fusion the patient is seized with a fit of coughing, or with feelings of constriction of the chest and faintness. If these are severe they may be regarded as indications for stopping the flow of fluid. Usually, though not always, the transfusion is followed by smart fever which soon subsides. A similar occurrence may follow intramuscular injection of atoxyl, and has been attributed to toxins liberated from the trypanosomes killed by the drug.
As with atoxyl, there are differences in the methods of employing antimony injections. Some give them daily in courses of fifteen days at intervals of fifteen days; others, once a week; others, again, according to indications supplied by temperature and the microscopical examination of the blood. After the short fever which may ensue, the administration of antimony is usually followed by marked relief of symptoms.
Unless contraindicated, atoxyl and antimony treatment should be combined or alternated. One or both should be instituted immediately the diagnosis of trypanosomiasis is established.
As pointed out by Ehrlich, certain strains of trypanosomes are "arsenic- fast," that is, they resist the action of the drug—— a property which becomes hereditary and is continued in sub- inoculations into the lower animals. This undoubtedly accounts for the failure of arsenical treatment in a large proportion of cases. Presumably there are strains having a similar resisting power to antimony. As the atoxyl-fast trypanosomes may respond to antimony, and vice versa, both drugs should be employed in every case. In the face of so grave a disease great risks are justified.
Recently, Daniels and Newham report favourably on treatment of Rhodesian trypanosomiasis by intramuscular injections of 30 minims of Martindale's injectio antimonii oxidi given twice daily and kept up for some time. The injections are painless and cause no necrosis. This method of giving antimony is worth further trial. The dose mentioned is equivalent to 1/20 gr. of tartar emetic.
