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NpTICES OF THE EPIDEMICS OF 1719-20 AND *1759 IN PERU; ALSO OF THE MEXICAN HE- MORRHAGIC DISEASE OF 1736 AND 1855.

By ARCHIBALD SMITH, M.D. (Read Nov. 2nd, 1863.)

In the Medical Gazette of 15th March, 1862, we find a narrative from the manuscript of an old Cuzco chronicler, regarding the epidemic that reigned in that city and depart- ment in the year 1720. It begins by stating that in the month of April, 1720, Cuzco was visited by a pestilence which, early in the preceding year, commenced in Buenos Ay res, and from thence extended northward as far as Gua- manga, or Huancavilica, in Central Peru. From the perusal of this document, we learn that it was considered to be of the nature of typhus?a malignant tabardillo?so violent and deadly that it hardly admitted of any remedy. The symptoms enumerated are intense fever, with vehe- ment headache, and pain of abdomen; some were seized with phrenzy, others with blood by the mouth, and black blood from the nostrils, or with vomiting of blood, which was always a bad sign. But the symptoms appear to have varied very -much in different cases or circumstances; for the historian remarks, that they were so different, and even contradictory, that no correct diagnosis, or curative plan, could be fixed. The disease proved very fatal to pregnant women; and after the fever ceased, some of those who had been afflicted by it succumbed to other complications?as dysentery. In the midst of so much necessity and obscurity many expedients were resorted to, and new remedies tried; but many cases of cure appeared to be altogether accidental. For example, individuals impatient of the burning heat and restlessness of the fever, threw themselves into the cold- bath and recovered; while others, with equal advantage, drank freely of cold water; and there were not wanting in- stances of those whose bodies were deposited in the cemetery for dead, but again restored to life. That this pestilence was was particularly contagious," evinced by its ravages among the barbers," and other attendants on the sick, as well as those who assisted at the EPIDEMICS IN PERU. 135 interments ; and it was observed that the greater number of the llamas and donkeys employed in carrying the dead bodies to their graves were affected with the emission of blood from the mouth. Under such afflicting circumstances public processions, prayers, and rogatories were resorted to, in order to avert the pestilence from a people whom the chronicler describes as so hardened in their vices, that they felt unmoved by the " common calamity. He emphatically relates that The white race in particular continued their strife, theft, fraud, scan- dals, injustice, and other iniquitous practices with greater eagerness than ever, and passed their time in diversions and gambling." During the height of the epidemic, the deaths in the city of Cuzco were no fewer than 100 per day. The days of greatest mortality were the 6th, 10th, 15th of August, and the 2nd of September?the maximum of deaths being 700 on the 10th of August. This climax in the rate of mortality was preceded on the night of the 26th of July by the unu- sual appearance to the northward of an extensive igneous phenomenon, or aurora borealis, which very much fright- ened the inhabitants. According to the most judicious estimates, 2000 persons died of this epidemic in the city of Cuzco ; and in other provinces, towns, and villages of the episcopate, the deaths were 4000?" entre Espanoles, Indios, y parbulos, including Spaniards, Indians, and young children." In all 6000, little more or less, though some were of opinion that the gross amount of deaths exceeded 8000. In the midst of so much confusion no exact register was kept; but in this, as in all other epidemics, such as measles, small-pox, etc., the indigent native was the greatest sufferer. In the month of November, 1T20, the epidemic began to abate in Cuzco, where it had reigned since the end of March or beginning of April; and it soon ceased altogether, as the rainy season was fully established in the following month of December. For two years after there was a scarcity of pro- visions, though not from deficient seasonal rains, nor sterility of soil, but in consequence of the want of hands to gather in the harvest during the first year, and the scarcity of labourers in the succeeding, on account of the depopulation caused by the pestilence.* * In the Lima Almanac, 1795, this epidemic of 1710-1720 is briefly noticed by Dr. Cosmo Bueno, who further records that a strong earthquake was experienced in Huarnanga on the 17th June, 1719. 136 EPIDEMICS IN PERU.

