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

Abstract

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.

Introduction

The Captaincy-General of Venezuela in 1786 was an increasingly prosperous and cultured section of the Spanish Empire. Because it did not have the overwhelming mining capacities of Peru and New Spain (Mexico), Venezuelan development was slow but progressive, where the 18th century saw growing income from tobacco, cattle, cocoa, and later coffee. Pearls were in the past, whereas, rubber, gold, and oil were in the future.^1,2

The Central University of Venezuela, which was both “royal and pontifical,” was established in Caracas in 1721. The city, which was capital of the province, was nested in a fertile valley with a refreshing climate. Caracas grew and developed a nucleus of cultured persons that were, as noted by Humboldt, acutely aware of world politics.

La Guaira is the seaport of Caracas, being few miles from the city. Vargas was born here in this fortified town of well to do but not aristocratic parents. He studied medicine in Caracas and graduated at age 22 with a Doctor of Medicine degree. Vargas then moved to the city of Cumaná in the eastern part of Venezuela. It is the first city founded by Spaniards on the mainland. He developed a successful practice, but soon Vargas became involved in pro-independent activities. That period coincided with the Napoleonic occupation of Spain. (See Fig. 1.)

A devastating earthquake destroyed a great part of Caracas in 1812. Vargas returned to that city to help. Later, there was a Spanish offensive and royalist forces took over Caracas and its surroundings. Vargas was put in prison in a fortress in his native La Guaira (Figure 2). Eventually, freed, he left Venezuela and went to Edinburgh (a rather unusual decision) to pursue further training. He was successful, earned a Fellowship of the Royal Colleges of Surgeons of Edinburgh and learned much about botany and chemistry. He then went to France where he also studied and practiced and finally settled in Puerto Rico, which was then under Spanish rule. His family had property on the island, and he devoted several years of his life to the practice of medicine and surgery there. (See Fig. 3, Fig. 4.)

Vargas returned to Venezuela in the mid-1820s. When Simón Bolívar returned to Venezuela for the last time in 1826, he reorganized the Central University of Venezuela and closed forever The Catholic Inquisition. Vargas was appointed Professor of Surgery and later president of his alma mater, and was the first physician to occupy the position.

Friendship and trust grew between the two great men, so that Vargas eventually became an executor of Bolívar’s last will in Venezuela.

Vargas always maintained a simultaneous interest in medicine and in public affairs. He was deeply respected not only by the people but by General José Antonio Páez, a great hero of Venezuela´s War of Independence, who would become the foremost Venezuelan figure after Bolívar, and gave up power and died in 1830. Páez became the first President of Venezuela after this former province achieved independence from the so-called “Great Colombia.” The latter was a federation integrated by the former provinces of New Grenade (that included today’s Colombia and Panamá), Quito, which is today’s Ecuador, and Venezuela.

General Páez became the leading power during the first 15 years of the newly constituted country. He was an outstanding strategist and tactician, became a conservative, and allied himself with the ruling Venezuelan aristocracy. There was economic and scientific progress at that time; yet, there were social tensions that would lead to convulsions, and these would increase to become very destructive in the coming decades.

After Páez’s first presidency, Vargas was looked upon as a leading candidate. He was skeptical and initially resisted the nomination. He finally was persuaded, won the election in 1834, and became president in 1835. He was the second president of Venezuela, the first civilian president, and the first physician to have reached that position.

Vargas’ worries were well founded. A coup d’état led by a Colonel Carujo was initially successful. Vargas was detained at the Presidential residence and the following translated dialogue took place¹:

…Carujo said, “We would like to know, doctor, whether you are going to resign or not?” Vargas answered, “The authority which the nation has given me cannot be resigned, except before Congress.”

Carujo said, “You know that the triumph of the revolution ends all previous authority. Governments are based on fact.” Vargas answered, “Venezuela’s government is not a de facto one, the Nation has been constituted and has established its government. It is a national government in fact and in right.” Carujo snapped, “The government, doctor, comes from the facts!” Vargas answered, “If government comes from fact, it has to be one of overwhelming importance in the primitive state of a society and not from a disorderly fact of a military garrison. I cannot consider this but in such a fashion as understood and qualified by the laws.” Carujo retorted , “This will become later a national fact. Doctor, the world belongs to the brave.” Vargas concluded, “The world belongs to the just and honest man. It is the good man and not the brave one, who has lived and will live happily on earth and will be sure about his conscience.”

Vargas was imprisoned and sent temporarily to exile. Fortunately, the revolution was quickly brought under control by General Páez and Vargas duly reinstated. He realized, however, that he was not the appropriate man to rule the country at this stage of its development. After a while, he formally presented his resignation to Congress. It was accepted with great regret. Carujo never achieved power or exerted lasting influence in Venezuela or elsewhere. He was wounded in action in 1836 and died shortly afterward under unclear circumstances.³

Vargas continued to teach and practice. He wrote a textbook of anatomy and had several outstanding students. One of these was Dr Guillermo Michelena, the greatest Venezuelan surgeon of the 19th century.

Although Vargas was no dermatologist (the specialty did not exist in the country then), he made a masterful differential diagnosis that sheds light on his knowledge of dermatology. This was a case where pellagra was suspected and Vargas was consulted. He decided that the lady in question did not have pellagra but erythema marginatum. He stressed that pellagra was common in Italy then, and that it was probably due to the eating of spoiled corn. The diverse facets of the differential diagnosis were outlined in a correspondence with the Consul of Sardinia about this case and another one and was published by Dr Medina Jimenez in 1934 and was emphasized in one of our very first papers written in collaboration in 1962.[4], [5], [6], [7]

In 1842, Vargas had the satisfaction to preside the Committee that arranged for the remains of Simón Bolívar to be honorably returned to Venezuela, from his original grave in Colombia.

Vargas continued his work until he became ill from chronic urinary infections and uremia. He died in New York in 1854; one of his pupils, Eliseo Acosta, was there. He performed the autopsy. The death mask of Vargas and other Vargasiana lie in the library of the National Academy of Medicine in Caracas, located at the Palace of the Academies.

Nowadays, after about two centuries of independence, the city and port of La Guaira, where Vargas was born, is the capital of the State of Vargas. The main airport of the country is also located here and is separated from Caracas by the mountains of the coastal range of Venezuela.