142 TROPICAL MEDICINE AND HYGIENE 



recovery, and particularly whether all possibility of the 

 recurrence of the cerebral symptoms or of sleeping sick- 

 ness has been obviated. 



It is somewhat unfortunate that a different line of treat- 

 ment has been adopted on a large scale,. This plan, 

 introduced by Koch, was to use large doses and repeat 

 them a fortnight later. The immediate effects were good, 

 so much so that the method was widely advertised, and 

 has been extensively employed. Further experience has 

 shown that the effects are temporary, relapses the rule, 

 and optic atrophy common. These results have to some 

 extent discredited the use of atoxyl. 



The attempt to treat diseases by a few heroic doses of 

 a specific has often been tried and failed. As instances : if 

 syphilis be treated with a few large doses of mercury, 

 or malaria similarly by quinine, the temporary results 

 may be good, but relapses are usual and the disease 

 recurs. The same drugs in moderate doses continued 

 for a long time have a permanent beneficial effect, and 

 the same appears to hold good with atoxyl in trypanoso- 

 miasis. Alternate treatment with atoxyl and mercury has 

 been advocated, but the results, in man, have been no 

 better than with atoxyl alone. 



Injections of preparations of antimony have a more 

 powerful effect on the trypanosomes than atoxyl or any 

 other arsenical preparations, but the antimony prepara- 

 tions used cause much pain and local tissue necrosis unless 

 very dilute and even then do so in some persons. Finely 

 divided metallic antimony suspended in Lambkin's medium 

 usually causes less necrosis, and is as effective. Intra- 

 venous injection of a solution of tartar emetic, i to 2 gr. 

 in 10 c.c. of sterilized normal saline, is the most effective 

 method. If the vein be irrigated with a little normal 

 saline before the tartar emetic solution is injected, and 

 after the injection of that solution, there will be no local 

 trouble. A rigor and sharp reaction will occur in most 

 cases. The immediate effects are striking even in cases 

 which do not yield to atoxyl. In some cases, such in- 



