The Kiss of Death

triatomines in all stages of development. Every item of this demonstration was carefully examined by us. The doctors gathered there, undisputable authorities in their fields… had nothing to deny or add to the analysis of the symptoms or their interpretations… On that day it was up to me to give a name to those traditional diseases of the Minas backlands, which were now unified as one disease with cause and development clearly established. To name it after only one of its symptoms would be to limit its description, and to name it for all its symptoms would be impossible… And so, at dinner, while toasting Carlos Chagas, I… chosen because of my age, standing with Oswaldo Cruz on my right and surrounded by the men most representative of Brazilian medicine of that era, with gravity equal to a liturgical act in our religion, such as a baptism, gave the name of Chagas’ Disease to that illness…in the name of the entire delegation (Couto, in Kean 1977).

^{Figure 8.}

^{Progression of Chagas’ disease. (From Jared Goldstein, “Darwin, Chagas’, Mind, and Body,” Perspectives in Biology and Medicine 32, no. 4 ([1989]:595.)}

Carlos Chagas died in 1933 of angina pectoris as he was looking through a microscope into the universe of parasites. A year before his death, he optimistically spoke to a class of graduating physicians: “Gentlemen, the practical applications of hygiene and tropical medicine have destroyed the prejudice of a fatal climate; the scientific methods are prevailing against the sickness of the tropics” (Kean 1977). On a less optimistic occasion, he remarked, “This is a beautiful land, with its tremendous variety of vegetation. Nature made animal and vegetable life stronger and thus created conditions which bring sickness and death to the men who live here” (Chagas Filho 1993).

Since Carlos Chagas’ amazingly rapid discovery of it in 1909, research concerning this disease has been slow. After Chagas discovered Trypanosoma cruzi, the disease was not described until ten years later and was not recognized as a serious health problem in Brazil for another forty years. Other countries of Latin America have been even slower in recognizing the problem, with Bolivia beginning in 1991. The first and only drugsnifurtimox and benznidazolefor treatment did not appear until 1970 and then met with only partial success. Discovering disease is only a short first step toward treating and preventing it.

CHAPTER TWO Early Andean Disease

The earliest indications of Chagas’ disease in the Andes are found among mummies dated as living at A.D. 400. Anthropologists Rothhammer, Allison, Nufiez, Standen, and Arriaza (1985) recently discovered the ancient mummies of twenty-two Andeans in Quebrada de Tarapaca, Chile. The mummies were 1,500 years old and belonged to an extinct culture, called the Wankari. Eleven of the bodies had greatly enlarged hearts, colons, or esophagi. One forty-five-year-old male had both an enlarged colon and heart. Another twenty-five-year-old male had an enlarged colon and esophagus. Three forty-five-year-old males had enlarged colons, and a three-year-old boy had an enlarged heart and colon. Four women had enlarged colons.

What caused the enlarged organs in half of these bodies? Scientists considered various explanations. Cardiomegaly, enlarged heart, sometimes results from atrophied heart muscles caused by degenerative diseases associated with aging. This could explain the older victims of ages forty to forty-five but not the enlarged heart of the child. The average life span of the people was around thirty-five years at this time.

Megasyndromes appeared in all cases. Enlargement of the colon was explainable by fermentation of food, creating gas and causing intestinal walls to expand, a condition found in unembalmed corpses in warmer climates. The climate of Quebrada de Tarapaca in the northern highlands of Chile is frigid because of its high altitude. The nerves of the intestinal walls were severely atrophied, perhaps resulting from a long-term disease condition.

Another possibility was that the corpses could have suffered severe gastritis and flatulence from spoiled lima beans shortly before death. After the petrified contents (coprolites) of the colons were examined, scientists found carob-tree sheaths (Prosopisjuliflora) but no lima beans (Phaseolus lunatus). It is possible that the victims may have eaten the carob sheaths as medicine. The impacted bowels indicated long-term constipation, usually caused by the inability of the colon’s sphincter muscles to contract, expand, and dispel the feces. Degenerated neuron cells of the sphincter muscles can cause this as well as enlarged hearts and esophagi.

The anthropologists inquired about modern Andeans from this region to see if they suffered from similar symptoms, and, not surprisingly, many peasants suffered these symptoms. Among modern Andeans 90 percent of individuals with megacolon and 100 percent of those with megacolon and megaesophagus are tested seropositive for Chagas’ disease (Atias 1980). Degeneration of neuron tissues of the heart, esophagus, and colon are common to patients with chronic Chagas’ disease. The exhumed Wankari Andeans likely died from Chagas’ disease, which was quite likely as debilitating and as deadly a disease then as it is now, 1,500 years later.

Long-Term Adaptation of T. cruzi

Modern Andeans, however, from this region suffer milder forms of Chagas’ disease than those living in lower regions. This indicates long-term adaptation of early Andeans at Quebrada de Tarapaca. Clinical surveys of chronic Chagas’ patients indicate that in the lower Andean region of northern Chile the infection rate is low and great evidence of cardiac involvement is detected by electrocardiograms (Arribada et al. 1990). In the higher Andean region of Quebrada de Tarapaca a very high infection rate is detected, but cardiac involvement is lower than that of the lower region (Apt et al. 1987). This indicates the importance of altitudinal factors on the T. cruzi infection causing cardiac involvement (Villarroel et al. 1991). The more benign character of Chagas’ disease detected in higher altitudes of Chile is significant because it may relate to the ancient adaptation of the parasite to the human host in the Andean highlands of Quebrada de Tarapaca (Gonzalez et al. 1995:126; Neghme 1982).

It is possible that the varying severities of Chagas’ disease may be due to different strains of T. cruzi circulating in each area. Such T. cruzi strains display unique characteristics. Individual T. cruzi strains and geographic distribution of different strains and their source (sylvatic or domestic) play a role in the wide variety of clinical signs encountered in Chagas’ disease (Rassi 1977). Nevertheless, early adaptation of T. cruzi to humans in the southern Andean highlands likely explains the more benign character of Chagas’ disease found there today (Gonzalez et al. 1995: 132-33) (see Appendix 2: Strains of T. cruzi).

Enlarged Colons in Bolivia: A Case of Empacho

In Bolivia in 1992 I observed similar megasyndromes among Quechua peasants in the village of Choromoro, about seventy-five miles east of Sucre, Bolivia. One woman suffered an enormously enlarged heart (five times its normal size) and had died shortly before I arrived. A man named Jacinto had an enlarged intestine about the size of a basketball (see Figure 9). Jacinto hadn’t gone to the toilet for half a year and was dying. Jacinto said that he had empacho, a culturally defined illness that includes constipation. Empacho has accompanying emotions of sadness, lethargy, and embarrassment. Even though his constipation sounded like it could relate to the anthropologists’ fermented-bean theory, Jacinto understood his body better than did physical anthropologists.