Adolpho Lutz and controversies over leprosy

vector to include rural and suburban foci of Hansen's disease.54 The leprologist from Manguinhos defended this thesis at the 10th Brazilian Congress on Hygiene, held in Belo Horizonte in October 1952, and at the 5 th International Congress on Tropical Medicine and Malaria, which took place in Istanbul in AugustSeptember of 1953.

Adolpho Lutz’ ideas were defended before other audiences by his daughter, Bertha Lutz. During the seventeen months in which she held office as a legislative deputy (Partido Autonomista) for the Federal District, representing the Liga Eleitoral Independente (Independent Voters League), she urged that mosquitoes be combated as part of leprosy prophylaxis. She in fact lodged a petition with the House of Representatives, requesting information on the anti-culicidian measures taken at the leprosariums and isolation hospitals then being created in different places around Brazil (Benchimol and Sá, Jan.-Apr. 2003, p.203-50).

World War II was a watershed in treatment of the disease. As of the 1940s, the use of compounds derived from diamino-diphenyl-sulphone (Promin, by Parke Davis; Diazone, by Abbot; Sulphetrone, by Burroughs Wellcome) would bring a cure to thousands of interned patients who began receiving their treatment in dispensaries, until they could be finally released after some years (Coutinho, 1957, p.321). These pages are not the place for a detailed investigation of all the chemical-pharmaceutical, socioeconomic, and political-cultural factors that made leprosariums and leper colonies obsolete, destined to decay or to be transformed into monuments meant for other purposes, among which preserving our memory of medical practices now fortunately left behind. But should you, the reader, happen to come across rusty screens protecting the doors and windows of one of these ghostly institutions, now you will know they represent prosaic vestiges of the ideas so fiercely defended by Adolpho Lutz. In this case, as in many others, the historian does not find the neat closing chapter always imagined to finalize scientific polemics, separating truth from error like wheat from the chaff.

 

Photo 1 shows Sebastião and Benedita, spontaneously

contaminated by Hansen's bacillus, in Rola Moça, Bambuí, Minas

Gerais, where Souza Araújo and his staff collected many Triatoma

infestans, Chagas’ disease transmitter. Photo 2 shows Dr.Vandyck

taking notes about J.A. Luz and his daughter, in Arraial da Mata, in

São Gotardo, Minas Gerais, “the core of leprosy, Chagas disease

transmitters and ticks”. Souza Araújo photos (1943, p.453a), on

December 13 and 18, 1942.

Ten diseased people selected for the experimental contamination of

mosquitoes in natural condition. In the photo, taken by Souza Araújo

in March 1943, entomologist Oliveira Castro and guard Otto stand

with the diseased by Rio do Peixe Lagoon. At this site, at sunset, the first mosquitoes contaminated with Hansen's bacilli were collected at the very moment they were suching blood from the diseased (Souza

Araújo, 1943b, p. 170, fig. 5).

Adolpho Lutz and his daughter, Bertha Maria Júlia Lutz, at the foot of

the central stairs of Rio de Janeiro House of Representatives, at her

inauguration ceremony as federal representative in July (BR. MN.

Fundo Bertha Lutz)

 

Notes

1 Although in Brazil and other nations the term ‘Hansen's disease’ has been adopted to refer to this illness as part of an effort to relieve its sufferers of the stigma associated with ‘leprosy', we have nonetheless chosen to apply the word that was in current use during the historical period examined in these pages. From a historiographic perspective, a ‘politically correcf stance would in this case yield an unacceptable anachronism. For more on the current implications of the use of the term “Hansen's disease” see Oliveira et al. (2003).

2 See Danielssen and Boeck (1848). Heráclides Cesar de Souza Araújo edited a commemorative centennial edition of the Atlas de la lèpre par C. Danielssen e C. W. Boeck, Bergen en Norvèege, 1847 (Rio de Janeiro, 1946).

3 Obregón, 2000, p.266; Lutz, 1887. Originally published in Norsk Magazin for Laegevidenskaben (1874), Hansen's work was reprinted in 1955 by the Intern. Journ. of Leprosy. Obregón, currently one of the leading scholars on the history of leprosy, has just published a fine book on the topic (Medellin, 2002), and, more recentjy, an article on the campaign against the disease in Colombia (2003).

