8 



qucncy of alterations in the raythm of 

 the heart-beat among the local inhabi- 

 tants especially among those who lived 

 în írja/oma— infested houses. This was 

 extremely common and generally took 

 the form of extrasystolcs frequently with 

 slow pulse. I must mention that in view 

 of the anatomical alterations of the thy- 

 reoid commonly observed in these pa- 

 tients, either as a great hypertrophy 

 or as an almost inappreciable enlargement 

 of the gland, I at first believed these 

 cardiac perturbations to be ascribable 

 to goitre. 



Soon, however, I made sure that 

 patients showing an unrhythmic heart- 

 beat had not infrequently a normal thy- 

 reoid. About this time I got the opportu- 

 nity of practising a post-mortem on a child 

 In whom I had diagnosed the acute form 

 of the disease with trypanosomes in the 

 peripheric circulation. The material I 

 obtained I sent to the Instituto Oswaldo 

 Cruz where it was examined by the re- 

 grelled GASPAR VIANNA, whose high 

 technical ability and great competence 

 in the field of pathological anatomy we- 

 re of the greatest help to us. 



CASPAR VIANNA described, within 

 the cardiac fibres of the child's myocar- 

 dium some very curious parasitical 

 forms, very numerous and taking the 

 form of actual kysts. Similar aspects 

 of the parasite were observed in other 

 organs. 



There was at the time, as I heard 

 from OSWALDO CRUZ, some doubt as 

 to the interpretation of there parasitic 

 forms, VIANNA believing them to be 

 special stages of Trypanosoma Cruzi. All 

 doubts were dispelled, however, when, 

 at Lassance, OSWALDO CRUZ, showed 

 me sections and smears from the myo- 

 cardium, in which I recognised parasi- 

 tic forms identical to those I had obtai- 

 ned in artificial cultures of the trypa- 

 nosorae. No doubt could be left over, 

 therefore, as to VI ANNA'S observations 



of the localisation of the trypanosome, 

 under a special form in the myocardi- 

 um, within the muscle-fibres. This fur- 

 nished the acceptable interpretation to 

 one of the most frequent clinical 

 symptoms of the disease, disturbance 

 of the rhythm of the heart. The histo- 

 pathological results of the first autopsy- 

 were so interesting that OSWALDO 

 CRUZ decided to become better acqua- 

 inted with my work and made with this 

 purpose the fatiguing journey to the in- 

 terior of Minas Geraes where he remai- 

 ned for a week in the enthusiastic ap- 

 preciation of the clinical cases and expe- 

 rimental facts which were opening a 

 new chapter in human pathology. 



I must here allude to a cause of 

 error in the first laboratory work for 

 the diagnostic of the disease. 



In the earlier studies on Trypanoso- 

 ma Cruzi I had connected with the evo- 

 lutive cycle of the trypanosome in ver- 

 tebrates, special forms found with great 

 frequency in the lungs of infected gui- 

 nea-pigs. It was from this interpretation, 

 in which I had the assent of PROWA- 

 ZEK and MAX HARTMANN, that came 

 the forming of the genus Schizolrypanum 

 in which to place the new species of pa- 

 rasitic flagellates. In view of this obser- 

 vation I for some time made use of 

 these forms founds in the lungs of the 

 guinea-pig as a factor in the diagnostic 

 of patients whose blood had been inocu- 

 lated in guinea-pigs. It was later obser- 

 ved, first by Prof. CARINI and DELA- 

 NOË and tnen by some research- wor- 

 kers of the Institute, that the parasitic 

 forms from the lungs of the guinea-pig 

 hady nothing to do with Trypanosoma 

 Cruzi and were really another parasite, 

 Pneumocystis. This parasitologic diag- 

 nostic was thereby rendered valueless 

 and we had to base on other grounds 

 our opinion regarding the chronic forms 

 of the disease. Numerous post-mortems in 

 which the parasites were seen localised 



