54 SURGICAL SHOCK 



transfusion, especially in patients with nephritis. The 

 Griinbaums consider that the use of ether as an 

 anaesthetic helps to determine the occurrence of such 

 pulmonary oedema. If the salt solution injected was 

 too concentrated, a greater degree of hydraemic ple- 

 thora is induced, and the risks of pulmonary oedema 

 are increased ; naturally it is more likely to occur 

 after a large injection than a small one. 



These unfavourable possibilities are not mentioned 

 to proscribe the use of saline transfusion, but to call 

 attention to the best methods of avoiding complica- 

 tions. Of the last eight cases in which it has been 

 used at the Bristol Royal Infirmary, only one (a case 

 of mesenteric thrombosis) died, although the treat- 

 ment is reserved for the most desperate conditions, 

 especially haemorrhage, and most of the patients were 

 pulseless. In these cases it does not appear to have 

 produced either fever or lung complications, although 

 a solution which had been standing was used. 

 Several of the patients, however, had fever before the 

 injection began, and this continued. Not more than 

 one or two pints were used, and this was followed 

 up by saline per rectum in most instances. 



To obtain the best results and the fewest fatalities 

 not more than thirty or forty ounces of freshly 

 distilled water, collected in a sterile glass vessel, 

 should be injected. In this a powder having the 

 composition of Ringer's fluid, with dextrose, should 

 be dissolved. The powder must be sterilized or the 

 solution boiled. The transfusion must be made 

 slowly, and at a suitable temperature (ioo° F.), 

 and it should be followed by saline injections per 



