4 VASSAL. 



Case number 15 is interesting on accouiit of the accidents caused by 

 atoxyl. We will discuss them later. Four grams were injected in eight 

 days. The fever showed a tendency to decline. 



Another patient, number 16, was treated even more energetically; 4 

 grams were given in seven days; his high temperature was found to fall 

 rapidly but a serious remission occurred. The drug was well borne, but 

 the premature departure of the patient prevented any commentary on the 

 future results of the treatment. 



Observation number 17 was similar to observation number 6. This 

 was also a case of tertian fever. There was no doubt again as to the 

 failure of the specific treatment. As soon as quinine was given the 

 temperature became reduced and pursued a noraial course. 



Part II. 

 TREATMENT BY ATOXYL AND QUININE. 



A mixed treatment was tried in ten cases (1, 3, 4, 5, 7, 9, 10, 11, 13, 

 14) in the following manner: 



1. Injections of quinine associated with injections of atoxyl. 



2. Injections of quinine associated with atoxyl per os. 



We used a solution of hydrochlorate of quinine in a dilution of 1 to 

 10. jSTumber 13 was the only case in which injections of quinine were 

 associated with injections of atoxyl. 



The first nine days we gave injections of quinine, 0.50 gram each; these 

 were immediately followed by three injections of atoxyl, 0.50 gram each, given the 

 first, second, and sixth day. The affection was of long duration and crescents were 

 frequently met with in the peripheral blood. The results on the whole were 

 favorable, the patient's condition being much improved when he left the hospital. 



The nine other cases concern the action of atoxyl per os combined 

 with hypodermic injections of quinine. 



In case number 1 quinine was injected for six days in succession. Six days 

 later apyrexia set in. The haematozoa {Laverania malarioE) which had disap- 

 peared, showed themselves again in the blood in considerable numbers. Atoxyl 

 was then administered per os, 10 centigrams a day; there was again a febrile 

 reaction the third day, then the temperature became normal. The spleen diminished 

 in size and improvement in the general state of health became manifest. 



The principal fact to be noted in case number 3 is the occurrence of repeated 

 febrile attacks of malignant, tertian fever against which atoxyl per os was quite 

 ineffective. Quinine was efficacious the moment it was given by injection. It was 

 continued nevertheless at the rate of 1 gram a day for five daj's. It is possible 

 to suppose that although atoxyl itself was powerless against the parasite, it 

 prepared the way for the action of the quinine. The patient left the hospital 

 improved. 



Number 4 was a particularly tenacious case of malignant, tertian fever which 

 had never before been treated. The spleen was enlarged extending beyond the 

 border of the short ribs. First, a series of six injections of quinine (0.50 gram) 



