Pre-Columbian Diseases
On the eve of the European arrival, there are only a limited number of diseases that can be documented for South America. The best evidence survives for Peru in the ceramics of the Moche and Chimu, who accurately depicted diseases, ulcers, tumors, and congenital or acquired deformities in their portrait pots, and in the remains of mummies and skeletons preserved in the coastal deserts and at high altitudes in the Andes (Perera Prast 1970; Horne and Kawasaki 1984).
Because so many ancient Peruvians lived in crowded towns and cities, it is hardly surprising that paleopathologists have found evidence for tuberculosis, a disease so often associated with urban populations (Cabieses 1979). In a study of 11 mummies from Chile and Peru, two dating from A.D. 290 had “cavitary pulmonary lesions from the walls of which acidfast bacilli were recovered.” According to William Sharpe, two of these mummies have “diagnoses of tuberculosis about as solidly established as paleo- pathologic techniques will permit” (Sharpe 1983).
A second disease for which convincing evidence survives is arthritis. According to Fernando Cabieses (1979), Peruvian museums have many vertebrae and bones that reveal “typically rheumatic injuries.” While examining these remains, A. Hrdlicka discovered a type of arthritis of the hip in adolescents, which modern experts identify as Calve-Perthes disease (Cabieses 1979). Another specific study on bone lesions in skeletons from Chancay, in coastal Peru, documents osteoarthritis in the skeletal remains (Berg 1972), and Jane Buikstra (in this volume, V.8) reports a “convincing case of juvenile rheumatoid arthritis in an adolescent from the Tiwanaku period.” A mummy of a young girl of the Huari culture exhibits “one of the earliest known cases of collagen disease” with “many aspects compatible with SLE” (systemic lupus erythematosus) (Allison et al.
1977).Evidence for the presence of treponematoses (venereal syphilis, yaws, endemic syphilis, and pinta) also exists for Peru and northern South America. Although the debate on the origin of venereal syphilis continues unabated, skeletal remains suggest that some type of treponemal disease existed in South America before 1500 (see Buikstra in this volume, V.8). Some deformations in bone surfaces in skeletons and a skull from Paracas in coastal Peru suggest venereal syphilis (Cabieses 1979). Sixteenthcentury chroniclers in Peru also described bubas (a word used for syphilis and yaws) in Spanish con- quistadores, such as Diego de Almagro, who had had sexual intercourse with Indian women. Furthermore, in sixteenth-century Chile more Spaniards than Indians suffered from bubas (Costa-Casaretto 1980), which may suggest that the Indians had a longer experience with a treponemal disease than did the Spaniards. At that time it was a “seemingly venereal ailment that produced genital secretions” (Cabieses 1979). According to Francisco Lopez de Gomara, “all Peruvians” suffered from bubas (Cabieses 1979). The problem, however, is that bubas is such a vague term used for skin sores or ulcers that it could refer to verruga (Carri6n,s disease) and yaws, whereas Cabieses (1979) believes that bubas descriptions resemble Nicolas-Favre disease (lymphogranuloma).
Another treponemal disease, pinta (also car ate), was called ccara by the Incas (Guerra 1979) and is now endemic in Colombia. Descriptions of pinta in Colombia date from the arrival of the Spanish, who adopted the Indian name for the disease: carate. The Jesuit Juan de Velasco often observed the disease, and it seems to have been a common skin disease in slaves (Chandler 1972). Colombia is also one of the few countries in which yaws, pinta, and venereal syphilis occur together (Hopkins and F16rez 1977).
Possibly confused with treponemal diseases that cause skin changes was bartonellosis (Carri6n,s disease, Oroya fever, Peruvian verruga).
Characterized by high fever, anemia, and a warty eruption on the skin, it severely afflicted Francisco Pizarro’s soldiers when they invaded Peru (Hirsch 1885). In one area of Ecuador, Spanish soldiers died of it within 24 hours or suffered from warts “as large as hazelnuts,” whereas the Indians experienced less severe forms of the disease (Cabieses 1979). Pre-Columbian ceramics depict the warty eruptions of the disease, whereas a case of Carrion’s disease in the warty phase has been documented in a mummy of the Tiwanaku culture (Allison et al. 1974b). On the basis of this evidence, as well as the high Spanish mortality in verruga areas in the Andes, there is little doubt that this endemic disease was of great antiquity in the Peruvian Andes (Herrer and Christensen 1975).Another old Peruvian disease is uta, a type of leishmaniasis (Herrer and Christensen 1975). The Spanish called it the “cancer of the Andes,” since it left ulcers on the nose and lips and often destroyed the septum. Pedro Pizarro may have described it when he reported that “those who entered the jungle contracted a ‘disease of the nose’ very similar to leprosy for which there was no cure” (Cabieses 1979). Ceramic evidence of mutilated noses and lips also documents the existence of uta in the preColumbian period for Colombia and Peru. A preColumbian ceramic from Cundinamarca, Colombia, where leishmaniasis is now endemic, depicted “mutilated nasal tissue” on an Indian’s face (Werner and Barreto 1981).
