Old World Diseases

Which of the new diseases brought to the New World by the Europeans first touched South America is unknown, but the best documented disease in terms of its progression is smallpox. In 1514 smallpox may have arrived in Panamá with a group of Spanish colonists (Hopkins 1983). Because of frequent trade and communication between the isthmus and Peru, smallpox preceded the Spanish into the Inca Empire. A devastating illness of the mid-1520s, characterized by "fever, rash, and high mortality," struck the Inca and his imperial court in Quito and killed the Inca, Huayna Capac; it also killed many in the capital of Cuzco. Henceforth, smallpox would sweep ahead of the Spanish conquistadores and claim thousands of victims before they arrived. By 1554 it had reached as far south as Chile, where it attacked the Araucanians. A year later it appeared at Rio de Janeiro among a group of French Huguenots, who spread it to the coastal Indians. They in turn fled into the interior, where they passed it on to others living far from the coast. By the 1590s it was decimating the Indians of Paraguay (Luque 1941). Jesuit missionaries unwittingly took the contagion as far inland as the Upper Amazon, and from the seventeenth century on, smallpox epidemics reappeared in even the most remote parts of the interior. The continuous arrival of ships from Portugal, Spain, and Africa would renew the epidemics, and, because control measures were often ineffective, smallpox would continue to ravage South America until it was finally eradicated in Brazil in 1971 (Hopkins 1983; Ruffié and Sournia 1984; Lanning 1985; Alden and Miller 1987).

Less easily traced but often as virulent in its impact on the Indians was measles, which often accompanied smallpox epidemics or was confused with the disease. It arrived in Peru in 1530-1 (Ruffié and Sournia 1984), settled in among all population groups, exacted a high cost in lives among mission Indians and Africans in the slave trade, and reappeared in frequent epidemics throughout the centuries (Luque 1941). It continued to attack isolated Indians as late as the 1980s, as road builders and settlers opened up the Amazon region to migrants and their children from endemic-measles areas.

Next to smallpox and measles, possibly the major killers of the Indians, past and present, were the respiratory diseases, which early missionaries and miners inadvertently encouraged by gathering Indians into mission villages and mines, where influenza and the common cold could sweep from person to person with lethal impact. Pneumonia, tuberculosis, and bronchitis also preyed on the survivors. Peruvian Indians forced to work in the mines died of pneumoconiosis and silicosis (Munizaga et al. 1975); only by fleeing the missions, mines, and European settlements could Indians survive. In the 1990s, their descendants still confront, and die of, the same diseases.

Because so many Indians could and did flee into the interior, the impact of European diseases in sixteenth-century South America was uneven and possibly less catastrophic in some regions than in Mexico. Population decline in the southern highlands of Peru, for example, was not as precipitous as in coastal Peru (Cook 1981) or central Mexico. Nonetheless, all peoples would eventually suffer depopulation as a result of flight, disease, forced labor, warfare, and the massive disruptions in indigenous food supply and consumption that accompanied the European conquests. In other words, although environmental diversity blunted the catastrophe that so quickly overtook the Caribbean and Mexican populations in the sixteenth century, it also prolonged the trauma of the impact of disease through the centuries until the present.

On the other hand, much of South America's environment facilitated the establishment of new mosquito-borne diseases in the tropical lowlands of northern South America, the Amazon basin, and coastal Brazil. These diseases came from Europe and from Africa aboard slave ships and in the bodies of the African slaves forcibly imported into South America.

The first of these great killers was malaria; when and where and in what form its parasites and vectors entered the continent has long been debated (Dunn 1965). Malaria may have been indigenous and hence may have been the reason ancient Peruvians built their houses far from the rivers (Cabieses 1979); it also might have been one of the "fevers" that attacked the Inca armies as they invaded the Upper Amazon (Cabieses 1979). On the other hand, this seems unlikely, given population densities achieved in the Upper Amazon before the conquest.

Prevailing opinion is that malaria was an imported disease, and one or more strains of malarial parasites were undoubtedly introduced into the Americas in the sixteenth century from endemic areas in Europe and Africa (and, as a matter of fact, as late as 1930 when an epidemic spread by A. gambiae erupted with particular virulence in Brazil) (Marks and Beatty 1976). Sixteenth-century Jesuits recorded attacks of fever throughout the tropics; and a century later Europeans discovered the treatment for these fevers, cinchona bark (the source of quina or quinine), but did not use it very effectively (Luque 1941; Dunn 1965; McCosh 1977). In the eighteenth century, malaria was known as sezoes in the Brazilian interior, and by the nineteenth century as intermittent or pernicious fever (Documentos 1942; Karasch 1987). More recently, scientists identified and classified the parasites and vectors as causal agents, and widespread spraying with insecticides followed, retarding malarial incidence until the 1980s, when it once again became a serious problem of health. A chloroquinine-resistant strain of parasite, and massive deforestations in Rondonia and other parts of the Amazon have led to significant outbreaks of malaria among miners, Indians, and settlers in the region.

