1288 SOUTH AMERICAN TRYPANOSOMIASIS 



trypanosomiasis. As a rule, there is no globular anaemia, but there is a 

 definite diminution in the haemoglobin and in the specific gravity. The 

 leucocytosis is slight in the acute and exceptional in the chronic cases. In 

 acute cases there is a macrolymphocytosis. 



Metabolism. — Guerreiro, from careful experiments associated with urine 

 analysis, concludes that there is a true liver insufficiency in most forms of the 

 disease, but not in the cardiac form unless associated with other symptoms. 



Sequelae. — Chagas considers that infantilism may be a sequel of 

 the disease, especially as it is associated with hypothyroidism. 



Diagnosis. — ^The diagnosis must be effected by finding the para- 

 site in the blood during a febrile attack. The disease is most likely 

 to be confounded with ankylostomiasis, from which^ it can be 

 recognized by the absence of the typical ova in the faeces and the 

 presence of 5. cruzi in the blood, though, of course, both infections 

 may occur together. 



It might also be mistaken for malaria during the febrile attack, 

 especially as there is splenic enlargement, but the absence of the 

 malarial parasite and the presence of S. cruzi in the peripheral 

 blood will enable a diagnosis to be made. 



In the chronic stage it may be mistaken for goitre, especially 

 when the myxoedematous or pseudo-myxoedematous symptoms are 

 present, and the diagnosis will depend upon the discovery of the 

 parasite or the history. 



Prognosis. — ^The prognosis is most serious in the acute attacks 

 and the acute or subacute exacerbations. The severer cardiac 

 forms are also of grave import. 



Treatment.— The indications for treatment are the same as those 

 for African trypanosomiasis, associated with treatment for hypo- 

 thyroidism. 



Prophylaxis. — ^The prophylaxis must aim at the prevention of the 

 Lamus biting man, 



REFERENCES. 



All the more important papers are to be found in the Memorias do Instituto 

 Oswaldo Cruzi, Rio di Janeiro, for the years 1909 to 1916 inclusive. 



Brumpt (1919)- Bull. Acad, de Medecine, March 4, 



Chagas (1909). Archiv f. SchifEs- u. Tropen-Hygiene, 120, 351. Leipzig. 

 Chagas (1909). Brazil Medico, April 22. Rio di Janeiro. 

 Chagas (1909). Bulletin de la Societe de Pathologic Exotique, 304. Paris. 

 Chagas (1910). Revista Medica de Sao Paulo, Nos. 22 and 23. 

 Chagas (191 i). Memorias do Instituto Oswaldo Cruzi. Rio di Janeiro 

 (Clinical) . 



Chagas (191 2). Brazil Medico, August. Rio di Janeiro. 

 Chagas (1916). Memorias do Instituto Oswaldo Cruzi. viii., II., 5 and 37. 

 Rio di Janeiro. 



Chagas (1918). Rev. Med. Cirurg. do Br^,zil, vol. xxvi.. No. 5. 

 DiAS (191 2). Memorias do Instituto Oswaldo Cruzi. Rio di Janeiro (Blood). 

 Guerreiro (191 2). Memorias do Instituto Oswaldo Cruzi, Rio di Janeiro 

 (Urine). 



Neiva and Penna (1916). Mem. Inst. O. Cruz., vol. viii., No. 3. 

 ViANNA (191 1), Memorias do Instituto Oswaldo Cruzi, Rio di Janeiro 

 (Pathology). 



