Chagas, Carlos Ribeiro Justiniano

(b. Oliveira, Minas Gerais, Brazil, 9 July 1879; d. Riode Janeiro, Brazil, 8 November 1934),

medicine.

Chagas was the first son of a coffee planter whose family had arrived in Brazil from Portugal around the middle of the sixteenth century. His paternal granduncle, João das Chagas Andrade, was a medical doctor, as was his mother’s brother. The latter, Carlos Ribeiro de Castro, graduated from the Medical School of Rio de Janeiro in 1888 and in the early 1890’s established, in Oliveira, a hospital in which the methods of Lister were used for the first time in Brazil. This young surgeon was to exert a great influence on his nephew.

In 1914 Chagas enrolled in the School of Mining Engineering in the old capital of the state of Minas Gerais. Having been taken ill in 1895 (with a typical case of B-deficiency avitaminosis), he spent some time in Oliveira, where, under the influence of his uncle, he decided to take up medicine. He started medical training at the Medical School of Rio de Janeiro in 1896 and finished the course there in 1902. He earned the M.D. in 1903 with the completion of a thesis, “Estudos hematológicos do impaludismo,” at the Institute Oswaldo Cruz.

As a student, Chagas’ main concern was malaria and yellow fever, which were endemic at the time in Rio de Janeiro. He became familiar with the laboratory methods for diagnosing malaria—these methods having been introduced into Brazil by his first teacher, Francisco Fajardo.

In 1907 Chagas became a full-time staff member of the Instituto Oswaldo Cruz. His friendship with that institution’s founder, which was to end only with Cruz’s death in 1917, was a major influence in his career. For the first years of his professional practice, Chagas established himself as a general practitioner in Rio de Janeiro.

In 1905 financial difficulties forced Chagas to accept a mission to Santos in order to fight malaria, endemic to the workers employed for the construction of the port. In Itatinga, a small village nearby, Chagas undertook the first successful Brazilian campaign for malaria control. He did not use the already well-established technique of destroying larvae, but instead used pyrethrum to disinfect households and thus achieved a surprising success. He published his technique in Prophylaxia do impaludismo, a work which was revived forty years later as a guide to the use of new synthetic insecticides.

In 1909 Cruz asked Chagas to undertake a new antimalaria campaign in the village of Lassance, about 375 miles from Rio, which was at that time the terminal of the projected Central Railways System. Chagas stayed in Lassance for two years (1909– 1910), living in a railroad car. During this time he discovered and described the disease that bears his name.

A few days after his arrival in Lassance, Chagas’ attention was drawn to the large number of bugs that infested the walls of the huts there. Upon examining them he found that they frequently harbored a trypanosome. Chagas identified this trypanosome as a new genus and species and proposed to name it Schizotrypanum cruzi (known generally as Trypanosoma cruzi), the species name being in honor of his friend and teacher. He then verified the pathogenicity of this trypanosome in monkeys, dogs, and cats. The positive infectiousness of the trypanosome in these animals led him to consider that such an infection in humans would explicate the pattern of disease that he found in the region, Chagas then looked for the trypanosome in human blood; he found it in an infant patient who presented the symptoms of an acute infection.

Chagas described and studied the manifestations of the disease as well as its pathogenic mechanism. He depicted the disease as consisting of an acute phase, marked by fever and a generalized hard edema, which might be followed by one of three chronic forms. Chagas classified these later stages by their symptomatology, the most frequent form being characterized by cardiac disturbances, while the other two presented gastrointestinal and neural syndromes, respectively. While in Lassance, Chagas performed more than 100 postmortem examinations on patients who exhibited the chronic form of the disease, although he was able to observe and describe only twenty-two cases of the acute form.

Chagas further established a basis for epidemiological studies related to the new disease. He described its vectors, studied the various grades of infectiousness of Triatoma in general, and observed the armadillo to be the most frequent reservoir of the microorganism. Chagas’ work may therefore be pointed out as a unique feat in the history of medicine—it is the only instance in which a single investigator has described the infection, its agent, its vector, its manifestations, its epidemiology, and some of the hosts of the pathogenic genus.

After his stay in Lassance, Chagas made a ten-month trip to the Amazon Basin to study tropical diseases further. In his later years, he was responsible for the reorganization of the Department of Health in Brazil, and was very active in the establishment of international centers for preventive medicine and in the reformulation of Brazilian medical education.

Chagas was the first Brazilian to be awarded an honorary degree by Harvard University and by the University of Paris. Among his many other honors was an award given him at the Pasteur centennial exhibition in Strasbourg, in 1922.

BIBLIOGRAPHY

A complete bibliography of Chagas’ work and of writings on Chagas’ disease up to 1959 is in Annals of the International Congress of Chagas’ Disease, 5 vols. {Rio de Janeiro, 1960).

Chagas’ most important writings are Prophylaxia do impaludismo (Rio de Janeiro, 1905); “Beitrag zur Malariaprophylaxis,” in Zeitschrift für Hygiene and Infektionskrankheiten, 60 (1908), 321–334; “Nouvelle espèce de Trypanosomiase humaine,” in Bulletin de la Société de pathologie exotique, 2 (1909), 304–307; “Nova trypanozomiaze humana. Estudos sobre a morfologia e o ciclo evolutive do Schizotrypanum cruzi n. gen., n. sp., agente etiológico de nova entidade mórbida do homem,” in Memórias do Instituto Oswaldo Cruz, 1 (1909), 159–218, text in Portuguese and German; “Ueber eine neue Trypanosomiasis des Menschen. Zweite vorläufige Mitteilung,” in Archiv für Schiffs-und Tropenhygiene, 13 (1909), 351–353; “Les formes nerveuses d’une nouvelle Trypanosomiase (Trypanosoma Cruzi inoculé par Triatoma megista) (Maladie de Chagas),” in Nouvelle iconographie de la Salpêtrière, clinique des maladies du système nerveux, 26 (1913), 1–9; Revision of the Life Cycle of “Trypanosoma cruzi,” Supplementary Note (Rio de Janeiro, 1913); “Processes patogénicos da tripanosomiase americana.” in Memórias do Instituto Oswaldo Cruz, 8 (1915), 5–36; Cardiac Form of American Trypanosomiasis (1920); “American Trypanosomiasis. Study of the Parasite and of the Transmitting Insect,” in Proceedings of the Institute of Medicine of Chicago, 3 (1921), 220– 242;Amerikanische Trypanosomiases (Chagasche Krankheit). Kurse aetiologische and klinische Betrachtungen (1925); “Ueber die amerikanische Trypanosomiasis (Chagaskrankheit),” in Münchener medizinische Wochenschrift, 72 (1925), 2039–2040; “Quelques aspects evolutifs du Trypanosoma cruzi dans l’insect transmetteur,” in Comptes rendus de la Société biologique (Paris), 97 (1927), 824–832; “Sur les altérations du coeur dans la trypanosomiase amé ricaine(Maladie de Chagas),” in Archives des maladies du coeur, des vaisseux et du sang, 21 (1928), 641–655; and “Amerikanische Trypanosomenkrankheit, Chagaskrankheit,” in Carl Mense, Handbuch der Tropenkrankheiten, 3rd ed., V, pt. 1 (Leipzig, 1929), 673–728, written with Enrico Villela and H. da Rocha Lima.

Carlos Chagas