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Ramón Carrillo


Ramón Carrillo (March 7, 1906 - 20 December 1956), was an Argentine neurosurgeon, neurobiologist, and public health physician born in Santiago del Estero.

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Career in neurosurgery and neurobiology

Between 1930 and 1945 he contributed valuable original research about the brain cells which are not neurons—named glial cells—and the method for staining and observing them under the microscope, as well as on their evolutionary origin (phylogeny), and the comparative anatomy of the brain across the several classes of vertebrates. In the same period Ramón Carrillo contributed novel techniques for neurological diagnosis: he refined iodine-contrasted ventriculography, called iodoventriculography, and discovered signs in it for several diseases; developed tomography, which by lack of electronic means at the time was prevented from integrating computation yet was a precursor of what is today known as computerized tomography; and achieved its combination with electroencephalogram (EEG), termed tomoencephalography.

Still in the same period, Carrillo attained valuable results investigating the brain herniations protruding into blood cysterns (cysternal herniations) and the syndromes occurring after a closed brain traumatism or contussion (postcommotional syndromes); he discovered the "Carrillo's disease" or epidemic acute papillitis; described in detail the cerebral scleroses, during whose investigation he performed many cerebral transplantations (brain grafts) between living rabbits; and histologically reclassified the cerebral tumors and the inflammations of the innermost brain envelope (arachnoid mater), which inflammations are called arachnoiditis. He also proposed a widely used, pre-DSM "Classification of mental diseases." At the age of 36 (1942), by opposition concourse he became the University of Buenos Aires Chair of Neurosurgery.

Career in social medicine

Then, in a sudden professional change, Carrillo left his brilliant career as neurobiologist and neurosurgeon and renounced the calm and prestige derived from it, in order to fully devote himself to social medicine, often called sanitarism in Spain and Latin American countries. From this angle he hoped to flesh out his aspirations regarding health. By taking profit of the opportunity allowed by the rise of a certain political party (Peronist Party) with whose leader Ramón Carrillo had made friends only during the last two and a half years, in 1946 he moved to confront the causes of diseases with the public power now at his disposal. In this way Carrillo later became the first Minister of Public Health of the Argentine Republic. During eight years he developed an innovative and highly valuable contribution, but quitted in July 1954, more than a year before than Juan Domingo Perón's second term become ended with a coup d'état (September 16, 1955. In spite of his long disconnection, he was to remain outside of the country, first in the United States and then in Brazil.

Exiled, seriously ill (insufficiently treated hypertension), politically chased (the Argentine government which ousted Peron presented a formal protest to the Brazilian government which had provided some medical help to Carrillo, labeling him as a "malingerer"; his books and pictures in Buenos Aires were sacked) and suffering grievous poverty with his wife and little children, Ramon Carrillo died in Belém do Pará, Brazil (December 20, 1956). Circumstances notwithstanding, during this year he still produced works on philosophical anthropology. Defamed by them as a "gasoline robber", his figure and accomplishments were silenced until Perón's brief third presidential period (1973-1974).

In this stage Carrillo was recognized, although only as architect and achiever of a National Health system carefully designed and carried out. His name was then imparted to numerous Argentine hospitals and institutions related to public health. It is frequently ascribed to the embarrassment produced by Carrillo's model in less competent politicians the fact that, afterwards, his biography, ideas, and contributions to science remained generally unknown, except by outlines in the neurobiological tradition in which Carrillo took part. The large skeletons for several hospitals that he left behind without completion never became finished, and were demolished during this period even as late as 2004. In 2005 his brother Arturo Carrillo, still in hardship and without any official funding, completed a book expounding the magnitude of his achievements and sacrifices. It triggered that, by Executive Order 1558 dated Dec. 9, 2005, the Argentine government decreed the full year 2006 as "Year of Honor to Ramón Carrillo". Many events were carried out to make amends for the previous injustices and the ideas of social medicine steering his work became republished.

