The application of this therapeutic measure is defined under the headings of the various diseases in which it is indicated.
A region that seems especially advan tageote; for hypodermoclysis is the space between the highest part of the crest of the ilium and the lower border of the ribs, which, for convenience, may be denominated the ilio-lumbar region. It does not interfere with the dorsal posture, nor do movements of the limbs or neck, or thoracic or abdominal res piration, cause discomfort. It would seem to be a point of very little motion. The decinormal saline solution should be employed, the formula, roughly speak ing, being in the proportion of 1 drachm of salt to 1 pint of water. The solution should be sterile, also the needle, and the region to be punctured should be sterilized. The fountain-syringe or the Davidson syringe should also be steril ized. The specific action of small quan tities of normal saline solution on renal secretion has been clearly demonstrated, and 2 to 0 ounces injected frequently— every three or four hours—is advocated as a better diuretic and causing less strain on the kidneys than 1 pint given three or four times daily.
In any clinical condition in which the general circulation is markedly im paired, hypodermoclysis is a slower method than under other conditions; nevertheless it is of great value, for, even so, absorption can be hastened by the addition of euteroclysis (at 110° to 120° F.) while performing the hypo dermoclysis, or even by a simple hot saline enema. Enteroclysis (continu ous) at 110° to 120° F. while giving the subcutaneous saline injection is advo cated. Gentle peripheral massage dur ing the injection also hastens absorp tion.
A single attachment converting an as pirating or a hypodermic needle into a needle for hypodermoclysis consists merely of a small fitting, with a screw thread of a size suitable to screw into the average aspirating or hypodermic needle. It has an enlargement adapted to fit snugly the rubber tube of a fount ain-syringe or Davidson's syringe. The attachment, being metal, can be boiled. Hypodermoclysis may be performed with successful results, even with the finest hypodermic needle and a fountain syringe. In such a case the fountain syringe had better be elevated six or seven feet, as the force exerted by the fine stream is slight, and extra back pressure is desirable. The fluid should flow freely from the needle as the punct ure is being made. If the flow ceases, on
account of the resistance to the small stream, pushing the needle in and then withdrawing it slightly or rotating it will generally start it again.
There is a great loss of beat when the fine needle is employed, and the fluid in the fountain-syringe should then be about as hot as the hand can bear com fortably, or about 110° F. If the larger aspirating needle is used, the fluid can be at 105° R. as even here there is con siderable loss of heat.
The pain of the puncture may be avoided by freezing with ethyl-chloride. Peripheral massage hastens absorption. R. C. Kemp (Med. Record, Apr. 14, 1900).
In haemorrhage and collapse rectal in jections of warm saline solutions recom mended. Half a gallon of the solution, containing 1 ounce of table-salt to the gallon of water, at 110° to 115° F., may be injected into the intestine and re tained by pressure on the anus. The solution is absorbed rapidly in the sig moid flexure and colon, and the pulse and color promptly return. The rectal method takes less time than bypodermo clysis or transfusion; it is less painful and less dangerous. A fountain-syringe is alone needed and in its absence a com mon hand-syringe may be employed. T. B. Greenley (Jour. Amer. Med. Assoc., Feb. 9. 1901).
By transfusion is meant the introdue tion into the vessels of the body of fluid material, especially of blood taken from another body, also the act of causing a fluid to pass through the skin into the body; infusion, a pouring into, as dis tinguished from transfusion, the gentle injection of any other liquid than blood into a vein or subcutaneous tissue; and, by antotransfusion, the application of elastic or muslin bandages to the ex tremities for the purpose of forcing the blood toward the vascular and nervous centres. emptying the vessels of the ex tremities into the vessels of the abdo men, lungs. and brain, and keeping it there until the crisis has passed. (G. W. Wagoner.) Autotransfusion can only be con sidered as a good transient expedient, applicable until saline injections can be used, or to supplement the latter. For all practical purposes the infusion of saline solution alone deserves considera tion as a therapeutic agent. It is indi cated in the following conditions:— Haemorrhage, from whatever cause, and especially the obstetrical heemor rhages.