40 PROTEIN THERAPY 



This has a definite value in such conditions as arthritis where a 

 sharp reaction on the part of the patient is usually very desirable. 



MISCELLANEOUS 



Hypertonic and Hypotonic Salt Solutions. The injection of large 

 intravenous doses of salt solution in the treatment of typhoid 

 fever dates from the report of Englander. Englander while treating 

 a case of typhoid that had had a severe hemorrhage injected some 

 300 c.c. of normal saline intravenously. This was followed shortly 

 after the injection by a severe chill, and the usual nonspecific re- 

 action. The following day the temperature declined to 35.2 C. (95.4 

 F.), and the patient made a prompt recovery by lysis that commenced 

 the day following the injection. Other cases were then treated by 

 Englander with the same method. 



Sodium chlorid cannot, however, in the light of our present 

 knowledge be considered as an indifferent substance to the organism. 

 The observation of Hutinel that salt causes fever even when injected 

 in infants in small doses has been the subject of considerable dis- 

 cussion, Samelson contending that such temperature disturbance was 

 due to the fact that impurities were injected with the salt or in the 

 water used in making up the salt solution. Bendix and Bergmann 

 came to the same conclusion. More recent observations concerning 

 the role of the sodium ion in its relation to the permeability of cell 

 membranes, and the role of the water content of the tissues in the 

 mechanism of fever leave the status somewhat uncertain. 



Instead of using large doses and producing a marked reaction 

 in the patient as Englander did, Danielopolu has used repeated small 

 doses of hypotonic salt solution (.065) in the treatment of typhus 

 fever. By this method he claims to have obtained remarkable re- 

 sults. 



Two other methods have been devised in which salt solutions are 

 used, both for local injection. Eisel has injected from 10 to 15 c.c. 

 of physiological salt solution locally between the scrotum and tunica 

 vaginalis in cases of epididymitis. It is said to be followed by a 

 diminution of pain and hastening of resorption. 



The production of salt abscesses is another method recently de- 

 vised, but one that cannot be recommended. This is produced by 

 injecting a (5 to 8 c.c.) concentrated solution of salt intramuscularly 

 (30 parts sodium chlorid, 1 part calcium chlorid, 100 parts water) 

 and was recommended by v. Szily and Stransky. Needless to state, 

 in this case an abscess usually forms and from it autolytic products 

 are absorbed; as Luithlin has pointed out, it is merely a form of the 

 older "fixation abscess" of Fochier with the disadvantage that the 

 method is very painful and leads frequently to complications. Raege 

 and Zieler, who have both used the method, condemn it. 