4 After testing it at Instituto Bacteriológico de São Paulo, Adolpho Lutz gave his negative opinion regarding the serum produced by Colombian physician Juan de Dios Carrasquilla. Obregón's affirmation that the search for a vaccine against leprosy turned into “almost the only acceptable program of scientific investigation” (Obregón, 2000) does not apply to Brazil, albeit yellow fever was the object of intense research.

5 “Report on the status of Lazarus Hospital, prefaced by some considerations on morphea, its treatment, and experiments conducted at this hospital in 1869 by Dr. João Pereira Lopes” (in Port.), found in Lopes (1870) and partially transcribed in Souza Araújo (1946, p.463-71).

6 For a description of the cited plants, see Cruls (1965).

7 Before finishing his medical schooling in Strassbourg in 1875, Paul Gerson Unna (1850-1929) studied in Leipzig and Heidelberg. His doctoral dissertation on the histology and history of the development of human epidermis (Archiv für mikroskopische Anatomie, 12, p.665, 1876) was a precursor to original approaches in the field of skin diseases. In 1881, he founded a private dermatological clinic which three years later was moved to more modern facilities in Eimsbüttel, a suburb of Hamburg. The institution soon attracted a large number of students from Germany and other countries. Co-editor of InternationalerAtlas seltener Hautkrankheiten (Hamburg and Leipzig, 1889-1899), Unna did research on biochemical skin processes and discovered Stratumgranulosum. He described a number of diseases and introduced new therapies. His book on histopathology, published in 1884, consolidated his prestige as one of the world's greatest dermatologists (www.whonamedit.com/index.cfm). In the next volume of the Complete Works of Adolpho Lutz, we will look more carefully at his relationship with Unna and the role that both played in the medical specialty of dermatology, which was becoming established in a number of countries.

8 Neumann was a professor at the University of Heidelberg and associated with both the Seemannskrankenhause (Sailors’ Hospital) and the Institut für Schiffs und Tropenkrankheiten (Institute of Naval and Tropical Diseases), in Hamburg. In the summer of 1904, he traveled to Brazil with M. Otto to study yellow fever, shortly thereafter publishing Studien überdas Gelbe Fieberin Brasilien (Leipzig, 1906).

9 “Relatório do dr. Lutz comunicado ao dr. Azevedo Lima”. Rio de Janeiro, July 4, 1887. In Azevedo Lima, 1887, p.24-32. Transcribed in Souza Araújo (1946, p.491-3).

10 See the bibliography on Adolpho Lutz edited by Herman Lent, in Neiva (1941). It was reprinted, with corrections and additions, in História, Ciências, Saúde – Manguinhos, 10:1, p.362-409.

11 BR. MN. Fundo Adolpho Lutz, pasta 255, maço 2.

12 On September 20, 1884, he inoculated Keanu, “rubbing pus from a leprous ulcer into blistering boils on his right arm and his ear. From a 9-year-old girl with tuberous leprosy he removed a leproma immediately after a bout with fever … [this] was introduced into a long, deep incision in Keanu's left forearm, and retained there by five stitches … The following month, the patient began to feel rheumatoid pains; immediately thereafter, the cubital nerves began to become obstructed, this lasting until the 5th th to the 8 month. … On 9/25/1888, tuberous leprosy was quite marked in Keanu, and he was transferred to the leprosarium in Molokai” (Souza Araújo, 3.9.1936). The second controversial incident involving Arning was his examination and diagnosis of Father Damien, which will be discussed later.

13 As in Brazil, Chinese immigrants were considered by the Europeans and North Americans to be racially inferior, dirty, and sexually promiscuous, as well as having other physical and moral characteristics that jeopardized public hygiene (Obregón, 1996, p.165; Crosby, 1992, p.194; Gussow, 1989, p.96-7).