Short biography

After attending elementary and middle school in his native city, Ramón Carrillo moved to Buenos Aires to start a career in Medicine. He did it brilliantly, studying with Christfried Jakob among others, and graduated in 1929 with the Gold Medal for the best student.

After this he showed a preference for neurology and neurosurgery, collaborating with eminent neurosurgeon Manuel Balado, a Mayo alumnus and also a disciple of Christfried Jakob. Under Balado, Carrillo published his initial scientífic articles. After graduation he obtained a travel grant in order to further his studies in Europe, where he worked in the best neuroscience laboratories, Cornelius Ariens Kappers's and the Vogts' among them.

He returned to Buenos Aires in the middle years of what historian José Luis Torres labeled "The Infamous Decade". In it, Carrillo witnessed what has been described as the "systematic sacking and destruction of his fatherland, a period characterized by the leaders' deep moral decadence, in which self-imposed corruption, economic felonies, the selling out of the national patrimony, and the impoverishment of the population's majority" (Ordóñez). Thus disillusioned – because of the "Infamous Decade's" mismanagement – of the socio-cultural proposals of the liberal, American-style democratic system, and explicitly rejecting both its nazifascist and stalinist alternatives, Carrillo adhered to the locally rising nationalist thought. Looking forward to a re-moralizing revolution, he complemented his scientific formation with evolving political ideas and cultural education. He reinforced his close relationship with his former companion of elementary school Homero Manzi, as well as Arturo Jauretche, Raúl Scalabrini Ortiz, and tango and theater composers Armando Discepolo y Enrique Santos Discépolo, representatives of tango culture and the new nationalistic ideas; and the Argentine-German neurobiological tradition active at the neuropsychiatric hospitals later known by the names of two disciples of Christfried Jakob, Drs. Borda and Moyano. In 1937 Ramon Carrillo suffered an acute illness, the sequel of whose fever was hypertension and progressively severe headaches. He barely saved his life through the devoted efforts of his lifetime friend Salomón Chichilnisky, a medical doctor and literary author who started life carrying loads in the docks in the port of Buenos Aires to support his parents, brothers and sisters and, against all odds, became a Chaired Professor of neurology, then acting in the level of Secretary of Health helped minister Carrillo to build many public hospitals in Argentina, and later died in one of them.

During those years Ramón Carrillo exclusively dedicated himself to research and teaching, until becoming Head (1939) of the Neurology and Neurosurgery Service in the Argentinian Military Central Hospital. This position in Buenos Aires afforded him deep acquaintance with the real situation of the country's health. He became well informed on the clinical files of all the young men examined for enrolment into the military service, coming from the whole of Argentina, and became aware of the high prevalence of poverty-linked diseases, specially in the candidates from the poorest provinces. He carried out statistical studies showing that the country only had 45% of the required hospital beds, moreover unevenly distributed, with regions falling to 0,00% of beds for every thousand inhabitants. He thus ratified the recollections and images from his own province, evincing the state of neglect of the majority of the country.

Doubly employed because of salary needs (he was still single, but helped his mother and ten younger brother and sisters, caring for all of them to have a career), in 1942 Carrillo obtained by opposition the Chair of Neurosurgery of the Medicine Faculty. There he formed a squad of talented disciples, among them German Dickmann, Raúl Matera, D. E. Nijensohn, Raúl Carrea, Fernando Knesevich, Lorenzo Amezúa, Jorge Cohen, Jacobo and Leon Zimman, Rogelio Driollet Laspiur, Juan C. Christensen and Alberto D. Kaplan. His scientific and academic career was brilliant. Nevertheless, his life was to radically change. Great transformations were occurring in the country. In 1943 president Castillo was overthrown and another military government took on. In these circumstances, in the Hospital Militar Carrillo became acquainted with colonel Juan Domingo Perón, a patient with whom Carrillo shared long talks. The colonel was precisely who persuaded Ramón Carrillo of collaborating in planifying the national health polítics. Soon afterwards Carrillo, at age 39, briefly served as Dean of the Medicine Faculty, acting as a go-between in a fierce, highly politized, Left-Right university conflict. For early 1946, both sides were resenting him, forcing him to quit office.

