REFERENCES 



1577 



tion, and the reappearance of fever pains, etc. Cold weather and 

 high altitudes are unfavourable, and complications increase the 

 gravity of the case considerably, the former because it delays the 

 development of the eruption and may cause it to abort, and the 

 latter because it increases the tendency to haemorrhage. The 

 mortality varies from 10 to 40 per cent. 



Treatment. — ^No specific treatment is known, but Odriozola 

 recommends hypodermic injections of arsenic, and removal from 

 the endemic region to the warm countries along the littoral will also 

 be of benefit. Atoxyl, salvarsan, and neo-salvarsan may be tried. 

 Chills and cold baths must be specially avoided as being apt to stop 

 the development of the eruption, and hence to endanger the life of 

 the patient. Drugs appear to be useless in the febrile stage, and 

 though decoctions of maize, of Buttneria cordata (Buttneriaceae), 

 Buddleiaincana (Scrofulariaceae), or Schimis wo//t^(Terebinthinaceas), 

 have been popular, they are now believed to be useless. 



Tonics of iron and arsenic are useful during convalescence, but 

 the iron is best administered by hypodermic injections. Carrion's 

 fever must be treated in the same manner as typhoid fever. 



Prophylaxis. — In the present state of our knowledge the only 

 possible prophylaxis is to avoid the endemic regions, and to protect 

 the body against biting arthropods, especially at night. 



REFERENCES. 



There are numerous references in the ' Cronica Medica,' pubhshed in Lima, 

 but the most important monograph is that by E. Odriozola, which is excellently 

 illustrated with maps and coloured plates, and in which the subject is treated 

 in the fullest manner. See also the valuable pubHcations by Strong and his 

 collaborators. 



Arce (1918). An. Facult. Med. de Lima, vol. i., Nos. i, 2, and 4. 

 Bassett-Smith (1Q01-12). British Medical Journal. 

 BiFFi (1908). Archiv f. Schiffs- u. Tropen-Hygiene, xii. i. 

 Bour.se (1876). Archiv. de Med. Nav., p. 353. 

 Chastang (1879). Ibid.,p. 4iy. 

 Cole (191 2). Arch, of Inter. Med. 



DouNON (1871). Ibid., p. 255. (A very excellent paper.) 

 FouRNiER (1874). Ibid., p. 156. 



Hall (1883). Lancet, ii. 845. (Verruga in Ecuador.) 



Hercelles {191 8). An. Facult. Med. de Lima, vol. i., No. 4. 



HiRSCH {1883). Handbook of Histology and Geographical Pathology, ii. 114. 



(A most useful account.) 

 Letulle (1898). Comptes Rendus de la Socicte de Biologic, p. 764. 

 Mayer (1910). Cent, fiir Bakter. 



Monge, C. (191 i). Carrion's Disease, or Verruga Peruviana. These de Lima. 



Lima. (Translation in the Journal of the London School of Tropical 



Medicine, 191 2.) 

 Odriozola, E. (1898). La Maladie de Carrion. Paris. 

 Odriozola, M. (1858). Medical Times and Gazette, p. 280. 

 Smith (1858). Edinburgh Medical and Surgical Journal, p. 67. 

 Strong, Tyzzer, Brues, Sellards, and Gastiaburu (191 5). Report of 



the First Expedition to South America of the Harvard School of Tropical 



Medicine. Cambridge, U.S.A. 

 TowNSEND (191 3). Journal of Economical Entomology, vii. 5, 357-367. 



(1915.) American Journal of Tropical Diseases, iii. 16-32. 

 TscHUDi (1843). Viages al Peru. 



Vecchi (1909). Beihefte Archiv f. Schiffs- u. Tropen-Hygiene, No. 4. 



