Peru Epidemic

The revised paper was subsequently published with the other papers from this symposium by Harvard University Press, see:

The Catastrophic Convergence of Inca Imperial Policy, Sand flies, and El Niño in the 1524 Andean Epidemic

The invasion of the Inca realm by Pizarro and his followers after 1530 caused a sudden and dramatic re-direction of Andean cultural evolution. All accounts agree that the rapid Spanish conquest followed a period of dynastic destabilization and subsequent civil war between the contending claimants to the imperial authority following the death of the last legitimately installed Inca emperor, Huayna Capac, and many of his relatives in a widespread epidemic circa 1524. We have argued at length elsewhere against previously accepted diagnoses of smallpox while advancing our contention that bartonellosis was the real cause of this outbreak. (Kiracofe and Marr, 2002)

Recent research (2002 Jiayu Zhou, et al.) demonstrates the relationship between el Niño events and the cyclical occurrence of bartonellosis outbreaks in the Andean region and shows how el Niño events dramatically increase the intensity of bartonellosis epidemics and permit the spread of the disease into new areas. In what follows we will briefly describe the disease, explain its mode of transmission, and show how the military campaigns of Huayna Capac along the Manabi Coast of Ecuador set the stage for a wide spread disaster. We will conclude by showing how the evidence points to a convergence of Huayna Capac’s fatal campaigns with an el Niño event.

Bartonellosis

Bartonellosis is a potentially fatal, exclusively New World arthropod-borne bacterial disease, long endemic in the northeastern Andean region. Its acute phase is characterized by irregular fever, headache, muscle aches and pains and a severe hemolytic anemia that may lead to death if untreated. The acute phase of bartonellosis is known as Oroya fever, named after an 1871 epidemic that killed 8,000 railroad workers along the Lima-La Oroya railroad line in the Rimac Valley of Peru.

A chronic phase may follow in weeks or months and is referred to as verruga peruana (or Peruvian wart), so named by a highly vascularized, wart-like nodular (and occasionally pedunculated) skin eruption that may cover the entire body, but is usually most prominent on the extremities. Prior to 1913 the disease was known as Carrión’s disease, an eponym conferred on the Peruvian medical student, Daniel Carrión, who in 1885 through self-experimentation, gave his live discovering the linkage between Oroya fever and verruga peruana. Transmitted from person to person by the bite of sand flies, the disease is caused by a bacterium, Bartonella bacilliformis, named in honor of the Peruvian bacteriologist, Alberto Barton.

In historic times epidemics of bartonellosis occurred in public works projects and armies on the march. The Incas mobilized tens of thousands of rotational laborers from various regions of the empire, concentrating them on vast construction projects. The symptoms of Huayna Capac’s illness reported in the early accounts, including fever and a severe skin rash, while resembling smallpox in some ways, we now know more accurately correspond with clinically documented symptoms of bartonellosis, a disease then unknown to the Spanish. [see figure 1]

Jiménez de la Espada in his Antigualla Peruana, mentions an epidemic, of what he called smallpox at the time of Huayna Capac’s death. In his Relaciones geográficas de Indias, he also copied the following regarding Tomebamba: “In which Huayna Capac was during ten years for it was his major residence rather than any other, and in this time befell a very great illness and pestilence in which innumerable people died of a measles that opened everyone to an incurable leprosy of which died Lord Huayna Capac.” (Polo, 1913, authors’ translation)

A pre-Columbian ceramic found near San Isidro shows verruga peruana in a severe manifestation, such as suffered Pizarro’s men when they passed through the same area. (Alexander 1995, Cieza de León 1998, p. 469) [see figure 2]

Other pre-Columbian evidence of the presence of bartonellosis is found in the mummified remains of a ritually sacrificed young man, demonstrating that armies on the march were an important triggering mechanism for epidemic bartonellosis in the pre-Columbian world, as they have been in modern times. (Allison et al. 1974, 298)

Epidemiology of Bartonellosis

Bartonellosis is endemic to certain mountain valleys throughout the northwestern Andes region, but recent research has expanded the geographical distribution of its vector (various Lutzomyia species), as well as human cases. The pathogenic organism resides in both symptomatic and asymptomatic (carrier) human reservoirs where its potential infectivity may extend for years. Recently the possibility of a rodent reservoir has been postulated since infected Lutzomyia species were recovered in areas with sparse human populations. (Cooper et all. 1997)

The interval between the acute and chronic phases may be variable. As Barbara A. Ellis, et al. pointed out, “…the cutaneous phase of the disease does not always follow the anemic phase.”(Ellis et al. 1999, p. 348) In addition, the anemia caused during the fulminant hemolytic onset may linger and remain a debilitating factor even during the dermatological presentation. (Salazar 1858) Between the acute and chronic manifestations there may be an asymptomatic intermediate period.( Maguina and Gotuzzo 2000, p. 5) The disease is transmitted indirectly from person to person by phlebotomine sand flies. (Ellis et al. 1999 p. 344, and Ihler 1996, p. 2)

The incident at the La Oroya railway bridge was the single most deadly outbreak recorded in modern times. ( Garcia-Caceres, et al. “Bartonellosis…” p. 61. It is “said to have killed more than 7000 of the 10,000 workers building the railroad between Lima and La Oroya.”(Ihler, et al. “Bartonella…”. p. 2) This would mean a general mortality rate in excess of 70%. This exceeds the typical mortality rates of smallpox, stated to have been 20-40% or more, in the standard text, and the stated case mortality rate for plague of 50-60%. ( Chin 2000, p. 456 and 381) “Untreated, Oroya fever comes close to having the highest death rate of all infectious diseases, 40-85%, since essentially 100% of the red cells can be parasitized, and because of secondary bacterial infection.”( Ihler 1996, p. 2) Thus, even in isolated areas, with an inapparent asymptomatic human reservoir, bartonellosis can quickly erupt in epidemic fashion with extremely high mortality rates, since infected sand flies can effectively spread the disease, rapidly infecting thousands of susceptible non-immune individuals entering the area, such as armies or construction workers.

