Feature

Research in the Argentine Outback: The Health Quest of Salvador Mazzal

JONATHAN LEONARDO

ew people today will recall the name sophisticated medical mecca of Buenos F of Salvador Mazza. That is under- Aires to lavish his attentions on outlying standable, for lasting fame typically de- regions where doctors were few and pends on single accomplishments, and health care was problematic. Mazza did no single thing that led to greatness. He was not a public health BEGINNINGS martyr; nor did he discover a grave ill- ness, conquer a leading disease, or have One reason was that Salvador Mazza his name attached to a leading health in- could identify personally with the prob- stitution or vaccine. lems of outlying regions. His childhood But if you were engaged in medical home was in the town of Rauch some research or public health during Argen- 150 miles south of . Rauch tina’s years of prominence, between the was close enough to the Argentine cap- two world wars, his name would have ital to attract some of the European im- rung a bell. You might not have known migrants flooding into the port of Buenos him personally, for during most of this Aires. But it was also far enough away time Mazza was working at a rural out- to suffer medical neglect. post a thousand miles from Buenos Aires. Mazza, who was born there on 6 June But you might well have read one or an- 1886, was well positioned to gain a keen other of his works on a score of subjects. awareness of that neglect. His parents, You would have recognized him as a who had immigrated from , were careful medical investigator with a tower- not rich; his father died when Salvador ing command of several fields. And you was only four; and while his mother’s might have wondered why he left the subsequent remarriage to a local govern- ment official presumably provided much- needed support, it did not suggest any fundamental change of status. IThis contribution will also be published in Spanish As a result, in early youth Mazza’s life in the Boletin de la Oficina Sanitaria Panamericana, Vol. 113, No. 4, 1992. resembled that of many bright sons of ZJonathan Leonard is a free-lance medical writer immigrants striving to make good. At and editor of the Bulletin of PAHO. school-first a religious school taught by

256 Bulletin of PAHO 26(3), 1992 the Silesian fathers, then the National oratories, publishing his first article (on Central High School of the University of snake and spider bites), and serving briefly Buenos Aires, and finally the university (during school vacation) as a surgeon third itself-he worked hard, advanced by class on an Argentine naval transport car- merit, and became known as a top scholar. rying prisoners to the Tierra de1 Fuego In his college years he took jobs to help settlement of . defray expenses. Some of these, like his He also put a lot of energy into the work as a French and Latin instructor at Circulo Mtdico y Cenfro Esfudiantes de Med- a private school near the university, had icina (Medical Circle and Medical Stu- little later import. But one job, that of dents’ Center), a student organization that vaccination assistant at the Jenner Insti- he variously served as secretary, direct- tute in Buenos Aires, helped shape his ing council member, biomedical library future. When Mazza worked there, dur- and museum director, and journal editor. ing the first decade of this century, the While all of these activities seem to have Jenner Institute was pursuing a heady been reasonably successful, Mazza’s brew of medical research and other tasks journal management was an obvious hit. directed at improving public health. And According to two who came later, “under while Mazza’s position at the institute Mazza the publication’s scientific content was humble, he quickly grasped enough acquired its greatest breadth” and “Mazza, of the principles involved to apply them with less funds, produced twice the elsewhere. pages. “3 When he stepped down in 1910 Besides working for the institute, Mazza his job was divided up among three had taken a school vacation job at home people. in Rauch working as a public health in- spector. Partly because of large-scale im- BUENOS AIRES,1910-1920 migration, Rauch was then confronting outbreaks of smallpox, scarlet fever, and Upon completing his medical studies other ailments. Some of these outbreaks in 1910, Mazza went to work for the Na- could have been prevented by vaccina- tional Health Department building a pro- tion, but the existing vaccination pro- gram designed to quarantine and screen gram was very weak. So in 1906 Mazza immigrants for . Today the job asked permission to organize a “disin- might be all but impossible. In 1910 it fection office” at Rauch. That permission was possible because there was no air granted, Mazza proceeded to create a travel to contend with, travel in general health facility where he applied his Jen- was more limited, and most immigrants ner Institute training and took personal were entering at the port of charge of vaccinating some 6,000 people. Buenos Aires. But was then in The next spring he entered medical school. the throes of a cholera pandemic; Argen- His first year at the University of Bue- tina’s many immigrants were largely Eu- nos Aires Medical School was a disaster. ropean; and the screening plans called He contracted an infection, apparently in for examination and temporary quaran- an operating theater, that attacked his tining of them all. arm, caused him to lose a year, and Mazza did just that. He oversaw quick threatened his life. But Mazza survived, rebuilding of an abandoned island center not much the worse for wear, and reen- and directed the screening and five-day tered the Medical School in 1907-where he maintained his good academic record while working as an assistant at two lab- 3A. Ivern, p. 13.

