- Email: [email protected]
A NEW FORM OF HUMAN TRYPANOSOMIASIS.
1774 when the heart was lifted forward with the right hand and rotated slightly to the left, the wound in the right auricle three-quarters of an inch above the auriculo-ventricular groove was seen. It was nearly half an inch long and with each beat a stream of dark blood spurted out. A suture of Number 0 chromicized catgut was passed on a curved intestinal needle ; the ends were left long at first in order to steady the heart, while three more similar sutures were inserted, and these completely controlled the haemorrhage. An attempt was made to avoid piercing the endocardium with the stitches, but the movements of the heart were so rapid that the operator was not certain whether they entered the cavity of the heart or not. The pericardium was emptied of blood and clot by means of the hand and a gauze sponge, and it was closed without drainage. The flap was replaced and an intravenous saline infusion was given. The operation lasted just over an hour and recovery followed. For the first week there were signs of a mild pleurisy, but these cleared up by the end of the second week. The patient left her bed on the seventeenth day and was discharged from the hospital 34 days after the operation. Dr. Peck discusses the details of the operation, and he expresses himself as in favour of the square flap with the binge externally. He gives a table of 159 cases classified according to the portion of the heart injured, and from this he shows that though most writers on heart wounds have considered wounds of the auricle to be more dangerous than those of the ventricle, yet the mortality of auricular wounds has been 363 per cent., while the general mortality of heart wounds is about 64 per cent. Dr. Peck’s case shows the value of rapid operation in heart wounds. From the great intrapericardial tension it seems to be practically certain that cessation of the beating of the heart would have occurred ’before long had not surgical intervention taken place.
A NEW FORM OF HUMAN TRYPANOSOMIASIS. IN the province of Minas Geraes, Brazil, a new form of human trypanosomiasis has been discovered by Dr. Carlo Chagas while engaged in organising anti-malarial measures for the protection of the labourers employed in constructing a new railway in that region. His attention was drawn to a ’large biting bug locally known as "barbeiro,"which, in,festing in large numbers the hovels of the poorer working class, remains hidden during the day time in the cracks of the walls or ceiling and issues forth at night when lights are extinguished to obtain its meal of blood from the occupants of the dwelling. This bug belongs to the Hemiptera heteroptera, family Reduvida3, genus Conorrhinus ; it is more than an inch in length and bites its human victim chiefly on In the hind gut of this insect Chagas found the face. numerous flagellates with the morphological characters of ’Crithidia. Some of these bugs were sent to Dr. Oswaldo Cruz, in whose laboratory they were allowed to bite monkeys, .and 20 or 30 days later in the blood of these animals were found numerous trypanosomes differing obviously from The parasite could also other members of the genus. be transmitted to guinea-pigs, rabbits, and dogs, in whose peripheral blood the trypanosomes were constantly found, at times in increasing numbers. The new parasite has been named by Dr. Chagas Schizotrypanum cruzi. An abstract of the discoverer’s original memoir has been recently published in the Sixteent7i Builetan (If the Sleeping Siokn688 Bureau, to which we are indebted for the following particulars. Dr. Chagas made search for the usual host of this new parasite and for this purpose he examined the human occupants of some of the bug-infested hovels. In the blood of some of these persons he found the trypanosomes, as also in a domestic cat. In some of the houses he found children suffering from an illness characterised by
anasmia, with delayed development, cedema general partial, enlargement of the peripheral glands and spleen, and functional disturbances, especially of the nervous system, with frequent occurrence of actual imbecility. No mention, however, is made of somnolence as a symptom ; in this particular the South American trypanosomiasis appears to differ from the African variety. The mortality among the children attacked seems to be great, the deaths being often attributed to convulsions." The local names of this malady-"opilacao or canguary" -are the same as are given to ankylostomiasis, which in many respects it resembles ; but Dr. Chagas excluded the latter disease from his cases by careful examination of the patients’ fasces. It is admitted that the course of this new disease is as yet only imperfectly known, and therefore more study of its clinical characters and progress is needed: From the blood of the patients experimental animals could be infected in the laboratory, and the parasites could also be cultivated- on artificial media outside the animal body. It is not contended that all the bugs in the hovels become infected, nor that all the bugs having flagellates in their extreme
or
"
"
"
"
hind gut can convey the disease to vertebrates. In a few instances the trypanosomes were found in the salivary glands of the insects, and it is therefore suggested that possibly only those bugs presenting this condition are capable of transmitting the disease. Dr. Chagas sums up the results of his laboratory investigations as follows : Schizotrypanum cruzi has in the organism of the Conorrhinus two methods of development-the first representing a simple culture of the parasite; the second, probably ushered in by sexual processes not yet observed, showing perhaps the cycle of development which occurs in the transmission from vertebrate to vertebrate. Conorrhinus is the true intermediate host of Schizotrypanum cruzi, the development cycle of which occupies a period of at least eight days. The in free of which occur the Crithidia living flagellates type, Conorrhinus, may be culture stages of the Schizotrypanum or exclusively insect parasites. The occurrence of the sexual cycle of development in the organism of Conorrhinus depends on states of the flagellates, in the blood of the vertebrates, as yet unelucidated. -
CHRONIC DIFFUSE PARENCHYMATOUS NEPHRITIS.
i
THE Address- in Medicine delivered at the annual of the Canadian Medical Association by Dr. W. P. Herringham (the proceedings of which are rereported at p. 1787) was devoted to a practical clinical study of chronic diffuse parenchymatous nephritis, based upon his own experience of cases of this condition. The anatomy of this form of nephritis has been carefully studied by numerous observers, and it is generally recognised that various forms exist. In some fatty changes predominate, leading to the condition of "large white kidney,"while in others fibrous lesions are marked, leading to a " small white kidney," but perhaps the most common form is one in which both forms of change co-exist, constituting the fibro-fatty kidney. The pathology of these conditions is still obscure, since it is difficult to determine the part played by infection in their production, and the relation of the various forms to one another is still the subject of controSome authorities affirm that the small white versy. is kidney a later stage of the large white, while others, and among them Dr. Herringham,l consider that there is no evidence of this. One of the special dangers of an attack of nephritis to which Dr. Herringham paid special attention in his address is the vulnerability of the kidneys which it leaves behind as a sequel, rendering them especially liable
meeting
morbid
1
Text-book of Medical Practice.
