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The discovery of Schistosomiasis mansoni in Brazil Naftale Katz a,b,∗ a b

Laborat´ orio de Esquistossomose, Centro de Pesquisas Ren´e Rachou/Fiocruz, Av. Augusto de Lima 1715, 30190-002 Belo Horizonte, Minas Gerais, Brazil Santa Casa de Belo Horizonte, Av. Francisco Sales, 1111, Belo Horizonte, Minas Gerais, Brazil

a r t i c l e

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a b s t r a c t

Article history: Available online xxx

The important contribution of Piraja´ da Silva, the Brazilian medical doctor, who found schistosomiasis in Brazil is highlighted. In fact, in 1908 schistosomiasis was detected for the first time in this country, and by careful examination of worms collected from necropsies and stool examination, an exact description of worm and egg morphology was reported. Although not recognized in the scientific literature by the English authors, the discovery and description of the new species of Schistosoma in Brazil, was fundamental in favour of the dualist theory, or better, for the identification of Schistosoma haematobium and Schistosoma mansoni, as two different species. © 2008 Elsevier B.V. All rights reserved.

Keywords: Schistosoma mansoni Brazil Piraja´ da Silva

´ The scientific journal “Brazil Medico” (dated August 1st 1908) published the first work on schistosomiasis in Brazil, by the 35year-old medical doctor Manoel Augusto Piraja´ da Silva. The work was entitled “Contribution to the study on schistosomiasis in Bahia” (Piraja´ da Silva, 1908a). In this paper, it was reported that the author had observed, 4 years ago, by means of stool examination, eggs endowed with a lateral spine. Further, it was reported that “this fact raised our curiosity, however, we could not promptly find an explanation on that occasion”. “Only after reading the “new” studies by Patrick Manson and Sambon carried out at the School of Medicine, in London. . . we were able to perform some studies on schistosomiasis mansoni in Bahia” (Piraja´ da Silva, 1908a). Piraja´ da Silva published three papers in 1908/1909, describing 20 cases diagnosed by means of stool examinations, showing Schistosoma mansoni eggs (lateral spine), and explaining that no eggs could be found in urine. But the great Brazilian researcher went on to perform necropsy in three cases, finding one worm during the two first necropsies, and 24 worms in the third one; from these 19 were males, 1 female and 2 pairs. He found and produced a photograph showing the presence of one egg with lateral spine in the uterus of a female, and the eclosion of miracidium, after the transversal breakage of the shell. He described minutely the size and characteristics of the worms, concluding that they were not Schistosoma haematobium (Piraja´ da Silva, 1908a,b,c, 1909). Historically, the first researcher in Brazil who tried to find cases of schistosomiasis was Otto Wucherer. This medical doctor, an expert in tropical diseases, born in Porto, Portugal on July 7th, 1820 (but always cited as being German), arrived in Bahia, Brazil

∗ Tel.: +55 31 9949 0999. E-mail address: nkatz@cpqrr.fiocruz.br.

when he was 23 years old, after receiving the grade of Medical Doctor and Surgeon, from the School of Medicine in Tubingen, Germany. Wucherer examined, at the request of Wilhelm Griesinger, the occurrence of haematuria in many samples of urine, in Bahia. He was careful and competent (he introduced the use of the microscope to laboratories in Brazil), but he never found S. haematobium eggs in urine, although he had found microfilariae in this material, on August 4th, 1866, that constituted a new species named later on as Wuchereria bancrofti (Coni, 1952; Falc˜ao, 1953). In 1850, Wilhelm Griesinger was invited to be the Director of a School of Medicine and Hospital in Kasr al-Aini, in Egypt. In that year, Theodor Bilharz came from Germany in order to be his assistant. Both of them were internists in Tubingen, in 1845, in the same year that Wucherer was there too (Farley, 1991). The next year, i.e., on May 1st, 1851, Bilharz reported, in a letter addressed to Karl Theodor von Siebold, that during a necropsy he found some white worms in the portal vein, with flat bodies and sexual differentiation. On December 1st, 1851 Bilharz described and named this new worm Distomum haematobium, and in May, 1852 he found the egg with terminal spine. These reports were forgotten until the 1870s with the rediscovery of Bilharzia haematobia by the Italian researcher Prosper Sonzino (Farley, 1991). In the year 1902, Patrick Manson examined an Englishman, who had lived in various islands of the West Indies, and found eggs with lateral spine in the faeces of his patient. Based on his experience, as well as on his own intuition peculiar to brilliant mind, Manson formulated a hypothesis that it could be a new species causing bilharziasis (Manson, 1902). Later on, in 1907, Sambon, his faithful shield-bearer, proposed a new species named S. mansoni, based on the morphology of a single male worm, found under bad maintenance conditions, but mainly on the morphology of the egg with lateral spine (Sambon, 1907a,b). Rejecting this new species