14 Letter from Emerson to Lutz, on November 6, 1888, partially transcribed by Corrêa (1992, p.145-6).

15 Letter to Emerson, dated June 2, 1888. According to Marcelo Oswaldo Álvares Corrêa (1992, p.144), the main source on this period of Lutz’ life, his name had become known to Emerson by means of H. W. Schmidt, the Swedish and Norwegian Consul, who also had ties to a business, H. Hackfeld & Co. On May 5,1888, Unna wrote Lutz from Paris. He forwarded him a letter from Schmidt, on the subject of his trip to Hawaii, and left it to Lutz to decide what was best (BR. MN. Fundo Adolpho Lutz, pasta 252, maço 2). At the beginning of 1888, Emerson consulted Dr. Edward Arning to find out whether he would like to resume his investigations, this time directed toward therapeutics, but Arning declined, saying that the disease was being studied by competent professionals in European medical centers that offered more advantageous conditions than Hawaii (Law, n.d., p.3; also hml.org/mmhc/mdindex/arning.html).

16 In the next volume of this collection, focusing on dermatology and mycology, we will analyze the meaning of this conference for Lutz and for the areas of medical-biological specialization with which he was involved.

17 At the Molokai community, a number of physicians served as directors:. N. B. Emerson (1879), C. Neilson (1880-1881), G. L. Fitch (1882-1884), A. St. M. Mouritz (1884-1887), C. A. Peterson (1888), S. B. Swift (1889-1892) e E. Oliver (1892-1902) (Souza Araújo, 1929, p.83).

18 During a visit to Honolulu in January of 1885, Father Damien burned his leg and foot. The physician who examined him, Dr. George Trousseau, noted that he lacked sensation in his limbs. Dr. Edward Arning was called in, and he applied a strong electric current using a platinum needle placed in the leg. The fact that the priest did not feel this confirmed the death of the peroneal nerve, along with other ramifications, due to Hansen's disease. Father Damien refused treatment by Arning at Kakaako hospital. Source: hml.org/mmhc/mdindex/arning.html (consulted in February, 2003). On this subject, see also Obregón, 2002; Huenermann, 1953.

19 Law (n.d., p.1). Based, apparently, on the diary of Sister Leopoldina Burns, this author affirms that Amy converted to Catholicism in order to win her patients’ confidence, entering the Third Order of Saint Dominic only on the eve of her departure from England.

20 Also in Albuquerque (1950, p.11-2) we read that the trip through the United States had the air of a “triumphant procession.”

21 The other members of the Board were L. A. Thurston and S. M. Damon, whom she qualified as “excellent,” and W. E. Rowell and J. T. Waterhouse, who were described as “honorable;" Potter was merely a squire.

22 Born in the state of Maine, on July 9,1832, Kimball graduated from Harvard Medical School in 1857, and served in the U.S. Civil War (1861-1865) as a surgeon for the Union Army. Accompanied by his daughter, he arrived in Hawaii on June 11, 1882. In October, he was named government doctor of the Hilo district, in which post he remained until May, 1888. He also provided services to four large land-owners in rural areas. Transferred to Honolulu, he became responsible for the capital's dispensary until January, 1890, when he assumed the presidency of the Board of Health. He resigned from this position after the scandal involving Adolpho Lutz and Amy Fowler, which will be described here later, and returned to the United States. He died in Bridgton on June 20, 1902 (http://hml.org/mmhc/mdindex/arning.html; accessed on March 7, 2004).

23 Its members were John W. Kalua (president), A. P. Paehaole, H. G. Grabbe, WM. H. Halstead and T. R. Lucas. The last visit by the Board of Health committee, which included J. O. Carter and Waterhouse, ocurred days before the first visit by the legislative commission. Legislature of 1890. Select Committee on Complaint of Rose Gertrude in regard to Kalihi Hospital.

24 Legislature of 1890 (p.40-2). It was signed by Kalua, Paehaole, Crabbe and Halstead. In the “dissenting report,” Lucas endorsed the group's conclusions but proposed that Kahalehili remain at the hospital under the authority of Lutz and Rose Gertrude, and that Reynolds maintain his position (ibid., p.43). Among the depositions taken by the commission, there are indications that the story about the indigenous woman's lover who was committed by his brother, as told by Bertha Lutz may be true, but that the brother was not a priest but Carter himself, of the Board of Health.

