TREATMENT 



The composition of the pills is : — 



Potassium permanganate . . . . . . 2 grains. 



Kaolin and vaseline as may be required to make a pill. 



This pill is coated with a varnish composed of i part of salol and 

 5 parts of sandarach varnish, or with keratin. Pills kept for any 

 length of time are apt to become hard and useless. 



The patient must be kept warm, and supphed with plenty of 

 water to drink, which preferably should be taken in sips, and 

 sinapisms or turpentine stupes should be apphed to the abdomen. 



When collapse has set in, hot bottles must be applied to the 

 extremities and round the body, and when the pulse fails, the 

 median cephalic vein should be opened at the elbow, and Rogers's 

 special silver cannula, made by Messrs. Down and Company, in- 

 serted, and through this injections of hypertonic saline solution 

 should be injected until the blood-pfessure returns as tested by the 

 pulse, or more preferably by a Riva-Rocci's instrument. If the 

 blood-pressure sinks below 70 millimetres, Rogers considers this to 

 indicate the presence of a dangerous degree of collapse and an 

 indication for an immediate intravenous injection. He takes the 

 specific gravity of the blood by the simple method of placing a drop 

 of blood in the centre of a small vial containing a mixture of glycerine 

 and water of known specific gravity (at the mean temperature of 

 the air), and if the droplet rises or falls, trying another vial of lesser 

 or greater density until the right specific gravity is reached. 



He concludes that, if the specific gravity is over 1060, while the 

 blood-pressure is low, a copious intravenous injection may be safely 

 administered. If the specific gravity is over 1065, even if the blood- 

 pressure is over 70 millimetres, it is advisable to give an intravenous 

 injection, as the blood is dangerously concentrated, and a single 

 evacuation may lead to a rapidly fatal collapse. 



Restlessness, cyanosis, and cramps are also taken as indications for 

 intravenous injection, especially if the blood from the pricked finger 

 is black, and may be obviously thicker in consistency than normal. 



The hypertonic saline solution recommended by Rogers is:— 



Sodium chloride .. .. .. 120 grains (8 grammes). 



Calcium chloride .. .. ,. 4 (0'25 gramme). 



Potassium chloride .. .. 6 (0'4 ,, ). 



Water .. .. .. .. To i pint (568 c.c). 



The temperature of the sterilized solution (in an emergency pure 

 water filtered through cotton-wool, and boiled for fifteen minutes 

 will suffice) has to be judged by the rectal temperature. If this is 

 99° F. or over, Rogers injects the fluid at about the normal tempera- 

 ture of the body (98-4° F.) — i.e., the flask temperature is about 

 100° F. If the rectal temperature is a degree or so below 99° F., the 

 temperature of the solution in the flask should vary from 102° to 

 104° F. If the rectal temperature is high — i.e., over 100° F. — the 

 solution should be run in below 98*4° F. ; if the temperature is over 

 102° F. the solution should not be warmed. About 4 pints of fluid 



