62 SURGICAL SHOCK 



shock, and especially of collapse after haemorrhage, 

 has caused it to be used more and more extensively 

 for these conditions. At the same time, some very 

 serious drawbacks, in a degree avoidable, have come 

 to light, and with these we must now deal. 



We need barely mention the difficulty of finding 

 and introducing the cannula into the vein, the danger 

 of injecting air-bubbles, and the necessity, when the 

 solution is made up in a private house, of using cook- 

 ing salt, and not a table salt diluted with farinaceous 

 or other material. More care is necessary than is 

 usually taken to see that the temperature at which 

 the fluid enters the vein is correct ; that of the saline 

 in the funnel may be many degrees higher, especially 

 at first. It is easy to let the solution flow over the 

 bulb of a thermometer before introducing the cannula. 

 Then, again, the proper strength of sodium chloride 

 (0-9 per cent ; a teaspoonful and a half to the pint) 

 must be employed. It is far more physiological to 

 use Ringer's fluid, containing calcium and potassium 

 salts as well, with a little dextrose added to act as a 

 food-stuff. Compressed tablets of the correct com- 

 position are upon the market. This fluid approxi- 

 mates more nearly to that of plasma, and is capable of 

 maintaining the life and activity of the tissues much 

 longer than simple saline will. 



There are two dangers which may follow the trans- 

 fusion. The first depends upon the water, and the 

 second upon the salt. Wechselmann in Germany, 

 and Hort and Penfold in England, have pointed out 

 that water supposed to be sterile usually produces 

 shivering and fever in animals, and frequently in 