Feature 257 quarantining of 60,000 people. By inter- it became impossible for those who knew national agreement, all immigrants were them to speak of Mazza’s work without supposed to have been screened already remembering his wife.4 at their ports of embarkation; even so, By the time they were married, Europe Mazza’s workers found two asympto- was at war. In those days Argentina, the matic carriers, one a regular immigrant most advanced Latin American nation of who had not been screened for cholera the time and one awash with Italian and before leaving Genoa and the other a Spanish immigrants, seemed almost a part stowaway from Naples. While there is no of Europe. So it is not surprising that the way of knowing just how effective the Great War’s unfolding struck a respon- program was, detection of these cases sive chord and raised public interest in suggests it worked largely as planned. things martial. In any case, it was working well enough Perhaps this explains why Salvador to impress the famed German bacteriol- Mazza, who had no significant military ogist and vaccine expert Rudolph Krause. background, chose to leave the Bacteri- Krause, who arrived in Buenos Aires in ologic Institute in 1915 to work for the September 1913 to head the Argentine Armed Forces’ Central Military Hospital Health Department’s Bacteriologic Insti- in Buenos Aires. His initial job there, as tute, soon spotted Mazza’s ability, had head of bacteriology at the hospital’s lab- him transferred to the institute, and pro- oratory, kept him close to the university cured his collaboration on various projects. medical school, where he also served as Around this time collaboration of an- a substitute professor of bacteriology. other sort began. In 1914 a bright young In 1916 the War Ministry broadened native of Rosario, Clorinda Brigada Ra- Mazza’s horizons by sending him to Eu- zori, accompanied her aunt to the clinic rope. The official purpose of the trip was of a leading Buenos Aires physician, Jose to study communicable disease preven- Arce, where the aunt had come for sur- tion as practiced by the German and Aus- gery and convalescent care. Mazza was trian armies. But Mazza and his wife then manning the night shift at Arce’s (Clorinda accompanied him on all his Eu- clinic, where the quiet gave him a good ropean travels) decided to explore more opportunity to write and where, when broadly, extended their stay into 1917, sleep threatened, it was his custom to and visited several other countries. In the pace the floors. His pacing kept Clorin- process, Mazza became fascinated by da’s aunt awake, and Clorinda com- health-related engineering and briefly plained to the authorities. Mazza came considered taking up study of that subject. by in the morning to apologize, struck That would have been an unusual de- up an acquaintance with Clorinda, and parture, because by then Mazza was a began finding excuses for more visits. By prominent microbiologist. Upon return- the time the aunt was well enough to ing from Europe he was placed in charge leave, he and Clorinda were engaged. of the Central Military Hospital Labora- The marriage, which took place on 7 tory and all its affiliated regional labo- December 1914, proved fortunate for ratories. In 1918 he was made a delegate Mazza. Clorinda was no shrinking violet. to the Second South American Confer- She was well-educated, organized, and ence on Health, Microbiology, and Pa- effective; and as time passed she became wholly devoted to her spouse and his endeavors. Indeed, they came to form *A. Cornejo, “Vida y obra de Salvador Mazza,” p. such a close-knit team that in later years 844.

258 Bulletin of PAHO 26(3), 1992 thology in Rio de Janeiro. In 1919, fol- in Tunis run by the noted French phy- lowing up earlier work with Krause on sician and future Nobel laureate Charles typhoid that produced what had become Nicolle. Mazza was impressed by Ni- known as the “Krause-Mazza vaccine,” colle’s brand of research and medicine in he succeeded in making the world’s first a public health backwater. Also, he and typhoid vaccine administered in a single Nicolle found they had much in com- dose. The vaccine, developed for the mon. Both started out in bacteriology, armed forces from 20 local strains of the possessed enormous curiosity, pro- Salmonella fyphi disease agent, was not foundly respected science, and favored perfect. But it surpassed the multi-dose an almost solitary research style. Beyond typhoid vaccines then available and was that, they both cared greatly about the regarded in its day as a real break- sick, extended their work into many fields, through. had a tremendous capacity for work, and In 1920 he left the Military Hospital to seemed perpetually in a hurry to get on become Laboratory Director of the Bue- with complex tasks. All this could hardly nos Aires University Medical School’s help emerge as they got acquainted; as a Clinical Hospital, and that same year he result, their acquaintance engendered a was named President of the Society of strong bond of friendship, long discus- Health and Microbiology of Buenos Aires. sions, and some preliminary plans. Later, By then Mazza, who was 33, had ac- after Mazza returned home, he paved the quired a thorough working knowledge way for Nicolle to visit Argentina. And not only of bacteriology but also of path- from that visit arose a major project to ologic anatomy, serology, immunology, which Mazza dedicated the remainder of epidemiology, and clinical work on in- his life. fectious and parasitic diseases-enough In this period Jose Arce, the physician to suggest he might toss off study of a running the clinic where Mazza met his somewhat more distant subject like en- wife, began to provide key tactical sup- gineering without much trouble. More to port. By the time the Mazzas returned to the point, by the end of 1920 he had Buenos Aires in 1924, Arce was Rector of reached the top of his profession; and so Buenos Aires University. He was also Di- the real question was what he should do rector of the Institute of Clinical Surgery next. affiliated with the medical school, and he invited Mazza to head the institute’s lab- ADVENTURES WITH CHARLES oratory. Mazza accepted the invitation and NICOLLE proceeded to improve the laboratory with such dispatch that he strongly impressed That answer was some years coming. Arce, who came to take an almost pater- He stayed at the medical school until 1922, nal interest in his progress, and who from when the university sent him to Europe then on remained a lifelong friend. as its delegate to events commemorating Around this time Nicolle wrote Mazza the Pasteur Centenary in Strasbourg. The expressing an interest in obtaining cul- two-year trip, which took him to various tures of the disease agent Leishmania bra- parts of Europe and northern Africa, may ziliensis. Nicolle was an expert on leish- have Iasted longer than originally planned, maniasis, a mild to fatal recurring disease for Mazza used it to become familiar with of the skin and mucous membranes many institutions doing work related to caused by flagellated protozoans that in- his own. fect animal reservoirs and are spread by One of these was the the bites of sandflies. However, the only

