Carlos Ribeiro Justiniano Chagas
Biography of Carlos Ribeiro Justiniano Chagas
Carlos Ribeiro Justiniano Chagas was a pioneer in the use of insecticides in the fight against malaria. He identified Trypanosoma cruzi as the casuative agent of American trypanosomiasis in 1909, while working at the Oswaldo Cruz Institute in Rio de janeiro. Chagas’ work is unique in the history of medicine - it is the only instance in which a single investigator has described the infection, its agent, its vector, its manifestations, its epidemiology, and some of the hosts of the pathogenic genus.
The coffee planter’s son
Chagas was the son Jose Justiniano das Chagas, a coffee planter descending from farmers who had arrived in Brazil from Portugal around the middle of the sixteenth century. His father died when he was four years old and his mother, Mariana Candida Chagas, was just 24. At the age of seven he was sent to the boarding school of the Jesuits at Itu. Because of the many serious incidents following the abolishment of slavery in 1888, he changed to the school in San Juan del Rey where his new teacher sowed in him the interest in observing the nature. Following his mother's wish the he should become an engineer, Chagas prepared for the Mining School in Ouro Preto,
At the age of 14 he enrolled in the School of Mining Engineering in Oro Prieto, the old capital in the state of Minas Gerais. This school was the the higher goal for the rich boys of that colonial time in the old Villa Rica. In 1995, aged 16, he survived a beri-beri attack and spent some time in Oliveira with his uncle Carlos Riveiro de Castro. His uncle who had graduated from the Medical School of Rio de Janeiro in 1888, had just established a new hospital in which the methods of Joseph Lister (1827-1912) were used for the first time in Brazil.
Influence by his uncle, Chagas in 1897 entered the Faculty of Medicine of Rio de Janeiro. He finished the course there in 1902, and in 1903 he earned the M.D. with the thesis, Estudos hematológicos do impaludismo ("A Hematological Study of Paludism") at the Manguinhos Institute, where he first met Oswaldo Goncalves Cruz (1872-1917), only seven years older, who became his life-long friend.
Attracted by clinical practice, however, Chagas turned down an invitation to work at Manguinhos, despite his admiration for the sanitarian who had created this model institute for research and for the production of serum and vaccines. Instead Chagas chose to work in a lower position in a hospital in Jurujuba, in which he also opened a private consulting room.
In 1905 financial difficulties forced Chagas to accept a mission to to work for Docas de Santos Company in the interior of the state of São Paulo in order to fight malaria, endemic to the workers employed for the construction of the port. In Itatinga, a small village nearby, Chagas undertook a successful campaign against malaria this disease. His method consisted in a minute observation of the domestic transmission cycle. Instead of using the already well-established technique of destroying larvae, he used pyrethrum to disinfect households and thus achieved a surprising success. He published his technique in Prophylaxia de impaludismo, a work which served as a basis for the combat of malaria all over the world and was revived forty years later as a guide to the use of new synthetic insecticides.
In 1906, he joined the Oswaldo Cruz Institute where he should work for the rest of his life. In the following year, Oswaldo Cruz sent him to fight a malaria epidemic in Xerém, at the periphery of Rio de Janeiro.
In 1909 Oswaldo Goncalves Cruz asked Chagas to undertake a new antimalaria campaign in the village of Lassance, about 375 miles from Rio, near the margins of the São Francisco River, where the camps of the railroad workers were attacked by malaria. The Brazilian government was trying to connect Belem in the Amazon Basin to Rio de Janeiro, but construction had to be halted because of the malaria. Lassance was at that time the terminal for the projected Central Railway System.
Working with Belisario Pena Chagas stayed in Lassance for two years (1909-1910), living in a railrod car which served as served as consultation room, laboratory and sleeping quarters.
The bugs of disease
A few days after his arrival in Lassance, Chagas observed a large number of bloddsucking insects that infested the walls of the huts there. He first observed the critical stage of the flagellate in the intestine of an insect of the genus Triatoma. Believing it to be a stage of development of a trypanosome, he allowed infected insects to feed on marmosets and twenty days later found trypanosome in the blood of the laboratory animals and found it present in domestic animals. He identified this trypanosome as a new genus and species and proposed to name it Schizo-trypanum cruzi (known generally as Trypanosoma cruzi), in honor of his friend and teacher, Oswaldo Cruz.
Chagas had already observed some unexplained pathological alterations in the inhabitants of the region from which the infected bugs were obtained. This had different characteristics to any disorder previously reported. On April 23, 1909, he discovered the parasite for the first time in the blood of a human being: a three year old girl. He observed morphologically identical trypanosomes and noted Leishman-Donovan-like inclusions in the brain and myocardium, thus accounting for the clinical involvement of these organs. From his surveys he suggested that the armadillo was the reservoir of the trypanosome. This is one of the few instances where the causative organism was found before the disease it produced was identified.
While in Lassance, Chagas performed more than 100 postmortem examinations on patients who exhibited the chronic form of the disease, although he was able to observe and describe only twenty-two cases of the acute form. After his stay in Lassance, Chagas made a ten-month trip to the Amazon Bazin to study tropical diseases further.
In 1907 Chagas became a full-time staff member of the Manguinhos Institute. His friendship with the institution’s founder, which was to end only with Cruz’ death in 1917, was a major influence in his career.
