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On Endemic and Epidemic Influences in Peru

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On Endemic and Epidemic Influences in Peru 260 ON ENDEMIC AND EPIDEMIC INFLUENCES IN PERU. By ARCHIBALD SMITH, M.D. [Read 6th July, 1868.] The coast of Peru, from 3 deg. 30 min. to 21 deg. 30 min. S. lat., is naturally a continuous, arid, and sandy desert, which is here and there intersected by rivers, or consider- able streams of watgr, that descend through rocky clefts from the Andes. By these channels, which are partially dried up in the dry season on the mountains or Sierra, the maritime valleys are partly irrigated and fertilised. In olden times the land of the Incas was extensively watered, through the medium of a most laborious and widely spread system of aqueducts, leading from the hills to the coast, which was closely peopled, as numberless ruins of large towns and adoratories bear witness. The most northern province of this coast range is called Piura, of which Payta in lat. 5 deg. 5 min. 30 sec. S., long. 81 deg. 8 min. 30 sec. W. is the well known seaport. Twenty-eight leagues inland from Payta, is the headland of this coast district, and it is occupied by three large estates, namely, Yupatera, Moropon, and Mono de las Padres. The aspect of this spot is indescribably beau- tiful. The surrounding hills are clothed in a lovely verdure of flowery luxuriance, and ample fields produce arrow-root, yucas, Indian corn, sugar cane, and all sorts of savoury and refreshing fruit matured under a uniformly clear and serene sky. When it rains in the province, the river Chiri over- flows its banks, and spreads out into stagnant marshes at the three estates just mentioned; whilst lower down, the stream is almost altogether absorbed, and swallowed up in its sandy channel. From 6 a.m. to 6 p.m. you have all the region bathed in glowing sunshine ; and, at sundown, an icy wind from the Cordillera blows over the heated plains underneath, so that no clothes can protect one from its chilling midnight effects. Dur- ing the season of inundations near the foot of the Andes of Yu- patera, the malaria on this property is so intensely active, that EPIDEMIC INFLUENCES IN PERU. 251 it produces the most malignant remittent and intermittent fevers, which often prove fatal in the first, second, and third accession. In other instances, the endemic fever of this locality assumes the continued type, with a duration of two or three weeks ; much of which time the lies " during patient atabardillado," or in an insensible state of fever with de- lirium. I have known an English overseer who was thus affected, and when he awoke into a state of consciousness, he found himself the only surviving inmate of his once happy home, his wife and children having been all suddenly cut off by the fever, whilst he lay insensible to the sorrows that sur- rounded him. The white inhabitants of the district who survive the endemic fevers, become subject to chronic disease and enlargement of the spleen and liver, while the negro race are the only human beings that thrive in it. The ques- tion of the special influences of race on the origin and spread of particular diseases, is a subject which deserves more atten- tion than it has yet received. On the coast of Peru the negro resists the evil effects of malarial exposure far better than the Indian or European, and he also suffered compara- tively little in the hsemagastric pestilence which recently committed great havoc among the other races. Cold notably modified the type of the recent epidemics, and though the temperature of Piura by day is dry and hot, yet it is a curious problem for the epidemiologist, what may be the effect of nocturnal cold on the type of malarial fevers in such a climate as that of Mono de los Padres, Moropon, and Yupatera? Has the gelid nocturnal breeze from the Cordillera the power of so modifying the miasm of the plains, as that it should in any instance be able to generate the continued, instead of the intermittent or remittent form of fever?and so run its entire course, as I have already observed, in the typhous shape? In the city of Lima, lat. 12 deg. 2 min. S.,long. 76 deg. 58 min. W., six miles from the sea, and about 500 feet above the level, with a population of about 100,000 in- habitants, malarial and pythogenetic causes combined, are in co-operation, and therefore it is quite usual to see the in- termittent fever pass into the typhoid; but the latter often occurs independently, and is one of the prevailing diseases of the capital, though pure typhus is rarely seen there. In the eminently dry province of Piura, the epidemic yellow fever of 1852 and 