Human reservoir populations in endemic foci may develop immunity to the disease so that many members of a community may act as carriers and have minimal, sub-clinical or no symptoms of disease. (Amano et al.,1997 p. 178) New outbreaks with subsequent development of additional endemic foci may result when asymptomatic infected populations travel through or settle in adjacent non-immune areas where sand flies are present. Alternatively, non-immune members from outside communities may pass through endemic areas, become infected and then pass into other areas heretofore free of disease. Thus, in any area with human and sand fly populations, bartonellosis may be introduced either by infected insects, or by asymptomatic carriers, or by overtly infected humans. (Alexander 1995, p. 357) During a 1990 epidemic in a Peruvian Andean village where bartonellosis had not been endemic “the case fatality rate for patients who did not receive antibiotics was 88%. … The overall case fatality rate was 50%.”(Gray et al. 1990, p. 217 and p. 219)

Significantly, the local water source, running in unprotected open canals through the village, was contaminated with “coliforms” – bacteria indicative of fecal contamination. This finding also illustrates another co-factor associated with high bartonellosis case fatality rates. Both food and water-borne bacterial pathogens (particularly, salmonellosis) are synergistic co-factors associated with mortality as high as 90%.(Gray et al. 1990 p. 220)

Ollantaytambo in the Urubamba Valley near Cusco is perhaps the only example of Inca urban planning to survive more or less as built in a continuously inhabited community. The ceremonial center cut into the mountainside adjacent to the town was unfinished when the Spanish conquistadors arrived in the 1530s. Under the Spanish, Mediterranean architectural elements were superimposed on existing dwellings, but the distinctive trapezoidal grid plan of the streets has remained in place together with the hydraulic system that provides water throughout the town through open canals that run down the edges of the stone paved streets. (Protzen 1993 and Wright et al. 1999) The water from these canals in Ollantaytambo was still being routinely used for household purposes during my visit in 1994. [see figure 3] The opportunity for the introduction of salmonella from free ranging animal populations as well as human contamination of the waters is obvious.

Between April and May of 1998 an epidemic of bartonellosis occurred in the Urubamba region, during which patients reported for treatment in Urubamba, Calca, and Ollantaytambo. (Ellis et al.1999, p. 345) This was an area of Peru not previously believed to be endemic for bartonellosis. However, results of the study “…may indicate that Cusco is an endemic area of transmission that was previously unrecognized, and that adults in this area are at least partially immune to [bartonellosis].” Furthermore, the researchers noted, “the only sand fly species encountered in the Urubamba area was Lutzomyia peruensis, known to feed on dogs and humans. This is the first report of sequence-confirmed B. bacilliformis from this species of Lutzomyia, though a report from 1942 suggested that L. peruensis may be associated with transmission of bartonellosis.” The authors go to note “favored harborage and breeding areas for Lutzomyia include adobe walls inside homes, and stone walls outdoors. Many of the homes in the area had these constructions, and we collected Lutzomyia by aspiration from adobe and stone walls in case and control households.” (Ellis et al. 1999, p. 348)

Stone and adobe were the favored construction materials in the area when Ollantaytambo was being built by the Incas. [see figures 4 and 5] The typical architecture of domestic residences, both elite and commoner, as well as military barracks incorporated these materials and techniques, making them as ideal ecological nidi for the breeding of large sand fly populations that favor small micro-environmental niches in natural and man-made cracks in rock and adobe.[i] [

Bartonellosis and the 1531 Spanish expedition on Ecuador’s Manabi coast

Documentary, archaeological and paleopathological evidence show that bartonellosis existed in pre-Columbian times, in endemic foci, and in the very regions through which Pizarro passed with his troops in 1531-2. They were struck by an unusual disease that was described as “a certain type of smallpox”, but it is now apparent that the infection was acute and chronic bartonellosis.

Comparing a map of endemic foci with a map of Pizarro’s path in 1531-2, in (Amano et al., p175, Hemmings 1970, p. 13), it is clear that Pizarro’s march traversed an area long endemic for bartonellosis. [see figures 6 and 7] His non-immune Spanish soldiers paid a terrible price for their intrusion along the Manabi coast:

In Coaque were found many mattresses of ceyna these being from a tree they grow. It so happened that some of the Spaniards who rested on these woke up paralyzed, so that their arms could not be bent or their legs straightened without considerable effort; this occurred to certain of them and it was understood that this was the onset of a sickness that caused warts, so bad and grievous that it caused many to be much fatigued. They toiled in great pain as if they had buboes, until they broke out in warts that covered the whole body, some as large as eggs. On being burst these produced matter and blood, so that it was necessary to cut them off and place upon the sores strong potions to remove the root. Others were as small as measles that covered the whole of the men’s bodies. Few escaped the disease, although some suffered more than others. Others will say that this sickness was caused by some fish that they ate in Porto Viejo, that the Indians in their wickedness gave to the Spanish. (Alexander 1995, pp. 355-356)

Stiffness of the joints associated with pain and fatigue followed by the eruption of warts and lesions corresponds precisely with the classic signs and symptoms of the progress of bartonellosis from its acute, Oroya fever phase through the eruptive phase marked by the lesions of verruga peruana. (Kosek 2000, p. 866) Of the same incident at the Bay of Coaque, Garcilaso de la Vega reported that:

...The excrescences broke out all over their bodies, but principally on their faces. They thought at first that these were warts. But as time passed, they grew larger and began to ripen like figs, of which they had both the size and shape; they hung and swung from a stem, secreted blood and body fluids, and nothing more frightful to see or more painful, because they were very sensitive to touch. The wretched men afflicted with the disease were horrible to look at, as they were covered with these purplish-blue fruits hanging from their foreheads, their eyebrows, their nostrils, their beards and even from their ears nor did they know how to treat them. Indeed, some died of them while others survived. (Schultz 1968, p. 508)

Myron Schultz did not believe that the illness the Spaniards suffered at Coaque was bartonellosis because the epidemic at Coaque occurred on the coast at less than 500 feet above sea level, and according to Schultz, “it would be the only one that has ever occurred, either in ancient or modern times outside the range of 2,500 to 8,000 feet.” (Schultz, 1968, p. 508) However, subsequent published studies of bartonellosis cases and Lutzomyia populations show the disease has much larger distribution. (Ollague L., W., and Guevera de Veliz 1977, Alexander 1995, Amano et al. 1997, Ellis et al. 1999, Kosek et al. 2000, Jhou et al. 2002)

In 1547, 16 years after the incident at the Bay of Coaque, following the Spanish conquest when Francisco Pizarro rebelled against the Spanish Crown, an army was sent from Panama to quell the revolt. They landed at Manta, on the Manabi coast of Ecuador. On the way from Manta to Porto Viejo, many became ill, as was graphically reported by Juan Cristobal Calvete de Estrella:

…warts as big or bigger than nuts on their noses, eyebrows or beards, of a pestilential humor between red and black. They may last four or five months and until they begin to dry up do not cease to cause pain. Finally they begin to heal and those that have suffered them remain clean and healthy. It is thought by the men of these lands that these warts and other diseases which occur below the equator are due to certain constellations, the influence of which is stronger here than elsewhere. (Alexander 1995, p. 356)

Citing the same incident and Spanish source, N. D. Cook points out that “Medical historian Lastres wondered if it might have been ‘smallpox.’ But, given the context of the illness infecting mostly the Europeans, a more likely diagnosis is verruga peruana, a form of Carrion’s disease.” (Cook 1998, p. 108)

Like others before them, Pizarro and Calvete de Estrella discovered that the Manabi coast of Ecuador is a dangerous land. Even today “Most of the suspected and confirmed cases of bartonellosis in Ecuador have been reported from Manabi, which is an arid, coastal province whose name derives from the Quechua words mana pi, meaning no water.”(Alexander 1995, p. 355)

The Conquest of the Manabi coast, Huayna Capac’s Last Campaign

During the last years of his reign, Huayna Capac sought to complete the conquest and pacification of coastal Ecuador. Even though it is not known if the Incas were successful in bringing these coastal regions into their hegemony, there is little doubt that they wished to do so. “One motive of the Incas for the conquest of Manta, Puerto Viejo, and La Puna was precisely to obtain direct access to the mullu shells.” (Rostworowski 1999. p. 72. map p. 20)

Colin McEwan and María Isabel Silva demonstrate late Inca presence along the Manabi coast by identifying grave goods of imperial, Cusqueño manufacture in a ritual burial site at Isla de la Plata, and other sites nearby, including Agua Blanca, 8 km. inland, near Puerto López. McEwan and Silva state that it is indisputable that there was an established Inca presence on the continental coast of Ecuador and conclude that references made by Betanzos and other chroniclers to Inca activities along the Manabi coast can not be taken lightly as “fables” without foundation, or on the other hand interpreted as simply imperial propaganda. (McEwan and Silva 1992, Authors’ translated paraphrase of their text.)

A shell working industry existed at the time of first Spanish contact at the nearby site of López Viejo on the coast. “Excavations at Valdivia sites along the southern coast: San Pablo, Valdivia itself and San Isidro [where the pre-Columbian ceramic depicting severe verruga eruption shown above was said to have been found] all contain reports of mother-of-pear together with Spondylus.” (Currie 1995, p. 51)

Aqua Blanca was the principal seat of the Señorío de Salangome, an independent pre-Columbian polity between the valley of Rio Buenavista and the valley of Jipijapa that attracted much attention from the Incas, beginning with Topa Inca Yupanqui, who, according to Cabello Valboa, had his first glimpse of the sea from the heights of the hills nearby. ( McEwan and Silva 1992, pp. 74-75) Jipijapa is significant because it remains an endemic foci and is, along with Pajan nearby, the source of the majority of reported cases of bartonellosis in Ecuador today. (Alexander 1995, p. 352)

This area around Jipijapa and the adjacent coast, that was the Señorío de Salangome, was the center of an independent and lucrative long distance maritime trade network based on a local industry producing specialized luxury shell artifacts. These were highly valued by the Incas, among others, for religious, ceremonial, and sumptuary purposes. Therefore, the Incas especially wished to control this señorio, its industry, maritime technology, and its trade routes.

The sources show that to secure the Manabi coast Huayna Capac traveled with a large army along the coast of Ecuador from Puna to Manta, and most probably passing though Señorío de Salangome.[ii] From Manta they continued on to the equator and back, subduing, we are told, the tribes along the way. The Caranques, north of Manta, rebelled, and he returned with an army to crush the rebellion.

Mestizo chronicler Garcilaso de la Vega was born in Cusco, April 12, 1539 of a union between Captain Sebastian de la Vega Vargas and the former Inca Princess Nusta Chimpu Ocllo. Garcilaso’s account of Huayna Capac’s later days was based, at least in part, on stories he heard as a boy in his mother’s house told by former members of the Inca elite, including his uncle Francisco Huallpa Túpac Yupanqui, Cusi Huallpa, and Juan Pechuta and Chauca Rimachi, “who had been commanders under the emperor Huaina Cápac.”(Garcilaso 1966, p. xxi)

Relating Huayna Capac’s last campaigns, Garcilaso was probably as well informed as any author since he personally listened to stories told by military commanders who served in them and survived. He also tells of an earlier expedition with 40,000 upland soldiers along the northern coast of Peru during which the soldiers were regularly rotated, two or three times in two years, back to their villages in the Inca heartland: “…the Inca had his army replaced two or three times: the replacement of the soldiers by others was caused by the danger to health which the uplanders experience when they leave their own cold climate for the hot coastal region.” (Garcilaso 1966. p. 546)

His Book Nine, Chapter VIII “The gods and customs of the Manta tribe; their subjugation and that of other savage peoples,” tells that after further campaigns elsewhere Huayna Capac “gave orders for an army of fifty thousand warriors to be raised in the provinces of Chinchasuyu, to the north of Cusco. They were to assemble in the confines of Túmbez,“(Garcilaso 1966, p. 549) From Tumbez they went to the Island of Puna and spent “some days.” (Garcilaso 1966, p. 551)[iii]

From Puna, they began the march north to the Manabi coast: “Huaina Cápac directed his march toward the seacoast for the conquest he desired to undertake there. He reached the borders of the province known as Manta, the district in which the port the Spaniards call Puerto Viejo lies.”(Garcilaso 1966, p. 559)[iv] The Inca continued north “to the conquest of another great province called Caranque.” Having obtained their submission he continued until he arrived in the lands of the Passau, “who live exactly on the equator.” (Garcilaso 1966, pp. 560-561)

Garcilaso glosses over some serious resistance Huayna Capac encountered from these rebellious coastal peoples. But he notes that in bestowing many favors and honors on Atahualpa

