SURGICAL SHOCK 51 



post-operative flatulence, due to intestinal paralysis 

 reflexly induced by the injury to the peritoneum, is 

 more or less completely abolished, and the death-rate 

 is reduced. The writer can testify by personal 

 experience to the truth of these claims ; the comfort 

 after a big abdominal operation is sometimes most 

 remarkable. 



Nevertheless, something remains to be desired. 

 The local anaesthetics are not yet perfect in their 

 action. Case i, recorded above, died of shock in 

 spite of very thorough use of these methods (called 

 byCrile " anoci-association "). Quinine-urea-hydro- 

 chloride, which is used for the peritoneum instead 

 of novocain because the anaesthesia is more long- 

 lasting, has the great drawback of being destructive 

 to the tissues, and may cause trouble with the wound 

 or even impair the security of an intestinal anasto- 

 mosis. However, it ought not to be an insoluble 

 problem for the chemist to produce a more powerful, 

 long-lasting, non-destructive local anaesthetic, and 

 when this is in our hands the prevention of surgical 

 shock will be as feasible as the triumph over those 

 three conquered foes, haemorrhage, pain, and sepsis. 



INTRAVENOUS SALINE TRANSFUSION. 



During the past few years, the scope for this 

 proceeding has been enlarged considerably by the 

 introduction of the intravenous methods of giving sal- 

 varsan for syphilis, or ether as a general anaesthetic ; 

 and Rogers reports great benefit from the injection of 

 hypertonic saline solutions for cholera. The success 

 which has attended its use in the treatment of 