By then colonel Perón democratically obtained the nation's presidence, confirming Carrillo as head of the State Secretary of Public Health, later Ministry of Public Health and Social Assistance of the country. Besides Chichilnisky, Ramón Carrillo wanted to be assisted by his close friend and companion medical student the neuroscientist Braulio Moyano, another of the ablest disciples of Christfried Jakob, yet Moyano felt himself unable to serve society from such a role and preferred remaining as a neurobiologist. Who to this end left science and moved from the today hospital Borda was, instead, Santiago Carrillo, a disciple of Moyano and brother of the new minister. Perón's wife, "Evita", coordinated her political action with Carrillo's, so contributing to his technical achievements.

Ramón Carrillo's action was prolific, hitherto unsurpassed. He increased the number of hospital beds in the country, from 66.300 in 1946 to 132.000 in 1954. He eradicated, in only two years, endemic diseases such as malaria, by means of highly aggressive campaigns against the vector. Syphilis and veneral diseases practically vanished. He built 234 free, public hospitals or policlinics, lowered tuberculosis' mortality rate from 130 per 100.000 to 36 per 100.000, ended epidemics sych as typhus and brucellosis, and decreased drastically the infantile mortality rate from 90 to 56 per thousand live births.

All this Ramón Carrillo did while acknowledging priority to the development of preventive medicine, the hospitals' running organization, and concepts such as regulative centralizing and executive decentralizing ("centralización normativa y descentralización ejecutiva"). The later differs from the decentralizing with merely economic goals imposed by the markets. Corresponding by letter with Norbert Wiener, the so-called "creator of cybernetics", Ramón Carrillo applied it to the art of government with the name of cybernology (cibernología), creating an Instituto de Cibernología or strategic planning in 1951.

Numerous authors agree that the most important heritage bestowed by Ramón Carrillo were the ideas, principles, and grounding motives which accompanied his deeds. "The problems of Medicine as a branch of the State cannot be resolved while sanitary politics is not backed by a social politics. Similarly, there cannot be a social politics without an economy organized to benefit the greater part of the population." "In the field of health, the scientific achievements only are useful when they get at the reach of the whole population." These sentences portray a personality capable to abandon his admirable scientific career, internationally recognized, in order to fully devote himself to the concrete needs of his people.

Ordóñez writes: "He died in Belém do Pará, North Brazil, on 20 December 1956, at his age of fifty, poverty-stricken, ailing and exiled, receiving money by mail from his friend Salomón Chichilnisky exactly as San Martín did from his friend Aguado. Perhaps thinking, as libertador Simón Bolívar did, that he has been tilling the sea ... Maybe one of his better known sentences indicates that his work remains unfinished: 'Facing the diseases generated by poverty, facing the peoples' sadness, wretchedness, and social tribulation, the microbes inasmuch as causes of disease only are secondary causes.' "

Sources

The State journal Electroneurobiología, of the Hospital Borda (Government of the Autonomous City of Buenos Aires) in whose scientific tradition the biographied participated, publishes on line a set of articles on Ramón Carrillo, including chapters of the biography written by his brother, voice files, and numerous photographies. All the written, graphic and sound materials are of free reproduction on condition of acknowledging the source and its URL: http://electroneubio.secyt.gov.ar/index2.htm

This article incorporates adapted material from the Spanish as well as from articles by Mario Crocco and Marcos A. Ordóñez, originally published in Electroneurobiología 2004; 12 (2), pp. 144- 147 and Electroneurobiología 2006; 14 (1), pp. 173-179; [1], of open access and distribution. See the Discussion page for a complete transcription of the copyright notice.

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