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Koch treated g 86 cases of sleeping sickness with Atoxy/.* Out 
of gj 6 cases positive results were obtained in He points out the 
importance of the drug in early cases when it is much more efficient 
than in advanced cases. Koch divides his cases into two classes— 
‘ early ’ and ‘ advanced ’ cases. He gives a short clinical account of 
the symptoms. Debility, nervous excitement, trembling of the 
extremities, general disturbance of the psychical functions, and 
nervousness very often in the form of mania. In the latest stages 
of this disease, apathy and sleep. Atoxyl was usually administered 
in the forms of two double injections of 0‘5 gramme. Usually, after 
the second injection the parasites had disappeared from the blood 
and from the lymph glands, but a real improvement is only to be seen 
three or four weeks after the injection. In advanced cases, it was 
impossible to drive out the parasites from the circulation, even after 
prolonged administration. Under the influence of Atoxyl, the trypano¬ 
somes sometimes disappeared for 30 to 40 days; when they 
reappeared they were only observed in very small numbers. Attempts 
to shorten the treatment by the administration of one large dose of 
Atoxyl only have given uncertain results as yet. In 12 cases, in 
which only one full dose of Atoxyl was given, the trypanosomes 
disappeared for 30 to 40 days. 
R. Koch, ‘ Schlussbericht iiber die Tatigkeit der deutschen 
Expedition zur Erforschung der Schlafkrankheit ’ (Deutsch. med. 
Wochenschrift, 1907, No. 46), gives liis further experiences. 
He believes that some of the appearances, after Atoxyl 
treatment, can only be explained by the resorbtion of the dead 
trypanosomes. He still uses as the mode of administration the double 
injection of 0'5 gramme Atoxyl on two successive days, then 10 days 
interval, and two more injections. Koch was not able to observe, 
as Erlich did. that the trypanosomes become resistant to the Atoxyl, 
Attempts to administer Atoxyl in doses of one gramme were 
unsuccessful in so far as after such large doses of atoxyl blindness 
very frequently occurred, due to atrophy of the optic nerve. Very 
interesting from an epidemiological point of view is the fact, which 
he has pointed out in his previous reports, that in Kisiba fifteen 
married women were found suffering from sleeping sickness. As 
• Up to dale he has treated some 2,000 cases. 
