CHAPTER LXII 



VERRUGA PERUVIANA 



Synonyms — Definition — History — Climatology — ^Etiology — Pathology — 

 Histopathology — Symptomatology — Diagnosis — Prognosis — Treatment 

 — Prophylaxis — References . 



Synonyms. — Peruvian wart, Verruga Blanda, Carrion's Fever, Verruga de 

 Castilla, Verruga of the Andes, Verruga de Zapo 6 de Quinua, Verruga Andi- 

 cola, Verruga Mular, Verruga de Sangre, Fiebre de la Oroya, Verruga de 

 Crapaud, Bouton des Andes. The word ' verruga ' signifies in Spanish a wart. 



Definition. — ^Verruga peruviana is a chronic endemic specific 

 general disorder of unknown origin, not contagious, but apparently 

 inoculable, and characterized by an irregular fever associated with 

 rheumatoid pains and anaemia, followed by granulomatous swellings 

 in the skin, mucous membranes, and organs of the body. 



History. — It is probable that the disease existed in South America 

 before the advent of the Spaniards, for the earliest references to it 

 are found in Spanish works on Peru in the sixteenth century. The 

 first record is by Agustin de Zarate, Treasurer of Lima, in his 

 ' History of the Conquest of Peru,' written in 1543, in which he 

 relates that warts or small tumours appeared on the face and other 

 parts of the body, which were more deadly than smallpox, and 

 almost as fatal as plague. 



Garcilas de la Vega records that a quarter of the small army of 

 Fran9ois Pizarre perished from this cause, while Gomara, Garcilazo 

 (1617), and other early writers, also drew attention to the disease. 

 After this period writers on Peru either fail to mention the disease 

 at all, or only write short paragraphs such as that in Cosme Bueno's 

 geographical description of the province of Canta, published in 

 1764, in which it is mentioned under its ancient name of ' berrugas.' 



The modern descriptions of the disease begin with the works of 

 Tschudi in 1843, Malo in 1852, Smith in 1858, Salazar and Manuel 

 Odriozola in 1858, Velez in 1861, and Dounon in 1871, the last named 

 giving a very clear account of the complaint. 



But little interest was, however, taken in it until 1870, when a 

 severe outbreak of fever took place among the workpeople laying 

 the railway-line between Lima and Oroya. This complaint for 

 some reason was called ' Oroya fever,' although it did not affect 

 Oroya. About the same time Dounon's excellent paper appears to 

 have interested French naval surgeons, so that numerous investiga- 

 tions as to verruga and Oroya fever were made both by Peruvian 



1566 



