— 9 



în diffe e^il organs aiid the lesions for 

 which they an; responsible rjnpîy justi- 

 fied the clinical diagnostic of the diffe- 

 rent forms of the disease by establi- 

 hing beyond d(»ubt its cause. 



But to proceed to the detail: Of 

 the acute forms of the disease, charac- 

 terised by the easily observed existence 

 of the trv7^anosome in the peripheric 

 circulation within a short period. I ob- 

 tained several clinical ol)servations to 

 which no objection can be made. 



A': to the chronic forms, my con- 

 clusions were no less conclusive, based 

 as they were on a great number of post- 

 mortems with parasitológica! and at the 

 same time histo-pathological study. Of 

 tlie clinical cases in which cardiac symp- 

 toms dominate, I quickly obtained a 

 great number of observations and also 

 several post-mortems. In the latter the 

 imiformity of the lesions of the myocar- 

 dium and the constant occurrence of 

 the parasite in it founded on anatomical 

 reasons the diagnostic of chronic cases, 

 carerully studied while alive. The cli- 

 îiical diagnostic of these lesions 

 necame one of the characteristics of 

 the new disease. Recent researches of 

 GROWEI.I. prove that the cardiac le- 

 sions in american trypanosomiasis can 

 be recognised independently of the fin- 

 ding of trypanosomes and are to be 

 considered as a well characterised spe- 

 cific lesion. 



Contrarily to wbat those who say 

 we only know a few cases of american 

 trypanosomiasis, a patient with domi- 

 nant cardiac symptoms is, according to 

 the acceptation of the disease, infected 

 with Trypanosoma Cruzi: besides the 

 rhythm other s\Tnptoms indicating lesions 

 of other organs can be foimd. And judging 

 the nmnber of cases by the cardiac for- 

 ms oin: opponents would certainly admit 

 that there has been no exaggeration in 

 estimating as very high the number of 

 «ndemic cases. 



Tlie ;.is''erlaining of the nervous forms 

 was also based ou clinical observation 

 and post-mortem findings of undoubted 

 value. The niunerous cases of cerebral 

 diplegia, of organic idiocy, of monople- 

 gias, of aphasias etc., observed in the 

 regions where we worked had long since 

 impressed me. The first supposition of 

 syphilis to which these lesions mighl 

 have been attributed was quickly dispel- 

 led by all clinical and laboratorj^ me- 

 thods of syphilis-diagnostic. And con- 

 trarly to the fallacious tradition, this 

 disease is an extremely rare occurrence 

 amongst the inhabitants of the interior, 

 where it is taken only by new comer* 

 Ironi more civilised and contaminated 

 zones. In another publication we will 

 speak of this subject proving that in 

 the remote zones of the interior syphi- 

 lis remains unknown vmfil it is introdu- 

 ced v.ith the advent of the railways. 



(.ould the nervous phenomena be 

 attributed to endemic cretinism as 

 K1Í AUS later proposed ? Certainly not, sin- 

 ce under the most strenuous observation, 

 they w ere far from show ing, what several 

 authors have considered to be the clas- 

 sical nervous manifestations of creti- 

 nism. And this is not a question to solve 

 by hypotheses but rather by the surer 

 methods of pathological anatomy. 



The first post-mortem was carried 

 out on a case of cerebral diplegia that 

 had lasted for 22 years. According ta 

 information given by the family, the 

 subject had been paralytic since she 

 was 3 years old and had suffered from 

 organic idiocy with excitable phases. 

 Death ensued from accidental burning. 

 Autopsy showed the existence of trypa- 

 nosomes and well defined cerebral lesions 

 distributed in foci. Histo-pathological stu- 

 dies carried out by GA.Si^AR VIANNA lefl. 

 no doubt as to the etiological cause of the 

 nervous phenomena studied. After 

 this, other post-mortems followed and 

 among them those of cases of acute rae~ 