Feature 259 Leishmania parasites available to Nicolle would make a good site for a medical were “Old World” strains, while most of research and treatment center modeled the severe cases in the Americas were after Nicolle’s in Tunis. being caused by the “New World” strain To begin with, there was plenty of geo- L. braziliensis. Nicolle wanted to study the graphic diversity to permit health re- latter agent; and even though L. - search in a wide range of climates; for iensis had not been isolated in Argentina, although the climate at San Salvador de severe leishmaniasis cases had been re- Jujuy’s 4,200 feet was one of pleasant ported in northern parts of the country, moderation, nearby territories included so seeking L. braziliensis there seemed everything from tropical lowlands to reasonable. snow-capped mountains. At the same Mazza therefore suggested that Nicolle time, medical research and knowledge of be invited to visit Argentina for this pur- many local diseases were very limited. pose, and Arce agreed to help. Eventu- Local government enthusiasm for a med- ally-with the assistance of an enthu- ical center directed at regional health siastic chronicle that Mazza wrote of his problems seemed strong. And it was im- own foreign travels-the National Health portant that such a center be located in Department was convinced to sponsor the the interior rather than in Buenos Aires visit. so that, as Nicolle put it, “the metropol- Nicolle, who arrived in October 1925, itan hodgepodge with its prevailing in- spent little time in Buenos Aires. His in- trigues not stifle the purpose of the in- terests lay to the northwest. Besides stitution and divert its people from their seeking L. braziliensis there, he wanted to task.“5 see the rural northwest province of Jujuy Beyond that, Mazza was no stranger that Mazza had discussed with him in to the public health problems of poorly Tunis. Accordingly, the National Health served areas. Rauch was such an area. Department arranged for him to visit this His experience spearheading the vacci- region in the company of two designated nation program there suggested what experts. Nicolle, however, insisted that could be done. And his recollections of Mazza accompany him by reason of his that time must have made the northwest good French as well as their personal and project seem a bit like coming home. scientific ties. The Health Department When Mazza and Nicolle returned to acceded to this request; and in short or- the Argentine capital, they told Arce about der, perhaps smiling slightly to them- their hopes for a university-backed med- selves, the two departed for Jujuy. ical research center in Jujuy. Convinced From the standpoint of medical re- the proposal was worthwhile, Arce pro- search and public health, the trip was a ceeded to press for what would ulti- success. Nicolle and his party were cor- mately become known as the “Argentine dially received by the governor of Jujuy; Mission for Regional Studies” and at a health post in San Salvador de (Misio’n de Esfudios de Pafologia Regional Ar- Jujuy, the principal town, material from gentina, or MEPRA). A favorable Medical a patient was cultured to yield the first School endorsement was forthcoming, and isolate of Leishmania braziliensis ever ob- on 16 April 1926 the University Council tained in Argentina. authorized Arce to execute the project, Mazza and Nicolle also visited several which he did. other towns, got a first-hand look at the medical neglect of the northwest, and confirmed that San Salvador de Jujuy 5H. E. Castagnino, p. 14.