1853, did not reach'the fatal climax of black vomit; and the'deaths produced by it in certain Indian towns and villages, were chiefly owing to overcrowding in the ill-ven- tilated dwelling places of the poor. It was observed like- 252 EPIDEMIC INFLUENCES IN PERU. wise, in southern Peru, that this epidemic did not, in 1855, diffuse itself within the dry and volcanic oasis of Arequipa ; and though hundreds of cases were imported into the city of that name (lat. 16 deg. 20 min. S., long. 71 deg. 32 sec. W., at the foot of the;snow-capped Misti), no new cases are known to have sprung from them. But beyond and above the richly cultivated and fertile oasis, and suburbs of Arequipa, as at Pocsi and Chihunta,for example, at the elevation of from nine to ten thousand feet above the sea level, and in a cool bracing climate, this pestilence established itself, and extended epi- demically to the southern and inland departments of Puno and Cuzco; and proved most fatal in the city of Cuzco, which is situated at the elevation of about 11,300 English feet. At Cajamarca, lat. 70 deg. 7 sec. S., long. 78 deg. 31 sec. W., and at an elevation above the -Pacific of 9,000 feet, the seasons were observed greatly to influence the force and spread of the epidemic yellow fever, in the years 1855 and 1857. Here the disease abated in the dry season, from May to October, and increased rapidly on the first ap- pearance of gentle showers in the latter end of October. One morning, after some refreshing falls of rain on the pre- ceding evening, almost all the cottages or native huts scat- tered over the extensive plain of Cajamarca, were revisited by the pestilence in the most sudden manner?and in front of every door there lay a corpse of livid or yellow hue, which but a few hours before, was the active living form of a human being: and in course of one month, we are told that Cajamarca lost 3,000 of its inhabitants from the ravages of this formid- able disease. In other parts of inland Peru, however, as on the intercordillera table-land of Cerro Pasco, Janja, and Ayacucho, &c., the epidemic of 1855, much modified in its forms, had widely and rapidly spread abroad in the dry season of the Andes ; and no success has, as yet, attended the attempts made to trace the source of this pestilence to any ascertained peculiarity of atmospheric condition. It is only certain that successive outbreaks of the same epidemic, on different sections of the Andes, were continued from 1853 to 1857-8, as a sequel to the grippe, which in 1851 com- menced simultaneously all over the coast in the month of July, and thence traversed the whole Republic, highlands as well as lowlands, before the middle of September of the same year. This influenza, or grippe, was evidently dependent on some general atmospheric disorder, though too recondite to be made manifest to our ordinary senses; and I am not aware that any scientific meteorological observations were EPIDEMIC INFLUENCES IN PERU. 253 made, in regard to the atmospheric or epidemic constitution of that year.* It was from Lima and the seaports, that the various epi- demics radiated to the interior in north south and central Peru. So that it must be always remembered that while the epidemic had retained sufficient vitality to climb the snowy Cordillera, strewing the mule road and footpaths, with the dead and the dying, it was not in the colder elevations it originated, but in the warm and humid climate of the coast, and in the heat of summer. And it is certainly noteworthy, that wherever a new focus of infection originated (even in cases of ascertained con- tagion) the first symptoms of the malady were confounded with those of an ordinary catarrhal affection, so as to have very generally misled the doctors in the treatment, and especially as to the use of blood-letting, which was followed by rapid prostration of the vital forces. Independently, however, of all considerations respecting the origin of these and other Peruvian epidemics of older date, the diffusion and propagation of them, must have exhibited in their course, various climatic modifications, at the different well- marked zones of elevation above the sea, and particular variations of temperature connected with the epidemic region. As regards the eastern and western side of the same moun- tain chain, Humboldt remarked long ago, that people of a * I may here allude to what I have fully related elsewhere (see Transac- tions of the Epidemiological Society of London, " On the Epidemics of 1719 20, and 1759, in Peru," part i, vol. 2) regarding the participation of animals, donkeys and dogs, etc., in some of the Peruvian epidemics.
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