816 HERBERT S. CARTER 



Mills(n), who has done much work on this, and presents the best historic;)] 

 resume of the subject, finds that -fats similar in composition to fats of 

 the body are best absorbed, emulsions better than plain oils, the best 

 being a 3' to 5 per cent emulsion o^f egg lecithin in sterile water. Sixty 

 grams of oil may thus be given slowly. He also used oils of lard, cocoanut 

 and peanut oil emulsified with egg lecithin, and proved that fats introduced 

 subcutaneously may be burned directly, sparing body fat, and may be 

 either retained in the body in their own form or may be reconstructed 

 into body fat. 



Lard, according to Winternitz, can be given by subcutaneous injection, 

 but is of slight usefulness except in an emergency. 



Carbohydrates. The only form of carbohydrate which has been suc- 

 cessfully used has been dextrose. Voit(o) in 1896 found he could inject a 

 10 per cent solution without producing glycosuria, although it was too 

 painful a process, caused too much tissue infiltration and was not prac- 

 tical. Kausch used a 2 per cent solution, injecting as much as 1,000 c.c. 

 In an 8 to 10 per cent solution i^ was promptly excreted in the urine, 

 although it produced no renal irritation. It was also observed by him 

 that the poorer the patient's nutrition, the better was the sugar borne. 

 Gautier found he could use 60 to 80 gm. in 1,000 c.c. of sterile normal 

 saline solution, and that it was well absorbed; but this furnishes only 

 about 240 to 320 calories, which is not more than a fraction of the neces- 

 sary amount. A four and one-half per cent solution of dextrose is isotonic 

 with the blood, and would seem the best strength to use. 



Salts and Water. The hypodermic method of getting water* and salts 

 into the system has long been used with complete success and has formed 

 one of the easiest and safest ways of supplying these necessary elements 

 when the normal route is closed. This can be given as sterile normal saline 

 solution (0.6 to 0,9 per cent) or in the following solution, which forms 

 a more complete reproduction of the saline elements in normal serum: 



Sodium Chlorid 0.9 gm. 



Calcium Chlorid 0.026 " 



Potassium Chlorid 0.01 " 



Aq. destil 99.064 " 



Taken then altogether, it can easily be seen that as yet the subcutaneous 

 method of maintaining nutrition is of minor importance and practically 

 about all that can be done is to supply a small amount of protein in the 

 form of blood serum or ascitic fluid (with a little emulsified fat given 

 separately?) and dextrose in a 4.5 per cent solution in normal saline. 

 The serum or ascitic fluid may prove of benefit eventually in treating 

 certain diseases, e. g., cholera where the loss of fluids and nitrogen is 

 excessive, care being taken to rule out the presence of syphilis or tubercu- 

 losis in the donor before using either ; but even here the" intravenous route 



