1912.] Trypanosomiasis and Yaivs with Metallic Antimony. 209 



health and had been without treatment for four months. She was one of 

 the few who had a complete course. The tenth case had one injection of 

 salvarsan and was unable to take antimony on account of extreme sus- 

 ceptibility. Atoxyl was substituted, but the patient developed toxic 

 symptoms. She is now having small doses of atoxyl, but is getting steadily 

 worse. 



The salvarsan has been given both as an intramuscular injection in olive 

 oil, and by intravenous injection in alkaline solution. 



III. Antimony and Atoxyl. 

 The patients in this series have been treated as follows : — 



(1) Five doses of antimony 1 gr. at intervals of four days. 



(2) Atoxyl 5 gr. every three days for 40 days. 



(3) Three doses of antimony 1 gr. at intervals of four days. 



(4) Atoxyl 5 gr. every three days for one month. 



There is no interval between these courses, so the patients have continuous 

 treatment over a period of rather more than three months. An interval 

 of a month is then given and atoxyl treatment is then continued, as a 

 tonic and precautionary treatment. 



Thirty-one patients have been treated ; but three were unable to take the 

 complete course of antimony. 



This is the most recent series, and the three months' course has just been 

 completed ; it is too early to speak of results. At the time of writing all 

 have done well ; the improvement, in many instances, has been striking ; 

 some, however, were advanced cases, and it is not expected that the 

 improvement can be maintained permanently. 



IV. Old Atoxyl Cases, Treated with Short Courses of Antimony. 



After we had seen that intravenous injection of antimony was bringing 

 about improvement in the newly admitted cases and could easily be carried 

 out on a large scale, it was decided to give short courses of antimony to 

 the old cases that had been under treatment with atoxyl, atoxylate of 

 mercury, etc. The majority of the patients so treated have had two 

 separate courses of three doses of antimony, 1 gr. 



In some instances, patients have not had all these six doses on account of 

 susceptibility, intercurrent affections, bronchitis, etc., but 813 injections have 

 been given to 143 patients. 



In this series there has been one death. The two fatal cases in the first 

 series had doses which have been found to be inadvisable in advanced 