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violently, the famous German researcher Arthur Looss – who was working in Egypt since the last decade of the XIX century – became his opponent. Thus, a strong polemic was established between two schools for parasitology, the German and the English schools, specifically between Looss and Sambon. Sambon’s great idea of giving the name of Manson to this new species gave him at the same time the support of perhaps the strongest political and scientific strength on that occasion in England. We do not wish to discuss the reasons why – one side defended the existence of a unique species, and the other affirmed that there were two species – but only to show that the literatue provides evidence that they were having an argument about the question. Each side did not present only scientific arguments, but several offensive personal exchanges too, as can be seen in the papers published by both of them, e.g. “this is comprehensible for logical minds”, “the great German helminthologist in Cairo” and that “it is not correct to make a statement and ask for other peopleˇıs help to validate it” (Looss, 1908; Sambon, 1909). Under this aggressive situation, before the First World War (1914–1918), Piraja´ da Silva had contributed greatly to a better understanding concerning the real possibility of the existence of two species, and that the species found in Brazil (Bahia) produced only eggs with a lateral spine. In 1908 he published in France and in 1909 in England the results previously published in Brazil (Piraja´ da Silva, 1908a,b,c,d, 1909). As far as the paper written in French is concerned, some important data on “Histologie Pathologique” of schistosomiasis, performed by Prof. Letulle, were added, whereas in the paper written in English he declares that the photos of worms and eggs were sent to Dr. Leiper, at the London School of Tropical Medicine. Thanks to the excellent work carried out by a student and admirer of Piraja´ da Silva, the medical historicist Edgard Cerqueira Falc˜ao, the correspondence between Piraja´ da Silva and Manson, Leiper, as well as other authors working with Parasitology and Tropical Medicine worldwide is available (Falc˜ao, 1959). Unfortunately, only the answers to the letters sent by Piraja´ da Silva are quoted in the books, and not the letters written by him. The first letter received by Piraja´ da Silva from Manson was sent from London on June 25th 1909, after reading the papers published in The Journal of Tropical Medicine and in the journal edited by Prof. Blachard, “Annales de Parasitologie”. It must be emphasized that 1 year before, Piraja´ da Silva had sent slides and a letter to Manson, who addressed the material to Robert Leiper. The first answer from Leiper was written in July 24th, 1908. In this letter, Leiper thanks for the slides and the letter from Piraja´ da Silva, and besides asking for worm samples he recommends some procedures related to rectum, urine and bladder examinations (Falc˜ao, 1959). In the second letter, dated January 12th, 1909, Leiper acknowledges the receipt of the work and worm specimens, which according to him were presented to Sir Patrick Manson “who will answer soon”. As already mentioned, the answer came only 6 months later! Leiper asks for permission to cut out the anatomical differences between S. mansoni and S. haematobium presented in the publication, with the strange argument that the worms found in the portal vein were immature, and that the adult and mature worms are normally found in bladder and in rectal mucosa. Besides, he does not consider the way the rupture of the egg shell takes place for the hatching of the miracidium (Falc˜ao, 1959) to be important. The request from Piraja´ da Silva asking Leiper to send him some worm samples was never granted. If Leiper had sent the worm specimens, it would have been possible that the differences between the unitary and dualist theories, at that occasion, would have been resolved. But Leiper, only in 1915, publishing a series of papers

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containing excellent experimental work, was able to elucidate the complete cycle of S. mansoni and S. haematobium, thus solving definitely the question in favour of two different species (Leiper, 1915a,b). It must be noted that in those works no reference either to the important participation of Piraja´ da Silva or to the receipt of worm samples was acknowledged. Although the works by Piraja´ da Silva were quoted in the bibliographic references (529 papers on schistosomiasis, published up to that year), the work published in ´ “Gazeta Medica da Bahia”, the first one, was not mentioned (Leiper, 1915a). Falc˜ao, who profoundly analyzed the correspondence between Piraja´ da Silva and Leiper, noticed that this latter researcher, when he showed the difference between the eggs with terminal and lateral spine of the Schistosoma, the different characteristics of the two species (S. haematobium and S. mansoni), “he mentioned precisely everything that Piraja´ da Silva had already noticed since 1908, as far as the worm found in Bahia is concerned, i.e., in relation to the second species mentioned: number of testicular masses, almost in double in males, position of the ovarium in the anterior half of the body, short dimension of the uterus, which bears in its inner only one mature egg at each time, and an extensive distribution of vitellogenic glands into the two posterior thirds of the female body”, as published previously in the Archives de Parasitologie (Falc˜ao, 1957, 1959). However, Leiper completely omitted the name of the Brazilian researcher. Perhaps, it is interesting to remark that Leiper “destroyed all his correspondence when he retired; it would have been totally out of character for him to have allowed some meddling historian to browse through his private papers” (Farley, 1991). Although there appeared an exact description of the morphology of the worms and eggs found by Piraja´ da Silva in Brazil, in the already mentioned papers, Sambon made the following comment, with reference to a presentation by Leiper in 1911: “Holcomb (1907) and da Silva have written papers on the subject, and they have attempted to describe more fully the anatomy of the adults, but in truth they have added nothing” (Leiper, 1911). While Piraja´ da Silvaˇıs contribution was not recognized in the literature written in English, it is worthwhile to mention that in ´ the first edition of the book “Precis de Parasitologie”, published in 1910 in Paris, by the French parasitologist Brumpt, the figure of a S. mansoni female, showing in detail one egg with lateral spine in the uterus, is a copy of a figure already presented by Piraja´ da Silva, according to the author of the book himself, who said furthermore: “Actuellement, a` la suite des travaux zoologiques de Sambon (1907) et de Piraja´ da Silva (1909) . . . lˇıindividualite´ de la bilharziose intestinale est admise par la majorite´ des auteurs” (Brumpt, 1910, p. 301 and 302). In the excellent book entitled “Bilharzia: A History of Imperial Tropical Medicine”, by Farley (1991), the author was of the opinion that the lack of recognition of Piraja´ da Silva as the discoverer of S. mansoni was due to the fact that the Brazilian medical doctor had formulated the hypothesis that the new species could be exclusive to the Americas, and proposed for this species the name of Schistosomum americanum. This argument has also been previously used by Lutz (1919). We think that although this opinion carries a lot of weight, the lack of recognition given to the findings of Piraja´ da Silva could have a better explanation within the general idea of the researchers pertaining to the first world (at the colonial times), who did not value very highly the contributions of researchers living in third world countries. Besides, there is the famous quotation by Louis Pasteur “that Science does not have homeland, but the scientist does”. Scientists, not only have a homeland, but also present narcissism, as a strong character.