Urban yellow fever is more easily traced than malaria in historical sources, owing to the distinctive bloody (black) vomit and high mortality with which it is associated (Goodyear 1978). One of the first unmistakable descriptions of the disease dates from 1623, when Aleixo de Abreu, who had served in Brazil and Africa, wrote his Treatise of the Seven Diseases in which he described a "disease of the worm" marked by blood vomit. The disease, henceforth to be called bicha or os males (the evils), took epidemic form in Pernambuco in the northeast of Brazil between 1685 and 1694 (Rosa and Franco 1971) and then apparently disappeared until it attacked Salvador and Rio de Janeiro in 1849 (Ward 1972; Cooper 1975).

The first good descriptions of sylvan or jungle yellow fever date from 1898-9 from the interior of Sao Paulo when the authorities encountered cases of yellow fever "in full virgin forest" (Franco 1969). Since the mid-nineteenth century, yellow fever (in both its urban and sylvan forms) has swept through tropical and subtropical South America (Henschen 1966). Because of successful twentieth-century eradication programs that began with the efforts of Osvaldo Cruz in Brazil in 1903, yellow fever was eliminated from many parts of the continent. It has, however, resumed the offensive in the 1980s as settlers have moved into areas of sylvan yellow fever or built towns in the Amazon region that created optimal breeding conditions for A. aegypti, the most prominent vector of the disease, and thus for the transmission of urban yellow fever. Indeed, the breakdown in public health programs in coastal cities of South America has led to the reappearance of the vector A. aegypti in cities such as Rio de Janeiro and sporadic outbreaks of yellow fever. Most cases continue to be reported in the Amazon region or other parts of rural, tropical South America. As James Ward concluded in 1972, "Yellow fever is not a disease of the past" but rather "a disease of the present" in South America.

A third tropical fever is dengue, which attacked Lima, Peru, in 1818 and northern South America in the 1820s. By the 1840s it had reached Rio de Janeiro (Hirsch 1883). Since that time, dengue is often difficult to trace because of its confusion with other fevers. With the eradication of its vector, A. aegypti (which also carries yellow fever), in twentieth-century coastal cities, dengue retreated until the 1980s, when it again swept urban, southeastern Brazil - wherever the vector had reestablished itself owing to faltering public health campaigns. By 1990 it was in the Amazon region as far inland as Iquitos, Peru.

Next to the tropical fevers in virulence were other diseases that reached South America from Africa. As long as the slave trade with Africa existed, so too did epidemics associated with Africans and the trade (Karasch 1987). Thus, until the effective abolition of the slave trade to Brazil in 1850, smallpox and measles attacked slave ships and port cities or wherever infected Africans were unloaded for sale. Dysentery (Hirsch 1886; Karasch 1987) preyed on those confined to slave ships and the great slave markets of Cartagena, Salvador, Buenos Aires, and Rio de Janeiro. From the markets it often spread to kill untold victims in the coastal cities and neighboring Indian missions. Intestinal parasites infested most slaves, and sometimes led to wormy ulcers in the rectum, the malady known as bicho or maculo in Brazil and Africa (Guerra 1970). Schistosomiasis (S. mansoni) settled into coastal Brazil (Silva 1983), Suriname, and Venezuela (WHO 1985), whereas leprosy reached into the interior of the continent to as far as Goias in the eighteenth century and the tropical lowlands of Colombia. Filarial worms (filariasis) found congenial breeding grounds in the swampy lowlands of Brazil and northern South America, and soon the bodies of their human hosts swelled to "elephantine size." The African disease ainhum, which led to the loss of toes, was observed in slaves in Brazil (Peixoto 1909). Blinding eye diseases of conjunctivitis and trachoma (ophthalmia) accompanied slave ships and attacked coastal cities and plantation areas. Onchocerciasis found new vectors in northern South America and settled into the river valleys of Colombia's Pacific lowlands (Trapido, D'Alessandro, and Little 1971), Venezuela, and northern Brazil (Pan American 1974). The Guinea worm arrived in the bodies of Africans, along with a variety of other worms and parasites. The sarna, or "itch," caused epidemics of itching on ships and in ports, whereas scurvy, pellagra, and beriberi, as well as other nutritional diseases, affected slaves fed manioc or corn with beans and a little dried beef. Yaws swept through slave quarters and settled down among blacks in coastal Colombia, where it is still endemic (Chandler 1972). In blacks it was often confused with syphilis. Once the slave trade ended, the most lasting legacy of these waves of epidemics was the establishment of the African diseases as endemic diseases in tropical South America.