We find the same pest alluded to in cursory terms Dr. " by Unanue under the denomination catarro-maligno," as the consequence of an eclipse of the sun, which, on the 15th of August, 1719 (just at the period of new moon), at the hour of eleven and forty-nine minutes, a.m., extended from 17 degrees 29 min. south , to 40 degrees 13 min.; and for a long time the day was converted into night over those wide regions, as far as the River Plate and the ocean. Dr. Unanue remarks, that in all those southern provinces, the eclipse was followed by the most fearful pestilence ever, up to that period, known in Peru. But the Cuzco chroni- cler, who also notices this remarkable eclipse, suggests that as the epidemic had commenced on the side of Buenos Ay res, before this phenomenon had occurred, it could not be considered as the primary cause of the infection. The symptoms of the disease given by Unanue are the following:?" Prostration ofstrength; excessive pains through- out the body, and especially in the costal region (en especial al costado) ; spitting of blood; difficult respiration ; and little fever (y poca jiebre).* Now, if we only look at the hemorrhagic aspect of this epidemic, as described at Cuzco, we are struck by its resem- " blance in this respect to the Matlazahuatl epidemic" of the Mexican table lands, as related by Humboldt, Essai Politique, liv. 5, ch. xii, but when the comparison is made with more precision, wide differences will be observed. While Dr. Unanue of Lima describes the Peruvian epidemic of 1720 as grippe, or a severe catarrhal disorder, the Cuzco chronicler represents the same epidemic, as witnessed in his

* " Observationes sobre el Clima de Lima", p. 124, where the author indi- cates as authority, the treatise of Botoni, " On the Circulation of the Blood," printed in Lima, 1723. EPIDEMICS IN PEliU. 137 from twelve to thirteen hundred fathoms above the sea. But neither of these conditions belonged to the Peruvian pesti- lence of 1719-20. We have shown that it attacked the white race, or Spaniard ; and far from being the offspring of the cold Cordillera, it originated in the warm maritime pre- cincts of the Rio de la Plata, where, so recently as 1858, yellow fever had intruded itself from the Brazils. In the progress of this epidemic of 1719-20 northward from Buenos Ayres to Central Peru, it diverged eastward from Cuzco into the warm and humid woodlands on the Atlantic side of the Andes, where it is reported to have produced its greatest mortality among the savage tribe of Chuncho In- dians.* Of the Peruvian epidemic of the year 1759, we have spe- cial intimation in the Noticias Americanas, p. 202-3, by Don Antonio de Ulloa. This malady, like that of 1719-20, took its rise in the southern or south-east provinces. Its precise place and manner of origin was not easily traced in regions so extensive and remote ; but when it was first heard of by those who lived near the , it had already arrived at Chuquisaca and Potosi, whence it extended to La Paz, Oruro, Chucuito, Cuzco, Guamanga, Guancavilaca, Iauja, and Lima; and it continued its course through other provinces along coast and mountains?" alto y bajo"?until it reached . Its progress was extremely rapid, for in the short space of five or six days not one individual, young or old, remained free from its attack, though some were affected less severely than others.f The streets were aban- doned and desert; the market places had neither buyers nor sellers; the houses were solitary, with all their inmates prostrate. Ulloa remarks, that "The providence of God only permitted the disease to continue in force in well-con- stituted individuals for two or three days; and though by the end of this time they remained excessively weak, they could in some degree help others in a worse condition than themselves." The symptoms of this as Ulloa, con- " pestilence, given by sist of great dizziness and heaviness of the head ; a feeble- ness in all the senses ; strong pains all over the body ; fever moderate?" calentura no muy violenta," literally, not very violent; general lassitude ; blood from the mouth and nos-

# " Unanue, Sobre el Clima de Lima", ? vii, p. 25. + En el termino de 5, o' 6 dias no quedaba persona grande, ni pequena, que no adolesciese de ella, manifestandose en unas con mas rigoi' que en otras. (Ulloa.) 138 EPIDEMICS IN PERU.