In contrast to uta and Carri6n's disease, American trypanosomiasis (Chagas’ disease) is difficult to document before the sixteenth century. It is, however, unquestionably of New World origin, because the vectors and the disease do not exist outside of the Americas. Now one of the most important vector- borne diseases in South America, Chagas’ disease extends throughout much of the interior of South America, but especially from northeastern Brazil to north central Argentina in a wide savanna corridor sandwiched between the coastal forests and the tropical rain forests of the Amazon (Bucher and Schofield 1981; Schofield, Apt, and Miles 1982).
Because this region was remote from the Incas or coastal European settlements, historians know little about the disease before 1500. The earliest descriptions of Chagas’ disease symptoms were made in sixteenthcentury Brazil, whereas those for the vectors (triatomine bugs) date from the sixteenth century for Chile, Argentina, and Peru and the seventeenth century for Bolivia, where the illness is still endemic (Buck, Sasaki, and Anderson 1968; Guerra 1970; Schofield et al. 1982). Charles Darwin was attacked by triatomine bugs - what he termed “Benchuca” - when he traveled through endemic areas in 1835 (Schofield et al. 1982). Because of the way in which Chagas’ disease causes facial edema, it was sometimes confused with endemic goiter, which often occurred in the same regions because of the lack of salt in the diet (Guerra 1970). The Incas identified goiter as coto (Guerra 1979).Another disease of the Brazilian interior that may have existed among “the aborigines of Brazil” (Silva 1971) is fogo selvagem (endemic pemphigus foliaceus), which means wild fire in English and is endemic in central Brazil along the Tocantins and Parana rivers and their tributaries. In 1902—3, Caramuru Paes Leme reported it among the Indians living along the Araguaia River of central Brazil, whereas another good description of the disease from 1900 dates from Bahia, a state near the Tocantins River. Apparently, fogo selυagem was limited in incidence as long as the Brazilian interior was sparsely settled or people avoided living along the rivers. Since the construction of Brasilia and the opening of the interior to the landless poor, the disease has spread to Acre, Amazonas, and Rondonia, where it was once unknown, as well as to neighboring countries (Diaz et al. 1989).
Since many of the pre-Columbian peoples in the Andes raised animals for food and wool or kept them as pets, intestinal parasites may have been common. Some parasite remains have been recovered in autopsies on mummies from Chile and Peru.
An examination of the body of a young boy revealed Trichuris trichiura on3l as well as those for head lice (Horne and Kawasaki 1984). According to chroniclers, the poor in the Inca Empire had to “pay tribute in the form of small containers of lice.” Not surprisingly, typhus was “a very common disease in ancient Peru” (Cabieses 1979). Evidence of pinworms from Chile and hookworm from Brazil has been collected in fossilized feces (Parasitologista 1986), whereas a mummy of the Tiwanaku culture yielded hookworms from around A.D. 900 (Allison et al. 1974a). Tunga penetrans, the chigger that burrows into the feet where it lays its eggs and causes painful foot ulcers, was native to Brazil. In the nineteenth century it spread to Africa (Crosby 1986) and thus was one of the few New World vectors to migrate to the Old World.On the eve of the conquest, the people of South America had a limited number of diseases: tuberculosis, arthritis, and one or more treponemal diseases - Carri6n,s disease, uta, Chagas’ disease, endemic goiter, and hookworm infestation. In addition, many doubtless suffered from nonlethal diarrheas caused by other worms and parasites as well as from foot ulcers caused by the chigger. Unspecified fevers, such as typhus, also caused ill health; and viruses have even been found in a well-preserved mummy from near Santiago, Chile (Home and Kawasaki 1984). Not all diseases existed everywhere, however, because of known environmental limitations, particularly of the vectors. Carrion’s disease, for example, occurs only where the sandfly lives, whereas Chagas’ disease follows the range of the triatomine insects. Thus, prior to 1500, diseases were limited to specific environments (tuberculosis in the cities and towns) or vectors, and few deadly epidemics decimated populations.