The treatment of advanced cases of rhodesian sleeping sickness by Mel B and arsobal

Summary The reactions of three small groups of “incurable” patients to treatment with Mel B and with two separate batches of arsobal are described. Of the first group of eight patients, treated with Mel B, seven were alive and well with normal or near-normal cerebrospinal fluids 18 months after treatment, although one of these was perhaps by then showing early signs of a relapse. The second and third groups, both treated with arsobal, comprised together 25 patients, of which number 21 were followed up for periods of between 4 and 8 months after treatment. Of these 21, two died during treatment, although probably the arsobal itself was not entirely to blame owing to the late stage of the disease at which treatment was started. There were also three relapses, all occurring at approximately 6 months after treatment. The remaining 16 patients were alive and well. It is pointed out that the dosage used in all except five of the patients was the very low one of 1.8 mg. per kg., and this was used in all the cases in the first group. The occurrence of relapses caused this dosage to be raised to 3.6 mg. per kg. and, although only a few have so far received this higher dosage, they have stood the treatment well. The question of dosage is discussed from the point of view of the necessity for this to be large enough to prevent relapses and yet reasonably safe. It is considered that Mel B is too dangerous to use for the treatment of early Rhodesian sleeping sickness, for which stage antrypol continues to be the drug of choice, but the conclusion has been reached that, for the treatment of those hitherto classed as “incurable,” Mel B and arsobal show very great promise and give greater cause for hope than any other drug yet tried.