AFRICAN TRYPANOSOMIASIS i49 



It can be given bv the month or rectum, 1-2 grains in large 

 quantities of water, say 1J-2 pints, every third day. 



'J'artar emetic is perhaps best given by the vein, |-i^ grains every 

 third day. Method of administration. 



I'se a 20-c.c. Record sAringe. Prepare a sohition of tartar emetic 

 so that 10 c.c. contain ^ or more grains of the drug. Apply a 

 tournicjuet to the arm so as to distend the veins, paint the spot with 

 iodine, draw into the syringe 10 c.c. of the drug, fill syringe with 

 boiling water, attach rubber connecting tube, expel the air, give 

 syringe to assistant to hold, take needle and plunge it into the dis- 

 tended vein, allow a few drops of blood to run through to ensure that it 

 is well in the \-ein, attach syringe holding piston end upwards so that 

 any air bubble will be at :he upper end, unfasten tournicjuet, inject the 

 fluid leaving- one c.c. in the svringe, withdraw needle and empty syringe 

 through the needle so as to expel any drop of coagulated blood that 

 may be in the lumen, put the whole in a solution of antiseptic and it 

 is ready again for use. A little iodine and bandage on the site of the 

 injection is sufificient. It is not necessary to dissect out the veins 

 except in ver\' few cases. With plenty of assistants one can give 40 

 injections in an hour in this wa}'. The reactions \\hich follow tartar 

 emetic are alwavs marked. Young infected natives cannot take more 

 than h-i grain at a time no matter for how long the drug has been 

 taken. Soamin was given whh tartar emetic intravenously but toxic 

 symptoms were marked and it was abandoned. 



After giving more than 6,000 injections of arsenic and tartar emetic 

 the method and drugs found by me to be most useful up to the present 

 were : — 



A combined treatment of : — 



One grain (o'o6 grm.) of tartar emetic intravenously every third 

 day, every second day in selected cases. 



1-2 grains (o"o6-o"i2 grm.) tartar emetic by the mouth in a mixture 

 containing glycerin, sodium bicarbonate, and chloroform water. 



11^ grains (o"jy grm.) soamin intramuscularly once weekly. Omit 

 treatment every fifth week or on the appearance of toxic svmptoms. 



Arsenic alone tends to produce arsenic-fast trypanosomes. One 

 must give heroic doses of whatever drugs one uses. Ascertain the 

 idiosyncrasy of the patient towards the drugs and administer them 

 just short of toxic symptoms, omi'.ting them ever\' fifth week. 



Solutions of merctirv, formalin and collargol have been tried 

 separately and together, intravenouslv, but without success. Many 

 natives would rather die than have intramuscular injections of any 

 kind. They prefer intravenous injections in spite of the after reaction. 



