Historical Aspects of American Trypanosomiasis (Chagas' Disease)

At the dawn of the twentieth century, tropical medicine was exploding upon the public consciousness. Many of the best and brightest physicians stood ready to bring experimental science to bear in conquest of any and all ailments, but especially the exotic diseases associated with the insalubrious latitudes between the tropics. This initial phase of the institutionalization of tropical medicine was closely allied with military medicine. Governments, especially those engaged in the colonial enterprise in the tropics, such as the United States and Great Britain, were willing to dedicate resources toward scientific research on health problems that beset the local labor supply, or thinned the ranks of nonlocals engaged in the overt political control of Africa and Asia or the economic development of Latin America.

Carlos Chagas (1879–1934) was a medical student in Rio de Janeiro between 1897 and 1903. These same years witnessed the Reed Commission’s research in Cuba on yellow fever, the first complete description of the malaria cycle, and the appointment of Oswaldo Cruz as director of the fledgling Serum Therapy Institute at Manguinhos. And for good measure, an epidemic of bubonic plague erupted in the Brazilian port city of Santos. Within young nations such as Brazil, a nascent corps of medical professionals eagerly answered the call of tropical medicine. Chagas was a charter member of this group. While a medical student, he undertook hematological studies of malaria at the Manguinhos Institute. Oswaldo Cruz recognized his talent and placed him in charge of a malaria prophylaxis campaign (1905) in Santos. Following upon this highly successful effort, the Brazilian government called upon his expertise to combat endemic malaria in the interior.

It was during the field reconnaissance for this project that Chagas encountered an interesting triatomine, a bug known to locals as the barbeiro, which seemed especially promising as a research subject because it commonly lived in houses and took blood meals from human hosts. These two characteristics led Chagas to suspect that the bug was a potential transmitter of human parasites—and he was right. Through his research he identified a new trypanosome (1908), which he named T. cruzi in honor of Oswaldo Cruz. Subsequent investigation proved that the parasite was capable of infecting a variety of vertebrates including humans. This last observation resulted in the establishment of a pathological condition termed “Chagas’ disease”—a condition found to be widespread in the Brazilian interior, and in Latin America generally.

Matthias Perleth provides the broad context and rich details of this story. He uses the discovery of a tropical disease as a frame within which to view the extraordinary career of Carlos Chagas, as well as the early history of public health in Brazil. Relying extensively on secondary sources, he tries to summarize the aspects of the social and political history of Brazil during the Old Republic (1889–1930) that had a bearing on his subject, as well as to sketch out pertinent historical aspects of preceding epochs. These are ambitious goals for such a slim volume, and those familiar with Brazilian history will find his presentation wanting.

For many readers, the story of the eclipse of Carlos Chagas is more interesting than his rise to fame. Chagas rode his research findings to international as well as national acclaim. Eventually he was appointed director of the National Department of Public Health (1920). Ironically, this distinguished career was about to deteriorate at home, owing to competing strategies about public health policies, to power politics, and to Chagas’s own personality, which prompted him to feud in the press with his rivals. Though Perleth devotes his final chapter to these events (regularly citing the 1985 thesis of E. Labra), his version is too abbreviated to do the tale justice.

Very much to Perleth’s credit, however, is the extensive, up-to-date bibliography he includes. It is probably the most comprehensive listing of publications relevant to Chagas’ disease and Carlos Chagas available in a single English-language...