260 Bullefin of PAHO 26(3), 1992 NORTHWEST TRAVELS, the new society’s local chapter in that 1926-1929 province; a month later, on 28 March, he was doing the same thing in Tucuman Mazza threw himself into the task like Province; and the next day he was back a crusader. Even before Arce’s proposals in San Salvador de Jujuy for the first of had been drafted, he took the thousand- the regional society’s nine meetings. mile trip to Jujuy. There, on 23 February Twenty-three works were presented at 1926, he presided over a local physicians’ this meeting, four by Mazza alone, six by meeting that brought into being an “Ar- Mazza and collaborators, and thirteen by gentine Society of Northern Regional Pa- others. Mazza’s contributions included the thology” loosely associated with MEPRA first finding anywhere of a dog naturally that was directed at improving public infected with the Chagas’ disease agent health in the hinterlands. The next day T~~~nosoma cruzi, the first adult case of he was in overseeing formation of Chagas’ disease found in Argentina, and the first indigenous cases of the infantile each of an array of provinces7 stretching form of kala-azar (visceral leishmaniasis from Argentina’s northwest corner to the caused by Leishmania donovani infanfum) East Coast and roughly 1,200 miles ever recorded in the country.6 southward, wrapping around the prov- Mazza’s university mandate called for ince of Buenos Aires and actually ex- him to visit MEPRA twice a year. By May tending beyond Mazza’s childhood home 1926 he was again criss-crossing the in Rauch. northwest to do research, prepare for By the time Mazza moved to Jujuy, the meetings, and encourage participation in roughly annual meetings of the Regional the regional pathology society. In this way Pathology Society had gained momen- he built a head of steam for his organi- tum. The third, held at Tucuman in July , zation, gained a commanding medical 1927, saw presentation of roughly 100 pa- knowledge of the northwest, and founded pers, among them 13 from New Orleans, pathology society chapters in all six Paris, Tunis, Arequipa, Montevideo, and northwest provinces. Asuncion-including one by future PAHO By 1928 he had things well enough in Director Fred L. Soper, who was then hand to continue his foreign travels. That assigned by the Rockefeller Foundation year he attended the International Con- to Asuncion. Mazza, who spoke seven gress of Tropical Medicine and Hygiene languages, did most of the translating in Cairo, where Egypt’s King Faud I con- himself. Beginning with the fourth meet- ferred the Order of the Nile upon him. ing (Santiago de1 Estero, May 1928), at- He followed this with another extended tendance by delegates from neighboring period of work and travel in Europe and countries became the norm. By the fifth Africa, returning to Argentina in mid-1929. (Jujuy, 1930), which coincided with the official inauguration of MEPRA and its new headquarters building, the list of in- AT HOME IN JUJUY ternational delegates had swelled to in- clude a number of Brazil’s leading med- At this point Mazza’s northwest beach- ical researchers, and by 1932, when Jose head seemed secure but badly in need of Arce addressed Argentina’s Fourth Na- more attention, and the MEPRA head- tional Medical Congress in Buenos Aires, quarters building in San Salvador de Ju- he was able to characterize Mazza’s in- juy was ready. So Mazza and his wife (they had no children) left Buenos Aires and set up permanent residence at 7Accordfng to H.E. Castagnino and J. Albert0 Aguirre MEPRA’s new headquarters in Jujuy. Thus (see bibliography), Mazza’s principal collaborators, liberated from responsibilities in Buenos proceeding roughly north to south, included M.E. Aires, Mazza was free to strengthen his JBrg, V. Bernasconi, N. Alvarez Soto, A. Fiora, G. ties with local workers and to build a Paterson, and C. Undiano in Jujuy; A. Cornejo, J. Lovaglio, and R. Villagran in Salta; H. Reyes Oribe research and correspondence network that in Formosa; E. Corsi, A. Seiiorans, R.S. Freire, and came to include several collaborators in J. Braverman in El Chaco; A. Ruchelli in Cata- marca; R. Cossio and C. Romafia in Tucuman; E. Canal Feijoo and C. ArgaAaraz in Santiago de1 Es- ‘3. Mazza, “Observacibn de infection espontanea tero; C. Benitez in ; S. Diaz Malaver and de1 perro por el Schizotry~unum cruzi (nota preli- R. Catalan in La Rioja; 8. Parma, E. Zambra, and minar)“; S. Mazza, “Caso de esquizotripanosis hu- J, Romero Cereijo in Santa Fe; G. and R. Basso, mana observado en la ciudad de Jujuy”; and S. C. Gimenez, J. Kiel, and S. Miyara in Mendoza; Mazza and J. Cornejo Arias, “Primeros cases de F.L. Nitio and S.E. Parodi in Buenos Aires; E. kala-azar infantil comprobados en el norte de la Castro Rendon in Nequen; and F. Bertolini in Rio Republica.” Negro.

262 Bulletin of PAHO 26(3), 2992 stitution as “currently the country’s most that could be examined for the Chagas’ important scientific production center.“’ disease agent, Typanosoma cruzi. In the end the program worked be- Before starting, Mazza had Cornejo cause Mazza did not just do his job, he change some bills into small coins and lived it. He personified both the pathol- buy two boxes of chocolates. When they ogy society and MEPRA. When money arrived, the farm looked deserted. Mazza for worthwhile trips, meetings, or pub- said “it seems nobody lives here,” lications was not available, he gave it. whereupon a woman’s head appeared. (On one occasion, when a 1931 change While Mazza engaged the woman in small in government temporarily abolished the talk a boy appeared, and Mazza at once MEPRA grant, Mazza personally funded opened his hand and gave him a coin the Mission for over nine months with and a chocolate. This brought forth the money from his savings equivalent to whole family. about four years’ salary.) He examined He proceeded doling out a coin and thousands of people free of charge, and chocolate to each child, and, after some if someone needed something but couldn’t conversation, to the adults as well. Mazza pay, he saw to its provision. He an- turned to one of the children and asked swered all of his technical correspon- who was going to give him a drop of dence personally, usually starting at six blood from his ear in return for two choc- in the evening, and despite his admin- olates and two coins. The children looked istrative duties he continued to pursue at one another, the most alert said “me,” his own research with vigor. Indeed, he and pretty soon everybody had agreed, eventually developed special long-distance samples were taken from the whole fam- research tools, including a railroad car ily, and the necessary information (each outfitted as a mobile laboratory; and from person’s full name and address) was re- the beginning the range of subjects cov- corded. Mazza then asked if there were ered was immense. any dogs, cats, or domesticated wild an- Undoubtedly, the person who helped imals on the farm. The grownups said him most in all this was Clorinda. Far no, but one child said he had a puppy more than an unpaid “honorary secre- and another said he had a kitten, both tary,” she was his manager, supply chief, of which were brought forth to provide personnel officer, corresponding secre- blood. tary, librarian, photographer, and sched- Mazza inquired about the woman’s ule manager all rolled into one. husband and was told he was in the field. Another mighty assist came from Maz- Upon asking whether his health was good, za’s own sensitivity and common sense. Mazza got an equivocal response. Some- While he could be gruff and abrupt, es- one was sent to get him. When he arrived pecially when busy, he also understood Mazza greeted him, explained he was a human nature and was good gaining physician providing free services, and said people’s confidence. One tale told by he would need a drop of blood to help And&s Cornejo, a close associate, recalls assess his condition. The man permitted the day in 1935 when he accompanied a sample to be taken, and Mazza and Mazza on a visit to a farm near Salta. Cornejo soon departed. Their aim was to collect blood samples Three days later they returned as promised, and Mazza greeted everyone by name. The blood examinations showed that several family members had 8A. Ivem, p. 74. and the father was infected with T. cruzi.