A celebrated man
In 1910 The National Academy of Medicine elected Chagas as extraordinary member, a singular fact in its history given that at that moment there was no vacancy. In 1912 an international jury chose him as the recipient of the Schaudinn Price, awarded every four years for the best work in the field of protozoology and tropical medicine in the world, by the Institut für Schiffs- und Tropenhygiene in Hamburg. Chagas received the diploma on June 22, 1912. Up to then this honour had only been conferred to the Austrian bacteriologust and zoologist Stanislaus Josef Mathias Edler von Prowazek (1875–1915).
The contenders for this highly prestigeous prize were Paul Ehrlich (1854-1915), Émile Roux (1853-1933), Ilya Ilich Mechnikov (1845-1916), Charles Louis Alphonse Laveran (1845-1922), Charles Jules Henry Nicolle (1866-1936) and Sir Wiliam Boog Leishman (1865-1926). Of these great names 3 had already been awarded the The Nobel Prize in Physiology or Medicine: Laveran in 1907, Mechnikov and Ehrlich jointly in 1908, while Nicolle was to be the 1928 recipient. Chagas was twice nominated for the Nobel Prize – in 1913 and in 1921, but never received the award. This was probably due to opposition that Chagas faced in Brazil from jealous colleagues.
In 1922 he was granted the Great Prize of the Pasteur Centenary Commemorative Exposition in Strasbourg. On June 23, 1921, he became the first Brazilian to be honored with the title of Doctor honoris causa by Harvard University, and later by the University of Paris.
With the death of Oswaldo Cruz in 1917, Chagas took over the direction of the Manguinhos Institute, remaining in this position until 1934. In 1918 the Brazilian government asked him to lead the campaign against the epidemic of Spanish Influenza ravaging Rio de Janeiro and entrusted him with the reorganisation of the Department of Health in Brazil, of which he was director from 1920 to 1924. He was active in the establishment of international centers for preventive medicine and he played an imprtant role in the prophylaxis and investigation of leprosy. Chagas also organized different special services, among them services for infant hygiene, for the combat of rural endemic diseases, tuberculosis, and sexually transmitted diseases. He created nursery schools and established the career of a sanitary physician.
From 1922 he was professor of Tropical Medicine at the University of Rio de Janeiro, where he established the chair for tropical diseases and introduced the study on hygiene as a specialty in Brazil. He died from a heart attack only 55 years old.
"gentlemen, the hygienic practical applications and the tropical medicine have destroyed the prejudice of a terrible climate; the scientific method has conquered the tropics unhealthiness".
Chagas to some graduate doctors one year before his death.
We thank Remo Farina Junior and Bruno Marcondes Kozlowski for information submitted.
- Prophylaxia do impaludismo.
Rio de Janeiro, Typ. Besnard Frères. 1905. 48 pages.
(Trabalho do Instituto de Manguinhos).
- Beitrag zur Malariaprophylaxis.
Zeitschrift für Hygiene und Infektionskrankheiten, 1908, 60: 321-334.
- Nouvelle espèce de Trypanosomiase humaine.
Bulletin de la Société de pathologie exotique, 1909, 2: 304-307.
- Nova trypanozomiaze humana. Estudos sobre a morfolojia e cíclo evolutivo do Schizotripanum cruzi n. gen. n. sp., ajente etiolòjico de nova entidade morbida do homem.
Memòrias di Instituto Oswaldo Cruz, Rio de Janeiro, 1909, 1 (2):159-218, ests 9-13. Text in Portuguese and German.
- Ueber eine neue Trypanosomiasis des Menschen. Zweite vorläufige Mitteilung.
Archiv für Schiffs- und Tropenhygiene unter besonderer Berücksichtigung der Pathologie und Therapie, 1909, 13 (11): 351-353.
- Les formes nerveuses d’une nouvelle Trypanosomiase (Trypanosoma Cruzi inoculé par Triatoma megista) (Maladie de Chagas).
Nouvelle iconographie de la Salpêtrière, clinique des maladies du systeme nerveux, 1913, 26: 1-9.
- Revision of the life cycle of “Trypanosoma Cruzi.” Supplementary note.
Rio de Janeiro 1913. 5 pages. Manguinhos.
- Processos patogénicos de tripanosomiase americana.
Memòrias di Instituto Oswaldo Cruz, Rio de Janeiro, 1916, 8 (2): 5-36, ests. 4-5.
- Cardiac form of American Trypanosomiasis. 25 pages. 1920.
- American Trypanosomiasis. Study of the parasite and of the transmitting insect.
Proceedings of the Institute of Medicine of Chicago, 1921, 3: 220-242.
The Chicago Medical Recorder, Chicago, 1921, 43: 609-627.
- Amerikanische Trypanosomiases (Chagasche Krankheit). Kurse ätiologische und Klinische Betrachtungen. 14 pages. 1925.
- Ueber die amerikanische Trypanosomiasis (Chagaskrankheit).
Münchener medizinische Wochenschrift, 1925, 72 (47): 2039-2040.
- Quelques aspects evolutifs du Trypanosoma cruzi dans l’insecte transmetteur.
Comptes rendus de la Société biologique, Paris, 1927, 97 (25): 824-832.
- Sur les alterations du coeur dans la trypanosomiase americaine. (Maladie de Chagas).
Archives des maladies du coeur, des vaisseaux et du sang, Paris, 1928, 21(10):641-655.
- Amerikanische Trypanosomenkrankheit, Chagaskrankheit.
Written with Enrico Villela and H. da Rocha Lima. In Carl Mense: Handbuch der Tropenkrankheiten, 3rd edition, 1929. Volume 5, part 1: 673-728.