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Carlos Chagas

By: Ana Palma

“It won’t be long until we pass on a great and beautiful science, that does art in defense of life.” (1928)

On April 22nd, 1909, Oswaldo Cruz formally announced, to the National Academy of Medicine, the discovery, by Carlos Chagas, of a new disease: American trypanosomiasis or Chagas disease.

The discovery process started in 1907, when Chagas (a researcher at the Federal Serum Therapy Institute, later to become the Oswaldo Cruz Institute), arrived in Lassance, in the North of the Brazilian state of Minas Gerais, with the mission of fighting malaria among workers of Brazil’s Central Railroad. There, he got intrigued by an insect that lived in the walls of wattle and daub houses, feeding on the blood of its inhabitants. Since it mainly stung in the face, the bug was called the “barber” by the locals.

When examining these insects, Chagas found a new parasite, which he called Trypanosoma cruzi, as a tribute to Oswaldo Cruz. He discovered that it also caused the disease in laboratory animals and that it also infected pets. At the same time, he had already noticed unexplained pathological alterations in the population. He then started studying the connection between the new parasite and the disease the people were having. On April 23rd, 1909, Chagas discovered the protozoan for the first time in the blood of a human being: a three-year-old girl, Berenice, which was in the acute stage of the disease.

That was an unparalleled accomplishment in the history of medicine: Chagas discovered and described the parasite (Trypanonoma cruzi), its life cycle, its vector (the kissing bug - Triatoma infestans) and its habits, its domestic reservoir (the cat), and the disease (the Chagas disease).

Repercussion

<EM>Trypanosoma cruzi.</EM> Photo: Helene Barbosa/IOC

Trypanosoma cruzi. Photo: Helene Barbosa/IOC

The repercussion was enormous, both in Brazil and abroad. The Academy of Medicine, in a unique occurrence, made him an extraordinary member (since there was no spot available at the time). “The discovery of the disease is the most beautiful example of the power of logic in the service of science. In biological sciences, never such a complex and brilliant discovery had been made, and, what’s more, by a single researcher,” said Oswaldo Cruz.

Chagas received the Schaudinn award - given to the best work in protozoology carried out until then - on July 1912, as a tribute of the Hamburg Institute of Tropical Diseases, in Germany. The international acclaim allowed the research on the new disease to continue, now with the collaboration of various researchers from the Oswaldo Cruz Institute, among which were Gaspar Vianna, Arthur Neiva, Eurico Villela, Magarino Torres, César Guerreiro, Astrogildo Machado, Evandro Chagas and Emmanuel Dias.

The kissing bug full of blood

The kissing bug full of blood

Chagas and collaborators identified several different types of clinical disease outcomes, having distinguished the acute stage from the chronic stage; described very minutely the morphology and biological cycle of T. cruzi both in the vector insect that transmits the disease and in the vertebrate host; and studied the biology of various Triatominae that pass it on.

Moreover, they carried out experimental investigations, conducted studies on the pathogeny (the process and evolution of the disease) and on the anatomic pathology (the study of lesions caused by the disease through necropsies), developed diagnostic methods, analyzed the role of both domestic and wild T. cruzi reservoirs, and stressed the relevance of the disease as a burden that hindered the physical and social development of rural populations in the country.

Between November 1922, and December 1923, the Brazilian National Academy of Medicine was the stage of a great controversy regarding Chagas disease. A group of doctors (among which were Afrânio Peixoto, a professor of Hygiene in the Medical University of Rio de Janeiro; Henrique Figueiredo de Vasconcellos, researcher of the Oswaldo Cruz Institute; and Parreiras Horta, professor of Parasitology in the Agriculture and Veterinary Medicine School) contested the authorship of the discovery of T. cruzi, accused the American trypanosomiasis of having been made up and questioned the importance it had been attributed to by the government, claiming that there was no evidence of the disease extending beyond the boundaries of Lassance. After examining the claim, a committee of the Academy identified Chagas as indeed the true discoverer, but couldn’t respond as to the distribution of the disease in the country.

The end of the controversy

Shack

Shack

The problem was once and for all solved in the 1930s. The research of Argentinean doctors Salvador Mazza and Cecilio Romaña, detected hundreds of acute cases in Argentina and proved the disease was not restricted to Brazil, but it also affected other countries in the continent.

At the same time, Brazilian researchers worked hard to prove the ample distribution of the disease. In 1935, Chagas’s oldest son, Evandro, created, at the Oswaldo Cruz Institute, the Great Endemic Diseases Study Service, thus stimulating research on the disease. In 1940, researcher Amilcar Vianna Martins described 25 acute cases of Chagas disease in the city of Bambuí, in the Brazilian state of Minas Gerais.

