1568 



VERRUGA PERUVIANA 



absent in patients suffering from verruga peruviana without fever. 

 It is agglutinated by the serum of persons suffering from Carrion's 

 fever, but not by that of patients suffering from verruga who have 

 not had fever. The micro-organisms are, however, not always of 

 the same strain. Thus, Biffi has separated two different strains, 

 one of which resembles Schottmiiller's B. par atypho sits B, and the 

 other Gartner's bacillus. Biffi and Carbajal were unable to confirm 

 Barton's results as to the presence of a skin eruption in animals 

 inoculated by these strains. They therefore conclude that Carrion's 

 fever is a separate pathological entity distinct from verruga, and 

 that it is a fever belonging to the paratyphoid group, but differs 

 from the usual types by being due to a different organism, and by 

 occurring in patients suffering from verruga. In this finding they 

 are supported by the clinical observations of several observers, 

 among whom may be mentioned Eder. 



The next question which must be considered is the nature of 

 verruga peruviana, for it has been suggested that it is fram- 

 boesia, and this has been specially emphasized, since it has been 

 realized that it may run its course without any fever. Biffi, how- 

 ever, has clearly shown that they are separate, framboesia being 

 contagious, verruga not; framboesia beginning with an initial 

 lesion, verruga not ; framboesia being due to Treponema pertenue 

 Castellani, verruga not. We may therefore conclude that verruga 

 peruviana is a definite pathological entity. Further researches in 

 the disease have been made by Bassett-Smith, Mayer, and others. 



In 191 5 Strong, Tyzzer, Brues, Sellards, and Gastiaburu published 

 a valuable report, pointing out that Oroya fever was distinct from 

 verruga peruviana. 



The former, according to these investigators, is due to Bartonella 

 hacilliformis [vide p. 502), which in many ways resembles Theileria 

 parva, while the latter is probably caused by a filterable virus, and 

 can be inoculated into monkeys; it resembles closely Bassewitz's 

 angiofibroma cutis contagiosum tropicum (p. 2253) . Verruga may be 

 spread by a blood-sucking arthropod. Townsend, in 1914 and 1915, 

 declared his belief that this arthropod wSiS Phlebotomus verrucarum. 



Climatology. — Verruga peruviana is confined to South America, 

 and to the western slopes of the Andes in Ecuador, Peru, Bolivia, and 

 the northern parts of Chili, the most important endemic area being 

 Peru, where it is almost limited to the departments of Ancachs and 

 Lima, lying north and south of the tenth parallel, and on the western 

 side of the Andes. The department of Ancachs comprises seven 

 provinces, of which the provinces of Pallusca, Huaylas, Huaraz, 

 and Cajatambo, which are on the western slopes of the Andes, are 

 most afiected, while that of Santa, which runs along the littoral, is 

 almost free. The disease is, however, peculiarly limited to certain 

 places in these provinces. The heights of these places vary from 

 Cochas, in the province of Cajatambo, which is only at an elevation 

 of 406 metres, to Cajatambo, in the same province, which is at an 

 altitude of 3,350 metres, but according to Monge it is never naturally 



