCE: 1821-1856*

Medical studies were conducted in the School of Medicine and Surgery, renamed the School of Independence by express orders of General San Martin, in tribute to the contributions made by its masters and students during the war of independence.

Jose Cayetano Heredia (Catacaos, 1797 – Lima, 1861)

Francisco Javier de Luna Pizarro was the rector at the time (1819-1823) and Hipolito Unanue was the director of the school. The rector was in charge of all administrative aspects, whereas the post of director was an honorary role to which the Royal Physician was generally appointed.
After completing four years of studies in the school, students were capable of obtaining university degrees as Bachelors in Philosophy and/or Medicine at the University of San Marcos. Likewise, they could obtain Masters’ degrees in Philosophy or Medicine after two compulsory years of clinical internship or external practice in the Santa Ana, San Andres and San Bartolome hospitals. Upon completion of their examinations and practices, following six years of studies and sitting a general examination on every subject, students were entitled to be examined by the examining board of physicians in order to obtain the degree of «Professor of Medicine », which authorised them to publicly exercise the medical profession.

Faculty of Medicine, Lima 1906

Like any other national organisation, the running of the school was seriously affected by the anarchy and political strife that characterised the 1821 – 1844 period. Furthermore, Unanue’s Synoptic Plan was only just being put into practice and in addition, the best professors left the school to take
up important political posts. The situation became critical in 1831, when the authorities had to convince parents to send their sons to medical school. It was under such circumstances that Cayetano Heredia was appointed rector of the school. Valdizan made the following comment in this respect:

« The school had declined so pitifully that the only school record published in the 1836 to 1840 annals were the degrees awarded by the examining board of physicians.»
Coinciding with this comment, Paz Soldan pointed out the efforts made by Heredia under such difficult circumstances: «When Dr. Heredia was appointed Rector of the School in 1834, it was in the worst state of abandonment, short of basic income and students due to the current contempt for the medical profession. With the school rapidly declining (…) in the midst of the political discussions that the country was involved in at the time, he had to overcome thousands of problems in order to keep the school going until 1839, when he was dismissed» (...). Subsequently, when General Francisco de Vidal began his term in office as President, he reinstated Cayetano Heredia as rector of the school (...).
From 1841, Cayetano Heredia introduced a number of reforms in the School of Independence, which culminated in 1856 with the creation of the Faculty of Medicine. In order to orchestrate such academic reforms and with limited private funds, Heredia sent a group of young men who had completed their studies in the School of Independence to Paris. The beneficiaries of «Father Cayetano’s» altruism were Jose Casimiro Ulloa, Jose Pro, Francisco Rosas, Rafael Benavides and Camilo Segura. From Paris, they sent back books for the school library and materials of the Physics and Natural History departments and the Chemistry laboratory. Since the early nineteenth century, Paris had been considered the regeneration centre for medical sciences. Ulloa and his peers stayed in this city from 1851 until 1854.
* Carlos Bustios Romani. Cuatrocientos anos de la salud publica en el Peru (Four hundred years of public health in Peru) (1533-1933). Concytec/ UNMSM Publishing Fund, Lima 2004, 707 pages. www.concytec.gob.pe webmaster@concytec.gob.pe http://www.unmsm.edu.pe/fondoeditorial/

DEFYING THE ALTITUDE
Jean-Paul Richalet*

This book**, for which it is a pleasure to write a few introductory lines, contains important information regarding life in the Andes, coordinated and edited by two scientists of international prestige in the field of altitude physiology and pathology.
Carlos Monge C., a physician and researcher, dedicated his entire work to the exploration of mechanisms for adjusting to life in the Andes, particularly the renal functions of natives and highland residents, having conducted numerous studies on comparative physiology. He continued the pioneering work carried out in 1923 by his father Carlos Monge M., to whom we owe the first descriptions of chronic altitude polycythemia or Monge’s Disease.
Fabiola Leon-Velarde S., a faithful disciple of Carlos Monge C., also continued his work, directing the Oxygen Transport Laboratory in the Cayetano Heredia University, increasing the research work and developing numerous international cooperation opportunities with France, the United Kingdom and Italy, among others.
The two main authors of this collective work therefore gained international prestige: she is the Vice-President of the International Association of Mountain Medicine, a role he had previously undertaken.
Peruvian scientists and physicians involved in this field share their interest in life in the altitude with other Andean countries. In particular, the clinical and experimental work of the Bolivian Institute of Altitude Biology created in La Paz with French cooperation, has contributed significantly to the biology of hypoxia.
Ecuadorian and Argentine scientists have also made valuable contributions to this information, which now forms part of the universal heritage. Nevertheless, Peruvians have always been the pioneers in this field, describing the chronic pathology of the inhabitants of highland plateaus and the acute pathology associated with a sharp increase in altitude. Many people forget that the first clear descriptions of pulmonary edema caused by the altitude were made by Peruvians working in the Morococha or La Oroya mines. Unfortunately, they did not receive the acknowledgement they deserved, since their works were not originally published in English in international magazines.
The Peruvian school of altitude physiology is the only one of its kind in the world. Few countries have devoted so much energy and passion into discovering how man adapts to such a particular environment. It is worth pointing out that this subject is directly related to the health of millions of Andean people who live and die in highland plateaus. This work will help clarify certain concepts about adjusting to hypoxia, based on the genetic cellular response to hypoxia. This book will help give mountain biology and medicine the importance it deserves, as it is often disregarded….. even by Peruvians themselves, particularly those who live in Lima.

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* University of Paris, Biobigny, France
** Carlos Monge C. and Fabiola Leon Velarde S. El reto fisiologico de vivir en los Andes (The physiological challenge of living in the Andes). IFEA/Universidad Peruana Cayetano Heredia. Lima, 2003. 435 pages.
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