ATOXYL IN THE TREATMENT OF MALARIA, 5 



was given during- a period of ten days, then atoxyl was administered per os 

 for nine days. A serious relapse ensued. A second series of six injections of 

 quinine was given in the usual quantities. From that moment recovery seemed 

 certain, the spleen diminished in size, and the weight of the patient increased 1 

 kilogram in five days. The benefits of atoxyl and quinine seemed incontestable. 



Observation number 7 was made upon a similar ease. From the gravity of 

 the febrile attacks and the curve of the chart, atoxyl was soon abandoned and 

 replaced by quinine, three injections of 1.50 grams in three days were given. 

 Then atoxyl was again administered per os for fourteen consecutive days. At 

 this time a slight relapse necessitated the employment of quinine. In conse- 

 quence, atoxyl again failed as a febrifuge, but was probably not useless as a 

 reconstituent, for the patient became convalescent and gained 2 kilograms in 

 twenty days weighing 36 kilograms; at the end of this time moreover he was able 

 to undertake his rough work on the railway again after remaining only one 

 month ill in the hospital. 



The cases numbered 7 and 9, who were in an advanced stage of cachexia, were 

 certainly benefited by the combined treatment, since they were able to undertake 

 their work again after two months in the hospital. During this time an increase 

 of weight occurred, their general condition improved, and their spleens decreased 

 in size. Number 7 was given atoxyl at the same time as the quinine and nimiber 

 9 directly after it as the respective charts indicate. 



If observation 10 seemed favorable to the routine employment of atoxyl, obser- 

 vation 11 shows its impotence, but I must add that number 11 was an exceptional 

 case, rebellious against all treatment. 



Observation 14 was interrupted. 



ACCIDENTS DUE TO ATOXYL. 



We already possess much knowledge concerning accidents which may 

 arise from the use of atoxyl. Passing troubles, such as loss of appetite, 

 nausea, and diarrhoea, are common to all forms of treatment with arsenic 

 and are easily overcome. The complications which occur as a result of 

 the localization of atoxyl in the nervous centers are more serious. 



B. Waelsch relates that Bornemann observed an atrophy of the optic nerve 

 due to hypodermic injections; it is true that the doses were large, 27 grams. 

 R. Koch relates several cases of amaurosis among the negroes suffering with 

 sleeping sickness, who were treated with large doses of atoxyl. A dose of 

 1 gram continued for some time provokes nausea, giddiness, attacks of colic, and 

 finally amaurosis. Koch thought that this amaurosis was transitory and would 

 disappear when all medication was eliminated; such was not the ease, the patients 

 recovered otherwise, but remained blind. 



This is a danger of capital importance which should make the 

 physician very cautious whenever atoxyl is employed as an adjuvant. 



At first we only noted phenomena of little importance (cases num- 

 bered 2 and 7). In the course of treatment, number 7 had a passing 

 diarrhoea. Number 2, who had been injected subcutaneously, seems to 

 have felt a pain like that of a wasp's sting at the time of the injection, 

 while the other patients found no difference between the injection of 

 atoxyl and that of quinine. Case 2 after each dose suffered from itching 



