HODGKIN'S DISEASE 379 



we give Fowler's solution, one to five drops once or twice daily, best given 

 diluted with twice or three times this amount of ordinary or aromatic water. 

 I believe arsenious acid to be even more effective, either in the form of the 

 pilulffi asiaticffi (1^ Acid, arsenicos. 0.06, piperis nigri pulv. 1.5, rad. liquir. 

 pulv. 3.0, mucilag. gummi arab. q. s. ad pil. Ix) of which one pill is taken 

 once to three times daily To avoid irritating the stomach, these, like all 

 other arsenic preparations, are not to be given upon an empty stomach, but 

 only while eating or immediately after a meal. A very serviceable arsenic 

 preparation is sodium cacodylate, also known under the name of arsycodile, 

 which contains considerable arsenious acid (nearly two-thirds) and is well 

 borne. The dose for adults is 0.025 to 0.1, and this is gradually increased 

 in pills (sodium cacodylate 0.25 to 0.1, sacch. et gummi arab. q. s. ad pil. xx, 

 daily one to five pills) or for children in solution (1: 15, according to age 

 three to ten drops). After prolonged use of this preparation, in some cases 

 a disagreeable garlicky odor of the breath appears and causes us to desist from 

 its use. 



Arsenic acts more readily by subcutaneous or parenchymatous injections 

 (into the glandular substance) than by internal administration. Usually 

 Fowler's solution is employed (beginning with 0.1 and cautiously increasing 

 even up to one gram) or the solution of sodium arsenite advised by v. Ziems- 

 sen, of which a somewhat larger dose is injected. But even here cacodylic 

 acid is to be preferred on account of its greater solubility and larger contents 

 of arsenic. A 10 per cent, solution of sodium cacodylate in sterilized water is 

 used for about a week (one-half of a Pravaz syringeful being injected) ; it is 

 then stopped for a few days, and then resumed, the same dose being injected, 

 until gradually, with pauses of a few days, the dose is increased to an entire 

 syringeful. 



Eecently a preparation containing a large quantity of arsenic atoxyl (ani- 

 lidmetarsenite) has been advised by Walter Schild, and this seems to deserve 

 preference even above the cacodylate. Of a solution of two parts in ten of 

 water, two to ten divisions of the hypodermic syringe are injected and the 

 dose is gradually increased. The injections are almost painless, and are well 

 borne. In the only case of Hodgkin's disease that I treated by this method 

 the result appeared to be satisfactory, but the duration of observation was too 

 brief to permit me to speak of a permanent success. 



A good auxiliary remedy in every arsenic treatment is formed by the min- 

 eral waters containing arsenic and iron, those of Eoncegno, Levico, Srebrenica 

 (Guber spring), and of Cudowa (Eugene spring), which, on account of the 

 arsenic they contain (and this is greatest in the Eoncegno water and smallest 

 in the Cudowa water), must be administered with all the caution with which 

 we prescribe other arsenic preparations (therefore not upon an empty stom- 

 ach), in from one to five tablespoonfuls for adults and as many teaspoonfuls 

 for children ; these waters are best administered in milk or Seltzer water. 



Besides, preparations of iodin have been administered internally and used 

 as inunctions over the enlarged glands. They have, however, not proven par- 

 ticularly serviceable. 



More effective are inunctions with potassium soap which, as is well known. 



