TREATMENT 



1277 



Newham recommend the painless Martindale's injectio antimonii oxidi, 

 30 minims ( = gr. antim. ox.) to be given subcutaneously once or twice 

 daily. Apparently the trypanocide action of antimony is more powerful 

 in the lower animals than in man, in whom the results are inferior 

 to those given by atoxyl. A mixed antimony and atoxyl treatment is, 

 however, of advantage in most cases, an atoxyl injection (3 grains) being 

 given every third day, or 7^ grains every fifth day, and sodio-tartrate of 

 antimony (Plimmer's salt) administered daily- — -2 grains dissolved in a large 

 quantity of water (2 pints) by the mouth or by the rectum. Tartar emetic, 

 however, is best given by intravenous injections, using solutions of i in 100 

 or I in 1,000. The dose of the drug to be given is 5 to 10 centigrammes per 

 injection. It is important that none of the fluid of the injection should escape 

 into the surrounding tissues, as a violent inflammation may result. These 

 injections should be administered monthly on ten consecutive days for a long 

 period. The injection of salts of antimony may produce a marked fall in the 

 blood-pressure, dyspnoea, and signs of collapse, and therefore Tliiroux sug- 

 gested that subcutaneous injections of caffein should precede ten or fifteen 

 minutes their administration. 



Basing his opinions upon the very successful treatment carried out by 

 Captain Simson, R.A.M.C., at the Yei Sleeping Sickness Camp in the Mongalla 

 Province of the Sudan, Captain Spence, R.A.M.C., is treating cases in the 

 Bahr-el-Ghazal Province as follows : — 



A. Cases in the early stage : — 



1. Six intravenous injections each of 6 centigrammes of antimony at 



three-day intervals. 



2. Interval one month. 



3. Twelve intramuscular injections each of 30 centrigrammes of atoxyl 



at three-day intervals. 



4. Interval one month. 

 5 and 6. Repeat 1-4. 



7. Three months after last t eatment the blood of the patient is 

 inoculated int3 an animal. If the animal remains uninfected the 

 patient is given a numbered disc and told to report every three 

 months. 



Total dosage: Atoxyl, io-8 grammes in about one year; antimotiy 

 i-o8 grammes. 



B. Relapses and cases first seen in a late stage of the disease : — 



1. Nine intramuscular injections each of i gramme of atoxyl at ten- 



day intervals. 



2. Interval one month. 



3. Nine intramuscular injections each of i gramme of atoxyl at 



twenty-day intervals. 



4. Interval one month. 



5. Nine intramuscular injections of atoxyl at thirty-day intervals. 



6. Interval of three months. 



7. Animal is inoculated as above. 



Total dosage: 27 grammes of atoxyl in two years. 



Cases in which no symptoms are noted and in which animal inoculations 

 are negative are kept under close control for twj years, aker which they 

 report every six months for two years and the result judged. 



Mercury and Atoxyl. — Mercury was first introduced in 1902 for the treat- 

 ment of sleeping sickness by Low and Castellani, using intravenous injection 

 of Baccelli's sublimate solution (hydrargyri perchloridi, o-io gramme; sodii 

 chloridi, 0*50 gramme; aquae destillatae, loo'oo c.c; i to 4 c.c. per intra- 

 venous injection), in association with arsenic and quinine by the mouth. A 

 fall of the temperature was observed in some cases, but the fatal course of the 

 disease was not influenced. Moore, Nierenstein, and Todd have used mercury 

 and atoxyl in combination or alternation, with the idea that mercury might 



