UNCOMMON DISEASES IN PERU AND BOLIVIA. 151 
In 1871-2, when the Callao, Lima & Oroya (now Trans-Andine) R. R. was 
in course of construction and had its terminus at, the present station of San Bar* 
toleme, thirty-nine miles from Lima, with its camps extending some ten miles 
beyond, the workmen were attacked by severe and distressing pains throughout 
their entire bodies. At first, the attending physician supposed them to be rheu- 
matic, but their ceasing as soon as the eruption appeared, proved them to be 
the promonitory symptoms of " varrugas ". The eruption consisted of a fungus, 
spongy outgrowth from which blood oozed upon the least touch and often spon- 
taneously. Their size varied from the size of a pea to two and a half inches long 
by one in diameter. The roots perforated the derma when external and the 
muscular coats when on the mucous membranes. The eye-balls, nasal, buccal 
and vaginal cavities not escaping, and post mortem examinations revealed the 
mucous and serous coats affected with smaller but similar warts. 
There were three varieties, the large, distinct, spongy wart ; the confluent 
undeveloped eruption, resembling variola, with rounded instead of depressed 
center; and that fine eruption as if millet seed were between the derma and epid- 
ermis. The two last were occasional after-effects of the first. A patient having 
the first, upon recovery, might have the second and, barely better of that, break 
out with the third, or intervals of from six to twelve months might elapse during 
which time perfect health was enjoyed. Again one could have either without the 
other, although none were ever known to have them in the reverse order, and 
once having they seemed to be protected from a repetition except in the passage 
from the first to the third as above mentioned. If the eruption did not appear, 
if they appeared internally, or the first variety was very abundant, fatal haemor- 
rhages or paralysis occurred. Except for the pains and annoyance from the loss 
of blood one could attend to his daily duties. 
A ravine, some six miles beyond San Bartoleme, bears the name Varrugas. 
The general disinclination of the native Indian to bathing in cold, mountain 
streams, and their statement that the varrugas resulted from baths in the stream 
of that name gave that as its origin, which for a time was believed. 
The unprecedented magnitude of the work attracted many visitors, most of 
whom came with fear of the varrugas, and great care was observed not to touch 
water, either as a beverage or article for cleanliness. Passengers, arriving at 1 1 
A. M. and leaving at i P. M. abstaining from food and drink and shunning water 
as one attacked by hydrophobia, did not insure them against the disease, many 
breaking out within two months of their visit to the varrugas region, and often 
these were the worst cases. Others worked there for years, drinking and bathing, 
with impunity, in all kinds of water. 
A few, after they had returned to the United States or Europe, at the end of 
one and two years were attacked, so that the period of incubation could be said 
to vary from six weeks to three years. 
Three hundred miles north of Lima on the Pacasmayo, Guadalupe & Magde- 
lina R. R., at the station of Chiletethe same disease broke out but less violently. 
Varrugas ravine, on the Trans-Andine R. R. , is sixty three miles from the coast 