25 These papers dealing with dermatology and mycology are examined in detail in the next volume of the Complete Works of Adolpho Lutz.

26 The arguments made by the author are based on a number of papers later written by Lutz. Presented in this form, they do not make it clear that the observations and hypotheses arose in Hawaii, nor how the theory that he would espouse so decidedly beginning in the 1910s was born and matured.

27 Aragão, 1915, cited in Souza Araújo, 1956, p.137, and Obregón, 2002. We have found only Leçons sur la syphilis, professées à lhôpital Saint-Sauveur (Paris, 1886) by Henri Leloir. In a document from the Adolpho Lutz Archives ('Transmissão da lepra por mosquitos,” caixa 19, pasta 74), Bertha Lutz wrote references apparently taken from Edvard Ehlers, “Transmissibilité de la lèpre par les insectes succeurs de sang (parasites lectulaires),” in II Lepre Konferenz Mitteilungen u. Verhandlungen III, p.25-38. The list mentions a paper by Leloir entitled Traite pratique et théorique de la lèpre (1886). It also includes Ashmead (although nothing other than the author's name); Baldomero Sommer, “La lèpre en Argentine,” Semaine Médicale, 1898; articles by Blanchard but with no titles specified (see bibliography); Arning (Archiv. F. Dermat. U. Syph., 1891); Scott (British Medical Journal, Aug. 18-Sep. 29, 1900); Noc (Annales dHygiene et de Médecine Coloniale, Jul.-Sep. 1903, p.481; Jan.-Mar. 1904, p.11). More detailed references are provided by Chosky, author of Report on Leprosy and the homeless Lepers Asylum Matunga at Bombay (1901); Hallopeau, “Leçons cliniques de l'hÔpital St. Louis,” Bulletin de l'Academie de Médecine, Jul. 1901; Chantemesse (same publication, same session, Jul. 30, 1901); Pierre Cazamian, Archives de Médecine Navale, Dec. 1904, p.452); Goodhue, Indian Medical Gazette, Aug. 1906, and Journal of Tropical Medicine, Sep. 15, 1906; Marchoux and Bouret, Annales de l'Institut Pasteur, 19, 1908, p.389 and Bulletin de la Societé de Pathologie Exotique, 1908, p.288; Laveran (same periodical, same session).

28 A helpful entry on Blanchard can be found at http://www.pasteur.fr/infosci/archives/f-bio.html. See also Brumpt (Feb. 13, 1910) and Linossier (Feb. 15, 1919).

29 This brochure was most likely ‘The mosquito as an agent for spreading yellow fever” (in Port.) by Emilio Ribas (1901), which transcribes a note by Adolpho Lutz. Lutz must have sent some of his works on leprosy, because the Frenchman comments in surprise (Oct. 1, 1905): “I was unaware that you had already pointed out the role of insects as infectious agents of leprosy. if there is a second edition of my book, I will not fail to mention this interesting fact. I am delighted to find myself in agreement with you on this point. I am more and more convinced that this is the only reasonable interpretation” (BR. MN. Fundo Adolpho Lutz, pasta 255, maço 1).

30 The report presented on July 28, 1897, to Emílio Ribas, director of São Paulo's Sanitation Service, contains the results of an analysis of the material Lutz had received from Colombia shortly before his trip to Montevideo, where he attended the conference at which Giuseppe Sanarelli announced discovery of the icteroid bacillus, the presumed agent of yellow fever (Benchimol, 1999). The labels of the ten bottles were marked: “Instituto Carrasquilla – Suero antileproso [antileper serum] – Bogota – Plaza de los Mártires.” With the help of Arthur Mendonça, Lutz ascertained that all contained bacilli similar to coli, a larger bacillus, and cocci. They injected the serum into a dog and noticed no “phenomena other than a bit of local tumefaction.” Lutz judged it should not be used since it contained “several different organisms.” “As to its therapeutic actions,” he wrote, ‘"we can say that the little we have found in literature provides absolutely no scientific basis for justifying any hope in this realm. This appears to be merely a work guided by no criteria, or of commercial speculation” (BR. MN. Fundo Adolpho Lutz, pasta 12, maço 1). Carrasquilla's serum was widely accepted in Colombia, and the government of that country gave him an institute so he could continue his research. Prepared from the blood of infected patients, his serum was criticized by the international scientific community, including a number of participants at the Berlin congress, who argued that “Hansen's bacillus is not found in the blood of patients” (Obregón, 2002, p.194-6).