“He behaved like father smitten with passionate love for his son, and wished to spend the rest of his life in Quito and its district, taking this decision partly to favor and further Atahualpa’s reign, and partly to subdue and pacify the newly won provinces of the coast and interior, which had still not settled down under the rule and administration of the Incas, but behaved like warlike though savage bestial people. For this reason it was necessary to shift many of these tribes to other provinces, and bring in quiet and peaceful races in their stead, the remedy that those kings usually resorted to to secure themselves against rebellion, as we explained at length in speaking of the emigrants, called mítmac. (Gracilazo 1966, p. 568)

Pedro Sarmiento de Gamboa, writing before 1572 (and before Garcilsao) gives a slightly different account of the coastal campaign:

…Huayna Capac went out of Tomebamba to put in order [concierto] the nations that had been conquered around Quito and Pasto and Guancabilicas. And so he arrived at the river called Angasmayo, between Pasto and Quito, where he put boundary stones at the end and terminus of the land he had conquered, and in the boundary stones he put certain golden stakes for greatness and memory. And he followed the same river down to get to the sea, looking for people to conquer, for he had news that there were a great quantity of people down there. And in this road the army of Huayna Capac suffered great danger and travail for the lack of water in some great sandy areas through which they passed. One day, [they encountered hostile warriors, but] … they routed them and followed them to their towns, which were on the sea coast, near Coaques, where they found a great sum of rich booty and very rich emeralds and turquoises and a great amount of very rich mollo, which is an aggregate made of sea shells more highly esteemed among them than gold or silver.

Here he received messengers from the ruler of the island of Puna, with whom he sent a great present and gift which was sent to receive service at his island of Puna. Guayna Capac did this in this manner, from where he went to Guancabilica, to where he met up with the rest of his army which he had left there. And there he learned how in Cusco there was a great pestilence, of which were dead his governors Apo Hilaquita, his uncle, and Auqui Topa Inga, his brother, and his sister Mama Coca with many other relatives. And to give order in the lands he had conquered there, he departed for Quito in order that from there to go to Cuzco to rest.

Before he was at Quito, he was given an illness of fevers, even though others say that it was smallpox or measles. Because he sensed he would die from it, he called to the privileged nobles his relatives, who asked him who he named as his successor. (Sarmiento de Gamboa 1942, pp 130-131, authors’ translation.) [v]

Huayna Capac assembled an army of fifty thousand soldiers from the highlands north of Cusco and marched them from Puna past Manta and Porto Viejo along the Manabi coast to Coaque on the equator and back, probably rotating them at regular intervals back to their homes in the Inca heartland. As the Spanish expedition led by Pizarro through this very same area discovered less than a decade later, and at great cost, this was an area already hyper-endemic for bartonellosis. Furthermore, Huayna Capac employed the standard Inca “remedy” for dealing with recalcitrant populations, “shifting” many of these tribes along the Manabi coast, forcibly incorporated into the empire, to other provinces and replacing them with colonists from “peaceful” areas.

Following this campaign along the Manabi coast, Huayna Capac and much of his army became ill and died. But this was not before they learned of an epidemic that had already swept through Cusco, killing many of his relatives among countless others. We can now clearly see how a regularly rotated army of 50,000 highland soldiers and an unknown number of relocated coastal tribes from the endemic Manabi coast, may all have carried in their blood the seeds of a great disaster.[vi]

Because the Jipijapa-Pajan area is now, and apparently was even in Pre-Inca time, endemic for bartonellosis; and because there is solid archaeological evidence of an Inca presence in this area; and because the most direct route from Puna or Guayaquil to Manta passes through Pajan and Jipijapa; and because the early Spanish sources say that Huayna Capac operated in this area with his army; we believe it is the area most likely to have spawned the epidemic of 1524.

The Death of Huayna Capac

Juan de Betanzoz (d. 1571) was married to the former wife of Inca Atahualpa. She was also the niece of Inca Huayna Capac. “Betanzoz questioned his wife’s relatives at length… Juan de Betanzoz reported that after the conquest of the province of Yaguarcoche, Inca Huayna Capac returned to Quito and was there six years. At the end of that time, he came down with an illness which deprived him of his senses and understanding, and gave him a saran [cutaneous disease] and lepra [leprosy] that made him very debilitated…” (Cook 1998, p. 76)[vii]

Images of advanced cases of leprosy[viii] show there is a similarity to the pre-Columbian ceramics depicting verruga peruana and to Pedro Pizarro’s description of the bartonellosis outbreak that afflicted his compatriots during their early expedition. [ see figure 8] We are not suggesting that the illness that killed Huayna Capac or other of his subjects in the 1520s epidemic or that struck Pizarro's men was Hansen’s disease (leprosy), but there are evident similarities in appearance, at certain phases, between leprosy and verruga peruana that might help to explain Betanzos’s phrase.

Bartonellosis is typically described as a two-stage disease. The first, acute stage -- characterized by a severe progressive hemolytic anemia accompanied by high fever, often called Oroya fever – is usually the deadly phase. The second, chronic stage – characterized by a verrucous skin eruption -- is usually thought to be a sign that the patient has survived the crisis and will recover, but this is not always true.

Thomas Salazar’s bachelor’s thesis, "Historia de las verrugas," published in the Gaceta Medica de Lima in 1858. In it appeared the first medical photograph ever published in Peru of a patient in his care, Don Anecito de la Cruz who entered the hospital June 21, 1857 suffering from verrugas which he first noticed a year earlier. [see figure 9] In spite of continuous treatment the verrugas multiplied and increased in size while his general condition steadily deteriorated until his death on 3 December 1857. Don Aniceto “descended into an endemic area from the uplands of central Peru, and died a week after this photograph was made,” (García-Caceres, and Garcia 1991, p. s61) having apparently suffered from the debilitating effects and complications from bartonellosis probably including secondary infections.[ix]

The case of Don Aniceto may help us understand the real meaning of Betanzos’s account of the death of Huayna Capac in which the ruler was said to have developed “a saran [cutaneous disease] and lepra [leprosy] that made him very debilitated…. “ Elsewhere we hear that Huayna Capac suffered from fevers. Certainly these descriptions are consistent with the case of Don Aniceto. Since the photograph clearly shows the unmistakable evidence of verrucous bartonellosis and since Don Aniceto died one week after this photograph was taken, there is reason to believe that Huayna Capac may have died under similar circumstances wherein skin lesions were already apparent. Huayna Capac was a highlander who descended into an endemic area on the coast and died after that with symptoms that were described as “leprous.” Like Don Aniceto, Huayna Capac may have died from the consequences of acute bartonellosis after suffering with an eruption of verrugas. The eruption of verugas may occur as soon as 15 days after the onset of the fever. [personal communication, Dr. Jesus Gonzalez, MD] Even though some have argued that verrugas are not concomitant with the acute anemic phase, nevertheless general debility consequent to profound anemia (and increased susceptibility to enteric pathogens such as salmonella), may have contributed to Huayna Capac’s death during the later eruptive phase.