trils; deafness; great prostration ; and complete loss of appetite." Such as were subject to habitual ailments, par- ticularly of the chest, found these complaints aggravated when attacked by the epidemic, and in protracted cases they succumbed. Those who were free from previous disease recovered under the use of diaphoretics and a warm, sweat- ing regimen. After the force of the attack had passed away, its effects were long felt during a tedious convales- cence, for the body continued weakly, the sight perturbed, the aspect sad, and the mind depressed. It required more than a month to dissipate these dregs of the disease. As this pestilence was rapid in its invasion and progress, so also it was of short duration, for it fortunately terminated after a reign of about one month. In those more remote southern provinces, where it first was observed, the mortality was greater from ignorance of the right manner of treatment. It was noticed that the use of the lancet was not only pernicious, but fatal; and the more approved mode of cure ultimately adopted was the simple sudorific regimen already mentioned. Don Antonio de Ulloa suggests that a comet which appeared in those regions of , on the 25th April, 1759, might have had some meteorological influence as a precursory cause of this epidemic, which, to all appearance, was of atmospheric origin; for during the month of July, and even from the month of April, the south winds prevailed, and the stream of infection, like the current of the wind, ran from south to north. Were we to imagine that the malady was conveyed by contagion from one person to another, then we should allow that its propagation could not be so extensive and rapid as it proved. Dogs partook of the disorder, and they might be seen stretched in the streets without ability to stand on their feet; yet it was observed of them, as of well-constituted men, that though many suffered, few died of this epidemic.* In Lima, where chronic disease and weakly constitutions are very prevalent, Dr. Unanue tells us that the pestilence of 1759, described by Ulloa, was the same in kind, though less in degree, with that of the inland regions in 1720.

* In the Cuzco pestilence of 1720, we are told that the dogs in packs fed on the dead bodies of the epidemised, on which they appeared to thrive, until they were shot or otherwise destroyed. The corpses were thus scattered abroad at the mercy of hungry hounds, for want of able-bodied men to collect and bury them in sufficient time. Funeral rites were also omitted, for want of opportunity and the necessary number of priests to meet the urgency of the occasion. EPIDEMICS IN FERU. 139

And, again, in 1749, during the first days of autumn, this epidemic, or rather another of the same nature, appeared in Lima, and committed great ravages there, as recorded by the municipal authorities and medical corporation of that capital.* Humboldt, judging from what he calls the "incomplete description of Ulloa," characterises the epidemic of 1759 as a "typhus peculiar to the elevated regions of the Cordillera."f This malady was no doubt of an adynamic nature, but so ephemeral as hardly to merit the name of typhus. It cannot be said to have been peculiar to the Cordillera range ; for while, as Ulloa says, it commenced in some indeterminate climate of the southern provinces, towards Buenos Ayres or Brazil, in Peru it spared no race or age, and spread from " Lima northward, by alto y baxo," by highlands and coast lands to the equatorial of Quito and other parts. Hcemorrliagic Disease.?During the year of 1736 a dis- ease called by the natives Matlazahuat.1, and consisting of haemorrhage, or bloody flux from the nose, destroying the power of life in a few hours, prevailed at . It raged during the rainy season, namely, the months of May, June, July, and September, attacking the higher portions of the town, and destroying the greater number of the inhabitants. This was the only disease prevalent at the time. In 1855, the disease reappeared in the months above- mentioned ; thermometer averaging 10 to 24 degrees cen- tigrade ; atmosphere moist; height of city of Mexico 7400 feet above the sea. It attacked chiefly women of sanguine temperament, and between the ages of 35 and 50. Mr. J. Tobin, assistant-surgeon 36th Regiment, described the symptoms and treatment of the disease as follows :? " Symptoms :?Patient seized suddenly with sense of ful- ness about the head, cold extremities, skin cool, pulse regular, great pulsation of carotids, haemorrhage now super- vened from the nose, and destroyed life in a few hours, from sixteen to twenty-four hours. The blood is florid, but does not flow continually ; but at intervals the pulse gradually becomes weaker, and the patient remaining conscious till the last moments, generally dies after syncopy. Hiccough often precedes death. This disease is not contagious, and does not generally attack Europeans, nor is it liable to seize new comers. Convalescence is slow. In fatal cases, soon

* " Dr. Unanue, Sobre el Clima de Lima", p. 124. f Essai Politique, livre v, ch. xii, tome iv, p. 483. 140 EPIDEMICS IN PERU. after death, the skin often assumes a purple colour, chiefly over the upper portions of the face. " Treatment:?Sinapisms to calves of legs, and foot-bath, with mustard or salt and ashes. The anterior nares plugged with some sponge ; and the application of iced metal plates over the forehead."*