Feature 263 Appropriate treatment and guidance were practical courses on microscopic diagno- provided. The findings were later re- sis of the principal parasitic diseases in ported to the Ninth Meeting of the Ar- the area. These courses, which typically gentine Society of Northern Regional Pa- lasted less than a week, were given at thology held at Mendoza in October 1935 different sites. The first, a relatively hum- and were published in the proceedings ble affair, was given at MEPRA Head- of that meeting. quarters in 1929. The eighth and last, given Mazza also used field work as a tool at the northeastern city of Corrientes in for alerting local doctors to hidden trou- 1936, was attended by over 200 physi- bles. One such doctor was the future Ar- cians. gentine president Arturo Illia, who in the To report what they were doing, Mazza early 1930s was a young physician work- and his colleagues created a flood of ar- ing at a small factory hospital in Cruz de1 ticles for learned medical publications. Eje, Cordoba, that had 20 beds and few Many of these appeared under Mazza’s supplies. One day Salvador Mazza pulled name. In 1930, the year after moving to into Cruz de1 Eje in his rail car laboratory, Jujuy, he authored or coauthored 30; and visited the hospital, and asked Illia in 1935, a peak year, he authored or co- whether any of the patients had brucel- authored 69. Considering only the 1926- losis. Illia, who was unfamiliar with the 1936 period, Mazza and his coauthors symptoms, did not know what to say. produced 273 articles on an array of sub- Illia later reported that they next vis- jects ranging from blastomycosis to ma- ited the ward where, larious gangrene. These articles amount to an almost daily . . . facing a worker presenting orchitis, he record of what MEPRA and its collabo- [Mazza] observed the patient, classified his rators did. There is no way of telling pre- case as “acute brucellosis,” and extracted cisely how many of these articles Mazza blood. We then went to the rail car, where wrote himself; but it seems clear he was he carried out reactions with the antigen the only one who could have inspired, and showed me the high titer: 1:4,000, thus directed, and controlled the torrent of di- providing me with a simultaneous lesson verse information being reported; for in research, diagnosis, and treatment. We had lunch, he asked me if there were within the collection of fields involved, many triatomid bugs about, and we went few were as diverse as Mazza. For in- to several huts where he collected those stance, any number of qualified workers insects in a can. We then returned to the around the world might have felt com- rail car, where he showed me Typanosoma fortable presenting their learned col- cruzi in those arthropods, giving me an- leagues with an article on acute lymphoid other lesson, this time about Chagas’ dis- leukemia in 1930. lo But few except Mazza ease, that I had known virtually by name would have felt comfortable combining only; he taught me about the etiology, acute this in the same year with scholarly ar- and chronic forms . . . [and] I then under- ticles on drug treatment of New World stood [the reason for] the number of sud- leishmaniasis, malaria symptomatology, den deaths that one could only classify as “syncope.“g

Mazza also formalized his instruction ‘OS. Mazza, C. Arias Aranda, “Leucemia aguda lin- foide.” Paper presented at the Sixth Meeting of of local medical workers through short the Argentine Society of Northern Regional Pa- thology held in Salta on 29 and 30 September and 1 October 1930. Cited in Universidad de Buenos 9A. kern, pp. 98-99. Aires, 1945.

264 Bulletin of PAHO 26(3), 1992 Convincing rural folk to give medical specimens required a deft touch. Here Mazza extracts blood for a thick smear from the earlobe of a native villager while a coworker, Rafael Villagran, looks on.

Mazza palpating the spleen of a child; this diagnostic step led to his first discovery of a’ case of visceral leishmaniasis in Argentina.