However, even if Betanzoz was not referring to verrucous symptoms of bartonellosis in a manifestation of the disease that would have paralleled the case of Don Aniceto, a pronounced skin rash can be present at the onset of the acute stage that might offer an alternative explanation consistent with Betanzos’s description of a “leprous” disease.[x]

There is another phrase in Betanzos's account that bears careful scrutiny in light of what is now known about bartonellosis. Betanzos said “...he came down with an illness which deprived him of his senses and understanding..." (Cook 1998, p. 76) However, a slightly different and more complete rendering of Betanzos's account may be found in another English translation. In this version Betanzoz reported the following description of the Inca Huayna Capac's death:

At the end of those six years in Quito, he fell ill and the illness took his reason and understanding and gave him a skin irritation like leprosy that greatly weakened him. When the nobles saw him so far gone they came to him; it seemed to them that he had come a little to his senses and they asked him to name a lord since he was at the end of his days. To them he replied that he named as lord his son Ninancuyochi, who was barely a month old and was in the province of the Cañares. Seeing that he had named such a baby, they understood that he was not in his right mind and they left him and went out. They sent for the baby Ninacuyochi, whom he had named as lord. The next day they returned and entered and asked him again whom he named and left as the ruler. He answered that he named as lord Atahualpa his son, not remembering that the day before he had named the above mentioned baby. The nobles went immediately to the lodgings of Atahualpa, whom they told was now lord, and they gave him their respects as such. He told them that he had no wish to be the ruler even though his father had named him. The next day the nobles returned to Huayna Capac and in view of the fact that Atahualpa did not wish to be ruler, without telling him anything of what happened the day before, they asked him to name a lord and he told them it would be Huascar his son. ... Huascar retired for a period of fasting after he heard the news in Cusco. Here we will leave him and return to Huayna Capac, who was in his final days. After having named Huascar as ruler in the way we have described, he died in four days. After he died, the messengers who had gone for the baby who had been named as ruler by Huayna Capac returned. The baby had died the same day they arrived of the same leprous disease as his father. (Betanzos 1996, pp. 183-184)

Echoing Don Aniceto’s case, Huayna Capac suffered a skin irritation like leprosy that greatly weakened him, the illness also took his reason and understanding, but then he came a little to his senses, suggesting a period of relative lucidity following delirium. He did not remember what had happened from one day to the next or what he had said. Then, four days after his last reported communication, he died.

J. O. Trelles et al. gave detailed descriptions of nine clinical cases of bartonellosis treated in hospitals in Lima between 1945 and 1955 involving lesions within the brain (encephalitis). (Trelles et al. 1969) Some of the patients experienced delirium and temporal-spatial disorientation. Case eight experienced loss of vision, nausea and vomiting followed by loss of consciousness. These symptoms were preceded by a brief period of delirium and "talking to himself." But, nevertheless, the next day he was lucid. Subsequently his fever increased dramatically and he died five days later of bronchopneumonia. (Trelles et al., pp. 265-66) Case nine entered the hospital in a comatose condition, but four days later when he was able to begin the interrogatory process with the doctors he evidently suffered amnesia, stating that he had no recollection of events during the previous period of his illness beginning two days before his entering the hospital. (Trelles et al., p. 269) In these cases death followed onset in 13-34 days. Treatment with antibiotics did not prevent death. Accounts of Huayna Capac's death parallel the findings of the neurological forms of Carrión's disease (bartonellosis). It seems likely, therefore, that Huayna Capac suffered from a cerebral form of bartonellosis similar to those cases described in Trelles et al.

Analysis of duration of incubation to onset and death provides further evidence in favor of bartonellosis as opposed to smallpox. In eight of the nine cases of neurological bartonellosis cited by Trelles et al. death followed onset of symptoms in 13 to 34 days.[xi] In the famous case of Daniel Carrión's experiment, the duration between his autoinoculation until death was 39 days.

Careful analysis of the duration of the illness after onset of symptoms is important because 16th-century documents state that Huayna Capac first felt ill at Tumibamba, and returned from there to Quito where he died. According to Cook:

Cabello Balboa reports that after Huayna Capac completed conquests in the north, he paused in Tumibamba. He continued to the coast and reached the island of Puná, where he may have first been notified of the arrival Viracocha –the European. At Puná, Huayna Capac also “received very sad news from Cusco, where they informed him that there was an incurable and general pestilence that had taken his brother Auqui Topa Inca and his uncle Apo Illaquita, whom he had left as governors when he left Cusco, and his sister Mama Toca, and other principal lords of his lineage.” Profoundly saddened by the news, Huayna Capac continued toward Tumibamba. …From Tumibamba, “feeling indisposed and in ill health, he continued to Quito with the greatest and best part of the army, and arriving there his malady worsened, and turned into deadly fevers.” … Cabello Balboa gives the date of the ruler’s death as “according to our count, in the year 1525.” (Cook 1998, pp. 80-81) [xii]

It is impossible to know the exact travel time of Huayna Capac’s journey, but John Hyslop’s study of the Inca road system suggests 60 km per day as the extreme distance for carriers in the eighteenth century, 50 km for guides on his field trip, and 40 km per day is given as the speed of Pizarro's army's movement. (Hyslop 1984, p. 297) There are 350 km between Tumibamba and Quito. At 40 km per day the travel time would be approximately ten days, but no less than six days traveling at the highest rate of speed reported.

Huayna Capac came “a little to his senses" following a period of delirium. We are not told how long he had been in the city following his return from Tumibamba. On the day when he returned to lucidity, and on each of the two following days he was questioned by the nobles about his successor. Then after four more days he died. Taken together, this makes seven days. Added to an estimated ten days of travel time, not including any time that may have elapsed not accounted for in the sources, this makes at least 17 days, over 2 weeks, during which time his illness progressed from indisposition to death. As Cabello Balboa reports, upon arriving in Quito, "his malady worsened, and turned into deadly fevers," so from this one might assume that there was some additional, but unknown, period of time not accounted for in this estimate of 17 days.

