1774

when the heart was lifted forward with the right hand androtated slightly to the left, the wound in the right auriclethree-quarters of an inch above the auriculo-ventricular

groove was seen. It was nearly half an inch long and witheach beat a stream of dark blood spurted out. A suture of

Number 0 chromicized catgut was passed on a curved in-testinal needle ; the ends were left long at first in order tosteady the heart, while three more similar sutures were in-serted, and these completely controlled the haemorrhage.An attempt was made to avoid piercing the endocardiumwith the stitches, but the movements of the heart were sorapid that the operator was not certain whether they enteredthe cavity of the heart or not. The pericardium was emptiedof blood and clot by means of the hand and a gauzesponge, and it was closed without drainage. The flap wasreplaced 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, butthese cleared up by the end of the second week. The

patient left her bed on the seventeenth day and was dis-charged from the hospital 34 days after the operation. Dr.

Peck discusses the details of the operation, and he expresseshimself as in favour of the square flap with the bingeexternally. He gives a table of 159 cases classified accordingto the portion of the heart injured, and from this he showsthat though most writers on heart wounds have consideredwounds of the auricle to be more dangerous than those ofthe ventricle, yet the mortality of auricular wounds has been36 3 per cent., while the general mortality of heart woundsis about 64 per cent. Dr. Peck’s case shows the value of

rapid operation in heart wounds. From the great intra-

pericardial tension it seems to be practically certain thatcessation 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 ofhuman trypanosomiasis has been discovered by Dr. Carlo

Chagas while engaged in organising anti-malarial measuresfor the protection of the labourers employed in constructinga 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 i

class, remains hidden during the day time in the cracks ofthe walls or ceiling and issues forth at night when lightsare extinguished to obtain its meal of blood from the occu-

pants of the dwelling. This bug belongs to the Hemipteraheteroptera, family Reduvida3, genus Conorrhinus ; it is more

than an inch in length and bites its human victim chiefly onthe face. In the hind gut of this insect Chagas foundnumerous 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 werefound numerous trypanosomes differing obviously from

other members of the genus. The parasite could alsobe transmitted to guinea-pigs, rabbits, and dogs, in

whose peripheral blood the trypanosomes were constantlyfound, at times in increasing numbers. The new parasitehas been named by Dr. Chagas Schizotrypanum cruzi. An

abstract of the discoverer’s original memoir has been recentlypublished in the Sixteent7i Builetan (If the Sleeping Siokn688Bureau, to which we are indebted for the followingparticulars. Dr. Chagas made search for the usual host ofthis new parasite and for this purpose he examined thehuman occupants of some of the bug-infested hovels. In

the blood of some of these persons he found the trypano-somes, as also in a domestic cat. In some of the houses hefound children suffering from an illness characterised by

extreme anasmia, with delayed development, cedema generalor 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 somnolenceas 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 inmany respects it resembles ; but Dr. Chagas excluded thelatter disease from his cases by careful examination of thepatients’ fasces. It is admitted that the course of this newdisease is as yet only imperfectly known, and therefore morestudy of its clinical characters and progress is needed:

From the blood of the patients experimental animals couldbe infected in the laboratory, and the parasites could also becultivated- on artificial media outside the animal body. It

is not contended that all the bugs in the hovels becomeinfected, nor that all the bugs having flagellates in theirhind gut can convey the disease to vertebrates. In a fewinstances the trypanosomes were found in the salivary glandsof the insects, and it is therefore suggested that possiblyonly those bugs presenting this condition are capableof transmitting the disease. Dr. Chagas sums up the resultsof his laboratory investigations as follows : Schizotrypanumcruzi has in the organism of the Conorrhinus two methods ofdevelopment-the first representing a simple culture of theparasite; the second, probably ushered in by sexual pro-cesses not yet observed, showing perhaps the cycle of

development which occurs in the transmission from verte-brate 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

flagellates of Crithidia type, which occur in the free livingConorrhinus, may be culture stages of the Schizotrypanum orexclusively insect parasites. The occurrence of the sexual

cycle of development in the organism of Conorrhinus dependson states of the flagellates, in the blood of the vertebrates,as yet unelucidated.

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CHRONIC DIFFUSE PARENCHYMATOUSNEPHRITIS.

THE Address- in Medicine delivered at the annual

meeting of the Canadian Medical Association by Dr.

W. P. Herringham (the proceedings of which are re-

reported 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

morbid anatomy of this form of nephritis has been carefullystudied by numerous observers, and it is generally recognisedthat various forms exist. In some fatty changes predominate,leading to the condition of "large white kidney," while inothers fibrous lesions are marked, leading to a " small whitekidney," but perhaps the most common form is one in whichboth forms of change co-exist, constituting the fibro-fattykidney. The pathology of these conditions is still obscure,since it is difficult to determine the part played by in-fection in their production, and the relation of the variousforms to one another is still the subject of contro-

versy. Some authorities affirm that the small white

kidney is a later stage of the large white, while others, andamong them Dr. Herringham,l consider that there is no

evidence of this. One of the special dangers of an attackof nephritis to which Dr. Herringham paid special attentionin his address is the vulnerability of the kidneys which itleaves behind as a sequel, rendering them especially liable

1 Text-book of Medical Practice. Edited by William Bain. London,1904, p. 443.