Feature 265 vaginal moniliasis, hydatidosis of the neck, time passed he became aware that the vaccine contamination in Jujuy, and Chagas’ disease agent T. crtlzi, present in arachnidism produced by a spider be- his area as well as in other parts of Ar- longing to the genus Lafrodectus.*l It was gentina, was doing serious harm. And as if Mazza had been born fifty years he became increasingly frustrated by the earlier, when medical knowledge was medical community’s failure to recognize more limited and exploration of diverse this fact. medical fields by single reseachers, if not That failure is easy to understand. To common, was closer to the norm. begin with, detecting the disease was tricky. The acute phase often produced CHAGAS’ DISEASE no obvious symptoms or mimicked other ailments; and the chronic symptoms Despite Mazza’s wide-ranging inter- pointed out by Carlos Chagas (cardiac ests, as the years at Jujuy passed he came arrhythmias, heart failure, nervous sys- to focus increasingly on one ailment: tem disorders, and edema) were all com- Chagas’ disease. This well-hidden killer, mon problems readily attributed to other discovered by the Brazilian health pi- things. Besides, one could argue con- oneer Carlos Chagas in 1909,12 is now vincingly that variations in T. cruzi strains recognized as a major scourge of the severely limited the geographic areas Americas. Caused by the protozoan par- where T. cruzi infections were doing any asite Trypanusuma crtlzi, it afflicts both harm; and few if any of the victims, typ- people and various domesticated animals ically poor and illiterate rural folk, were and is spread by the nocturnal bites of in any position to understand the prob- blood-sucking triatomid bugs. Fatal per- lem, much less complain about it or make haps 5% of the time, it infects roughly 8 their voices heard. million people in this hemisphere (an es- For all these reasons, after Chagas’ dis- timated 2 million in Argentina alone) and covery and the blaze of publicity that fol- threatens some 40 million more, lowed, physicians became skeptical. In Mazza had no way of grasping the 1914 Rosembusch and Maggio, a pair of problem’s true scope in his day. But as Argentine researchers working under Rudolf Krause, said they had been un- able to find any T. cruzi among people in “S. Mazza, C. Arias Aranda, “Ensayos de trata- Argentina, even though they found plen- miento de la leishmaniosis americana por la ‘Fu- tiful T. cruzi in vector bugs. The influ- adina’ “; S. Mazza, C. Arias Aranda, “Nuevo case ential Krause, who was then Mazza’s chief de aracnoidismo por Lafrodecfus”; S. Mazza, C. Pasquini Lopez, “Micetoma podal actinomicosico at the Bacteriologic Institute, signed his observado en Tucumdn”; S. Mazza, G. Pu16, J. name to the published findings. And this, Costas, H. Quintana, R. Alvarado, “Sobre gan- combined with confused data and grow- grenas paludicas”; S. Mazza, A. Ruchelli, “Con- ing doubts in Brazil and elsewhere, gave sideraciones sobre un case de hidatidosis de1 cuello rise to a long period in which Chagas’ comprobado en Catamarca”; S. Mazza, M. Sylves- ter, “Hallazgo de Sefariu labiufopapillosu (Alessandri disease was virtually ignored, despite 1838) en vacunos de Jujuy.” Papers presented at continued efforts by Chagas himself to the Sixth Meeting of the Argentine Society of correct misconceptions and set the matter Northern Regional Pathology held in Salta on 29 right. and 30 September and 1 October 1930. Cited in In truth, Chagas was not in a good Universidad de Buenos Aires, 1945. l*See J. Leonard, “Carlos Chagas, health pioneer position. Having discovered the disease, of the Brazilian backlands,” BuIl Pun Am Health he was considered an interested party. Organ, 1990;24(2):226-39. Moreover, he had become a leading health