31 Art. 145, title II, “Profilaxia geral das moléstia infectuosas,” in Barbosa and Rezende (1909, p.1000).

32 In 1817, Enxadas Island, a storage place for gunpowder, provided temporary shelter to the ill who were transferred from the leprosarium in the neighborhood of São Cristovão. The lepers were moved to Bom Jesus Island, where they stayed until the construction of Lazarus Hospital was completed in 1850. Another island, Boa Viagem, in Niteroi, was site of a pesthouse for seamen afflicted with contagious diseases. Created in 1810, shortly after the Portuguese Court moved to Brazil, this pesthouse was supported by daily fees paid by merchant marine ships docked in Guanabara Bay (Kushnir, 2002; Sarthou, 1964).

33 These words were pronounced by Emilio Gomes at the July 22, 1915 session of Brazil's Academia Nacional de Medicina. They were published in the academy's annals (v.81, p.161) and reproduced by Souza Araújo (1956, p.123).

34 Hannaway (1993) names two works as the essential foundations of Germany's medical geography: Leonhard Ludwig Finke's, published in 1792-1795, and the two volumes that Hirsch published in the 1860s, on the eve of the Pasteurian revolution. In these pages, the German physician compiled a remarkable amount of data on the distribution and types of diseases during different periods and locales around the world and on the relation between these diseases and the environments in which their victims lived.

35 Among those defending the transmission of leprosy by fleas was Juan de Dios Carrasquilla, who advocated this theory at the 3rd Latin American Scientific Congress, held in Rio de Janeiro in 1905. In 1947, another Colombian physician, Guillermo Muñoz Rivas, won an award from Brazil's Academia Nacional de Medicina for his work on the transmission of leprosy by fleas. Continuing with Carrasquilla's line of study, Muñoz Rivas conducted a number of experiments with human and canine fleas and ascertained that the leprosy bacilli remained in these insects’ digestive tubes for up to 76 hours (Obregón, 2002, p.173, 317).

36 Lutz attributed this discrepancy to the use of mosquito netting. No white person slept without one and even during daytime pyrethrum powders were widely used. The natives had no such habits. “On the other hand, the locals are very fond of water, and a lack of cleanliness cannot be alleged, as is always invoked, clouding the issue of disease transmission" (Jorn. Comm., Nov. 7, 1915).

37 Souza Araújo (1956, p.219, 303, 305, 332); Coutinho et al (2001, v.5, p.5890-2).

38 Lutz’ papers were published in the Jornal do Commercio, 12/6/1915 and the Diario Official, 12/15/1915, p.901-6; Valverde's came out in O Brazil-Medico, v.1, 1924, p.233-6. 1924. These articles are transcribed in Souza Araújo (1956, p.129-31, 131-7, 141-4).

39 On Dec. 3, 1915, Valverde questioned the analogy drawn between the processes by which leprosy and yellow fever are transmitted. “If one sole case of yellow fever, which only has the power to infect for three days, is enough to produce a pandemia, how can we allow that leprosy, with such a lengthy febrile period … can be transmitted so slowly and capriciously? Given the number of lepers around the world and the number of mosquitoes likewise in the world, if this theory were true, the world would be transformed into one huge leprosarium” (cited in Souza Araújo, 1956, p.132). The hardest blow against this aspect of Lutz’ theory came from a scientist at Instituto Oswaldo Cruz, leprologist Souza Araújo (1946, p.6). After examining venous blood from dozens of sick people who visited his office at this Institute between 1927 and 1929, he proved that “every lepromatous leper is constantly in a state of bacillemia, contrary to the classic notion defended … by Ad. Lutz, that this bacillemia only occurs during bouts of fever.”