These symptoms and time frames are consistent with the clinically reported onset of the Oroya fever phase of bartonellosis. The likelihood of this disease being smallpox is lower than bartonellosis, due to the more rapid onset and progress to crisis of smallpox, where death usually occurred between the 5^th to 7^th day after onset of symptoms, and occasionally as late as the second week. (Chin 2000, pp. 455-457)

Tantalizing Temptations, Missing Links, and the Great New World “Pandemic”

The weight of the evidence supports an interpretation in favor of bartonellosis, but contradicts Schultz who said “The descriptions of a rash together with the high fever and high mortality of the native Andeans are suggestive of an exanthematous disease. Furthermore, the great rapidity of its spread and the intriguing fact that Huayna Capac fell ill after he had received a messenger from Cusco, the epidemic center, also suggest that this was a disease spread by contact rather than one spread by an arthropod (sic. insect) vector.” (Schultz 1968, p. 506) Skin rash, high fever, and high mortality are all characteristic of acute bartonellosis, as is its rapid spread by the sand fly vector as seen in the Lima-La Oroya R.R Bridge epidemic.

If the messenger was the carrier of smallpox that came from Cusco, “the epidemic center,” as Schultz seems to suggest, there is no mention of his suffering symptoms of smallpox, which would have been advanced and noteworthy, as well as debilitating. If the messenger who arrived to infect Huayna Capac was only the last in a series of multiple relay runners from Cusco it would be even more difficult to explain how a continuous, unbroken chain of transmission was maintained over the thousand odd miles separating the emperor from Cusco.

Nor is there any mention anywhere in the sources of others around Huayna Capac suffering from the contagious symptoms of smallpox from whom he could have contracted the disease at that time, as would have been noteworthy and necessary for Huayna Capac to have contracted smallpox while in the area. On the other hand, inhabitants of the endemic areas through which Huayna Capac would have recently passed would have been immunologically adapted to bartonellosis over time, and need not have been suffering or presenting visible symptoms to have been reservoirs from whom sand fly vectors could have transmitted bartonellosis. (Amano et al. 1997) Huayna Capac and the others could have remained asymptomatic for up to 210 days after having become infected, although the typical incubation period has recently been placed at 61 days. (Maguiña and Gotuzzo 2000, p. 5)

According to the sources, Huayna Capac marched 50,000 soldiers recruited in the highlands through coastal areas endemic for bartonellosis. During the course of the campaign, these highland soldiers were probably regularly rotated back to their homelands as was the practice during earlier coastal campaigns according to Garcilaso. Unknown numbers of uprooted rebellious tribesmen from the same endemic coast were relocated to pacified areas long under Inca rule. Once physically transported to the highlands in the blood of these carriers, the disease could have been rapidly spread to others by sand flies prior to Huayna Capac’s infection or onset of symptoms.

There are three important points we would like to emphasize before closing the argument. The first is to repeat that mortality rates for bartonellosis are dramatically increased when other systemic bacterial infections are present. Among these Salmonella typhimurium (Salmonella enterica, serovar Typhimurium), which includes over 2,000 serotypes widely spread in wild and domestic animal populations throughout the world. (Maguiña and Gotuzzo 2000) Moreover, “case fatality ratios (CFRs) of untreated Oroya fever exceed 40% but may reach more than 90% when super infection with Salmonella species occurs.” Ellis, et al. 1999, p. 344)

Public water supply systems using open canals, such as described in the 1987 case of the Peruvian Andean village studied by Gray, et al., and as may be seen today at Pisac and numerous other Inca sites including Ollantaytambo may become contaminated by human and animal feces which may contain Salmonella and other pathogenic enteric organisms.

Leaving aside any consideration of the sanitary conditions among an army of 50,000 foot soldiers with whom Huayna Capac traveled on his way back to Quito following the onset of his fatal illness, if large Inca population centers, such as Cusco, relied on open canal public water delivery systems that were susceptible to contamination, this may have caused a condition of endemic viral, bacterial and protozoan gastrointestinal diseases, as may be seen even today in many parts of Latin America, including the Andean region.

In rural farming areas drawing water directly from natural springs or rivers similar contamination may have occurred, as it does today in rural areas of Latin America and elsewhere. While the rural and urbanized Inca population may have routinely experienced episodic bouts of self-limited gastroenteritis, including salmonellosis, once epidemic bartonellosis were to be introduced, mortality rates would be expected to rise from 30% to 90% from septisemic salmonella super-infections in areas non-immune to bartonellosis.

Secondly, we call attention to the magnitude and rapidity of the ecological changes brought about during the reign of Huayna Capac, from approximately 1498 to 1524. Indeed many of the vast public works for which the Inca Empire has become so famous, were still works in progress when the Spaniards arrived. This is to say that the construction of large private elite estates and of sophisticated urban systems and the consequent concentration of population was still under way. These were young cities and villas, at a time when the empire was still rapidly expanding into new territories, absorbing and relocating new ethnic groups who may have brought with them new diseases to the non-immune Inca heartland from the remote endemic periphery of the empire. Huayna Capac put into the field armies of 40 and 50,000 soldiers, soldiers who were rotated regularly. The Inca state mobilized tens of thousands of rotational laborers to work on public projects. Even larger numbers worked on royal estates. Huayna Capac himself mobilized over 150,000 laborers “from throughout the empire” on his estate alone. (Niles1999, p. 296)

Concentrating a human workforce of this magnitude, composed of rotational laborers working in a relatively confined area for a sustained period of time, stretching over several years certainly begs the question of how they were fed and housed and how even rudimentary sanitation was managed, if it existed at all. The fact that many if not most of the workers were employed in hydraulic works brings with it additional questions about exposure to coliforms that, as previously mentioned, dramatically increase mortality rates during bartonellosis epidemics.

