The Treatment of Trypanosomiasis

1908 The Lancet  
THE researches which have been carried out in recent i years with the object of discovering an effective treatment for sleeping sickness and other forms of trypanosomiasis are of 1 great importance to both human and veterinary medicine, ( since this group of diseases is responsible for an enormous .loss of life, both human and animal, in Africa and other tropical regions. Until 1904, when EHRLICH and SHIGA recorded their results with trypan-red, a new dye discovered i by the former, the only
more » ... former, the only drug which was known to be of any value in these diseases was arsenic, the beneficial effect of which was first observed in the tsetse fly disease by the ex-1 plorer LIVINGSTONE. The value of this drug was confirmed by H. W. THOMAS and by LAVERAN in 1902, and before that time LINGARD and BRUCE had employed it, but its toxicity when given in effective doses and the liability to produce sloughing at the site of injection were found by LAVERAN and MESNIL to militate against its use in the form of sodium ,arseniate or any of the ordinary preparations. Various attempts have been made to obtain effective non-toxic preparations of arsenic and the most successful so far has been that of W. LANDSBERGER of Charlottenburg who, in 1901, obtained atoxyl. This substance was at first regarded as the anilid of meta-arsenious acid but was shown by EHRLICH and BERTHEIM to be the sodium salt of paraamido-phenyl-arsenic acid. At the outset it must be stated that atoxyl is not non-toxic but that it is less liable to produce sloughing when injected or to give rise to toxic symptoms than the ordinary preparations of arsenic and can therefore be given in larger doses. It is stated that its toxicity is only one-thirtieth of that of other preparations. It was first employed therapeutically by BLUMENTHAL in 1902, who reported favourably upon its use, but it achieved but little notice until THOMAS and subsequently THOMAS and BREINL administered it in cases of trypanosomiasis in 1905. Since that time it has been extensively given in various forms of disease due to trypanosomes in man and animals, such as sleeping sickness, nagana and surra, with, at any rate, temporary benefit. Its actual value as a curative agent cannot be said as yet to be determined definitely and there is some diversity of opinion in this respect in regard to the cases already published, but there is a general agreement that it causes at any rate at first a disappearance of trypanosomes from the blood of infected animals with remarkable rapidity, a single dose often clearing the blood within from eight to ten hours. Unfortunately, they usually reappear after a longer or shorter interval but can be again removed by atoxyl again to reappear. As many as seven reappearances have been observed in rats with trypanosomiasis treated with atoxyl by Mr. H. G. PLIMMER and Dr. J. D. THOMSON. In most cases the trypanosomes sooner or later acquire a resistance to the action of atoxyl and they are then able to develop unchecked, eventually causing the death of the infected animal. This condition of resistance to the action of atoxyl is called by EHRLICH " atoxyl-fest." Unfortunately, it appears that such a resistant or atoxyl-fest trypanosome can infect another animal, producing the disease in a form which also resists the action of atoxyl ; in other words, the condition of resistance once acquired is transmitted. In view of these facts, which have been elicited from a study of various forms of trypanosomiasis in animals, many of which are of rapid course, it is not surprising to find that in the human disease of sleeping sickness with its much more protracted course no very conclusive results have yet been obtained. The use of atoxyl in such cases with due caution and care in its administration is now recommended by most authors, and it has been employed
doi:10.1016/s0140-6736(01)47486-1 fatcat:ofj6e5f2qjcozanihdpzjr6snu