TREATMENT OF CHOLERA. 103 



A SIMPLE METHOD OF TRANSFUSING SOLUTIONS INTO THE ABDOMINAL 



CAVITY. 



The peritoneal sac affords a rapidly absorbing surface of wide dimen- 

 sions, and one which would appear to be an ideal location for the intro- 

 duction of the saline injections if the technical difficulties could be over- 

 come, and the shock incidental to opening the cavity with a knife avoided. 

 I have devised a simple form of canula which has been used in some 

 thirty or forty cases at one of the Calcutta hospita,ls, with very satis- 

 factory results. It consists of a steel tube about the size ordinarily used 

 in paracentesis of the abdomen, and possesses a flat circular flange to 

 prevent its introduction for more than 1| inches. The end is sharpened 

 like a cork borer and is inserted into a narrow incision made through 

 the skin and fascia. The instrument is bored through the remaining 

 portion of the abdominal wall with fairly firm pressure, a finger prevent- 

 ing a sudden slipping in of the instrument to any great depth. The 

 incision is made about half an inch below the navel where the peritoneum 

 is adherent, and will not strip before it. It has been found impossible 

 to perforate or otherwise injure the bowel with this instrument, while by 

 attaching a sterile bulb and nibber tube to the external end, saline solu- 

 tion to the amount of 3 or 4 pints can be run into the cavity within ten 

 minutes or less. If the pulse of the patient can be detected at all the 

 fluid is rapidly absorbed, while an immediate further material rise of 

 blood pressure is obtained by applying an abdominal binder after the 

 transfusion has been completed, care being taken not to embarrass the 

 respiration. For example, 3^ pints of hypertonic saline solution were 

 run into the abdomen of a cholera patient with a blood pressure of only 

 15 millimeters. After the operation the pressure was found to have 

 risen to 65 millimeters, while an abdominal binder further raised it to 73 

 millimeters. Three hours later the fluid was mostly absorbed, and the 

 pressure was 88 millimeters, while on the following morning it had 

 reached the normal (for a Bengali), of 100 millimeters. The specific 

 gravity and proportion of serum in the blood had both returned to 

 normal, and the patient was passing urine freely and doing well. He 

 subsequently made an uninterrupted recovery, except for a rise of tem- 

 perature, which was found to be due to malaria, and which rapidly fell 

 under quinine treatment. This plan requires further testing, but it 

 promises to be a valuable addition to the methods of introducing saline 

 solutions into the circulation, while it should also prove valuable in shock 

 produced from other cause than cholera. In both there is a good deal of 

 vaso-motor paralysis, and consequent accumulation of blood in the portal 

 system, which may be materially relieved by the pressure exerted by an 

 elastic abdominal bandage after intraperitoneal transfusion. The same 

 aseptic precautions are necessary as for intravenous or subcutaneous 

 injections, but boiled tap water has been safely used for preparing the 

 salt solutions used in Calcutta in the cholera cases. 



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