40 
5 - Large doses of atoxyl are not necessary to secure this 
result. 
6. Large doses of atoxyl should be avoided, as they are apt 
to cause serious lesions, peripheral neuritis, optic atrophy, 
gastro-intestinal inflammation, and other toxic conditions which 
necessitate suspension of a valuable remedy. 
7. Trypanroth, mercury and parafuchsin seem ineffective in 
human trypanosomiasis. 
8. Antimony may have a therapeutic influence in trypano¬ 
somiasis, but the hypodermic injection of the sodio-tartrate is 
impracticable. 
The prospects of atoxyl treatment I consider most hopeful. As 
regards efficiency, promptness and mode of action, it seems to me 
that it is almost on a par with mercury in syphilis and quinine in 
malaria; and I think in using atoxyl we should conform our practice 
to what experience has taught us to be the best methods of using 
these other efficient and long tried remedies. 
I do not believe we can kill the trypanosome outright by one or 
two large doses of atoxyl, any more than we can kill the treponema 
of syphilis or the parasites of malaria by large doses of their respective 
specifics. Mercury does not immediately cure syphilis, nor does 
quinine immediately cure malaria; but they deprive the respective 
parasites of their pathogenic qualities and keep the patient alive and 
in good health till, in process of time, the parasites either die out or 
become permanently inert. So I read the action of atoxyl in 
trypanosomiasis, and so I would regulate its administration, being 
careful, as we would with mercury or quinine, not to push the drug 
too far, and thereby necessitate its suspension. Case 7 distinctly 
shows that a dose of 2*3 grains given twice a week controlled the 
disease; why then risk poisoning by a larger dose? Some of my 
patients have been for months on 2 to 4 grain doses two or three 
times a week and have done well. 
I would therefore suggest for the routine treatment of trypano¬ 
somiasis, a two to three grain dose of atoxyl every second or third 
day and kept up for at least two years. At the same time concurrent 
specific disease such as malaria, syphilis, &c., should be carefully 
treated; and, further, the patient should be brought home to his 
native country, be spared fatigue, worry, exposure, excesses of all 
