42 
Vni. _C. G., aged 34, an engineer, was stationed at Katanga 
on the Upper Congo (Lualaba river) for three and a half years. He 
took five grains of quinine daily and enjoyed excellent health til! 
November, 1906. About that date he began to suffer from fever, 
apparently uncontrolled by quinine. On November ,yth, his 
temperature at the time being 102°, he started to return to England 
via Rhodesia and the Cape, riding 500 miles of the way on a bicycle 
and suffering from fever all the way. On the voyage from the Cape 
he gave up taking quinine as it seemed to do him no good. Fever 
persisting, he became bilious and yellow. 
I saw him on his arrival (January 5th, 1907). Mis temperatore 
was 103°, pulse U2. He was somewhat emaciated, slightly icteric 
and markedly anaemic. Liver and spleen, especially the latter, were 
both enlarged. The superficial cervical glands were also slightly 
enlarged and the skin of the trunk was splashed with rings and 
patches of erythema miiltiforme. A blood examination ga'f 
2,848,000 erythrocytes per c.mm. and 4,000 leucocytes per cnini , the 
large mononuclears being in marked excess (37-3 per cent). Malaria 
parasites were not found at that time, but trypanosomes were 
numerous. 
Atoxyl. He was at once put to bed and atoxyl in hyp<idermic 
injections begun. At first the injections were given every second 
day, the dose being rapidly increased from 11 to 7 grains, and 
occasionally 8 grains. In a few days trypanosomes had disappeared 
rom the peripheral circulation, so that when Dr. Todd, of Liverpool, 
saw the patient with me on January i ith he failed to find a single 
specimen during a prolonged examination. The skin eruption, the 
adenitis, the fever and, in great measure, the debility disappeared 
fev“er ‘here was a return of 
benTJ™ examination, proved to be malarial 
and feneat H" t to the atoxvl 
and repeated at intervals ever since. 
conbnuer '^The'' have been 
J^e aeth to fu V oT ^6th to June t.th, from 
taking perchloride orLrcu^.^“and"^\’’ 
November 27th 1^’ ^ ^ ^ November 6th to 
sodictartrat/of anHmonr Tl'd " 
y- The dose of atoxyl varied from 7\ to 
