98 • Oscar Urteaga-Ballon 



oral destructive lesions. Kean and 

 Childrees (1942) made a summary of 

 103 autopsies of leprosy cases at the 

 Gorgas Hospital, Canal Zone, Panama. 

 They described the leprosy osseous le- 

 sions as follows: "Amputation of one 

 toe 12, one or more fingers 14, leg 9, 

 foot 1; absorptions of fingers 19, toes 

 18, feet 3; gangrene of the toe 2, mis- 

 cellaneous lesions 7." They also did not 

 find the naso-oral destructive lesions. 

 Desikan and Job ( 1968) in the General 

 Hospital in Vellore, India, reviewed 37 

 autopsies of leprosy. They did not de- 

 scribe one case of naso-oral destructive 

 lesions. 



Enna (1968), in Ryukyu Island in 

 Okinawa, studied 996 leprosy patients 

 with lesions showing advanced defor- 

 mity; 15.2% had nasal deformities, but 

 not one had the osseous destruction of 

 the oral and nasal cavities. Bernard and 

 Vazquez (1973) studied 60 necropsies 

 with similar results. 



However, other leprologists have 

 found some degree of destructive le- 

 sions in the nasal cavity of leprosy pa- 

 tients. Powell and Swan ( 1955), in the 

 National Leprosarium at Carville, 

 Louisiana, in advanced cases of lep- 

 romatous leprosy found that ulceration 

 and perforation of the nasal septum 

 were common, with destruction of 

 nasal cartilage and bone resulting in 

 varying degrees of "saddle" deformity. 

 Kumar et al. (1979), in the Leprosy 

 Clinic in Chandigarh, India, described 

 25 selected patients. Of these 88% had 

 nasal obstruction, while 48% and 32% 

 had ulceration and perforation of nasal 

 septum. Barton et al. (1982), in the 

 Victoria Hospital in Dichpalli, India, 

 studied 62 patients of lepromatous lep- 

 rosy; one of them showed a completely 

 perforated septum. 



Furthermore, in a North American 

 textbook of pathology, Marcial Rojas 

 and Kissane ( 1985) made more radical 

 affirmations. They said that mucocuta- 

 neous leishmaniasis produces "exten- 

 sive destruction of the soft and underly- 



FiGURE 9. Mucocutaneous leishmania- 

 sis. Total destruction of septum and de- 

 formation of nose and lips. Photo from 

 Atlas of Tropical Pathology (Binford 

 and Connor 1976:207). 



ing hard tissues of the nose and pharynx 

 producing severe mutilation of the 

 face." 



Finally, Binford and Connor (1976) 

 make the most complete revision of lep- 

 rosy and leishmaniasis. In Section 6 of 

 this atlas, Binford and Meyers pub- 

 lished 76 photographs of gross and mi- 

 croscopic lesions of all types of leprosy. 

 Despite the fact that some of their cases 

 show tremendous deformation of the 

 nose and the lips, none of these patients 

 show the destructive bone lesions in 

 their nasal-oral cavities. However, in 

 Section 7 of the same atlas Connor and 

 Neafie show one case of mucocutane- 

 ous leishmaniasis with tremendous de- 

 structive lesions. The authors say, "A 

 Brazilian with mucocutaneous leish- 

 maniasis has a destroyed nasal septum 

 and deformed nose and lips" (F-3-B-6, 

 page 261). 



We have included as comparison two 

 figures from this atlas. Figure 9 shows a 

 case of mucocutaneous leishmaniasis 

 with a massive destruction of the nasal 

 septum and deformities of the nose and 

 lip. Figure 10 corresponds to a case of 

 lepromatous leprosy with tremendous 



10 



Figure 10. Lepromatous leprosy. Tre- 

 mendous deformation of nose and lips, 

 without destruction of nasal septum, in 

 contrast to case of leishmaniasis in 

 Figure 9. Photo from Atlas of Trop- 

 ical Pathology (Binford and Connor 

 1976:261). 



deformation of the nose and the lips, 

 but with no destruction of nasal-oral 

 bones. 



In medicine nothing is exact; we can- 

 not say with certainty that the gran- 

 ulomatous nasal-oral destruction is 

 pathognomonic of one specific disease. 

 According to its ancient and modem in- 

 cidence, mucocutaneous leishmaniasis 

 occupied first place. Lepromatous lep- 

 rosy is in second place. Tertiary syph- 

 ilis and yaws are in third place. Rhi- 

 noscleroma and other infectious 

 diseases rarely produce this anatomical 

 lesion. 



More important in this academic, 

 historical discussion is the fact that an- 

 cient Peruvian physicians had left in- 

 disputable evidence of their knowledge 

 of some of the most complex chapters 

 of medicine. Their graphic ceramic 

 representations are unquestionable. 



Surgical amputation and limb 

 prostheses 



We have studied 65 ceramic pieces in 

 which the Mochica craftsmen repre- 

 sented traumatic medical surgery. 



Zagreb Palenpalhftto^y S\mp t9HH 