The diseases of the slave trade were followed by a new wave of diseases in the nineteenth century, as European and Asian immigrants replaced the Africans. German colonists brought epidemics of typhus to southern Brazil, whereas severe outbreaks of diphtheria and scarlet fever, probably accompanying the Europeans, attacked southern South America (Hirsch 1883; Karasch 1987). This was, however, not the first time diphtheria had appeared in South America. In 1614 it struck Cuzco, Peru, and reportedly touched every household (Marks and Beatty 1976; Cook 1981). As once small towns grew into densely crowded cities with slums lacking clean water or sewer systems, the incidence of typhoid fever increased and hepatitis worsened.

Tuberculosis attacked the black slaves and the poor of the growing cities with exceptional virulence. Indeed after the late nineteenth century, possibly more died of tuberculosis in cities like Rio de Janeiro than of the "great tropical killers" as a result of swamp removals and public health campaigns against mosquito habitats. As so many rural migrants crowded into urban slums with precarious food, water, and health care, the frequency and virulence of these "urban" diseases increased dramatically.

These urban slum populations would be among those to fall prey to a new disease that appeared in South America for the first time in the nineteenth century: Asiatic cholera. This Asian import was first reported among sailors coming from Europe to Brazil in 1855. The first Brazilian case occurred in Belem in 1855 with the next in Salvador about a month later, followed by cases in Rio de Janeiro. This first great epidemic of 1855-6 may have claimed up to 200,000 lives in Brazil alone (Cooper

1986). It also attacked Argentina and appeared in a major epidemic during the Paraguayan War (1864-70), where it claimed both civilian and military lives (Reber 1988). Cholera continued to reappear in epidemics throughout the continent until twentieth-century public health campaigns brought it under control.

Another Asiatic disease that has settled into South America is the bubonic plague. How it came to survive in countries as far distant as Brazil and Ecuador is still uncertain. In 1899 the plague broke out in Rio de Janeiro and Santos (Vianna 1975). About 9 years later, in 1908, merchant ships introduced the plague into the port of Guayaquil and coastal Ecuador, from which it spread to the highland populations, among whom it was still endemic in the 1930s (Jervis 1967). Most cases of plague, however, occurred in Brazil, especially in the region of the Northeast. In 1903 an epidemic of plague broke out in Maranhao and Para, and the disease was well established in the interior of Pernambuco by the 1920s (Oliveira 1975; Vianna 1975). In 1973 Brazil registered 35 percent of the cases of plague reported to the World Health Organization (Marks and Beatty 1976). Over 10 years later, from 1984 to 1986, epidemics of bubonic plague erupted in Parafba and Minas Gerais, but isolated cases occur every year in the states of Ceard and Bahia. Only rapid medical intervention prevents a high mortality (Peste 1986).

In most of the twentieth century, public health programs and massive immunization projects, combined with the removal of mosquitoes and their habitats, led to the control of many epidemic diseases. Exceptions are the great influenza epidemic of 1918-19, which exacted the same high cost in lives in South America as elsewhere in the world, and the AIDS epidemic of the 1980s, which rages unchecked in the heterosexual population of Brazil. In the 1960s modern medicine and scientific technology had seemed to be victorious over epidemic disease, but in the 1980s the deteriorating economies of South America have stifled public health and immunization programs. Children's diseases such as measles, chickenpox, and pertussis once more prey on the nonvaccinated, whereas polio cripples children and meningitis sweeps through the slums of Brazil. Diarrhea and dehydration kill infants, and intestinal parasites plague the poor. Schistosomiasis saps their strength, and Chagas' disease extends its range as deforestation changes habitats and people continue to live in thatched-roof houses, where the vector hides. Malaria, yellow fever, and dengue have once more re sumed the offensive as a result of the environmental changes in the Amazon region and the reestablish-ment of vectors in the towns and cities. While the ancient Peruvian fevers still attack and disfigure the rural poor, unknown but deadly fevers have erupted in settlers along the Trans-Amazon Highway. Viral hemorrhagic fevers, for example, whose victims died of massive bloody hemorrhages, erupted in the 1970s and 1980s. Even cholera reappeared in South America in the early 1990s.

The combination of population growth, environmental devastation, and deteriorating public health services due to a debt crisis and capital outflows have led to severe setbacks in the modern campaigns to contain epidemic disease in South America. As the number of rural and urban poor increase, so too does the frequency of disease, since so many diseases, such as Chagas', hepatitis, and typhoid, are often linked to low socioeconomic standards of living. Thus, although once isolated from the onslaught of Old World diseases, the South American continent now suffers from all those illnesses that international travelers carry with them from the urban coastal cities to the most remote parts of the Amazon region. Unless economic and political strategies are developed to improve public health in the 1990s, the diseases of both the Old and the New World will continue to flourish and grow in virulence in South America.

Mary C. Karasch

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