Beyond this is the more intriguing question of non-human reservoirs recently raised by Ihler, among others: “The source of the bacteria which colonize sand flies is not known. Because of the close phylogenetic relationship to the former Grahamella species, which are widely prevalent in small woodland animals, it seems possible that a mammalian reservoir for B. bacilliformis might exist. It seems also possible to me that B. bacilliformis might grow on some plant or fruit debris with which the sand flies associate, eat, or obtain fluids.” (Ihler 1996 p. 2)

Another recent study of epidemic bartonellosis in Ecuador closely examined the possibility of a non-human reservoir. (Cooper et al. 1997) They found dead rodents present only in the case houses and suggest that the outbreak may have followed increased rodent invasion of houses due to food shortages because of draught conditions. They point out that “All case houses were located in isolated areas at the margin of forest and the presence of dead rodents was reported only in case houses. We suggest that human bartonellosis is a zoonosis with a natural rodent reservoir and that migrant humans infected in this way may become a temporary reservoir host in populated areas.” (Cooper 1997, p. 544)

This important finding about wild rodents may have a direct bearing on the epidemic of 1524 for several reasons. Firstly, because one of the major goals of Inca state and imperial policy was to increase the ability to produce food by mobilizing immense human work forces implementing vast terracing programs on royal estates and elsewhere. Not only did the relatively sudden creation of terrace walls built of coursed stone presenting millions of square feet of vertical surface as new habitat for sand flies, creating their “favored [outdoor] harborage and breeding areas,” but also the terraces themselves greatly increased food production, not only for the human population, but no doubt for the expanding wild rodent populations as well. [see figure 10] Secondly, because along with the construction of the famous Inca Road, still one of the wonders of the world, there was also a systematic construction of special infrastructure, built at regular intervals all along the road, for maintaining and distributing food supplies, principally consisting of grains. (LeVine1992) Not only would this have provided needed food for the human population, but, again, it also would have provided the means for expanding the wild rodent populations. Similarly, rapidly expanding human urban populations, such as in Cusco, may also have contributed to a corresponding increase in wild rodent populations within the urban precincts.

Therefore, if, as Cooper et al. suggest on the basis of their recent investigation, human bartonellosis is a zoonosis with a natural rodent reservoir, the relatively sudden expansion of the rodent reservoir in response to greater availability of food from intensified human agriculture may have played an all important role in the epidemic of 1524. Furthermore, if, as seen in the case Cooper et al. studied, hydroclimatological conditions, such as drought, tend to intensify rodent invasion of houses, leading to epidemic outbreaks or intensified epidemic outbreaks, then this too must be considered in the analysis of the 1524 event.

Clearly the reign of Huayna Capac saw unprecedented ecological changes resulting from construction and military campaigns, the former resulting in the concentration of enormous human workforces and the expansion of urban populations, while the latter moved large bodies of soldiers great distances into new territories and back. Increased mass mobility at a time of increased construction. This was not a time of stasis, but a time of great and rapid change, large scale ecological change brought about deliberately by human activity organized and manipulated on a vast scale by imperial command at the state level, creating new conditions and new opportunities, not only for the human population, but also, perhaps, for the florescence of microbial pathogens.

Finally, the third major point we want to make in closing is to call attention to recent, ground breaking research by Jiayu Zhou, Richard Andre, and others, that demonstrates a linkage between epidemic outbreaks of bartonellosis and “el Niño” weather patterns. (Zhou, Jiayu, et al. 2002, a & b) When seasonal air temperatures increase above normal during periods of “el Niño” weather phenomena, the vector sand fly population increases correspondingly, resulting in dramatically increased incidence of bartonellosis outbreaks. In the 1997/98 event they studied, “…the monthly disease case number was almost doubled and the disease transmission lasted much longer.” But, perhaps even more importantly for this investigation of the epidemic of 1524-25, their research showed that “During 1997/98 el Niño event, the disease epidemics expanded to the southern part of the country, where bartonellosis had not been recorded earlier.” We believe the outbreak of 1524-25 may have been influenced or exacerbated by a convergence of factors including an el Niño event of unusual severity. Our ongoing research is currently focused on accumulating corroborative geo-physical evidence. [xiv]

Until we identify mummified remains of a human known to have died in the 1524-25 epidemic, it will be impossible to demonstrate absolutely that bartonellosis was the cause of this disaster. Nevertheless, as has been shown here, the application of current medical science to the existing archaeological and documentary evidence makes bartonellosis a more likely diagnosis than

smallpox for the death of Huayna Capac and his subjects, particularly when considered in light of recent discoveries of the influence of el Niño weather patterns in spreading epidemics of this disease.

1995 A review of Bartonellosis in Ecuador and Colombia. American Journal of Tropical Medicine and Hygiene 52(4):354-359.

1974 A Case of Carrion’s Disease Associated with Human Sacrifice from the Huari Culture of Southern Peru. American Journal of Physical Anthropology 41:295-300.

1997 Bartonellosis in Ecuador: Serosurvey and Current Status of Cutaneous Verrucous Disease. American Journal of Tropical Medicine and Hygiene 57(2):174-179.

1996 [sixteenth century] Narrative of the Incas. Translated & edited by R. Hamilton and D. Buchanan, University of Texas Press, Austin.

1998 [sixteenth century] The Discovery and Conquest of Peru. Edited and translated by A. P. Cook & N. D. Cook, Duke University Press, Durham.

2000 Control of Communicable Diseases Manual. American Public Health Association, Washington DC.

1983 [seventeenth century] History of the Inca Empire. Translated and edited by Roland Hamilton, University of Texas Press, Austin.

1998 Born to Die, Disease and New World Conquest, 1492-1650. Cambridge University Press. Cambridge.

Cooper, P. R. Guderian, P. Orellana, C. Sandoval, H. Olalla, M. Valdez, M. Calvopiña, A. Guevara, and G. Griffin

1997 An outbreak of bartonellosis in Zamora Chinchipe Province in Ecuador. Transactions of the Royal Society of Tropical Medicine and Hygiene 91: 544-546.

Ellis, B. A., L. D. Rotz, J. A. D. Leake, F. Samalvides, J. Bernable, G. Vemtura, C. Padilla, P. Villaseca, L. Beati, R. Regnery, J. E. Childs, J. G. Olson, and C. P. Carrillo

1999 An outbreak of Acute Bartonellosis (Oroya fever) in the Urubamba Region of Peru, 1998. American Journal of Tropical Medicine and Hygiene 61(2):344-349.

1991 Bartonellosis, An Immunodepressive Disease and the Life of Daniel Alcides Carrion. American Journal of Clinical Pathology April(Suppl. 95 (4) (Suppl. 1): s58-s66.

1961 [seventeenth century] The Incas Royal Commentaries of the Inca Garcilaso de la Vega. Translated by M. Jolas [from the French edition], edited by A. Gheerbrant, Avon Books, New York.

