24
METHODS OF TREATMENT USED.
The great majority of our cases have, up to the present, been treated entirely with atoxyl combined with strychnine (in the case of patients in an advanced state of the discase).
The methods of atoxyl treatment employed, as I stated in my previous report, have been:-
(a) The original method employed: 0.4 grammes given on the twentieth and twenty-first days, and repeated for an indefinite period. This method was soon discarded for:-
(b) Similar to the above, but the injections are given on the tenth and eleventh days.
(e) Similar to the above (b), but the doses are gradually increased by 5 c.c. at a time until a maximum of 0.7 grammes is reached. This is continued for a month, and then the dose reduced.
(d) Dr. van Campenhout's method-very similar to method (c), except that the initial dose is much smaller, the injections are given every fifth day up to a maxi- mum of 0.7 grammes, and continued at this point for a month.
(e) Method lately recommended to us by the German Commission. One gramme of atoxyl on two successive days, and repeated on the fifteenth and sixteenth day.
Our medical officers have used method (b) as a routine method.
When there is only one medical man at a camp to attend to four or five hundred patients, a method which entails as few injections as possible during the month is a great advantage. Method (e), which entails only four injections in a month, would, therefore, seem useful, but the doses are large, and as there has been some reported uncertainty in the action of some of the atoxyl supplied to us, it has only been used in a few cases. The actual results that we have obtained with atoxyl alone are shown in this table:-
CASES TREATED WITH ATOXYL ALONE.
779 Cases.
One Month's Treatment.
Two Months' Treatment. Three Mouths' Treatment.
Totals.
Present State on November 30th, 1907.
Amount of Atoxyl given in Grammes.
Under 2Grms 2-4 Grms.
4-6 Grms.
6-8 Grms. 8-10 Grms. Over 10Grms
Relapse after in-
provement.
=
38 4
107
32
64
325
10
10
18
64
Continue in same
8
51
44
21
51
190
state.
Died
66
44
34
14
21
200
Total
74
137
195
142
77
151
779
Iimproved
11
ཚམའམལྷ
211 cases treated for one month.
292
337 231
11
two months.
"1
21
three months.
23
ུམའ
And the following table gives a comparison of the results obtained in patients who have been treated for one, two, and three months consecutively :-
25
The high death-rate among cases treated for one month in the above table is due to the fact that lately we have had a large number of patients in a state of starvation in Usoga, who have only lived long enough to receive a month's treatment in camp.
:
A point that the above table seems to show is that rather fewer cases show improvement after three months' atoxyl treatment than after two months' treatment (41 per cent. of the former against 56.5 per cent. of the latter), the percentage of deaths in the two cases being the same.
As I mentioned in my previous report, there seems to be no doubt at all that more than half the cases of sleeping sickness show marked temporary improvement in their general bodily health after atoxyl treatment, and the enlarged glands diminish rapidly in size in nearly every case.
Up to the present our medical officers have only twice succeeded in finding trypanosomes in patients who are at the time actually undergoing a course of atoxyl treatment-once in the gland juice and once in the blood, and only twice in patients However, as can be seen from these tables, even in who have left off atoxyl. the case of early cases of this disease who have been under observation one year, taking the A and B cases admitted during the first quarter-75 in number--that 23 of them (or 34 per cent.) are dead at the end of the year.
Owing to the fact that our medical officers have had no trained hospital assist- ants to help them they have not had the time to thoroughly examine the treated cases for trypanosomes.
The gland juice of these cases has been examined, and the medical officers are unanimous in reporting that hardly ever can trypanosomes be found there after treatment, and that in the majority of patients the gland enlargement disappears. The period since the last dose of atoxyl was given has, however, not been more than a few months in the case of these treated cases, and it may be that trypanosomes will yet re-appear in a good many. This absence of trypanosomes from the lymphatic glands cannot mean that all the trypanosomes throughout the body have been destroyed in these people, because, as I have just said, 34 per cent. of the early cases (A and B cases) that have been under continued observation for a year are dead at the end of that period in spite of the fact that the gland juice does not contain parasites. When our medical officers have more time to make exhaustive exami- nations of the blood and cerebro-spinal-fluid of treated cases, I cannot help think- ing that trypanosomes will be found in a great many.
With regard to treatment by other methods, the following table shows that 294 people have been treated with atoxyl combined with mercury.
The method employed up to the present consists of giving two injections of 0.4 grammes of atoxyl on two successive days followed by one-sixth of a grain of perchloride of mercury given hypodermically after an interval of three days, and this latter injection repeated three or four times at a three days' interval unless A few cases who did not look after their untoward symptoms manifest themselves. mouths properly did complain of sore gums as a result of these injections of mercury, but in the rest no bad result was followed.
It is only three months since this treatment was started by Dr. van Someren. and the results have been encouraging, as seen by the table.
TABLE showing the number and present condition of patients treated with atoxyl and mercury (hypodermic injections) and mercury alone (intravenous injections).
Duration of Treatment.
Present State, November 30th, 1907.
One Month
Two Months.
Three Months.
Present State, November 30th, 1907,
Atoxyl and Mercury.
Mercury alone.
Improve
183
Relapsed after course of treatment
Continue in the same statė
ឌ៩
1
90
3
Died
Totals treated
20
294
3
19 per cent. 56-5 per cent. 41 per cent.
Improved
Relapsed
2
9.5
12
15
11
M
Continue in same state Died
29
18
31
"
19
"
50
16
16
**
17
Number of cases
211
337
231
Three cases have been treated by means of intravenous injections of a mercury
salt by Dr. Bayon, but without any marked improvement following.
We have not had sufficient sodium-amino-phenylarsinate (Burroughs and
D
32655
PUBLIC RECORD OFFICE
Reference :-
C.O.885
19 PUBLIC RECORD OFFICE, LONDON
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