40 Jorn. Comm., Dec. 6, 1915, cited in Souza Araújo, 1956, p.131. At another point during the second conference, Lutz stated: “It is only in recent years that experimental work on this topic has appeared, and its authors have usually grown discouraged as soon as they have run into their first problems concerning the mosquito's role … As a result, they have made the mistake of singling out flies and bedbugs, without taking into consideration that these could never explain the capricious way in which the disease spreads” (p.130). Lamborn (1937) provides a fine review of the plentiful literature on the transmission of leprosy by flies.

41 Lutz pointed to the "Culex fatigans - or ‘quinquefasciatus', as Americans would have it – and its corresponding pipiens; secondarily comes Stegomyia calopus, whose distribution is more limited” (Aragão, cited in Souza-Araújo, 1956, p.139). According to Consoli and Oliveira (1994, p.139), Culex quinquefasciatus [Say, 1823] was long known as Culex fatigans or Culex pipiens fatigans. “It is considered tropical-cosmopolitan. It is basically found in meridional parts of Asia and in Africa, the Americas, and Oceania.” A domestic mosquito, it was “a curse for those living in the warmer climes of the aforementioned continents. It is found … in greater numbers in human agglomerates, inside cities or rural villages, becoming rare as housing is spread farther apart, and eventually not found at all where man has not yet arrived or where he left long ago … It attacks precisely during periods reserved for rest, following the hours of work or study.”

42 Lutz’ interest in mosquitoes led him to gather a representative collection with the help of collectors in different parts of Brazil (see BR. MN. Fundo Adolpho Lutz, pasta 216). He devoted himself with great enthusiasm to the taxonomic study of the group, and one of his main interlocutors was Frederick Theobald, the entomologist to whom the British Museum had entrusted the task of writing a monograph about mosquitoes of the world. Theobald used Lutz’ descriptions of mosquitoes collected in Brazil. For five years, the two of them corresponded about the characteristics of the species they were studying (Sá, 2002).

43 th Regarding the debates at the 5 Brazilian Congress of Medicine and Surgery, held in Rio de Janeiro in mid-1903, see Benchimol (1999). “I am well aware that new ideas are always received with a certain caution, up to a point quite acceptable,” stated Aragão in December 1915, “but a great distance lies between this and assuming an unyielding opposition … without taking into account the authority of who is presenting these. Unfortunately, this is what seems to be the tendency concerning the culicidian doctrine of leprosy, repeating earlier campaigns against the culicidian theory of malaria and yellow fever, and, in general, against all hypotheses about the spreading of diseases by an intermediary host” (cited in Souza Araújo, 1956, p.137).

44 Emilio Gomes presented these “Conclusões aconselhadas pela Comissão de Prophylaxia da Lepra para servir de base a um projeto de lei” to Brazil's Academia Nacional de Medicina. They were published in the academy's Boletim, v.2, 1919, p.738-40 (cited in Souza-Araújo, v.III, p.159).

45 Delegates from Argentina, Colombia, Costa Rica, Cuba, Ecuador, the United States, Guatemala, Mexico, Panama, Paraguay, Peru, Uruguay, and Venezuela attended the conference, held in October 1922 at the National Exhibif s Festival Pavillion, as part of Brazil's Independence centennial celebrations ("Conferência Americana de Lepra,” Jorn. Comm., Oct. 10,1922).

46 Souza-Araújo (1956, p.365, 369, 371-2). The paper by Emílio Gomes there transcribed (p.368-71), was published in O Brazil-Medico (year XXXVI, v.II, 10/28/1922, p.252); the final conclusions of the conference are contained in the same edition of the periodical (p.276). Lutz’ paper (1922) is not reproduced by Souza-Araújo and did not receive attention from the press; it did, however, create a “sensation” in the audience that applauded, that same night, the arrival of a telegram from Dr. Samuel Libânio telling of the inauguration of the cornerstone of Santa Isabel leprosarium in Belo Horizonte.