In reference to the epidemic of 1719-20, its chief point " of resemblance to the Mexican Matlazahuatl" consists in the emission of blood from the nostrils, which cannot be considered as pathognomonic, as it is equally a frequent concomitant in the malignant malarial fevers of the coast and deep warm inland valleys of Peru. But were I to look for stronger symptoms of agreement between the epidemic of 1759, as described by Don Antonio de Ulloa, and some more recent Peruvian pestilence, I would direct the atten- tion of the Epidemiological Society to that precursory dis- order which, in 1852-3, was introductory to the outbreak of declared yellow fever in January, 1854. The epidemic of 1852 was ushered in by the usual signs of a severe cold?such as suffused eyes and a sensation of tension over the forehead, pains in the limbs and loins, and in the more severe cases, general muscular uneasiness, which lasted for several days without remission, until the circula- tion and secretions became free, and the fever abated; or terminated altogether by perspiration. In not a few patients of those days might be observed insomnolency and a vague wandering of thought, headache, and general restlessness of body ; and after the invasion had passed, and the fever was established, the pulse was in some cases as low as eighty, and rarely exceeded ninety, in native and acclimatised individuals. The febrile stage of this mild, though widely-spread, epidemy usually disappeared with a critical flow of blood from one or both nostrils ; or with the presence of a peculiar red, or rosealous, eruption on the skin, and a free, but pecu- liarly fetid, perspiration, leaving behind great weakness, lassitude, and inappetency, from which (as in the epidemic of 1759) it often took several weeks to convalesce.* Again, in the epidemy of 1853, as witnessed by myself in Lima in the earlier months of that year, the red eruption was much less prevalent than in the earlier stadium of 1852.

* I am indebted for this information to a manuscript in the possession of the late Dr. J. O. M'William, and which was read to me by himself shortly before his death in April, 1862. EPIDEMICS IN PERU. 141

I have elsewhere shown how the successive pestilences which reigned on the Andes of Peru from the later months of 1853 to 1857 inclusive were marked, like the contemporary yellow fever of the coast, by well defined stages?the diffe- rent distinctive forms being developed during the second stage. In the transition from one of these periods to the other, viz., from the first to the second, red, purple, and black maculae of different dimensions and import, appeared on the skin ; while, in continuation, the surface of the body frequently assumed a yellow colour, sometimes of a deep, but oftener of a bright tint, like broom blossom ; and, finally, in many instances, where the epidemised were cut off, only a few hours after being suddenly attacked by this relentless malady, the transudation from the dead body imparted a yellow hue to the spot where the victim fell, or to the bed and bed-clothes, when the deceased was so fortunate as to have had these comforts. No such descriptive symp- toms as now enumerated are noticed in the existing his- torical records of the older Peruvian Andine epidemics, and we may therefore reasonably conclude that none such existed.

* As an addendum, it may be here noted that in the year 1797, a fever of the nature of Tabardillo (typhous) broke out spontaneously in the mountains of Cajatambo, about 35 leagues to the N. of Lima (at Calpa), and was thence imported to the coast region of Chancay by an infected individual. Under a new combination of local and atmospheric conditions this disease became epidemic, and presented in various instances a great degeneration of type, as indicated particularly by the ominous symptoms of green and black vomit, merging into vomito-negro. (Villalobos on the Epidemic of Chancay, 1796- 1797 : Lima, 1800.) It may be further recorded in this place, that contemporaneously with the irregular form of yellow fever that broke out in Lima early in 1818, a disease very similar to it in many respects, and very possibly transmitted from the coast, became general in the transandine town called Jarma, at an elevation above the sea of about 10,000 feet, and 120 miles N.E. of Lima, lat. 11 deg. 25 mins. S.; and long. 75 deg. 30 mins. W. The symptoms of this disorder were "Fever, strong headache, bodily heaviness, petechias, haemorrhage by nose or mouth, and irritation in the throat and glands of the neck." See Lima Guia de Forasteros, or Almanac for 1819. See, also, Geographical Summary of the Yellow Fever Epidemics of Peru, p. 210, Brit, and Foreign Med. Chir. Review, Jan. 1855.