1904, p. 443.
Edited
by William Bain. London,
A NEW FORM OF HUMAN TRYPANOSOMIASIS. IN the province of Minas Geraes, Brazil, a new form of human trypanosomiasis has been discovered by Dr. Carlo Chagas while engaged in organising anti-malarial measures for the protection of the labourers employed in constructing a new railway in that region. His attention was drawn to a ’large biting bug locally known as "barbeiro,"which, in,festing in large numbers the hovels of the poorer working class, remains hidden during the day time in the cracks of the walls or ceiling and issues forth at night when lights are extinguished to obtain its meal of blood from the occupants of the dwelling. This bug belongs to the Hemiptera heteroptera, family Reduvida3, genus Conorrhinus ; it is more than an inch in length and bites its human victim chiefly on In the hind gut of this insect Chagas found the face. numerous flagellates with the morphological characters of ’Crithidia. Some of these bugs were sent to Dr. Oswaldo Cruz, in whose laboratory they were allowed to bite monkeys, .and 20 or 30 days later in the blood of these animals were found numerous trypanosomes differing obviously from The parasite could also other members of the genus. be transmitted to guinea-pigs, rabbits, and dogs, in whose peripheral blood the trypanosomes were constantly found, at times in increasing numbers. The new parasite has been named by Dr. Chagas Schizotrypanum cruzi. An abstract of the discoverer’s original memoir has been recently published in the Sixteent7i Builetan (If the Sleeping Siokn688 Bureau, to which we are indebted for the following particulars. Dr. Chagas made search for the usual host of this new parasite and for this purpose he examined the human occupants of some of the bug-infested hovels. In the blood of some of these persons he found the trypanosomes, as also in a domestic cat. In some of the houses he found children suffering from an illness characterised by
anasmia, with delayed development, cedema general partial, enlargement of the peripheral glands and spleen, and functional disturbances, especially of the nervous system, with frequent occurrence of actual imbecility. No mention, however, is made of somnolence as a symptom ; in this particular the South American trypanosomiasis appears to differ from the African variety. The mortality among the children attacked seems to be great, the deaths being often attributed to convulsions." The local names of this malady-"opilacao or canguary" -are the same as are given to ankylostomiasis, which in many respects it resembles ; but Dr. Chagas excluded the latter disease from his cases by careful examination of the patients’ fasces. It is admitted that the course of this new disease is as yet only imperfectly known, and therefore more study of its clinical characters and progress is needed: From the blood of the patients experimental animals could be infected in the laboratory, and the parasites could also be cultivated- on artificial media outside the animal body. It is not contended that all the bugs in the hovels become infected, nor that all the bugs having flagellates in their extreme
or
"
"
"
"
hind gut can convey the disease to vertebrates. In a few instances the trypanosomes were found in the salivary glands of the insects, and it is therefore suggested that possibly only those bugs presenting this condition are capable of transmitting the disease. Dr. Chagas sums up the results of his laboratory investigations as follows : Schizotrypanum cruzi has in the organism of the Conorrhinus two methods of development-the first representing a simple culture of the parasite; the second, probably ushered in by sexual processes not yet observed, showing perhaps the cycle of development which occurs in the transmission from vertebrate to vertebrate. Conorrhinus is the true intermediate host of Schizotrypanum cruzi, the development cycle of which occupies a period of at least eight days. The in free of which occur the Crithidia living flagellates type, Conorrhinus, may be culture stages of the Schizotrypanum or exclusively insect parasites. The occurrence of the sexual cycle of development in the organism of Conorrhinus depends on states of the flagellates, in the blood of the vertebrates, as yet unelucidated. -
CHRONIC DIFFUSE PARENCHYMATOUS NEPHRITIS.
i
THE Address- in Medicine delivered at the annual of the Canadian Medical Association by Dr. W. P. Herringham (the proceedings of which are rereported at p. 1787) was devoted to a practical clinical study of chronic diffuse parenchymatous nephritis, based upon his own experience of cases of this condition. The anatomy of this form of nephritis has been carefully studied by numerous observers, and it is generally recognised that various forms exist. In some fatty changes predominate, leading to the condition of "large white kidney,"while in others fibrous lesions are marked, leading to a " small white kidney," but perhaps the most common form is one in which both forms of change co-exist, constituting the fibro-fatty kidney. The pathology of these conditions is still obscure, since it is difficult to determine the part played by infection in their production, and the relation of the various forms to one another is still the subject of controSome authorities affirm that the small white versy. is kidney a later stage of the large white, while others, and among them Dr. Herringham,l consider that there is no evidence of this. One of the special dangers of an attack of nephritis to which Dr. Herringham paid special attention in his address is the vulnerability of the kidneys which it leaves behind as a sequel, rendering them especially liable
meeting
morbid
1
Text-book of Medical Practice.
1904, p. 443.
Edited
by William Bain. London,