47 In an article published in 1929, this corresponding member of the Academia, who was a professor of hygiene at the pharmacy and agronomy schools in Manaus, did an inventory of the animals who were possible transmitters of leprosy, including rats. Without denying his contagionist convictions, he stated that the experimental evidence still did not support these “indirect contagions” but that it was advisable to take preventive measures.

48 “A transmissão da lepra e suas indicações profiláticas,” published in May 1936 in Memórias do Instituto Oswaldo Cruz (in Port. and Eng.), is a short version of another, longer article, published in June in Annaes da Academia Brasileira de Sciencias (in German). It was reprinted in Boletim da Campanha contra a Lepra (May-Jun. 1936).

49 Unpublished typewritten text, 7 p.(BR. MN. Fundo Adolpho Lutz pasta 254, maço 5).

50 BRMN Arquivo. Fundo Adolpho Lutz, pasta 254, maço 4, together with correspondence between Bertha Lutz and Paula Souza about this contribution by Lutz.

51 We hesitate when it comes to the best verb to employ: the modal seems to address these instructions to other researchers, but this surely was the protocol for the experiments Lutz himself had been undertaking, which would justify using the simple past.

52 The existence of leprosy in rats was first mentioned in 1902, during a rat extermination campaign conducted in Ukraine. The following year, Stefansky identified Bacillus derRattenlepra as its agent. The evolution of the disease in rats, as it was found in 1903 in the United Kingdom and then in most countries of the world, showed clinical and pathological similarlities to leprosy in humans, with the result that for many years this bacillus was classified together with Mycobacteriumleprae. Basing their position primarily on morphological arguments, in 1912 Marchoux and Sorel proposed ("Recherches sur la lèpre,” Annales de (Institut Pasteur, v.26, p.675-700) that it be denominated Mycobacterium lepraemurium. Later, analyses involving molecular biology and antigens confirmed that the disease found in rats was due to a different species of microorganism than human leprosy. Stefansky's bacillus, which was also responsible for “cat leprosy” (canine granulomatose leproid syndrome), fell, then, into synonymy. List of Bacterial names with Standing in Nomenclature

(www.bacterio.cict.fr/bacdico/mm/lepraemurium.html, term created on June 7, 1998, most recent modification made on Jan. 23, 2002).

53 “Acid fastness” is a property of Mycobacteria established by Paul Ehrlich in 1882. Tuberculosis and leprosy bacilli are hard to stain, but when dyed with gentian violet and saturated in an aniline and water solution, they resist discoloration by mineral acids. This feature became the main way of distinguishing them from other microorganisms (Obregón, 2002, p.34).

54 Dr. Henrique Aragão and Dr. Herman Lent, protozoologist and entomologist at Instituto Oswaldo Cruz, worked together on these experiments. José Mariano and Ruy Noronha Miranda (director of São Roque Leprosarium in the state of Paraná) signed articles on the topic, in collaboration with Oliveira Castro and Souza Araújo. In his paper of 1952, Souza Araújo cited experiments by E. Montestruc and R. Blache (1951), in Martinique; Guillermo Muñoz Rivas (1946), in Colombia; and Celso S.C. Rossel (1947, 1946), at Instituto Oswaldo Cruz. He also referred to observations and materials sent to the Leprology Laboratory at Manguinhos by physicians working in different leprosariums around Brazil, all of whom were convinced of the role played by haematophagous insects in transmitting the disease: Max Rudolph, clinician in Estrela do Sul (MG); Paulo Cerqueira, from Santa Isabel leprosarium; J.A. Soares, leprologist from Espírito Santo; Dr. Orestes Dioniz and Dr. Josefino Aleixo, who, together with Souza Araújo, visited lepers living in Bambuí, Minas Gerais, just before Centro de Estudos e Profilaxia da Moléstia de Chagas was founded there in November 1943. Further on this topic, see Souza Araújo (1941; 1942a and b; 1943a, b, and c; 1944a and b); Oliveira Castro and Mariano (1944); and Rossell (1947, 1946).

 

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