In 1943, the Oswaldo Cruz Institute built a research center in Bambuí, conducted by researcher and Carlos Chagas’s collaborator, Emmanuel Dias. The center was renamed the Emmanuel Dias Advanced Research Station in 1980, which is considered a landmark for the assertion of Chagas disease as a relevant public health issue for both Brazil and Latin America.

In 1959, the 1st International Congress on Chagas Disease, carried out in Rio de Janeiro, made it evident that the disease had finally been recognized as socially important and that the scientific trail picked up by Carlos Chagas should be followed and explored in search of new paths and solutions.

Childhood and education

Born on July 9th, 1879, in Oliveira, in the west of Minas Gerais, Carlos Justiniano Ribeiro Chagas lost his father at the age of four. He attended prep school at Escola de Minas, in Ouro Preto, because his mother wanted him to be an engineer. At 16, however, he discovered his calling and, in 1897, he was admitted to the Medical University in Rio de Janeiro.

Finishing his course, he chose Hematological studies in malaria as the theme of his dissertation, which put him in contact with Oswaldo Cruz for the first time. Attracted by clinical practice and despite his admiration for the doctor, Chagas refused an invitation to stay at the Serum Therapy Institute. In 1904, he started seeing patients in his private office in downtown Rio de Janeiro and married Íris Lobo. They had two kids: Evandro Chagas, born in 1905, and Carlos Chagas Filho, born in 1910.

At Fiocruz

In 1905, he carried out, in Itatinga, in the state of São Paulo, the first successful campaign against malaria in the country. He decided to fight the mosquito inside homes, sanitizing them by burning Pyrethrum. His theory of the place of infection being the home served as the basis for various strategies against the disease throughout the world.

After returning from São Paulo in 1906, he joined the Oswaldo Cruz Institute, where he would work for the rest of his life. The following year, he was sent by Oswaldo Cruz, together with Arthur Neiva, to Xerém, in the Lowlands of Rio de Janeiro state (north of the city of Rio) to fight a malaria epidemic.

In 1912, Chagas carried out an expedition to the Amazon, having conducted a complete assessment of the medical/health conditions of the region. In a report to the Ministry of Agriculture, Industry and Trade, Chagas and the other members of the expedition reported how Amazon populations were socially and medically abandoned, stressing the need for public health measures to ensure the region’s economic development.

When Oswaldo Cruz passed away, in 1917, Chagas was nominated director of the Oswaldo Cruz Institute, on February 14th. In his administration, he sought to consolidate what had been established by Oswaldo Cruz, in the image of the Pasteur Institute, which was characterized by managerial and financial autonomy and the close link between research, education and the manufacture of products for human and veterinary medicine, with the purpose of aiding the country’s public health services.

In the field of research, his administration focused on investigating the causes of the epidemiology and clinical outcomes of rural diseases. He was also responsible for the creation of scientific sectors, an organization into knowledge areas with which he intended to establish a clearer division of labor within the Institute. In Education, he broadened the Institute’s Applied Courses program.

As to production, Chagas diversified the array of drugs and biological products manufactured at the Institute, among which some developed were by their own researchers, and stimulated these products to be commercialized, thus increasing the Institute’s self-generating resources. From 1920 on, the Institute also took responsibility for assessing the quality of medical products used on humans in the country, either produced domestically or abroad.

Public health

In 1918, Carlos Chagas was invited by the Brazilian government to lead the campaign against the Spanish flu epidemic, which was ravaging Rio de Janeiro. The success of the endeavor would be heavily influential and culminated in him being chosen to manage the reform of the country’s public health system, as of 1919.

Chagas with patients

Chagas with patients

Having been designated head of the National Public Health Department (DNSP, in its Portuguese acronym), Chagas increased the federal government’s power to intervene in the field of public health, as well as organized several specialized services, such as those regarding child health and the fight against rural diseases, tuberculosis, leprosy and venereal diseases.

Carlos Chagas was also dedicated to training professionals in public health, having created the Anna Nery Nursing School. He also developed a specialization for doctors in public health by creating the Special Course on Hygiene and Public Health, connected to the Medical University, whose lectures were given by researchers of the Oswaldo Cruz Institute. Those finishing the course were assured appointment for positions in the federal government’s health services. He also created the São Francisco de Assis Hospital, which would be used as a model for the modernization of hospital services in the country.

In 1925, he was nominated professor of the Medical University of Rio de Janeiro, where he created a course on Tropical Medicine and established the basis for research in this field in the country. Moreover, Chagas represented Brazil in several international committees, especially as a permanent member of the Hygiene Committee of the League of Nations.
On November 8th, 1934, at 55, he passed subtly.

Photos:

Arquivo Casa de Oswaldo Cruz/Fiocruz

See also:

Chagas Disease Web Portal

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