12 86 SOUTH AMERICAN TRYPANOSOMIASIS 



Symptomatology. — ^There are two principal varieties of the disease 

 — the acute and the chronic. 



In the acute stage the disease begins with a violent attack of fever 

 in a young child or a new-comer into the district. This fever shows 

 a morning remission and an evening rise, and is associated with a ' 

 palpable increase in the thyroid gland, adcma of the face, in which 

 characteristic crepitation can be felt by palpation, enlargement of - 

 the lymphatic glands in various regions of the body, but especially 

 of the neck; and fugitive oedemas in different parts of the body — as, 

 for example, the forehead and extremities. The spleen enlarges 

 and becomes painful, and the liver also becomes enlarged, and 



Fig. 642. — Neuroglia Cell of Fig. 643. — Trypanosoma cruzi 



Brain distended to a Cyst and in a Neuroglia Cell of the 



Fii.-L'E-D WITH Trypanosoma cruzi. Brain. (X 2,000.) 



(X 2,000.) (After Vianna.) (After Vianna.) 



there may be signs of meningitis, and also of albumen in the urine. 

 After a time the attack of fever passes off, only to return after 

 periodical intervals. During an attack the typical trypanosomes 

 can be found in the blood, but during the apyrexial interval they 

 are absent. After these attacks have lasted some time the child 

 either dies, recovers, or passes into the chronic stage. 



In this chronic stage the children show signs of marked thyroiditis 

 and loss of hair, with hypertrophy of the lymphatic glands, a dull 

 expression, a peculiar bluish-bronze pallor, tachycardia, and in- 

 testinal and nervous disorders, especially convulsions. 



Chagas has classified the various symptoms of the chronic stage 

 of the disease into five subvarieties: — 



