1576 



VERRUGA PERUVIANA 



of the parasites in the blood, from typhoid by the serum reactions, 

 from tuberculosis b}^ skin and ophthalmic reaction, from rheumatism 

 by the absence of the swelling of the joints, and from histoplasmosis 

 by the absence of the parasite. The stage of eruption must be dis- 

 tinguished from framboesia by the absence of the eruption on the 

 trunk, by the tendency to haemorrhage, and the absence of Trepo- 

 nema pertemie. 



It should be remembered that according to Strong, Tyzzer, Brues, Sellards, 

 and Gastiaburu's valuable researches, Oroya fever and verruga are two 

 separate diseases, Oroya fever being characterized by the profound anaemia, 

 the fever, the presence of Bartonella bacilliformis in the blood, its non-inocu- 

 lability in monkeys, while uncomplicated verruga is clinically identical with 

 angiofibroma contagiosum ; there is no fever, no severe anaemia, there is 

 absence of B. bacilliformis and the condition is inoculable in monkeys and 

 human beings. 



Fig. 707. — Verruga Peruviana : Eruption on the Face, Lips, and Tongue. 

 (After Biffi, from the Archiv fi'ir Schiffs- u. Tr open-Hygiene.) 



Prognosis. — With the possibility of such a serious complication 

 as Carrion's fever arising, or in later stages of internal verrugas 

 forming, the prognosis must be very guarded. A good sign is an 

 early appearance of a widely-spread eruption, while a poorly- 

 developed eruption associated with anaemia and marked weakness 

 is of grave import. Monge states that the difference between two 

 consecutive blood counts is of importance in deciding the prognosis, 

 as an increase in the mononuclears and of the erythrocytes and the 

 appearance of eosinophile cells marks an improvement. 



The appearance of the eruption per se should not be considered a 

 good sign if there is still marked oligocythaemia and polymorpho- 

 nucleosis. 



Especially serious is the disappearance of a poorly-marked erup- 



