SURGICAL SHOCK 53 



man, after intravenous transfusion or subcutaneous 

 injection. In Wechselmann's cases this was usually 

 due to actual contamination with bacteria during the 

 days or weeks that the water was left standing after 

 distillation. The English observers found that 

 although water just distilled and collected in a glass 

 retort produced no fever, yet within a few days after 

 standing in sealed sterile vessels it acquired the 

 property of giving rise to fever, and that in spite 

 of boiling or filtration through a Berkefeldt filter 

 immediately before use. In some cases the tempera- 

 ture was high, but not fatal unless quite unsuitable 

 injections were given. 



Another danger depends on the salt used. The 

 total quantity injected may be very large — ten grams 

 or more. A condition of hydrsemic plethora is likely 

 to be induced, that is, a dilution and increase in the 

 total volume of the blood. As Lazarus Barlow has 

 shown, the specific gravity at once falls (e.g., from 

 I "064 to 1*054). The kidneys and lymph channels 

 promptly excrete the excess of fluid, and in many 

 cases overshoot the mark, so that eventually the 

 specific gravity may be i"o67, signifying of course 

 that the blood is less in bulk and more concentrated 

 than it was before. This does not occur if the 

 supply of fluid is kept up by further injections, or 

 saline given by the bowel. 



If the kidneys are not capable of excreting the 

 water and s-alt quickly enough, some degree of dropsy 

 may occur, and as the Grunbaums have pointed out, 

 this may take the form of fatal oedema of the lungs, 

 which has frequently been described as following saline 



