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Forgotten Epidemic: Tiltepec

History of onchocerciasis in Oaxaca during the 20th century

El Dr. Larumbe en TiltepecBiblioteca Francisco de Burgoa (BFB-UABJO)

The Start of the Research

In April 1925, Dr. Larumbe visited Tiltepec, Ixtlán District, Oaxaca, and found a community severely affected by blindness and malnutrition. This marked the beginning of key research on onchocerciasis, known as "river blindness."

Niños, mujeres y hombres de TiltepecBiblioteca Francisco de Burgoa (BFB-UABJO)

Conditions of the Inhabitants

Tiltepec, with just 44 houses, was extremely poor. Families lived in adobe huts, faced bat attacks and subsisted on a limited diet. Malnutrition and anemia were common.

Girl affected by onchocerciasis (1925/1930) by José LarumbeBiblioteca Francisco de Burgoa (BFB-UABJO)

Ocular manifestations

The cases of the inhabitants of Tiltepec ranged from mild conjunctivitis and photophobia to total blindness. Some had corneas that looked like polished glass, while others showed loss of vision in one eye, with deformed pupils and no reflexes.

Retrato de niños y adultos de TiltepecBiblioteca Francisco de Burgoa (BFB-UABJO)

Initial hypothesis

Dr. Larumbe initially attributed the blindness to vitamin deficiency, but upon observing cysts on the skin, he began to suspect a parasitic cause, similar to Dr. Robles' findings in Guatemala.

Microfiliarias de Onchocerca (1927) by Isaac OchoterenaBiblioteca Francisco de Burgoa (BFB-UABJO)

Relationship with filaria

In 1926, Dr. Larumbe extracted filarial worms from cysts during his second visit to Tiltepec, similar to those described in Guatemala by Dr. Robles. A fly of the Simulium genus was suspected of being the transmitter, a hypothesis later confirmed.

Tres individuos de TiltepecBiblioteca Francisco de Burgoa (BFB-UABJO)

Field Studies (1926)

In Tiltepec, Dr. Larumbe confirmed that up to 90% of the inhabitants had skin cysts. He extracted parasites in another neighboring town, Yagila, demonstrating the relationship with the disease and the supposed improvement in the condition of those affected with the removal of the parasites.

Medical presentation

On November 25, 1926, Dr. Larumbe presented six patients from Tiltepec, Oaxaca. He showed parasites under a microscope and performed surgery to remove cysts, but the visual improvement in the affected patients was limited.

Mosca del género Simulium (1930/1935) by Francisco Reyes SalgadoBiblioteca Francisco de Burgoa (BFB-UABJO)

Vector identification

It was established that the transmitter was a black fly of the Simulium genus, the same one identified by Dr. Robles in Central America and in African cases. Some samples that were sent to international institutes confirmed this.

Panteón de Tiltepec (1926) by José LarumbeBiblioteca Francisco de Burgoa (BFB-UABJO)

Demographic impact

Between 1887 and 1927, Tiltepec's population fell from 503 to 150. Disease, malnutrition, and poor sanitation contributed to this demographic collapse.

Mapa de prevalencia de oncocercosis (1949) by Francisco Reyes SalgadoBiblioteca Francisco de Burgoa (BFB-UABJO)

Health campaigns (1930)

In 1930, the first national campaign against onchocerciasis began in Mexico, led by Dr. Miguel Bustamante. This effort marked a milestone in the global fight against the disease.

Sujeto afectado por la oncocercosis (1926) by José LarumbeBiblioteca Francisco de Burgoa (BFB-UABJO)

Reflection on blindness

The Tiltepec case showed that blindness was not only caused by filaria, but also by environmental and nutritional factors. This underlined the need to address health from a comprehensive perspective.

Periódico Excelsior (1926-11-27) by Periódico ExcelsrioBiblioteca Francisco de Burgoa (BFB-UABJO)

Legacy of research

The research of Dr. José Larumbe, Dr. Max Weihamn, and Dr. Ramón Pardo laid the groundwork for onchocerciasis control in Oaxaca and Mexico. Tiltepec became a landmark case in tropical medicine and public health.

Credits: Story

Onchocerciasis Collection. Fray Francisco de Burgoa Library.

Credits: All media
The story featured may in some cases have been created by an independent third party and may not always represent the views of the institutions, listed below, who have supplied the content.

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