266 Bulletin of PAHO 26(3), 1992 administrator, head of the Oswald0 Cruz concentrating his efforts on the ailment; Institute in Rio de Janeiro, a post that MEPRA uncovered many other acute cases removed him from the field and gave him before Carlos Chagas’ death in Novem- little time to do his own research. ber 1934; and when the Argentine Society But Mazza had no personal axe to grind. of Regional Pathology held a meeting in From 1926 onward he was perpetually in Mendoza to honor Chagas’ memory, 35 the field. Despite a blizzard of other du- additional cases were described. ties, he was continually doing personal Mazza did not stop there. From 1935 research. And his work placed him in onward he applied a lot of his own efforts close contact with the communicable dis- and those of his organizations to detect- ease problems of rural folk, to such an ing, treating, and reporting Chagas’ dis- extent that he was generally recognized ease cases. In 1935 he wrote or co- as the great Argentine expert on such authored 31 articles on the subject; over matters. So he was in a good position to the ensuing decade he issued an average delve into what was happening and tell of 17 such articles a year; and in the end others what he found. he and MEPRA registered some 1,400 In 1926 Mazza reported finding the fifth cases of the disease. human case (the first in an adult) of T. All this had the desired effect. In short, crtrzi infection in Argentina.13 And in 1927, Mazza succeeded in showing that Cha- when Mazza and his coworkers diag- gas’ disease was a major threat, awoke nosed Chagas’ disease in a five-year-old the Argentine medical community to the girl with overt symptoms, they gave the true nature of the ailment, and saw that matter a good airing.14 Carlos Chagas’ great medical discovery For some years after that, however, not received the thoroughgoing international much happened. MEPRA merely re- attention it deserved. As one Brazilian ported finding the parasite in armadillos investigator noted, “It was . . . Argen- and opossums, and Mazza directed most tina that undertook by itself, through the of his attention elsewhere. Then, in 1932, voice of Mazza and his collaborators, the MEPRA found another pediatric case in rehabilitation of the great work of Carlos Santa Fe; in 1933 it found another; and, Chagas.“16 In the end, it was enough for as Mazza reported, some to suggest that the ailment should be called “Chagas-Mazza disease”; and Toward the end of 1933, MEPR4 found in while this name never became common the province of Santa Fe a one-year-old child parlance, it is still heard occasionally as with schizotrypanosis who died in a short time and whose postmortem, the first done a faint echo of Mazza’s work. in this country on the acute form of Chagas’ disease, enabled us to find . . . signs of THE 1940s severe “Chagas’ myocarditis.“‘5 By then the 1940s had begun and Maz- These cases provided plenty of incen- za’s energies were waning. Since 1937 he tive to look further. So Mazza began had known that he had a heart condition, and in 1944 he suffered an episode of retinal thrombosis that robbed him of most ‘3. Mazza, “Caso de esquizotripanosis humana ob- of the vision in one eye. In 1944 he had servado en la ciudad de Jujuy,” Rev Asoc Argent Biol, 1926;2:79-87. ‘5aIvador Mazza, “Chagas’ disease in the Argen- tine Republic,” p. 290. 160. de Magalhaes, Mem Inst Ezequiel Dias (Belo Hor- 151bid., p. 291. izonte), 1942;4, as quoted in A. Ivern, p. 122.

Feature 267 Mazza with Evandro Chagas (left), son of the late Carlos Chagas who discovered Chagas’ disease. The ninth meeting of the Regional Pathology Society, held in Mendoza in 1935, was dedicated to the memory of Carlos Chagas. Seated to the right of Mazza is Dr. J. Echeverri Gainza, President of the Medical Society of Mendoza. four periodic electrocardiograms taken; was there, at 9 p.m. on 7 November 1946, and the next year he made arrangements that he died suddenly of heart failure at to move MEPRA back to Buenos Aires, the age of 60. Whether or not “the day a move that was completed in June 1946. before his death he worked at a micro- He had been made a member of Bra- scope for seven hours,“17 it seems clear zil’s National Academy of Medicine, and that Salvador Mazza died suddenly in the in September 1946 he went to Rio de midst of unrelenting activity, the way he Janeiro as a leading participant in the First would have wished. Inter-American Congress of Medicine MEPRA’s end was slower and more sponsored by that body. He was also rec- painful. Shorn of its leader and confront- ognized as a leading expert on brucel- ing the “metropolitan hodgepodge” to losis, and so the next month he flew to which Nicolle had prophetically referred, City with Clorinda to attend a the Mission underwent a series of ad- five-day medical conference on that sub- ministrative changes but never regained ject. When the conference ended on 2 a strong sense of direction. In the process November, he went to Nuevo Leon with it lost university support, experienced a a group of researchers at the Mexican slow decline, and after more than a dec- Government’s behest to conduct dem- onstrative studies on Chagas’ disease. From Nuevo Leon he went to Monterrey to speak on his own experience; and it 17Unidentified news report cited in A. Ivem, p. 7.

