6 VASSAL. 



all over the bod}', M'hicli M'as particularl}' violent about the nostrils, on 

 the scalp, and about the pubis. Finally he had diarrhoea and a metallic 

 taste in the mouth. 



The only serious accidents were those in case number 15 who had 

 received 4 grams of atoxyl in eight days. Less than twenty-four hours 

 after the last injection, an erythema broke out on his face, and at the 

 same time diarrhoea set in, with decided anorexia and nausea. Prom 

 the beginning the itching Avas violent. The following day the whole 

 ti-unk, the arms and hands, and the front of the thighs became covered 

 M'ith rubeoloid spots, which became confluent on the lower part of the 

 back and there formed patches about the size of the hand. The pruritus 

 was very intense. The eruption attained its maximum the third day; 

 it was confluent on the chest and back, and spread out OA^er the thighs; 

 the face, feet, and legs were cedematous. Albumin appeared in small 

 quantities in the urine on the third day. The spots on the fourth day 

 were paler and the oedema of the lower limbs had diminished; on the 

 fifth day the erythema had totally disappeared and the other symptoms 

 had improved. Under an appropriate treatment recovery was the work 

 of a few days. 



It follows from the above that therapy with atoxyl must be kept 

 within certain limits. As a general rule with the Annamese more than 

 2 grams should not be given hypodermically Avithin a Aveek. 



There is no object in using large doses of atoxyl for malaria, as the 

 drug is of really no value in the acute stages of the disease. The dose of 

 10 centigrams a day per os seems one that could be continued for some 

 time, but my experience is not complete enough and is too recent for me 

 to speak positively upon this question. 



THE ACTION OF ATOXYL IN MALARIA. 



Atoxyl alone, in large therapeutic doses, is incapable of stopping or 

 modifying a febrile attack of malaria. It is not a febrifuge, nor is it even 

 moderatel)^ antipyretic in its action. 



Its direct action on the hsematozoa of tertian and malignant, tertian 

 fever is inappreciable, whether it is given in single large doses or is 

 continued Avithout interruption in small ones. It is poAverless against 

 the acute symptoms of malaria. It does not prevent relapses. In short 

 its specific action is nil. 



As an adjuvant to quinine on the contrary, atoxyl shoAvs an un- 

 questionable efficacy. We have cited numerous examples. It rapidly 

 improves the general condition and restores strength. It is a recon- 

 stituent A\'hich is superior to the other Avell-known arsenical compounds. 

 In cachectic enlargement of the spleen, Avhere quinine itself often fails, 

 atoxyl, combined with quinine, proves efficacious. 