1966 [seventeenth century] Royal Commentaries of the Incas and general History of Peru, Part One. Translated by H. l. Livermore, University of Texas Press, Austin.

Gray, G. C., A. A. Johnson, S. A. Thornton, W. A. Smith, J. Knobloch, P. W. Kelley, L. Obregon Escudero, M. Arones Huayda, and F. S. Wignall

1990 An Epidemic of Oroya Fever in the Peruvian Andes. American Journal of Tropical Medicine and Hygiene 42(3):215-221.

1996 Bartonella Bacilliformis: dangerous pathogen slowly emerging from deep background. FEMS Microbiology Letters 144:1-11.

2002 The Great Andean Epidemic of 1524-4: Smallpox or Bartonellosis? Paper presented at the Inter-American Institute For Advanced Studies in Cultural History conference ”Disease and Disaster in Pre-Columbian and Colonial America,” Washington DC.

2000 Natural History of Infection with Bartonella bacilliformis in a Nonendemic Population. Journal of Infectious Disease 182:865-872.

1992 ¿Que fueron hacer los Incas en la Costa Central del Ecuador? In 5000 Años de Ocupación, Parque Nacional Machalilla. Centro Cultural: Ediciones abya-yala, Ecuador, pp. 71-102.

2000 Bartonellosis Old and New. Emerging and Re-emerging Diseases in Latin America, Infectious Disease Clinics of North America 14(1):1-22.

1999 The Shape of Inca History, Narrative and Architecture in an Andean Empire. University of Iowa Press, Iowa City.

1977 Veruga Peruana en el Ecuador. Medica Cutanea Ibero-Latino-Americano (4):235-240.

1993 Inca Architecture and Construction at Ollantaytambo. Oxford University Press, New York.

1999 History of the Inca Realm. Translated by Harry B. Iceland, Cambridge University Press, Cambridge.

1858 Historia de las verrugas. La Gaceta Médica de Lima 2:2 (Marzo de 1858):161-164; 175-178.

1942 [sixteenth century] Historia Indica. Edited by Roberto Levillier, Espasa-Calpa Argentina S.A. Buenos Aires.

1968 A History of Bartonellosis. American Journal of Tropical Medicine and Hygiene 17(4):503-515.

1969 Formas neurologicas de la enfermedad de Carrión. Revista de neuro-psiquiatria 32 (4):245-306.

1999 [November] Ancient Machu Pichu Drainage Engineering. Journal of Irrigation and Drainage Engineering pp. 360-369.

1997 Bartonellosis in Ecuador: Serosurvey and Current Status of Cutaneous Verrucose Disease. American Journal of Tropical Medicine and Hygiene 57(2):174-79.

Zhou, J., W. K.-M. Lau, L. W. Laughlin. P. M. Masouka, R. Andre, and J. Chamberlin

2002 The effect of Regional Climate Variability on Outbreak of Epidemics of Bartonellosis in Peru. Preprints of the 3rd Symposium on Environmental Applications: Facilitating the Use of Environmental Information. American Meteorological Society 82nd Annual Meeting, 3-17 January, Orlando, Florida.

Zhou, J., W. K.-M. Lau, P. M. Masouka, Richard Andre, Judith Chamberlin, P. Lawyer and L. W. Laughlin

2002 El Niño helps spread Bartonellosis Epidemics in Peru. Eos, Transactions, American Geophysical Union 83 (14):157, 160-61.

[i] For more information on sand flies, see: http://cipa.snv.jussieu.fr/

[ii] See: “Carta de la provincia de Quito 1750: Pedro Vicente Maldonado” in Nuevo Atlas del Ecuador. Quito: Ediguias C. ltda., 1999. This map shows a road from Quayaquil to Xipixapa, calling it ‘Camino desierto.” Given the geography, the descriptions of him movements in the sources, and Huayna Capac’s objectives, it seems likely that he would have passed this way.

[iii] See also Garcilaso 1983, p. xii for map showing the Four Quarters of the Inca Empire, including that of Chinchasuyu, to the north of Cusco, as mentioned in Garcilaso’s text.

[iv] See also the map in Garcilaso 1961, p. 126 showing the areas of Hyauna Capac’s activities described in Garcilaso’s account.

[v] “Guancabilicas” refers to Huancavillca, or more or less the area south of a line running east and west through Chongon, including Guayaquil and the Point of Santa Elena.

[vi] It should be noted that even after full recovery from bartonellosis, the survivor may become an asymptomatic carrier, as may also happen in the case of survivors of typhoid fever, staphylococcal infections, among others. These “carriers” can act as “seeds.”

[vii] Cook cites his source as: Betanzos1987, p. 200.

[viii]For examples see: http://wwwihm.nlm.nih.gov/</

[ix] Photograph originally published in: Salazar 1858. This copy made from a photograph of the original kindly taken for me by Jorge Lossio.

[x] See also the description of the rash given by Daniel Carrión, in Schultz 1968. This is consistent with the cases studied by Trelles et al. below who reported death following onset of symptoms in 13 to 34 days. The petichial skin rash developed on the fourth day after onset, and after the onset of fever.

[xi] The ninth was a case of 25 years duration of a different category.

[xii]Cook cites: Cabello de Balboa 1951, pp. 393-394.

[xiii] William of Occum 1300-1349. “It is vain to do with more what can be done with less.” [Occum's Razor]

[xiv] See figure___, a graph constructed from Greenland Ice Core data sets showing relative quantities of atmospheric gasses and corresponding conditions, provided by Paul Mayewski. A passage from Garcilaso de la Vega’s account of omens predicting the demise of the Inca realm may prove to be the key to this mystery:

“… There were also great earthquakes and tremors, and though Peru is greatly subject to this scourge, it was noted that the tremors were much worse than usual and that many high hills fell down. They learnt from the coastal Indians, moreover, that the tides of the sea greatly exceeded their normal limits, and they saw that many fearful and horrifying comets appeared in the air. Among these wonders and alarms, they noticed one clear calm night that the moon was surrounded by three large rings, the first the color of blood; the second, further out, greenish-black; and the third smokey-looking. …Most of the wizards gave bad auguries, so that all the empire feared some great adversity. But as none of the new things feared occurred in the first three or four years, their former confidence was restored and they lived without care for a few years until the death of Huayna Capac.” (Garcilaso 1966, pp. 573-575)