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Since the centenary of the discovery of schistosomiasis in Brazil by the great Piraja´ da Silva is being commemorated this year, we hope that as already happened 50 years ago, his merit will be recognized, and that special tributes will help to perpetuate the recognition of the important Brazilian contribution to a better knowledge of schistosomiasis. Acknowledgment The author would like to thank FAPEMIG (Fundac¸a˜ o de Amparo a` Pesquisa do Estado de Minas Gerais) for his fellowship. References ´ ` edition. Brumpt, E., 1910. Precis de Parasitologie. Premiere Coni, A.C., 1952. A Escola Tropicalista Bahiana. Tipografia Beneditina Ltda, Bahia, p. 82. Falc˜ao, E.C., 1953. Estudos sobre o “Schistosomum mansoni” (1908-1916). Author Edition. S˜ao Paulo, p. 123. Falc˜ao, E.C., 1957. Novas achegas ao estudo da determinac¸a˜ o da especificidade do “Schistosomum mansoni”. S˜ao Paulo, p. 211. ´ Falc˜ao, E.C., 1959. Piraja´ da Silva, o incontestavel descobridor do Schistosoma mansoni. S˜ao Paulo, p. 314. Farley, J., 1991. Bilharzia: A History of Imperial Tropical Medicine. Cambridge University Press, p. 359.

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Holcomb, R.C., 1907. The West Indian bilharziosis in its relation to the Schistosoma mansoni (Sambon, 1907) with memoranda in ten cases. US Nav. Med. Bull. 1, 55–80. Leiper, R.T., 1911. Note on the presence of a lateral spine in the eggs of Schistosoma japonicum. Trans. R. Soc. Trop. Med. Hyg. 2, 133–136. Leiper, R.T., 1915a. Report on the results of the Bilharzia mission in Egypt ,1915. Part III. Development. J. R. Arm. Med. Corps 26, 253–267. Leiper, R.T., 1915b. Report on the results of the Bilharzia mission in Egypt, 1915. Part V. Adults and ova. J. R. Arm. Med. Corps 30, 235–260. Looss, A., 1908. What is Schistosomum mansoni, Sambon 1907? Ann. Trop. Med. Parasitol. 2, 153–191. Lutz, A., 1919. Schistosoma mansoni and schistomatosis observed in Brazil. Mem. Inst. O. Cruz 11, 109–140. Manson, P., 1902. Report of a case of bilharzia from the West Indies. Br. Med. J. 2, 1894–1895. Piraja´ da Silva, M.A., 1908a. Contribuic¸a˜ o para o estudo da Schistosom´ıase na Bahia. Braz. Med. 22, 281–282 (August 1st). Piraja´ da Silva, M.A., 1908b. Contribuic¸a˜ o para o estudo da Schistosom´ıase na Bahia. Dezesseis observac¸o˜ es. Braz. Med. 22, 441–444 (December 1st and 8th). Piraja´ da Silva, M.A., 1908c. Contribuic¸a˜ o para o estudo da Schistosom´ıase na Bahia. Vinte observac¸o˜ es. Braz. Med. 22, 451–454. Piraja´ da Silva, M.A., 1908d. La Schistosomose a Bahia. Arch. Parasitol. 13, 281–300. Piraja´ da Silva, M.A., 1909. Contribution to the study of Schistosomiasis in Bahia, Brazil. J. Trop. Med. Hyg. 12, 159–164. Sambon, L.W., 1907a. New or little known African Entozoa. J. Trop. Med. Hyg. 10, 117. Sambon, L.W., 1907b. Remarks on Schistosoma mansoni. J. Trop. Med. Hyg. 10, 303–304. Sambon, L.W., 1909. What is Schistosoma mansoni. J. Trop. Med. Hyg. 12, 1–11.

discovery

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Schistosomiasis

mansoni

in

Brazil,

Acta

Trop.

(2008),


The discovery of Schistosomiasis mansoni in Brazil