268 Bulletin of PAHO 26(3), 1992 ade in the twilight closed its doors for BIBLIOGRAPHY the last time in 1958. Despite MENU’s demise, Mazza clearly Aguirre JA. Semblanza de Salvador Mazza: changed the face of “regional” medicine 1886-1946. El Dia Med (Buenos Aires). 24 March 1947:367-71. in Argentina. As And&s Cornejo of Salta Bejarano FR. Profesor Dr. D. Salvador Mazza. put it, Rev San MiZ (Buenos Aires). 1946;45:1253- 57. We have often heard it said that Mazza left Bianchi AE. Salvador Mazza: 1886-1946. Rev neither school nor successors. Are “school Asoc Med Argent. 1948;62:265-66. and successors” not embodied in the fact Castagnino WE. Salvador Mazza. Todo es his- that today every doctor knows leishman- toria. 1986;17:14-20. iasis, Chagas’ disease, brucellosis, mycosis, Cornejo A. Vida y obra de Salvador Mazza: etc.? Today we doctors in the city of Salta Junio 6 de 1886-Noviembre de 1946. Se- do not see cases of leishmaniasis or myce- mana Med (Buenos Aires). 1956;108(25):843- tomas, because the doctors in the endemic 56. zones have already treated them them- Cornejo A. A un ario de1 fallecimiento de un selves, and if cases come to us it is because sabio: Salvador Mazza. SemanaMed (Buenos they are sent to us by those doctors, already Aires). 1948;55(11):419-21. diagnosed, to be treated by us with better EI Dta MMico. Salvador Mazza: su biografia. means.ls Dia Med (Buenos Aires). Ivern A. Vida y obra de Salvador Mkzza: Historia Beyond that, Mazza left the interna- de una epopeyacientifica. Rosario, Santa Fe, Argentina: Universidad National de Rosa- tional medical community aware of what rio, Servicio de Publicaciones; 1987. he had done and sensitized to a number Mazza S. Action de la plasmoquina sobre 10s of significant health problems. The most gametocitos de infecciones espontaneas por visible signs of this legacy in the years hemoproteus.Prensa Med Argent. 1928;15:55- immediately following his death were 58. numerous testimonial acts and dedica- Mazza S. Acerca de la infeccidn espontanea tions extending as far north as Wiscon- de la mulita en el norte por el Trypanosoma cruzi: nota preliminar. Prensa Med Argent. sin. Of these, the most notable came from 1930;16:1171-73. the Oswald0 Cruz Institute during the Mazza S. Caso de esquizotripanosis humana First Pan American Meeting on Chagas’ observado en la ciudad de Jujuy. Rev Asoc Disease held in Tucuman, Salta, and Ju- Argent Biol. 1926;2:79-87. juy in July 1949. On that occasion the Mazza S. Chagas’ disease in the Argentine Brazilian delegation gave Clorinda a scroll Republic. Mem lnst Oswald0 Cruz. 1949;47(1- honoring her husband that was signed 2):289-301. by all 76 members of the institute, and Mazza S. Frecuencia de1 Blastocystishominis en las deposiciones de diarreicos cronicos y su upon Mazza’s tomb it placed a plaque tratamiento apropiado. Rev Asoc Med Ar- from the institute bearing his likeness and gent. 1922;35:125-31. an appropriate inscription. It was apt re- Mazza S. Observation de infection espontk membrance for an immigrants’ son from nea de1 perro por el Schizotypanum cruzi Rauch who rose by dint of his driving (nota preliminar). Rev Asoc Argent Biol. intellect and who showed what one mo- 1926233-41. tivated person could do to reveal medical Mazza S. On the duration of relative immu- nity in malaria of birds. J Trap Med Hyg. hazards, inspire others, and improve 1924;27:98-99. health in rural zones. Mazza S. Valor diagnostico de la linfocitosis en la sifilis. Rev Asoc Med Argent. 1920;32: 5-7. laA. Cornejo, Vida y obra de Salvador Mazza, p. 854. Mazza S, Cornejo Arias J. Primeros cases au-

Feature 269 toctonos de kala-azar infantil comprobados sadas. Bol Inst Clin Quirurg (Buenos Aires). en el norte de la Republica. Rev Asac Argent 1927;3:909-14. Biol. 1926;2:96-101. Mazza S, Rickard E. Investigation sobre las Mazza S, Cossio M. Consideraciones sobre un relaciones entre paludismo y cultivo de1 ar- foco de anguilulosis en la provincia de Tu- roz en la provincia de Tucuman. Bol lnst cumdn. Bol Inst Clin Quirurg (Buenos Aires). Clin Quir (Buenos Aires). 1927;3:175-80. 1926;2:518-22. Prof Dr Salvador Mazza. Rev Asoc Med Argent. Mazza S, Forte E, Alvarez Soto N, Arias Ar- 1946;60:1031. anda C. Nota preliminar sobre 10s efectos Salvador Mazza. Rev Sanid Hig Publica (Ma- de la plasmoquina y plasmoquinaquinina drid). 1947;21(6):646-48. en el paludismo. Bol Inst Clin Quirurg (Bue- nos Aires). 1927;3:657-69. Scobie JR. Secondarycifies ofArgentina: the social Mazza S, Franke I. Grupos sanguineos de in- history of Corrientes,S&x, and Mendoza, Z&50-- dios y de autbctonos de1 norte argentino. 1920. Stanford: Stanford University Press; Bol Inst Clin Quirurg (Buenos Aires). 1927; 1988. 3:137-39. La SemanaMedica. Dr Salvador Mazza. Semana Mazza S, Ivanissevich 0. Cysticercus cellulosae Med (Buenos Aires). 1946;53:983-84. de1 masetero en el hombre. Rev Asoc Med Sociedad Medica de Mendoza. Prof. Dr. Sal- Argent. 1922;35:1-11. vador Mazza, 8 de Noviembre de 1946: ac- Mazza S, Iraeta D. Observaciones de1 indice tos de homenaje. Bol Sot Med Mendoza. No- refractometrico en suero de embarazadas y vember 1946;26:3-6. sus variaciones en la crisis hemoclasica. Rev Universidad de Buenos Aires, Mision de Es- Asoc Med Argent. 1922;35:115-25. tudios de Patologia Regional Argentina. Mazza S, Niiio F. Notas hematologicas y ser- Bibliografia de la Misio’n de Estudios de Patologia olbgicas sobre leishmaniosis tegumentaria Regional Argentina (MEPRA): 1926-1944. americana. Prensa Med Argent. 1929;16:88- Buenos Aires: Universidad de Buenos Aires; 91. 1945. Mazza S, Parodi S. Mitosis laringea con par- Winter NO. Argentina and her people of today. dsitos andlogos a 10s Megalosporideosde Po- Boston: LC Page; 1911.

270 Bulletin of PAHO 26(3), 1992